Heston & Isleworth Urban District Council. 1924. ANNUAL REPORTS OF THE Medical Officer of Health AND School Medical Officer FOB THE URBAN DISTRICT OF HESTON AND ISLEWORTH FOB THE Year ending 31st December, 1924. 1924. REPORT on The Health of the HESTON & ISLEWORTH URBAN DISTRICT FOR THE YEAR 1924. BY ELWI N h. T. NASH, M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health. Public Health Department, Council House, Hounslow. April, 1925. To the Chairvian 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. The work of the Department has been disorganised to a certain extent through sickness and promotion of members of the staff to other districts. I beg to express my appreciation to the Council for the consideration shewn to me during the past twelve months. I am, Ladies and Gentlemen, Your obedient servant, ELWIN H. T. NASH, Mcdical Officer of Health. THE HEALTH COMMITTEE of HESTON AND ISLEWORTH URBAN DISTRICT COUNCIL For the Year 1924. Members of the Council:— F. W. Buckley, Esq. (Chairman). F. T. Hart, Esq. (Vice-Chairman). S. Carter, Esq., j p. ex-officio (Chairman of the Council). A. L. Lang, Esq. ex-officio (Vice-Chairman of the Council). J. J. Bonnett, Esq. E. W. Heath, Esq. C. Crush, Esq. j.p. J. A. Jessop, Esq. A. Dennis, Esq. R. Langdon, Esq. C. J. Geary, Esq. N. L. Sammels, Esq. Medical Officer of health:— Elwin H. T. Nash, d.p.h. MATERNITY AND CHILD WELFARE COMMITTEE. Members of the Council:— N. L. Sammels, Esq. (Chairman). J. J. Bonnett, Esq. F. W. Buckley, Esq. E. W. Heath, Esq. A. L. Lang, Esq. R. Langdon, Esq. Co-opted Members:— Mrs. C. W. Bezer. Mrs, E. Chedgey. 6 STAFF. The following persons constituted the Staff of the Health Department on the 31st December, 1924. Medical Officer of Health— Elwin H. T> Nash, M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officer of Health— Mrs. E. Louise Roberts, M.B., Ch.B., D.P.H. Sanitary Inspector— R. H. Butler, Cert, as S.I., M.I., and S.E. District Sanitary Inspectors — G. W. Ashworth, Cert, as S.I. and M.I. E. W. Barton, Cert, as S.I. and M.l. One vacancy. Disinfector and Laboratory Attendant — J. H. Cobb. Health Visitors— Mrs. C. E. M. Ottley, Cert. C.M.B., H.V., S.N., M.C.W.W. Miss B. N. Tetley, 3 years childiens' training. Cert. C.M.B. Mrs. A. E. Tyrell, Cert. C.M.B., H.V., and S.N. Miss W. E. Scott, general training, Cert. C.M.B. , H.V., S.N., M.C.W.W. Miss J. D. Law, 4 veins general training, Cert. C.M.B., M.C.W.W., H.V. Home Help— Mrs. E. Yates. Chief Clerk— B. W. Kilby, Ceit. S.l.E.B. ar,d R.S.I. (M.I.) Clerks— A. G. Hubbard. Miss R. Marshall, Cert. R.S.I. E. Cromwell. J. Holmes. Mr. F. Humphreys left on 31-3-24. Mr. E. W. Barton took up his duties on 1-7.24. 7 EXTRACTS FROM VITAL STATISTICS OF THE YEAR 1924. Population— At the Census, 1921 46,729 Registrar-General's estimate of nett Civil population 47,700 (Birth rate) 46,970 (Death rate) Births— Male. Female. Total. Legitimate 418 400 818 Illegitimate 15 10 25 Birth rale (nett) ... 17.67 Deaths— Male. Female. Total. 262 245 507 Death rate (nett) ... 1079 Number of women dying in, or in from sepsis 1 consequence of, childbirth from other causes nil. Deaths of infants under one year of age per 1,000 births— Legitimate 5623 Illegitimate 200 Infantile Mortality Rate 60.5 Deaths from Measles (all ages) 14 ,, ,, Whooping Cough (all ages) 1 „ „ Diarrhoea (under 2 years of age) 5 Area 6,893 acres. Number of inhabited houses (Census 1921) 8,790 „ of families or separate occupiers (1921) 9,893 Rateable value £236,958 Sum represented by a penny rate £958 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 years 1923—1924:— 1923. 1924. £ s. d. £ s. d. Parish of Heston 1825 8 7 2156 10 1 Parish of Isleworth 4081 16 2 4852 15 8 £5907 4 9 £7009 5 9 8 Medical Relief. Particulars as to the extent to which hospitals 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.—The Relieving Officers issued 531 medical orders during 1924. Some of these cases received also outrelief and institutional treatment. The Hounslow Hospital is the only voluntary Hospital within the district; it is a modern and well equipped institution which was enlarged by the addition of 20 beds in 1922, making a total of 47. Its sphere of usefulness will, it is hoped, be extended by the provision of maternity beds, and a children's ward. During the year 1924, there were admitted 535 in-patients, whilst 2,391 new out-patients received treatment. Medical relief is also given by certain voluntary organisations in the district, namely:— 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 1924, the estimate of net civil population is given under two figures supplied by the Registrar-General. The death-rate population (46,970) excludes all non-civilian males whether seiving at home or abroad; whilst the birth-rate 9 (and marriage-rate) population (47,700) 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-civilian enlisted from this country. Deaths. The number of deaths registered in the district was 1,053, but 591 of these did not belong to the district, while 45 residents died without the district. Thus the number of deaths properly attributable to the district was 507. Adopting the basis of the population estimated by the Registrar-General, the death-rate for the district conies to 10 79 per 1,000, which is comparable with the following figures:—122 for England and 121 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. Births. The total number of births registered during the year was 907, but 101 of these did not belong to this district, while 37 births properly belonging to this distiict occurred outside the district. The nett number of births thus attributable to the district is 843. Adopting the population basis suggested by the Registrar-General for the calculation of the birth-rate, this comes to 17 67 per 1,000. The birth-rate of England and Wales is 18 8 per 1,000, and for Loudon 18 7 per 1,000. Legitimacy. The following figures give the number of births:— Legitimate. Male. Female. Total. 418 400 818. Illegitimate. Male. Female. Total. 15 10 25. 10 The figure obtained under this heading is regarded as a valuable index of the sanitary conditions of a district. Furthermore, as it is based on ascertained facts (i.e., the actual numbers of births and infant deaths), it is more reliable that the death-rate which is calculated on an estimated population. The rate for 1924 is 60 5 per 1,000 births. The rates for England and Wales and for London during the same period were 75 end 69 respectively. Less than 15 years ago, one Medical Officer who ventured to hold up an infantile mortality of 60 per 1,000 as the goal to be aimed at, a goal unbelievable, and undreamt of, was looked upon as a visionary and a dreamer. Of a truth "Peace hath its victories." Previous low figures were:— 1920 57 0 1921 69.4 1922 73 5 1923 54 9 SANITARY CIRCUM8TANCES. Water Supply. There were, as far as is known, at the end of the year 42 private wells from which the water was used for domestic purposes. In nine other cases there are wells, but an alternative supply from the main exists for domestic purposes. In 63 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. 11 In the western portion of the district, there are some houses not yet linked up with the general system The present methods of drainage employed at these houses are not satisfactory. The following extensions to the sewerage system have been carried out during 1924:— Jersey Road,—Extension from Rose Farm, Wood Lane, to Great West Road, completed. Wood Lane.—(a) From Borough Road extending for a length of 167 yards in a southerly direction. (i) From London Road extending in a northerly direction for a distance of 394 yards. This work has been completed. Westbrook Road.— Church Road, Heston, to New Heston Road. This work has been commenced. Closet Accommodation. Accommodation on the water carriage system is almost general throughout the district, 93 per cent, of the houses having water closets. Scavenging. This is carried out by the Local Authority and is under the control of the Surveyor. During 1924, collection of house refuse has continued weekly as before, and was disposed of by means of a dump in the Staines Road. During the year there were supplied 104 new ashbins. Sanitary Inspection of District. See pages 53—63. 12 Nuisances, Contraventions of Bye-laws, Defective Drainage, etc. The number of premises on which nuisances were outstanding at the end of 1923 was 497. To these another 470 premises whereat nuisances were recorded in 1924 were added, giving a total of 967 premises. Of these 504 had the nuisances remedied, leaving 463 premises at which nuisances still existed at the end of the year. During the year, nuisances at 19 houses were reported to the Health Committee, which added to the 46 brought forward from 1923, make a total of 65. Before asking the authority to serve statutory notices, the premises are inspected by the Medical Officer of Health and Sanitary Inspector. Statutory notices were authorised and served in most of these cases, and by the end of the year, the nuisances were remedied in 26 of the houses, and in 1 case it was resolved to take no further action, leaving 33 cases to be carried forward in 1925. Comparative figures for the years 1922, 1923 and 1924, in connection with nuisances are submitted herewith:— 1922. 1923. 1924. Number of complaints received 460 459 381 Premises at which nuisances were located 722 740 470 Informal notices sent— First 568 636 402 Second 217 190 110 Statutory notices served 79 114 44 It is my duty once more to point cut that the staff of Sanitary Inspectors is inadequate. It must be placed on record that twice during 1920, leccmmendations urging the appointment 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 Regulation. There are 421 known places in this district which call for periodical inspection as follows:— 13 Houses let in Lodgings, Common Lodging Houses, Bakehouses, Slaughter-houses, Cowsheds, D.lines and Milkshops, Offensive Trades, Laundries (non-factory), Workshops, Workplaces and Outworkers. 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 up-to-date sanitary conditions. FOOD. The following is the record of inspection of food premises:— No. of Inspections made. Meat 556 Fish 316 Provisions 503 Greengroceries and Fruit 552 Hawkers' Food Stuffs 269 Number of other Food Inspections 39 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. 201 inspections were carried out in respect of dairies and milkshops. Unofficial milk analyses are made by the Medical Officer of Health. 1. Meat Inspection.—The Chief Sanitary and the District Sanitary Inspectors hold special certficates for meat inspection. Slaughter-houses and butchers' shops are visited psriodically, but during the year no diseased meat was seized, but 332 lbs. was surrendered. There are 8 slaughter-houses and 30 butchers' shops in the district. Each slaughter-house received on an average 213 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. 14 3. Action under Section 111, Public Health Act, 1875.—None during 1924. 4. Tubercular Meat.— There was none seized, but 242 lbs. were surrendered during the year. 5. The following tabular statement on slaughter-houses is required:— In 1914. In January, 1924. In December, 1924. Registered 6 4 4 Licenced 3 4 4 Total 9 8 8 The slaughter-houses as a whole are unsatisfactory. Sale of Food and Drugs Act. 1 am indebted to Dr. J. Tate, 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 1924. List of Samples purchased:— Article Taken. Adulterated Milk 171 11 Milk, separated 4 — Cream 9 2 Cream, preserved 1 — Beer 2 — Butter 7 — Cream of Tartar 2 — Bicarbonate of Potash 1 — Boracic Acid ... 