HES6 Heston and Isleworth Urban District Council. 1919. 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, 1919. 1919 REPORT on The Health of the HESTON and ISLEWORTH URBAN DISTRICT FOR THE YEAR 1919 by W. A. BERRY, M.D., B.S., D.P.H., Medical Officer of Health. 50 (M.O.H.) 50 (S.M.O.) Z7.82. Health Department, Council House, Hounslow. May, 1920. To the Chairman and Members of the Heston and Isleworth Urban District Council. Gentlemen, In submitting the Annual Eeport for the year 1919, it is necessary to put on record certain changes that took place in your Medical Staff. Dr. Bramwell Eeid, your late Medical Officer, died 7th May, 1919. Dr. Allan Hair acted as Deputy Medical Officer from then until the end of July. Dr. Kerr Simpson was appointed as your first Assistant Medical Officer and took up his duties July 14th, 1919, and I myself took over from Dr. Hair as from August 1st. In the body of the report I have drawn attention to the desirability of increasing the outdoor staff to enable me to cope with the increasing demands in respect of Maternity and Child Welfare Work and Inspection of Food, etc., and urgent Housing requirements. I have to express my hearty thanks to the Staff of the Health Department for their extremely willing and efficient service. I am, Gentlemen, Your obedient servant, W. A. BEEEY, Medical Officer of Health. THE HEALTH COMMITTEE OF THE HESTON AND ISLEWORTH URBAN DISTRICT COUNCIL For the Year ending April, 1920. W. W. Woods, Esq. (Chairman). W. Mann, Esq. (Vice-Chairman). F. Nowell, Esq., j.p. (Chairman of the Council). C. Crush, Esq. (Vice-Chairman of the Council). E. A. Beldam, Esq. D. Bonnett, Esq. G. A. Griffith, Esq. A. E. Hales, Esq. R. Langdon, Esq. F. W. Langstone, Esq. W. G. Lobjoit, Esq., j.p., c.a. J. J. Wilmot, Esq. Medical Officer of Health: W. A. Berry, m.d., b.s., d.p.h. 5 SUMMARY OF VITAL STATISTICS, 1919. Population— At the Census, 1911 43,316 Registrar-General's estimate of nett 42,020 (Birth rate) civil population 40,338 (Death rate) Birth rate (nett) 16.8 England and Wales 18.5 London 18.3 Death rate (nett) 11.6 England and Wales 13.8 London 13.4 Infantile Mortality Rate 99 per 1,000 births England and Wales 89 „ „ London 85 „ „ NATURAL AND SOCIAL CONDITIONS. Area. The Urban District of Heston and Isleworth, in the County of Middlesex, has an area of 6,893 acres. It comprises the two parishes of Heston and Isleworth, and is divided for civil purposes into five wards. Heston Parish includes Heston and Hounslow North Wards, and has an area of 3,708 acres. The Parish of Isleworth lies to the east and south of Heston, and is situate on the western bank of the River Thames where that river winds to the north-east towards Kew. The area of this Parish, which embraces Isleworth North and South and Hounslow South Wards, is 3,185 acres. Physical Features. The level of the District rises gradually from the River Thames and reaches at Heston a height of 100 feet above Ordnance Datum. The geological subsoil formation is valley gravel, which is covered in large areas by loam. This thin loamy covering is of great value for market gardening, to which considerable portions of land within the district are devoted. 6 Social Conditions. It cannot be said that the district has a staple industry, except possibly agriculture, in which about 1,400 persons are employed. It, however, contains various factories, the principal of which are as follows:— No. of persona employed. Flour Mills 110 Pharmaceutical chemist's factory 650 Colour factory 90 Brewery 200 Rubber factory 550 Soap works 900 Sweet factory 250 whilst on the outskirts of the district there are large Powder Mills in which a certain number of the inhabitants find employment. Owing to the situation of the District and its being served by the District and London & South Western Railways, as well as by trams and 'buses, a considerable proportion of the inhabitants find occupation in London. Such include (1) Clerks, (2) Professional Men, Merchants, Agents, etc. and (3) Artisans. Public Health is not apparently prejudicially influenced by occupations carried on within the district. Poor Law Relief. I am indebted to Mr. F. E. Harmsworth, Clerk to the Brentford Guardians, for information respecting the amounts paid in money and kind as out-relief to poor persons within the parishes of Heston and Isleworth during the year 1919:- £ s. d. Parish of Heston 665 2 7 Parish of Isleworth 1667 8 0 £2332 10 7 7 Medical Relief. Particulars as to the extent to which hospital and other forms of gratuitous medical relief are utilised are not available, save in a few instances, as many people apply to hospitals outside the district as for example, the Royal Hospital, Richmond, the West London Hospital, Hammersmith, and other General Hospitals within the Metropolitan area. Poor Law Medical Relief is reported to have been afforded to 544 cases, and some of these received also out-relief and institutional treatment. The Hounslow Hospital is the only voluntary Hospital within the district; it is a modern and well equipped institution doing valuable work, but is scarcely large enough to meet the needs of this district. Its sphere of usefulness will, it is hoped, be extended by the provision of maternity beds. During the year 1919, there were admitted 247 in-patients, whilst 573 received treatment as out-patients. Medical relief is also given by certain voluntary organisations in the district, namely:— The Gunnersbury House Nursing Home. The Hounslow Central Aid Society. The Isleworth District Nursing Association. The Ellis Day Nursery. Curative agencies directly under the control of the Council will be referred to under their appropriate headings. They include Maternity and Child Welfare Clinics (two centres). School Clinics (inspection and treatment of school children). Hospital provision at Mogden and Dockwell for infectious diseases. VITAL STATISTICS. Population. For the year 1919, the estimate of nett civil population is given under two figures supplied by the Registrar General. 8 The death-rate population (40,338) excludes all non-civilian males whether serving at home or abroad; whilst the birth-rate (and marriage-rate) population (42,020) includes all the elements of the population contributing to the birth and marriage rates and may be represented by:— Death-rate population plus this district's proportional share of all non-civilians enlisted from this country. The non-civilian element has been distributed over all the districts in the country in proportion to their estimated population. Consideration of the following data suggests that the RegistrarGeneral's estimate of the population for 1919 is much below the actual figure. In the census returns of 1911, we find the following figures:— 1. The population 43,316 2. The inhabited houses 8,006 3. The uninhabited houses 572 4. The number of tenements with more than two occupants per room 307 The number of dwelling-houses in the district to-day is given as 8,814 and there certainly is nothing like 572 unoccupied. Indeed it would be difficult to find a score unoccupied. Moreover, the number of tenements with more than two occupants per room, whilst not ascertainable at present owing to shortage of staff, is doubtless much in excess of 307 judging from the extent of the overcrowding which exists and the difficulty, common to most districts, of securing housing accommodation. The estimated population for 1914 was 48,361, and it would probably not be overstepping the mark to place it at 50,000 for 1919. If it be allowed that the population as estimated by the Registrar-General is understated by several thousands it will therefore follow that the birth and death rates given in this report, which are calculated on his estimate, may be somewhat higher than the actual figures warrant. 9 Deaths. The number of deaths registered in the district was 949, but 528 of these did not belong to the district, while 47 residents died without the district. Thus the number of deaths properly attributable to the district was 468. Adopting the basis of the population estimated by the Registrar-General, the death-rate for the district comes to 11.6 per 1,000, which is comparable with the following figures: —13.8 for England and 13.4 for London. The causes of death during 1919 show substantial reductions in the cases of Influenza, Pulmonary Tuberculosis, Pneumonia and Cancer, but slight increases may be noted in Bronchitis and the developmental diseases amongst infants. As it is not possible to calculate the population in each Ward with any reasonable degree of accuracy, I am unable to furnish the death-rate for each separate Ward, but a fairly reliable index to the comparative mortality of the Wards may be found in the Infant death-rates given on page 6. Births. The total number of births registered during the year was 767 but 90 of these did not belong to this district, while 30 births properly belonging to this district occurred outside the district. The nett number of births thus attributable to the district is 707. 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 18.5 per 1,000 and for London, 18.3 per 1,000. Legitimacy. The following figures give the number of births:— Legitimate. Male Female. Total. 312 343 655 Illegitimate. Male. Female. Total. 24 28 52 10 Infant Mortality. The figure obtained under this heading is regarded as a valuable index of the sanitary conditions of a district. Furthermore, as it is based on ascertained facts (i.e., the actual numbers of births and infant deaths), it is more reliable than the death-rate which is calculated on an estimated population. Taken as a whole the infant death-rate (99 per 1000 births) is higher than that for London (85) though not greatly in excess of the average for this district during the five year period 1915-1919 (96.3). From the undermentioned table, it will be seen that the rate of infant mortality varies in a significant manner from Ward to Ward:— Infant Death-rate per 1,000 births. During 1919. Average for 1915-1919. Heston 89 74.6 Hounslow North 59 75.0 Hounslow South 105 109.6 Isleworth North 145 129.8 Isleworth South 99 83.4 The whole district 99 96.3 SANITARY CIRCUMSTANCES. Water Supply. The water supply for the district is from the mains of the Metropolitan Water Board; the quality of water has throughout this year been good, and the service is a constant one. 42 houses in Heston Parish are supplied from the main of the South-West Suburban Water Co. There were, as far as is known, at the end of the year 39 private wells from which the water was used for domestic purposes. In three other cases there are wells but an alternative supply from the main exists for domestic purposes. In 16 instances draw-taps were placed on the main to the house, in compliance with notice from the Health Department, in lieu of a supply drawn from an inaccessible and uncovered cistern. 