HES8 Heston & Isleworth Urban District Council. 1921. 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, 1921. 1921 REPORT ON The Health OF THE HESTON and ISLEWORTH URBAN DISTRICT FOR THE YEAR 1921. BY elwin h. t. nash, M.R.C.S.. L.R.C.P., D.P.H. Medical Officer of Health. Z 7 82. Public Health Department, Council House, Hounslow. April, 1922. To the Chairman and Members of the Heston and Isleworth Urban District Council. Ladies and Gentlemen, The Annual Report this year, which is designated by the Ministry, an ordinary report has been drawn up on the lines laid down in their Memorandum and reduced to the smallest compass consistent with those instructions. Dr. Berry left the services of the Council to take up the post of Medical Officer of Health of Bloemfontein, after which Dr. Eva Cairns Roberts acted as temporary Medical Officer of Health, until I took up my duties on June 13th, 1921. 1 do not intend to express any opinion so early after taking up my duties in many of the subjects arising in this report I beg to express my appreciation to the Council for the consideration shewn to me since my appointment. I am, Ladies and Gentlemen, Your obedient servant, Elwin H. T. NASH, Medical Officer of Health. THE HEALTH COMMITTEE of HESTON AND ISLEWORTH URBAN DISTRICT COUNCIL For the Year ending April, 1922. Members of the Council:— G. A. Griffith, Esq. (Chairman). J. J. Bonnett, Esq. (Vice-Chairman). C. Crush, Esq. j.p. ex-officio (Chairman of the Council). E. W. Heath, Esq. ex-officio (Vice-Chairman of the Council). F. W. Buckley, Esq. A. L. Lang, Esq. A. E. Hales, Esq. B. Langdon, Esq. Selected Members;— Mrs. E. J. Chedgey. Mrs. M. Mason. „ W. H. Dumsday. E. W. Goode, Esq. P. Murphy, Esq., j.p. Medical Officer of Health. Elwin H. T. Nash, d.p.h. 5 SUMMARY OF VITAL STATISTICS, 1921. Population— At tha Census, 1921 46,729 Registrar-General's estimate of nett 47,290 (Birth rate) Civil Population 45,932(Death rate) Birth rate (nett) 20.0 England and Wales 22.4 London 22.3 Death rate (nett) 11.28 England and Wales 12.1 London 12.4 Infantile Mortality Rate 69.4 per 1,000 births. England and Wales 83 „ ,, London 80 ,, „ Area 6,893 acres. Number of inhabited houses 9,097 „ of families or separate occupiers Not known. Rateable value £215,983 Sum represented by a penny rate £851 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 1921 :— £ s. d. Parish of Heston 1493 0 11 Parish of Isleworth 3891 17 8 £5384 18 7 6 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 315 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 1921, there were admitted 36'2 in-patients, whilst 886 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. Curative agencies directly or indirectly 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 1921, the estimate of nett civil population is given under two figures supplied by the Registrar-General. 7 The death-rate population (45,732) excludes all non-civilian males whether serving at home or abroad ; whilst the birth-rate (and marriage-rate) population (47,290) 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. Deaths. The number of deaths registered in the district was 1,029, but 547 of these did not belong to the district, while 34 residents died without the district. Thus the number of deaths properly attributable to the district was 516. Adopting the basis of the population estimated by the Registrar-General, the death-rate for the district comes to 11.28 per 1,000, which is comparable with the following figures 12.1 for England and 12 4 for London. 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 8. Births. The total number of births registered during the year was 1,027, but 91 of these did not belong to this district, while 14 births properly belonging to this district occurred outside the district. The nett number of births thus attributable to the district is 950. Adopting the population basis suggested by the Registrar-General for the calculation of the birth-rate, this comes to 20 09 per 1,000. The birth-rate of England and Wales is 22.4 per 1,000 and for London 22.3 per 1,000. Legitimacy. The following figures gives the number of births :— 8 Legitimate. Male. Female. Total. 549 453 910 Illegitimate. Male. Female. Total. 21 19 40 Infant Mortality. The figure obtained uuder 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. The rate for 1921 is 69.4 per 1,000 births. The rates for England and Wales and for London during the same period were 83 and 80 respectively. In view of the extremely hot summer these figures are most satisfactory. In 1912 the rate for this district was 85, and in 1918, 86; in 1920 it was 57; these were the lowest figures previously recorded. From the undermentioned table, it will be seen that the rate of infant mortality varies in a significant manner from Ward to Ward :— During 1921. Heston 89.3 Hounslow North 48.1 Hounslow South 84.0 Isleworth North 72.8 Isleworth South 51.9 The whole district 69.4 9 SANITARY CIRCUMSTANCES. Water Supply. 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 91 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. Drainage and Sewerage. The sewerage of almost the whole district is arranged on the " separate " system. In the western portion of the district, 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 1919 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 control of the Surveyor. The refuse is collected weekly and is disposed of by burning in a destructor. During the year there were supplied 217 new ashbins, and 7 ashpits were abolished. Sanitary Inspection of District. See pages 46 to 51. Nuisances, Contraventions of Bye-laws, Defective Drainage, etc. The number of premises on which nuisances were outstanding at the end of 1920 was 565. To these, other 932 premises whereat nuisances were recorded in 1921, were added, giving & 10 total of 1497 premises. Of these 801 had the nuisances remedied, leaving 696 premises at which nuisances still existed at the end of the year. During the year, nuisances at 97 houses were reported to the Health Committee, which added to the 40 brought forward from 1920, make a total of 137. 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 118 of the houses, leaving 19 cases to be carried forward in 1922. Comparative figures for the years 1919, 1920 and 1921 in connection with nuisances are submitted herewith :— 1919. 1920. 1921. Number of complaints received 265 598 496 Premises at which nuisances were located 655 1326 932 Informal Notices sent— First 571 1069 682 Second 232 385 213 Statutory Notices served 243 231 142 It is my duty once more to point out that the staff of Sanitary Inspectors is inadequate. It must be placed on record that twice during 1920, recommendations urging the appointmeut of a District Sanitary Inspector to fill the existing vacancy, were sent forward by the Health Committee to the Council, but were defeated. Premises and Occupations controlled by Bye-laws or Regulations. There are 319 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, etc. 11 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. FOOD. The following is the record of inspection of food premises:— No. of Inspections made. Meat 497 Fish 292 Provisions 309 Greengroceries and Fruit 458 Hawkers' Food Stuffs 253 Number of other Food Inspections 6 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. 76 inspections were carried out in respect of dairies and milkshops. The milk (Mothers and Children) Order, 1919, was rescinded by the Minister of Health during the spring of 1921, and Local Authorities must now obtain the sanction of the Minister under the Maternity and Child Welfare Act, 1918, to schemes for the supply of milk to nursing and expectant mothers and young children. In accordance with the desire for economy in this direction as expressed by the Ministry, a fresh scale for the distribution of free milk in this district was introduced. See page 21. 579 grants were made during the year. Unofficial milk analyses are made by the Medical Officer of Health. 1. Meat Inspection.—The Chief Sanitary and the District Sanitary Inspectors hold special certificates for meat inspection. Slaughter-houses and butchers' shops are visited periodically, but during the year no diseased meat was seized, but 368½ lbs. were surrendered. There are 8 slaughter-houses and 26 butchers' shops 12 in the district. Each of these received on an average 1.53 visits per month ; there is therefore room for improvement. 2. Public Abattoir.—There is no public abattoir in the district, nor are there any arrangements for meat being inspected at the time of slaughter. Killing may take place any time. 3. Action under Section 117, Public Health Act, 1875.—None during 1921. 4. Tubercular Meat.—There were none seized, but 276 lbs. were surrendered during the year. 5. The following tabular statement on slaughter-houses is required :— In 1914. In January, 1921. In December, 1921. Registered 6 4 4 Licensed 3 4 4 Total 9 8 8 The slaughter-houses as a whole are unsatisfactory. Sale of Food and Drugs Acts. I am indebted to Dr. C. W. F. Young, County Medical Officer, for the following report prepared by Mr. Robinson, the Chief Officer of the Public Control Department, as to the samples purchased in this area during 1921. List of Samples purchased :— Article. No. taken. Adulterated Milk 350 23 Separated milk 20 1 Cream 1 — Preserved cream 1 — Butter 11 Cake 3 2 Camphorated oil 1 — Calves-foot jelly 1 — Cocoa 1 — Dripping 1 — Tincture of Iodine 1 — Tablet jelly 1 — 392 26 13 Milk. Of the 23 samples of milk reported against, 17 were informal samples. The six formal samples of milk reported against were all deficient in non-fatty solids to the extent of 2% only. Separated Milk. One sample of separated milk contained boric acid, and the vendor was prosecuted and fined £2. UNSOUND FOOD, 1921. Tons. cwts. qrs. lbs. Fruit ... 4 3 18 Bacon 3 0½ Meat ... 5 3 o½ Fish ... 5 2 24 Butter 5½ Total quantity surrendered, 17 cwts., 0 qrs., 20½ lbs. INFECTIOUS DISEASE. General Remarks. The chief illnesses which have affected the district have been Influenza of the mild type with a certain iucrease in the accompanying Pneumonia and to a comparatively small amount of Diarrhoea and Sickness, this latter being extremely small compared to what was anticipated in view of the exceptionally hot summer. The table on page 39 sets forth by months the number of cases of infectious diseases notified during the year, 1921. It will be observed on reference to this table that there were 220 cases of Scarlet Fever notified during 1921. This disease has been more prevalent in the district in common with others in the Greater London area, since 1919. During the year there were 6 return cases of this disease, all the originating ones having been treated at Mogden Isolation Hospital. 