H E S 14 Heston & Isleworth Urban District Conncil. 1927. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE URBAN DISTRICT OF HESTON AND ISLEWORTH FOR THE Year ending 31st December, 1927. 1928. LOWE & SONS, (Printers) Ltd., Whitton Road, Hounslow. 1927. REPORT ON The Health OF THE HESTON & ISLEWORTH URBAN DISTRICT FOR THE YEAR 1927. BY ELWIN H. T. NASH, M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health. Public Health Department, Hounslow. June, 1928. To the Chairman and Members of the Heston and Isle-worth Urban District Council. Gentlemen, The Annual Report this year is designated by the Ministry as an ordinary report of a more simple character than the full survey report which was required in 1925. I beg to express my appreciation to the Council for the consideration shewn to me during the past twelve months. I am, Gentlemen, Your obedient servant, ELWIN H. T. NASH, Medical Officer of Health. THE HEALTH COMMITTEE OF MESTON AND ISLEWORTH URBAN DISTRICT COUNCIL For the Year 1927 28 Members of the Council: A. E, Hales, Esq. (Chairman) (Deceased) G. Newell, Esq. (Vice-Chairman) J. P. A. L. Lang, Esq. ex-officio (Chairman of the Council). E W. Heath, Esq. (Vice-Chairman of the Council). F. W. Buckley, Esq. C Crush, Esq. S. Carter, Esq. hi A. Dennis, Esq. H. Collar, Esq. C. J. Geary, Esq. J. J. Clements, Esq. F. T. Hart, Esq. C. M. Robinson, Esq. Medical Officer of Health:— Elwin H. T. Nash, m.k.c.s., l.r.c.p., d.p.h. MATERNITY AND CHILD WELFARE COMMITTEE. Members ot the Council: C. M. Robinson, Esq. (Chairman). J.J. Bonnett, Esq. o.b.e. F. W. Buckley, Esq. J, J, Clements, Esq. W. J. R. Divine, Esq. E. W. Heath, Esq. Co-opted Members: Mrs. C, W. Bezer (Resigned). Miss E. A, Ankritt. Mrs, E, Chedgey. 6 STAFF. The following persons constituted the Staff of the Health Department on the 31st December, 1927 : — 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.I. One vacancy. Disinfect or and Laboratory Attendant— F. J. Cobb. Health Visitors and School Nurses— Mrs. C. E. M. Ottley, Cert. C.M.B., H.V. and S.N., M.C.W.W. Miss B. N. Tetley, S.R.N., Cert. C.M.B. Mrs. A. E. Tyrrell. Cert. C.M.B., H.V. and S.N. Miss W. E. Scott, S.R.N., Cert. C.M.B., H.Y., S.N., M.C.W.W. Miss B. G. Sorlie, S.R.N., Cert. C.M.B., Cert. R.S.I. Miss M. G. Gribble, S.R.N., Cert. C.M.B., H.V., and S.N., A.R.R.C. Home Help— Mrs. E. Yates. Chief Cleric—- B. W. Kilby, Cert. S.I.E.B. and R.S.I. (M.I.) Clerics— Miss R. Marshall, Cert. R.S.I. E. Cromwell. Miss G. E. Curtis. B. Garrod. K. I. Bisshopp. 7 NATURAL AND SOCIAL CONDITIONS OF THE AREA. 8 EXTRACTS FROM VITAL STATISTICS OF THE YEAR 1927. Population— At the Census, 1921 46,664 Registrar-General's Estimate of nett 55,870 (Birth rate) Civil population 54,910 (Death rate) Births— Male. Female. Total. Legitimate 445 420 865 Illegitimate 22 11 33 Birth rate (nett) 16.07 Deaths— Male. Female. Total. 294 337 631. Death rate (corrected) 10.69 Number of women dying in, or in consequence of, childbirth from sepsis 2 from other causes 2 Deaths of infants under one year of age per 1,000 births— Legitimate 67.05 Illegitimate 90.9 Infantile Mortality Rate 67.93 Deaths from Measles (all ages) Nil. „ „ Whooping Cough (all ages) 6 „ Diarrhcea (under 2 years of age) 1 Area 6,851 acres. Number of inhabited houses (Census, 1921) 8,790 „ of families or separate occupiers (19'21) 9,893 Rateable value £320,029 Sum represented by a penny rate £1,293 Poor Law Relief. I am indebted to Mr. F. E. Harmsworth, Clerk to the Brentford Guardians, for information respecting the amounts paid i?i money and kind as out-relief to poor persons within the Parishes of Heston and Iselworth during the years 1926-1927 : — 1926. 1927. £ s. d. £ s. d. Parish of Heston 1611 18 8 5799 3 3½ Parish of Isleworth 4280 0 11 £5891 19 7 £5W9 3 3½ 9 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 the hospitals outside the district, as for example, the Eoyal Hospital, Richmond, the West London Hospital, Hammersmith, and other General Hospitals within the Metropolitan area. Poor Law Medical Relief.—The Relieving Officers issued 438 medical orders during 1927. Some af 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 with 54 beds. Its sphere of usefulness has been extended by the provision of a children's ward and X-Ray Department, During the year 1927, there were admitted 912 in-patients, whilst 3,104 new out patients received treatment. Medical relief is also given by certain voluntary organisations in the district namely: — The Isleworth District Nursing Association. The Osterley, North Hounslow and Heston 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). Ante-Natal Clinic. School Clinics (inspection and treatment of school children). Hospital provision at Mogden and Dockwell for infectious diseases. VITAL STATISTICS. Population. The Registrar-General's estimate for the population for 1927, is (Birth rate) 55,870—(Death rate) 54,910, despite the fact that our building activities for the last three years particularly have been 10 very large, the extent of which may be demonstrated by the fact that the amount of the loans to house purchasers under the Housing and Small Dwellings Acquisition Acts at the end of 1927 amounted to £1,422,671. This estimate has a detrimental effect on all the vital statistics, in that they appear larger than they really should be owing to being based on a smaller population. This however cannot be avoided in intercensal periods as the figures throughout the Country must be taken on a uniform basis, and the fact that our housing activities are producing a large influx of population, does not appear in the figures supplied to us by the Registrar-General which are based on a definite mathematical basis used uniformly. The