11 Drainage and Sewerage. The sewerage of almost the whole district is arranged on the "separate" system, and the method of disposal at the outfall works is that of precipitation and bacterial filtering beds, the effluent being passed into the Thames. In the western portion of the district, however, there are some houses not yet linked up with the general system. It is to be regretted that at the enquiry by the Ministry of Health during the year, sanction was not forthcoming for the provision of a sewer along the western portion of Bath Road, which would have enabled houses in the vicinity to be connected with the general system of sewerage. The present methods of drainage employed at these houses are not satisfactory. Closet Accommodation. Accommodation on the water carriage system is almost general throughout the district, 98 per cent. of the houses having water-closets. Scavenging. This is carried out by the Local Authority and is under the control of the Surveyor, who informs me that for the year, 1919, house refuse was collected at intervals of ten days. The refuse is disposed of by burning in a destructor. Recently, motor vehicles for the collection of house refuse have been introduced. Some of these are provided with covers and are satisfactory; others are not so provided and consequently permit dust and papers to be dispersed when the vehicle is full and travelling at a rapid rate towards the destructor or during strong winds. During the year there were supplied 223 new ashbins, and one privy and five ashpits were abolished. Sanitary Inspection of District. Attention is directed to the Table on page 40 where particulars are set forth of the number and nature of premises visited, the 12 defects or nuisances discovered and the action or result of action taken in regard to these. This includes the report rendered by the Inspector of Nuisances for the year, 1919. Nuisances, Contravention of Bye-laws, Defective Drainage, etc. The number of unremedied nuisances* brought forward from 1918 was 394. The number of nuisances recorded during the year was 655, but during the year 447 nuisances were remedied, leaving 602 premises in which nuisances still existed at the end of the year. During the year, nuisances at 125 houses were reported to the Health Committee, which added to the 7 brought forward from 1918, make a total of 132. Before asking authority to serve statutory notices, the premises are inspected by the Medical Officer of Health and Inspector of Nuisances. Statutory notices were authorised and served in most of these cases, and by the end of the year, the nuisances were remedied in 68 of the houses, leaving 64 cases to be carried forward in 1920. *More properly, houses in which nuisances were found. In this connection, I may perhaps advert to the comments of your Medical Officer in his reports for 1916 and 1917 as to the greater difficulty and longer time taken in the remedying of nuisances as compared with pre-war days. This difficulty and delay still obtains and tends to increase the arrears of work due to shortage of staff. 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. With the return of two of the Assistant Inspectors from war service, a beginning has been made with the complete revision 13 of the departmental records with regard to these premises. This revision is still proceeding, and it is hoped to furnish a full report next year. It has been found impracticable to furnish a statement as to the number of inspections and other work in connection with these premises. SCHOOLS. In this district there are 13 public elementary schools, of which 3 are modern the remainder being for the most part old and lacking in good sanitary conditions. As a result of the occurrence of several cases of Diphtheria at the Isleworth Blue Girls' School, a complete inspection of the premises was made and reported to the Health Committee. The report was forwarded to the Education Committee, but little or nothing has been done to correct the unsatisfactory state of things found to exist. It is hoped to examine the schools in detail and submit particulars in the next annual report. FOOD. During the war, the inspection of food premises had necessarily to be seriously curtailed, owing to the shortage of staff. In the course of the year under report, a beginning has been made towards the more regular inspection of these places, and the bringing up-to-date of the departmental records with regard to them. As, however, the staff has not yet been brought up to its pre-war level it has not yet been possible to complete these records, and it is therefore impossible to present a complete report for 1919 It is hoped that full particulars will be available for the report in respect of 1920. Milk. 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. 14 I am indebted to Dr. C. W. F. Young, County Medical Officer, for the following figures respecting action taken by the County Council in this district in 1919 under the Sale of Food and Drugs Acts:— Milk: Samples taken, 256; found adulterated, 39. Prosecutions, 4; convictions, 3; dismissed (warranty), 1. I understand that the number of samples given includes informal samples. It will be observed that 15% of the samples taken were found to be adulterated. Having regard to the vital importance of the milk supply, I think that much more active steps should be taken to enforce the provisions of the Sale of Food and Drugs Acts, both by taking more formal samples and by the institution of proceedings against all vendors of milk found upon analysis to be adulterated or deficient. No action has been taken with regard to milk affected by Tuberculosis or dirt, owing to the fact that the provisions of the Milk and Dairies Act, 1914, do not come into operation until "after the war." In view of the fact that one cow in 50 suffers from Tuberculosis of the udder, it is highly probable that a fair proportion of the milk sold contains the germ of Tuberculosis. It may also be considered probable that dirt is present in many cases, as the standards of cow-keeping and milk vending have, it is feared, suffered during the war, owing to the absence of the staff on war service and the consequent inadequate supervision. The Milk (Mothers and Children) Order, 1918, has been administered by the Maternity and Child Welfare Committee, and 251 grants have been made. Milk was granted, either free or at reduced rates, to expectant and nursing mothers, and to children up to the age of five years on a graduated scale according to the family income. Meat. It will be noted from the table on page 15 that although much unsound food was surrendered, only one seizure was effected under Section 117 of the Public Health Act, 1875, 15 a carcase affected by Tuberculosis. Successful proceedings followed this seizure, and the occupier of the slaughterhouse was fined £160. One other carcase, also tuberculous, wa6 surrendered during the year. It is to be feared, however, that these were not the only tuberculous carcases which may have been intended and used for the food of man during 1919. The remedy does not lie merely in increased staff and supervision, because unless the times of killing were definitely restricted to certain days and hours it would be practically impossible to exercise adequate supervision over all the various slaughter-houses in the district. Complete supervision would appear to he only possible by means of a public abattoir, directly under the control of the Local Authority. As I stated in a report to the Health Committee, urging the necessity for bringing the sanitary inspecting staff at least up to its pre-war strength, I consider the attention paid to food inspection in this district as quite insufficient. UNSOUND FOOD. The quantity of unsound food found during the year was as follows:— Tons cwt. qrs. lbs Fruit 2 19 1 1 Vegetables 12 3 19 Bacon 2 13 3 13 Meat surrendered 7 1 19 „ seized 4 0 21 Fish 5 0 1 Milk 100½ galls. Other dairy produce 1 0 23 INFECTIOUS DISEASE. General Remarks. The table on page 39 sets forth by months the number of cases of infectious diseases notified during the year 1919. Following upon the re-opening of the Schools after the summer holidays, an outbreak of Scarlet Fever occurred among the pupils attending the Spring Grove Girls' School. 