14 The table hereunder gives the number of cases of Scarlet Fever and Diphtheria that occurred in the several Institutions in the district during 1921 :— Scarlet Fever. Diphtheria. Isleworth Infirmary 11 2 Nazareth House 1 — North Hyde Schools — 1 Gumley House 1 — Royal Naval School 5 — Boys' Home, Barrack Road — 3 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 219 „ ,, removed to Hospital 197 Percentage of cases removed to Hospital 89.5 One case was also reported among the military population and removed to hospital. The incidence rate of Scarlet Fever in the civil population was 4.68 per 1,000. Six deaths took place from this cause during the year. The mortality rate was 18 per cent. 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 100 ,, ,, removed to Hospital 95 Percentage of cases removed to Hospital .. 95 In addition to these cases two military cases were reported and removed to Hospital. The incidence rate per 1,000 of the civil population was 214. Thirteen cases occurred in public institutions during the year, 11 of the persons affected being non-residents. 12 deaths took place from this disease, i.e. a case mortality rate of 13 per cent. 15 Diphtheria Antitoxin. During 1921, 30 vials of Antitoxin were supplied to medical practitioners. (18-2,000 units and 12-4000 units). Typhoid Fever. There were five cases notified during the year. Dysentery. One case was notified. Erysipelas. 16 cases of this disease were notified, of whom nine were institutions cases, the persons affected being non-residents. No deaths were recorded from this disease. Puerperal Fever. 10 cases of this disease were notified, all were institution cases, the persons affected being non-residents. Ophthalmia Neonatorum. Three children were notified as suffering from this disease. Encephalitis Lethargica. There were two cases notified of this disease. Cerebro Spinal Fever. One case of this disease was notified and proved fatal. Acute Poliomyelitis. There was one case notified. Pneumonia. 43 cases were notified, 17 being non-residents in the Infirmary. Malaria. One case was notified, being a recurrence. Pulmonary Tuberculosis. The number of new cases notified during the year was 48. 22 cases (or over 45%) were notified from Institutions :— Sanatoria 15, Infirmary 1, General Hospitals 6. 16 The targe proportion of cases which come under observation for the first time as a 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 11. Seven of them were notified as receiving institutional treatment. 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 :— Measles 10 Rubella 8 Chicken Pox 166 Mumps 167 Whooping Cough 125 Upon receipt of information of the existence of a case, inquiry is made by a Health Visitor to obtain all necessary facts. Influenza. The mortality from Influenza was 24 per 1,000. Small-Pox. No vaccinations were performed by the Medical Officer of Health under the Public Heath (Small-Pox Prevention Regulations, 1917, during the year under review. Cleansing of Verminous Persons. Particulars are asked for as to the facilities available in the district for the cleansing and disinfection of verminous persons and their belongings. Neither the Education Authority nor the Sanitary Authority possesses a cleansing station. This matter has been brought to the 17 notice of the Education Committee on many occasions. Where application is made, the Health Department undertakes the spraying of rooms for the removal of bed bugs, and bedding and clothing generally can be disinfected by steam at Mogden Isolation Hospital. MATERNITY AND CHILD WELFARE. The Inspection of Midwives is under the supervision of the County Council. It is, however, generally recognised that the authority administering a Maternity and Child Welfare Scheme should also exercise control over the Midwives practising in its area. During the year, it was necessary to report to the Supervising Authority one Midwife in connection with a case of puerpural fever. In this district it is the practise of the Health Visitors not to visit the newly-born till 14 days after the birth, in order not to interfere with the Midwife. Were the Local Authority the supervising one under the Midwives Acts, visits might be made earlier and such conditions would be bound to receive attention, for Midwives to avoid reprimand, would find it wiser to comply with the rules. The Municipal Midwife appointed during 1920, attended the following number of cases, but there does not appear to be sufficient demand in the district for the services of a whole time Municipal Midwife and the retention of her services is being re-considered. What is wanted much more is a Lying-in-Home Visits. Confinements attended 32 Post-Natal 400 Attendances at Clinics 74 Ante-Natal 700 According to the County Medical Officer's last list, there are 23 Midwives practising in the district. Work at Clinics. Owing to the increase in this work it was necessary to add an extra session both at the Council House and at Isleworth. During the summer months the infant consultations increased 18 enormously and there has been a steady increase on the whole throughout the year, in fact that work has now got to such a stage that the provision of a further session must be considered shortly. The ante-natal work ebbs and flows, but is not up to the standard one would like to see. The difficulty in both centres is, that the premises are not adequate for the purpose. The three clinics at the Council House and two at the Isleworth Public Hall have remained open throughout the year. The attendances totalled 7,575 for the year as compared with 3,599 in 1920. The average attendance at the Council House being 40 2 and at the Isleworth Centre 38 8. In accordance with the recommendations of the Ministry, a third centre was opened at Heston on the 4th January, but owing to the extremely scanty attendance. only five mothers attending in three sessions, it was closed down again. The arrangements with chemists for the dispensing of prescriptions on terms similar to those under the National Insurance Act, have been continued. During the year 8,173 lbs. of glaxo and 5.34 lbs. of Virol, 335 lbs. Malt Extract, 238 lbs. Cod Liver Oil with Malt, 23 pkts. Lactagol, 9 lbs. Marylebone Cream were distributed and have been greatly appreciated by the mothers attending the Clinics. The increase in the number of mothers and children is shewn hereunder :— Council House, Hounslow. Isleworth Public Hall. 1919. 1920. 1921. 1919. 1920. 1921. Mothers 199 315 538 139 170 268 Children 250 407 774 162 185 296 There are no facilities at present for the treatment of dental defects in nursing and expectant mothers nor for any other treatment for children under five years of age. With the advent of hot weather in July, the Committee authorised the publication of posters which were made as striking as possible :— HESTON & ISLEWORTH URBAN DISTRICT COUNCIL. INFANTILE DIARRHOEA. The continuance of the hot weather is practically certain to produce a severe outbreak of Diarrhoea amongst bottle fed babies. This form of epidemic Diarrhoea is generally accompanied by sickness, and is extremely serious and often fatal. The last HOT SUMMER was 1911. In 1911 the deaths from Infantile Diarrhoea were 550 per cent. greater than in 1910! In 1911, amongst infants under 12 months old, the deaths from Diarrhoea were 28 times as many as the deaths from TYPHOID FEVER, SCARLET FEYER and DIPHTHERIA together ! Summer Diarrhoea is mainly due to germs which thrive in dirt in some form, such as Dirty Milk, Dirty Jugs to contain Milk, Dirty Feeding Bottles, Dirty Teats, Dummies (which are always dirty) also Dirty Houses, Dirty Yards, Dirty Dustbins, and Flies Attracted by Dirt. To protect your children avoid as far as possible all of the above causes. NOTE. Boil all your milk directly it is delivered. Put it into a jug that has been thoroughly scalded out. Stand this jug in a basin of cold water and cover it at once with a piece of muslin to keep out the flies. Boil your babies' bottle and teat at least once a day, and keep them in clean cold water when not in use. Cleanse them thoroughly after each feed. Don't wean a baby during July, August or September, without medical advice. If you notice bad smells near your house, or your baby gets Diarrhoea, send word to the Health Department, Council House, Hounslow. N.B.-IF YOUR BABY GETS DIARRHOEA, GET MEDICAL TREATMENT IMMEDIATELY. Delay is Dangerous July, 1921. Elwin H. T. Nash, Medical Officer of Health. 20 HESTON & ISLEWORTH URBAN DISTRICT COUNCIL During the continuance of the HOT WEATHER MOTHERS! Breast Feed Your Babies ! ! IF YOU CANNOT, DON'T TRY ANY OTHER METHOD Until you have been advised what to do, either by 1. Your Own Doctor ok 2. The Infant Welfare Clinics. The Infant Welfare Clinics are, open at the Council House, Hounslow — Monday, 2-4 p.m. Thursday, 2-4 p.m. Public Hall, Isleworth — Wednesday, 2-4 p.m. N.B.—IF YOUR CHILD GETS DIARRHOEA TAKE IT TO A DOCTOR IMMEDIATELY. Council House, Hounslow. Elwin H. T. Nash, Medical Officer of Health. 21 Home Help for Mothers. The Home Help paid 349 visits during the year and her work was found of considerable value. Grants of Milk and Food. The scale of grants for provision of milk have been fixed as follows :— Where the amount per head is less than 4/- the grant is free. Where the amount per head is over 4/- but less than 5/-, the recipient pays one-third of the cost. Where the amount per head is 5/- but less than 7/6, the amount paid is two-thirds of the cost. Where the amount per head is 7/6, no grant is made. Previous to April, 1921, milk was supplied free or at reduced rates to expectant mothers (during last three months of pregnancy) to nursing mothers, and to children under five, according to the full scale. Where the family income after deducting rent, was less than 8/- per head free. 8/—9/- per head parent pays ¼ cost. 9/—10/- „ „ „ ½ „ 10/—11/- per head „ ,, ¾ ,, 22 CLINICS AND TREATMENT CENTRES IN THE DISTRICT. The two Maternity and Child Welfare Centres are kept almost entirely for consultation purposes, treatment being reduced to an absolute minimum so as not to clash in any way with local Medical Practitioners. The only Day Nursery in the district was closed last year. There are two School Clinics at each of which the Medical Officer attends twice a week, and at which treatment for minor ailments is carried out on five mornings in the week. The Tuberculosis Clinic which is part of the County machinery is situate in Hounslow in the centre of a populous district. There is no clinic for Veneral Diseases. Professional Nursing in the Home The Isleworth Nursing Association carried on this work throughout the district. There is an arrangement with them also for nursing Measles and Whooping Cough. No payments are made either by the County Council or by the Local Authority. Home Visiting. The visits by the Health Visitors are shewn in the following table : — 1919. 