death-rate population excludes all non-civilian males whether serving at home or abroad; whilst the birth-rate (and marriage-rate) population includes all the elements of the population contributing to the birth and marriage rates and may be represented by : — Death-rate population plus the district's proportional share of all non-civilians enlisted from this country. Deaths. The number of deaths registered in the district was 1,226, but 660 of these did not belong to the district, while 65 residents died without the district. Thus the number of deaths properly attributable to the district was 681,. Adopting the basis of the population estimated by the Registrar-General, the death-rate for the district comes to 11.49 per 1,000, which is comparable with the following figures :—12.3 for England and Wales, and 11.9 for London. The death-rate corrected by the Registrar-General's factor^ of .931 is 10.69. Births. The total number of births registered during the year was 998, but 155 of these did not belong to this district, while 55 births properly belonging to this district occurred outside the district. The nett number of births thus attributable to the district is 808, 11 Adopting the population basis suggested by the Registrar-General for the calculation of the birth-rate, this comes to 16.07 per 1,000. The birth-rate of England and Wales was 16.7 per 1,000, and for London 16.1 per 1,000. legitimacy. The following figures give the number of births : — Legitimate. Male. Female. Total. 445 420 865 Illegitimate. Male. Female. Total. 22 11 .33 12 Table of Causes of Deaths during 1927. Causes of Death. Civil Residents all ages. Male. Female. All causes 294 337 1 Enteric Fever 1 ... 2 Small-pox ... ... 3 Measles ... ... 4 Scarlet Fever ... ... 5 Whooping Cough 2 4 6 Diphtheria ... 1 7 Influenza 7 20 8 Encephalitis Lethargica ... ... 9 Meningococcal Meningitis 1 ... 10 Tuberculosis of Respiratory System 23 21 11 Other Tuberculous Diseases 5 5 12 Cancer, Malignant Disease 28 49 18 Rheumatic Fever ... 2 14 Diabetes 1 3 15 Cerebral Haemorrhage, &c. 19 18 16 Heart Disease 36 66 17 Arterio-sclerosis 12 14 18 Bronchitis 19 19 19 Pneumonia (all forms) 40 22 20 Other Respiratory Diseases 2 3 21 Ulcer of Stomach or Duodenum 5 ... 22 Diarrhoea, etc. (under 2 years) 1 ... 23 Appendicitis and Typhlitis ... 3 24 Cirrhosis of Liver ... 2 25 Acute and Chronic Nephritis 14 4 26 Puerperal Sepsis ... 2 27 Other Accidents and Diseases of Pregnancy and Parturition ... 2 28 Congenital Debility and Malformation, Premature Birth 18 9 29 Suicide 2 4 30 Other Deaths from Violence 11 3 31 Other Defined Diseases 47 61 32 Causes ill-defined or unknown According to figures furnished by the Registrar-General. Infantile Mortality during the year 1927. Nett Deaths from stated Causes at various Ages under i Year of Age. Cause of Death. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks. 4 weeks and under Smts. 3 mts. and under 6mts. 6 mts. and under 9 mts. 9 mts. and under 12 mts. Total Deaths under 1 year. Certified 22 6 3 1 32 8 10 5 6 61 Smallpox Chickenpox Measles Scarlet Fever Whooping Cough ... ... ... ... ... 2 ... ... ... 2 Diphtheria and Croup Erysipelas Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 1 Abdominal Tuberculosis Other Tuberculous Diseases Meningitis (not Tuberculous) ... ... ... ... ... ... ... 1 ... 1 Convulsions ... 1 1 2 ... 3 Laryngitis Bronchitis ... ... ... ... ... ... 1 1 1 3 Pneumonia (all forms) ... ... ... 1 1 3 5 2 4 5 Diarrhoea Enteritis ... ... ... ... ... ... ... 1 ... 1 Gastritis ... ... ... ... ... 1 ... ... ... 1 Syphilis Rickets Suffocation, overlying ... ... ... ... ... ... 1 ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 3 ... ... ... 3 ... ... ... ... 3 Congenital Malformations 1 ... ... ... 1 1 ... ... ... 3 Premature Birth 13 2 2 ... 7 ... ... ... ... 17 Atrophy, Debility and Marasm 2 2 1 ... 5 1 ... ... ... 6 Other Causes 2 1 ... ... 3 ... ... ... ... 3 22 6 3 1 32 8 10 5 6 61 Nett Births Legitimate 865 Illegitimate 33 Nett Deaths Legitimate infants 58 Illegitimate infanta 3 14 Infant Mortality. The figure obtained under this heading is regarded as a valuable index of the sanitary conditions of a district. Furthermore, as it is based on ascertained facts (i.e., the actual numbers of births and infant deaths), it is more reliable than the death-rate which is calculated on an estimated population. The rate for 1927 is 67.93 per 1,000 births. The rates for England and Wales and for London during the same period were 69 and 59 respectively. PHYSICAL FEATURES OF THE DISTRICT. The Urban District comprises an irregularly rectangular district of approximately eleven square miles, the average elevation lying betwen 16 and 104 above ordnance datum, the higher part being Osterl,ey and Heston, and the lower part along the margin of the river from Brentford to the boundary at Twickenham. The Western end is also low lying and the water level comparately near the surface, this part of the district being bounded by the River Crane. The greater part of the district is on valley gravel with pockets of clay at the Western end. The district is bounded on the Eastern side by the River Thames, the Grand Junction Canal and the River Brent, and crossed from West to South East by the River Crane. The district is roughly divided into two by the main Bath Road which intersects it from East to West. Large tracts of the district are occupied by market gardens, which are being rapidly cut into by new housing schemes. There are two large parks, one surronuding the residence of the Earl of Jersey at Osterley Park, and one at Syon House, the property of the Duke of Northumberland. The greater part of the rest of the district is largely a dormitory for workers in London The industries are few, the chief being : — (1) Beer, etc., brewing. (2) Boat building and repairing. 