1 — Cocoa 1 — Coffee 4 — Honey 3 — Vinegar 3 — 209 13 UNSOUND FOOD, 1923. cwts. qrs. lbs. Fish 3 1 21 Fruit — - 3 Meat 2 3 24 6 1 20 15 INFECTIOUS DISEASE. General Remarks. The incidence of Scarlet Fever and Diphtheria remained comparatively low. SMALL-POX. On October 7th a telephone message was received from the County Medical Officer of Health of Surrey, that a case of Small-pox had been discovered in the Casual Ward of the Epsom Poor Law Infirmary, in the person of a tramp who had walked from Isleworth after taking his discbarge from the Brentford Union Institution there. Investigation produced the following history:— On September 14th he entered the Casual Ward at Hitchin. On September 15th lie walked to Luton and slept at the "Welcome Stranger." On September 16th he walked to Harpenden and spent the night under a hedge. On September 17th he went to Hatfield and slept in the Casual Ward ; on the 18th he went to Coli's barn and slept there that night and the night of 19th September. On 20th September he walked to Luton and being refused admission to the "Welcome Stranger" which was under quarantine, he stopped at a lodging house in a street off the St. Alban's Road. On September 22nd ho walked back to Hatfield and slept in the baru where he remained till September 24th, when he walked to Watford and slept in the Casual Ward. On the night of 2oth September he injured his arm and slept under a hedge On September 26th he suffered from a headaehe and walked from Watford, through Willesden to Isleworih, where he was admitted to the Infirmary within a short time after admission to the Casual Ward. On September 27th his temperature was 103°, on 28th September it was still 103°, and on 29th September it was 99°. His condition was diagnosed as Influenza and on his temperature approximating to normal, he was allowed to get up. He would have been transferred to the Male Infirm Ward in the Workhouse but as his head was unclean; he was not sent across until October 16 3rd. As he was up and about waiting for transfer, his temperature was not further recorded. From his own statement there would appear to have been spots during that period. On his admission to the Infirmary the spots were noticed, and the Medical Officer's (a temporary locum) attention was called to them. The condition was diagnosed as a crop of Septic Spots, and well rubbed with the sulphur ointment prescribed. The man wanted his discharge and was allowed to go on October 6th. He walked to Epsom and was admitted to the Casual Ward. It appears that a man in the scabbing stage was an inmate of the " Welcome Stranger" on or about the 16th September. Whilst the patient was up and about, many visitors were in the Ward on visiting day, and as he was allowed out in the ground he roamed about. The list of contacts in the Institution was in consequence very large. In the meantime, a number of casuals and patients had been discharged and had to be followed up. Kingston, Redhiil, Reading, Bracknell, London, East Grinstead, Horsham, Guildford, Chertsey, Dorking, Chiswick, Ealing, Hanwell, Hackney, Teddington, Woolwich, Edgware, Slough, being the districts involved. The patient's clothes had been sent to the Union Laundry where many of the workers were non-resident. In addition many of the attendants were non-resident; incidentally the attendant whose duty it was to rub the sulphur ointment into the rash had not been vaccinated for 25 years. The Medical Superintendent of the Brentford Union and his Staff set to work and vaccinated practically all the contacts. All the outside contacts were referred to the Public Vaccinator or their own Doctor and vaccinated. One woman contact who had visited the ward gave rise to some suspicion. She suffered from Acne but later developed a temperature with ache and pains and two suspicious spots. She was admitted to Dockwell as a precaution. The symptoms turned out to be due to the vaccination and she was discharged after 3 days. 17 No further cases occurred in the Infirmary or amongst the contacts. Further cases occurred amongst the patients in the Male Infirm Ward to which the 1st case was transferred. The next case commenced on October 15th, 12 days after the admission of the first case to the Male Infirm Block. Patient aged 77, the progress being as follows:— Oct 15th. Temperature 99. ,, 16th. ,, 101. Vague pains. Feeling seedy. „ 17th. 102. Feeling seedy. ,. 18th. 100. Left eye inflamed. ,, 19th. ,, 99-2 Restless and inclined to be delirious. „ 20th. 98. Bash appeared at 1 p.m. A few spots on chesk, abdomen and back and front of upper parts of thighs. Forehead, wrists and face free. At 10 p.m. no doubt as to diagnosis. The 2nd case commenced on Oct 21st, patient aged 68, the onset being as follows:— Oct. 21st. Temperature 102. „ 22nd. „ 100.5. „ 23rd. ,, 98. Rash appeared. The 3rd case commenced on Oct. 21st, patient aged 61 his record being as follows:— Oct. 21st. Temperature 102. ,, 22nd. ,, 98. „ 23rd. 97. „ 24th. 97. ,, 25th. ,, 98. ,, 26th. ,, 98. „ 27th. a.m. 98 p.m. 99 4. ,, 28th. „ 98 4. 18 Rash first appeared on morning of 27th, isolated, more definite on 28th. No constitutional symptoms. Removed to Hospital 28th October. The 4th case commenced on Oct. 23rd, patient aged 73, his history being as follows:— Oct. 23rd. Temperature 101.2. „ 24th. 988. ,, 25th. ,, 99. „ 26th. „ 99. 27th. 98.4. 28th. 98.2. Very feeble old hemiplegic. No prodromal rash, spots appeared on 28th. The 5th case commenced on 25th, patient aged 67, his history being as follows:— Oct. 25th. Temperature 100. ,, 26th. „ 100-4. „ 27th. 99. „ 28th. 99. Pains in loins over old scar on 25th and 26th. A few pustular spots discovered at inspection on 28th. The 6th case commenced on October 25th patient aged 61. October 25th temperature 100.6, normal next day and until 29th then 99. Rash appeared on 30th and lemoved to hospital same day. The last case (7th) was a female aged 73, whose history was as follows:— Previously in Little Watkworth House which is situated in the far corner of the grounds, and there would be no possible chance of contact except at the Sunday Service. She was removed from Little Warkworth House on October 24th to the Female Infirm Block complaining of abdominal pain. On 22nd temperature had been 101—rash appeared on October 30th. Vaccinated in childhood. Removed to South Wharf M.A.B. Hospital as Dockwell was full. 19 Investigation of this case disclosed no source of contact except a remote possibility in the Chapel on Sunday. The Female Infirm Block is situated at the extreme south end of the grounds, a long way from all the other buildings where the former cases had arisen. Investigation of all sources of infection—laundry, staff, staffs relations, etc., produced no evidence of the source of infection other than the most remote. The type of case was very mild discrete of the same type as the Gloucester outbreak, characterised by rapid maturation of the pocks. As an example, on seeing a case with the Medical Officer of the Dockwell Hospital, I pointed out that this was a 4th day rash with which the Medical Officer agreed. The patient thereon remarked that he had only two spots on yesterday which the Doctor marked as he was not sure of them, which turned out to be the case. All the cases made a perfectly good recovery. No vaccinations were performed by the Medical Officer of Health under the Public Health (Small-Pox) Prevention Regulations, 1917) during the year under review. Scarlet Fever. The following table shows the number of cases which have been notified, and the number and percentage of cases which have been emoved to Hospital:— No. of civil cases notified 115 ,, ,, removed to Hospitals 102 Percentage of cases removed to Hospitals 89 The incidence rate of Scarlet Fever in the civil population was 2.4 per 1,000. No death took place from this cause during the year. Diphtheria. The following table shows the number of notifications received and the percentage of cases of Diphtheria removed to Hospital:— No. of civil cases notified 105 „ ,, removed to Hospitals 98 Percentage of cases removed to Hospitals ... 93 The incidence rate per 1,000 of the civil population was 2.23. Fifty-one cases occurred in public institutions during the year, 7 of 20 the persons affected being non-residents. 10 deaths took place from this disease, i.e. a case mortality rate of 9 5 per cent. DIPHTHERIA-NORTH HYDE SCHOOLS. The North Hyde School is a large Roman Catholic Institution dealing mainly with Poor Law boys. Most of its cases are admitted from the Boards of Guardians up and down the Country. Roughly one-fifth are re scue cases paid for by voluntary subscriptions. A few that do not come into this category are admitted as private cases and paid for by their p irents. The buildings were originally Military Barracks, but on the whole give plenty of air space for the boys. Many of the boys come from very poor homos and are in a miserable condition on admission. They are well fed and clothed and the administration is very good, the Mother Superior being a person of very high intelligence and devoted to the welfare of the boys. There is a Medical Officer attached to the School who visits daily. There is also a Dentist. The average number of boys is 500. There are, however, a considerable number of boys whose tonsils and naso-pharynx want attention. The School is handicapped in carrying out any large scheme of Medical Inspection and Treatment, owing to the fact that the payments made per boy only amount to 13/-. Cases had been occurring during 1923 in twos and threes—ex. tensive swabbing and repeated visits and examinations failed to reveal any definite source of trouble. The early part of 1924 was free from trouble, the first case being notified on 13/5/24 of a boy age 4. There were 47 contacts in the Nursery but no further case arose till 2/7/24, this was a boyaged 8 who had been admitted from Soho on 8/6/24. In this case there were 38 contacts in the Dormitory. On 21/7/24 a further case arose in the same dormitory. This child had only three days previously been admitted to the Institution from Staines. 21 The next case arose on 11/9/24 another boy aged 8, but in this instance the boy was in the receiving block and only been admitted to the Institution eight days previously from the Kensington Union. As the result, of swabbing the contacts a positive result was obtained in the case of a boy who had been in the School for five months. The next case occurred in the Nursery on 17/10/24 a boy aged 5. He had been recently adinitte1 on 2 )/8/24. This was a nasal case, the first obvious signs being a nasal discharge. The boy was first out of sorts on 13/10/24. In this instance there were 50 contacts in the Nursery. The next case arose on 19/10/24 a hoy aged 5 in the same Dormitory. The next was a boy aged 14, in the same dormitory as the last. The next was a boy aged 11 from the same Dormitory. After three weeks freedom, a case broke out in another Dormitory, aged 13, who had only been in the Institution 5 months. Two cases occuried on 17/11/24, one aged 8 in the Junior Dormitory who had only been in the School two months, and another aged 3 in the Nursery. None of the last three had any connection with one another. On 18/11/24 another case aged 8, was admitted from the same Dormitory as the last case but one, he had only been in the School two months. The next case which occurred on 24/11/21 was a boy aged 4, who had been admitted from Grimsby on 23/11/24, four days previously, and retained in the Receiving Room and who had had no connection with any of the school children. The next case which occurred on 25/1 1/24 was a boy aged 11, having had no connection with previous cases. Despite extensive swabbing, we bad not made any discovery of the source of the trouble. In view of the serious situation, I advised the Governors that 1 thought the whole school should be Schick tested and the non-immunes immunised. A conference with the Representatives of the Managers of the School was held at the 22 Ministry of Health. It was agreed that the only proper course was to carry out my suggestion. I undertook to swab all the inmates and report on the cultures, provided the Managers of the Institution indemnified the Council against any expenditure in connection with the work. Had I realised what an enormous job the examination of 1200 swabs meant, I should have let some laboratory do it, despite the desire for uniform results./ The Officials of the Ministry lent every assistance that was wanted; Dr. Scott examining all positive and doubtful cases for virulence. The work was pushed on as fast as possible, and both I and my assistant, Dr. Roberts,spent a great deal more time than usual over each case to ensure that nothing was missed. The result was that after two days working from early morning till after 10 at night our eyes gave out and we had to slow down, the cases being finished in nine days. The net result was that 9 virulent carriers were discovered, 1 of whom was the Sister-in-Charga of the Infirmary. The cases were No. 1 aged 6—Nasal. No. 2 „ 2 No. 3 „ 7 No. 4 ,, 12—Nose and Throat. No. 5 „ 12—Throat. No. 6 „ 14 No. 7 „ 11 No. 8 „ Sister Mildred.