16 tions revealed the fact that there had been two "missed" cases during the vacation, and that the system of excluding children needed revision. Quite a number of cases came to light upon personal examination of children absent from school and for whom no medical advice had been sought, the attacks being, on the whole, mild in type; and several cases reported as Measles were found to be Scarlet Fever. One case developed ear discharge subsequent to its leaving the hospital and gave rise to three "return cases" in the same family. The attention of the Education Committee having been drawn to the rules for excluding children, whereby it was directed that contacts with infectious diseases should, save in the case of Small-Pox, continue attending school, and to the fact that the practice in vogue was encouraging the spread of infection, the regulations were amended in accordance with the Memorandum on School Closure and Exclusion from School issued jointly by the Local Government Board and the Board of Education, 1909. Scarlet Fever. The following table shows 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 162 No. of civil cases removed to Hospital 133 Percentage of cases removed to Hospital 82.1 Three cases were also reported among the military population and removed to hospital. The incidence rate of Scarlet Fever in the civil population was 4.0 per 1,000. One death took place from this cause during the year. Diphtheria. The following table shows the number of notifications received, and the percentage of cases of Diphtheria removed to Hospital:— No. of civil cases notified 102 No. of civil cases removed to Hospital 91 Percentage of cases removed to Hospital 89.2 17 In addition to these cases, one military case was reported and removed to Hospital. The incidence rate per 1,000 of the civil population was 2.5. Seven 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 5 per cent. During the year, 92 swabs were taken from contacts of which eight were found to be harbouring the germs of Diphtheria. In connection with the School Medical Service, 59 swabs were taken and 25 were found to be positive. Diphtheria Antitoxin. During 1919, 20 vials of Antitoxin were supplied to medical practitioners. Typhoid Fever. Two cases were notified from the Infirmary, one (a nonresident) being removed to Hospital, while the other one (a nurse) was treated in the Infirmary, but no deaths were recorded from this cause. Erysipelas. Sixteen cases of this disease were notified, of whom 4 were institution cases, the persons affected being non-residents. Two deaths were recorded from this disease. One military case was also notified. Puerperal Fever. Eight cases of this disease were notified, of whom 5 were institution cases, the persons affected being non-residents. Ophthalmia Neonatorum. In this district 5 children were notified as suffering from this disease, 1 of the cases (a non-resident) occurring at the Infirmary. This is equal to a case rate of 6 5 per 1,000 births occurring in the district. 18 Cerebro-Spinal Fever. Two cases of this disease were notified, but one was subsequently cancelled, it being proved to be a case of Tubercular Meningitis. The other case was treated at the Hospital, but recovered with permanent nerve deafness as a sequel. Acute Polio Myelitis. One case of this disease was notified, having been discovered by the School Medical Officer. When last seen, the patient had partially recovered, but there still remains some slight paralysis of the right upper arm. Measles and German Measles. The incidence of these diseases was much reduced during 1919 as compared with preceding years. The total numbers of notifications received were:— Measles 62 German Measles 43 Only one military case (Measles) was notified. Pneumonia. 22 cases were notified, 4 being non-residents in the Infirmary. Malaria. Four cases were notified. Pulmonary Tuberculosis. The number of new cases notified during the year was 79. Forty-six cases (or 58%) were notified from institutions:— Sanatoria 29, Infirmary 7, General Hospitals 10. The large proportion of cases which come under observation for the first time as the result of notification from an institution would appear to show that the notification of cases by private practitioners is not as complete as it should be. Other Forms of Tuberculosis. The number of new cases notified during the year was 16. Twelve of them were notified as receiving institutional treatment. 19 Non-notifiable Diseases. Information respecting non-notifiable infectious diseases is usually gained through notifications by the School Attendance Officers. The undermentioned table sets forth the numbers of such cases for the year Chicken pox 104 Mumps 18 Whooping Cough 37 Upon receipt of information of the existence of a case, inquiry is made by a Health Visitor to obtain all necessary facts. The mortality from Influenza was 0069 per 1,000. I am informed that special inquiry was not made in this district with regard to the epidemic. Small-Pox. No vaccinations were performed by the Medical Officer of Health under the Public Health (Small-Pox Prevention) Regulations, 1917, during the year under review. MATERNITY AND CHILD WELFARE. The year has been marked by a great development in the Maternity and Child Welfare Work in the district. At the beginning of the year, the new Committee set up under the Maternity and Child Welfare Act, 1918, came into operation. Work at Clinics. The two Clinics at the Council House and Isleworth Public Hall have been more adequately furnished with apparatus, including model sets of infant's and children's garments. Arrangements have been made with local chemists, on similar terms to those under the National Insurance Act, for the dispensing of prescriptions given at the Clinics. Glaxo and Virol have also been placed on sale at cost price to mothers attending the Clinics. The increasing popularity of the Centres is shown in the attendances of children which have risen from 922 in 1916 (first complete year), 1312 in 1917 and 1657 in 1918 to 2299 in 1919. 20 Much, however, still needs to be done to develop the work of the Centres, particularly as regards treatment and educational facilities. Treatment could be provided with little difficulty and at slight cost at the School Clinics established by the Education Committee for the treatment of Defective Vision, Ringworm, Minor Ailments and Dental Defects among school children. In this connection, provision is urgently needed for the treatment of Carious and Septic Teeth found in expectant and nursing mothers, as it has been proved that the presence of such teeth gives rise to toxic effects which are prejudicial directly to the mother and indirectly to the child through the maternal milk. Application has been made to the Education Committee for the use of their facilities, on agreed terms, but has been refused. The need for increased educational work at the Centres and for an extra Centre at Heston has been pointed out by the Ministry of Health (arising out of a visit by one of their medical inspectors), but both proposals are impracticable with the present limited staff, especially having regard to its changing personnel. Health Visitors. A fourth Health Visitor was appointed at the beginning of the year, and as will be seen from the statistics it has been possible to pay a few more visits to babies and to children under five, but the full benefit of the increase of staff has not been reaped for two reasons:— (1) There has been a substantial and continuous increase in the demands on the time of the Health Visitors for attendance at schools and clinics in connection with School Medical Work as well as at the Maternity and Child Welfare Centres. (2) There have been continual changes in the staff, owing to discontent with the salaries paid by the Council. This latter factor greatly militates against the success of antenatal work, as Health Visitors rarely remain long enough in the district to get to know the mothers intimately and thus gain their 21 confidence. An unsuccessful attempt was made during the year to induce the Brentford Union Guardians to appoint the Health Visitors as Infant Protection Visitors under the Children Act, 1908. The need for a further Health Visitor has been pointed out by the Ministry of Health and has been endorsed by the Maternity and Child Welfare Committee, but the proposal of the latter that provision should be made in the Council's estimate for the purpose was not acceded to. Home Visiting. The Health Visitors have visited 667 babies in the course of the year, and have also made 3,311 re-visits. There were 15 still births. The enquiries made at the original visits to babies elicited the following results:— Feeding—Natural 469. Artificial 48. Both 17. No information 133. Sleeping with parents 300. Using comforter 182. Mother working during pregnancy 73. These figures show an improvement on those for last year, the percentage of children who are receiving the mother's milk being 88 as compared with 86, and the percentage of women employed during pregnancy being 11 as compared with 15. Home Help for Mothers. A Home Help was appointed by the Committee in March to assist mothers with their domestic work during their confinement. Her services have proved very useful and have been much appreciated. Grants of Milk and Food. Much good has been done daring the year by making grants of milk and food to expectant and nursing mothers and of milk to children under five years. Grants, which are regulated according 22 to a scale adopted by the Committee with regard to family income and the number of children, were made in 251 cases. Some restriction of this useful work has been necessitated by the decision of the Committee that no assistance should be given in cases of destitution. As many of these cases consist of unmarried mothers or families who decline to apply for Poor Law Relief, several cases have been thus debarred from help under the Council's scheme. Nursing Assistance. Arrangements have been made with the Isleworth Nursing Association whereby nursing assistance may be obtained for maternity cases. Hospital Accommodation. The need for hospital accommodation for maternity cases and for sick children has been reported on and has been discussed during the year, but owing to the difficulties in the way of securing suitable premises, no definite steps have yet been taken in the matter. Infant Deaths, Still Births, Measles, etc. Infant Deaths are systematically enquired into, 73 visits having been paid for this purpose. Still Births have not yet been investigated, but 15 are noted as having occurred during the year.* For the incidence of infectious disease among parturient women and children see the table on page 38. The following numbers of visits were paid in connection with infectious disease among mothers and young children:—Puerperal Fever, 1; Measles, 107; Ophthalmia Neonatorum, 28. Three of the cases of Ophthalmia notified were being nursed at home, both eyes being affected. No special measures have been adopted for dealing with unmarried mothers or illegitimate children, as such, but much useful assistance has been rendered in these cases through the Council's scheme for grants of milk and food. Voluntary Societies. The Isleworth Nursing Association is the only local Voluntary Society in direct contact with the Council's Maternity and Child Welfare Scheme. Negotiations are, however, pending with the Ellis Day Nursery at Hounslow. 