Heston and Isleworth Urban District Council. 1918. ANNUAL REPORTS OF THE Medical Officer of Health AND School Medical Officer FOR THE URBAN DISTRICT OF HESTON AND ISLEWORTH For the Year ending 31st December, 1918. 1918 REPORT ON The Health OF THE HESTON and ISLEWORTH URBAN DISTRICT FOR THE YEAR 1918 BY w. bramwell reid, M.B.. d.p.h. Medical Officer of Health. 45 (M.O.H.) 25 (S.m.O.) Z 7-82. 7 the year, and to the fact that the time of the Health Visitors is increasingly being taken up in attendance at the various Inspection and Treatment Clinics. The percentage of children who are receiving mother's milk is about the same as last year, being 86 as compared with 85. The number of women employed during pregnancy has decreased, the percentage being 15 as compared with 18 last year. Maternity and Child Welfare Centres. The Baby Clinics are proving successful, but very few persons have, as yet, taken advantage of the Maternity consultations. The children's attendances at the centres were 1,657, as compared with 1,312 in the previous year. Infant Deaths. The total number of Infant deaths during 1918 was 63, giving an Infant Mortality rate of 86 per 1,000 births. This figure is lower than that of 1917, which was 117 per 1,000 births. It is also lower than the rate for England and Wales for the same period, 97, and London, 107. The Infant Mortality rate, as seen from the following table, varies from 40 in Isleworth South Ward, which is the lowest, to 118 in Isleworth North Ward, where the rate is highest :— HE8TON. Heston 59 Hounslow North 81 Isleworth. Hounslow South 106 Isleworth North 118 Isle worth South 40 INFECTIOUS DISEASE. Cases Removed to Hospital. During the year, 132 cases (other than Tuberculosis) were removed to hospital. Of these 132, 3 were treated in the Infirmary, 4 were treated in other hospitals, leaving 125 who were treated at Mogden Hospital. 8 Scarlet Fever. The following table shews the number of cases which have been notified, and the number and percentage of cases which have been removed to Hospital: — No. of civil cases notified 81 No. of civil cases removed to Hospital 78 Percentage of cases removed to Hospital 96.3 Four cases were also reported among the military population. The incidence rate of Scarlet Fever in the civil population was 2-1 per 1,000. One death took place from this cause during the year. Diphtheria. The following table shews the number of notifications received, and the percentage of cases of Diphtheria removed to Hospital:— No. of civil cases notified 55 No. of civil cases removed to Hospital 50 Percentage of cases removed to Hospital 90 9 In addition to these cases, five military cases were reported and were removed to Mogden Isolation Hospital. The incidence rate per 1,000 of the civil population was 14. Three cases occurred in public institutions during the year, the persons affected being non-residents. Five deaths took place from this cause, i.e. a case mortality rate of 9 per cent. Diphtheria Antitoxin. During 1918, 8 vials of Antitoxin were supplied to medical practitioners. Typhoid Feyer. Three cases were notified, one of which wa3 removed to Hospital, the other 2 being treated in the Infirmary, but no deaths were recorded from this cause. Erysipelas. Eight cases of this disease were notified, of whom 3 were institution cases, the persons affected being non-residents. Two deaths were recorded from this disease. 9 Puerperal Fever Four cases of this disease were notified, of which 3 were institution cases, the parsons affected being non-residents. Ophthalmia Neonatorum. In this district 11 children were notified as suffering from this disease, 4 of the cases occurring at the Infirmary. This is equal to a case rate of 14 0 per 1,000 births occurring in the district. Cerebro-Spinal Meningitis. One (Military) case of this disease was notified. Acute Polio Myelitis. No case of this disease was notified. Measles and German Measles. The first half of 1918 was characterised by an epidemic of Measles, principally located in Isleworth. The bulk of the civil cases were visited by the Health Visitors. The total numbers of notifications received were :— Civil. Military. Measles 330 4 German Measles 28 1 Pulmonary Tuberculosis. The number of cases notified during the year was 66. Fortysix cases (or 69%) were notified as receiving institutional treatment: Sanatoria 30, Infirmary, etc. 16. It will be observed that there has beeu a substantial increase in the number of deaths from this disease. Other Forms of Tuberculosis. The number of cases notified during the year was 17. Twelve of them were notified as receiving institutional treatment. COUNCIL LABORATORY. The following specimens were examined in the Laboratory during the year 1918 :—Diphtheria, 90 ; Tuberculosis, 134 ; Typhoid lever, 2; Ringworm, 11; Gonorrhoea, 3; Total, 240. 10 SANITARY ADMINISTRATION. The remarks which were made in last year's report with regard to the water supply, drainage and sewerage, closet accommodation and scavenging of the district, apply generally to the year under report. Sanitary Inspection of the District. Some particulars of the work done are set out in the Appendix to this report. Nuisances, Contraventions of Byelaws, Defective Drainage, etc. The number of unremedied nuisances* brought forward from 1917 was 322. The number of nuisances recorded during the year was 209, but during the year 137 nuisances were remedied, leaving 394 premises in which nuisances still existed at the end of the year. During the year, nuisances at 16 houses were reported to the Health Committee, which added to the 29 brought forward from 1917, make a total of 45. Statutory notices were authorised and served in most of these cases, and by the end of the year, the nuisances were remedied in 38 of the houses, leaving 7 cases to be carried forward in 1919. More properly, houses in which nuisances were found. Premises and Occupations controlled by Bye-laws or Regulations. There are about 350 premises in this district which call for periodical inspection such as the following :— Houses let in Lodgings, Common Lodging Houses, Bakehouses, Slaughter-houses, Cowsheds, Dairies and Milkshops, Offensive Trades, Laundries (non factory) and Workshops and Work Places. Owing to pressure of work, the Inspector of Nuisances has been unable to tabulate the number of inspections and other work in connection with these premises. 