—Nose and Throat. No. 9 „ 17—Nose. Driver of car. In addition to the 1063 original cultures, 137 doubtful cases were sub-cultured, and if there was still any doubt (some of the short forms giving rise to difficulty) they were sent to Dr. Scott at the Ministry of Health bnd tested for virulency. All the cases of virulent carriers were isolated in the School Infirmary and treated by the Medical Officer to the School. Following the swabbing, all the boys and the majority of the Staff of the School were Schick Tested as were also the Public Health, Medical and Nursing Staff. The Assistant Medical Officer Health, Medical and Nursing Staff. The Assistant Medical Officer and three Nurses were found positive and the final results were:— 23 The percentage of immunes is much above the average. It was found that many of the 54 positives among the boys were very weak or doubtful, and of the 15 strong positives alone found no less than 11 had been admitted to the School within 3 months or less. All the non-immunes were subsequently immunised. The results among my staff were more severe than one had expected from all the previous records. Two of the Nurses had severe reactions and the third had a very bad arm and was ill for six weeks. All the Nurses had the three full injections. I got Dr. O'Brien of the Welcome Research Laboratories to come down and see them. His opinion was that the symptoms in the Nurses were due to protein sensitiveness. The injection used was the latest evolved and contained the highest antigen strength hitherto evolved. None of the children shewed the slightest inconvenience. I wish to place on record my thanks to Dr. Copeman and Dr. Scott for the trouble they took in connection with the work. Diphtheria Antitoxin. Arrangements have been made whereby boxes containing Sterile Antitoxin, syringe and the necessary dressings, etc. are kept at the two Police Stations so as to be available in case of emergency. Daring 1924, 25 vials of Antitoxin were supplied to medical practitioners. (6 of 2000 units and 11 of 4000 units and 8 of 8000 units). Enteric Fever. There were four cases notified during the year. Dysentry. None were notified. Total. Positive. Percent age. Staff (Medical, Nursing and Staff at (North Hyde School) 50 15 30% Boys 432 54 12.5% Nursery 57 9 15.8% 24 Erysipelas. 32 cases of this disease were notified, of whom 21 were West Middlesex Hospital cases, 10 of the persons affected being nonresidents. Puerperal Fever. 10 cases of this disease were notified, 9 were institution cases, and were not residents in this district. Ophthalmia Neonatorum. Four children were notified as suffering from this disease. One was notified from Warkworth House. In one severe case two Nurses were placed in the house as accommodation could not be obtained for the mother and child in Hospital. The results were entirely satisfactory. Encephalitis Lethargica. There were 33 cases notified this year, four of which proved fatal. This is a much larger number of cases than any year previously—last year there was one case notified and in 1922 three cases. As will be noticed from the following table, 16 out of the 33 cases were notified in May and 4 in June, constituting a small epidemic. Most of the 20 cases were of a mild nature, the main symptoms being dizziness and diplopia. On the 21st May, Dr. Parsons of the Ministry of Health, visited 8 of the earlier cases and confirmed the diagnosis, except in one case about which he was doubtful. An interesting feature of the outbreak was that the cases were confined to a small and populous area of Hounslow. With the exception of one case in June which occurred in Isleworth, the other 9 cases were all within the approximate radius of ½-mile from the junction of the Bath and Staines Roads, whilst the majority were within as small a radius as ¼mile. 25 A second smaller outbreak occurred in August and September, when there were 10 cesses. These all occurred in Hounslow and 9 of them were within a similar area to the May outbreak. Two of the cases proved fatal, 2 brothers aged 4 and 2½ years respectively, a third brother aged 8 months, who was also notified as Encephalitis, died in Guy's Hospital but a post mortem shewed the death to be due to Tubercular Meningitis. Cerebro - Spinal Fever. No cases of this disease ware notified. Acute Poliomyelitis. No cases were notified. Pneumonia. 171 cases were notified including 1 military case. 105 were non-residents in the West Middle-sex Hospital. Malaria. There were no cases notified during the year. Pulmonary Tuberculosis. The number of new cases notified during the year was 44. Twenty-nine cases (or nearly 66%) were notified from Institutions:— Sanatoria 16, Poor Law Institutions 1, General Hospitals 6, Mental Hospitals 2, T.B. Dispensary 1. Naval and Military cases 3. Total number of cases admitted to Sanatoria, etc. 34. Of the new cases notified 28 received Institutional Treatment during the year and 10 died in Institutions. Other Forms of Tuberculosis. The number of new cases notified during the year was 21. Eleven of them were notified as receiving institutional treatment. Ten cases were notified from Institutions. Death from Tuberculosis. Tuberculosis of Respiratory System 36. (15 were primary notifications and 5 were not not notified at all). Other Tuberculosis 13 (4 were not notified). 26 OPHTHALMIA NEONATORUM. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 4 3 1 3 ... ... ... One case removed from District the day after visiting. 27 Cases of Encephalitis Lethargica in 1924. Under 1 year, 1-6. 5-10. 10- 20. 20-80. 80-40. 40-60. 60-60. 60-70. 70-80. Age not known. Total. Male 1 2 1 6 1 2 ... 4 ... ... ... 17 Female % ... ... 1 3 3 4 3 ... ... 1 1 16 Totals 1 2 2 9 4 6 3 4 ... 1 1 33 Date of Notification. J AN. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. ... ... ... ... 16 4 1 6 4 ... 1 1 28 TUBERCULOSIS. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0 ... ... 2 ... ... ... 2 ... 1 1 ... ... ... ... ... 2 ... 5 1 ... 2 4 ... ... 2 ... 10 ... ... 2 3 ... ... 2 3 15 3 4 2 1 2 3 ... ... 20 8 2 1 1 3 1 ... ... 25 4 7 1 ... 2 6 ... ... 35 5 1 ... 2 11 1 ... 1 45 4 2 ... ... 2 1 ... ... 55 2 ... ... ... 3 ... ... 1 65 and upwards ... ... ... ... ... 1 ... ... Totals 28 16 10 11 23 13 8 5 3 Military Cases included. Five of the deaths from Pulmonary Tuberculosis were not notified and four of the deaths from Non-Pulmonary Tuberculosis were not notified. 29 Non-notifiable Diseases. Information respecting non-notifiable infectious diseases is usually gained through notifications by the Head Teachers and School Attendance Officers. The undermentioned table set forth the numbers of such cases for the year : — Measles 563 German Measles 30 Chicken Pox 100 Mumps 308 Whooping Cough 67 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 0.23 per 1,000. 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 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 practicing in its area. In this district it is the practice of the Health Visitors not to visit the newly-born till 14 days after the birth, in order not to interfere with the Midwife. 30 According to the County Medical Officer's last list, there arcs 15 midwives practicing in the district. MATERNITY AND CHILD WELFARE CLINICS. The new premises for the Hounslow Maternity and Child Welfare Clinic were opened on Wednesday, December 3rd, 1924, and owing to the restriction of days when the premises were available, the Clinics were reduced to two, held on Wednesday and Thursday, and a separate ante-natal clinic is hell at the original premises in the Council House. The new premises are an immense improvement, there being ample room in the Waiting Room. We have not yet been able to secure sufficient volunteers to take the toddlers in a room apart. The attendances totalled 8817 for the year as compared with 8322 in 1923, and 8398 in 1922. The average attendance at the Council House and later at Douglas Road Centre was 35.6, and at the Isleworth Centre 33 7. The number of individual mothers and children attending the Clinics is shewn hereunder Council House, Hounslow. Isleworth Public Hall. 1920. 1921. 1922. 1923 1924. 1920. 1921. 1922 1923. 1924. Mothers 315 538 541 525 530 170 268 278 270 381 Children 407 774 726 646 610 185 296 350 330 489 Sales at Clinics. Quantity. Receipts £ s. d. Glaxo 7064 lbs. 519 15 6 Virol 384 lbs. 6 ozs 32 0 7½ Malt 396 lbs. 16 5 1 Oil and Malt 475 lbs. 18 18 0 Marylebone Cream 18½ lbs. 1 10 11 Lactagol 172 pkts. 9 19 6 Almata 46 lbs. 3 9 0 Cow & Gate 32 lbs. 3 1 4 £ 604 19 l1½ 31 The arrangements with chemists for the dispensing of prescriptions on terms similar to those under the National Insurance Act, have been continued. The difficulties of the Isleworth Centre remain as before, it says much for the appreciation of the work that the attendance is so good. The Isleworth Centre had the limelight of notoriety focussed upon it by winning the Daily Sketch Challenge Shield for the finest child in the United Kingdom between 2 and 5 years of age. The winner was a boy named Lionel Burnett. The mothers at the centre felt that the presentation of the Shield at Wembley was an occasion to be duly honoured. 62 accordingly went to do honour to the recipient, accompanied by Medical Officers and Nurses. Conside able excitment was caused by the contingent, and the fact that the two representatives who went up to receive the shield, had between them contributed 28 children to the nation, produced additional applause. One was present with her 19th child and another mother with her 9th, being the first daughter after eight successive sons. Ante-natal work is still very far from what is desired. The advent of two new Midwives in the district is improving matters. There is ample need for this work to be developed, as by careful supervision of the mother during the latter mouths of pregnancy, many tragedies to the family are avoided, and the welfare of the child assured. There are not only the tragedies of the loss of life, but of the mother's impaired health, which results from an unsatisfactory confinement, which are almost always accompanied by continuous pain or discomfort, the existence of which often entirely spoils the atmosphere of the homo, in that the previously healthy cheerful mother tends to become an irritable semi-invalid on whom the cares of the family weigh unduly. 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. 