1920. 1921. 1st visits to babies under one year 667 1132 1029 Re-visits to babies and children up to five years 3311 4715 4484 Inquiries made, elicited— Feeding—Natural 469 870 631 Artificial 48 59 54 Both 17 23 51 Sleeping with parents 300 477 354 Using Comforter 182 300 236 Mother working during pregnancy 73 56 45 23 VOLUNTARY SOCIETIES AND HELPERS. The Isleworth Nursing Association is the only Voluntary Society in direct contact with the Council's Maternity and Child Welfare Scheme. Acknowledgement must be made of the interest taken and useful help rendered by the members of the Womens' Co-operative Guild, Mrs. Dollaston, Mrs. Bartlett and Mrs. Luto, assisting at the Hounslow Clinic, Mrs. Evans at the one held at the Isleworth Public Hall. During the present year the Isolation Hospital accommodation has been taxed to its utmost and the Medical Officer of Richmond and I both reported that we considered extensions necessary. The report at the end of the year is under consideration. Hospitals provided or subsidised by the Local Authority or by the County Council :— 1. Tuberculosis.—The County Council have two institutions : The Bell Road Hospital, with 16 beds, and a section of the West Middlesex Hospital. 2. Maternity.—There is no definite provision in the district other than the West Middlesex Hospital (Guardians) for maternity cases apart from private nursing homes charging considerable fees. There are a few beds in the Hounslow Hospital and cases can also be dealt with at the West HOSPITALS. INFANT DEATHS, STILL BIRTHS, MEASLES, etc. Infant Deaths: visits paid 52 Still Births noted 32 Measles 21 Whooping Cough 160 Ophthalmia Neonatorum 8 (3 cases) No special measures exist for dealing with unmarried mothers or illegitimate children as such, but cases not wholly destitute have derived benefit through the Council's scheme for grants of food and milk. 24 Middlesex Hospital, but the great majority of the cases which come under the notice of the Public Health Department are dealt with by the large London Hospitals. 4. Fever.—This district joins with Richmond in the form of a Joint Hospital Board, which is responsible for the Mogden Hospital dealing with Scarlet Fever, Diphtheria and Enteric, and the Dockwell Hospital with 13 beds for the accommodation of Smallpox. 6. The Hospitals in the district are the West Middlesex Hospital which is the Poor Law Infirmary. The Hounslow Hospital with 27 beds, which is entirely supported by voluntary contributions and the Mogden and Dockwell Hospitals for Infectious Diseases and Smallpox supported from the rates by the Councils of Heston and Isleworth and Richmond. There is practically no difficulty in getting cases into the West Middlesex Hospital, but there is no out-patient department. The Hounslow Hospital has a staff of consultants, but there appears to be a feeling for preference for the larger Hospitals with national reputation such as Gt. Ormond Street, Queen's Square, Brompton, Chelsea Hospital for Women and the larger hospitals. The difficulty in connection with this however, is that it entails a considerable expense, which many of the parents can ill afford and in other cases where specialised treatment is wanted, there is often considerable difficulty in obtaining the necessary letters demanded by the Hospital. AMBULANCE FACILITIES. (a). For Infectious Cases.—This is provided by the Joint Hospital Board. (b). For Non-Infectious and Accident Cases.—There are none in the district. 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. 25 *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. COUNCIL LABORATORY. (a). Swabs for Diphtheria. Positive. Sent by Medical Practitioners 162 50 Taken at Schools, School Clinics and from Contacts 570 44 732 94 26  Positive. (b). Specimens of Sputum for Tubercle Bacilli Sent by Medical Practitioners 60 5 (c). Hairs for Ringworm. Taken at Schools or School Clinics 56 47 (d). Specimens of Pus 9 „ „ Urine 55 „ ,, Vaginal discharge 5 „ ,, Eye discharge 1 Films examined 1 Widal 1 negative. (e). Milk Analysis. Samples taken 23 Showed added water 2 (f). Water Analysis 2 Evidence of pollution 2 (g). Virulency Test 1 Preparation of Materials. Tubes of Serum 1149 Throat Swab Outfits 800 Sputum Outfits 74 SANITARY ADMINISTRATION. Staff. The following persons constituted the staff of the Health Department on the 31st December, 1921:— Medical Officer of Health— Elwin H. T. Nash, M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Offieer of Health— Mrs. E. Cairns Roberts, M.B., D.P.H. Inspector of Nuisances— R. H. Butler, Cert. as S.I., M.I. and S.E. 27 District Sanitary Inspectors— G. W. Ashworth, Cert. as S.I. and M.I. S. H. Franklin, Cert. as S.I. and M.I. One vacancy. Disinfector and Laboratory Attendant— J. H. Cobb. Health Visitors— Mrs. C. E. M. Ottley, Cert. as H.V., S.N., M.C.W.W. and C.M.B. Miss B. M. Tetley, Cert. C.M.B Miss G. P. Chatfield, Cert. as H.V., S.N. and C.M.B. Mrs. A. E. Tyrrell, Cert. as H.Y., S.N. and C.M.B. Miss W. E. C. Scott, Cert. as H.Y., S.N., M.C.W.W. and C.M.B. Midwife— Mrs. R. Barcroft, Cert. C.M.B. Home Help— Mrs. E. Yates. Chief Clerk— A. G. Hubbard. Clerks— F. G. Boto. Miss R. Marshall, Cert. R.S.I. Miss W. L Rogers. Miss O. Parfitt. E. Cromwell. J. Holmes. HESTON & ISLEWORTH URBAN DISTRICT COUNCIL. Public Health Department, Council House, Hounslow. 2nd February, 1922. 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 ended 28 31st December, 1921, 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 (Chief Sanitary Inspector), G. W. Ashworth and S. H. Franklin (District Sanitary Inspectors), are appointed to act as Canal Boat Inspectors. No special remuneration is paid for the position. Number of Inspections, etc. During the year 20 inspections were made of 17 boats, 12 boats were in order and on each of four boats one infringement and on one boat three infringements of the and Regulations were found. The nature of the contraventions were as follows:— (a). No vessel provided for storing drinking water. (b). No registration marks on boat. (e). Overcrowding. (d). Interior of after cabin dirty (2). (e). Improper marking of boat. (f). After cabin not in a habitable condition. 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. I am, Sir, Your obedient servant, ELWIN H. T. NASH, Medical Officer of Health. The Secretary, Ministry of Health, Whitehall, S.W. 1. HOUSING. There is at present a considerable amount of overcrowding in the district, not so much legal overcrowding as moral overcrowding. The condition is rendered much more difficult by the 29 refusal to let furnished rooms to families with children. It is almost a universal statement of those in the overcrowded premises, that having made repeated attempts to obtain accommodation elsewhere they have been immediately refused as soon it was known that there was a family of children. It is true that to a certain extent people have become accustomed to sharing a house with other families, but the Minister's statement, that overcrowding does not exist to a serious extent would appear from the reports given by my Health Visitors to be incorrect, if moral overcrowding is taken as a standard and not legal overcrowding. SHOPS ACTS. The number of contraventions of the Acts which were reported during the year was as follows:— Open on half-holiday 5 Open after closing hour 2 Notices not exhibited 32 Notices not in prescribed form 2 Notices (Assistants) not exhibited 4 PROCEEDINGS. Proceedings were taken during the year in respect of:— (a) re-letting of a house in respect of which a Closing Order was in force, and (b) the sale of non-exempted articles after the legitimate closing hour. In the case of (a) a fine of £10 was imposed upon the owner and (b) a fine of 10/- and costs to the extent of £1:1:0 was imposed. HOUSING. I. 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. 30 (c) How far defects are due to the lack of proper management and supervision by owners: The defects found are in the main, due to owners neglecting to have repairs carried out. (2) Action taken as regards unfit houses under: (a) Public Health Acts See appendices. (b) Housing Acts ,, (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:—a weekly collection is made. II. Unhealthy Areas. Information as to complaints received or representations made and action taken in regard to unhealthy areas, under Part I. or Part II. of the Housing Act of 1890: Nil. 31 III 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. 1Y. General and Miscellaneous. Other action taken in connection with overcrowding, insanitary-property and housing Nil. V. Appendices, Statistics for year ending 31st December, 1921. 32 APPENDICES. Housing Conditions Statistics. Year ended 31st December, 1921. 1. GENERAL. (1) Estimated population Birth rate 47,290 Death rate 45,732 (2) General Death Rate 11.28 (3) Death Rate from Tuberculosis .98 (4) Infantile Mortality 69 4 (5) Number of dwelling houses of all classes 9,066 (6) *Number of working-class dwelling houses 4,565 (7) Number of new working-class houses erected by Council 184 *Number of new houses other than working class 31 2. UNFIT DWELLING-HOUSES. I. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 500 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 2 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 307 (5) Number of houses, listed for inspection under the Housing (Inspection of District) Regulations, 1910, at end of year 1519 33 II. Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered lit in consequence of informal action by the Local Authority or their Officers 343 III. Action under Statutory Powers. A. Proceedings under Section 28 of the Rousing Town Planning, etc. Act, 1919— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 15 (2) Number of dwelling houses which were rendered fit— (a) by owners 8 (b) by Local Authority in default of owners nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close nil. B. Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 28 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 40 (b) by Local Authority in default of owners Nil. C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc. Act, 1909— (1) Number of representations made with a view to the making of Closing Orders 1 34 (2) Number of dwelling-houses in respect of which Closing Orders was made 1 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 1 (4) Number of dwelling-houses in respect of which Demolition Orders were made ... nil. (5) Numbor of dwelling-houses demolished in pursuance of Demolition Orders nil. D. Proceedings under Section 32 of the Housing, Town Planning, etc. Act, 1919— Number of prosecutions taken for letting, attempting to let, occupying or permitting to occupy houses ordered to be closed 1 3. UNHEALTHY AREAS. Areas represented by the Local Authority with a view to Improvement Schemes under (a) Part I. or (b) Part II. of the Act of 1890 nil. (1) Name of area – (2) Acreage – (3) Number of working-class houses in area – (4) Number of working-class persons to be displaced – (4) Number of houses not complying with the building bye-laws, erected with consent of Local Authority under Section 25, of the Housing Town Planning, etc. Act, 1919 5 (5) Staff engaged on housing work with, briefly, the duties of each officer (6) Staff engaged in housing work:— The outdoor staff of the Health Department consists of normally of one Chief Inspector and three District Inspectors. 