439 (1) EALING EAL 49 Ack The Health of Ealing in the year 1958 EAL 49 ube Dealtb of Ealing tn tbe \>ear 1958 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, Town Hall, Ealing, W„5. Telephone: Ealing 3030, INDEX Page Section 1 - INFECTIOUS DISEASES 7 Section 2 - SANITARY CIRCUMSTANCES OP THE BOROUGH 14 Section 3 - SANITARY INSPECTION 29 Section 4 - GENERAL 39 Section 5 ~ STATISTICAL TABLES 46 Section 6 - APPENDIX : REPORT OP THE SCHOOL MEDICAL OFFICER 52 Supplement - FOR GENERAL INFORMATION 70 4 STAFF OF THE PUBLIC HEALTH 1>EPAtt-TllEIiT William G, Booth M. D., B. S., D, P. H. Medical Officer of Health I,H. Seppelt M.A., M B., B Chir., D.P.H Deputy Medical Officer of Health G„T.H, Blackie Chief Public Health Inspector E, Belfield Deputy Chief Public Health Inspector E„H, Evans Public Health Inspector C„ We Baxter „ „ „ E.W. Budd J „ „ „ A.E. Pooley „ „ „ G.O. Axon „ „ „ A.C. Bamping „ „ „ N.V. Saunders „ „ „ Harry M. Birrell Retired 2.9.52 Chief Administrative Assistant A,S M: Pratt, Appointed 3.9.58 Barrister-at=Law Chief Administrative Assistant (Part-time) Miss D E McKenzie Secretary to Medical Officer of Health R. S. Leggatt Senior Clerk D. R. A. Smith Clerk Miss S. Pox „ Mrs. D. Barker Clerk and Typist Mrs. M.G, By ford Shorthand Typist R. M. Newbury Trainee Public Health Inspector R. S. Cox Rodent Operative R. Lazzolo „ „ F. Bedley „ „ L.B. Radford Driver/Disinfector E. Sheldrick „ „ 5 Mr, Mayor, Aldermen and Councillors, The year 1958 was one that showed the effects of the new antibiotics on public health problems in subtle and unexpected ways. No longer do we find children deaf as a result of infections of the middle ears but rather we are faced with the deafness due to inner ear defects for which no cure is at present possible, Again the umbrella provided by the practitioners treatment is causing us to lose the protective reactions of the body to the resistant types of staphylococcus and we are having many more infections arising in hospitals as a result of the onslaught by resistant bacteria. The curing of one problem so often leads to the raising of another, that it would ill become us to feel complacent about the victories of medicine. Nevertheless let us be very grateful for the overall picture with the introduction of poliomyelitis vaccination, the gradual disappearance of tuberculosis, the conquest of diphtheria, meningitis, venereal disease, and other conditions The improvement in the general standard of food hygiene the raising of the nutritional level„ the care given to the expectant and nursing mothers and the sight of healthy children being reared in comfortable homes should give us all the satisfaction of feeling that our service has played some small part in the formation of the present picture. It is now 10 years since Ealing undertook to make a special feature of its examination of children's feet and foot wear Not only has much infection and deformity been found and treated but an enormous amount of health educational work has been done that must inevitably pay dividends in the future. The officers who have devoted so much time to this work are to be congratulated. I regret to record the death during the year of Mr, Arthur Miller who was Ear, Nose & Throat Consultant when Ealing was responsible for the School Medical Service. This is a great loss to the Ear, Nose & Throat Department, and has caused considerable disorganization. Your Deputy Medical Officer (Dr. Seppelt) together with an Assistant Medical Officer of the County Council (Dr. Taylor) have carried out some interesting new work in the field of speech therapy. It is set out in full in the report and is an example of the kind of useful research project that can still be done by local initiative and enterprise under the aegis of the local authority. It 6 will certainly be desirable carefully to assess the value and cost of all treatments, now that the all embracing arm; and rate aided purse of the health authority are expected to meet so many health problems. It is clear that the scene is changing,, no longer do we have to be concerned with the orthopaedic problems of Rickets, Tuberculosis and Poliomyelitis, but of much less serious but none the less worrying problems of inherited defects and accident sequelae. It is therefore from surveys by health officers, by research into the problems of genetics, and the use of health education to prevent accidents, and promote healthy living that we must hope for future progress to be made. The report would not be to my satisfaction if I were not once again to express my appreciation of the work of the officers who have all played their part so fully in carrying out the detailed work so necessary to a successfully accomplished job. The loss of the Public Health Department Chief Clerk, Mr. Birrell, by retirement at the end of his service, has indeed been a great loss to the department. His work was always exemplary, and Ealing has cause to be grateful for his conscientious service in its interest. We wish him every happiness in his retirement from a job well done. 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 under this Act 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. Pood Poisoning is notifiable under the provisions of the Pood and Drugs Act of 1955, and Gastroenteritis under the Milk and Dairies (General) Regulations, 1959, made under this Act. It would seem that the time has come for some reconsideration of which diseases should be notifiable. Thus scarlet fever and measles are today relatively mild conditions and a sampling procedure in selected areas to determine their incidence might satisfactorily replace the present nation wide notification. On the other hand a change in the incidence of leptospirosis and psittacosis might have occurred but as neither of these diseases is notifiable there is no means of assessing this. With regard to the more serious diseases such as smallpox and diphtheria speed is the essential factor in control and a telephone message might, with advantage, replace the present statutory written notification. Finally, at present as stated above infectious diseases are notifiable under four different pieces of legislation and consolidation of these would seem rational. 1,908 cases of Infectious Disease were notified in the Borough during the year.. Of these 12 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 1,896, DIPHTHERIA, No cases were notified in 1958. During the year 2,228 primary immunisations were given either at Clinics or by General Practitioners and 1,485 booster doses. 1,754 children under one year had primary 8 immunisations which means that approximately 67% of children in their first year of life were immunised in Ealing. The need for maintaining a high percentage of children who are immunised against diphtheria remains as great as ever and this is stressed at every opportunity. DYSENTERY 244 cases were notified compared with the 252 cases in the previous year. An outbreak of Sonne Dysentery occurred in a Welfare Department temporary accommodation hostel. The sixteen rooms of the hostel accommodate 15 families, comprising 29 adults and 42 children. Twelve families use one communal kitchen and the remaining three families use a second communal kitchen separate stoves being available for each family. A total of 5 W Css is available and use is divided amongst the families It will be seen therefore that the possibility of spread of infection under such conditions was high Initially two children were affected and although they were admitted to Isolation Hospital two children of a second family, on the same floor were subsequently affected. These children were also admitted to Isolation Hospital, All children of both families when better were discharged from hospital and the original family affected moved to permanent accommodation, Unfor tunately the mother of the second family had become a symptomless carrier and one of her children developed further symptoms and had to be re admitted to hospital. The restriction of the outbreak so far, within these limits, has been in large measure due to the regular visiting and supervision by the Health Visitor and Health Inspector concerned to ensure that the strictest attention is paid to hygiene by all residents of the hostel. The outbreak emphasises the continual difficulties to be faced in dealing with Sonne Dysentery, It is often impossible to render carriers free from organisms, and in the absence of symptoms to convince them that they are a potential source of infection, On the other hand failure to eliminate a carrier leaves the risk of an outbreak ever present. This is an unsatisfactory situation even though the disease is of course relatively mild. ERYSIPELAS. 19 cases were notified. 9 FOOD POISONING 18 notifications were received and of these 12 were confirmed by laboratory examination- Of these, 10 were S. typhimurium, 1 S. heidelberg and 1 S veije, No outbreaks of a communal character were recorded. MALARIA, One case occurred in a man who had recently returned from New Guinea. MEASLES, 985 cases were notified compared with 1,854 in 1957 This decrease was expected, in that epidemics of measles occur every two years, 1958 being an inter epidemic year MENINGOCOCCAL INFECTION Three cases were notified and were treated in Hospital. OPHTHALMIA NEONATORUM» Six cases were notified. All cleared up satisfactorily without impairment to the vision, PNEUMONIA There were 151 notifications and of these 44 males and 43 females died, POLIOMYELITIS Two cases occurred, the first in a man of 33 and the second in a girl of 13 years. Both were paralytic Vaccination against Poliomyelitis has continued during the year. In the Spring abundant supplies of Canadian and American vaccines enabled us to eliminate the waiting list. It is gratifying that an increased volume of this work has been done by General Practitioners, In the Autumn vaccination was made available to a wider group of persons comprising (1) All persons up to the age of 26, (2) Expectant Mothers. (3) Persons particularly at risk, e.g. medical, nursing and ambulance staff. Arrangements were made for these to be done by family doctors, at clinics, or at places of work where this is the most satisfactory arrangement. During the week beginning 27th October a campaign to publicise these extended 10 arrangements was held throughout Middlesex. This included radio and television broadcasts, local press publicity, and distribution of leaflets and pamphlets. An offer was made to the management of all factories to immunise staff at work. Where interest in this proposal was apparent a visit was made by the Health Inspector in whose area the factory was situated to further explain the scheme, This has resulted in encouraging response and a programme of immunisation sessions has been arranged at a significant number of factories in the Borough. In the Autumn, arrangements also commenced whereby a third dose of vaccine was given after an interval of seven months. The figures for vaccination in Ealing from the beginning of the scheme until the end of the year are:- Number vaccinated with two doses Group 28,884 6 months-15 years. 1,288 16 years-26 years. 1,467 Expectant Mothers, 145 Doctors and families. 