32 Home Help for Mothers. The Home Help paid 229 visits during the year and her work was found of considerable value. She also assists at the Centres when not occupied with her other duties. In addition to her ordinary work, in her unoccupied time she carries out cleansing of unclean heads, under a special scheme. She was trained at one of the London Cleansing Stations, the Council provides the Sacker's combs and the necessary shampoo and towels. A fee of 1/- is charged for each case. By this means, any child who is excluded from school, can be back within two days, and the cleansing is not carried out by any officer of the department acting as such. There have been certain parents who objected to going to the Home Help, but a considerable number of parents have been very glad of the opportunity. The presence of this service acts in another way, in that if a case is taken before the Magistrates the fine is considerably heavier now that means are at the disposal of the parents, whereby the child can be re-admitted to school within 48 hours. There is certain class of parent who rather than face the fact of paying the 1/-, will spend more than that on various medicaments wherewith to cleanse the child's head, and run to the extreme limit of the period allowed by the Committee, and then at the last minute face the fact that that it is better to pay 1/- and get the head clean, than run the risk of a substantial fine by the bench. During the year, 132 children have been cleansed. Grants of Milk. Milk is supplied free or at reduced rates to expectant mothers (during last three mouths of pregnancy) to nursing mothers, and to children under three. The scale of grants for provision of milk has been fixed as follows:— Where the family income after deducting rent is less than 4/- per head free. 4/- to 5/- per head parent pays 1/3cost. 5/- to 7/6 „ „ 2/3 Where the amount is over 7/6 per head, no grant is made. Number of grants made during the year was 137. 33 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 in 1920. There are two School Clinics at each of which the Medical Officer attends twico 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 Venereal 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 in connection with the Maternity and Child Welfare Work are shown in the following table :— 34 1920. 1921. 1922. 1923. 1924. 1st visit to babies under one year 1132 1029 ... 913 803 754 Re-visits to babies and children up to five years 4715 4484 ... 4241 4150 3594 Inquiries made, elicited— Feeding—Natural 870 631 ... 536 516 487 Artificial 59 54 ... 43 61 59 Both 23 51 ... 41 42 32 Sleeping with parents 477 354 ... 319 282 248 Using Comforter 300 236 ... 198 285 236 Mother working during pregnancy 56 45 ... 56 44 37 Ante-Natal. First visits 102 Subsequent visits 63 Infant Deaths. Visits paid 41 Still Births 2 Ophthalmia Neonatorum 3 Infantile Diarrhoea 3 Puerperal Fever 1 Measles and German Measles 63 Children under 5 years. Whooping Cough 56 Mumps 12 Chicken Pox 14 Pneumonia 11 Bronchitis 2 Milk and Food Cases 40 Home Help 13 Social Conditions 54 Milk Samples 2 Other visits 121 Health Visitors attendances at the Maternity and Child Welfare Centres, 508. The Health Visitors also paid 51 visits to Infectious Disease cases, and patients notified as suffering from Tuberculosis, etc., and 9 special visits to the North Hyde Schools in connection with the Diphtheria investigation. 35 Notification of Births. Number of live births notified during the year 839 „ „ still births notified 22 Notified by Midwives 546 Notified by parents or doctors 315 No special measures exist for dealing with unmarried mothers or illegitimate children of such, but cases not wholly destitute have derived benefit through the Council's scheme for grants of food and milk. 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. Special mention must be made of the services rendered at the Welfare Clinics by Miss K. Castell, Mrs. Chadwick and Mrs. Schultz at the Hounslow Centre, and Mrs. E. Chedgey, one of the Co-opted Members of the Committee, Mrs. Evans and Mrs. Watson at Isleworth. HOSPITALS. 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 IIo=pital (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 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. 36 3. The Hospitals in the district are the West Middlesex Hospital which is the Poor Law Infirmary. The Hounslow Hospital with 47 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 wit.h 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. 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. 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 the District: *Infectious Diseases (Prevention) Act, 1890. *Public Health Acts Amendment Act, 1890, Part III. *Public Health Acts Amendment Act, 1907, Parts II., *III., *1V., *V., VI. and VIII. 37 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. Small Dwellings Acquisition Acts, 1899-1923. Local Government and other Officer's Superannuation Act, 1922. 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. 41). *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.O.M.O. 1885, s. 13). Allotments (A.A. 1887, s. 6). Allotment Regulations, 1922. *These are administered wholly or artly by the Health Committee. The unstarrcd are administered by other Commitees of the Council. 38 COUNCIL LABORATORY, 1924. Total. Positive (a) Swabs for Diphtheria sent by Medical Practition ers 84 10 Sub-cultures 4 0 Taken from Schools, Clinics and from Contacts 521 19 Sub-cultures 11 l Sent from Staines Joint Isolation Hospital 250 31 Sub-cultures 0 0 Mogden Isolation Hospital. 1 1 St. Mary's School, North Hyde 142 22 Total cultures examined . 1013 84 Virulency Tests . 5 4 Diphtheria Investigation at St. Mary's Schools, North Hyde, in December 1064 swabs examined and 144 sub-cultures made. 11 cultures proved virulent. (b) Blood examination for Typhoid Widal Tests 1 0 (c) Cerebro Spinal Fluid Examinations . 1 1 (d) Specimens of Sputum for Tubercle Bacilli :— Sent in by Medical Practitioners 66 8 Sent by M.O.H. 3 0 Total 69 8 (e) Hairs for Ringworm- Taken at Schools or Clinics 32 . 21 (f) Other Specimens— Urine 67 Discharge 10 (g) 1 Analysis Mothers Milk 1 Analysis Glaxo 1 Analysis Milkal Preparation of Materials— Tubes of Serum 2680 Throat Swab Outfits 2000 Sputum Outfits 82 Typhoid Outfits 0 39 The bacteriological work of the Staines Joint Isolation Hospital continues to be done in the Council Laboratory. We also continue to supply the Mogden Isolation Hospital Diphtheria Culture Tubes. The Virulency and Widal Tests were carried out for us by Dr. Harold Spitta at St. George's Hospital, except in the case of the investigation at St. Mary's School, those being carried out by Dr. Scott of the Ministry of Health. 40 HESTON & ISLEWORTH URBAN DISTRICT COUNCIL. Public Health Department, Council house, Hounslow 7 th May, 1925. Sir, Canal Boats Acts, 1877 to 1881. In accordance with Section 3 of the Canal Boats Act, 1884, I beg herewith to present the Annual Report for the year ended 31st December, 1924, as to the execution of the Canal Boats Acts, 1877 and 1834, and of the Regulations made thereunder, within the Urban District of Heston and Isleworth, Middlesex. Inspectors appointed under Canal Boats Acts— R. H. Butler (Chief Sanitary Inspector). G. W. Ashtuorth (District Sanitary Inspector). E. W. Barton (District Sanitary Inspector). No special remuneration is paid for the position. Number of Inspections, etc.— Number of inspections made 54 Number of Canal Boats inspe0cted 52 Number of boats found in order 47 Number of boats with three infringements 1 Number of boats with two infringements 1 Number of boats with one infringement 3 Nature of Contraventions, etc.— Overcrowding 1 Cabins not in a habitable condition 2 Painting of interior of cabins required 1 No proper water vessels provided 3 Bilge water not removed daily 1 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.L. 41 HOUSING The housing conditions in the district remain unsatisfactory. There are still a number of cases of legal overcrowding, but no remedy can be found so long as the present shortage of houses exists. These cases have been duly reported to the Public Health Committee and a special report on all known cases was presented. The Public Health Committee recommended the appointment of a special Officer for a period of three months, to report on certain areas, in order to get a real picture of the overcrowding. This was negatived by the Council. Moral overcrowding is much more frequent and produces more discontent than actual overcrowding where there is no difficulty with regard to mixing the older children with parents. There appears to be amongst a section of the population, les reluctance to live in close contact with others in small tenements than before the war, mainly brought about by the stress of war conditions. There is no doubt that in some of the families, the condition under which they live is having a really deleterious effect on the health of the children. 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. (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 ,, 42 (3) Difficulty 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. (3) 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, hut 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. Unhealty 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. 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. 43 (2) As to need for new bye-laws and revision of existing byelaws : 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. IV. General and Miscellaneous. Other action taken in connection with overcrowding, insanitary property and housing Nil. V. Appendices, Statistics for year ending 31st December, 1924. SHOPS ACT. The number of contraventions of the Acts which were reported during the year was as follows:— Open on half-holiday 5 Open after evening closing hour 6 Prescribed form of notices not exhibited (exempted articles afternoon) 10 Prescribed form of notices not exhibited (exempted articles evening) 9 Prescribed form of notices not exhibited (assistants half-holiday) 1 Prescribed form of notices not exhibited (employment of young persons) 1 Provision or improvement of sanitary conveniences (P.H.A.A.A 1890, s. 22) 2 PROCEEDINGS. No proceedings have been taken during the year. 44 APPENDI CES. Housing Conditions Statistics. Year ended 31st December, 1921. 1. GENERAL. (1) Estimated Population Birthrate 47,700 Death rate 46,970 (2) General Death rate 10.79 (3) Death rate from Tuberculosis (all forms) 1. 04 (4) Infantile Mortality 60.5 (5) Number of dwelling houses of all classes 9,611 (6) *Number of working-class dwelling houses 4,837 (7) Number of new working-class houses erected 139 *Number of new houses other than working-class 165 Total number of new houses erected of all classes 304 2. UNFIT DWELLING-HOUSES. I. Inspection. (1) Total number of dwelling-houses inspected lor housing defects (under Public Health or Housing Acts) 338 (2) Number of dwelling-houses which were inspected and recorded under the Housing(Inspection of District) Regulations, 1910) 1 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceeding subheading) found not to be in all respects reasonably fit for human habitation 95 (5) Number of houses, listed for inspection under the Housing (Inspection of District) Regulations, 1910, at end of year 1544 II. Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 12 45 III. Action under Statutory Powers. A. Proceedings wider Section 28 of the Housing Town Planning, etc., Act, 1919— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 10 (2) Number of dwelling-houses which were rendered fit— (a) by owners 6 (b) by Local Authority in default of owners 1 (3) Number ot 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 16 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 12 (b) by Local Authority in default of owners 2 C. Proceedings wider 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 nil. (2) Number of dwelling-houses in respect of which Closing Orders were made nil. (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 1 46 (4) Number of dwelling-houses in respect of which Demolition Orders were made nil. (5) Number of dwelling-houses demolished in suance 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 nil. E. Other matters— (1) Number of dwelling-houses closed voluntarily 3 (2) Number of dwelling-houses demolished voluntarily 6 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 placed (5) Staff engaged on housing work with, briefly, the duties of each officer. The outdoor staff of the Health Department consists normally of one Chief Inspector and three District Inspectors. During the War, two of the District Inspectors joined the Army and the third left to take up a position elsewhere, whilst the Chief Inspector carried on as best he could. Upon their discharge from the Army the 47 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. 