35 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. 36 Table I. shewing dwelling-houses represented as unfit for human habitation. Premises. No. of houses represented by M.O.H. Date of representation. Date Closing Order made Date Closing Order determined. Date Demolition Order made. Date Demolition Order obeyed. Date Demolition Order enforced. Br't forw'd from 1920— *1.3, Poplar Cottages 3 8/1/14 24/2/14 ... 22/12/14 ... ... ‡15, South Street 1 11/1/15 27/4/15 ... 23/11/15 ... ... 1.4, Baker's Cottages 4 3/6/15 23/11/15 ... ... ... ... †14-34, London Road 11 12/5/19 22/7/19 ... ... ... ... + 1-10, Syon Place 10 ,, ,, ... ... ... ... The Depot, North Hyde 1 10/11/19 23/12/19 28/6/21 ... ... ... +65-75, Hanworth Road 6 12/1/20 23/11/20 ... ... ... ... 175, Twickenham Road 1 12/1/20 26/4/21 ... ... ... ... 177. 1 ,, ... ... ... ... ... 1, Wellington Road North 1 9/2/20 ... ... ... ... ... 3, ,, ,, ,, 1 9/2/20 ... ... ... ... ... 5, ,, ,, ,, 1 9/2/20 28/7/20 ... ... ... ... Inspected in 1921— 10, South Street 1 10/10/21 22/11/21 ... ... ... ... *17/4/14 Notices served on tenants of Nos. 1, 2 and 3 and complied with. 16/3/16 Demolition ordered in default of owner. 16/10/17 Notices served on new tenants of Nos. 1 & 3. 31/12/20 Nos. 1, 2 & 3 occupied. †Closing Orders not served. ‡Demolition deferred until after the War. 37 Table II. Causes of Deaths during 1921. Causes of Death. Civil Residents all ages. Male. Female. All causes 2.59 257 1 Enteric Fever ... ... 2 Small-pox ... ... 3 Measles ... 1 4 Scarlet Fever 2 4 5 Whooping Cough 4 ... 6 Diphtheria 9 3 7 Influenza 8 3 8 Encephalitia Lethargica ... ... 9 Meningococcal Meningitis ... ... 10 Tuberculosis of Respiratory System 22 16 11 Other Tuberculous Diseases 2 5 12 Cancer, Malignant Disease 23 36 13 Rheumatic Fever 1 1 14 Diabetes 4 4 15 Cerebral Haemorrhage, &c. 8 13 16 Heart Disease 29 39 17 Arterio-sclerosis 6 3 18 Bronchitis 20 24 19 Pneumonia (all forms) 21 20 20 Other Respiratory Diseases 4 3 21 Ulcer of Stomach or Duodenum 1 1 22 Diarrhœa, etc. (under 2 years) 7 8 23 Appendicitis and Typhlitis 3 ... 24 Cirrhosis of Liver 1 2 25 Acute and Chronic Nephritis 6 4 26 Puerperal Sepsis ... 3 27 Other Accidents and Diseases of Pregnancy and Parturition ... ... 28 Congenital Debility and Malformation, Premature Birth 18 8 29 Suicide 2 5 30 Other Deaths from Violence 12 4 31 Other Defined Diseases 46 47 32 Causes ill-defined of unknown 1 ... According to figures furnished by the Registrar-General. Table III. Infantile Mortality during the year 1921. 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 3 mts. 3 mts. and under 6 mts. 6 mts. and under 9 mts. 9 mts. and under 12mts. Total Deaths under 1 year. Certified 19 5 2 12 38 8 10 6 4 66 Smallpox Chickenpox Measles Scarlet Fever Whooping Cough ... ... ... ... ... ... ... 1 ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... 1 1 Erysipelas Tuberculous Meningitis Abdominal Tuberculosis Other Tuberculous Diseases Meningitis (not Tuberculous) ... 1 ... 1 2 ... ... ... 1 3 Convulsions ... ... ... 1 1 1 ... ... ... 2 Laryngitis ... ... ... ... ... ... 1 ... ... 1 Bronchitis ... ... ... ... ... 1 1 1 2 5 Pneumonia (all forms) ... 1 ... 1 2 2 2 1 ... 7 Diarrhœa ... 1 ... 1 2 ... 1 ... ... 3 Enteritis ... ... 2 1 3 1 3 2 ... 9 Gastritis ... ... ... ... ... 1 ... ... ... I Syphilis Rickets Suffocation, overlying 1 ... ... ... 1 ... ... ... ... 1 Injury at Birth Atelectasis 4 ... ... ... 4 ... ... ... ... 4 Congenital Malformations 1 ... ... ... 1 ... ... ... ... 1 Premature Birth 9 1 ... 1 11 ... ... ... ... 11 Atrophy, Debility and Marasmus 2 ... ... 4 6 1 2 ... ... 9 Other Causes 2 1 ... 2 5 1 ... 1 ... 7 19 5 2 12 38 8 10 6 4 66 Nett Births Legitimate 910 Illegitimate 40 Nett Deaths Legitimate infants 58 Illegitimate infants 8 39 Table iv—A Infectious Diseases, 1921. Cases Notified. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Erysipelas. Cerebrospinal Fever. Encephalitis Lethargica. Poliomyelitis. Pneumonia. Malaria. Pulmonary Tuberculosis. Other forms of Tuberculosis. Ophthalmia Neonatorum. Dysentery. January 17 10 ... 2 2 ... 2 ... 5 ... 4 ... ... ... February 29 21 ... ... 2 ... ... ... 15 ... 3 1 1 ... March 9 6 ... ... ... ... ... ... 7 ... 4 1 ... ... April 17 6 ... ... 1 ... ... ... 1 ... 6 4 ... 1 May 10 3 ... ... 1 ... ... ... 4 ... 1 1 ... ... June 13 7 ... 1 ... ... ... ... ... ... 3 ... 1 ... July 15 13 ... 2 1 ... ... ... 4 ... 6 ... ... ... August 10 10 1 ... 1 ... ... ... 2 ... ... ... ... ... September 16 8 ... ... ... ... ... ... ... ... 1 1 ... ... October 34 4 1 3 1 ... ... ... 1 I 6 I 1 ... November 28 9 1 1 3 ... ... ... 2 ... 3 2 ... ... December 22 5 2 1 4 1 ... 1 2 ... 6 ... ... ... Totals 220 102 5 10 16 I 2 1 43 1 43 II 3 1 40 Table IV.—B. Cases of Infectious Disease notified and Cases removed to Hospital during 1921. Disease. Notified. Admitted to Hospital. Deaths. Small-pox ... ... ... Enteric Fever 5 5 ... Scarlet Fever 220 197 6 Diphtheria 102 95 12 Erysipelas 16 ... ... Puerperal Fever 10 4 3 Ophthalmia Neonatorum 3 .. ... Acute Poliomyelitis 1 ... ... Cerebro Spinal Fever 1 ... ... Pneumonia 43 ... 41 Malaria 1 ... ... Encephalitis Lethargica 2 ... ... 41 Table IV.—C. Deaths from Notifiable Infectious Diseases, 1921 Age Groups. Under 1 year. 1 year. 2 years. 3 years. 4 years. 5 years. 10 years. 15 years. 20 years. S5 years. 45 years. 65 years and over. Scarlet Fever ... ... ... l ... 5 ... ... ... ... ... ... Diphtheria ... 2 l l ... 4 3 l ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... 2 l ... ... Pneumonia 6 5 l 2 ... 2 1 2 1 l 12 8 Pulmonary Tuber. ... ... ... ... ... ... 2 1 15 8 10 2 Other Tuberculosis ... 1 ... ... ... ... 1 1 ... 2 1 1 42 Heston and Isleworth, 1921. TUBERCULOSIS. Notifications. Pulmonary—New Notifications 43 Cases admitted to Sanatoria or Hospital 44 Cases discharged from Sanatoria or Hospital 36 Eleven of the new notifications were admitted to Institutions during the year, five of which were discharged later. Fourteen of the cases admitted to Institutions were discharged during the same year, three of which subsequently died. Sputum and the Work of the Council Laboratory. Out of 43 new cases of Pulmonary Tuberculosis notified during 1921, only 5 had specimens of sputum sent to the Laboratory for examination. Pour of these were positive, one was negative. There were 59 specimens sent for examination, of these 5 were positive. In only 2 cases was a second specimen sent, and in one of these a second examination proved positive. Deaths—Pulmonary. There were 38 deaths during the year. Ten were primary notifications, three of which were notified after death. Eleven cases were not notified at all. Report on the administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. Table V.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections madk by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory Laundries) 37 3 Nil. Workshops (including Workshop Laundries) Workplaces (other than Outworkers' premises 89 3 included in Table VII. 37 ... Total 163 6 Nil. Table VI.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) w (5) Nuisances under the Public Health Acts:Want of cleanliness 1 1 Want of ventilation 1 Overcrowding Want of drainage of floors Other nuisances 3 3 †Sanitary accommodation— Nil. Nil. Insufficient Unsuitable or defective 9 5 Not separate for sexes 1 1 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S.101) Breach of special sanitary requirements for bakehouses (ss. 97-100) 2 1 Other offences (excluding offences relating to outwork which are included in Table VII. Total 16 12 Nil. Nil. †Section 22 of the public Health Acts Amendment Act, 1890, has been adopted by the District Council, and the standard of sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops enforced is that required by the Sanitary Accommodation Order of 4th February, 1903. 44 Table VII.—HOMEWORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Outwork in unwholesome premises, Section 108. Outwork in infected premises, Sections 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices Served. Prosecutions. Instances. Orders made (s. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending onoe in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors Workmen. Contractors Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10 (11) (12) (13) (14) (15) (16) Wearing Apparel— making, &c. ... ... ... 3 ... 5 3 ... ... ... ... ... ... ... ... cleaning & washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Household linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... ... ... ... †1 ... ... *1 ... ... Total ... ... ... 3 ... 6 3 ... ... 1 ... ... 1 ... ... *A resident at the premises occupied by this outworker was notified as suffering from Diphtheria and removed to hospital. †A Closing Order has been made with respect to the premises occupied by this outworker. Number of outworkers on register, 21. Inspections made 21. Number of Lists received from other Sanitary Authorities, 13 (sent twice in the year, 5). 45 Table VIII.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) *Bakehouses (Retail)—Workshops 15 Laundries (non-factory) 24 Workshops 156 Workplaces 34 Total number of workshops on Register 229 *In addition there are in the district 10 Retail—Factory Bakehouses. Table IX.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts, (S.133, 1901) — Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory Acts (S.5, 1901)— — Notified by H.M. Inspector 7 Reports (of action taken) sent to H.M. Inspector 6 Other – Underground Bakehouses (S. 101).— In use at the end of the year 1 *Retail—Factory Bakehouse. 