23 SANITARY ADMINISTRATION. Staff. The following persons constituted the staff of the Health Department on the 31st December, 1919:— Medical Officer of Health— W. A. Berry, M.D., B.S., D.P.H. Assistant Medical Officer of Health— K. Simpson, M.D., Ch.B., M.R.C.P., D.P.H. Inspector of Nuisances— R. H. Butler, Cert. R.S.I. as S.I. and M.I. District Sanitary Inspectors— G. W. Ashworth, Cert. R.S.I. as S.I. and M.I. W. E. Balchin, Cert. R.S.I. as S.I. and M.I. One vacancy. Disinfector and Lab. Attendant— J. H. Cobb. Health Visitors— Mrs. C. E. M. Ottley, Cert. R.S.I. as H.V. and S.N. and M.C.W.W. Miss B. N. Tetley. Miss G. P. Chatfield. One vacancy. Home Help— Mrs. E. Yates. Chief Clerk— J. Henry Lloyd, Cert. S.I.E.B. as S.I. Clerks— A. G. Hubbard. F. G. Boto. Miss R. Marshall, Mrs. I. Joyce. A. Pound. 24 ISOLATION HOSPITALS. Isolation Hospital Accommodation. This district, with the Borough of Richmond (Surrey), maintains two Isolation Hospitals (1) Mogden Hospital, situate in the southern portion of the district, for Scarlet Fever, Diphtheria, Enteric Fever, etc. It has 61 beds, allowing 1,500 cubic feet of air space to each bed. (2) Dockwell Hospital, situate on the western confines of the district, for Small-Pox. It has 13 beds, allowing 1,500 cubic feet of air space per bed. No definite number of beds is assigned to either Authority, but on the basis of the amount of money contributed by each for upkeep, it may be said there are 45 beds (37 at Mogden and 8 at Dockwell) for Richmond, and 29 beds (24 at Mogden and 5 at Dockwell) for Heston and Isleworth. The following table shews the number of cases admitted to Mogden Hospital from this district during the year 1919 Scarlet Fever 136 cases. Diphtheria 101 cases. Enteric Fever 1 case. Cerebro-Spinal Fever 1 case. Tuberculous Meningitis 1 case. Acute Poliomyelitis 1 case. Total 241 cases. I am informed that on 45 days the number of Scarlet Fever patients did not permit of 2,000 cubic feet of air space per patient, whilst Diphtheria cases were in excess on 54 days. Taking the limit as 1,500 cubic feet of air space per patient, there was found to be overcrowding in respect of Scarlet Fever and Diphtheria on 14 and 11 days respectively. It has usually happened that outbreaks of infectious disease have not synchronised in the two districts and consequently the 25 degree of overcrowding has not been marked ; but in view of the above and the fact that the accommodation at Mogden does not provide one bed per 1,000 population for the districts served, an extension would appear necessary. ADOPTIVE ACTS AND BYE-LAWS IN FORCE. Adoptive Acts in force in District: *Infectious Diseases (Prevention) Act, 1890. *Public Health Acts Amendment Act, 1900, Part III. *Public Health Acts Amendment Act, 1907, Parts II., *111., * IV., *V., VI. and VIII. Maternity and Child Welfare Act, 1918. Baths and Wash-houses Act, 1846-82. Burial Acts, 1852-85. (Applicable to parts of district only). Private Street Works Act, 1892. Public Libraries Act, 1892. Bye-laws in force in District: *Common Lodging Houses (P.H.A. 1875, s. 80). *Cleansing, etc., and Removal of Refuse (P.H.A. 1875, s. 44). *Houses Let in Lodgings (P.H.A. 1875, s. 90). *Tents, Vans, Sheds, etc. (H.W.C.A. 1885, s. 9 (2) ). *Slaughter Houses (P.H.A. 1875, s. 169 and T.I.C.A. 1847, s. 128). *Prevention of Nuisances (P.H.A. 1875, s. 44). *Keeping of Animals (P.H.A. 1875, s. 44). *Removal of Offensive Matters (P.H.A.A.A. 1890, s. 26). New Streets and Buildings (P.H.A. 1875, s. 157, and P.H.A.A.A. 1890, s. 23). Pleasure Grounds (P.H.A. 1875, s. 164). *Fish Frying (P.H.A. 1875, s. 113). Regulations made by Local Authority in force in District: *Dairies, Cowsheds and Milkshops (D.C.M.O. 1885, s. 13). Allotments (A.A. 1887, s. 6). *These are administered wholly or partly by the Health Committee. The unstarred are administered by other Committees of the Council. 26 LABORATORY. Council Laboratory. During the year 1919, specimens were examined in the Laboratory as follows :— Positive. Negative. Total. Diphtheria (Swabs) 73 161 234 Tuberculosis (sputum) 12 59 71 Widal Tests Total 85 220 305 It is a noteworthy fact that no samples of blood were sent for the diagnosis of Enteric Fever, and of the latter disease there were only two cases notified, both from the Brentford Union Infirmary. One of them came from outside the district, whilst the other was a nurse in the Institution (in—attondanoo—on—the oiiao). The swabs examined for Diphtheria included 59 taken in connection with the School Medical Service, of which 25 were positive, and 92 from contacts, of which 8 were positive. 27 HESTON & ISLEWORTH URBAN DISTRICT COUNCIL. Health Department, Council House, Hounslow. 10th January, 1920. 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 31st December, 1919, 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. Inspectors. Messrs. R. H. Butler (Inspector of Nuisances) and W. E. Balchin (District Sanitary Inspector) are appointed to act as Canal Boats Inspectors. No special remuneration is paid for the position. Number of Inspections, etc. During the year 14 inspections were made of 14 boats. 13 boats were in order and on one boat two infringements of the Acts and Regulations were found. The attached table gives details of the contraventions. Legal Proceedings. No legal proceedings have been taken during the year. Infectious Disease. No cases of infectious disease were reported as occurring among the Canal Boat population during the year. General. It has not been possible to make an adequate number of inspections during the year, owing to the shortage of inspectorial staff in the, Health Department. I am, Sir, Your obedient servant, The Secretary, W. A. BERRY, Ministry of Health, Medical Officer of Health. Whitehall, S.W. 1. 28 SHOPS ACTS. The number of contraventions of the Acts which were reported during the year was as follows :— Open on half-holidays 3 Notices not exhibited 2 Notices not exhibited in a conspicuous position — Notices not in prescribed form — Notices (assistants) not exhibited — 5 PROCEEDINGS. Proceedings were taken during the year in respect of:— (a) nuisances at 2 houses, (b) the establishment of an offensive trade without permission and (c) the seizure of an unsound carcase. In the case of (a) fines and costs were imposed and abatement orders made for the works to be carried out. In the case of (b) the summons was adjourned to enable the defendant to find suitable and approved premises, the offensive trade being discontinued in the meantime. In the case of (c) the occupier of the slaughter-house at which the carcase was seized was fined £160 and costs. ROADS. The condition of many of the roads in the district has given cause for anxiety, due to accumulation of stagnant liquids and detritis. The gradual substitution of all water-bound road surfaces by surfaces of an impervious character is highly desirable from a hygenic standpoint, more especially in the side streets in the more congested portions of the district where the street is used to a large extent as a playground for the children. HOUSING. The housing conditions in the district are very unsatisfactory. Between the passing of the Housing Town Planning, etc. Act, 1909, and the outbreak of War in 1914, I understand that only 29 a small part of the district had been systematically inspected under the Act, and only a comparatively few houses had been either rendered fit or closed and demolished. The then existing staff of four inspectors did not permit of much more being done. Your Medical Officer in his report for 1914, said " I believe it is necessary to increase the number of houses inspected per annum to about 200 houses, but I do not feel that it would be safe to go beyond that number with the present staff without causing a sacrifice of the efficiency with which the other work is carried out." Since 1914, the staff has been greatly reduced (for a long time consisting, I believe, of only one inspector) and nothing in the way of systematic inspection has been possible. It is obvious, therefore, that there are great arrears of work which need to be over-taken, especially as for reasons arising out of the War, the normal work of keeping houses in a proper state of repair has not been carried out. In the latter part of 1919, the Ministry of Health called for a Survey of Housing Needs and among the information prepared for this Survey by this Department were the following figures: — No. of inhabited bouses which are not and cannot be made fit for human habitation = 260 (estimated). No. of persons inhabiting these houses = 1,300 (approximate). No. of houses already subject to (a) Closing Orders, (b) Demolition Orders=(a) 29, (b) 4. No. of houses seriously defective but can be made habitable = 1,250 (estimated). The estimates in most cases may be taken as conservative, as they are based on the houses actually listed. It is very probably that many houses not on the list should be included, but the full facts can only be ascertained by a complete survey of the district. Out of a total of 8,814 houses in the district, 4,376 were described as working-class houses where the prevailing rents were then from 3/6 to 10/- per week. It is not quite clear, however, whether the term "working class" has been applied to houses 30 between the particular limits of rental value merely as a convenient description, or whether it is intended that " working class " houses should be defined as those falling within these limits. In any case, there is no doubt that there is a large number of houses above these rental values which urgently needs inspection and improvement whether their occupiers be described as of the working-class or otherwise; such occupiers are quite entitled to such protection against bad housing conditions as is afforded by the Housing Acts, etc. It is probable, therefore, that the number of houses which should be inspected as to their general fitness and state of repair is not far short of 7,000. For a very large proportion of these houses it is desirable that an inspection should be made at least once every seven years. The number of houses which should be inspected every year may therefore be put as about 750. In a very full report dated the 8th December, I urged the Council to bring the Sanitary Inspecting Staff up to its pre-war strength (four Inspectors). This recommendation was not adopted. It is, however, quite the minimum that is necessary. Effectively to grapple with the housing conditions of the district as well as with other P.H. work (e.g. food inspection) an even larger staff will be necessary. In the Housing Survey referred to, the following questions and answers are important:— What immediate actioi) is contemplated by the Local Authority with regard to :— (a) Houses which are It is proposed to postpone not and cannot be made any further action until houses fit for human habitation ? have been erected under the new scheme. (b) Houses which are Action will be taken under seriously defective but can the Housing Acts, and particube made habitable ? larly under Section 28 of the Housing, Town Planning, etc., Act, 1919. 