11 HOUSING. # Houses with Sanitary Defects. The following statement gives the information required by the Local Government Board relative to this class of property, dealt with during the year under the Housing (Inspection of District) Regulations, 1910 :— Houses. Brought forward from 1917 3 Disposed of during the year 3 Carried forward to 1919 nil Houses Unfit for Human Habitation. The following statement gives the information which the Local Government Board requires the Medical Officer of Health to furnish for the year ending 31st December, 1918, in relation to houses represented by him as unfit for human habitation :— Number of houses represented by Medical Officer of Health nil. ,, Closing Orders made by the Local Authority nil. „ appeals against Closing Orders nil. ,, notices served on occupying tenants nil. „ occupying tenants summoned nil. ,, Orders made by Court requiring occupying tenants to quit nil. ,, Closing Orders determined nil. ,, Demolition Orders made nil. „ appeals against Demolition Orders nil. „ Demolition Orders obeyed nil. ,, Demolition Orders enforced nil. „ demolitions carried out without Demolition Orders being made nil. The following table gives more detailed information in regard to the houses remaining on the records at the end of 1917 12 Table shewing dwelling houses represented as unfit for human habitation. Premises. No. of houses represented by M.O.H. Date Closing Orders made. Date Closing Orders determined. Date Demolition Orders made. Date Demolition Orders obeyed. Date Demolition enforced. Br't forvv'd from 1917- al-3, Poplar Cottages 3 24/2/14 22/12/14 10-16, Church Street 4 23/2/15 26/10/15* 15, South Street 1 27/4/15 23/11/15* 1-4, Baker's Cotts. 4 18/12/15 St.Alban's Farm and cottage adjoining, Staines Road 2 25/7/16 23/10/17* 24, 26, 28, 30, Lampton Road 4 27/3/17 18 18 10 a—Notices served on tenants of Nos. 1 and 3, 18/10/17. Still occupied. *—Demolition deferred until after the War. New Houses. I am informed by the Surveyor that no houses suitable for the working classes were erected during the year. FOOD. Milk Supply. No material change has been observed during the past year in the conditions under which cow-keeping and milk-vending are carried on in the district. Other Food. The quantity of unsound food found during the year was as follows:— Fruit and vegetables 1 parcel. Meat (including Bacon) 14 cwt. 18£ lbs. Fish 3 parcels. Cheese, etc. 2 qrs. 13 13 cwt. of the condemned meat and bacon were disposed of for use as pig food, fat melting, etc. FACTORY AND WORKSHOP ACT, 1901. It has been found impracticable to tabulate the inspections made and other work done during the year in connection with premises under this Act. SHOPS ACTS. The number of contraventions of the Acts which were reported during the year was as follows:— Open on half-holidays — Notices not exhibited 2 Notices not exhibited in a conspicuous position 1 Notices not in prescribed form — Notices (assistants) not exhibited — 3 PROCEEDINGS. Proceedings were taken during the year in respect of:— (a) nuisances at 12 houses, (b) the exposure of unsound cheese for sale, (c) the non-registration of a cow-keeper. ROADS. The condition of many of the roads in the district has given cause for anxiety due to accumulation of stagnant liquids and detritus. The gradual substitution of all water-bound road surfaces by surfaces of an impervious character is a necessity from an hygienic standpoint. REMOVAL OF REFUSE. The irregularity in the removal of household refuse due to the War, demands immediate consideration with a view to re-establishing at the earliest possible moment the weekly collection of all refuse, in any case before the advent of the hot weather. 14 APPENDIX. Certain tables have been omitted either at the suggestion of the Local Government Board or because the necessary data could not be collected. Table III. Causes of Death during 1918. Causes of Death. Civil Residents all ages.* Non-residents.* (Certified 689 682 All causes lUncertified ... ... 1 Enteric Fever ... ... 2 Smallpo) c ... ... 3 Measles . 8 2 4 Scarlet Fever 1 ... 5 Whoopir ig-cough 5 ... 6 Diphthe: ria and Croup 5 ... 7 Influenz a 114 127 8 Erysipel as 2 ... 9 Phthisis (Pulmonary Tuberculosis) 64 62 10 Tubercu lous Meningitis 5 3 11 Other T uberculous diseases 9 10 12 Cancer, malignant disease 64 54 13 Rheuma tic Fever 2 3 14 Meningi tis 2 7 15 Organic Heart Disease 62 35 16 Bronchii tis 44 35 17 Pneumo riia (all forms) 62 32 18 Other Di iseases, Respiratory Organs 10 3 19 Diarrhoe ia and Enteritis 11 16 20 Appendi citis and Typhlitis — — 21 Cirrhosii 3 of Liver 2 2 21a Alcohol ism ... 2 22 Nephriti is and Brights Disease 13 15 23 Puerper; al Fever ... 2 24 Other a Preg tccidents and diseases of nancy and Parturition 2 2 25 Congeni inclu tal Debility & Malformation iding Premature Birth 27 10 26 Violent Deaths, excluding suicide 18 24 27 Suicide 1 2 28 Other d efined diseases 156 234 29 Disease! 3 ill-defined or unknown ... ... 689 682 * According to figures furnished by the Registrar General, flncluding soldiers who died in the district. Table IV. Infantile Mortality during the year 1918. Nett Deaths from stated Causes at various Ages under i Year of Age Cause of Death. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks. 4 weeks and under 8 mts. 3 mts. and under 6 mts. 6 mts. and under 9 mts. 9 mts. and under 12 mts. Total Deaths under 1 year. All causes Certified Uncertified Smallpox Chickenpox Measles Scarlet Fever... Whooping Cough ... ... ... ... ... ... 1 ... ... 1 Diphtheria and Croup ... Erysipelas Tuberculous Meningitis Abdominal Tuberculosis Other Tuberculous Diseases Meningitis (not Tuberculous) .. Convulsions 2 ... ... ... 2 ... ... ... ... 2 Laryngitis Bronchitis ... ... ... ... ... ... 3 ... 1 4 Pneumonia (all forms)... ... ... ... ... ... 1 1 1 5 8 Diarrhoea Euteritis ... ... ... ... ... 3 2 1 1 7 Gastritis ... ... ... ... ... 1 ... ... ... 1 Syphilis ... ... ... ... ... 1 ... ... ... 1 Rickets Suffocation, overlying ... Injury at Birth 2 ... 1 ... 3 ... ... ... ... 3 Atelectasis 2 ... ... ... 2 1 ... ... ... 3 Congenital Malformations ... ... ... ... ... 2 ... ... ... 2 Premature Birth 12 2 1 ... 15 3 ... ... ... 18 Atrophy, Debility and Marasmus 1 1 ... ... 2 3 2 ... ... 7 Other Causes ... 1 1 ... ... 2 ... 1 2 1 6 20 4 2 ... 26 15 10 4 8 63 Legitimate 687 Legitimate infants 53 Nett Births Nett Deaths Illegitimate 46 Illegitimate infants 10 16 HESTON & ISLEWORTH URBAN DISTRICT COUNCIL. Health Department, Council House, Hounslow. 22nd May, 1919. Canal Boats Acts, 1877 and 1884. Sir, In accordance with Section 3 of the Canal Boats Acts, 1884, I beg herewith to present the Annual Report for the year ending 31«i December, 1918, as to the execution of the Canal Boats Acts, 1877 and 1884, and of the Regulations made thereunder, within the Urban District of Heston and Isleivortli, Middlesex. During the absence of Mr. W. E. Balchin on military duty,. Mr. R. H. Butler (Inspector of Nuisances) has continued to act as Canal Boat Inspector, but oiving to the reduction of the Inspectorial Staff due to enlistment and removal, it has not been possible to make any inspections. I am, Sir, Your obedtent servant, Allan Haib, Deputy Medical Officer of Health. (for the late Medical Officer of Health). The Secretary, Local Government Board. 