48 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 1923— ‡*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 ,, ,, ... ... ... ... †65-75, Hanworth Boad 6 12/1/20 23/11/20 ... ... ... ... 175, Twickenham Boad 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 ... ... ... ... 10, South Street 1 10/10/21 22/11/21 12/5/24 ... ... ... 2, Forman's (or Field's) Cotts., North Hyde Lane, Heston . 1 10/7/22 ... ... ... ... ... 20, Tivoli Road, Hounslow 1 9/10/22 28/11/22 ... ... *†8/8/24 ... 22, ,, ,, ,, 1 9/10/22 28/11/22 ... ... *†8/8/24 ... 24, „ ,, ,, 1 9/10/22 28/11/22 ... ... *†8/8/24 ... * 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 and 3. 31/12/23 Nos. 1, 2 and 3 occupied. †Closing Orders not served. ‡ Demolition deferred until after the War. *†Houses demolished prior to Demolition Order being made. 49 Table II. Causes of Deaths during 1924. Causes of Death. Civil Residents all ages. Male. Female. All causes 262 245 1 Enteric Fever ... ... 2 Small-pox ... ... 3 Measles 7 7 4 Scarlet Fever ... ... 5 Whooping Cough 1 ... 6 Diphtheria 8 2 7 Influenza 4 7 8 Encephalitis Lethargica 3 ... 9 Meningococcal Meningitis ... ... 10 Tuberculosis of Respiratory System 23 13 11 Other Tuberculous Diseases 8 5 12 Cancer, Malignant Disease 31 32 13 Rheumatic Fever 1 ... 14 Diabetes ... 2 15 Cerebral Haemorrhage, Ac. 6 15 16 Heart Disease 35 36 17 Arterio-sclerosis 8 8 18 Bronchitis 16 22 19 Pneumonia (all forms) 19 18 20 Other Respiratory Diseases 3 3 21 Ulcer of Stomach or Duodenum 1 3 22 Diarrhoea, etc. (under 2 years) 2 3 23 Appendicitis and Typhlitis 1 3 24 Cirrhosis of Liver 3 2 25 Acute and Chronic Nephritis 5 4 26 Puerperal Sepsis ... 1 27 Other Accidents and Diseases of Pregnancy and Parturition ... ... 28 Congenital Debility and Malformation, Premature Birth 18 8 29 Suicide 4 30 Other Deaths from Violence 7 2 31 Other Defined Diseases 48 49 32 Causes ill-defined or unknown ... ... According to figuies furnished by the Registrar-Geneial. Table III. Infantile Mortality during the year 1924. 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 nits. 3 mts. and ui dcr (urn. 6 mts. nnd under 9 mts. 9 mts. nnd under 12 mts. Total Deaths under 1 vears Certified 13 4 2 4 23 1 2 8 5 3 51 Smallpox Chickenpox Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever Whooping Cough Diphtheria and Croup Erysipelas Tuberculous Meningitis ... ... ... ... ... ... ... 1 1 2 Abdominal Tubercnlosis Other Tuberculous Diseases Meningitis (not Tuberculous) Convulsions ... ... ... ... ... 1 ... 1 ... 2 Laryngitis Bronchitis ... ... ... 1 1 1 1 ... ... 3 Pneumonia (all forms) ... 1 ... ... 1 3 ... ... ... 4 Diarrhoea ... ... ... ... ... ... 1 ... ... 1 Enteritis ... ... ... 1 1 2 ... 1 1 5 Gastritis ... ... ... 1 1 1 ... ... ... 2 Syphilis Rickets Suffocation, overlying Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Congenital Malformations ... 1 ... ... 1 ... ... ... ... 1 . Premature Birth 7 2 2 1 1 2 3 ... ... ... 15 Atrophy, Debility and Marasmus 1 ... ... ... 1 1 4 1 ... 7 Other Causes 3 ... ... ... 3 ... 2 1 6 13 4 2 4 23 12 8 5 3 51 Nett Births Legitimate 818 Nett Deaths Legitimate infants 46 Illegitimate 25 Illegitimate infants 5 TABLE IV.-A Infectious Diseases, 1924. Cases Notified. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Erysipelas. Cerebrospinal Fever. Encaphalitis Lethargica. Poliomyelitis. Pneumonia. Malaria. Respiratory Tuberculosis. Other forms of Tuberculosis. Ophthalmia Neonatorum. Dysentery. Anthrax. Small-pox. January 3 7 ... 1 1 ... ... ... 31 ... 5 2 ... ... ... ... February 11 1 ... ... 1 ... ... ... 38 ... 5 1 ... ... ... ... March 17 7 ... ... 3 ... ... ... 23 ... 5 5 ... ... ... ... April 4 14 1 2 6 ... ... ... 18 ... 4 1 ... ... ... ... May 11 10 ... 2 4 ... 14 ... 8 ... 2 2 ... ... ... ... June 9 16 1 ... 4 ... 6 ... 18 ... 1 2 2 ... ... ... July 1 2 4 1 1 2 ... 1 ... 3 ... 6 ... ... ... ... ... August 7 ... ... ... ... ... 6 ... 6 ... 4 ... ... ... ... ... September 12 4 ... ... ... ... 3 ... ... ... 4 ... 1 ... ... ... October 8 16 1 ... 6 ... 1 ... 5 ... 4 4 ... ... ... 7 November 12 1 2 ... 2 3 ... 1 ... 10 ... 2 1 ... ... ... ... December 7 14 ... 2 2 ... 1 ... 11 ... 1 2 1 ... ... ... Totals 113 105 4 10 32 ... 33 ... 171 ... 43 20 4 ... ... 7 Table IY.—B. Notifiable Diseases during 1924. DISEASE. TOTAL CASES NOTIFIED. CASES ADMITTED TO HOSPITAL. Under 1 year. 1-2 years 2-8 years 8-4 years 4-5 years 5-10 years 10-15 years 15-20 years 20-35 years 35-45 years 45 65 years (55 years and over. MOGDEN. OTHEE HOSPITALS Small-pox ... ... ... ... ... ... ... ... ... ... 2 5 ... 7 Enteric Fever ... ... ... ... ... 1 ... 2 1 ... ... ... 3 ... Scarlet Fever 1 4 5 6 15 40 25 7 11 1 ... ... 96 6 Diphtheria 5 5 5 8 17 28 21 6 7 3 ... ... 63 35 Erysipelas ... ... ... ... ... ... 1 2 3 3 11 12 ... 21 Puerperal Fever ... ... ... ... ... ... ... ... 9 1 ... ... ... 10 Ophthalmia 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 Neonatorum Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro Spinal ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fever Pneumonia 10 21 9 7 3 ] 1 9 10 29 18 33 11 ... 141 Malaria • •. ... ... ... ... ... ... ... . . . ... ... ... ... ... Encephalitis Lethargica 1 ... 1 ... 1 2 2 8 7 5 5 1 1 5 Table IV.—C. Deaths from Notifiable Infectious Disases, 1924. Age Groups. Under 1 year. 1 year. 2 years. 3 years. 4 years. 5 years. 10 years. 15 years. 20 years. 35 years. 45 years. 65 years and over Small Pox ... ... ... ... ... ... ... ... ... ...... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... 1 l ... 1 6 l ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... 1 ... ... Pneumonia 4 4 l ... ... 1 ... ... 3 3 10 11 Encephalitis Lethergica ... ... l ... 1 ... ... l ... ... ... ... Cerebro Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... 2 Total 4 5 3 ... 2 7 l l 3 4 10 13 For Tuberculosis Deaths—see other Table. 53 Table IY.—D. The table hereunder gives the number of cases of infectious diseases that occurred in the several Institutions in the district during 1924:— SMALL-POX. ENTERIC FEVER. SCARLET FEVER, DIPHTHERIA. PNEUMONIA (all forms). ERYSIPELAS. PUEPPERAL l FEVER. CEREP.RO SPINAL FEVER. OPHTHALMIA NEONTORUM. ENCEPHALITIS LETHARGICA. PULMONARY TUBERCULOSIS. OTHER TUBERCULOSIS. POLIOMYELITIS. TOTAL. West Middlesex 7 ... 6 26 137 21 9 ... 1 1 2 ... ... 210 Hospital Dundee House ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 Gumley House ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Nazareth House ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Hounslow Barracks ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Military Hospital ... ... ... ... ... ... ... ... ... ... 3 ... ... 3 Colling wood College ... ... 2 ... ... ... ... ... ... ... ... ... ... 2 Hounslow Hospital ... ... ... ... ... ... ... ... ... 3 ... ... ... 3 North Hyde Schools ... ... ... 23 ... ... ... ... ... ... ... ... ... 23 7 ... 8 51 138 22 9 ... 1 5 5 ... ... 24G Report on the administration of the Factory and Workshop Act, 1901, IN CONNECTION WITH FACTORIES, WORKSHOPS AND WORKPLACES. Table V.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections siadk by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) factories (including Factory Laundries) 29 Workshops (including Work-hop Laundries) 103 3 Nil Workplaces (other thap Outworkers p.emises included in Table VII. 47 ... Total 179 3 Nil. Table VI.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. 1 Number of Defects. Number of Trosec. l)c i e. 7 Outstanding Jan. 1st. 1924. 2 bound during 1924. 3 Remedied during 1121. 4 Outstanding Dec 31st, 1924. 5 Referred to H M. inspector. 6 Nuisances under the Public Health Jets:-* Want of cleanliness Want of ventilation 1 Overcrowding Want of drainage of floors Other nuisances ... 2 ... 2 Sanitary accommodation— Insufficient Unsuitable or defective ... 1 ... 1 NIL NIL Not separate for sexes I 1 l 1 Offences under the Factory and Workshop Act: — Illegal occupation of underground bakehouse (s.ror) Utner offences :— Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921 2 7 5 4 Total 3 12 7 8 Nil. Nil. including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act, 1901, and remediable under the Public Health Acts. + Section 22 of the public Health Acts Amendment Act, 1890, has been adopted by the DistrictCouncil, and the standard of sufficiency and suitability of sanitary accommodation forpersons employed in factories and workshops enforced is that required by the y Accommodation Order of 4th February, 1903. 56 Table VII.—HOMEWORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107 Prosecutions. Outwork in unwholesome premises, Section 108. Outwork in infected premises, Sections 109, 110. Lists received from Employers. rotices served on Occupiers as to keeping or sending lists. Instances. Notices Served. Prosecutions. Instances. Orders made (s. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once 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. 2 ... 3 3 ... 7 ... ... ... ... ... ... ... ... ... cleaning & washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery 1 2 1 ... 1 ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Total 3 ... 5 4 ... 8 ... ... ... 1 ... ... ... ... ... tA Closing Order has been made with respect to the premises occupied by this outworker. Number of outworkers on register, 28. Inspections made 24. Number of Lists received from other Sanitary Authorities twice in the year, 7; once in a 3ear, 8. 57 Table VIII.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Bakehouses—Workshops 17 Laundries (non-factory) 30 Workshops 226 Workplaces 36 Total number of workshops on Register 309 •In addition there are in the district 10 factory Bakehouses. Table IX.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to II.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 (8.5. I9°I)— Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 2 Other - Underground Bakehouses (s. 101) .— *In use at the end of the year 1 * Retail—Factory Bakehouse. 