31 Within what time is it contemplated that conditions will be such as to warrant the demolition of the houses which are not and cannot be made fit for human habitation ? Within two years. As these answers must presumably be read in conjunction with the approximate dates, given in another answer, for the completion of the several housing schemes they give room for much disquietude. One scheme for 46 houses on the Warren Estate was estimated to be completed by May, 1920, but so far as I am aware, no building operations have yet been commenced at the date of writing (31/3/20). No other scheme was even estimated to be completed before May, 1921, and the greater number of houses were not expected until November, 1922. To ascertain the reasons for the delay in providing these urgently necessary houses does not fall within my province, but the consequences of such delay, clearly, are a matter for grave public health concern. In effect they mean the indefinite continuance of overcrowding, with increased risks of disease and high infant and general death rates, as well as the continued toleration of houses recognised to be unfit for human habitation, and of congested areas which may prove, upon inspection, to be unhealthy within the meaning of the Housing Acts. I feel it my duty, as your Medical Officer of Health, to draw attention to the urgency of this matter, and to submit that few considerations can outweigh the vitally important human considerations which are involved in better housing for the people. Information under the following headings is required by the Ministry of Health :— I. General Housing Conditions in the District. (1) Total number of houses 8,814 Working-class houses 4,376 (estimated) New houses for working-houses erected during the year or in course of erection 3 32 (2) Population: Registrar-General's estimate for Birth-rate is 42,020 and for Death-rate 40,338. As discussed on page 8 these figures are probably under estimated. There have been no important changes during the year, but it is anticipated that extensions will take place at one or two factories. (3) (a) Extent of shortage or excess of houses : The shortage is put at 1,064. (b) Measures taken or contemplated to meet shortage : Preparations for building are proceeding. II. Overcrowding. (1) Extent: Overcrowding is prevalent, but in the absence of a complete survey I am unable to say to what extent. (2) Causes: It is due to shortage of houses. (3) Measures taken or contemplated to deal with crowding : No temporary measures have been adopted. (4) Principal cases of overcrowding dealt with : One case remedied. III. Fitness of Houses. (1) (a) General standard of housing in the district: As already stated, the general standard is unsatisfactory. (b) General character of defects found to exist in unfit houses : Dampness due to want of proper damp-proofing, inadequate lighting and ventilation and general dilapidation are the main defects found. 33 (2) Action taken as regards unfit houses under : (a) Public Health Acts nil. (b) Housing Acts vide page 34. (3) Difficulties in remedying unfitness, special measures taken and any suggestions in the matter : Principal difficulty is absence of suitable accommodation for families displaced by closing or demolition of unfit houses. Landlords give the price of materials and cost of labour as reasons for delay or neglect in the repair of repairable houses. (4) Conditions, so far as they affect housing, as regards water supply, closet accommodation and refuse disposal, together with measures taken during the year in these matters : Water supply is on the whole satisfactory. Closet accommodation is generally adequate, but defective apparatus is frequently complained of, whilst in the outlying parts of the district are some houses not yet connected with the general sewerage system. Refuse disposal, partly owing to shortage of vans and partly owing to many houses being unprovided with portable ashbins, collections were not made sufficiently often. IV. Unhealthy Areas. (1) Action taken as regards areas represented before the beginning of the year under Part I. or Part II. of the Housing Act, 1890 : Nil. (2) Particulars of and action taken as regards areas represented during the year : None represented. (3) Information as to complaints made during the year that areas were unhealthy and action taken : Nil. 34 V. Bye-laws relating to houses, houses let in lodgings, tents, vans, sheds, etc. (1) As to working of existing bye-laws : For reasons given elsewhere it has been impracticable to maintain the inspection of houses let in lodgings, etc. Probably many houses are now technically houses let in lodgings owing to the abnormal housing conditions, but are not on the register. (2) As to need for new bye-laws and revision of existing bye-laws : Some difficulty has been experienced in dealing with caravan dwellers under the existing bye-laws with regard to the disposal of refuse and closet accommodation, and a revision of these bye-laws is under consideration. VI. General and Miscellaneous. Other action taken in connection with overcrowding, insanitary property and housing Nil. VII. Appendices. Statistics for year ended 31st December, 1919. (1) Number of dwelling-houses in respect of which complaints were made that they are unfit Nil. (2) ,, dwelling-houses inspected under Section 17 of Housing Act, 1909 22 ,, dwelling-houses considered unfit 22 „ ,, the defects in which were remedied without making of Closing Orders Nil. (3) Action under Section 28 of Housing Act, 1919 Nil. 35 (4) Number of representations made 22 „ Closing Orders made 22 „ Closing Orders determined Nil. ,, Notices of Closing Orders served on tenant 14 „ tenants summoned for non- observance of said notices 14 (5) ,, Demolition Orders made Nil. „ houses demolished in pursuance of Demolition Orders 6 (6) ,, houses demolished voluntarily Nil. (7) ,, Obstructive buildings No action. (8) Staff engaged in housing work :— The outdoor staff of the Health Department consists normally of one Chief Inspector and three District Inspectors. During the War, two of the District Inspectors joined the Army and the third left to take up a position elsewhere, whilst the Chief Inspector carried on as best he could. Upon their discharge from the Army the two District Inspectors resumed duty, but sanction to fill the vacancy for a third Inspector has not been granted by the Council, notwithstanding representations made by the Health Committee. There is no officer appointed wholly for housing duties, which are carried out by the above staff in conjunction with their other duties. In such circumstances, it is quite "impracticable to make a general survey of the district, and none has been attempted. 36 Table I. 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 1918al-3, Poplar Cottages 3 24/2/14 22/12/14 10-16, Church Street 4 23/2/15 26/10/15* 12/8/19 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* 5/8/19 24, 26, 28, 30, Lampton Road 4 27/3/17 Inspected in 1919— 14-34, London Road 11 22/7/19 1-10, Syon Place 10 22/7/19 The Depot, North Hyde 1 23/12/19 ... 6 a—Notices served on tenants of Nos. 1 and 3, 18/10/17. Still occupied. *—Demolition deferred until after the War. 37 Table 11. Causes of Death during 1919. Causes of death. Civil Residents all ages.* All causes Certified ... Uncertified ... 1 Enteric Fever ... 2 Small-Pox ... 3 Measles ... 4 Scarlet Fever 1 5 Whooping-cough 1 6 Diphtheria and Croup 5 7 Influenza 28 8 Erysipelas 2 9 Phthisis (Pulmonary Tuberculosis) 38 10 Tuberculosis Meningitis 4 11 Other Tuberculous diseases 1 12 Cancer, malignant disease 44 13 Rheumatic Fever ... 14 Meningitis 1 15 Organic Heart Disease 61 16 Bronchitis 56 17 Pneumonia (all forms) 17 18 Other Diseases, Respiratory Organs 3 19 Diarrhoea and Enteritis 8 20 Appendicitis and Typhlitis 2 21 Cirrhosis of Liver 1 21a Alcoholism ... 22 Nephritis and Bright's Disease 14 23 Puerperal Fever 2 24 Other accidents and diseases of Pregnancy and Parturition ... 25 Congenital Debility and Malformation including Premature Birth 35 26 Violent Deaths, excluding suicide 14 27 Suicide 5 28 Other defined diseases 125 29 Diseases ill-defined or unknown ... 468 According to figures furnished by the Registrar-General. Table III. Infantile Mortality during the year 1919. Nett Deaths from stated Causes at various Ages under 1 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 Smts. 3 nits, and under 6 rats. 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 ... ... ... ... ... 1 ... ... ... 1 Whooping Cough ... ... ... ... ... ... 1 ... ... 1 Diphtheria and Croup ... ... ... ... ... ... ... 1 ... 1 Erysipelas Tuberculous Meningitis Abdominal Tuberculosis Other Tuberculous Diseases Meningitis (not Tuberculous) Convulsions Laryngitis Bronchitis ... 1 ... ... 1 2 2 ... 1 6 Pneumonia (all forms) ... 1 ... ... 1 ... ... 3 1 5 ( Diarrhoea ... ... 1 ... 1 ... 2 ... ... 3 Enteritis ... ... ... ... ... ... 3 ... 1 4 Gastritis ... ... 1 ... 1 ... ... 1 2 Syphilis 1 1 Rickets Suffocation, overlying Injury at Birth Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations 2 1 ... ... 