40 Ambulance staff and families. It is estimated that 76,5% of children up to 15 years of age have been immunised with two doses. By the end of the year 10,145 third doses had been given. PUERPERAL PYREXIAo The Puerperal Pyrexia Regulations 1951 require the medical practitioner in attendance to notify the Medical Officer of Health of any febrile conditions occurring in a woman in whom the temperature of 100.4°F. or more has occurred within 14 days after childbirth or miscarriage. In Ealing, during 1958, 67 such notifications were received. 64 of these occurred among the 875 Ealing mothers confined in Perivale Maternity Hospital (7.3%) and this may be compared with the 4 notifications received relating to 739 mothers confined at home (0.4%). The percentages for the year 1957 of 7.7% for hospital confinements and 1.2% for domiciliary confinements do not vary to any great extent but it is gratifying to see that the cases of pyrexia among women confined at home, although low in 1957, were still lower in 1958. 11 Two probable explanations for the comparatively high incidence among hospital deliveries may be suggested. Firstly very careful selection is made by the Local Health Authority's medical officers and by the hospital staff before expectant mothers are allocated a hospital bed and highest priority is given to those where labour is expected to be difficult or complicated. Consequently there is a higher rate of abnormal deliveries in hospital. Surgical interference in such cases adds considerably to the risk of a post partum rise of temperature. Secondly, in spite of the most stringent aseptic precautions there is still a definite risk of cross infection in hospital - a risk which is not run by women confined in their own homes. Rarely is infection nowadays of a really serious nature thanks to the discovery of antibiotics. SCARLET FEVER. 232 cases were notified compared with 95 in 1957. SMALLPOX. There were no cases. Two families were kept under surveillance following their disembarkation from a ship in which a case had occurred in a Lascar seaman. All members of the families had been vaccinated and they remained in good health. The number of infants in Ealing vaccinated in their first year of life in 1958 was 1,727 which represents approximately 66%. TUBERCULOSIS. There were 97 pulmonary notifications, 65 males, 32 females, compared with 113, 80 males, and 33 females in 1957. Non-pulmonary cases consisted of 5 males and 3 females. There were 10 pulmonary deaths and no nonpulmonary deaths. WHOOPING COUGH. 85 notifications were received compared with 131 in 1957. Immunisation against Whooping Cough now consists of three injections and is completed early in the second year of life. 1,502 infants were immunised against whooping cough in Ealing in 1958, which it is estimated represents 56%. 12 WINTER VOMITING. During the year there have been several outbreaks of vomiting at schools in the Borough. They have appeared to be similar to outbreaks which have been described in various parts of the World since first being noted some 30 years ago in America when they were given the name "Winter Vomiting", Although it has never been possible to demonstrate the organisms responsible it is considered likely that it is a virus and that it is an upper respiratory tract infection. The various outbreaks described have been generally similar, consisting of sudden vomiting, a feeling of illness and mild temperature and only a few instances of diarrhoea. During the year there were three such outbreaks in Ealing< The first occurred in October in an Infant and Junior School on the same site. 36 children and 11 staff were affected on one day. 50% of these were back at school next day but a few severe cases were absent for several days. The second outbreak occurred in a Nursery class, the majority of children in the class were affected as well as the teacher and nursery assistant. A slight general feeling of illness during the afternoon was followed by vomiting in the night. Most children were back at school within two days. The third outbreak occurred in a Junior School in November. Early in the month three children were affected and three weeks later on three successive days three or four children were affected. All were from the same class and in some instances the same child was affected on successive days. Most children were better on the following day. 13 TUBERCULOSIS Age Periods New Cases Pulmonary Non Pulmonary 1953 1954 1955 1956 1957 1958 1953 1954 1955 1956 1957 1958 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 3 1 1 - 2 1 4 1 1 2 - - 2 1 - 1 - - 1 - - 5 - 14 7 4 1 2 1 1 2 5 4 1 1 1 1 2 - 2 2 4 - - - - - - 15 - 24 15 38 13 24 16 14 14 21 16 12 16 10 - 1 1 2 2 3 2 - 1 1 - 1 25 - 44 30 43 23 26 21 26 22 21 18 12 20 12 2 4 1 4 2 4 1 4 2 6 3 1 45 - 64 39 9 23 11 23 7 29 9 26 5 23 5 4 4 1 3 1 2 4 1 3 1 2 1 Over 65 7 6 3 2 6 o O 4 4 12 2 4 2 1 1 - 1 2 1 - - - - - - Total 103 102 66 66 68 51 73 61 80 33 65 32 8 12 5 12 10 14 8 5 6 9 5 3 Age Feriods Deaths Pulmonary Non Pulmonary 1953 1954 1955 1956 1957 1958 1953 1954 1955 1956 1957 1958 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. x? L f M. F. M. F. M. F. Under 5 - - - - - - - - - - - - - - - - 1 5 - 14 - - - - - - - - - - - - - - - - - - - - - - - - 15 - 24 - - - - - 1 - - - - - - - - - - - - - - 1 - - - 25 - 44 4 4 3 2 3 1 1 - 1 2 1 1 - 1 - - 1 - - - - - - - 45 - 64 o 3 5 3 5 - 11 2 6 3 2 2 - - - 1 1 - 1 - 1 - - - Over 65 5 3 4 2 6 1 5 9 q 6 2 2 2 - - - - - - - - - 1 - - Total 18 10 12 7 4 3 17 4 13 7 5 5 - 1 - 1 3 " 1 -- 2 1 - - 14 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 satisfac tory both in quantity and quality. Water from public mains is supplied to 53,983 houses with an estimated population of 183,000. 9 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. 5 samples were taken from different points in a School Kitchen and these were 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. 21 premises are still not connected to the Council s sewers, RIVERS AND STREAMS. The passage of a river through industrial areas has inevitably resulted in such waterways being used to a greater or lesser extent as sewers. With the taking of surface water drainage into such rivers it is always possible for soil drainage, where wrongly connected, to lead to considerable faecal contamination, and for industrial wastes to lead to chemical contamination. This has happened in the Ealing portion of the River Brent and in districts through which the river runs before its entry into Ealing. It is clear therefore that even under the very best conditions it would be unwise to trust the River Brent as a "safe" river. 15 The Course of the River Brent 16 Responsibility for prevention of pollution of rivers is divided thus (1) County Councils are responsible for the river itself under the Rivers (Prevention of Pollution) Act 1951. (2) Borough Councils are responsible for preventing contamination of surface water drains which enter thee river, under the Public Health Act 1936. As far as the River Brent is concerned the history of our efforts to reduce the liability to infection from the river is as follows Prior to 1952 regular sampling of the river was under taken as it flowed through the Borough and where pollution was discovered efforts were made to trace the source and remedy the defect Although this work did improve the0 situation it became apparent that the river was very badly polluted on entering the Borough Thus however great an effort was made the result could only be partially successful Accordingly in November 1952 at the instigation of the Ealing Borough Council a joint Conference was held between the Medical Officers of Health and Borough Surveyors of Ealing. Brentford & Chiswick Southall, Hendon and Willesden together with the County Medical Officer and the County Engineer and Surveyor in order to analyse the problem and means of remedying it It was agreed that there were three main causes of pollution of the River Brent. (a) Solid or liquid material deposited on the banks which falls or is washed into the river. It was decided that although the Borough Councils5 could deal with certain of these cases under their Publicc Health powers, the County Council had wider powers under the Rivers (Prevention of Pollution) Act. 1951 and cases should, in general be referred to them. This problem should also be borne in mind when considering planning applications submitted by riparian factory owners. (b) Polluted surface water sewers and ditches The Conference agreed that the problem of tracing the sources of pollution in such cases involved an immense amount of work and patient observation, especially where the discharge was intermittent and progress was limited by the manpower available. The County Council was conducting a survey in conjunction with other local authorities concerned, and samples taken each month from suspected Public Health Inspector taking safple from outfall into the River Brent 19 outfalls were referred to the Borough Councils for inves tigation Copies of the analyst s reports would in future be supplied for Medical Officers of Health through Borough Surveyors to ensure co ordination between the respective Departments (c; Storm water overflows from local authority sewers The Conference agreed that the solution of this aspect of the problem would involve very heavy capital expendi ture for which the Minister was not prepared to grant loan sanction at the present time During 1953 work continued along the lines envisaged at the Conference In March 1953 a meeting of the Medical Officers of Health and Chief Public Health Inspectors of Middlesex together with the County Engineer and the Chief Chemist from Mogden was held in order to further encourage work on river pollution Despite these efforts samples still showed pollution and in June 1953 it was decided to notify all schools regarding the madvisability of bathing in the river Efforts too were made by press and other publicity to acquaint property owners of the danger to health caused by illegal dram and sewer connections During 1954 efforts to prevent pollution reached a peak namely 500 inspections being made and over 100 defects being remedied In September 1955 the Middlesex County Council who had hitherto undertaken analyses of samples informed us that owing to staff shortages they were forced to dis continue the service Arrangements were therefore made with a private analyst The work continued at a high level in 1955 but shortage of staff reduced this considerably in 1956 The staffing position had improved sufficiently by 1957 to enable a renewed effort to be made This year, however, other commitments have again reduced the time available for this work The following table shows the work done in the last five years 20 1954 1955 1956 1957 1958[/$$$] No. of inspections 474 325 126 251 83 No. of samples taken (1) By County Engineer 20 27 19 22 19 (a) Satisfactory 11 14 12 12 5 (b) Unsatisfactory 9 13 7 10 14 (2) By Public Health Inspectors 27 _ 3 _ (a) Satisfactory 11 - - 3 - (b) Unsatisfactory 16 — — - - No. of drainage defects remedied (a) In factories 55 21 1 7 2 (b) In houses 52 32 16 14 10 The sources of pollution can be analysed as follows - Sinks 119 W.Cs. 5 Industrial Wastes 53 Soil sewers and drains 33 210 During recent years the work done in Ealing has had considerable success. When considering how further improve ment can be achieved it must be realised that the effort must be a joint one. The River Brent from its source at the Welsh Harp to the point where it leaves Ealing at Brentford is approximately 8.5 miles. For the first 2.5 miles of its course it flows through Willesden and Wembley. During its six miles course through the Borough, for three