17 Table X. Sanitary Work. Inspections :— It has been impracticable to tabulate the number of inspections made. Action Taken (other than under Housing, Town Planning, &c., Act, 1909:— Preliminary or Intimation Notices given 158 Second notices sent 18 Statutory notices issued 17 Proceedings taken 14 Dwelling Houses and action under Housing, Town Planning, &c., Act, 1909:—See pages 11-12. Unsound Food :— (a) Animals seized — (b) Articles or parcels seized 2 Animals condemned by Magistrate Articles or parcels condemned by Magistrate 2 Articles or parcels surrendered 21 Carcase surrendered 1 Organs or parts surrendered during slaughtering — Water Supply and Water Service: — Supply provided 7 Cisterns cleansed, repaired, covered, etc. 4 Draw-taps placed on mains 2 Water service pipes or taps repaired 1 18 Drainage and Sewerage of existing Buildings: Water closets— Eepaired,supplied with water or otherwise improved 50 Drains— Unstopped 23 Waste pipes (2), rain-water pipes (5), provided, disconnected, repaired, etc. 7 Gullies inserted or improved 10 Fresh air inlets provided or repaired 1 Soil pipes or ventilating shafts fixed or repaired 2 Disconnecting traps or chambers inserted or repaired 2 Dust: New ash bins provided 17 Sundry Nuisances abated: Overcrowding 2 Accumulation of refuse 5 Dampness 8 Roofs repaired 23 Guttering provided, repaired or unstopped 13 Rooms stripped and cleansed (after infectious disease) 75 Other rooms stripped and cleansed 28 Other Internal repairs 62 Yards paved, repaired or drained 6 Other nuisances 13 ... 8 Table I.—NUMBER OF CHILDREN INSPECTED IN 1917. Code Groups. Entrants. Intermediates. Leavers. Grand Total. Year of Birth... 1911 previous years' absentees Total. 1908 previous yearsabsentees Total. 1905 previous yearsabsentees Total. Half-Year 1st 2nd 1st 2nd lst 2nd Boys 149 101 41 291 211 172 56 439 153 159 33 345 1075 Girls 136 86 26 248 171 163 21 355 171 166 21 358 961 Totals 472 67 539 717 77 794 649 54 703 2036 Medical Treatment Special Casea. Re-Examinations. No. examined 1246* 826 *These 1246 special cases involved 3201 examinations, 7 Minor Ailments. Owing to difficulties in connection with the fitting up of the centres, it was not possible to open them until the 6th and 7th December. One centre is situated at the Alexandra School Clinic and the other at the Isleworth Public Hall, and a session is held at each centre once a week. Five sessions were held during December, and 9 individual children were treated, making 12 attendances between them. The diseases treated were :—Impetigo, 6 ; Scabies, Acne and Corneal Ulcer, 1 each. An inclusive charge of 6d. per attendance is made to cover the cost of dressings, ointment, lotions, etc. DEFECTIVE CHILDREN. During the year, further progress has been made in the classification of Mentally Abnormal children, detailed examinations of 9 children having been made, 3 of them being definitely defective, while 4 other children were classified at routine medical inspection as dull or backward. The numbers of other defective children have not materially changed since the detailed statement made in the annual report for 1914. I am, Ladies, and Gentlemen, Your obedient servant, W. BRAMELL REID, School Medical Officer. 6 MEDICAL TREATMENT. Re-examinations. Although the number of re-examinations made has again been increased, it is quite impracticable to keep pace with the new cases. The figures in Table IV. as to the cases untreated and treated (remedied, improved, etc.) relate therefore only to a minority of the cases on the records, and may be quite fallacious as an index to the amount of treatment actually sought. As in last year's report, a number of the slighter defects have been noted as " improved " and written off, although 110 specific information has been obtained as to their having had treatment. It may be doubted whether the labour spent on re-examination work produces or can produce any commensurate results in the absence of some power to enforce treatment for proved defects, at any rate where facilities are provided by the local authority for the treatment of such defects. Although, probably for the reasons indicated above, the figures show a slight improvement in the amount of treatment sought in dental and in throat, nose and ear cases, there is evidence of a considerable deficiency especially as regards the former. I must theiefore endorse the opinion expressed by my predecessor in his report for 1914, that there is great need of a dental clinic in the district. TREATMENT AT SCHOOL CLINICS. Defective Vision. 12 sessions have been held at the Alexandra School Clinic by Dr. A. E. Looseley, the Ophthalmologist. Glasses were prescribed in 80 cases (59 cases discovered at routine inspection, and 21 specially referred), and in five other cases glasses were found not to be required, or to be useless on account of other defects. Ringworm. Seven sessions have been held at the Alexandra School Clinic by Dr. D. Arthur, the Radiographer. Fourteen cases of Ringworm of the Scalp have been treated. The cure of the chronic cases has practically stamped out this disease, and the occurrence of fresh cases is now very rare. 5 SPECIAL CASES. The figures in Table III. give in greater detail information relating to children specially referred or coming under notice for the various conditions set out in the table. Two half-days in each week are devoted to an Inspection Clinic, where cases are referred by the School Attendance Committees, School Attendance Officers and Teachers, also children found on routine medical inspection to be in need of further examination. One clinic is held at the Health Department, the other at the Isleworth Public Hall. It will be seen that skin diseases still constitute the largest group of cases, but the incidence of Ringworm of the Scalp has been practically eliminated by the treatment of cases at the School Clinic, and it is hoped that the newly established Minor Ailments Clinics may reduce the number of examinations necessary and attendances lost in the case of Impetigo and similar diseases. The children referred to me for nitty and verminous conditions gave rise to the following action:—warning notices, 11; legal notices, 57 ; prosecutions, 3 ; resulting in fines of 5/-, 7/6 and 10/respectively. These cases aro in addition to those referred to on page 4, arising out of routine medical inspection. It will be observed that there is a distinct improvement in the number of cases of nitty and verminous conditions dealt with in 1917, as compared with recent years. In the absence of any more obvious explanation, it is not unreasonable to attribute part, at any rate, of this improvement to the prompt and systematic action taken in 1916 to enforce the Committee's resolution with regard to absence from school in these cases, the number of cases taken to court and the fines imposed by the magistrates no doubt having had a salutary effect. Those children who are excluded are re-examined at frequent intervals, and are closely followed up in order to encourage the parents to have the condition remedied, and permit the child returning to school. The number of days attendances lost by children thus excluded has declined from 35,438 in 1915 to 19,815 in 1916, and 17,432 in the year under report. 