3 1 1 ... ... 5 Premature Birth 20 ... ... ... 20 2 ... ... ... 22 Atrophy, Debility and Marasmus 1 ... 1 ... 2 4 ... 1 ... 7 Other Causes 6 ... 1 ... 7 1 1 2 ... 12 30 3 4 ... 37 14 8 8 3 70 Nett Births Legitimate Illegitimate 655 52 Nett Deaths Legitimate infants 57 Illegitimate infants 13 39 Table IV. Infectious Diseases, 1919. Cases Notified. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Erysipelas. Cerebrospinal Fever. Encephalitis Lethargica. Poliomyelitis. Pneumonia. Malaria. Pulmonary Tuberculosis. Other forms of Tuberculosis. Measles. German Measles. Ophthalmia Neonatorum. January 15 12 ... 1 ... ... ... ... ... ... 8 2 ... 1 ... February 6 20 ... ... 1 ... 1 ... ... ... 5 ... 3 ... ... March 7 11 ... ... 1 ... ... ... 9 1 5 ... 4 2 ... April 10 9 ... ... 1 ... ... ... 3 ... 5 ... 9 11 2 May 9 5 ... 1 1 ... ... ... 2 1 9 7 10 7 ... June 1 4 ... 2 1 ... ... 1 1 2 12 2 5 1 1 July 7 5 ... ... ... ... ... ... 1 ... 9 3 8 4 2 August 9 2 ... 1 1 ... ... ... ... ... 7 1 2 14 ... September 17 4 ... ... 1 ... ... ... 1 ... 8 ... ... ... ... October 48 12 1 ... 3 ... ... ... ... ... 2 1 ... ... ... November 23 10 ... 1 2 ... ... ... 1 ... 3 ... 1 1 ... December 13 9 1 2 5 ... ... ... 4 ... 6 ... 20 2 ... Total 165 103 2 8 17 1 i 22 4 79 16 63 43 5 40 Table V. Sanitary Work. Inspections: Canal Boats inspected 14 Contraventions found 2 Notices served 1 Movable dwellings inspected 6 Contraventions found 2 Notices served 1 Bakehouses inspected 6 Contraventions found 1 Notices served 1 Cleansed, etc. 2 Slaughterhouses inspected 4 Dairies and Milkshops inspected 47 Contraventions found 2 Defects remedied 2 Offensive trades inspected 8 Defects remedied 2 Shops Acts inspections 43 Contraventions found 2 „ remedied 2 Food premises inspected 94 Smoke observations made 2 Infectious disease visits 73 Rooms disinfected 43 Articles disinfected 254 Action taken (other than under Housing, Town Planning, &c. Act, 1909):— Preliminary or Intimation Notices given ... ... 571 Second notices sent ... ... ... 232 Statutory notices issued ... ... ••• 243 Proceedings taken ... 41 Dwelling-houses and action under Housing, Town Planning, &c., Act, 1909:—Sec pages 34 and 35. Unsound Food:— (a) Carcase seized 1 (b) Articles or parcels seized nil. Carcase condemned by Magistrate 1 Articles or parcels condemned by Magistrate - Articles or parcels surrendered 63 Carcase surrendered 1 Organs or parts surrendered during slaughtering— Water Supply and Water Service Supply provided 11 Cisterns cleansed, repaired, covered, etc. 6 Draw-taps placed on mains 16 Water service pipes or taps repaired 14 Drainage and Sewerage of existing Buildings: — Water closets— Repaired, supplied with water or otherwise improved 229 Cesspools— Emptied and cleansed 1 Abolished 1 Privies— Abolished 1 Drains— Unstopped 49 Waste pipes (22), rain-water pipes (25), provided disconnected, repaired, etc. 47 Gullies inserted or improved 24 Fresh air inlets provided or repaired 10 Soil pipes (5) or ventilating shafts (18) fixed or repaired 23 Disconnecting traps or chambers inserted or repaired 18 Tested 5 Repaired (178 feet) 6 42 Dust:— New ashbins provided 223 Ashpits abolished 5 Sundry Nuisances abated Overcrowding 1 Domestic cleansing effected 3 Accumulation of refuse 7 Dampness 16 Roofs repaired 72 Guttering provided, repaired or unstopped 35 Rooms stripped and cleansed (after infectious disease) 46 Other rooms stripped and cleansed 261 Other internal repairs 149 Yards paved, repaired or drained 18 Other nuisances 29 HESTON and ISLEWORTH URBAN DISTRICT EDUCATION COMMITTEE. twelfth ANNUAL REPORT OF THE School Medical Officer FOR THE Year ending 31st December, 1919. 50 (m.o.h.) 50 (s.m.o.) Z7.82. MEMBERS OF EDUCATION COMMITTEE, 1919-20. E. W. GOODE, Esq. (Chairman). A. L. LANG, Esq. (Vice-Chairman). Members of the Council :— F. NOWELL, Esq., j.p. (ex-officio, Chairman of the Council). C. CRUSH, Esq., j.p. (ex-officio, Vice-Chairman of the Council). A L LANG, Esq. (Vice Chairman of the Education Committee). E. A. BELDAM, Esq. F. W. LANGSTONE, Esq. A. A. BERGIN, Esq., j.p. W. G. LOBJOIT, Esq., o.b.e., j.p., c.a. G. A. GRIFFITH, Esq. H. J. NIAS, Esq., m.b.e., j.p. A. E. HALES, Esq. W. H. PHIPPS, Esq. J. WEATHERS, Esq. Selected Members— Miss B. J. M. CROAL. Mrs. C. F. EVA. Mrs. W. H.DUMSDAY. E. W. GOODE, Esq. P. MURPHY, Esq. School Medical Officer: W. A. BERRY, m.d., d.p.h. STAFF. Clerical Staff— J. Henry Lloyd (Chief Clerk). A. G. Hubbard. F. G. Boto. Miss R. Marshall. Mrs. I. Joyce. A. Pound. Health Visitors— Mrs. C. E. N. Ottley. Miss B. N. Tetley. Miss G. P. Chatfield. One vacancy. Dental Surgeon—I. Cohen, L.D.S., R.C.S. Radiographer—D. Arthur, M.D., C.M., D.P.H. Ophthalmologist—A. E. A. Loosely, F.R.C.S. Assistant School Medical Officer— K. Simpson, M.D., M.R.C.P., D.P.H. School Medical Officer—W. A. Berry, M.D., D.P.H. To the Chairman and Members of the Heston and Isleworth Urban District Education Committee. Ladies and Gentlemen, I beg to present the Annual Report of the School Medical Officer for the year ending 31st December, 1919. Several changes took place in the School Medical Staff during the year and have to be recorded. Dr. W. B. Reid, your late Medical Officer, died, and pending the appointment of a suceessor, the work was carried on by part-time officers. Mr. Fritche resigned his position as School Dentist, and Mr. I. Cohen was appointed in his place. Dr. Kerr Simpson, your first whole-time Assistant Medical Officer, was appointed in July, and my appointment as School Medical Officer began August 1st. The appointment of a full-time Assistant School Medical Officer has made it possible to develop the School Medical Service in various directions. The medical inspection clinics are now hold more frequently, while the organisation of the routine medical inspection and re-examination work has been greatly facilitated. It is, however, sometimes difficult to take full advantage of the services of the Assistant Medical Officer, owing to the absence of an available Health Visitor. The time of the Health Visitors is now so much taken up with attendances at clinics and inspections that difficulty is frequently experienced in getting their services for special work or even for routine visitiug. During the past year there has been a substantial increase both in school medical work and in other public health activities, so that the present staff is no longer adequate. This pressure of work has been accentuated by the frequent changes in the staff, due to resignations in order to take up better paid posts elsewhere. Towards the end of the year a census was prepared of the children in attendance at public elementary schools within the district. It is hoped to maintain this up-to-date by means of a monthly return from headteachers of the children entering and leaving their departments. I am, Ladies and Gentlemen, Your obedient servant, W. A. BERRY. 7 GENERAL SUMMARY. 119 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 during 1919 there were examined 4,315 children as against 3,655 during the year 1913. These 4,315 children involved 7,965 examinations, as against 5,160 examinations during 1918. These figures do not include children examined at cleanliness surveys. ROUTINE MEDICAL INSPECTION. The selection of children due for this inspection during 1919 included those children born during the years 1907, 1910 and 1913, and those absent at last Medical Inspection. 937 parents or 45 % attended the inspection. Some deterioration was found in respect of Clothing and Cleanliness of the Body, whilst the condition of Footgear and Cleanliness of the Head remained much as in 1918, thus :— Clothing 90.1% satisfactory (1918, 94-4%) Footgear 88.4% „ (1918, 88.3%) Cleanliness of Body 9 5.5% „ (1918, 96.7%) Cleanliness of Head 82.8% „ (1918, 82.2%) The percentage figures recorded for Nutrition are lower than the corresponding ones for 1918. Apart from any effect attributable to the high cost of food, allowance must be made for the personal factor in estimating the condition of nutrition in any particular instance. During the year Nutrition was marked normal in 76.5%, below normal in 18.3% and bad in 5.1%, as compared with 83.0, 12.4 and 4 6 per cent, respectively in 1918. Attention is drawn to the figures recorded in respect of Dental Conditions. Of 2,061 children examined 478 or 231% had more than 4 teeth decayed, 914 or 44.9% had less than 4 affected 8 and 603 or only 29.5% had teeth apparently sound. As the examination by the Medical Officer is made without the aid of a dental mirror and probe, these figures may be regarded as conservative. Little change can be noted as regards the number of Nose and Throat Defects and cases of external Eye Diseases, 17.9% of the children tested this year were found to have Defective Vision.; 7.7% less than 6/6 but not less than 6/9 in one or both eyes, 10 2% less than 6/9 in one or both eyes. 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. INFECTIOUS DISEASE. During the year the Committee revised its rules for the exclusion of children in contact with infectious diseases and adopted those set forth in the Joint Memorandum issued by the Local Government Board and Board of Education. The following cases of infectious diseases were notified by the School Attendance Officers during the year ending 27th December, 1919:— German Chicken Whooping Measles. Measles. Mumpa. Pox. Cough. Total. 