miles the left bank is in neighbouring districts, thus any renewed effort to prevent pollution must be made by Ealing, Willesden, Wembley and Southall in conjunction. Secondly, it must be appreciated that tracing pollu tion is a time consuming practice requiring patient, unhurried and methodical investigation. There is no short cut to this and with the many other demands made upon the time of Health Inspectors it is not always possible to provide the necessary staff. ATMOSPHERIC POLLUTION. Clean Air Act, 1956. A Smoke Control Order was made by the Council in December and now awaits the Minister's confirmation. This CLEAN AIR EXHIBITION Fuel Research Station's stand CLEAN AIR. EXHIBITION Part of Coal Utilisation Council's stand CLEAN AIR EXHIBITION Part of North Thames Gas Board's stand CLEAN AIR EXHIBITION Part of Southern Electricity Board's stand 25 will, it is expected, be given by June 1959 and will come into operation in December 1959, The area comprises 385 acres on the Northolt Grange Estate containing 1,301 houses of which 464 are private and 837 Council, and 15 other premises. When the Order comes into operation it will be an offence to permit the emission 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 to 7/10ths of the expenditure will be available through the Local Authority towards the cost of any adaptation which may be reasonably necessary. It should be emphasised that in order to qualify for this grant (1) expenditure on adaptation must be incurred after confirmation of the Order but before its coming into operation, a period of at least six months. Notice will be given in the local press prior to the Order being confirmed by the Minister, (2) It must be incurred with the written approval of the Local Authority and adaptations must be carried out to their satisfaction. A Clean Air Exhibition was held at Downe Manor School, Northolt, from the 10th to the 16th April, 1958, to give residents in the Smoke Control Area an opportunity of seeing a selection of approved electrical, gas and solid fuel appliances. The Exhibition was opened by His Worship The Mayor and during the six days approximately 700 adults and 800 school children attended. This must be considered very satisfactory as it was held in an isolated part of the Borough so that the people affected by the Order should be those most easily able to attend. The many enquiries received indicated considerable interest in the scheme. 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 was at the rear of 44 Long Drive, Greenford from 1.1.58 to 31.7.58 and then transferred to 140 Birkbeck Avenue, Greenford. There is also an instrument situated in the Town Hall for the measurement of the daily mean concentration of smoke and sulphur dioxide. 26 A Smoke Stain Reflectometer employing a photo electric cell is now being used to assess the smoke filter papers Until now visual estimation of the smoke stain with a standard scale of shades has been employed The new apparatus has a distinct advantage over this method as it eliminates inaccuracies inherent in visual estimation even by a trained observer, The results obtained from these instruments are given in the following tables. 1958 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. 14.07 14.74 8.86 2.56 4.04 2.35 Feb. 19.11 12.94 11.34 2.38 3.45 2.16 March 15.11 16.31 10.90 3.03 4.01 2.67 April 11.67 12.54 7.65 2. 11 2.44 1.26 May 15.01 15.10 14.84 1.04 1.73 0.90 June 15.17 13.01 11 95 1.09 1.67 0.93 July 9.98 10.47 9.76 0.71 1.52 0.67 Birkbeck Avenue Birkbeck Avenue Aug. 6.21 7.70 5.27 0.73 1.33 0.47 Sept. 9.57 10.14 7.79 0.85 1.21 0.82 Oct. 10.54 11.94 8.72 1.00 1.46 0.97 Nov. 14.17 11.67 5.03 1.44 2.58 1.82 Dec. 18.74 17.21 8.96 1.37 2.49 1.94 Average Monthly Concentrations of Smoke and Sulphur Dioxide at the Town Hall 1958 Smoke in Milligrammes per 100 cubic metres Sulphur Dioxide in parts per hundred million Jan, 15.45 8.7 Feb, 13.21 8.0 March 15.22 10.8 April 8.97 5.9 May 4.16 3.2 June 6.38 2.7 July 4.12 2.8 Aug, 3.65 2.1 Sept. 6.92 3.7 Oct. 12.19 5.7 Nov. 23.77 11.5 Dec, 20.89 9.6 FOOD HYGIENE. It is pleasing to report that excellent co-operation between the food traders and the Public Health Department 27 still continues, and it was not found necessary to take legal proceedings in any case during the year to enforce the provisions of the Pood Hygiene Regulations The con tact made with the owners of food premises and their staff during the lectures has resulted in many improvements in premises and equipment being carried out voluntarily and advice being sought from the Public Health Inspectors During 1958.. 29 lectures were given to food handlers and 143 received Certificates of Attendance upon com pleting the course Since the scheme commenced 478 lectures have been given and 1928 persons have received Certificates of Attendance In addition 19 talks on Food Hygiene were given by the Public Health Inspectors to approximately 780 school leavers at the Grammar and Secondary Modern Schools in the Borough The number of Certificates of Food Hygiene awarded to food establishments is now 59.4 new Certificates being issued during the year 2.272 Inspections of food premises were made and 290 repairs and improvements were carried out. The film strip on Food Hygiene made by the Council in 1954 is still in demand, a further 6 copies having been sold during the year This makes a total of 120 copies sold SLUM CLEARANCE Compulsory Purchase Orders. 35 37 39 41 43 & 45 The Grove W 5 1, 2, 3 4, 5, 6. 7, 8,9 & 10 Rose Cottages 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 (KNOWN AS THE GROVE CLEARANCE AREA). A Compulsory Purchase Order in respect of these properties was made by the Council in August 1957 A Public Local Inquiry was held by an Inspector of the Ministry of Housing & Local Government on the 22nd January, 1958, as a result of which the Compulsory Purchase Order was confirmed to take effect as from the 28th June 1958. All the houses are still occupied pending the adoption of a scheme for the development of the area. Closing Orders, 51 Green Lane, W 7. A Closing Order was made in respect of this property. The tenants have been re-housed by the Council and a schedule of works for the re-conditioning of the whole premises has been agreed. 28 Basement Dwellings. 18b Drayton Green Road W. 13. This basement was rendered fit by the owners and the Closing Order was determined by the Council. 11a Argyle Road, W. 13. An Undertaking was accepted from the owner not to relet the premises after vacation of the premises until an approved schedule of works had been car ried out. The tenant has been re-housed by the Council and the works are now in progress 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 supervision. 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. 272 bodies were taken to this Mortuary and postmortem examinations were carried out in every case. 29 SECTION 3 SANITARY INSPECTION THE WORK OF THE PUBLIC HEALTH INSPECTORS IN 1958 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 2,163 Other nuisances observed by Inspectors 118 Premises inspected in connection with infectious disease 840 Smoke observations 223 Houses without water supply 69 Inspections of moveable dwellings 18 Other inspections 1,901 Re-inspections 5,828 Intimation Notices served 1,332 Statutory Notices served 106 Letters written 2,060 Proceedings before magistrates 9 Legal Proceedings, PUBLIC HEALTH ACT, 1936, SECTIONS 93, 45 & 39 Non-compliance with Statutory Notices In 9 cases legal proceedings were taken to enforce compliance with notices requiring the abatement of nuisances. In 2 cases Orders were made by the Magistrates for the necessary work to be carried out within a stated period. The other 7 cases were adjourned sine die as the work was in hand. CLEAN AIR ACT, 1956 Inspections in connection with proposed Smoke Control Area 789 FOOD AND DRUGS ACT, 1955 Food Hygiene Regulations, 1955 Milk and Dairies Regulations, 1949 to 1954 Complaints received 138 Inspections of Milk Purveyors' Premises 92 30 Contravention of Regulations - Inspections of Ice Cream Premises 276 Pood Inspections 480 Inspections of Other Pood Premises 1,904 Contraventions found 200 Notices served 200 Proceedings before Magistrates 2 Samples of Milk and Cream taken 24 Samples of Ice Cream taken 1ll Samples of Synthetic Cream taken 40 Samples of other foods taken 15 Legal Proceedings, FOOD AND DRUGS ACT, 1955 In the following 2 cases proceedings were instituted under this Act:- 1. Cigarette end in bread £10 fine, £2,2,0. costs. 2, Cigarette end in bun - £25 fine. List of Food Premises in the Borongh of Ealing Bakehouses 28 Bakers' shops 55 Butchers 126 Cafes and Restaurants 148 Canteens - factory 75 Canteens - school 26 Confectioners 243 Dairies and Milk Sellers 76 Pish Fryers 23 Fishmongers 36 Greengrocers 164 Grocers 331 Ice Cream Manufacturers 4 Public Houses 64 Premises registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food 112 Premises registered for the sale of Ice Cream 375 Milk Supply. There are 90 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:- 31 Dealer's Licences Supplementary Licences Total Tuberculin Tested Milk 50 15 65 Pasteuriser! Milk 61 17 78 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. 24 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 19 19 - 17 2 T.T. Pasteurised 5 5 - 5 In addition 138 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 375 premises in the Borough registered for the sale of ice cream It was found that their ice cream is obtained from 4 registered manufacturers in the Borough or from 3 manufacturers outside the Borough. Samples from each of these manufacturers were taken once or more during the year, a total of 111 samples of ice cream and ice cream constituents being submitted for bacteriological examination. The results were as follows- Commodity Samples Grade Not graded 1 2 3 4 Ice Cream Local Manufacture 94 51 32 1 10 — Ice Cream Other Manufacturers 15 3 7 3 2 - Tee tollies 2 1 - — 1 ~ 111 55 39 4 13 - 32 The 10 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 two Grade 4 samples manufactured outside the Borough were reported to the Local Authority concerned and subsequent repeat samples proved satisfactory Ice Cream 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. 40 samples of synthetic cream were taken from the local manufacturer 39 were found to be satisfactory and 1 was doubtful, A repeat sample 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. Bacon 68½ Beef 1,580 Butter ½ Cheese 36½ Chicken 127 Corned Beef 663½ Currants 49½ Pish 203 Flour 61 Ham 19¾ Kidneys 63 Lamb 52½ Liver 29 Luncheon Meat 6½ Mutton chops 12 Ox tails 19 Pork 125½ Potatoes 56 Rabbit 56 Rice 14 Sausages 120½ 33 lbs.[/$$$] Sultanas 38 Turkey 30½ Veal 119 Wafers 1,680 Foodstuffs not calculated by weight:Assorted tins, packets, jars, cases and boxes 4,562 Herrings 1 barrel Apple Pulp 7 barrels Pigs kidneys 20 Pate de fois gras 1 Turkeys 5 Portions of turkey 2 legs 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 47 persons on the Register at 31st December, 1958. 