46 SANITARY WORK, etc. Inspections—General: Total number of inspections and re-inspections, etc., (excluding shops and petroleum) 7983 Inspections, etc. re Nuisances and Contraventions, etc: Number of premises, etc. inspected on complaint 581 Number of premises inspected in connection with infectious diseases 150 Number of premises inspected under Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 37 Number of other visits made to premises, etc. in connection with nuisances 811 Total number of premises, etc. primarily inspected in connection with nuisances 932 Number of visits made to works in progress 550 Number of interviews with owners, builders, etc., re abatement of nuisances 657 Action taken (other than under Housing Acts, 1909-1919): Number of premises, etc., in respect of which notices, etc., were served requiring defects to be remedied 828 Number of premises on which defects to be remedied— (a) by owners 801 (b) by Local Authority in default of owners 5 Number of cautionary or intimation notices given— (a) verbal 70 (b) written 682 Number of second (informal) notices given 213 Number of letters re nuisances sent 304 Number of statutory notices issued 142 Number of proceedings taken – Number of convictions obtained – Number of proceedings withdrawn – Number of cases dismissed – Common Lodging Houses: Number registered 2 Number of inspections made 7 47 Canal Boats used as dwellings: Number of inspections made 20 Number of contraventions found 7 Movable Dwelling, Caravans, Tents, etc: Number observed during the year 17 Number of inspections made 22 Number removed from district 10 Bakehouses: Number in district— (a) factories 9 (b) workshops 16 Number of underground bakehouses in district (factory) 1 Number of inspections made 23 Number of contraventions found 3 Number cleansed 3 Slaughter-houses: Number on register— (a) registered premises 4 (b) licensed premises 4 Number of inspections made 133 Number of contraventions found 2 Number repaired of improved 1 Number of accumulations of offal removed 1 Cowsheds: Number of persons registered 10 Number of cowsheds on register 16 Number of milch cows in districts (registered premises) 82 Number of inspections made 19 Number of contraventions found 5 Dairies and Milkshops: Number of persons registered 40 Number of premises on register 35 Number of inspections made 76 Number of contraventions found 2 Number constructed or re-constructed 2 Number cleansed 1 48 Offensive Trades: Number of businesses established in district 13 Number of businesses newly established during period 1 Number of inspections made 163 Number of contraventions found 11 Number repaired or improved 5 Number cleansed 4 Inspections of Food: Number of meat inspections 497 Number of fish inspections 292 Number of provision inspections 309 Number of fruit and greengrocery inspections 458 Number of hawker's foodstuff inspections 253 Number of other food inspections 8 Unsound Food: Number of carcases surrendered 2 Number of articles (56) and parcels (32) surrendered 88 Number of organs or parts surrendered during slaughtering 25 Water Supply and Water Service: Number of supplies provided Number of cisterns cleansed, repaired, covered, etc. 3 Number of draw taps connected direct to main 91 Number of water service pipes or taps repaired 47 Approximate percentage of houses supplied on constant system 99-95 Drainage and Sanitary Arrangements, etc., of existing buildings: Water Closets: Number of water closets provided or re-constructed 6 Number of water closets provided in substitution for dry receptacles 1 Number of walls, etc., cleansed Number repaired, supplied with water or otherwise improved 234 Number of apparatuses cleansed or unstopped 22 Approximate percentage of houses provided with water closets 98 49 Sinks: Number of new sinks provided 10 Number of sinks repaired or improved 28 Drains: Number examined, exposed, etc. 2 Number unstopped, repaired, trapped, etc. 79 Number of waste pipes provided, disconnected, repaired, trapped or unstopped 29 Number of soil pipes (3) or ventilating shafts (16) fixed, repaired or improved 19 Number of fresh air inlets provided, repaired or improved 30 Number of rain water pipes disconnected from drain 41 Number of gully traps inserted or improved 135 Number of disconnecting traps inserted 1 Number of inspecting chambers inserted 2 Number of disconnecting traps improved, sealed or cleansed 6 Number of inspection chambers repaired, improved, sealed or cleansed 15 Number of drains constructed or re-constructed 16 Total length of drain pipes laid (4" 460') (6" 16') 476 ft. Number of tests and re-tests applied 40 Number of other works executed 6 Approximate percentage of houses draining into Council's sewer 98 Cesspools: Number rendered impervious, emptied, cleansed, etc. 5 Infectious Diseases, Disinfection, etc. Number of visits made 719 Number of rooms disinfected— (a) ordinary infectious diseases 323 (b) Tuberculosis, etc. 71 Number of rooms stripped and cleansed after infectious diseases— 50 (a) by owners or occupiers 23 (b) by Local Authority 17 Number of articles disinfected or destroyed 2122 Removal of Household Refuse: Number of new ashbins provided 217 Number of ashbins repaired 2 Number of ashpits abolished 7 Number of complaints of non-removal received 3 Dampness: Number of roofs stripped, renewed or repaired 171 Number of gutters and rain water pipe provided, repaired or unstopped 253 Number of instances in which external brickwork, sills, etc., repaired, renewed or rendered impervious 274 Number of damp-proof courses provided 35 Number of yards paved, repaired or drained 103 Interior Work: Number of rooms stripped and cleansed (other in connection with infectious diseases) 576 Number of floors, walls and ceilings repairbd or renewed 455 Number of rooms in which ventilation provided or improved 21 Number of rooms in which lighting provided or improved 2 Number of window frames and sashes provided, repaired or unfixed 339 Number of stoves or grates provided or repaired 351 Number of instances in which ventilation under floors, provided or improved 47 Number of other repairs 72 Sundry Nuisances, etc. Number of instances in which domestic cleansing enforced 12 Number of food stores provided, cleansed or improved 12 Number of washing coppers provided or repaired 69 Number of instances in which verminous conditions abated 31 51 Number of rooms sprayed for removal of vermin by the Disinfector 94 Number of instances in which overcrowding abated 13 Number of instances of improper keeping of animals abated 17 Number of offensive accumulations removed 14 Number of urinals provided, repaired, cleansed or improved 3 Number of dung pits provided, repaired or improved 3 Number of other nuisances 12 OTHER WORKS. Shops Act, 1912-13: Number of inspections made 900 Number of contraventions found 45 Number of contraventions remedied 47 Number of warning notices sent 31 Number of proceedings taken 1 Number of convictions obtained 1 Petroleum Acts, 1871-1881: Number of premises licenced 35 Number of inspections made 219 Number of contraventions found 9 Number of contraventions remedied 9 Number of new stores provided 6 Number of warning notices sent 1 HESTON and ISLEWORTH URBAN DISTRICT EDUCATION COMMITTEE. FOURTEENTH ANNUAL REPORT OF THE School Medical Officer FOR THE Year ending 31st December, 1921. z 7-82. 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 Service for the year ending 31st December, 1921. During the year, Dr. Berry resigned his position as Medical Officer of Health and School Medical Officer, and left the services of the Committee on the 26th May, 1921. I took up my duties on the 13th June, 1921. I wish to express my thanks to the members of the Committee for the kindness and support they have shewn me. I am, Ladies and Gentlemen, Your obedient servant, ELWIN H. T. NASH. MEMBERS OF EDUCATION COMMITTEE, 1921-1922. E. W. GOODE, ESQ. (Chairman). J. WEATHERS, ESQ. (Vice-Chairman). Members of the Council:— C. CRUSH, ESQ., J.P., ex-officio (Chairman of the Council). E. W. HEATH, ESQ., ex-officio (Vice-Chairman of the Council). J. J. BONNETT, ESQ. F. W. BUCKLEY, ESQ. W. J. R. DIVINE, ESQ. W. D. COWELL, ESQ. A. E. HALES, ESQ. G. A. GRIFFITH, ESQ. R. LANGDON, ESQ. A. L. LANG, ESQ. W. KING RHODES, Esq. H. J. NIAS, ESQ., M.B.E., J.P. Selected Members— Mrs. W. H. DUMSDAY. Mrs. C. F. EVA. E. W. GOODE, ESQ. P. MURPHY, ESQ., J.P. J. WEATHERS, ESQ. School Medical Officer: ELWIN H. T. NASH, M.R.C.S.,L.R.C.P.,D.P.H. STAFF. Clerical Staff— A. G. Hubbard (Chief Clerk). F. G. Boto. Miss R. Marshall. Miss W. L. Rogers. Miss O. Parfitt. E. Cromwell. J. Holmes. Health Visitors— Mrs. C. E. N. Ottley. Miss B. N. Tetley. Miss G. P. Chatfield. Mrs. A. E. Tyrrell. Miss W. E. Scott. Dentist—I. Cohen, L.D.S., R.C.S. ENG. Radiographer—D. Arthur, M.D., D.P.H. Ophthalmologist—A. E. Loosely, F.R.C.S. Assistant School Medical Officer— Mrs. Eva Cairns Roberts, M.B., D.P.H. School Medical Officer— Elwin H. T. Nash, M.R.C.S., L.R.C.P., D.P.H. 5 CO-ORDINATION. The administrative work of the School Medical Service is carried out in the Health Department, under the supervision of the School Medical Officer who is also Medical Officer of Health with charge of the Council's scheme for Maternity and Child Welfare. The Assistant Medical Officer, whose duties are mainly in connection with school children, also gives assistance in public health matters generally, and has charge of two Maternity and Child Welfare Clinics, at one of which, ante-natal work in particular is dealt with. The Health Visitors act also as School Nurses, each being responsible for a district and the schools therein. Conference with the Education Office is facilitated, as it is housed in the same building as the Health Department. Unification of Health Services is obtained inasmuch as matters pertaining to the School Medical Service, Maternity and Child Welfare and Public Health generally, are now reported monthly to the same Health Committee. (a). Infant and Child Welfare. There are two centres in the District. These with the School Clinics share the same medical and nursing staff, and the record cards are available for school medical purposes. Occasionally a case of ringworm receives x-ray treatment by arrangement with the Education Committee, but there is no general scheme for remedying dental, visual and other defects in children below the age of five years. Proposals to this end have been put forward ; their consideration, has however, been deferred. (b). Nursery Schools. There are none in the district. (c). The Care of Debilitated Children under School Age. Children up to the age of five years have access to the centres above mentioned. Arrangements have also been made with the Isleworth Nursing Association for the nursing of measles, whooping cough, etc. 6 The School Medical Service in relation to Public Elementary Schools. School Hygiene. The school buildings and the sanitary arrangements are periodically inspected. MEDICAL INSPECTION. The following short resum6 describes the arrangements made for the medical inspection of the children. The afternoon sessions are chosen when possible, as it is found to be more convenient for those parents who desire to be present. The suggested dates are submitted to the teachers, and intimated to the Secretary who informs His Majesty's Inspector of Schools. The arrangements hitherto have been that all appointments for children being inspected at Routine Inspection were made from the office and the appointment