58 SANITARY WORK, ETC. Inspections - General: Total number of inspections and re-inspections, etc. (excluding shops and petroleum) 8553 Inspections, etc. re Nuisances, Contraventions, etc.: Number of premises, etc., inspected on complaint 393 Number of premises inspected in connection with infectious diseases 81 Number of premises inspected under Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 2 Number of smoke observations made 5 Number of other visits made to premises, etc., in connection with nuisances, etc. 119 Total number of premises, etc., primarily inspected in connection with nuisances 801 Number of visits made to works in progress 747 Number of interviews with owners, builders, etc., re abatement of nuisances 547 Number of premises, etc., whereat nuisances were recorded during the year 470 Number of premises, etc., on which defects, etc., were remedied— (a) by owners 491 (b) by local authority in default of owner or occupier 13 Number of cautionary or intimation notices given— (a) verbal 95 (b) written 307 Number of second (informal) notices given 110 Number of letters re nuisances sent 253 Number of Statutory Notices issued 44 Number of proceedings taken — Number of convictions obtained Number of proceedings withdrawn 59 Common Lodging Houses: Number registered 2 Number of inspections made 15 Canal Boats used as Dwellings: Number of inspections made 53 Number of contraventions found 8 Movable Dwellings, Caravans, Tents, etc.: Number observed during the year 77 Number of inspections made 81 Number removed from district 41 Number of contraventions found 3 Number of contraventions remedied 3 Bakehouses: Number in district (a) factories 10 (b) workshops 17 Number of underground bakehouses in district 1 Number of inspections made 75 Number of contraventions found 7 Number cleansed 2 Number of other contraventions remedied 3 Slaughterhouses: Number on Register (a) registered premises 4 (6) licenced premises 4 Number of inspections made 204 Number of contraventions found 15 Number cleansed 5 Number re-constructed, repaired or improved 3 Number of accumulations of offal removed 6 Number of other contraventions remedied 1 Cowsheds: Number of persons registered 10 Number of premises 11 Number of cowsheds on register 20 Number of milch cows in district 129 Number of inspections made 41 60 Dairies and Milkshops: Number of persons registered 47 Number of premises 37 Number of inspections made 204 Number of contraventions found 4 Number re-constructed, repaired or improved 2 Number cleansed 1 Number of other contraventions remedied 1 Offensive Trades: Number of businesses established in district 16 Number of inspections made 141 Inspection of Food: Number of me it inspections 556 Number of fish inspections 316 Number of provision inspections 503 Number of greengrocery and fruit inspections 552 Number of hawkers foodstuff inspections 269 Number of other food inspections 39 Unsound Food: Number of carcases surrendered 1 Number of parcels surrendeted 6 Number of organs or parts surrendered during slaughtering 1 Infectious Diseases, Disinfection, etc.: Number of visits made 554 Number of rooms disinfected (a) ordinary infectious diseases 239 (b) Tuberculosis 68 Number of rooms stripped and cleansed after infectious diseases— (a) by owners or occupiers 10 (b) by local authority 9 Number of articles disinfected or destroyed 1416 Water Supply: Number of supplies provided 3 Number of draw taps connected direct to main 63 61 Number of water service pipes or taps repaired 8 Approximate percentage of houses supplied on constant system 9995 Number of samples taken for analysis from local wells 2 Drainage and Sanitary Arrangements, etc., of existing Buildings: Water Closets: Number of water closets provided or re-constructed 5 N umber of walls, etc., cleansed 18 Number repaired, supplied with water or otherwise improved 146 Number of apparatus cleansed or unstopped 13 Approximate percentage of houses provided with water closets 98 Sinks: Number of new sinks provided 18 Number of sinks repaired or improved 27 Drains : Number unstopped, repaired, trapped, etc. 130 Number of waste pipes provided, disconnected, repaired, trapped or un-stopped 13 Number of ventilating shafts fixed, repaired or improved 11 Number of fresh air inlets provided, repaired or improved 15 Number of rain water pipes dis-connected from drain 13 Number of gully traps inserted or improved 30 Number of inspection chambers inserted 1 Number of dis-connecting traps improved, sealed or cleansed 2 Number of inspection chambers repaired, improved, sealed or cleansed 9 Number of drains constructed or re-constructed 9 Total length of drain pipes laid (4") 357 ft. Number of tests and re-tests applied 18 Number of other works executed 32 Approximate percentage of houses draining into Council's sewer 98 62 Removal of Household Refuse: Number of new ashbins provided 104 Dampness: Number of roofs stripped, renewed or repaired 159 Number of gutters and rain water pipes provided, repaired or unstopped 104 Number of instances in which external brickwork, sills, etc. repaired, renewed or rendered impervious 159 Number of damp-proof courses provided 14 Number of sites covered wi„h impervious materials 5 Number of yards paved, repaired or drained 86 Interior Work: Number of rooms stripped and cleansed (other than in connection with infectious disease) 266 Number of floors, walls and ceilings repaired or renewed 340 Number of rooms in which ventilation provided or improved 23 Number of rooms in which lighting provided or improved 6 Number of window frames and sashes provided, repaired or unfixed 281 Number of stoves or grates provided or repaired 78 Number of instances in which ventilation under floors provided or improved 41 Number of other repairs 17 Sundry Nuisances, etc.: Number of instances in which domestic cleansing enforced 7 Number of food stores provided, cleansed or improved 4 Number of washing coppers provided or repaired 76 Number of rooms sprayed for the removal of vermin by the disinfector 66 Number of instances in which overcrowding abate 1 3 Number of instances of improper keeping of animals abated 29 Number of offensive accumulations removed 17 Number of urinals provided, repaired, cleansed or improved Number of dung pits provided, repaired or improved Number of other nuisances abated 15 63 OTHER WORK. Shop Acts : Number of shops on register 871 Number of inspections made 1467 Number of contraventions found 34 Number of warning notices given 34 Petroleum Acts, 1871-1881: Number of premises licensed 50 Number of inspections made 368 Number of contraventions found 36 Number of new stores provided 6 Number of warning notices given 29 HESTON and ISLEWORTH URBAN DISTRICT EDUCATION COMMITTEE. SEVENTEENTH ANNUAL REPORT OF THE School Medical Officer FOR THE Year ending 31st December, 1924. 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, 1924. 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, 1924-25. W. J. R. DIVINE, Esq. (Chairman) E. W. HEATH, Esq., j.p. (Vice-Chairman). Members of the Council:— S. CARTER, Esq., j.p , ex-officio (Chairman of the Council). A. L. LANG, Esq., ex-officio (Vice-Chairman of the Council). J. J. BONNETT, Esq. D. BONNETT, Esq. W. D. COWELL, Esq. A. DENNIS, Esq. A. E. HALES, Esq. F. T. HART, Esq. R. LANGDON, 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. A. E. POPE, Esq. School Medical Officer : ELWIN H. T. NASH, m.r.c.s., l.r.c.p.,d.p.h. STAFF. Clerical Staff— B. W. Kilby, (Chief Clerk). A. G. Hubbard. Miss R. Marshall. E. Cromwell. J. Holmes. Health Visitors— Mrs. C. E. N. Ottley. Miss B. N. Tetley. Mrs. A. E. Tyrrell. Miss W. E. Scott. Miss J. D. Law. Dentist—I. Cohen, L.D.S., R.C.S., Eng. Radiographer—D. Arthur, M.D., D.P.H. Assistant School Medical Officer— Mrs. Eva Louise Roberts, M.B., Ch. 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. 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. (a). Infant and Child Welfare. There are two centres in the District. Thes9 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. The School Medical Service in relation to Public Elementary Schools. School Hygiene. The school buildings and the sanitary arrangements are periodically inspected. 6 The Committee asked for a special report on the sanitary arrangements of the schools. This was presented to the Committee, but owing to the pressure of other work, it could not be considered before the end of the year. MEDICAL INSPECTION. The afternoon sessions are chosen when possible, as it is found to be more convenient for those parents who desire to be present. 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 1924, includes those children born during the years 1912, 1915 and 1918, 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 1922, permission was received from the Board of Education for the Routine Medical Inspection of the Isleworth Blue, Worple Road and St. Mary's Schools to be held at the Isleworth Public Hall on account of the inadequate accommodation at these schools. Whilst this arrangement undoubtedly provides better accommodation, it has not proved as advantageous as was hoped, owing to the difficulty experienced by the head teachers in being present at an Inspection held away from their own schools. 7 FINDINGS OF MEDICAL INSPECTION, 1924. Uncleanliness. Out of 1,795 children examined at routine medical inspection, 171 were found to have nitty or verminous condition of the head, whilst 4 were marked for observation for uncleanliness of the body. 339 children were also seen at the school clinics. The total number of children excluded on account of nits and vermin during 1924 was 209. Further reference to this subject will be found on pages 21, 22 and Table IV. Tonsils and Adenoids. Out of 1,795 children examined at the routine inspections, 70 had enlarged tonsils, 18 of which were referred for treatment, 52 being kept under observation. 61 children had adenoids only, of which 22 required treatment, and 39 were for observation, whilst 34 children had both enlarged tonsils and adenoids, 18 requiring treatment, and 16 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 general improvement in the hygiene of the nose and mouth. At the special clinics 19 other children were found to have enlarged tonsils, 3 adenoids only, whilst 7 suffered from both conditions. Tuberculosis. Out of 1,795 children examined at the routine inspection there were 2 cases of suspected pulmonary tuberculosis requiring to be kept under observation. There were 3 definite cases of pulmonary tuberculosis found at the special clinics and 30 were found to be suffering from suspected pulmonary tuberculosis, whilst 2 children had tubercular glands. Skin. At the routine inspections, out of 1,795 children examined, 2 were found to be suffering from skin trouble. 8 At the special clinics there were 466 children suffering from various skin complaints, including scabies and impetigo (see Table II. for analysis of figures), 15 cases of ringworm of scalp and 16 cases of ringworm of body. External Eye Disease. Out of 1,795 children examined at the routine inspections, 17 were found to have minor eye diseases including blepharitis and conjunctivitis, whilst 10 had a squint. In addition 61 were found at the special clinics to suffer from the " minor " eye diseases. Vision. Out of 1,795 children examined at the routine inspections, 201 were found to have defective vision, 149 of which were referred for treatment, 52 being kept under observation. At the special clinics 22 children were referred for treatment for defective vision, 10 being kept under observation. Ear Disease and Hearing. Out of 1,795 children examined at the routine inspections, 71 were found to be suffering from defective hearing or ear disease, whilst an additional 111 were discovered at the special clinics. Dental Defects. Out of 1,795 children examined at the routine inspections, 663 had carious teeth and were referred for treatment, whilst 152 had slighter caries and were marked for observation. At the special clinics a further 74 were discovered, 71 of which were referred for treatment, while 3 were kept under observation. Dental inspections, 1,949 children were referred for treatment out of 2,836 inspected (for further particulars see Table IV. Group 4). 9 Crippling Defects. Out of 1,795 children examined at the routine inspections, there was one found to be suffering from a deformity. At the special clinics 2 were found to be suffering from rickets, 3 spinal curvature and 8 other forms, whilst 4 other forms of deformity were kept under observation. INFECTIOUS DISEASES. Cases of infectious diseases are occasionally met with at routine inspections or at one of the school clinics. Systematic swabbing of sore throats and suspicious nasal discharges bring 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 no doctor in attendance. Similar action is taken in respect of children kept at home on account of a "rash" During the year 1924, the following cases of infectious disease occurred among children attending public elementary schools in this district:— Scarlet Fever 57 Diphtheria 22 Measles 563 Rubella 30 Mumps 308 Chicken Pox 100 Whooping Cough 67 1147 10 Cases of infectious disease have occurred during the year among school children as follows:— SCHOOL. SCARLET FEVER. DIPHTHERIA. MEASLES. GERMAN MEASLES. MUMPS. CHICKEN POX. WHOOPING COUGH. Alexandra Boys 9 ... 