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) 1,968 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Act, 1957 21 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 7 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub: head) found not to be in all respects reasonably fit for human habitation 1,306 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 1,131 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 91 34 (2) Number of dwelling-houses in which defects were remedied after service of formal notice: (a) by Owners 63 (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) 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 16 and with respect to which owners have given an undertaking that they will not be used for human habitation 1 (4) Number of houses where demolition orders were revoked after reconstruction - 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 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined the tenement or room having been rendered fit 1 RENT ACT, 1957 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 154 (2) Number of decisions not to issue Certificates - (3) Number of decisions to issue Certificates: (a) in respect of some but not all defects 112 (b) in respect of all defects 42 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 101 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule - (6) Number of Certificates issued 68 Part II Applications for Cancellation of Certificates (7) Applications by landlords to Local Authority for cancellation of certificates 66 (8) Objections by tenants to cancellation of certificates 23 (9) Decisions of Local Authority to cancel in spite of tenants' objections 1 (10) Certificates cancelled by Local Authority 44 NEW DWELLINGS, 1958 Completion figures for the 12 months period ending 31st December, 1958 were:- Houses (1 bedroom) - Houses (2 bedrooms) - Houses (3 bedrooms) - - 35 Plats (bedsitters) 50 Plats (1 bedroom) - 49 Plats (2 bedrooms) 96 (84 Plats: 12 Maisonettes) Plats (3 bedrooms) 6 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 l,2,3,4 and 6 are to be enforced by Local Authorities 75 5 - - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authority 441 515 56 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out workers premises) - - - - Total 516 520 56 - 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 15 17 - 1 - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - « - - - Ineffective drainage of floors - - - - - Sanitary Conveniences (a) Insufficient 9 10 - 5 - (b) Unsuitable or defective 13 16 - 3 - (c) Not separate for sexes 1 1 - - Other offences against the Act (not including offences relating to out- workers) 10 12 - 1 - Total 48 56* - 10 - *This figure includes certain defects which were outstanding at the end of 1957. 36 Part VIII of the Act - Outwork Nature of Work Section 110 Section 111 No. of out-workers in August list recuired by Sect. 110(1)(c) No. of instances of work in unwholesome premises Wearing apparel: Making, etc. 273 - Cleaning and Washing 1 - Furniture and upholstery 2 - Artificial flowers 7 - Paper bags 7 - Making of boxes or other receptacles or parts thereof made wholly or partially or paper 8 - Carding, etc. of buttons etc. 24 - Stuffed toys 24 - Cosaques, Christmas crackers, Christmas stockings, etc. 51 - Lampshades 4 - Brass and Brass articles 1 - Total 402 - During 1958, 17 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 53 instances: Lighting and ventilation improved 8 Sanitary accommodation improved 27 Washing facilities provided 18 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 886 Premises inspected 1,046 Premises found to be infested with: 1. Rats 746 2. Mice 159 Re-visits to infested premises 3,119 Pees received for treatment £593. 14.0d. Rodent Control in Sewers In accordance with the requirements of the Ministry of Agriculture, Fisheries and Pood (Infestation Control Division), maintenance treatments of the soil sewers in the Borough were carried out during April and October. 37 A total of 1,900 sewer manholes were dealt with and of these 475 were found to be rat infested. Poison baits were used in the infested manholes. DISINFECTION Number of houses where disinfection was carried out 97 Number of houses disinfested of vermin 50 Number of articles disinfected by steam - Number of articles disinfected by formalin spray 209 Number of articles voluntarily destroyed 175 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 - Caravans - nuisances abated Cesspools - cleansed - Damp proof courses inserted in walls 28 Dampness - other forms remedied 189 Drains - connected to sewer - Drains - cleared and cleansed 442 Drains reconstructed 64 Drains - repaired 197 Drains - new soil and ventilating pipes provided 24 Dustbins provided 186 Firegrates - repaired or renewed 97 Floors - sub-floor ventilation provided29 Floors - repaired or renewed 94 Food cupboards ventilated 1 Rainwater eaves gutters, downpipes repaired 243 Refuse - accumulations removed 91 Roofs repaired 197 Sinks repaired or renewed 28 Sink waste pipes repaired or renewed 40 Staircases repaired 31 Walls and ceilings repaired or cleansed 206 Water supply reinstated 69 Water supply - draw taps fixed to main supply 4 Water closets - repaired, reconstructed or improved 78 Windows and doors repaired 194 Yards paved or repaired 51 Other defects remedied or nuisances abated 183 38 SUMMARY OF WORK DONE AND IMPROVEMENTS CARRIED OUT AT FOOD PREMISES Walls and ceilings repaired and cleansed 75 Floors repaired 27 Lighting and ventilation improved 8 Washing facilities provided 18 Hot water provided 15 Sinks provided 11 Storage accommodation improved 13 Water closets cleansed or repaired 27 Refrigeration installed or improved 15 Equipment improved 34 Other defects remedied 47 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 15 licences were renewed by the Council during the year after the premises had been inspected by the Public Health Inspector. 39 SECTION 4 GENERAL MEALS ON WHEELS The entire Borough is covered by a Meals on Wheels service to deliver hot meals to old people who have difficulty in providing them for themselves Meals are cooked centrally and delivered by van in heated containers. In the Ealing and Hanwell area this is operated by the British Red Cross Society Meals are delivered from two to five times weekly and the number of old people served is 56 The total number of meals delivered last year was 13, 166. In the Greenford Perivale and Northolt areas the service is operated by the Womens Voluntary Service, A paid Cook is now employed, but the rest of the work i.e preparing vegetables, driving the van. delivery of meals and washing up is done by voluntary workers. It is now possible to provide special meals for those on restricted diets. During 1958 4,880 meals were served The number of old people being so helped at the end of the year was 57, each receiving two meals per week. CHIROPODY. The Chiropody Service has been operated by the British Red Cross Society from the 1st April, 1958 Old people normally attend approximately every two months and treatment is now given at 14 different places in the Borough as follows;- Health Clinics 5 Community Centres 3 Almshouses 1 Old People's Home 1 Private Surgeries 4 In addition treatment is given in their homes to housebound patients. There is a considerable demand for this service but it has been possible to avoid a waiting list. The totals of attendances were as follows:- Total number of individual patients 465 Total number of treatments 1,239 Number of patients receiving domiciliary treatment 90 Number of domiciliary treatments 279 40 OLD PEOPLE'S WORK CENTRE. A notable addition to the services available to old people in the Borough was made in 1958. by the inauguration of an Old Persons Work Centre by the Ealing Central Aid Committee for the Employment and Recreation of Elderly Citizens, This Committee is widely representative of Ealing life, and membership includes nominees of the Borough and County Councils and trade organisations. The object of the scheme is to provide remunerative employment for old people under protected conditions and thereby give them a sense of being wanted by the community, to enable them to overcome loneliness in communal work and to provide themselves with small comforts from their wages. The centre is not intended to be financially self supporting, grants being made mainly by the Ealing Borough and Middlesex County Councils. The Work Centre was estab lished in the annexe of the Griffith Davies Memorial Hall in February On the first day seven elderly people started work and the number rapidly rose to 25. the capacity of the accommodation. The hours of work are 10 a.m. to 12 noon five days a week and the pay is 1/-per hour. The work done has included the following:- (1) Sewing buttons on cards, (2) Enclosure work for medical mailing (3) Needlework, including making surgical trolley cloths and roller towels for a factory, making drawsheets and various repairs for a nursing home, repairing factory overalls, and repairing bed and table linen for an hotel. (4) Stringing swing cards. (5) Assembling ball point and fountain pens, (6) Enclosing beads in cellophane envelopes and stapling. It is obvious that no scheme of this nature can function without the interest and co-operation of industrial firms. In this respect we have been most fortunate. The average age of those employed is 72 and ranges between 63 and 83, The beneficial effect is apparent to any visitor to the centre and the present centre, which was intended as a pilot scheme, has demonstrated that expansion and extension to all areas of the Borough is very worth while. It is therefore planned to move to larger premises in Ealing and in addition to open a second centre in Greenford, All assisting in the organisation have up till now been voluntary but clearly a paid Organiser is now essential and plans to this end have been made. 43 Our gratitude is due to all those who have helped in this new measure of preventive medicine in the Borough and particularly to Mrs. Corbyn. the Honorary Organiser. HOLIDAYS FOR OLD PEOPLE. During the year holidays for old people were arranged by the Womens Voluntary Service and the Greenford Philanthropic Society. The Womens Voluntary Service Party numbered 200. Considerable publicity was given to the scheme and every effort was made so that the most deserving were selected. They were accommodated in 22 different Guest Houses in Bexhill in May A nominal charge of £1.1.0d. was made. The weather was good and many entertainments were available for the enjoyment of the old people. The Greenford Philanthropic Society party numbered 36, and took over an entire Guest House in Ramsgate. A most enjoyable week's holiday was spent, which included coach drives, theatres and other entertainments. Many letters of appreciation were received LAUNDRY SERVICE FOR THE INCONTINENT, The Laundry Service is still continuing to perform an essential service for those people, mainly elderly, 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 1953; - 1953 1954 1955 1956 1957 1958 No. of cases dealt with during the year 46 66 84 78 70 56 No. of cases remaining at end of year 23 47 44 47 39 38 No. of cases that died 18 28 39 26 48 35 No. of cases removed to hospital 18 24 39 28 14 22 No. of cases where other arrangements were made 10 8 7 5 4 2 Total number of articles dealt with Total number of 17,587 25,097 34,259 36,755 44,466 36,723 collections 1,784 2,500 3,347 3,086 3,333 2,766 Average number of articles per collection 9.9 10.0 10.2 11.9 13.3 13.3 44 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. 