15 (3) Colours and dyes. (4) Flour, etc., milling. (5) Gravel quarrying. (6) Market gardening. (7) Patent Animal foods. (8) Pewter ware and candle machinery. (9) Pharmaceutical Chemistry. (10) Soaps and perfumes. (11.) Sweets, Confectionery. The district is now rapidly developing in nearly all directions, the great majority of houses that are going up being of the working class type, valued round about £600. Great use is being made of the Small Dwellings Acquisition Act, and the Housing Act, particularly the former. The large buildings of the Brentford Board of Guardians are situate at the Eastern end, and receive inmates from the constituent parishes of : — Acton, Chiswick, Ealing, Greenford, Hanwell, Heston, New Brentford, Old Brentford, Isleworth, Perrivale, Twickenham and West Twyford. Taken on the whole the district may be said to be comparatively flat from end to end. 17 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 18 HOSPITALS. Hospitals provided or subsidised by ihe Local Authority or bv the County Council : — 1. Tuberculosis.—The County Council have an institution; The Bell Road Hospital, with 15 (9 female and 6 male) beds. 2. Maternity.—There is no definite provision in the district other than the West Middlesex Hospital (Guardians) for maternity cases apart from private nursing homes charging considerable fees. There are a few beds in the Hounslow Hospital and cases can also be dealt with at the West 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. 3. The Hospitals in the district are the West Middlesex Hospital which is the Poor Law Infirmary. The Hounslow Hospital with 54 beds, is entirely supported by voluntary contributions. A Children's Ward of 8 cots with a solarium has also been provided. The Mogden and Dockwell Hospitals for Infectious diseases and Small Pox are supported from the rates by the Councils of Heston and Isleworth and Richmond. The local usefulness of the hospitals is seriously hampered by the number of motor accidents admitted from the Great West Road. These cases do not contribute their proper quota to the funds of the hospital, but what ismore important, they occupy beds which were subscribed for by the charitable people of the district for the residents in this area, and some of those who subscribe feel that their charity does not lie towards strangers whose admission from outside districts to ours is often the result of either their indiscretions or infringements of the laws connected with motoring, to the exclusion of those of their own district who are in need of surgical assistance. There is practically no difficulty in getting cases into the West Middlesex Hospital, but there is no out-patient department. 19 The Hounslow Hospital has a staff of consultants, who are almost entirely concerned with in-patients, but there appears to be a feeling for preference for the larger Hospitals with national reputation such as Gt. Ormond Street, Queen 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. There is still considerable difficulty in getting satisfactory outpatient treatment for children. Things have improved somewhat since the appointment of a House Surgeon at the Hounslow Hospital, but there is a definite need in the district for a properly staffed out-patient department. 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. Arrangements have been made to substantially improve the Mogden Hospital. Central heating has been installed to replace the previous unsatisfactory isolated units, and the Administration Block has also been increased to adequately house the Staff. Plans were also prepared for an Observation Block, but this was postponed. The Hospital Committee were approached with a view to arranging for the admission of cases of Puerperal Fever and Ophthalmia Neonatorum, but consideration was adjourned until the additional accommodation has been provided. AMBULANCE FACILITIES. (a) For Infectious Cases.—This is provided by the Joint Hospital Board, 20 (b) For Non-Infectious and Accident Cases.—A Wilson and Stockall Ambulance has been provided for accident cases and removal of non-infectious cases to hospitals or nursing homes within or without the district. The Ambulance commenced duty on 23rd June, 1927, and during the remainder of year 109 accident cases were removed to hospital, and 86 cases of non-infectious disease were removed to hospitals or nursing homes. 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. An Ante-Natal Clinic is held at the Council House, every third Monday in each calendar month. The only Day Nursery in the district was closed in 1920. There are two School Clinics at each of which treatment for minor ailments is carried out on five mornings in the week. A Medical Officer attends at each clinic now once a week. Previously there were two clinics a week, and an endeavour to economise these were reduced to one, but the attendances are such that applications have been made to reinstate the second morning at each Centre, as the amount of work seriously inconveniences the Staff, and still more so the mothers who are attending, as they are not able to get away in order to provide the mid-day dinner in time. 