32 4 2 ... 2 „ Girls 1 1 20 ... 3 4 1 Brentford End Infants ... ... 5 3 ... 1 Grove Road Boys 2 ... 2 ... 1 16 „ „ Girls 5 1 1 ... ... 3 „ „ Infants ... 3 47 ... 3 25 15 Heston Mixed 1 ... 26 1 1 1 „ Infants ... ... 38 ... 1 ... 8 Hounslow Heath Boys 2 ... 4 2 13 „ „Girls 1 ... 5 2 10 2 ,, ,, Infants 2 ... 26 1 9 Hounslow B.C. Mixed ... ... ... ... 2 ,, ,, Infants ... ... 1 ... 2 Hounslow Town Boys 5 ... 2 ... 1 3 „ „ Girls 4 5 1 ... 3 5 ,, „ Infants 1 ... 32 ... 1 8 Isleworth Blue Boys ... ... 12 1 8 ,, ,, Girls & Infants ... ... 55 ... 18 3 15 Isleworth Town Boys 1 1 11 1 14 4 ,, „ Girls & Infants 1 3 22 12 33 3 11 St. Mary's Boys 4 ... 9 1 15 ... 3 „ Girls & Infants 2 ... 61 1 13 4 1 Spring Grove Mixed 11 2 11 ... 16 ,, ,, Infants 3 4 53 ... 22 4 Woodlands St. John's Infants 1 ... 37 1 25 2 Worple Road Mixed 1 1 10 ... 31 2 1 „ „ Infants ... l 40 ... 61 10 10 Total 57 22 563 30 308 100 67 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 sent to the parent. The Health Visitor visits the home and explains to the parents what steps should be taken to have the condition treated. Revisits are made to ascertain what action has been taken. A "following up" card is made out for each defect and kept "alive" until the defect is remedied. 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 follow up cases absent or attending the clinics irregularly. Summary of work by the Health Visitors during 1924. 173 attendances at School Inspection Clinics. 199 ,, ,, Dental Clinics. 40 ,, ,, Eye Clinics. 341 ,, „ Minor Ailments Clinics. 3 ,, ,, School Sports. 1ll visits to schools for medical inspections. 26 ,, „ „ ,, re-inspections. 32 ,, „ „ dental inspections. 7 „ ,, „ cleansing surveys. 1058 „ homes in connection with following-up. 1580 „ ,, „ ,, infectious diseases. 915 other visits (clinic absentees, dental visits, etc.) 12 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 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 Tonsils and Adenoids is by arrangement carried out at the local hospitals. MINOR AILMENTS. Skin. Ringworm of the. Scalp.—Out of 15 cases referred for treatment 7 were successfully treated by the application of X-rays, 8 refusing this form of treatment. The X-ray treatment is carried out by Dr. D. Arthur, of Ealing, at his own surgery, a fee of £1:1:0 per case being paid to him. A charge of 52/6 per case is made, except in necessitous cases, when free treatment may be obtained on application to the Education Committee. Ringworm of Body.—11 cases were successfully treated at the School Clinics, 227 children were treated at the School Clinics for other skin diseases, including 3 cases of Scabies and 203 cases of Impetigo. Ear Disease and Hearing. At the School Clinic 55 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 this. 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 13 minute, any farther extension of the disease to the upper place of bone covering the inner ear, may lead to suppuration within the brain cavity and death. The number given 55, does not by any means exhibit the total number of cases existing in the schools, 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. 28 cases of Eye Disease have been treated at the School Clinics. These have been chiefly Conjunctivitis, Blepharitis, with some Phylctenular and Corneal Ulcers, and suppurative conditions of the lids. Tonsils and Adenoids. Out of 78 children referred for treatment, 40 received treatment either privately or through a hospital, whilst 14 were treated under the Education Authority's Scheme. Arrangements have been in force since 1921, whereby children requiring operative treatment for enlarged tonsils and adenoids, can obtain this either at the Hounslow or Richmond Hospital, the Education Committee accepting all responsibility tor the fee. Re-payments are claimed from the parents in accordance with the following scale:— Weekly family income Amount per per head, less rent. case. Under 8/- nil. From 8/- to 10/- 5/From 10/- to 12/- 10/Above 12/- 21/Under the above scale, which was authorised by this Committee since September 1922, the number of cases of Tonsils and Adenoids operated on, is comparatively small. Personally, I am strongly opposed to the wholesale removal of Enlarged Tonsils, as in my experience a considerable portion of these disappear in 1 4 course of time, particularly after a septic mouth has been cleaned up. I am also entirely opposed to recommending the removal of Tonsils, unless I can be assured of complete enucleation. I am bound to admit that some of the after results which I have seen do not agree with this standard. The mere slicing off of a comparatively superficial piece of an Enlarged Tonsil, does not cure the condition and with the recurrence of throat trouble, tends to bring the operation to disrepute. Vision. Fresh arrangements were made with regard to the Ophthalmic work in 1924. Dr. Roberts, the Assistant Medical Officer, who has had previous experience of this branch of work, took it over. Fresh arrangements were also made for the provision of spectacles, a contract being entered into which provides satisfactory glasses at an all round price of 4/- per pair. It has been found that as a result of this, there has been less difficulty in getting the parents to provide spectacles, owing to the comparatively small and definite cost. The previous price of the spectacles ranged from 8/- to 13/- per pair. In addition there is now a definite scale of charges for the repair of spectacles which have been damaged or broken, as follows:— s. d. Two new lenses 3 3 One lens 1 10 New frame 1 9 Solder bridge 9 Solder eye wire 5 New side 9 As the result of the flat rate and definite charges, the work has grown to such an extent that it has been necessary to put on two Clinics a week instead of one. 183 cases of Visual Defect were submitted for Refraction at the School Eye Clinic, whilst 13 children were treated privately or at hospitals. In 150 cases spectacles were prescribed and provided by the Education Authority, and 13 children obtained spectacles privately. 15 Dental Defects. 920 children were treated by the School Dentist under the Local Education Authority's Scheme and 556 re-treated. Further 98 attended the Dental Clinic and were referred elsewhere for treatment, e.g., hospital and 28 attended the Clinic but refused treatment. It will be seen that 98 cases of dental defects were referred to Dental Hospital for treatment. These are almost all cases requiring orthodontic treatment. The percentage of these cases that get treated is very small, for which there are two chief reasons. 1. It is difficult in the present dentally ignorant state of the population to make many parents understand that there is need for such treatment. Even the gravely disfiguring deformity of a bad superior protrusion is often ignored, if the parent suffered from a similar condition, the argument being that what was good enough for the parent is good enough for the child. 2. Expense. Orthodontic work requires frequent visits for adjustment and supervision. The Chief Medical Officer of the Board recommends that this work should be done at a Dental Hospital. Except in rare cases in this district, this is out of the question, the rare cases being almost all the children of men working on the railways, who get special passes. What does a days' journey to a London Hospital mean ? (а). Railway fares for two, mother and child, varying from 2/3 to 3/-. (b). Often the expense of some food. (c). Often the carrying of a toddler or baby who cannot be left at home. (d). The loss of a morning's or a day's work, when the mother is working, and finally a thoroughly exhausting day. It is no good expecting anything much to be done—it cannot be—in the present state of unemployment, it is out of the question. 16 If orthodontic work is to be effectually carried out, it must be done by the School Dentist acting on the advice of the consulting Orthodontist at the Dental Hospital, who could prescribe the necessary treatment in the way of extractions and/or appliances. This then could be carried out by the local School Dentist. Open Air Education. There is no open air school in the district, the only open air education being comparatively few classes held in the playground in the summer. There is a great demand for an open air school, as there are a considerable number of children who could attend such a school, with benefit from the point of view of education and also from the point of view of their physical well-being due to the proper feeding, rest, etc., which form such an important part of an open air school curriculum. There are a considerable number of border-line cases that it is very difficult at present to deal with. They cannot attend an ordinary day school and hope to cope with its curriculum. Their power of concentration is sadly lacking, and one feels that on the whole, the child is better running about in the fresh air, and even mud larking under what might be supposed to be far from ideal conditions, than sapping what energy it has by attempting to cope with the school curriculum. The presence of these children in a class also makes the work of a teacher infinitely harder, as they are apt to be a disturbing element amongst the normal children. PHYSICAL TRAINING. There is no Area Organiser of Physical Training for the elementary schools in the 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, and there is no machinery for enabling delicate school children to obtain milk and cod liver oil either free or at moderate prices. Such a scheme would greatly benefit many 17 children and would not entail much organisation or expense. It is mainly a question of co-operative baying and the friendly help of the teachers. SCHOOL BATHS. No school 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 children undergoing Medical Inspection. They may also attend Dental Inspections. During 1924, one or other parent attended in 1,034 instances, representing a percentage of 57 6 as against 58 6 for 1923. 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 now two 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 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. 18 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. 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 1924, examinations were conducted in respect of 72 children. There are no special schools in this district for the defective. In 1922, the Board of Education was approached to see if a concrete proposal for the formation of a Defective School in the area were brought forward, it would be considered, but the financial state of the country was such, that no hope was entertained in this direction, although the proposal put forward involved a very small outlay. During the year, psychotherapeutic treatment has been successfully given to children with phobias and "nervous" conditions. It is impossible to exaggerate the importance of a right understanding of these cases. Their whole outlook on life can be altered if properly treated, in some cases the principal factor to overcome is the mother, as she will constantly "suggest" to the child that it is nervous, by talking of it to other people in the child's presence, until the unfortunate child becomes obsessed with the idea that it cannot be normal. If only we could get new mothers for some of these cases, how different their outlook on life would be. 19 NURSERY SCHOOLS. There are no nursery schools in this 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 Employment of Children Act, 1903, and the Education Act, 1918. By these, certain employments are prohibited and in others the hours of employment are regulated; children between the ages of 13 or 14 employed in the sale or delivery of milk or newspapers or in domestic work away from home, must hold a certificate from th6 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. 