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 has fortunately not been necessary to use these powers this year. In all instances either the assistance of the Home Help, Home Nursing. Heal th Visiting and Laundry Services have proved successful in keeping the old person satisfactorily at home or persuasion has succeeded in obtaining agreement to admission to hospital or Old Persons Home when necessary. Section 50 - Burial of the Dead. Three burials were carried out for which the Council accepted financial responsibilityo In one of these the total cost was recovered, in one none of the cost, and in the remaining one a claim on the estate has not yet succeeded. MASSAGE AND SPECIAL TREATMENT ESTABLISHMENTS. One new licence was issued during the year and the number of establishments at the end of the year was 27. Five 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 were distributed through the same channels as in past years. 45 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 41 Sickness Pay Scheme (Servants)94 Gunnersbury Park Joint Committee Employees 3 Total 138 Nine of the above were rejected for the following causes: Anxiety State Chronic Bronchitis (2) Coronary Thrombosis Hypertension Prolapsed Intervertebral Disc Schizophrenia (2) Tuberculosis 46 SECTION 5 STATISTICAL TABLES SUMMARY OF STATISTICS Area (in Acres) 8,781 Population (Census, 1951)187,306 Population (estimated middle of 1958)183,000 Rateable Value, 1st April, 1958 £3,377,272 Net Product of a Penny Rate, 1958-59 (Est.) £13,800 Live Births:- Legitimate Males, 1,284 Females, 1,239 Total 2,523 Illegitimate Males,59 Females, 46 Total 105 Birth Rate per 1,000 of Estimated Population 14.4 Still-Births;- Males, 22 Females, 26 Total 48 Rate per 1,000 total Births (Live and Still-Births) 17.9 Deaths:- Males, 979 Females, 928 Total 1 897 Death-Rate per 1,000 of Estimated Population 10.4 Deaths of Infants under one year of age:- Legitimate Males, 25 Females, 12 Total 37 Illegitimate Males, 1 Females 1 Total 2 Death-Rate of Infants under one year of age:- All Infants per 1,000 Live Births 14.8 Legitimate Infants per 1,000 Legitimate Live Births 14.7 Illegitimate Infants per 1,000 Illegitimate Live Births 19.0 Deaths from Diseases and Accidents of Pregnancy and Childbirth:- From Sepsis Nil Death-Rate per 1,000 Total Births Nil From other Causes-Nil " " " " " Nil 47 Cases of Infectious and Other Notifiable Diseases notified in the Borough Disease 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 Smallpox - - - - - - - - - - - - Diphtheria 11 13 16 3 2 - - 1 _ - - - Scarlet Fever 133 204 176 294 203 402 238 287 108 159 95 232 Enteric Fever (including Paratyphoid) - 3 8 5 3 2 3 5 7 - 1 - Puerperal Pyrexia 27 25 27 24 38 70 61 54 44 71 77 67 Pneumonia: Primary 127 189 163 173 162 100 157 152 135 113 72 94 Influenzal 3 6 10 6 38 28 74 52 56 48 99 57 Acute Poliomyelitis 46 10 34 42 10 21 13 5 61 46 2 2 Meningococcal Infection 10 2 14 9 2 - - 6 3 2 2 3 Malaria 1 2 - 4 1 1 3 1 1 - - 1 Dysentery 5 7 23 24 542 179 132 225 149 193 252 244 Erysipelas 38 32 13 24 17 26 18 18 12 12 13 19 Tuberculosis: Pulmonary 204 206 205 209 210 211 205 132 119 134 113 97 Non-Pulmonary 25 27 32 41 24 29 20 17 24 13 16 8 Ophthalmia Neonatorum 5 - 5 3 6 - - 2 2 2 5 6 Measles 806 1,379 1,450 1,016 3,296 993 2,558 132 2,422 726 1,854 975 Whooping Cough 310 383 303 274 550 77 491 116 156 67 131 85 Food Poisoning - - 21 23 86 26 31 78 36 26 20 18 Totals 1,757 2,492 2,503 2,174 5,190 2,165 4,004 1,284 3,335 1,612 2,752 1,908 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 12 Diphtheria _ Meningococcal Infection 3 Scarlet Fever 232 Malaria 1 Enteric Fever (including Paratyphoid) _ Dysentery 238 Erysipelas 19 Puerperal Pyrexia 67 Tuberculosis Pneumonia Pulmonary 97 Primary 94 Non-Pulmonary 8 Influenzal 57 Ophthalmia Neonatorum 6 Acute Poliomyelitis 2 Measles 975 Acute Encephalitis Infective _ Whooping Cough 85 Post Infectious _ Total 1, 896 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 114 118 36 49 1 1 - - 482 493 - - 130 114 3 - PINAL numbers after correction Under 1 year - - 3 4 - - - - 9 14 - - 6 6 2 - 1 - 3 2 3 4 - - - - 35 50 - - 10 7 _ _ 2 - 13 5 6 1 - - - - 54 54 - - 6 6 _ _ 3 - 10 10 6 8 - - - - 66 58 - - 10 4 1 - 4 - 5 16 2 7 - - - - 43 57 - - 4 5 - - 5-9 70 74 16 22 - - - - 267 256 - - 19 19 - - 10 - 14 11 7 - - - 1 - - 6 11 - - 11 12 - - 15 - 24 1 2 - 2 - - - - 3 3 - - 11 10 - _ 25 and over 1 2 - 1 1 - - - - - - - 47 42 - _ Age unknown - - - - - - - - - - - - - - - - Total 114 118 36 49 1 1 - - 482 493 - - 124 111 3 - 50  Pneumonia Smallpox Acute Encephalitis Enteric or Typhoid ?ever Paratyphoid Fevers Frysipelas Pood Poisoning Infective Post-Infectious M F M F M F M F M F M F M F M F Numbers originally notified 87 64 _ _ _ _ _ _ _ _ _ _ 10 9 7 11 PINAL numbers after correction Under 5 years 19 11 _ _ _ _ _ _ _ _ _ _ _ _ _ 2 5 - 14 14 10 - - - _ - - - - - - - - 2 1 15 - 44 12 18 - - - - - - - - - - 3 3 3 3 45 - 64 33 15 - - _ _ - - - - - - 5 4 - - 65 and over 9 10 - - _ _ - - - _ - - 2 2 - 1 Age unknown - - - - _ _ - - - - - - - - - - Total 87 64 - - _ _ - - - - - - 10 9 5 7 Tuberculosis Other notifiable diseases Respiratory Meninges & C.N.S. Other Original Final M F M F M F M F M F Numbers originally notified 65 32 1 - 5 3 puerpera 1 Pyrexia FINAL numbers after correction Under 5 years 1 2 - - - - - 67 - 67 Onhth. N eonatorum 5 - 14 1 1 - - - - 5 1 5 1 15 - 24 16 10 - - - 1 25 - 44 20 12 - - 4 1 45 - 64 23 5 l - 1 1 65 and over 4 2 - - - - Age unknown - - - - - - Total 65 32 1 - 5 3 51 DEATHS Causes of Death, 1958 Cause of Death Deaths, 1958 Total Deaths 1957 Male Female Total Tuberculosis. Respiratory 5 5 10 20 Tuberculosis Other - - - 3 Syphilitic Disease 1 1 2 7 Diphtheria - - - - Whooping Cough - - - - Meningococcal Infections - - - - Acute Poliomyelitis - - - - Measles - - - - Other Infective and Parasitic Diseases - 1 1 3 Malignant Neoplasm Stomach 28 24 52 56 ,, ,,Lung Bronchus 75 19 94 105 ,, ,,Breast 1 44 45 41 " " Uterus - 20 20 18 Other Malignant Lymphatic Neoplasms 106 81 187 192 Leukaemia Aleukaemia 4 3 7 12 Diabetes 4 11 15 11 Vascular Lesions of Nervous System 96 152 248 229 Coronary Disease Angina 196 124 320 307 Hypertension with Heart Disease 22 28 50 44 Other Heart Diseases 104 149 253 267 Other Circulatory Disease 39 34 73 109 Influenza 1 - 1 12 Pneumonia 44 43 87 64 Bronchitis 98 42 140 108 Other Diseases of Respiratory System 11 10 21 14 Ulcer of Stomach and Duodenum 16 7 23 19 Gastritis Enteritis and Diarrhoea 2 2 4 6 Nephritis and Nephrosis 4 11 15 7 Hyperplasia of Prostate 21 - 21 11 Pregnancy Childbirth. Abortion - - - 2 Congenital Malformations 6 9 15 15 Other Defined and Ill-Defined Diseases 57 77 134 122 Motor Vehicle Accidents 22 3 25 19 All other Accidents 11 16 27 33 Suicide 5 12 17 30 Homicides and Operations of War - - - - Totals 979 928 1,907 1, 886 52 SECTION 6 SCHOOL HEALTH SERVICE The School Health Service had a comparatively uneventful year. The B.C.G. vaccination was limited to private school children who had not been dealt with in the previous year. Some 2,000 children attending state maintained schools were re-tested in connection with the M.R.C. Tuberculosis research scheme. The position with regard to obtaining special school vacancies continues to improve, and the only real difficulty in finding suitable placement is in cases of multiple defects. We have suffered a slight setback in our efforts against head infestation, The increase in the incidence of this condition is quite small, (only 70 cases were found in 54,638 examinations) but it is the first time for many years we have been unable to report an improvement. B.C.G. VACCINATION. Details of private school children offered B.C.G. vaccination through the approved arrangements under Section 28 of the National Health Service Act, 1946 during the year ended 31st December, 1958, are as follows:- 1. Number of children whose parents were approached regarding participation in the scheme 449 2. Number of children whose parents consented to participate 266 3. Number of those who were tested and found to be (a) negative 152 (b) positive 30 4 Number of those who were given B.C.G. vaccination 152 The apparent low acceptance rate was due to concurrent poliomyelitis injections. MINOR AILMENT CLINICS. The examinations carried out at these 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 53 investigation into any defect observed at the school inspection. Attendances at Minor Ailment Clinics 1956 1957 1958 7,897 9,951 9,996 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 1957 1958 First age group 2,016 2,050 Second age group 2,389 2,419 Third age group 1,305 l,991 Total 5,710 6,460 Classification of General Condition Satisfactory 6,442 Unsatisfactory 18 6,460 Defects requiring Treatment found at Routine Medical Inspection 1955 1956 1957 1958 Skin Diseases 559 859 738 846 Defective Vision 444 452 349 438 Squint 37 25 10 26 Defects of Hearing 68 73 53 114 Middle Ear Diseases 32 48 24 8 Nose and Throat Diseases 242 190 86 141 Speech Defects 34 36 12 28 Enlarged Glands 6 7 5 2 Heart Circulation conditions 14 5 2 7 Lung Diseases 79 72 52 74 Hernia 2 3 5 - Postural Defects 24 35 23 32 Orthopaedic Foot Defects 97 78 48 68 Epilepsy 3 2 - - ASTHMA CLINIC. The scope of the Asthma Clinic during the past year has been much increased. This is due partly to the new method of approach which had been initiated for the investigation of individual cases, and also a modification in the method of treatment. 54 During the current year the Asthma Clinic is to continue the investigation of the value of Skin Tests in cases of Asthma, which was started during the past year. A survey has been started to evaluate the use and reliability of history taking in cases of Asthma, and to attempt an assessment of the nervous temperament of asthmatic children attending the Clinic by comparing this group of children with a similar group who do not have asthma. The progress of this survey has been considerably helped by the kind advice and co-operation of the Allergy Clinic of St. Mary's Hospital London; the Brompton Hospital for Diseases of the Chest, London, and Professors Walton and Bradford Hill of the London School of Tropical Medicine and Hygiene, London The benefit derived from the Physiotherapy Classes by both bronchitic and asthmatic children in the Area is most encouraging. The number and severity of asthmatic attacks in cases attending the Clinic is reported by the parents as being greatly reduced, and in the case of the bronchitics similar improvements have been obtained. The need for routine revision of all discharged cases continues since many of the younger children fail to undertake their exercises at home Group exercises under supervision at the Clinic must therefore remain an essential feature of the treatment. The co-operation of the Child Guidance Clinic has been sought to help in the interpretation of the findings with regard to the emotional make up of asthmatic children compared with other children who do not suffer from this complaint. As compared with the previous year, the number of attendances at the Asthma Clinic rose from 889 to 2,157 this year. This increase in numbers is explained by the following reasons:- 1. The clinic has had the uninterrupted services of a Physiotherapist during the past year, whereas during the previous year the Physiotherapist was on sick leave for 19 weeks. 2. A larger number of cases which had been discharged from treatment were re-examined as part of a routine follow-up, so that their progress could be recorded. 