41 6 18 104 37 206 SPECIAL CASES. The figures in Table IIIa, give in greater detail information relating to children specially referred or coming under notice for the various conditions set out in the table. During the Autumn term the Committee sanctioned more frequent meetings of the Inspection and Treatment Clinics as follows:—At the Council House Inspection Clinics are held on Monday, Tuesday, Wednesday and Thursday at 9.45 a.m., whilst Inspection and Treatment Clinics (combined) are available at the Isleworth Public Hall on Monday and Thursday at 9.45 a.m., and at the Alexandra Road School on Friday at 9.45 a.m. 9 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 declined from 35,438 in 1915, 19,815 in 1916, 17,432 in 1917, to 16,155 in 1918, but has increased to 19,462 in the year under report, chiefly in consequence of the greater attention paid to cases of uncleanliness. The new regulations adopted by the Committee with regard to the exclusion of contacts with cases of infectious disease are also responsible for some increase in the number of attendances lost. CLEANLINESS SURVEYS. During the war, routine cleanliness surveys had been allowed to lapse, but were re-instituted in the Autumn. For this purpose the Health Visitors made 27 visits to schools and examined 1,590 children, of which 406 had warning notices sent and 133 were excluded. The removal from the schools of the worse cases of vermin infestation has undoubtedly had a beneficial effect upon the general standard of cleanliness in the schools, and although such removal is only temporary and dirty conditions are likely to recur in some chronic cases, these periodical surveys enable such cases to be more effectively dealt with. The children referred for nitty or verminous conditions gave rise to the following action :—Warning notices, 28 ; legal notices, 316; prosecutions. 28. The prosecutions resulted in twelve fines of 5/-, one of 7/6 and six of 10/-, while one case was withdrawn and eight were dismissed. There is little doubt that were there in the district a small Cleansing Station available for use when required, the attendances lost in respect of verminous conditions could be greatly reduced. Section 122 of the Children Act, 1908, empowers the Local Education Authority to effect cleansing, if within 24 hours of the receipt of a written notice the parent or guardian fails to do soFollowing such cleansing, should the verminous state recur, the 10 person responsible for the custody of the child becomes liable to prosecution. The procedure in this district is to allow the parents or guardians a variable period, but at least 14 days, in which to cleanse the child, and, if they fail, to order a prosecution. It will be noted that the Local Education Authority, by omitting to provide cleansing facilities, neglects its duty and incidentally loses considerably in grant on account of lost attendances. The provision of a centre with proper bathing accommodation would also enable Scabies, of which there have been 62 cases during 1919, to receive adequate treatment; for in many instances Scabies ran a protracted course simply because treatment was ineffectually applied. To counterbalance the expense the establishment of such a centre would entail, one might set off the gain that would accrue from the increase in grant to be obtained by reason of a speedier return to school, quite apart from the larger question of lessening the risk of vermin-borne disease. It must be understood that a large number of mothers exercise the greatest care to prevent their children from becoming infested with vermin ; and, it is not unnatural for such to attribute blame to the school when their children, perhaps for the first time, are found to harbour lice some weeks after they begin attending school. In this connection, therefore, greater care is necessary in the arrangement of pegs in school cloakrooms, so that each child has its separate place where garments may hang untouched by those of another child. MEDICAL TREATMENT. Re-examinations at School. The table shewing the results of re-examination in cases found at medical inspection to be in need of treatment reveals the fact that treatment is not being obtained in a large number of cases. It will be noted that 668 children who were found at previous medical inspections to be in need of treatment have been reexamined to see whether such treatment had been obtained. The results of the re-examinations showed that 51 per cent. had not received treatment. 11 As I have reported to the Committee during the year, this is particularly the case with regard to Enlarged Tonsils and Adenoids. During the year, 197 children were re-examined who were found to be suffering from these conditions, with the following results :— Remedied, 44 ; improved, 26 ; no treatment obtained, 127. It will be observed that only 35 3 per cent, of these children had been treated. A low percentage of children treated will also be noted in the table in the case of carious teeth and diseases of the heart and circulation. The children in the former group are the older children who do not come within the scope of the present School Dental Scheme. Some of this failure to obtain treatment may be attributed to the ignorance or neglect of the parents, but much more is due to the difficulties in the way of obtaining adequate treatment. A large number of parents cannot afford to obtain such treatment through private medical practitioners, and the local general hospitals do not deal with more than a fraction of the cases. To obtain treatment at one of the London general hospitals involves both expense in travelling and considerable waste of time and is in many cases refused on the ground that it is the duty of the local authority to provide treatment for the school children within their district. These difficulties are enhanced in cases of treatment involving operation, where it is obviously most undesirable that the patient should have to travel long distances in overcrowded public vehicles. For these reasons it seems to me that more facilities should be provided by the local authority for the provision of treatment for children in the district. Such provision is urgently needed in the case of Enlarged Tonsils and Adenoids, but is also greatly to be desired in regard to children suffering from physical defects, etc. With regard to the treatment of Enlarged Tonsils, provisional arrangements with the local hospitals are now under consideration and will probably meet the case for the moment, but eventually a more complete scheme will be necessary and in this connection the direct treatment of cases by the local authority might very well be 12 considered in conjunction with proposals which have been considered by the Maternity and Child Welfare Committee for a Maternity Hostel and Childrens' Hospital. Open-Air School. Another aid to treatment is the open-air school, which can be utilised to great advantage in the early stages of disease, for habitually delicate children in whom no disease can be detected and for those convalescing after illness. Through the kindness of Dr. E. E. Norton, Tuberculosis Medical Officer, Middlesex County Council, I have had submitted the names of 164 cases, of ages varying from 2 to 18 years, that came under his observation in the period 1913-1919. Of this number 120 were of school age. For many of the latter an opsn-air school was indicated as such would be tolerated, and perhaps with great benefit to the child, when attendance at an ordinary school would be inadmissible. It is justly said that every school should be an open-air school, but few can claim any such pretensions, and, indeed, the mere position of many precludes them from competing in such a class. There is little doubt that the school population of this district would derive great benefit by the prpvision of schools of open-air type with accommodation for, say, 50-60 pupils. In default, certain of the newer and more favourably placed schools, such as the Heath School or Alexandra Road School, might provide one or more openair class rooms. Your School Medical Off icer dealt very fully with this subject in his Annual Report for 1911 and again in 1914. The matter is undoubtedly one of great importance, and is entitled to the earnest consideration of the members of the Committee. TREATMENT AT SCHOOL CLINICS. Defective Vision. 14 sessions have been held at the Alexandra School Clinic by Dr. A. E. A. Looseley, the Ophthalmologist. Glasses were prescribed in 79 cases (65 cases discovered at routine inspection, and 14 specially referred), and in seven other cases glasses were found not to be required, or to be useless on account of other defects. 13 Ringworm. 12 sessions have been held at the Alexandra School Clinic by Dr. D. Arthur, the Radiographer. 24 cases of Ringworm of the Scalp have been treated. Minor Ailments. Treatment is available for Minor Ailments at Clinics held at the Isleworth Public Hall on Monday and Thursday, and at the Alexandra Road School on Friday. During the year 241 treatments have been recorded. Dental Inspection and Treatment. In April, 1919, Mr. G. E. Fritche resigned the post of School Dentist, and Mr. I. Cohen was appointed. The time devoted to dental inspection and treatment was then increased to two half-days per week until December, when the time was further increased to three sessions per week. It was not, however, found practicable to commence the administration of gas at the Dental Clinic until the beginning of 1920. During 1919, the following dental work was carried out:— Children inspected 1,374 Found to require treatment 1,117 Children treated at Clinic 471 The children inspected were those of six, seven and eight years of age. That 81 per cent. of those inspected should require treatment is an indication of the need there exists for this branch of the School Medical Service. Mr. Fritche conducted 11 treatment sessions and gave 97 treatments, while Mr. Cohen held 43 treatment sessions and treated 374 children, the treatment including 330 extractions and 18G fillings. Now that the benefits of the Dental Clinic are becoming better known, and especially since gas administrations have been introduced, parents are consenting to treatment in larger numbers. There is, in fact, a large demand for treatment among the older children, who do not at present come under the inspection of the School 14 Dentist. It is a question, therefore, whether the Committee should not consider at an early date, the appointment of a full-time Dentist, and the provision of a more adequate Dental Clinic, to secure that all the children in the schools are inspected by the Dentist, and, where necessary, receive treatment. The far-reaching effects of dental decay in physical deterioration make it plain that expenditure on dental treatment is one of the wisest investments for the School Medical and Public Health Authorities. Charges for Medical Treatment. On the 14th October, 1919, the Education Committee revised the scale of charges for medical treatment, which is now as follows: — Spectacles ... Free in cases considered necessitous. Ordinary cases, 4/- per pair. When special frames ordered by parents, full cost. Ringworm Free in cases considered necessitous. Other elementary school cases, 2/6. Cases from other schools, according to circumstances of parents. Dental 6d. per attendance at Clinic. Minor Ailments Free. The new scale has enabled the Department to dispense with much vexatious enquiry into family circumstances in connection with cases needing treatment, and it has made it much easier to get the consent of parents to the treatment of their children. Much time is also saved in the collection of the charges and in book-keeping. DEFECTIVE CHILDREN During the year, further progress has been made in the Classification of Mentally Subnormal Children detailed examinations of fourteen having been made. Of these, the diagnoisis was deferred in four; three were found to be dull or backward; and eleven mentally deficient, nine being feeble-minded, one an imbecile and one an idiot. 