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 in part of the district, and the Osterley, North Hounslow and Heston Nursing Associaton deals with the cases in the remaining area. 21 It was found that nursing assistance in the Northern part of the district was sadly deficient, and the new Nursing Association was formed in 1925 to remedy the defect. The demand for nursing assistance was found so great that it. has been found necessary to provide further assistance for the winter months, as the first nurse was being seriously over-worked. Midwives. The inspection of Midwives is under the supervision of the County Council. It is, however, generally recognised that the authority administering a Maternity and Child Welfare Scheme should also exercise control over the Midwives practising in its area. In this district it is the practice of the Health Visitors not to visit the newly-born till 11 days ofter the birth, in order not to interfere with the Midwife. According to the County Medical Officer's last list, there are 13 Midwives practising 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., *111., *IV., *V., VI. and VIII. *Public Health Act, 1925, Parts *11., *111., *IV. and *V. were adopted in November, 1925. Maternity and Child Welfare Act, 1918. Baths and Wash-houses Act, 1846-82. Burial Acts, 1852-86. (Applicable to parts of the district only). Public Libraries Act, 1892. Private Street Works Act, 1892. Small Dwellings Acquisition Acts, 1899-1923. Local Government and Other Officer's Superannuation Act, 1922. 22 Bye-Laws in force in District. *Common Lodging Houses (P.H.A. 1875, s. 80). *Cleansing, etc., and Removal of Refuse (P.H.A. 1875, s. 44). * Houses Let in Lodgings (P.H.A. 1875, s. 90). *Tents, Vans, Sheds, etc., (H.W.C.A. 1885, s. 9 (2). *Slaughter Houses (P.H.A. 1875, s. 169 and T.I.C.A., 1847, s. 128). *Prevention of Nuisances (P.H.A. 1875, s. 44). *Keeping of Animals (P.H.A. 1875, s. 44). * Removal of Offensive Matters (P.H.A.A.A. 1890 s. 26). New Streets and buildings (P.H.A. 1875, s. 157, and P.H.A.A.A. 1890, s. 23). Pleasure Grounds (P.H.A. 1875, s. 164). *Fish Frying (P.H.A. 1.876, s. 113). Regulations made by Local Authority in force in District. Allotments (A.A. 1887, s. 6). Allotment Regulations, 1922. *These are administered wholly or partly by the Health Committee. The unstarred are administered by other Ccimmittees of the Council. 23 SANITARY CIRCUMSTANCES. 24 SANITARY CIRCUMSTANCES. Water Supply. There were, as far as is known, at the end of the year 43 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 one case the use of water from a well for drinking purposes 'was dis-continued and in another case the well was closed following the demolition of the house. In 29 instances draw-taps were placed on the main to the house, in compliance with notice from the Public 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. The following extensions to the sewerage system have been carried out during 1927:— Name of Road. Length in Yards. Sewers laid in Public Highways. Foul Sewers. Dockwell Lane 90 Woodlands Road 67 Surface Water Sewers. Bath Road 167 Heston Road 1000 Wood Lane 613 North Hyde Lane 233 Sewers laid in Private Streets. Foul Sewers. Summerhouse Estate 547 Park Wood Estate 367 25 Name of Road. Length in yards. The Warren, Heston 538 New Road off Kingsley Road 190 Spring Grove Crescent ... 170 Bridge House Farm Estate 463 Linden Avenue 100 Alexandra Road 127 Maswell Park 90 Surface Water Sewers. Summerhouse Estate 768 Parkwood Estate 367 The Warren, Heston 533 New Road off Kingsley Road 190 Spring Grove Crescent 170 Bridge House Farm Estate 463 Linden Avenue 100 Closet Accommodation. Accommodation on the water carriage system is almost general throughout the district 99 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 1927, collection of house refuse has continued weekly as before, and was disposed of by means of a dump in the Staines Road. The method of disposal is that each day's tipping is completely covered with earth. During the year as a result of action taken there were supplied 71 new ashbins. Sanitary Inspection of District. See pages 28—34. 26 Nuisances, Contraventions of Bye-laws, Defective Drainage, etc. The number of premises on which nuisances were outstanding at the end of 1926 was 519. To these another 597 premises whereat nuisances were recorded in 1927 were added, giving a total of 1116 premises. Of these 525 had the nuisances remedied, leaving 591 premises at which nuisances still existed at the end of the year. During the year, nuisances at 15 houses were reported to the Health Committee, which added to the 31 brought forward from 1926, made a total of 46. Before asking the authority to serve statutory notices, the premises are inspected by the Medical Officer of Health and Chief 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 21. of the houses, and in one case it was decided to take no further action, leaving 24 cases to be carried forward to 1927. Comparative figures for the years 1925, 1926 and 1927, in connection with nuisances, are submitted herewith. 1925 1926 1927 Number of complaints received 366 415 40.3 Premises at which nuisances were located 472 558 597 Informal notices sent— First 368 503 493 Second 60 114 63 Statutory notices served 37 43 17 It is my duty once more to point out that the staff of Sanitary Inspectors is inadequate. 