4 There is a distinct improvement with regard to Cleanliness of Head as compared with 1916, 86 9 per cent, being clean as compared with 815 per cent, in that year. Warning notices were sent in 104 cases, and in 17 cases the children were excluded from school until the head was free from nits. The remarks in the cases of clothing and footgear apply to Cleanliness of the Body which shows a definite decline since 1914. Another slight improvement in Nutrition has been recorded, 89 8 per cent, being classed as normal, 9-2 per cent, as below normal, and 10 per cent, as bad, as compared with 84 4, 12 8 and 2.7 per cent, respectively, in 1914. The observations in respect of Dental Conditions are somewhat worse than last year's, 27 7 per cent, being sound, 48.1 per cent, having less than four decayed teeth, and 24.0 having four or more decayed teeth. In 1914 these percentages were 29.4, 488 and 21.8 respectively. Little change can be noted as regards the number of Nose and Throat Defects and cases of external Eye Diseases. The improvement in the number of cases of Defective Vision still continues, 211 per cent, of the children tested this year being found to have defective vision : 114 per cent, less than 6/6, but not less than 6/9 in one or both eyes, 9.7 per cent, less than 6/9 in one or both eyes. In 1914 32.0 per cent, of the children tested were found to have defective vision. In accordance with the request of the Chief Medical Officer of the Board of Education, the defects found in the course of routine medical inspection have been summarised in Table II. at the end of the report. The number of individual children notified to the parents as needing treatment was 485, or nearly 24 per cent. INFECTIOUS DISEASE. The following cases of infectious illness have been notified by School Attendance Officers during the year ending 29th December, 1917 :— German Measles. Mumps. Chicken Pox. Measles. Whooping Cough. Total. 23 ... 239 ... 89 .. . 391 . 106.. 848 msa-as 3 Health Department, Council House, Hounslow. 31s£ March, 1918. To the Chairman and Members of the Heston and Isleworth Urban District Education Committee. GENERAL SUMMARY. 121 visits were made to school departments for the purpose of Routine Medical Inspection. In addition, numerous other visits were made regarding Medical Treatment Cases, Special Cases, Infectious Diseases, etc. From the tables at the end of the report, it will be seen that this year the total number of children examined was 4108, as against 3531 last year. These 3793 children were examined 6063 times, as against 4708 examinations during 1916. ROUTINE MEDICAL INSPECTION. The selection of children due for this inspection during 1917 included those born during the years 1911, 1908 and 1905, and those absent at last Medical Inspection. The Board of Education has prescribed the extent of the medical examination of scholars attending public elementary schools, and the examination of scholars in this district has been conducted on the lines laid down by the Board. 1008 parents, or 49'5 per cent., attended the inspection. Objections to the examination of their children were received from parents in 16 instances. Both figures compare unfavourably with those for last year. Unsatisfactory conditions were found in respect of Footgear in 16.9 per cent, of the children inspected. This percentage has steadily increased since 1914, when it was 8'2. A similar but less marked deterioration may be noted in the case of Clothing, where the percentage of unsatisfactory conditions is 13 7 as compared with 9 3 in 1914. Some part of the explanation for these worsened conditions is no doubt the continued rise in the price of clothing and footgear. MEMBERS OF EDUCATION COMMITTEE, 1917-18. H. J. NIAS, Esq. (Chairman). S. SMITH, Esq. (Vice-Chairman). Membert of the Council :— Cftpt. F. T. CHAPMAN, Esq., j.p. (e.z-officie, Chairman of the Council). F. NOWELL, Esq. (ex-officio, Vice-Chairman of the Council). S. SMITH, Esq. (Vice-Chairman of the Education Committee). C. ARNOLD, Esq. . E. W. HEATH, Esq. A. A. BERGIN, Esq., j..p. F. W. LANGSTONE, Esq. J. J. BONNETT, Esq. W. G. LOBJOIT, Esq., j.p.,c.c. A. E. HALES, Esq. J. WEATHERS, Esq. W. W. WOODS, Esq. Selected Membert:— Mrs. W. H. DUMSDAY. E. W. GOODE, Esq. Mrs. C. F. EVA. P. MURPHY, Esq. H. J. NIAS, Ebq. (Chairman). School Medical Officer: W. BRAMWELL REID, m.b.,d.p.h. HESTON and ISLEWORTH URBAN DISTRICT EDUCATION COMMITTEE. tenth Annual Report OF THE School Medical Officer FOR THE Year ending 31st December, 1917. 45 (s.m.o.) 25 (m.o.h.) Z40-4. 20 Drainage and Sewerage of existing Buildings: Water closets— Repaired,supplied with water or otherwise improved 116 Draius— Unstopped 21 Waste pipes (11), rain-water pipes (20), provided disconnected, repaired, &c. 31 Gullies inserted or improved 23 Fresh air inlets provided or repaired 3 Soil pipes or ventilating shafts fixed or repaired 4 Disconnecting traps or chambers inserted or repaired 6 Constructed or reconstructed 15 Dust: New bins provided 44 Sundry Nuisances abated: Bakehouses cleansed or repaired 6 Cowsheds, contraventions abated 3 Milkshops, contraventions abated 3 Overcrowding 6 Accumulation of refuse 6 Dampness 23 Roofs repaired 24 Guttering provided, repaired or unstopped 17 Rooms stripped and cleansed (after infectious disease) 120 Other rooms stripped and cleansed 44 Other Internal repairs 33 Yards paved, repaired or drained 14 Other nuisances 11 19 Table X. Sanitary Work. Inspections:— It has been impracticable to tabulate the number of inspections made. Action Taken (other than under Housing, Town Planning, &c., Act, 1909:— Preliminary or Intimation Notices given 251 Second notices sent 44 Statutory notices issued 104 Proceedings taken 4 Dwelling Houses and action under Housing, Town Planning, &c., Act, 1909:—Seepages 12-13. Unsound Food: (a) Animals seized — (b) Articles or parcels seized 1 Animals condemned by Magistrate — Articles or parcels condemned by Magistrate — Articles or parcels surrendered 8 Organs or parts surrendered during slaughtering — Water Supply and Water Service : Supply provided 20 Cisterns cleansed, repaired, covered, etc 4 Draw-taps placed on mains 22 Water service pipes or taps repaired 4 18 HESTON & ISLEWORTH URBAN DISTRICT COUNCIL. Health Department, Council House, Hounslow. 1st March, 1918. Canal Boats Acts, 1877 and 1884. Sir, In accordance with Section 3 of the Canal Boats Act, 1884, I beg herewith to present the Annual Report for the year ending 31st December, 1917, as to the execution of the Canal Boats Acts, 1877 and 1884, and of the Regulations made thereunder, within the Urban district of Heston and Isleworth, Middlesex. During the absence of Mr. W. E. Balchin on military duty Mr. R. H. Rutler, Inspector of Nuisances, has continued to act as Canal Boat Inspector. Oiving to the reduction of the Inspectorial Staff due to enlistment anil removal, it has only been possible to make a few inspections. Two boats were inspected. Oil 1 of these boats 2 infringements of the Acts and Regulations were found, as follows :— Painting 1 Habitable condition 1 Both defects were carried forward to 1918. I am, Sir, Your obedient servant, William Bramwell Reid, Medical Officer of Health The Secretary, Local Government Board. Table IV. Infantile Mortality during the year 1917. Nett Deaths from stated Causes at various Ages under 1 Year of Age All causes Cause of Death. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks. 4 wrek and under 3 mts. 3 mts. and under 6 mts. 6 mts. and under 9 mts. 9 mts. and under mts Total Deaths under 1 year. Certified ... ... ... ... ... ... ... ... ... 85 1 Uncertified ... ... ... ... ... 1 ... ... ... 1 Smallpox Chickenpox Measles ... ... ... ... ... ... ... ... 2 2 Scarlet Fever Whooping Cough ... ... ... ... ... ... ... ... 2 2 Diphtheria and Croup Erysipelas Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 1 Abdominal Tuberculosis ... ... ... ... ... ... 1 ... ... 1 Other Tuberculous Diseases Meningitis (not Tuberculous) ... ... ... ... ... ... 1 1 ... 2 Convulsions 2 ... ... ... 2 ... 1 ... 1 4 Laryngitis Bronchitis ... ... 1 ... 1 1 1 1 4 Pneumonia (all forms) ... ... 1 ... 1 2 3 ... 5 11 Diarrhoea ... ... ... ... ... ... ... ... 1 1 Enteritis ... ... ... 1 1 7 5 3 1 17 Gastritis ... ... ... 1 1 ... 2 ... ... 3 Syphilis Rickets Suffocation, overlying Injury at Birth Atelectasis Congenital Malformations 3 1 ... ... 4 1 1 2 ... 8 Premature Birth 19 ... ... ... 19 1 ... ... ... 20 Atrophy, Debility and Marasmus 3 ... 1 ... 4 1 1 ... ... 6 Other Causes 1 ... ... ... 1 1 1 ... 1 4 28 1 3 2 34 14 17 6 15 86 Legitimate 689 Legitimate infants 17 Nett Births. Nett Deaths 1 Illegitimate 41 Illegitimate infants 14 9 births. It is also distinctly higher than the rate for England and Wales for the same period (97), and London (103). The Infant Mortality rate, as seen from the following table, varies from 76 in Isleworth South Ward, which is the lowest, to 175 in Isleworth North Ward, where the rate is highest:— Heston. Isleworth. Heston 84 Hounslow South 125 Hounslow North 128 Isleworth North 175 Isleworth South 76 It will be noted from Table IV. in the appendix that the principal increase of mortality is due to and Premature Birth. INFECTIOUS DISEASE. Cases removed to Hospital. During the year, 115 of the 1422 cases notified (other than Tuberculosis) were removed to hospital. Of these 115, 25 were treated in the Infirmary, 5 were treated in military hospitals, 5 were treated in other hospitals, leaving 80 who were treated at Mogden Hospital. Scarlet Fever. The following table shews the number of cases which have been notified, and the number and percentage of cases which have been removed to Hospital:— No. of civil cases notified 48 No. of civil cases removed to Hospital 32 Percentage of cases removed to Hospital 66.6 Six cases were also reported among the military population. The incidence rate of Scarlet Fever in the civil population was 1.2 per 1,000. No deaths took place from this cause during the year. Diphtheria. The following table shews the number of notifications received, and the percentage of cases of Diphtheria removed to Hospital:— 10 No. of civil cases notified 44 No. of civil cases removed to Hospital 38 Percentage of cases removed to Hospital 86 3 In addition to these cases, five military cases were reported to me and were removed to Mogden Isolation Hospital. The incidence rate per 1,000 of the civil population was 11. Four cases occurred in public institutions during the year, three of the persons affected being non-residents. Three deaths took place from this cause, i.e., a case mortality rate of 6.8 per cent. Antitoxin. During 1917, 13 vials of Antitoxin were supplied to medical practitioners. Typhoid Fever. Three cases were notified, one of which was removed to Hospital, but no deaths were recorded from this cause. Erysipelas. Twenty-eight cases of this disease were notified, of whom 13 were institution cases, 12 of the persons affected being non-residents, while one case occurred among the military. One death (nonresident) was recorded from this disease. Puerperal Fever. Seven cases of this disease were notified, of which 6 were institution cases, the persons affected being non-residents. One case proved fatal. Ophthalmia Neonatorum. In this district 11 children were notified as suffering from this disease, 4 of the cases occurring at the Infirmary. This is equal to a case rate of 141 per 1,000 births occurring in the district. Cerebro-Spinal Meningitis. Six cases of this disease were notified, 4 of them being military cases. Two (civil) cases were removed to Mogden Hospital. Acute Polio Myelitis. One case of this disease was notified. 11 Measles and German Measles. The latter part of 1917 was characterised by an epidemic of Measles, principally located in Hounslow South. The bulk of the civil cases were visited by the Health Visitors. The total numbers of notifications received were :— civil cases were visited by the Health Visitors. The total numbers of notifications received were:— Civil. Military. Measles 847 7 German Measles 312 96 Pulmonary Tuberculosis. The number of cases notified during the year was 62. Fortyfive cases (or 72%) were notified as receiving institutional treatment Sanatoria, 23, Infirmary, etc., 22. It will be observed that there has been a substantial increase in the number of deaths from this disease. in the number of deaths from this disease. Both notifications and deaths are particularly heavy in the Hounslow South and Isleworth North Wards, as may be seen from the following figures :— Residents only. H. H.N. H.S. I.N. I.S. New cases notified 9 9 19 15 5 Deaths 6 7 20 15 5 Other Forms of Tuberculosis. The number of cases notified during the year was 26. Seventeen of them were notified as receiving institutional treatment. COUNCIL LABORATORY. The following specimens were examined in the Laboratory during the year 1917 :—Diphtheria, 96 ; Tuberculosis, 212 ; Typhoid Fever, 1 ; Ringworm, 13 ; Gonorrhoea, 1 ; Pneumonia, 1 ; Total, 324. SANITARY ADMINISTRATION. The remarks which were made in last year's report with regard to the water supply, drainage and sewerage, closet accommodation and scavenging of the district, apply generally to the year under report. 