3. A certain extra number of cases which did not exhibit signs and symptoms of chest disease have been investigated, since they have been used as controls in the current survey of asthmatic cases started this year. 55 From the foregoing facts it does not appear that there has been an actual increase in the number of cases of asthma or bronchitis. The proportion of cases treated last year were as follows:- Asthmatics 50% Bronchitics 32% Chest deformities 14% Others 4% Follow- up cases 20 Control group (part) 12 Discharges 30 SCHOOL DENTAL SERVICE. The general pattern of the dental service remains much as reported in 1957. No further full-time Officers have left, but there has been a rapid turnover of parttime officers and the dental surgeon relatively inexperienced in school dental clinic work always takes some time to become fully productive. This, coupled with the continued difficulty in securing dental attendants of a suitable type, inevitably leads to a smaller output than would be desirable. From the results of school dental inspections it would appear that a higher proportion of children attending secondary schools receive private dental treatment compared with infants and juniors. This is rather the pattern that would be expected as by and large many parents still do not realise the importance of dental attention for the younger children, and also children of these ages are not so desirable as private patients taking generally more time for less return economically. But the valuable contribution of private practitioners to the dental health of children in the Borough must be acknowledged. Parents are given prior notice of school dental inspections and it is noteworthy that a considerable number of children are always found to have made appointments for treatment as a result of the "reminder'' of the proposed inspection. Attention has been drawn previously to the possibility of the fluoridation of water supplies as a means of reducing the incidence of dental caries. During the year we became aware that in the Northolt district, served by the Rickmansworth and Uxbridge Valley Water Company, water is 56 pumped from four wells which have a fluoride content of between 0 4 and 1.9 parts per million. The higher figure is well inside the range where a dental influence would be expected. However, before piping to the domestic supply this well water is mixed with other water from outside sources. The water company were unable to give us any exact data of fluorine analysis of the final tap water. As far as dental caries is concerned analysis of data obtained from two schools in Northolt did not show any significant difference from the general pattern in the Borough but the Northolt population is largely new and any effect could only be visible after several years among children who had lived there most of their lives. It was decided to seek the help of Miss J.R. Forrest, L.D. S., of the Ministry of Health in securing a series of analyses of the domestic water supplies in Northolt. Miss Forrest kindly arranged for this to be done by the Government Chemist and it was found that the fluoride content was 0.30 parts per million with very little variation. As a level of 1.0 part per million needs to be maintained for caries to be reduced it can be appreciated that the water supply in Northolt is unlikely to produce a beneficial effect. Though the result of the investigation was negative it was desirable that a water supply of possible high level fluoride content should be investigated and the ready help of the Government Officials concerned is gratefully acknowledged. Attendances Completing Treatment Fillings Permanent Teeth Fillings Temporary Teeth Extractions Permanent Teeth Extractions Temporary Teeth Anaesthetics Orthodontic treatment New Cases Gas Local 16,465 4,875 9,402 3,045 1,018 3,631 2,003 4,471 166 EAR, NOSE AND THROAT SERVICE. Mr. Savege, Consulting Otologist, reports:- It is interesting to note that the character of cases referred from School Medical Inspections and from General Practitioners to the School E.N. T. Clinics has changed over the years. 57 Before the war, the great majority of cases were chronic discharging ears; often so profuse was the dis charge that the children were sent home from school. The Hospital Out Patients Departments were unable to clear up these cases largely because daily treatment was required, and also a follow up system to ensure the attendance of the child, did not exist. The E. N,T School Clinics assisted by the Minor Ailment Clinics, giving daily treatment, were able to clear up a great many of these cases, although cases of chronic mastoiditis had to be referred for operation It is a great step forward, that this type of case is now rarely seen and a handicapping defect causing, at least, permanent middle ear deafness has been removed. Nowadays the cases referred to the School E.N. T, Clinics are - 1 those giving symptoms of infected Tonsils and/or Adenoids. Efforts are made to clear up the infection by nasal drops, breathing exercises etc., but if the trouble persists, the cases are referred for operation. 2. cases of deafness. Usually these are of the catarrhal middle ear type, which can be cleared up with treatment Sometimes the deafness is of the inner ear type, the result of infective conditions such as mumps, or of congenital abnormality Unfortunately, treatment will not help these cases, but careful assessment is neces sary to ensure that their education is affected to the smallest extent. 3 cases of chronic sinus disease Fortunately this trouble is not common in children, but suspected cases are referred for X-ray examination, and if confirmed by this are treated by displacement and diastolisation. If treatment fails, the cases are referred to hospital for operation. 1958 1957 Number of new cases 145 109 Number of re-inspections 292 343 Total Attendances 437 452 Number Treatment Advised 230 296 Number Operation Advised 99 80 58 Audiometry Report 1957 1958 Number of schools visited 34 32 Number of children examined 7,737 5,498 Number of children with hearing loss 225 193 Number of pure tone tests 5,365 5,498 Number referred to E.N.T. Specialist 74 53 The use of the pure tone audiometer was continued throughout the year. Unfortunately in November the Audiometrician left for another appointment and no testing was done for the second half of the Autumn term. This resulted in a drop in the number of children tested The age groups tested as a routine in schools are 6-7 years, 9-10 years, and 13-14 years. The decline in the total numbers tested was due mainly to the change over from gramophone audiometer to the pure tone audiometer in 1957. It is not possible to carry out as many tests with the latter as with the former, but against this one has the advantage of more accurate test ing. FOOT HEALTH, During 1958 the Foot Health nurse saw 11.177 children in school, a record so far for any one year. At these foot inspections, the condition of each child's feet and shoes is recorded on individual foot cards. It is usual for the nurse to see each child every 2½ years early foot troubles are readily detected by her and children with these are then asked to attend the foot clinics held by the Medical Officer in charge, at which advice can be given to the parents. The work of these foot clinics is varied. Children with foot pain are usually referred to the Orthopaedic Surgeon, Children with valgus ankles (so called "flat feet") are given wedges to be placed in the heels of their shoes, and simple but effective exercises to do at home, in order to strengthen the weak muscles and ligaments. Girls showing early Hallux Valgus (outward bending of the big toe) are advised on the importance of shoe design and fitting. It is now common to find girls from the age of 10 years upwards, wearing the "casual" or "slip on" type of shoe. These shoes are poorly designed and their shape bears no relation to that of a normal child's foot. These casual shoes can undoubtedly cause a great deal of harm to growing feet. 59 The girls want to wear them because their friends do so, and some mothers buy them because they think they are pretty and fashionable. It is hoped that the discussion between the parents, child and doctor at these foot clinics will promote a more sensible approach in the subsequent choice of shoes. The search for foot infection in the school children has continued every term. The incidence of Tinea (Athlete's Foot) is the same as in 1957-0,9%. The incidence of verrucae (Plantar Warts) has dropped from 12% in 1957 to 0 8% in 1958, There are still many children requiring treatment however, despite this apparent decrease. The School Chiropody Service now employs two chiropodists who work at four of the larger clinics throughout the Borough There are six chiropody sessions per week for the Ealing school children, at which 12 16 children are seen at each session A list of children awaiting treatment is kept in the Area Health Office. With very few exceptions so far, no child has had to wait longer than eight weeks. Those children marked as "urgent" cases are sent an appointment for the chiropodist at their nearest clinic, if possible, within four weeks of first being seen Foot Inspection Defects Total number examined 11,177 Referred to Medical Officer 346 3.1% Referred to Chiropodist 96 .8% Verrucae 94 .8% Defective shoes 2,311 20.6% Everted ankles 280 2.5% Hallux Valgus 2,175 19.4% Tinea 104 9% ORTHOPAEDIC CLINIC. Mr. J.A. Cholmeley, the Orthopaedic Consultant, reports: Although the Ealing Orthopaedic Clinics have been busy during the past year there appears to have been, to those working at them, a falling off of the work, at least during the latter half of the year. Compared with 1957 there certainly has been a reduction under every heading but compared with the previous year - 1956 - there has been a small rise in attendances at the surgeons' and physiotherapists' sessions. For some unexplained reason there was a considerable rise in all attendances during 1957. 60 A fall in attendances at children's orthopaedic and other specialist departments has not only occurred in school clinics but in a large number of hospitals through out the country and is certainly related to the improved state of health of the children of this country, much of which is due to the work of the Public Health, Maternity and Child Welfare and School Medical Departments, As far as children's orthopaedic clinics are concerned there have been few new cases of poliomyelitis as there has been no epidemic during the past few years and the disease in this country now affects adults as frequently as child ren. During the year l958 tnere was only one new case or poliomyelitis at the Ealing Orthopaedic Clinic. 1957 1958 Number of new cases 209 145 Number of re-inspections 585 449 Total attendances 794 594 Number of children referred for physiotherapy 321 232 Number of attendances 3,492 3,327 HANDICAPPED CHILDREN. The following table sets out in their various cate gories the number of handicapped pupils as at 31st December, 1958, 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 - - 3 1 - - 1 1 4 2 PartiallySighted Pupils 7 3 1 3 - - - - 8 6 Deaf Pupils 4 4 3 2 - - - - 7 6 Partially Deaf Pupils 5 7 3 2 2 1 _ 1 10 11 Educationally Sub-normal Pupils 42 27 15 8 3 6 2 - 62 41 Epileptic Pupils - - 1 - 4 - - - 5 - Maladjusted Pupils - - 45 34 2 1 1 _ 48 35 Physically Handicapped Pupils 11 11 5 4 6 2 _ 1 22 18 Pupils with Speech Defects - - - - 10 1 - - 10 1 Delicate Pupils 7 5 14 2 3 1 1 - 25 8 Pupils with Multiple Defect - - - - - - - - - - Total 76 57 90 56 30 12 5 3 201 128 61 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 December 1958 The total number of cases seen was 1 574 (1957 1.914) of which 470 (1957 390) were new cases, and 1,103 (1957 1 524) were re inspections. The number of pairs of glasses prescribed was 927 (1957 977) Abnormal Eye Conditions other than Errors of Refraction were as follows.