27 During the last six years, the Department has been definitely understaffed, and it has been quite impossible to deal with anything except complaints. District inspection has been quite out of the question. The extra work necessitated by the Public Health (Meat) Regulations, 1924, made matters worse. In order to case the situation which was becoming acute, the work under the Shops Act was last year ceased by the Public Health Committee and turned over to the Police. In addition to this, all the work under the Petroleum Acts which involved a considerable amount of work was transferred to the Fire Brigade. The problem of dealing with property as I said before is extremely difficult, the Rent Restrictions Act allowing only a 40 per cent. increase in the rent to cover the cost of repairs, which is in many cases totally inadequate. As things are now, many houses are being crowded with two, three or more families. Sometimes these houses have been of the better class more commodious houses, and in the ordinary way the 40 per cent. would have been comparatively just. Where these are sub-let, often at an exhorbitant profit to more families, the wear and tear on the landlord's property is not in arithmetical progression, and he is no way recompensed by the limited increase in the rent which he is allowed to charge. His tenant profiteers unblushingly and the landlord has to bear the burden, and has no remedy whatever unless legal overcrowding occurs. In nearly every case there is no legal overcrowding, but as pointed out elsewhere considerable moral overcrowding. At the same time there are landlords who are hard put to it, and the tenants have a great difficulty in getting anything done. It is very difficult at times to hold the scales justly between the tenant who has certain rights, and a harassed landlord who is in certain cases deprived of his rights by statute. Proceedings. Proceedings were taken during the year in respect of:— (a) Nuisances existing at one house due to the improper keeping of cats, and domestic cleansing not carried out 28 at frequent periodical intervals. An order was made for the defendant to abate the nuisances within seven days from the date of the service of the order and costs amounting to £3: 3: 0 were imposed. This order was not complied with, and a subsequent order was made for the Council to abate the nuisances in default of the owner-occupier, which order was duly executed by the Council. (b) Recovery of costs of carrying out repairs, etc., to ten dwelling-houses (Housing Act, Section 3), and providing ashbins at two of the dwelling-houses (Public Health Act, 1875, Section 36). An order was made for the defendant to pay amounts of claims, plus interest, and in addition costs amounting to £5: 5: 0 were imposed. SANITARY WORK, ETC. Inspections—General: Total number of inspections and re-inspections, etc. 12579 Inspections, etc. re Nuisances, Contraventions, etc.: Number of premises, etc., inspected on complaint 457 Number of premises inspected in connection with infectious diseases 56 Total number of premises, etc., primarily inspected in connection with nuisances 738 Number of premises inspected under Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 2 Number of smoke observations made 2 Number of other visits made to premises, etc., in connection with nuisances, etc. 456 Number of visits made to works in progress 1,437 Number of interviews with owners, builders, etc. 554 29 Action taken (including action taken under Housing Act, 1925, Section 3). Number of premises, etc., whereat nuisances were recorded during the year 597 Number of premises, etc., on which defects, etc., were remedied— (а) by owners 513 (b) by local authority in default of owner or occupier 13 Number of cautionary or intimation notices given— (a) verbal 174 (b) written 319 Number of second (informal) notices given 63 Number of letters re nuisances sent 108 Number of Statutory Notices issued 17 Number of proceedings taken 11 Number of convictions obtained 11 Number of proceedings withdrawn — Number of cases dismissed — Common Lodging Houses: Number registered 2 Number of inspections made 10 Number of contraventions found 3 Number of contraventions remedied 1 Canal Boats used as Dwellings. Number of inspections made 56 Number of contraventions found 5 Movable Dwellings, Caravans, Tents, etc. Number of inspections made 131 Number of contraventions found 53 Number of contraventions remedied 41 Bakehouses: Number in district (a) factories 11 (b) workshops 14 Number of underground bakehouses in district 1 30 Number of inspections made 51 Number of contraventions found 3 Number cleansed 3 Number of other nuisances, etc., remedied 2 Slaughterhouses: Number on register (a) registered premises 4 (b) licensed premises 4 Number of inspections and visits made 1400 Number of contraventions of conditions of licence 9 Number of other contraventions found 8 Number re-constructed,repaired or improved 1 Number accumulations of offal removed 3 Number of other contraventions remedied 1 Cowsheds: Number of persons registered 10 Number of premises registered 10 Number of cowsheds on register 11 Number of milch cows in district 105 Number of inspections made 21 Number of contraventions found — Number of contraventions remedied 2 Dairies and Milkshops: Number of persons registered 43 Number of premises registered 34 Number of inspections made 281 Number of contraventions found 3 Number of contraventions remedied 4 Offensive Trades: Number of businesses established in district 19 Number of inspections made 166 Number of contraventions found 2 Number of contraventions remedied 2 31 Public Health (Meat) Regulations, 1924: Number of inspections made 1388 No notice of slaughtering given 1 Improper notice of slaughtering given 79 No precautions taken for the prevention of contamination 9 Verbal notices given 22 Inspection of Food: Number of meat inspections 1820 Number of fish inspections 363 Number of provision inspections 598 Number of greengrocery and fruit inspections 625 Number of hawkers foodstuff inspections 515 Number of other food inspections 280 Unsound Food: Number of carcases and organs surrendered 6 Number of articles surrendered 106 Number of parcels surrendered 18 Number of organs or parts surrendered during slaughtering 323 Infectious Diseases, Disinfections, etc. : Number of visits made 438 Number of rooms disinfected (a) ordinary infectious diseases 152 (b) Tuberculosis 93 (c) Other diseases 12 Number of rooms stripped