12 Sanitary Inspection of the District. Some particulars of the work done are set out in the Appendix to this report. Nuisances, Contraventions of Byelaws, Defective Drainage, etc. The number of unremedied nuisances* brought forward from 1916 was 290. The number of nuisances recorded during the year was 287, but during the year 255 nuisances were remedied, leaving 322 premises in which nuisances still existed at the end of the year. During the year, nuisances at 49 houses were reported to the Health Committee, which added to the 30 brought forward from 1916, make a total of 79. Statutory notices were authorised and served in most of these cases, and by the end of the year, the nuisances were remedied in 50 of the houses, leaving 29 cases to be carried forward to 1918. •More properly, homes in which nuisances were found. Premises and Occupations controlled by Bye-laws or Regulations. There are about 350 premises in this district which call for periodical inspection such as the following: — Houses let in Lodgings, Common Lodging Houses, Bakehouses, Slaughter-houses, Cowsheds, Dairies and Milkshops, Offensive Trades, Laundries (non factory) and Workshops and Work Places. Owing to pressure of work, the Inspector of Nuisances has been unable to tabulate the number of inspections and other work in connection with these premises. HOUSING. Houses with Sanitary Defects. The following statement gives the information required by the Local Government Board relative to this class of property, dealt with during the year under the Housing (Inspection of District) Regulations, 1910 :— 13 Houses. Brought forward from 1916 7 Disposed of during the year 4 Carried forward to 1918 3 Houses Unfit for Human Habitation. The following statement gives the information which the Local Government Board requires the Medical Officer of Health to furnish for the year ending 31st December, 1917, in relation to houses represented by him as unfit for human habitation:— Number of houses represented by Medical Officer of Health 4 ,, Closing Orders made by the Local Authority 4 ,, appeals against Closing Orders nil. ,, notices served on occupying tenants 9 ,, occupying tenants summoned nil. ,, Orders made by Court requiring occupying tenants to quit nil. ,, Closing Orders determined nil. ,, Demolition Orders made 2 „ appeals against Demolition Orders nil. „ Demolition Orders obeyed nil. ,, Demolition Orders enforced nil. ,, demolitions carried out without Demolition Orders being made nil. The following table gives more detailed information in regard to the houses represented as unfit during the year 1917, and the action taken in those remaining on the records at the end of 1916 :— 14 Table shewing dwelling houses represented as unfit for human habitation. Premises. No. of houses represented by M.O.H. Date Closing Orders made. Date Closing Orders determined. Date Demolition Orders made. Date Demolition Orders obeyed. Date Demolition enforced. Br't forw'd from 1916— al-3, Poplar Cottages 3 24/2/14 22/12/14 10-16, Church Street 4 23/2/15 26/10/15* 15, South Street 1 27/4/15 23/11/15* 1-4, Baker's Cotts. 4 18/12/15 St.Alban's Farm and cottage adjoining, Staines Road 2 25/7/16 23/10/17 1917— 24, 26, 28, 30, Lampton Road 4 27/3/17 18 18 10 a—Notices served on tenants of Nos. 1 and 3, 18/10/17. Still occupied. *—Demolition deferred until after the War. New Houses. I am informed by the Surveyor that no houses suitable for the working classes were erected during the year. FOOD. Milk Supply. No material change has been observed during the past year in the conditions under which cow-keeping and milk-vending are carried on in the district. Other Food. The quantity of unsound food found during the year was as follows:— 15 Fruit and vegetables V parcels. Meat 150 rabbits. Fish. 1 box kippers. FACTORY AND WORKSHOP ACT, 1901. It has been found impracticable to tabulate the inspections made and other work done during the year in connection with premises under this Act. SHOPS ACTS. The number of contraventions of the Acts which were reported during the year was as follows:— Open on half-holidays — Notices not exhibited 2 Notices not exhibited in a conspicuous position — Notices not in prescribed form — Notices (assistants) not exhibited — 2 No legal proceedings were taken. 16 APPENDIX. Certain tables have been omitted either at the suggestion of the Local Government Board or because the necessary data could not be collected. Table III. Causes of Death during 1917. Causes of Death. Civil Residents all ages.* Non-residents.† All causes Certified 598 527 Uncertified ... ... 1 Enteric Fever ... ... 2 Smallpox ... ... 3 Measles 10 3 4 Scarlet Fever ... ... 5 Whooping-cough. 10 2 6 Diphtheria and Croup 3 ... 7 Influenza 6 2 8 Erysipelas ... 1 9 Phthisis (Pulmonary Tuberculosis) 53 67 10 Tuberculous Meningitis 11 3 11 Other Tuberculous diseases 8 6 12 Cancer, malignant disease 54 59 13 Rheumatic Fever 3 ... 14 Meningitis 7 3 15 Organic Heart Disease 61 45 16 Bronchitis 43 22 17 Pneumonia (all forms) 52 27 18 Other Diseases, Respiratory Organs 9 5 19 Diarrhoea and Enteritis 19 6 20 Appendicitis and Typhlitis 3 1 21 Cirrhosis of Liver 4 2 21a. Alcoholism ... 22 Nephritis and Blights Disease 12 16 23 Puerperal Fever 1 ... 24 Other accidents and diseases of Pregnancy and Parturition 2 1 25 Congenital Debility & Malformation including Premature Birth 34 12 26 Violent Deaths, excluding suicide 18 15 27 Suicide 1 28 Other defined diseases 174 229 29 Diseases ill-defined or unknown ... ... 598 527 *According to figures furnished by the Registrar General. ^Including soldiers who died in the district. THE HEALTH COMMITTEE of THE HESTON AND ISLEWORTH URBAN DISTRICT COUNCIL For the Year ending April, 1919. W. Mann, Esq. (Chairman). C. Arnold, Esq. (Vice- Chairman). F. Nowkll, Esq. J.P. (Chairman of the Council). C. Crush, Esq. (Fice- Chairman of the Council). J. J. Bonnett, Esq. A. E. Hales, Esq. F. W. Langstone, Esq. W. G. Lobjoit, Esq. j.p., c.a. P. F. C. Meyers, Esq. H. R. Peake, Esq. W. W. Woods, Esq. Medical Officer of Health: W. BrAMWELL Reid, m.b., d.p.h. Health Department, Council House, Hounslow. 24th May, 1919. To the Chairman and Members of the Heston and Isleivorth Urban District Council. Gentlemen, The accompanying report was prepared and in the hands of the late Dr. W. B. Reid, during his illness but he was unfortunately unable to complete it with his signature. I have therefore formally to present it to the Council as your Deputy Medical Officer of Health. I desire only to take advantage of the occasion to express the deep sense of loss felt by myself and the staff at the passing away of the late Medical Officer of Health, after a prolonged period of suffering heroically borne. I am, Gentlemen, Your obedient servant, ALLAN HAIR, m.r.c.s., d.p h., Deputy Medical Officer of Health. 5 SUMMARY OF VITAL STATISTICS, 1918. Population— Registrar-General's estimate of nett 43,129 (Birth rate) civil population 38,492 (Death rate) Birth rate (nett) 16 8 England and Wales 17.7 London 16.1 Death rate (nett) 17 9 England and Wales 17 6 London 18.9 Infantile Mortality Rate 86 per 1,000 births England and Wales 97 „ ,, London 107 „ „ YITAL STATISTICS. Population. The primary difficulty in presenting the vital statistics for the year under report is that of estimating the population of the district with any degree of accuracy. The data obtained under the National Registration Act are not available to this department, nor, of course, is the number of men still on active service known. It has only been possible, therefore, to estimate in very round figures that the nett civil residents, (i.e. excluding enlistments, etc.), at the middle of the year were 40,000. The RegistrarGeneral has furnished an estimate of the civil population as 38,492, but it is not quite clear whether this figure, like the similar figure for 1915, does not exclude residents in local institutions. Deaths. The number of deaths registered in the district was 1,302, but 682 of these did not belong to the district, while 69 residents died without the district. Thus the number of deaths properly attributable to the district was 689. Adopting the basis of the population estimated by the Registrar-General, the death-rate for the district comes to 17'9 per 1,000, which is comparable with the following figures:—17.6 for England and 18 9 for London. 