15 The following is a list, made up to the end of 1919, of mentally deficient children belonging to this district:— Name. Sex. Date of Birth. School attended. W.S. M 18-4-04 G.R.B. W.L. M 8-2-05 G.R.B. J.B. F 4-2-06 S.G.G. G.W. M 11-5-06 W.R.I. W.T. M 19-10-06 W.R.M. M.C. M 10-4-07 W.R.M. W.C. F 12-4-07 I.B.G. E.C. F 2-5-07 H.R.C.M. A.E. M 8-5-07 I.B.B. J.H. M 17-8-07 Nil. P.B. F 5-9-07 H.R.C.I. E.S. F 5-3-08 S.G.G. E.R. F 3-9-08 G.R.G. B.C. F 12-9-08 A.G. B.E. F 22-9-09 H.G. S.F. M 21-2-10 S.G.B. E.B. M 24-2-10 B.E.I. L.C. M 4-3-10 W.R.I. E.C. F 7-3-10 H.R.C.M. E.R. M 2-5-10 I.C.B. V.K. F 26-9-10 G.R.I. The above children are all within the age dealt with by Local Education Authorities and are suitable for a Special School, but I am informed by the Secretary that there are no vacancies. The Committee should therefore consider the provision of such a school under their own administration. I understand that the Local Education Authorities of Middlesex discussed this matter iu 1914, and it was agreed that the County Authority should provide the necessary accommodation, but owing to the War, the project could not be proceeded with. 16 The following children are mentally deficient and are also subject to epileptic fits and are recommended for a special school :— Name. Sex. Date of Birth. School attended. p. ii. M 2-5-06 ... G.R.B. E.S. F 11-4-06 ... I.B.G. J.A. M 5-9-05 ... Nil. The under-mentioned are considered unsuitable for a special school:— Name. Sex. Birth date. Remarks. M.A. F 9-9-04 Physically defective. W.P. M 10-6-04 Imbecile. A.R. M 22-5-09 Imbecile. D.K. F 20-6-10 Imbecile. A.C. M 2-2-07 Idiot, epileptic, physically defective. E.H. F 21-7-04 Idiot. There are three children attending special schools ; by reason of mental defect, 1, and on account of epilepsy, 2. These latter are also mentally deficient. SANITATION OF SCHOOL BUILDINGS. In this district there are 13 public elementary schools, of which three are modern, the remainder being for the most part old and lacking in good sanitary conditions. As a result of the occurrence of an outbreak of Diphtheria at the Isleworth Blue Girls' School, a complete inspection of the premises was made and reported to the Education Committee, but little or nothing has been done to correct the unsatisfactory state of things found to exist. It is hoped to examine the schools in detail and submit particulars in the next Annual Report. 17 MISCELLANEOUS. Medical Examination of Teachers. During the year 19 medical examinations were made of teachers. In the majority of cases these were in connection with their appointments under the Authority. Holiday Home for Children. 29 medical examinations were made of children preliminary to their going to the King Edward VII. Memorial Home, Heme Bay. 18 (Heston and Isleworth). Table 1.-NUMBER OF CHILDREN INSPECTED IN 1919. Code Groups. Year of Birth.. Entrants. Intermediates. Leavers. Grand Total. 1913 PREVIOUS YEARSABSENTEES Total. 1910 PREVIOUS YEARS ABSENTEES Total. 1907 PREVIOUS YEARS ABSENTEES Total. Half-Year 1st 2nd 1st 2nd 1st 2nd Boys ... 132 96 33 261 181 166 46 393 178 187 37 402 1056 Girls ... 142 62 27 231 163 163 69 395 152 170 57 379 1005 Totals 432 60 492 673 115 788 687 94 781 2061 Medical Treatment Special Cases. Re-Examinations. No. examined 1586* 668 *These 1586 special cases involved 5236 examinations. 19 (Heston and Isleworth). Table II.—RETURN OF DEFECTS found in the Course of Medical Inspection in 1919. Defects or Diweaae. Code Groups. Specials. Number referred for treatment. Number reqniring to be kept under observation, but not referred for treatment. Number referred for treatment. Number requiring to be kept under observation, but not referred for treatment. 1 2 3 4 5 Malnutrition 1 105 Uncleanliness— Head 68 286 223 28 Body 6 98 8 — Skin — Ringworm Head 2 — 15 — Body —- 32 3 Scabies 10 — 52 1 Impetigo 9 2 339 5 Other Disease 12 17 80 21 Eye- Defective Vision & Squint 120 40 66 65 External Eye Disease 9 31 30 11 Ear— Defective Hearing 7 10 10 8 Ear Disease 10 79 12 3 Teeth— Dental Disease 82 25 19 — Nose and Throat— Enlarged Tonsils 82 254 4 2 Adenoids 9 5 10 10 Enlarged Tonsils & Adenoids 7 8 13 11 Defective Speech 2 — 2 2 Heart and Circulation— Heart Disease — 10 2 Organic 6 — — — Functional — 78 — — Antenna 12 17 14 7 21; Table II—Continued. Defects or Disease. Code Groups. Specials. Number referred for treatment. Number requiring to be kept under observation, but not referred for treatment. Number referred for treatment. Number requiring to be kept under observation, but not referred for treatment. 1 '2 3 4 5 Lungs— Pulmonary Tuberculosis— Definite 1 — 5 — Suspected — — — — Chronic Bronchitis 9 31 46 4 Other Disease — 3 8 2 Nervous System- Epilepsy 2 1 3 1 Chorea — — — — Other Disease 1 25 7 4 Non-Pulmonary Tuberculosis— Glands – – 1 – Bones and Joints 2 — 2 — Other Forms — — 1 — Rickets — 9 – — Deformities — 20 – — Other Defects or Diseases 1 25 4 2 21 (Heston and Isleworth). TABLE III.—NUMERICAL RETURN of all Exceptional Children in the area in 1919. Boys. Girls. Total. Blind (including partially blind) Attending Public Elementary Schools ... ... ... Attending Certified Schools for the Blind 1 1 2 Not at School ... ... ... Deaf and Dumb (including partially deaf) Attending Public Elementary Schools ... ... ... Attending Certified Schools for the Deaf 1 ... ... Not at School ... ... ... Mentally Deficient Feebleminded Attending Public Elementary Schools 11 11 22 Attending Certified Schools for Mentally Defective Children ... 1 1 Notified to the Local (Control) Authority during the year 2 ... 2 Not at School 1 ... 1 Imbeciles At School 1 ... ... Not at School 2 1 3 Idiots 1 1 2 Epileptics. Attending Public Elementary Schools 3 3 6 Attending Certified Schools for Epileptics 1 1 2 Not at School 1 1 2 Physically Defective Pulmonary Tuberculosis Attending Public Elementary Schools 10 6 16 Attending Certified Schools for Physically Defective Children ... ... ... Not at School ... ... ... Other forms of Tuberculosis Attending Public Elementary Schools 16 12 28 Attending Certified Schools for Physically Defective Children ... ... ... Not at School ... ... ... Cripples other than Tubercular Attending Public Elementary Schools 3 2 5 Attending Certified Schools for 1 ... 1 Physically Defective Children Not at School 2 1 3 (Heston and Isleworth). Table Ilia.—Shewing the number of SPECIAL CASES excluded, re-admitted, and under observation during 52 weeks ending 27th December, 1919. Cases remaining excluded at 28-12-18. Cases coming under observation during 52 weeks under report. Cases excluded during 52 weeks under report. Cases re-admitted during n2 weeks under report. Cases remaining excluded or underobservat'n at 27-12-19. No. of examinations made of enses during 52 weeks under report. Total No. days Attendances lost in cases excluded for a known period. 1 a Bingworm 9 47 44 49 6 222 1620 1 Other Diseases of skin 14 471 444 422 32 2136 7465 2a Defective Vision 1 66 1 2 – 70 368 2 Other affections of Eye 2 30 19 19 1 91 408 3a Carious Teeth 19 3 3 25 39 3 Other dis. of throat, nose, etc. 2 135 75 68 9 353 982 4a Pulmonary Tuberculosis 2 5 5 4 4 20 447 4 Other diseases of Lungs 5 58 52 45 11 123 1082 5 Other forms of Tuberculosis 3 4 4 2 4 17 33 6 Diseases of Heart & Circulat'n 2 43 32 28 4 131 588 7 Diseases of Nervous System 2 10 5 6 1 26 460 8 Mental Conditions 2 25 1 – 26 – 9 Physical Defects 1 4 2 3 – 7 42 10 Diseases of Digestive System 1 13 11 11 1 34 202 11 Other Diseases 6 149 136 130 15 360 2455 12 Nitty & Verminous Conditions 2 331 303 296 9 1313 2836 13 Other reasons 176 30 25 6 282 435 Totals 54 1586 1166 1114 103 5236 19462 23 (Heston and Isleworth). Table IV.—TREATMENT OF DEFECTS, 1919. (Cases discovered at Routine Medical Inspection). DEFECT. No. of dofects 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 ... ... ... ... ... ... ... ... ... ... 1 Other Diseases of Skin. 15 20 35 29 5 5 ... ... l 83.3 2a Defective Vision 236 122 358 350 8 4* 2 2+ 30 100.0 2 Other Conditions of Eve 25 17 42 33 6 2 4 3 66.6 3a Carious Teeth 654 207 861 693 69 15 53 1 99 41.0 3 Other dis.of mouth, throat, nose, &c. 732 266 998 743 102 64 37 1 153 39.7 4a Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... 4 Other Diseases of Lungs 9 30 39 33 5 4 i ... 1 83.3 5 Other forms of Tuberculosis 2 2 ... ... ... ... ... ... ... 6 Heart and Circulation 137 70 207 165 19 5 li 3 23 45.2 7 Nervous System 10 4 14 10 3 ... 2 1 1 75.0 8 Mental Conditions 24 24 20 2 ... 2 ... 2 50.0 9 Physical Defects I 5 6 2 2 1 1 ... 2 50.0 10 Digestive System 2 2 2 ... ... ... ... ... ... 11 Other Diseases 39 8 47 39 5 2 3 ... 3 62.5 12 Nitty and Verminous Conditions 80 14 94 77 15 13 2 ... 2 88.2 13a Clothing 103 8 111 89 18 8 10 ... 4 81.8 136 Footgear 191 33 224 183 37 26 11 ... 4 90.2 13c Nutrition 103 57 160 116 31 ... 31 ... 13 70.4 Totals 2361 863 3221 2556 327 149 170 8 341 48.9 •Including 30 dealt with at School Clinic. Dealt with at School Clinic; glasses not required or useless.