and cleansed after infectious diseases— (a) by owners or occupiers 6 (b) by local authority 9 Number of articles disinfected or destroyed 1575 Water Supply: Number of supplies provided or re-instated 14 Number of draw taps connected direct to main 29 Number of water service pipes or taps repaired 15 32 Approximate percentage of houses supplied on constant system 99.95 Number of samples taken for analysis from local wells 2 Number of samples found polluted or impure 2 Drainage and Sanitary Arrangements, etc., of existing Buildings: Water Closets: Number of water closets provided or re-constructed 10 Number of water closets provided in substitution for dry receptacles 4 Number of walls, etc., cleansed 6 Number repaired, supplied with water or otherwise improved 125 Number cleansed or unstopped 8 Approximate percentage of houses provided with water closets 99 Earth and Chemical Closets: Number of earth and chemical closets provided 3 Sinks: Number of new sinks provided 21 Number of sinks repaired or improved 11 Drains: Number examined, exposed, etc. 25 Number unstopped, repaired, trapped, etc. 241 Number of waste pipes provided, disconnected, repaired trapped or unstopped 25 Number of soil pipes fixed, repaired or improved 4 Number of ventilating shafts fixed, repaired or improved 11 Number of fresh air inlets provided, repaired or improved 13 Number of rain water pipes disconnected from drain 14 Number of gully traps inserted or improved 49 Number of disconnecting traps inserted 4 Number of inspection chambers inserted 15 Number of disconnecting traps improved, sealed or cleansed 3 33 Number of inspection chambers repaired, improved, sealed or cleansed 7 Number of drains constructed or re-constructed 35 Total length of drain pipes laid (4 in.—1604 ft.) (6in.—148ft.) 1752ft. Number of tests and re-tests applied 144 Number of other works executed 8 Approximate percentage of houses draining into Council's sewer 99 Cesspools: Number rendered impervious, emptied, cleansed, etc. 8 Number abolished and drains connected to sewer 1 Removal of Household Refuse: Number of new ashbins provided 71 Number of ashbins repaired 2 Dampness: Number of roofs stripped, renewed or repaired 131 Numbers of gutters and rain water pipes provided, repaired or unstopped 111 Number of instances in which external brickwork, sills, etc., repaired, renewed or rendered impervious 70 Number of damp-proof courses provided 10 Number of sites covered with impervious material 1 Number of yards paved, repaired or drained 33 Interior Work: Number of rooms stripped and cleansed (other than in connection with infectious disease) 95 Number of floors, walls and ceilings repaired or renewed 300 Number of rooms in which ventilation provided or improved 9 Number of rooms in which lighting provided or improved 4 Number of window frames and sashes provided, repaired or unfixed 198 Number of stoves or grates provided or repaired 53 34 Number of instances in which ventilation under floors provided or improved 33 Number of other repairs 31 Sundry Nuisances, etc.: Number of instances in which domestic cleansing enforced 7 Number of foodstores provided, cleansed or improved 3 Number of washing coppers provided or repaired 43 Number of rooms sprayed for the removal of vermin by the Disinfector 49 Number of instances in which overcrowding abated 9 Number of instances of improper keeping of animals abated 12 Number of offensive accumulations removed 26 Number of black smoke emissions abated 1 Number or urinals provided, repaired, cleansed or improved 4 Number of dung pits provided, repaired or improved 1 Number of other nuisances abated 18 Report on the administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS AND WORKPLACES. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors. Premises. Number of Number on Register. Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) (5) Factories (including Factory Laundries) 54 63 5 Nil. Workshops (including Workshop Laundries) 267 142 1 Workplaces (other than Outworkers' premises 39 209 ... Outworkers 41 31 ... Total 401 445 6 Nil. DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Outstanding Jan. 1st. 1927. Found during 1927. Remedied during 1927. Outstanding Dec. 31st, 1927. Referved to H.M. Inspector l 2 3 4 5 6 7 Nuisances under the Public Health Acts:-* Want of cleanliness Want of ventilation Overcrowding Want of drainage of floors Other nuisances ... 6 6 Sanitary accommodation—† Insufficient 1 1 2 Nil. Nil. Unsuitable or defective 1 6 4 3 Not separate for sexes 1 1 1 1 Ofifences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s.101) Breach of special Sanitary requirements for bakehouses (ss. 97-100) 1 2 3 Other offences:— Excluding offences relating to outwork Total 4 16 16 4 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 District Council, and the standard of sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops enforced is that required by the Sanitary Accommodation Order of 4th February, 1903. 36 OUTWORK IN UNWHOLESOME PREMISES, SECTION 108 Nil. Premises and Occupations controlled by Bye-laws or Regulations. There are 431 known places in this district which call for periodical inspection as follows :- Houses let in Lodgings, Common Lodging Houses, Bakehouses, Slaughter-houses, Cowsheds, Dairies and Milkshops, Offensive trades, Laundries (non-factory), Workshops, Workplaces and Outworkers. SCHOOLS. In this district there are 13 public elementary schools and one Central school, 3 are modern buildings, the remainder being for the most part old and lacking in up-to-date hygienic conditions. 