6 Births. The total number of births registered during the year was 777, but 75 of these did not belong to this district, while 25 births properly belonging to this district occurred outside the district. The nett number of births thus attributable to the district is 727. Adopting the population basis suggested by the Registrar-General for the calculation of the birth-rate, this comes to 16-8 per 1,000. The birth-rate of England and Wales is 17 7 per 1,000. Legitimacy. The following figures give the number of illegitimate births :— Legitimate. Male. Female. Total. 348 339 687 Illegitimate. Male. Female. Total. 21 19 40 Notification of Births Act, 1907. The following figures give some idea of the work done under the Notification of Births Act, 1907, during the year 1918. The number of births notified duriDg the year was 729 or 93 8% of the births registered, as compared with 95 7 in 1917, and 91-6% in 1916. Births visited 501 Feeding—Natural 381 Artificial 45 Both 16 No information 59 Still births 18 Sleeping with parents 306 Using comforter 169 Mother working during pregnancy 77 Births re-visited 3162 Fewer re-visits were paid, as compared with last year, which is attributable to the changes in the Health Visiting Staff during HESTON and ISLEWORTH URBAN DISTRICT EDUCATION COMMITTEE. eleventh ANNUAL REPORT OF THE School Medical Officer FOR THE Year ending 31st December, 1918. 45 (s.m.o.) 25 (m.o.h.) Z 40*4* MEMBERS OF EDUCATION COMMITTEE, 1918-19. H. J. NIAS, Esq. (Chairman). S. SMITH, Esq. (Vice-Chairman). Members of the Council:— F. NOWELL, Esq., j.p. (ex-officio, Chairman of the Council). C. CRUSH, Esq. (ex-officio, Vice-Chairman of the Council). S. SMITH, Esq. (Vice-Chairman of the Education Committee). C. ARNOLD, Esq. J. J. BONNETT, Esq. A. E. HALES, Esq. E. W. HEATH, Esq. F. W. LANGSTONE, Eiq. W. G. LOBJOIT, Eso., J.r., c.c. H. R. PEAKE, Esq. J. WEATHERS, Esq. W. W. WOODS, Esq. Selected Members— Mrs. W. H. DUMSDAY. Mrs. C. F. EVA. e. W- GOODE, Esq. P. MURPHY, Esq. H. J. NIAS, Esq. (Chairman). Late School Medical Officer: W. BRAMWELL REID, m.b., d.p.h. Health Department, Council House, Hounslow. The accompanying report was prepared and in the hands of the late Dr. W. B. Reid during his illness, but he was unfortunately unable to complete it with his signature. J. Henry Lloyd, Chief Clerk. 24th May, 1919. 3 GENERAL SUMMARY. 117 visits were made to school departments for the purpose of Routine Medical Inspection. In addition, numerous other visits were made regarding Medical Treatment Cases, Special Cases, Infectious Diseases, etc. From the tables at the end of the report, it will be seen that this year the total number of children examined was 3,655, as against 4,108 last year. These 3,655 children were examined 5,160 times, as against 6,063 examinations during 1917. ROUTINE MEDICAL INSPECTION. The selection of children due for this inspection during 1918 included those born during the years 1912, 1909 and 1906, and those absent at last Medical Inspection. 915 parents, or 47 per cent., attended the inspection. Objections to the examination of their children were received from parents in 7 instances. There is a general improvement in the conditions found in respect of:— Clothing 94.4 % satisfactory (1917, 86.3 %) Footgear 88.3 % (1917, 83.1 %) Cleanliness of Body 96.7 % (1917, 92.8 %) but Cleanliness of the Head shows a slight deterioration, 82 2% only being satisfactory as compared with 86.9 % last year. A deterioration in Nutrition has been recorded, 83.0 per cent, being classed as normal, 12.4 per cent, as below normal, and 4.6 per cent, as bad, as compared with 89.8, 9.2 and 1.0 per cent, respectively, in 1917. The observations in respect of Dental Conditions show a distinct improvement on last year's, 35 4 per cent, being sound, 44.2 per cent, having less than four decayed teeth, and 20.4 having four or more decayed teeth. Little change can be noted as regards the number of Nose and Throat Defects and cases of external Eye Diseases. 4 25.8 per cent, of the children tested this year were found to have Defective Vision: 12.3 per cent, less than 6/6, but not less than 6/9 in one or both eyes, 13.5 per cent, less than 6/9 in one or both eyes. In 1914 32.0 per cent, of the children tested were found to have defective vision. In accordance with the request of the Chief Medical Officer of the Board of Education, the defects found in the course of routine medical inspection have been summarised in Table II. at the end of the report. The number of individual children notified to the parents as needing treatment was 376, or 19 2 per cent., but a further 443 (equal to 22.6 per cent.) were also found to have defects which required to be kept under observation. INFECTIOUS DISEASE. The following cases of infectious illness have been notified by School Attendance Officers during the year ending 29th December, 1918:— German Chicken Whooping Measles. Measles. Mumps. Pox. Cough. Total. 145 5 83 136 113 482 SPECIAL CASES. The figures in Table III. give in greater detail information relating to children specially referred or coming under notice for the various conditions set out in the table. Two half-days in each week are devoted to an Inspection Clinic, where cases are referred by the School Attendance Committees, School Attendance Officers and Teachers, also children found on routine medical inspection to be in need of further examination. One clinic is held at the Health Department, the other at the Isleworth Public Hall. The children referred to the School Medical Officer for nitty or verminous conditions gave rise to the following action warning notices, 4 ; legal notices, 56; prosecutions, 5 ; resulting in four fines of 5/-, andone of 10/-. It will be observed that 5 there is a further improvement in the number of cases of nitty and verminous conditions dealt with in 1918, as compared with recent years. Those children who are excluded are re-examined at frequent intervals, and are followed up in order to encourage the parents to have the condition remedied, and permit the child returning to school. The number of days attendances lost by children thus excluded has declined from 35,438 in 1915 to 19,815 in 1916, 17,432 in 1917, and 16,155 in the year under report. MEDICAL TREATMENT. Re examination. Although the number of re-examinations made has again been increased, it is quite impracticable to keep pace with the new cases. The figures in Table IV. as to the cases untreated and treated (remedied, improved, etc.) relate therefore only to a minority of the cases on the records, and may be fallacious as an index to the amount of treatment actually sought. As in last year's report, a number of slighter defects have been noted as "improved" and written off accordingly, although no specific information has been given as to their having had treatment. TREATMENT AT SCHOOL CLINICS. Defective Vision. 