- Congenital Abnormalities New Cases Old Cases Squint 64 175 Congenital Nystagmus 1 3 Albino with Congenital Nystagmus - 1 Nasal Duct Obstruction 2 1 Abnormalities Extra Ocular Muscle 2 - Abnormalities Extra Ocular Muscle with Torticollis 1 - Coloboma of Uveal Tract 1 1 Congenital Cataract - 1 Progressive Myopia - 1 Hydrocephalic with Optic Atrophy 1 - Marfan's Syndrome - 1 Abnoimalities due to Infection Conjunctivitis 3 - Blepharitis 1 2 Styes 2 - Meibomian Cyst 2 - Blind Eye from Uveitis 1 1 Old Uveitis 1 - Abscess of Lacrimal sac 1 - Abnoimalities due to Trauma Ulcer of Cornea 1 - Corneal scarring 1 - Abnormalities of Unknown Etiology Retinal Haemorrhage 1 - Detachment of Retina 1 - SPEECH THERAPY. During the past year the services provided by the Speech Therapy Department have been widely used, as is shown by the following figures, Number on roll at 1st January,, 1958 163 New cases during the year 95 62 Number discharged 42 Number on roll at 31st December, 1958 216 Number of attendances at Speech Therapy Clinics 4,134 There has thus been during the year an increase of 53 in the number of children on the roll. This is due first to a fall in the number of discharges following an unusually high number in 1957; and secondly to an increase in the number of new cases Some 95 children attended for the first time in 1958 as compared with 71 and 76 for the previous two years. This increase is mainly accounted for by an expansion of the school visiting programme Groups of children are selected by Head Teachers as possible cases of speech defect and are seen by a Speech Therapist at the school, Those children who are thought to require speech therapy are given treatment at the clinics after their parents' consent has been obtained. The frequency of the various types of speech defect encountered is shown below (1) Dyslalia- Mixing or missing out of consonants 51 7 (2) Stammering13.3 (3) Developmental aphasia Delayed or absent speech 15.0 (4) Dysarthria - Defects due to disorders of the muscles of articulation 15.0 (5) Aphasia associated with mental deficiency 3.3 (6) Disorder arising from deafness 1.7 Treatment of individual children has been given at most of the clinics in the area and sometimes, when convenient, at schools The playgroups for pre-school children held at Mattock Lane and Ravenor Park Clinics have continued to perform a valuable function in allowing young children with speech defects to mix together under conditions designed to promote the development of speech. The Speech class at Stanhope Infant School which caters for children with more severe speech defects is an established feature of the educational facilities of the area. It was felt that the advantages of this type of class, believed to be the first of its kind in the country, should be made more widely known. Accordingly a report was drawn up by two of my Medical Officers who have been closely associated with this project and was recently published in "The Medical Officer". This report is reproduced below by kind permission of the Editor. 63 THE FORMATION OF A SPEECH CLASS IN A NORMAL INFANT SCHOOL By I.H. Seppelt, M.A., M.B.- B.Chir., D.P.H. and I.O. Taylor, M. A., M.R.C.S. L.R.C.P., D.P.H. Assistant Medical Officers, Area 7, Middlesex County Council. In recent years consideration has been given in the Speech Therapy Department to the problem of the infant school entrant whose speech is sufficiently defective to interfere markedly with education. Some years ago the formation of a Play Group amongst older pre-school children had aimed at correcting the defect before school age. It was apparent however that some children were still reaching school age with the defect uncorrected- and an account will be given of the formation and management of a special class to cater for their needs. Such children on entering a normal infant class face considerable difficulties. First they are timid and shy and make little effort to talk. When the effort is made they are often unable to make the teacher understand and are thereby discouraged from further attempts. Clearly in the large classes of today such children are almost certain to be neglected if only due to lack of time. Even assuming a child is fortunate enough to find himself in a small class encouragement of speech and the correction of its defects is a specialised subject of which the teacher of a normal class is unlikely to have any particular knowledge. Secondly these children need frequent attendance at clinics for speech therapy which results in a sub stantial absence from lessons- This is, of course a problem common to all categories of handicapped pupils who have to attend hospitals or clinics for their defects when no provisions for this are made at school. Thirdly careful observation and follow up by the medical officer and speech therapist is difficult and such surveillance is of great importance in dealing with these children so that their management can be varied in the light of their development. The formation of a speech class in a normal primary school seemed to offer a solution to these difficulties. Here a specially experienced teacher could combine normal school routine with speech training the speech therapist could visit several times weekly and easy surveillance by the medical officer would be possible. One of the merits of the scheme was that it could be implemented utilising existing facilities. Thus (1) The speech therapist would devote to those children in school the time she would normally give to them in clinics. (2) Although the class teacher should perhaps theoretically be adoubly qualified person, i.e. speech therapist/teacher, this would be unlikely to be practicable and therefore it was decided to select a teacher with some experience of speech training and of the development of language and an interest in the scheme. Accordingly, in 1954 such a class was formed. The founder members varied between five and eight years old. These were selected from children having speech therapy at clinics who were making unsatisfactory progress in normal schools, due primarily to their 64 speech defect. Subsequently, the aim has been that children should enter the class at 4½ years old and only when the disability has been sufficiently overcome enter an ordinary class. The facilities available are well known in the Area to school medical officers, medical officers of child welfare clinics, health visitors, teachers, and, indeed parents themselves. Referral in the first instance is to the medical officer in charge of speech therapy as it is felt that the causes of defective speech are so diverse that speech therapy in its narrow sense plays only apart. Diagnosis and effective treatment may require the services of ENT surgeon neurologist or psychologist, and the appropriate co ordinator of these is considered to be the medical officer. The medical assessment consists of,- (1)(a) General medical history and inquiry into the child's milestones, disposition play habits and home background. (b) The history of the child's speech defect, together with family speech history. (2)(a) General medical examination. (b) Examination of tongue and palate movement formation of mouth and teeth, hearing central nervous system and preliminary estimate of intelligence. (3) Special investigations - (a) Routine assessment of Intelligence Quotient. (b) Routine pure tone audiometry. (c) Tape recording. Following the medical examination the child is seen by the speech therapist and a joint conference between medical officer, teacher and speech therapist is held to determine whether admission is indicated. If this is the case formal ascertainment as a handicapped pupil is made. As a general rule the criteria are: - (1) That a child should have a speech defect sufficient to impede education if admitted to a normal class and that this would be unlikely to improve in these circumstances. (2) Although children with other handicaps are admitted, the speech defect must be the primary disability. Subsequently the child has a routine medical exam ination twice yearly and is referred for special exam ination whenever required by conditions coming to light as a result of observations by teacher or speech therapist. In addition to this the medical officer visits the class at frequent intervals. In this way the children accept him as a normal visitor and he is able to observe the progress of the children under day to day conditions. Since the class commenced 30 children (19 boys and 11 girls) have been admitted. Of these, 21 have been discharged leaving nine still in the class. The average age of admission during the last six terms under review has been five years five months. The average age of discharge has been seven years six months, after an averaee st.av in the class of three terms. The children concerned had a wide range of speech defects classified as follows- 65 Diagnosis No. of Cases Developmental aphasia 10 Dysarthria 2 Dyslalia 9 Dyslalia and stammer 2 Dyslalia and dysarthria 5 Disorder due to deafness 2 30 It will be seen that developmental aphasia and dyslalia account for the majority of children admitted. The two cases of pure dysarthria were due to minor degrees of cerebral palsy. In the children with combined dyslalia and dysarthria the dysarthric element included orthodontic conditions and varying degrees of tongue immobility. One child had a thyroid deficiency and the large tongue often associated with this condition. Of the two children who had a disorder of speech due to deafness only one required to wear a hearing aid. It will be noted that cases of pure stammering are not admitted as it is not felt that the class caters for their particular need. In the cases where stammer has been part of a mixed defect it has been much the lesser of the two disabilities. The intelligence quotients of the children who have been in the class have been a little lower than would be expected in any normal group of children in the same age range. This was between 60 and 129. Most, however were in the range 80 to 89. On leaving the class the speech of the 21 children discharged was assessed as follows- Normal speech 14 Slight dyslalia 4 Slight dysarthria 2 Markedly defective speech but left class to go abroad 1 21 Differences from Ordinary Class Routine Prom the teaching point of view routine is basically as in a normal infant class with the following differences (1) The limitation of the class to 10 pupils allows for individual tuition and there is no formal syllabus. (2) Teaching is to a wider age range than in a normal class. (3) Time spent on speech training and encouragement of speech is much greater. (4) Correction of speech which in teaching a normal class plays only a small part is here of prime importance. In this respect, of course, example plays a major part and at all times the teacher's speech must be of the highest quality. (5) Use of piano and tape recorder to encourage the often late developing sense of rhythm, (6) Since the class is part of a normal school it can take part in all normal activities and in no way is there segregation of these children. In this respect the head teacher plays an essential role