37 HESTON AND ISLEWORTH URBAN DISTRICT COUNCIL. Public Health Department, Council House, Hounslow, 23 rd February, 1928. Sir, Canal Boats Acts, 1877 to 1884. In accordance with Section 3 of the Carnal Boats Act, 1884, I leg herewith to present the Annual Report for the year ended 31st December, 1927, as to the execution of the Canal Boats Acts, 1877, and 1884, and of the Regulations made thereunder, within the Urban District of Heston and Isleworth, Middlesex. Inspectors appointed under Canal Boats Acts— R. H. Butler, (Chief Sanitary Inspector). G. W. Ashworth (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 56 Number of Canal Boats inspected 52 Number of boats found in order 48 Number of boats with three infringements 1 Number of boats with one infringement 3 Nature of Contraventions, etc.— Overcrowding 2 Cabins not in a cleanly and habitable condition 1 No proper water vessels provided 1 Verminous condition 1 Lettering, etc, of boat not legible 1 Legal Proceedings.— No legal proceedings have been taken during the year. 38 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, 1. 39 HOUSING 40 The Council's contribution towards the housing problem is shown in the number of houses erected under the Small Dwellings Acquisition Act and the Housing Act. The total loans at the end of the year 1927 amounted to £1,422,671. A total of 1,071 houses were erected in the district during the year, and of this number 16 were erected by the local authority. These activities still however, leave a large number of steady decent class workmen who are, as I pointed out last year, unable to put down the necessary amount to enable them to purchase a house, either through the Council's scheme or through a building Society. In order to get over the difficulty of the size of the limited sum necessary under the Housing Act, mors Building Societies are taking second mortgages, and allowing sums as small as £20, to be paid in place of the £80 or £90 required by the Council. In the majority of instances this amount has to be paid off rapidly and is apt to be a serious burden on the finances of the family. Owing to the question of over-crowding constantly cropping up together with the demands for houses, the Council authorised a special investigation. I was fortunate in being able to obtain the services of a Health Visitor who was also a Sanitary Inspector with considerable experience. The investigation was limited to seven weeks, and certain areas which were considered likely to show over-crowding were taken as examples, but in addition to these, overcrowding was found as a result of casual inspections in the most unlikely places. The results show a state of affairs which necessitates amelioration. The facts as discovered are set forth below:— 41 Report on Special Investigation into Overcrowding in the District. I beg to report the result of the special enquiry into the over-crowding of the district. I was fortunate in obtaining the services for the purpose, of Miss Westmacott, who, in addition to a wide experience as a Health Visitor in London, is duly qualified Sanitary Inspector. The enquiry I directed more towards the question of moral over-crowding than to the actual cubic content of the premises. Owing to the amount of money being set aside for the purpose being limited, the enquiry was confined to certain roads which were expected to show over-crowding. The figures shown will probably be rather less than the true state of affairs, as it was found that in certain cases where no over-crowding was discovered, it was not until statements made by the neighbours pointed definitely to over-crowding, and a re-visit and special interrogation with regard to the individuals about whom information had been obtained was carried out, that the true state of affairs came to light. It is therefore reasonable to suppose that there are yet amongst the houses visited, some in which unsuspected over-crowding may have been concealed, so that the report is, as I said before, if not strictly accurate an under estimate rather than an exaggeration. I append herewith:— Table 1. A list of the roads visited, showing the number of houses, and the number of cases of over-crowding. Table 2. Samples of the worst cases which show very well the conditions of moral over-crowding and also the difficulties in two cases of over-crowding in cases of Tuberculosis, where there should be ample air space rather than the condition obtaining. 42 It is quite impossible to preserve the ordinary decencies of life when conditions such as are revealed in many cases exist. Take one house in which two families are living under the following circumstances. In one case, two females aged 20 and 1.5, and two males aged 18 and 13 sleeping in one room, whilst in the other part of the house a man and wife and a boy of 3 sleeping in one bed; two females aged 17 and 14, and two males aged 16 and 11 are sleeping in another bed in the same room. Table 3 shows the conclusions arising from these inspections. It will be seen in the resume that that 70% of the inmates keep their houses in a satisfactory condition. With regard to the general condition of the houses, it will be seen that 50% are reported as damp, much of this is as one knows, due to the fact that a large proportion of the houses belong to the older class of property without damp courses, but with the present inspectorial staff, it is quite impossible to deal adequately with the inspection of the district, and such houses as have been rendered dry through the activities of the Public Health Department have only come to our immediate notice as a result of either complaints or the occurrence of infectious disease in the house. An interesting point is, that it shows that owing to the small wage, it is necessary in many cases to sub-let, and the subletting is in 60% of the cases to relations. A further interesting point is the analysis of the overcrowding which shows the actual number of bedrooms which are required to relieve the over-crowding, and lastly, there are two interesting facts emerging, namely, that only 22 of the overcrowded families have been in residence in the district under ten years, and that of these people who require more accommodation, only 6% are unemployed. 