cards made out in the office and sent out for distribution by the teachers. The days of examination were spread over long periods as the administrative arrangements only permitted of a school being inspected one day in the week, which meant a prolonged visitation in the case of a larger school. This also meant a certain amount of difficulty in the office in arranging the inspection of the children, so that it did not clash with their instruction in special subjects. The machinery has been simplified, in that, now the cards and the list of all the children due to be examined are sent to the head teacher and the examinations are conducted on consecutive days until the whole school is finished. Further, all the parents used to be summoned at the beginning of the session, so that some of them had to wait considerable periods. They are now summoned at the rate of four every half hour. Under the new arrangement, the head teacher is able to make his or her own arrangements, so as to fit in with the special subjects and also with what is known of the habits of the parents, 7 so that they are summoned at times which are most convenient to them. It does not appear to me to be justifiable to waste the parents time by summoning them long before the time of the inspection of their child. Parents whose children are found to be defective and who require medical treatment, are duly informed of the necessity of medical advice being sought. The children are kept under observation either in the schools or at the Clinics until treatment has been obtained. (a). Age Groups Inspected. The selection of children due for routine medical inspection during 1921, includes those children born during the years, 1909, 1912 and 1915, together with those absent at the previous medical inspection. (b). Board's Schedule. In all cases the Board's Schedule of medical inspection has been followed. (c). Disturbance of School Arrangements The accommodation available for the purpose of medical inspection varies in different schools. In some the head teachers' rooms are used, but as a rule they are insufficiently large for vision testing; in others a class room or part of a class room, more or less screened off has to serve. In some of the schools this arrangement is most unsatisfactory and it is impossible to avoid considerable disturbance of some classes. More particularly, I would mention Isleworth Blue Girls' and Infants', where, owing to the design of the class rooms, it is impossible to avoid disturbing the routine of the school very materially. In view of the fact that the Isleworth Public Hall, which is used for Treatment Clinics and Infant Clinics, is in the centre of the several schools whose arrangements are unsatisfactory, I would suggest that the Board's sanction be obtained to Medical Inspections being carried out at the Isleworth Public Hall. This 8 will also ensure better results, as the conditions there are such that a really satisfactory examination can be made owing to the absence of noise. FINDINGS OF MEDICAL INSPECTION, 1921. Uncleanliness. Out of 2,022 children examined at routine medical inspection, 78 were excluded on account of nitty or verminous conditions, whilst 71 were marked to be kept under observation. Apart from these cases other 297 were seen at the school clinics and were referred for treatment, and 27 were kept under observation. Further reference to this subject will be found on page 19. Tonsils and Adenoids. Out of 2,022 children examined at the routine inspections, 339 had enlarged tonsils, 60 of which were referred for treatment, 279 being kept under observation. 58 children had adenoids only, of which 23 required treatment, and 35 were for observation, whilst 70 children had both enlarged tonsils and adenoids, 30 requiring treatment, and 40 observation. In many cases children marked for observation would probably require operative treatment, but only very well marked cases were referred for treatment on a first inspection, as the condition often clears up with removal of carious teeth and a general improvement in the hygiene of nose and mouth. At the special clinics, 42 other children were found to have enlarged tonsils, 7 adenoids only, whilst 12 suffered from both conditions. Tuberculosis. Out of 2,022 children examined at the routine inspection there were 5 cases of suspected pulmonary tuberculosis requiring to be kept under observation. At the special clinics, 2 were found to be suffering from pulmonary tuberculosis, and 16 from suspected pulmonary tuberculosis, whilst 3 children had tubercular glands. 9 Skin. At the routine inspections, out of 2,022 children examined, 37 were found to be suffering from skin trouble, and 1 with ringworm of head. At the special clinics there were 418 children suffering from various skin complaints, including scabies and impetigo (see Table II. for analysis of figures), 28 cases of ringworm of scalp and 15 cases of ringworm of body. External Eye Disease. Out of 2,022 children examined at the routine inspections, 39 were found to have minor eye diseases including blepharitis and conjunctivitis, whilst 40 had a squint. In addition 59 were found at the special clinic to suffer from the " minor " eye diseases, and 4 had squint. Vision. Out of 2,022 children examined at the routine inspections, 267 were found to have defective vision, 165 of which were referred for treatment, 102 being kept under observation. At the special clinics 67 children were referred for treatment for defective vision. Ear Disease and Hearing. Out of 2,022 children examined at the routine inspections, 33 were found to be suffering from defective hearing or ear disease, whilst an additional 82 were discovered at the special clinics. Dental Defects. Out of 2,022 children examined at the routine inspections, 773 had carious teeth and were referred for treatment, whilst 388 had slighter caries and were marked for observation. Over half of the children thus examined had carious teeth. At the special clinics a further 107 were discovered and referred for treatment. 10 At the routine dental inspections 1535 children were referred for treatment out of 2525 inspected (for further particulars see Table IV. D (1) & (2). Crippling Defects. Out of 2,022 children examined at the routine inspections, there were 36 found to be suffering from deformity, including 6 cases of rickets and 10 of spinal curvature. Cases of infectious disease are occasionally met with at routine inspections or at one of the school clinics. Systematic swabbing of sore throats and suspicious nasal discharges brings to light unsuspected diphtheria. All infectious cases and contacts are excluded from school till they are deemed free from infection (Joint Memorandum issued by the Local Government Board and the Board of Education). The non-notifiable diseases, Measles, Rubella Mumps, Chicken Pox and Whooping Cough, are visited by the Health Visitors, and in doubtful cases by one of the Medical Officers when there is do doctor in attendance. Similar action is taken in respect of children kept at home on account of a "rash." INFECTIOUS DISEASES. During the year 1921, the following cases of infectious disease occurred among children attending public elementary schools in this district:— Scarlet Fever 118 Diphtheria 57 Measles 10 Rubella 8 Mumps 167 Chicken Pox 166 Whooping Cough 125 Total 651 11 FOLLOWING-UP. Physical defects discovered at routine medical inspection are at once notified by the examining officer to the parent, if present, and in any event a written or printed notice of the defect is subsequently delivered at the child's home by the Health Visitor, who explains to the parents what steps should be taken to have the condition treated. Re-visits are made to ascertain what action has been taken. Summary of the work undertaken by the Health Visitors in connection with the School Medical Service:— 1. They are in attendance at the Inspection (Minor Ailment) and Special Clinics. 2. They accompany the Medical Officer to the Schools for routine medical inspections, and weigh and measure children, etc. 3. They pay periodic visits to the schools for the purpose of conducting Cleansing Surveys. 4. "Following-up" as outlined above. 5. Visits are also paid to the children's homes— (a). For inquiry in connection with non-notifiable infectious diseases. (b). To swab Diphtheria contacts. (c). To obtain signatures to consent forms for operative treatment of tonsils and adenoids and dental defects. (d). To follow up cases absent or attending the cliuics irregularly. Summary of work by the Health Yisitors during 1921. 210 attendances at School Inspection Clinics. 159 „ „ Dental Cliuics. 28 „ „ Eye „ 12 147 attendances at Minor Ailments Clinics. 102 visits to schools for medical inspections. 34 „ „ „ „ re-inspections. 25 „ „ „ dental inspections. 29 „ „ „ cleansing surveys. 2699 „ homes in connection with following-up. 807 „ „ „ „ „ infectious diseases. MEDICAL TREATMENT. Defects discovered at medical inspection are reported to the parents, who may elect to obtain treatment either privately or through a hospital, or in certain instances may avail themselves of the facilities afforded by the School Clinics. Visual and dental defects, X-ray treatment of Ringworm and the treatment of Minor Ailments are now undertaken by the Education Authority, whilst the operative treatment of Tonsil and Adenoids is by arrangement carried out at the local hospitals. MINOR AILMENTS. Skin. Ringworm of the Scalp.—Out of 26 cases referred for treatment 21 were successfully treated by the application of X-rays at the X-ray Clinic, 5 refusing this form of treatment. Ringworm of Body.—14 cases were successfully treated at the School Clinics. 227 children were treated at the School Clinics for other skin diseases, including 15 cases of Scabies and 198 cases of Impetigo. Ear Disease and Hearing. At the School Clinics 28 cases of Ear Disease or Defective Hearing were seen and treated. Ear Disease. The treatment of discharging ears, occupies a very large portion of the time of the nurses at the Treatment Clinics. There is no more unsatisfactory class of case to deal with than these. 13 Their treatment necessitates daily careful work which can only be carried out properly by a nurse. In many of these cases the conditions are long standing and there is already infection of the mastoid cells and nothing short of a fairly severe operation is going to permanently cure the condition. So long as this condition persists, the child is always in danger, in that any minute, any further extension of the disease to the upper plate of bone covering the inner ear, may lead to suppuration within the brain cavity and death. The number given 28, does not by any means exhibit the total number of cases existing in the school, as a large number with a small amount of discharge, regard the matter of no importance and are not discovered until Routine or Medical Inspection, or some complaint brings the matter to notice. A very large proportion of these cases suffering from ear trouble, can be cured in the early stage by ionization, but unfortunately, treatment is not available in the district, and it is difficult to induce many of the parents to take their children into the centre of London, as owing to the present prevailing unemployment, they cannot afford the necessary fare. Eye Disease. 