in general 66 supervision, and ensures integration of the class with the remainder of the school. At times a normal class may join the speech class for stories, since it is found that listening is facilitated when the class is part of a large listening group. Whilst continuing experience of teaching a class of this kind has resulted in some small alterations of a practical nature it has not been found necessary to make wide changes in the way that teaching is carried out and there is little difference in method since the inception of the class. There is no loss of continuity on entering normal classes as supervision by the medical officer continues and speech therapy is given by the same speech therapist where necessary. It is not possible to compare the progress of these children in precise terms during their time in the class with probable progress in a normal class, nor is there available a closely similar control group. Nevertheless the impression is that their time in the class enabled these children to make very much more satisfactory progress than would have been possible had they been in a normal class and attended clinics for speech therapy. Doubtless this is partly explained by the small size of the class in itself but it seems likely that the tuition planned to their needs plays the major part. One possible pitfall in a class of this nature is that it could become used for children with other handicaps, speech not being the primary handicap. Particular care must therefore be taken that it does not become a class for educationally sub normal or maladjusted children. A maladjusted child in the class is especially harmful, as children with defective speech are very sensitive to such a disruptive influ ence. The wide age range at first presented problems but now with early ascertainment it varies only between 4!4 and 5% years. The statutory limit for such a class is 10 and it has been found that a school child population of 24;000 furnishes this number. Even within the boundary of one authority a wide area is covered and transport has to be provided in some instances. The provision of a teacher presents one of the greatest problems and a suitable candidate is unlikely to be readily available. We feel that this class has been particularly fortunate in having a teacher who has been able to adapt herself readily to the new circumstances presented by it. The essential qualifications of a speech class teacher would seem to be a natural kindliness and regard for children and the ability to gain their confidence easily. Any suggestion of a formal approach to her subject would be a disadvantage. The teacher of this class feels that a study of the development of speech which formed part of her university course in English and a course of speech training for public speaking have been of great help to her. Whilst this is so. we feel that such experience is a helpful, additional qualification rather than an essential one and that the basic attributes already mentioned are the more important. Summary The formation of a Speech Class in a normal infant school is described. It is considered that it fulfils 67 a useful function in getting children with fairly severe speech defects to overcome this handicap more rapidly and with far less distress than if they had entered a normal infant class. The scheme has been found to be practicable for the Speech Therapy Department of a fairly large authority of about 200,000 people without additional resources being necessary except the willingness of the local Education Authority to provide a teacher for 10 children, and the services of one of the medical officers of the School Health Service staff for supervisory purposes. EALING CHILD GUIDANCE CENTRE. Dr. P, Holman, Consultant Psychiatrist, reports:- This centre covers both Ealing and Acton, but the following figures relate to Ealing only. Patients attending* 146 cases were referred during the year which is exactly the same number as were referred in the previous year. Cases withdrawn before Investigation, The number of cases withdrawn before investigation is not as large as in 1957. There were 50 cases in Ealing where there was lack of co operation on the part of the parents who failed to bring the child for treatment after originally accepting. In some cases there is a spontaneous improvement whilst the case is still on the waiting list. Problems referred to the Centre. The type of case referred remains remarkably unchanged over the years. We continue to be sent a high proportion of children of more than average intelligence (i.e. a higher proportion than there is in the school population), and a far greater number from primary schools than from secondary schools. Court cases. Of the secondary school children, a rather higher proportion than usual has come this year from the Juvenile Courts or Probation Officers. Day School for maladjusted Children. We have long thought that the work of the Clinic would be greatly helped, if some of the younger children could be sent for a time to a special Day School for Maladjusted Pupils. The County Council has approved the proposal and has found suitable premises for the school at No. 1 Aston Road. 68 Conclusion. We have undoubtedly been hampered in 1958 by changes and shortage of staff. 1958 was the second full year without an Educational Psychologist, Although there are few changes in the work that goes on in the Clinic from one year to another, and although the numbers dealt with there are small, we are convinced that there has been an advance and an expansion in the work that goes on outside the Clinic in the discussions with groups of mothers, with teachers, health visitors, Probation Officers and many other types of workers concerned with the welfare of children. Work of this type is not so easily measured or conveyed in figures, but has had a cumulative effect over the years, One example of the effect of the work of Child Guidance Clinics is the report of the Piatt Committee on the Welfare of Children in Hospital, While we cannot take any particular credit for the conclusions of this Committee, nevertheless it embodies the views that have been put forward by Child Guidance Clinics; views that would have been unheard of twenty years ago, but which are now officially accepted and advocated by the Ministry of Health, Although it will be many years before we have achieved all we hope for the well-being and happiness of children, there are many signs that our w <rk is^i^ying results, and that it has a greater value than we can convey in the report of our unsensational progress during any one year. Cases are referred to the Child Guidance Clinic to deal with the following problems:- Primary Behaviour Disorders Pears and anxieties Solitariness and unsociability Depression and lethargy Difficult to manage at home Difficult to manage at school Temper tantrums Direct aggression Sexual difficulties Psycho-somatic Disorders Enuresis Encopresis Sleep disorders Habit spasms Feeding difficulties Hysterical symptoms Speech disorders Asthma Eczema Constipation 69 Delinquent Behaviour Stealing Truancy and absconding Educational Difficulties Backwardness Retardation in school work Disorders with Organic Components Epilepsy Spasticity EMPLOYMENT OF CHILDREN AND YOUNG PERSONS, (1) Number of children medically examined .. ,. 335 (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 3 (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 5 Sub-Section 4 SubSection 5 Cases de notified under Section 8, Education (Miscellaneous Provisions) Act, 1948 MEDICAL EXAMINATION OF TEACHERS, Number of Teachers examined as to fitness for appointments 68 INFESTATION WITH VERMIN. No. Examined 54,635 No. Infested 70 70 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, Ealing and Acton forming Area No. 7. In Ealing the local administra tion 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 oppor tunity of attending ante-natal exercises and mothercraft classes. During the year 2.526 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 6a686 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. Islip Manor, Eastcote Lane, Northolt. Laurel House, Windmill Road, Ealing, W 5. 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. Pri. mornings. Mon. Wed. mornings. Thurs. mornings. Wed. Thurs. Pri. mornings. Wed. mornings. Mon. Thurs. mornings. See page 73 73 Child Welfare Clinics 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, Green ford Islip Manor, Eastcote Lane, Northolt. Northolt Grange Community Centre, Northolt, Laurel House, Windmill Road, Ealing, W, 5. Mattock Lane, 13 Mattock Lane, Ealing, W, 5, Perivale, Horsenden Lane, Greenford. Ravenor Park, Oldfield Lane, Greenford. Times Tues. Fri. 2-4 p.m. 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- Home confinements increased last year, numbering 740 compared with 622 in 1957. This has necessitated the appointment of two additional midwives to bring the staff to a total of 11. Anew rota has been introduced to provide more satisfactory off-duty and has been generally welcomed. All midwives are trained in the use of Trilene Analgesia machines for mothers in labour, and in the use of small oxygen cylinders should any baby have respiratory difficulty. The number of pupil midwives who received district training during the year was twenty. It was 21 years ago on May 1st of this year that the Domiciliary Midwifery Service was inaugurated in Ealing by the Borough Council. At a most pleasant gathering, attended by His Worship the Mayor, the first baby delivered, now 21 years old, was enabled to meet the midwife concerned. (Photograph page 72). Applications for the services of a midwife should be made through a Maternity and Child Welfare Clinic. HOME NURSING SERVICE, There are 28 home nurses in Ealing, including 3 male nurses, and during the year a total of 81,823 visits was made to 3,689 patients. The object of the service is to enable those patients whose illness does not require hospital admission to be nursed at home. The duties carried 74 out comprised general nursing, blanket bathing, giving of enemata and injections of antibiotics, etc, Hydraulic hoists are available for lifting of patients and ortho paedic walking aids are supplied. An increasing proportion of the work is concerned with old people. The services of a home nurse are available at the request of the patient's medical practitioner or hospital medical officer, Application 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 shopping, cooking, washing, cleaning, and looking after child ren are undertaken. There is an equivalent of 165 full -time 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. During the year a night service was inaugurated, Attendance is from 11 p.m. to 7 a,m, and the duties of the helper consist of sitting with and giving general care to the patient. This has proved most valuable, Applications for the services of either a day or night home help should be made, accompanied by a medical certificate, 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 Culmington 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 ai mother's illness, or on a doctor's recommendation for the' 75 sake of the child's health. Children under two years of age are only admitted if the mothers are the sole suppor terS; eg, divorced, separated or unmarried, or if the home conditions are unsatisfactory. The nurseries are open from 7,30 am, 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