11 sessions have been held at the Alexandra School Clinic by Dr. A. E. Looseley, the Ophthalmologist. Glasses were prescribed in 50 cases (38 cases discovered at routine inspection, and 12 specially referred), and in five other cases glasses were found not to be required, or to be useless on account of other defects. Ringworm. 17 sessions have been held at the Alexandra School Clinic by Dr. D. Arthur, the Radiographer. 34 cases of Ringworm of the Scalp have been treated. 6 Minor Ailments. 39 sessions were held and 80 treatments have been given to children. Dental Inspection and Treatment. In the latter part of the year, Mr. G. E. Fritche was appointed as School Dentist, and apparatus for a Dental Clinic was installed at the Alexandra School Clinic. Mr. Fritche took up his work on the 3rd October, and has inspected 216 six-year-old children at four schools. The urgency of the need for dental inspection and treatment may be judged from the fact that 185 children (or 85 %) were found to be in need of treatment. Mr. Fritche attended six treatment sessions at the Dental Clinic and gave 54 treatments. A charge of 6d. per attendance is made in respect of dental treatment. DEFECTIVE CHILDREN. During the year, further progress has been made in the classification of Mentally Abnormal children, detailed examinations of six children having been made, two of them being definitely defective, and one other being classified as an idiot. The numbers of other defective children have not materially changed since the detailed statement made in the annual report for 1914. Table 1.—NUMBER OF CHILDREN INSPECTED IN 1918. Code Groups. Entrants. Intermediates. Leavers. Grand Total. Year of Birth 1912 previous yearsabsentees Total. 1909 previous yearsabsentees Total. 1906 previous years absentees Total. Half-Year 1st 2nd 1st 2nd 1st 2nd Boys 180 103 31 314 175 166 18 359 170 172 15 357 1030 Girls 134 96 31 261 152 153 24 329 166 156 17 339 929 Totals 513 62 575 646 42 688 664 32 696 1959 Special Cases. Medical Treatment Re-Examinations. No. examined 986* 710 *These 986 special cases involved 2191 examiaations. 7 Table II.—RETURN OF DEFECTS found in the course of Routine Medical Inspection in 1918. Defects. No. of new defects found. Defects. No. of new defects found Referred for Treatment. Under Observation. Referred for Treatment. Under Observation. 1 Skin: 7 Nervous System : Ringworm (Head) 1 ... Epilepsy 1 1 Ringworm (Body) ... ... Chorea ... ... Impetigo ... 5 Paralysis ... ... Scabies ... ... Other ... ... Other ... 3 8 Mental Conditions: 2 Eye : Mentally defective ... ... Defective Vision 107 ... Dull or backward ... ... Blepharitis 1 6 9 Physically Defective: ... Conjunctivitis ... Spinal Curvature ... ... Other 3 2 Hernia ... ... 3 Mouth Throat, Nose and Ear: Other Defects ... I Carious teeth 36 202 10 Digestive System: Enlarged Tonsils 76 103 Diarrhoea ... ... Adenoids 4 ... Gastritis ... ... Enlarged Tonsils and adenoids .. 10 5 Constipation ... ... Enlarged Turbinate 6 1 Other ... 1 Tonsillitis ... 2 11 Other Diseases: Pharyngitis ... ... Enlarged Glands 6 5 Otorrhæa ... 16 Rheumatism ... ... Deafness ... 13 Urinary Organs ... 1 Other 3 48 Goitre and Myxodema ... ... 4 Lungs: Infections Diseases : ... Pulmonary Tuberculosis ... ... Scarlet Fever ... ... Bronchitis and Bronchial Catarrh ... 3 Measles ... ... Suspected Tuberculosis ... 1 Whooping Cough ... ... Influenza ... ... Mumps ... ... Other ... 2 Defective Speech ... 3 5 Other Tuberculosis: Rickets ... ... Glands ... ... Other 4 ... BoneB and Joints ... ... 12 Nitty and Verminous Conditions ... 31 Other ... ... 13 (a) Clothing (b) Footgear ... 24 6 Hear and Circulation : ... 63 65 Heart Disease, organic, functional 14 37 (c) Nutrition ... Anaemia 1 4 Totals 273 648 Table III.—Shewing the number of SPECIAL CASES excluded, re-admitted, and under observation during 52 weeks ending 28th December, 1918. Cases remaining excluded at 29-12-17. Cases coming under observation during 52 weeks under report. Cases excluded during52 weeks under report.s Cases re-admitted during b2 weeks under report. Cases remaining excluded or underobservat'n at 28-12-18. No. of examinations made of cases during 52 weeks under report. Total No. days Attendances lost in cases exoluded for a known period. 1 a Ringworm, head 6 40 38 41 5 186 1690 „ body 4 31 31 31 4 108 557 1 Other Diseases of skin 27 •398 381 395 14 1207 5756 2a Defective Vision 1 28 1 28 2 Other affections of Eye 2 19 17 17 2 73 355 3a Carious Teeth 1 12 5 6 21 80 3 Other dis. of throat, nose, etc. 3 62 35 37 2 115 655 4 a Pulmonary Tuberculosis 2 2 2 2 2 4 1540 4 Other diseases of Lungs 9 40 36 40 5 101 1084 5 Other forms of Tuberculosis 1 5 4 3 3 6 129 6 Diseases of Heart & Circulat'n 3 14 9 11 2 25 984 7 Diseases of Nervous System 4 26 15 18 2 49 578 8 Mental Conditions ... 1 5 2 2 6 9 Physical Defects 4 2 2 1 7 79 10 Diseases of Digestive System 1 31 26 26 1 50 233 11 Other Diseases 5 138 96 97 6 218 1535 12 Nitty & Verminous Conditions 2 68 67 68 2 203 807 13 Other reasons 1 63 10 11 84 93 Totals 73 986 774 807 54 2491 16155 10 Table IV.— TREATMENT OF DEFECTS, 1918. (Cases discovered at Routine Medical Inspection). DEFECT. No. of defects found. No. of defects for which no report. No. of defects treated. Result of Treatment. No. of defects not treated. Percentage of defects treated. From previous year. New. Total. Remedied Improved Unchan'd la Ringworm, Head • • • l 1 • • • 1 11 • • • • • • • • • 100.0 Body • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 Other Diseases of Skin 10 8 18 14 3 3 1 75.0 2a Defective Vision 135 107 242 194 48 41* 3 4+ 38 55.8 2 Other Conditions of Eye 17 12 29 24 4 4 1 80.0 3a Carious Teeth 496 238 734 562 81 13 67 1 91 47.1 3 Other dis of mouth,throat,nose,&c. 537 287 824 601 93 55 37 1 130 41.7 4a Pulmonary Tuberculosis ... • • • 4 Other Diseases of Lungs 4 6 10 9 1 1 100.0 5 Other forms of Tuberculosis • • • 6 Heart and Circulation 91 56 147 114 10 6 4 23 30.3 7 Nervous System 11 2 13 8 3 1 2 2 60.0 8 Mental Conditions 27 • • • 27 21 3 3 3 50.0 9 Physical Defects 4 1 5 4 1 3 1 80.0 10 Digestive System 2 1 3 *2 1 1 100.0 11 Other Diseases 25 19 44 35 5 2 3 4 55.5 12 Nitty and Verminous Conditions 80 31 111 75 31 26 5 5 86.1 13a Clothing 123 24 147 91 44 31 13 12 78.2 13b Footgear 194 63 257 172 66 51 15 19 77.6 13c Nutrition 56 65 121 97 18 2 16 6 75.0 Totals 1812 921 2733 2019 416 238 172 6 336 55.3 *Including 38 dealt with at School Clinic. †Dealt with at School Clinic ; glasses not required or useless. ‡Treated at School Clinic.