17 cases of Eye Disease have been treated at the Schol Clinics. These have been chiefly Conjunctivitis, Blepharatis, with some Phylctenular and Corneal Ulcers, and suppurative conditions of the lids. Tonsils and Adenoids. Out of 100 children referred for treatment, 23 received treatment either privately or through a hospital, whilst 23 were treated under the Education Authority's scheme. Arrangements have now been made whereby children requiring operative treatment for enlarged tonsils and adenoids can obtain this at one of the local hospitals, the Education Committee accepting responsibility for the fee. Re-payments are claimed from the parents in accordance with the following scale:— 14 Weekly family income per head, less rent. Amount per case. Under 8/- nil. From 8/- to 10/- 7/6 From 10/- to 12/- 15/- Above 12/- 31/6 The number of cases of Tonsils and Adenoids operated on is not large. Personally, I am strongly opposed to wholesale removal of enlarged tonsils, as in my experience a considerable portion of these disappear in course of time. Vision. 286 cases of Visual Defect were submitted for Refraction at the School Eye Clinic, whilst 23 children were treated at hospitals. In 265 cases spectacles were prescribed and provided, and 2 cases referred to hospital for further treatment. Dental Defects. 925 children were treated by the School Dentist under the Local Education Authority's Scheme and 150 re-treated. Further, 45 attended the Dental Clinic and were referred elsewhere for treatment, e.g., hospital, and 5 attended the Clinic but refused treatment. 12 children had treatment by private dentists. A proposal was brought forward with regard to dealing vvith dental defects other than those specified in the scheduled years In order to find out the amount of dental trouble actually existing in the schools, the Committee decided that special inspections should be carried out in two representative schools. OPEN-AIR EDUCATION. There are no facilities in this district for open-air education beyond the holding of playground classes, and I am not aware that this is practised to any appreciable extent. There is no doubt that there is a considerable demand in this area for an open-air school. This matter was the subject of report in 1919, and also on previous occasions. 15 PHYSICAL TRAINING There is no Area Organiser of Physical Training for the elementary schools in this district. Whatever is done is on the initiative of the teachers, but the School Medical Officers are not consulted, save as to fitness or otherwise of a particular child to engage in drill. PROVISION OF MEALS. The systematic provision of meals to school children was not undertaken during the year under review. SCHOOL BATHS. None of the schools in this district is provided with baths. CO-OPERATION OF PARENTS. As already indicated, cards are sent to the parents inviting their attendance on the occasion of their chilnren undergoing Medical Inspection. They are also invited to attend Dental Inspections, when the Dentist delivers a short lecture on the evils of dental caries and the need for treatment. During 1921, one or other parent attended in 1,056 instances, representing a percentage of 52 2 as against 50 9 for 1920. Where defects are found the children are followed-up as already described. CO-OPERATION OF TEACHERS. Review of the work undertaken by Teachers in facilitating the work of (1) Medical Inspection, (2) Following-up and (3) Medical treatment of the children. Teachers now recognise the part school medical inspection plays, and grant all the necessary facilities for the work. CO-OPERATION OF SCHOOL ATTENDANCE OFFICERS. In this district there are three Attendance Officers, and they have entre to the Health Department where they can ascertain the health status and fitness for school of any particular child. The function of these Officers is to maintain attendances, consequently they take no part in aiding the work of medical 16 inspection, nor do they engage in following-up save in the recovery of fees for the treatment of Tonsils or Adenoids or for the supply of glasses, but they do render valuable help in securing treatment for children absent from school for alleged medical reasons. If there is no doctor in attendance and the parent is unwilling to seek one, the case is referred to one of the School Clinics and a report is rendered to the Secretary of the Education Committee. Again, in instances where children are absent on account of sore throats or because of some rash, prompt reports by the Attendance Officers have frequently directed attention to early cases of infectious disease. CO-OPERATION OF VOLUNTARY BODIES. During the year the National Society for the Prevention of Cruelty to Children rendered assistance in cases of neglect, but other Voluntary Bodies concerned in the welfare of school children are not conspicuous in this district. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. (a). Periodical returns are made by the teachers of children judged to be abnormal. Arrangements are then made for a special medical examination, and based upon this, a report is made. During 1921, examinations were conducted in respect of 23 children. (b). There are no special schools in this district for defective children. NURSERY SCHOOLS. There are no nursery schools in the district. SECONDARY SCHOOLS, CONTINUATION SCHOOLS. The School Medical Service of the Local Education Authority does not at present extend to these. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS, (i) Employment of Children. The conditions of the employment of children and young persons in this area are regulated by Bye-Laws made under the 17 Employment of Children Act, 1903, and the Education Act, 1913. By these certain employments are prohibited and in others the hours of employment are regulated: children between the ages of 13 and 14 employed in the sale or delivery of milk or newspapers, or in domestic work away from home, must hold a certificate from the School Medical Officer to the effect that such employment will not be prejudicial to their health or physical development and will not render them unfit to obtain proper benefit from their education. 61 children were examined and all save 2 were ganted the necessary certificates of fitness for work. (ii) Co-ordination of the work of the School Medical Service with that of the Juvenile Employment Committee and of the certifying factory Surgeon for the District. The Health Reports for Juvenile Employment cards are taken from the medical inspection records and are entered in the Health Department. Where by reason of absence at Medical Inspection, sufficiently recent medical records do not exist, the cases are summoned to the Inspection Clinics and the necessary data obtained. These represent the limits of the services rendered by the School Medical Staff. I am unable to say what relationship exists between the Juvenile Employment Committee and the certifying factory Surgeon for the District. (iii) The findings of the School Medical Service as regards the physical conditions of employed children and young persons. From the time the Bye-Laws became effective in October, until the end of the year, there were examined 61 children and all save two were granted the necessary certificates of fitness for work. MISCELLANEOUS. Medical Examination of Teachers. During the year 12 medical examinations were made of teachers. In the majority of cases these were in connection with their appointment under the Authority. 18 Holiday Home for Children. 29 medical examinations were of children preliminary to their going to the King Edward VII. Memorial Home, Heme Bay. Juvenile Employment. 37 special examinations were conducted in respect of children whose medical inspection records were not sufficiently recent. CRIPPLE CHILDREN. By the Education Act, 1918, Section 20, the Local Education Authority are required to ascertain what children in their area are physically defective and to make provision for them. A special enquiry on this subject was made last year and a full report submitted. There is no provision in the district for such children. SCHOOL CLINICS. Facilities having been extended at the Council House we were enabled to hold combined inspection and treatment (minor ailment) clinics on five mornings a week. Owing to the extension of work in other directions, it was found impossible to continue this and the present arrangements are that there are two clinic days at the Council House and two at the Isleworth Public Hall per week, when a full morning's work is done, but treatment is carried out between 9 and 10 o'clock for minor ailments on five days a week by the Nurses. The Clinics at the Public Hall, Isleworth, are similar in scope and are as before held on Monday and Thursday mornings. School children come under the notice of the Medical Officers in one of the following ways: 1. They are discovered at Routine Medical Inspections and are perhaps marked for treatment or it may be merely for observation. 2. Parents may apply to the teachers for authority to attend the clinic. 19 3. The teachers may on their own initiative, refer children to the Clinic either because of illness or uncleanliness. 4. The School Attendance Officers or the Attendance SubCommittees may refer children who have been absent from school on account of alleged illness. 5. The Medical Officers or the Health Visitors may discover cases casually while visiting the schools. Charges for treatment are as follows:— Spectacles.—Free in necessitous cases. Up to 10th October, 1921, the charge for ordinary cases was 4/- per pair. From that date the Committee passed a resolution to the effect that where the income exceeded 10/- per head, after deduction of rent, the full cost of the glasses should be paid. 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. TREATMENT OF UNCLEANLINESS. The Schools were visited by the Nurses on 27 occasions for the purpose of conducting Cleanliness Survey. At these inspections there were examined 3,978 children, of which 507 were found to be unclean. Of the later number 108 were excluded and the remainder 399 warned and kept under observation. In this district neither the Education Authority nor the Sanitary Authority possesses a cleansing station, consequently when children are excluded from school by reason of nitty or verminous conditions and their parents fail to cleanse them within the period of 14 days, allowed them by by-law, a prosecution may be ordered. 