33 children were examined and all were granted 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. MISCELLANEOUS. Medical Examination of Teachers. During the year 12 medical examinations were made of teachers, in connection with their appointment under the Authority. 20 Holiday Home for Children. All children recommended for the King Edward VII. Memorial Home, Heme Bay, are medically examined before being sent away. Juvenile Employment. 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 in 1920 and a full report submitted. There is no provision in the district for such children. SCHOOL CLINICS. There are two clinic days at the Council House and two at the Isleworth Public Hall per week, when a doctor is in attendance, but treatment is carried out between 9 and 10 o'clock for minor ailments on five days a week by the Nurses. 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. 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 Sub- Committees may refer children who have been absent from school on account of alleged illness. 5. The Medical Officers or Health Visitors may discover cases casually while visiting the schools. 21 Charges for treatment are as follows:— Spectacles.—Free in necessitous cases. In other cases there is no charge for the examination of the eyes, but the parents are required to pay the cost of the spectacles, viz.—4/- per pair. 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 5 occasions for the purpose of conducting Cleanliness Survey. At these inspections there were examined 1,065 children, of whom 113 were found to be unclean. Of the latter number 16 were excluded and the remaining 97 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 7 days allowed them by by-law, a prosecution may be ordered. CLEANLINESS SURVEYS, 1924. Total number of children examined 1065 „ ,, ,, „ given warning notices 97 „ ,, „ ,, excluded as verminous 16 Pound to have nits— 1. (Few) 47 2. (Bad) 37 3. (Very bad) 29 22 Mrs. Yates, the Florae Help, still continues the work of cleansing heads begun in 1923, the conditions remaining the same, viz. the Council supplies the Sackers Combs and Shampoo and Mrs. Yates charges 1/- per case for cleansing. Attendance for cleansing is entirely voluntary, but parents as a rule are glad to avail themselves of the opportunity so as to avoid having the child excluded from school. During the year, 132 children have been cleansed. No cleansing has been carried out by the school nurses. During the year 1924, legal proceedings were instituted against the parents' of 6 children. Fines were imposed as follows:— 4 of 10/-; 2 of 5/-. There has been considerable improvement in the condition of the children's heads—not only in point of numbers, but also in the degree of uncleanliness. A really filthy head with the hair smothered in nits is now an exception, and it is gradually becoming understood that nits are not natural to childhood, but are the evidence of parasites which are harmful to the child's health and well being. LIST OF TABLES. 1. Return of Medical Inspection. 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. 23 TABLE I.—RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 442 Intermediates 680 Leavers 673 Total 1795 Number of other Routine Inspections nil. B.—Other Inspections. Number of Special Inspections 1090 Number of Re-Inspections 2797 Total 3887 24 Table II. A. RETURN OF DEFECTS found by Medical Inspection in the year ended 31st December, 1924. Defects or Diseases. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring: treatment. Requiring to be kept under observation, but not requiring treatment. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. 1 2 3 4 5 Malnutrition ... 19 7 3 Uncleanliness 171 4 337 2 Skin — Ringworm— Scalp ... ... 15 ... Body ... ... 15 1 Scabies ... ... 4 2 Impetigo ... ... 234 ... Other Diseases (non- tuberculous) 1 1 198 3 Eye- Blepharitis 4 6 14 ... Conjunctivitis ... ... 17 ... Keratitis ... ... 1 ... Corneal Opacities ... ... 1 1 Defective Vision (excluding squint) 149 52 22 10 Squint 8 2 ... ... Other Conditions 3 4 23 4 Ear— Defective Hearing 14 42 29 5 Otitis Media 1 ... 31 ... Other Ear Diseases 9 5 40 6 Nose and Throat— Enlarged Tonsils only 18 52 13 6 Adenoids only 22 39 2 1 Enlarged Tonsils & Adenoids 18 16 5 2 Other Conditions 22 65 31 19 Enlarged Cervical Glands (non-tuberculous) 6 36 19 12 Defective Speech ... ... ... ... 25 Table II—Continued. Defects or Diseases. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. 1 2 3 4 5 Teeth—Dental Diseases 663 152 71 3 Heart and Circulation— Heart Disease— Organic 5 8 7 Functional Anæmia 2 11 8 2 Lungs— Bronchitis ... ... 13 4 Other Non-Tuberculous Diseases ... 4 6 1 Tuberculosis— Pulmonary — Definite ... ... 2 1 Suspected ... 2 14 16 Non-Pulmonary— Glands ... ... 1 1 Spine ... ... ... 1 Hip ... ... ... ... Other Bones and Joints ... ... ... 1 Skin ... ... 1 ... Other Forms ... 2 ... Nervous System— Epilepsy ... 2 4 ... Chorea ... ... 14 1 Other Conditions ... ... 7 3 Deformities— Rickets ... ... 2 ... Spinal Curvature ... ... 3 ... Other Forms ... 1 8 4 Other Defects and Diseases 7 35 72 163 26 B.—Number of individual children found at Routine Medical Inspection to require treatment. (Excluding Uncleanliness and Dental Diseases). Group. Number of Children. Percentage of children found to require treatment. Inspected. Found to require treatment. Code Groups— Entrants 442 29 6.56 Intermediates 680 103 15.14 Leavers 673 121 17.9 Total (Code Groups) 1795 253 14.09 27 TABLE III.—RETURN of all Exceptional Children in the area. Boys. Girls. Total. Blind (including partially blind). (i.) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind ... 1 1 Attending Public Elementary Schools ... ... ... At other Institutions ... ... ... At no School or Institution ... ... ... (ii.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind ... 2 2 Attending Public Elementary Schools ... 1 1 At other Institutions ... 1 1 At no School or Institution 3 1 4 Deaf (including deaf and dumb and partially deaf). (i.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 2 1 3 Attending Public Elementary Schools ... ... ... At other Institutions ... ... ... At no School or Institution 3 1 4 (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf ... ... ... Attending Public Elementary Schools ... ... ... At other Institutions ... ... ... At no School or Institution ... ... ... Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority). Attending Certified Schools for Mentally Defective Children ... 2 2 Attending Public Elementary Schools 6 7 13 At other Institutions 1 ... 1 At no School or Institution 7 4 11 Notified to the Local Control Authority during the year. Feebleminded 2 1 3 Imbeciles 2 2 4 Idiots ... ... ... Epileptics. Suffering from severe Epilepsy. Attending Certified Special Schools for Epileptics 1 ... 1 In Institutions other than Certified Special Schools ... ... ... Attending Public Elementary Schools ... ... ... At no School or Institution 2 ... 2 Suffering from Epilepsy which is not severe. Attending Public Elementary Schools 1 2 3 At no School or Institution ... ... ... 23 Table III.—Continued. Boys. Girls. Total. Physically Defective. Infectious Pulmonary and Glandular Tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board ... ... ... At other Institutions ... ... ... At no School or Institution ... ... ... Non-infectious but active Pulmonary and Glandular Tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 3 4 At Certified Residential OpenAir Schools ... ... ... At Certified Day Open-Air Schools ... ... ... At Public Elementary Schools... 4 2 6 At other Institutions ... ... ... At no School or Institution ... 2 1 3 Delicate children, (e.g. pre- or latent Tuberculosis, Malnutrition, Debility, Anaemia, etc.) At Certified Residential OpenAir Schools ... ... ... At Certified Day Open-Air Schools ... ... ... At Public Elementary Schools 35 33 68 At other Institutions ... ... ... At no School or Institution 1 ... 1 Active nonPulmonary Tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 1 ... 1 At Public Elementary Schools 3 ... 3 At other Institutions ... 1 1 At no School or Institution 1 2 3 Crippled Children (other than those with active Tuberculous disease), e.g. children suffering from paralysis, Ac., and including those with severe Heart Disease At Certified Hospital Schools ... ... ... At Certified Residential Cripple Schools ... 1 1 At Certified Day Cripple Schools ... ... ... At Public Elementary Schools 10 5 15 At other Institutions ... ... ... At no School or Institution 2 3 5 29 TABLE IV. Return of Defects treated during the year ended 31st December, 1924. TREATMENT TABLE. Group I—Minor Ailments (excluding Uncleanliness, for which see Group V). Diseases or Defects. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. 1 2 3 4 Skin— Ringworm, Scalp 10 2 12 Ringworm, Body 11 5 16 Scabies 3 5 8 Impetigo 208 9 217 Other Skin Diseases 16 29 45 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 28 19 47 Minor Ear Defects 55 20 75 Miscellaneous— (e g. minor injuries, bruises, sores, chilblains, etc.) 81 30 111 Total 412 119 531 30 TABLE IV.—Continued. Group II.—DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments—Group 1). Defect or Disease. Number of defects dealt with. Under the Authority's Scheme. Submitted to refraction by private practitioner or at hospital apart from the Authority's Scheme. Otherwise. Total. 1. 2. 3. 4 5. Errors of Refraction (including squint) (Operations for squint should be recorded separately in the body of the Report). 183 13 6 202 Other Defect or Disease of the eye (excluding those recorded in Group 1.) ... ... 2 2 Total 183 13 8 204 Total number of children for whom spectacles were prescribed- (а) Under the Authority's Scheme 150 (b) Otherwise 13 Total number of children who obtained or received spectacles— (a) Under the Authority's Schema 141 (b) Otherwise 13 31 TABLE IV.— Continued. Group III.— Treatment of Defects of Nose and Throat. Number of defects. Received Operative Treatment Received other forms of Treatment. Total number treated. Under the Authority's Scheme, in By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 14 33 47 7 54 32 TABLE IV.— Continued. Group IV.— DENTAL DEFECTS. (1). Number of children who were— (a) Inspected by the Dentist: Routine age groups 5 315 Total 2437. 6 375 7 487 8 474 9 495 10 291 11 – 12 – 13 – 14 – Specials 399 Grand total 2836 (b) Found to require treatment 1949 (c) Actually treated 920 or 47% (d) Re-treated during the year as the result of periodical examination 556 (2). Half-days devoted to Inspection 32 Treatment 1621 Total 194. (3). Attendances made by children for treatment 1087. (4). Fillings Permanent teeth 1055 Temporary teeth 17 Total 1072. (5). Extractions Permanent teeth 79 Temporary teeth 1812 Total 1891 (6). Administrations of general anæsthetics for extractions. 450. (7). Other operations Permanent teeth 961 Temporary teeth 31 Total 99 33 TABLE IV.— Continued. Group V.- UNCLEANLINESS AND VERMINOUS CONDITIONS. (i.) Average number of visits per school made during the year by the School Nurses 0.38 (ii.) Total number of examinations of children in the schools by School Nurses 1065 (iii.) Number of individual children found unclean 113 (iv.) Number of children cleansed under arrangements made by the Local Education Authority 132 (v.) Number of cases in which legal proceedings were taken— (a) Under the Education Act, 1921 – (b) Under School Attendance Bye-laws 6