20 No cleansing has been carried out by the school nurses. Personally, I am of opinion, that the responsibility for cleansing of verminous children should be placed on the parent. With that in view, I proposed to the Committee that we should train one of the women members of the staff to carry out the cleansing of of heads and that a fee of 1/- should be charged for this purpose. Through the kindness of the Medical Officer of Health for the County of London, the woman selected is being trained at one of the London County Council Cleansing Stations, and her services will be available early in 1922. Owing to the attitude taken by the Bench of inflicting substantial fines on cases brought before them, there has been a noticeable improvement in the condition of the children's heads. During the year 1921, legal proceedings were instituted against the parents of 18 children. In three instances the summonses were withdrawn, in two orders were made and in the remainder fines were imposed as follows: 1 of 4/-; 1 of 7/6; 8 of 10/-; 3 of £1. LIST OF TABLES. 1. Number of Children Inspected. 2. Return of Defects found in the course of Medical Inspection. 3. Numerical Return of Exceptional Children. 4. Treatment of Defects of Children— A. Minor Ailments. B. Visual Defects. C. Defects of Nose and Throat. D. Dental Defects. 5. Summary of Treatment of Defects. 6. Summary of Children examined at Routine Inspections. 21 Heston and Isleworth. Table I. NUMBER OF CHILDREN INSPECTED 1st January, 1921, to 31st December, 1291. A—Routine Medical Inspection. Age. Entrants. Intermediates. Leavers. Grand Totals. 5 6 7 Totals. 8 9 10 Totals. .12 13 14 Totals. Boys 3 204 37 244 5 382 9 396 358 8 7 373 1013 Girls ... 226 42 268 5 296 15 316 416 7 9 432 1009 Totals 3 430 79 512 10 678 24 712 774 15 16 805 2022 B—Special Inspections. Children examined—Special Cases 1815 Re-examinations (i.e. No. of children re-examined) *823 C—Total number of individual children inspected by the Medical Officer, whether as Routine or Special Cases (no child being counted more than once in one year). No. of individual children inspected 3875 *The figures 823 relate to children found defective at Routine Medical Inspection and subsequently re-examined in the schools. The Special Cases were, in the majority of cases, seen at the School Clinics, and for these there were 6099 examinations, so that the total number of examinations amounts to 8944. 22 (Heston and Isleworth). Table II.—RETURN OF DEFECTS found in the Course of Medical Inspection in 1921. Disease or Defect. Routine Inspections. Specials. Number referred for treatment. Number reqniring to be kept under observation, but I not referred for treatment. Number referred for treatment. Number requiring to be kept under observation, but not referred for treatment.   1 a 3 4 5 Malnutrition ... 2 ... 1 Poor Nutrition v 16 U ncleanliness— Head 77 53 297 27 Body 1 18 ... 1 Skin — Ringworm Head 1 ... 25 3 Body ... ... 14 1 Scabies 1 2 15 Impetigo 3 2 198 18 Other Diseases (non- tubercular) 2 27 81 92 Minor Injuries ... ... 3 11 Eye- Blepharitis 1 27 5 12 Conjuntivitis ... 2 6 5 Keratitis ... 1 1 Corneal Ulcer .... ... 1 Corneal Opacities ... ... ... 1 Defective Vision 165 102 67 Squint 10 30 ... 4 Other Conditions 1 7 5 23 Ear— Defective Hearing. 1 12 1 14 Otitis Media 2 16 7 8 Other Ear Diseases 2 ... 15 37 Nose and Throat— Enlarged Tonsils 60 279 17 25 Adenoids 23 35 1 6 Enlarged Tonsils & Adenoids 30 40 5 7 Other Conditions 1 45 59 31 23 Table II—Continued. Disease or Defect. Routine Inspections. Specials. Number referred for treatment. Number requiring bo be kept un der 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 Enlarged Cervical Glands (non-tubercular) 2 377 11 11 Defective Speech 3 Teeth— Dental Diseases (see above) 773 388 107 Heart and Circulation— Heart Disease ... 58 4 19 Antemia ... 32 7 7 Lungs— Bronchitis 1 17 23 7 Other Non-Tubercular Diseases 1 21 16 31 Tuberculosis— Pulmonary Definite ... ... 2 Suspected ... 5 8 8 Non-Pulmonary Glands ... 2 2 1 Spine ... ... ... 1 Hip ... ... ... 1 Other Bones and Joints ... ... 2 Skin Other Forms ... 1 1 Nervous System— Epilepsy ... ... 3 Chorea ... 1 16 Other Conditions ... 2 3 3 Deformities— Pickets ... 7 Spinal Curvature ... 6 Other Forms ... 23 4 7 Other Defects and Diseases 3 65 141 111 Number of individual children having defects which required treatment or to be kept under observation—2993. 21 (Heston and Isleworth) TABLE III.—NUMERICAL RETURN of all Exceptional Children in the area in 1921. Boys Girls Total   Blind (including partially blind) within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools ... ... ... Attending Certified Schools for the Blind 1 ... 1 Not at School ... ... ... Deaf and Dumb (including partially deaf) within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools ... ... ... Attending Certified Schools for the Deaf 2 ... 2 Not at School 1 1 2 Mentally Deficient Feebleminded Attending Public Elementary Schools 9 15 24 Attending Certified Schools for Mentally Defective Children 2 ... 2 Notified to the Local (Control) Authority during the year 1 ... 1 Not at School 4 2 6 Imbeciles At School ... ... ... Not at School 2 2 4 Idiots 1 1 2 Epileptics. Attending Public Elementary Schools 1 3 4 Attending Certified Schools for Epileptics ... 1 1 In Institutions other than Certified Schools ... ... ... Not at School ... 1 1 Physically Defective Pulmonary Tuberculosis Attending Public Elementary Schools 1 1 2 Attending Certified Schools for Physically Defective Children ... ... ... In Institutions other than Certified Schools ... ... ... Not at School ... ... ... Crippling due to Tuberculosis Attending Public Elementary Schools 2 ... 2 Attending Certified Schools for Physically Defective Children 1 ... 1 In Institutions other than Certified Schools 1 ... 1 Not at School 3 ... 3 25 Table III.—Continued. Boys Girls Total   Physically Defective. Crippling due to causes other Attending Public Elementary Schools 17 15 32 than Tuberculosis Attending Certified Schools for Physically Defective Children ... ... ... i.e. Paralysis, Rickets. In Institutions other than Certified Schools ... ... ... Traumatism. Not at School 1 1 2 Other Physical Defectives, e.g. delicate & other children Attending Public Elementary Schools 3 5 8 able for admission to Open-air Attending Open Air Schools Attending Certified Schools for ... ... ... Schools ; Children Physically Defective Children, other than Open-Air Schools ... ... ... fering from severe Heart Disease Not at School ... ... ... Dull or Backward Retarded two years 163 82 245 Retarded three years 12 8 20 26 (Heston and Isleworth). Table IV.—A. Treatment of Minor Ailments, 1921. Disease or Defeot. Number of Children. Referred for treatment. Treated. Under Local Education Authority's Scheme. Otherwise.   Skin- Ringworm, Head 26 21 5 Ringworm, Body 15 14 1 Scabies 15 15 ... Impetigo 216 198 18 Minor Injuries 3 3 ... Other Skin Disease 81 81 ... Ear Disease 28 28 ... Eye Disease (external and other) 17 17 ... Miscellaneous Total 401 377 24 27 Table IV.—B Treatment of Visual Defect, 1921. Referred for refraction. Number of children. Submitted to Refraction. Under Local Education Authority's Scheme, Clinic or Hospital. By Private Practitioner or Hospital. Otherwise. Total. For whom glasses were prescribed. For whom glasses were provided. Recommended for treatment other than by glasses. Received other forms of treatment. For whom no treatment was considered necessary.   381 286 23 309 265 265 2 referred to Hosp. 12 8 to continue glasses 61 awaiting C.F. 11 Objectors. Table IY.—C Treatment of Defects of Nose and Throat, 1921. Referred for treatment. Number of children. Received other forms of treatment.   Received operative treatment Under Local Education Authority's Scheme, Clinic or Hospital. By Private Practitioner or Hospital. Total. 100 23 23 46 ... 7 Objectors. 4 Cannot afford at present. 11 Operation not necessary. 32 Awaiting receipt of C.F. 28 Table IV.—D.—TREATMENT OF DENTAL DEFECTS. 1. Number of Children dealt with. Age. 5 6 7 8 9 10 11 12 13 14 Specials. Totals.   (a) Inspected 249 617 554 520 363 104 26 3 4 ... 85 2525 (b) Referred for treatment ... .. ... ... ... ... ... ... ... ... ... 1535 (c) Actually treated ... ... ... ... ... ... ... ... ... ... ... 925 (d) Re-treated ... ... ... ... ... ... ... ... ... ... ... 150 (e) Attended Clinic, but referred elsewhere for treatment, e.g. Hosp. ... ... ... ... ... ... ... ... ... ... ... 45 (f) Attended Clinic, but refused to have treatment, "Objectors" ... ... ... ... ... ... ... ... ... ... ... 5 (g) By Private Dentist ... ... ... ... ... ... ... ... ... ... ... 12 29 Table IV.— D — TREATMENT OF DENTAL DEFECTS, 1921. 2. Particulars of time given and of operations undertaken. No. of half-days devoted to Inspection. No. of half-days devoted to treatment. Total No. of attend ances made by the children at the Clinic. No. of permanent teeth. No. of temporary teeth. Total No. of fillings. No. of adminittrations of general anaesthetics included in 4 and 6. No. of other operations. Extracted. Filled. Extracted. Filled. Permanent teeth. Temporary teeth.   1 2 3 4 6 6 7 8 9 10 11 24 113 1718 54 385 3309 3 388 631 29 ... 30 (Heston and Isleworth). Table Y.—Summary of TREATMENT OF DEFECTS as shown in Table IY. (A, B, C, D and F, but excluding E). Diseaso or Defect. Number of children. Referred for treatment. Treated. Total.   Under Local Education Authority's Scheme. Otherwise. Minor Ailments 401 377 24 401 Visual Defects 281 286 23 309 Defects of nose and throat 100 23 23 46 Dental Defects 1535 1075 57 1132 Other Defects ... ... ... ... Total 2317 1761 127 1888 31 (Heston and Isleworth). Table VI.—Summary relating to CHILDREN MEDICALLY INSPECTED at the Routine Inspections during the year 1921. (1) The total number of children medically inspected at the routine inspections 2022 (2) The number of children in (1) suffering from— Malnutrition 2 Poor Nutrition 16 Skin Disease 36 Defective Vision (including squint) 307 Eye Disease 39 Defective Hearing 13 Ear Disease 20 Nose and Throat Disease 513 Enlarged Cervical Glands (non-tubercular) 379 Defective Speech 3 Dental Disease 1161 Heart Disease 58 Anaemia 32 Lung Disease Tuberculosis— 40 Pulmonary Definate ... Suspected 5 Non-Pulmonary 3 Disease of the Nervous System 3 Deformities 36 Other Defects and Diseases 68 (3) The number of children in (1) suffering from defects (other than uncleanliness or defective clothing or footgear) who require to be kept under observation but not referred for treatment 140 (4) The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc) 925 (5) The number of children in (4) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 160