43 How far the provision of additional houses would relieve the present overcrowding of the kind mentioned in the report it is difficult to say, because in many cases it appears that participants in the overcrowding are those who are unable to afford a sufficient amount to provide the additional accommodation. Table 4 gives the analysis of the conditions found under diff erent headings. Table 1. Showing List of Houses visited, the number of houses visited in each road, and the number found to be overcrowded. Road visited. No. of houses Visited. Overcrowded. Chapel Road 43 1 Holly Road 31 6 Temple Road 28 — Pears Road 98 17 James Street 14 1 Ivy Road 21 2 Heath Road 25 2 Gordon Road 1.7 — Stanley Road 13 1 Queen's Terrace 27 12 Magdala Road 35 6 Richmond Road 8 1 Worton Road 68 13 Hartland Road 25 4 Downton Place 14 4 Church Street 14 2 Worple Road 8 3 Napier Road 23 2 44 Road visited. No. of houses Visited Overcrowded North Street 28 8 Vine Place 22 11 Derby Road 50 13 Cross Lances 21 2 Linkfield Road 193 23 Mill Platt 34 4 Field Lane 36 9 Wellington Road North 93 14 Crosby Terrace 14 4 Agra Cottages 5 1 Rising Sun Cottages 19 6 Neals Cottages 4 1 Duncans Cottages 5 — New Heston Road 3 — Gladstone Place 10 5 Weller's Cottages 4 2 Dundee Cottages 3 — Brooke's Cottages 4 - Courtenay Place 9 — Kirby Cottages 5 2 The Parade, Lampton 10 4 Tryon Place 3 - The Circle, Lampton 10 4 Agnes Place, Lampton 8 1 Brunswick Cottages 7 1 Osborne Road 10 3 Steele Road 18 - Gloucester Road 22 7 Tivoli Road 9 5 Fair Street 2 1 Argyle Avenue 25 4 1199 212 45 Table 2. Showing some of the worst cases of overcrowding which have been discovered. Reference No. Condition of Living. 13. Man, Wife, F. 15, .F.13, .F.10, sleep in one room. 14. F.21, F.20, M.24, sleep in one room. 2 males sleep at neighbours. 26. Man, Wife, F.27, F23, sleep in one room. 31. 7 sleeping in one room. 32. 6 sleeping in one room. (2 are T.B.) 34. 7 sleeping in one room. 35. 8 sleeping in one room. 37. 6 living and sleeping in one room. 49. 5 sleeping in one room. (1 is T.B.) 51. 6 living and sleeping in one room. 54. 7 sleeping in one room. 58. 6 sleeping in one room. 70. F.21, F. 15, F. 13, F.8,—one bed, M. 18, M. 17, M.10, one bed, sleeping in one roam. 71. Man, Wife, F.14.—one bed, M.20, sleeping in one room. 75. 9 sleeping in one room. 83. Man,, Wife, FA,—one bed, F.20, F.6, M.9,—one bed, F.7 whs,—cot, sleeping in one room. 86a F.20, .F.15, M. 18, M. 13, sleeping in one room. 86b Man, Wife, M.3—vne bed, F. 17, F. 14, M.16, M. 11, —one bed, sleeping in one room. 92b Man, Wife, M.2, F.2/12, live and sleep in one room, and M.9, M. 5, F.7, have to sleep out. 96. Man, Wife, M.20, .M.21, sleep in same room. 110. Man, Wife and Grandmother sleep in same room. 46 Table 2—Continued. Reference No. Condition of Living. 122. Man, Wife, M.18, M. 10, sleep in one room. 144. Mrs.—,& Mrs.—, F.14, .F12, M.17, sleep in one room. 147. F.21, .F.18, F. 12, M.22, sleep in same room. 157. Grandfather and F.20, sleep in one room. 169. Man, Wife. M.13, F.17,—one bed, sleep in one room. 203. Man, Wife, F.24, F.16, sleep in same room. 206. Man, Wife, Married daughter, F.8, F.3, sleep in same room. Table 3. A resume of the conditions found as the result of the investigation. Number of houses visited—1199 Number of houses overcrowded—212 Percentage of houses overcrowded—17.68% Details of Overcrowding. No. of cases 1. Man and Wife and Children over 12 years sleeping in 1 Room 96 2. 4 Persons or more living and sleeping in 1 Room 31 3. Males and Females over 12 years sleeping in the same room 62 4. 5 Persons or more sleeping in 1 Room 96 5. 4 Persons or more sharing 1 bed 29 General Conditions of Houses as regards Cleanliness. Excellent Good Indifferent Very dirty 30 per cent. 40 per cent. 18 per cent. 12 per cent. 47 Table 3 —Continued. General Condition of Houses as regard Repair. Inside decoration on the whole bad, unless the repairs are done by Tenant. Walls very damp, about 50% of the houses, in particular houses in the following roads — Pears Road. Magdala Road. Wellington Road North. The Circle, Lampton. Queen's Terrrace, Isleworth. Vine Place. Derby Road. Amount of Rent Paid. From 15/- to 2/6 per week. Average rent per week—8/9 Average Wage per Week. From £2: 10: 0 to £3: 0: 0 per week. Cause of Overcrowding. (a). Due to Sub-letting—50% (B). Due to 4 room Cottages with only 2 bedrooms, which give inadequate sleeping accommodation when the family is grown up—50% Type of Sub-Tenant. (i). Relations—60% (ii). Not relations—40% Length of time in the district of Tenants & Sub-Tenants. Born in the district 102 Families Over 20 years 65 Families Over 10 years 49 Families Over 5 years 1 15 Families Under 5 years 9 Number of Occupiers overcrowded, Out of Work. 13 persons—6.1% 48 Table 4. Analysis of the conditions found under different headings. Man, Wife and Children over 12 sleeping in same room. Case No. Males Females Case No. Males Females 1 M.W. - 18 20 58A M.W. - 4 7 8 16 2 M.W. - 30 61 M.W. - 10 16 28 3 M.W. - 17 63 M.W. - 1 13 5 M.W. 11 18 — 68 M.W. 18 7 6 M.W. 10 3 6 12 69B M.W. 3 13 7A M.W. - 14 71A M.W. 20 14 10 M.W. - 21 73B M.W. 14 3 7 13 12 M.W. 20 — 75B M.W. 2 wks. 5 9 13A M.W. - 10 13 15 10 2 6 12 15B M.W. 6 15 18 — 76B M.W. 1 6 8 13 17A M.W. 10 18 4 14 77A M.W. 12 0 0 20 M.W. 8 13 78A M.W. - 5 7 14 22 M.W. - 3 8 10 13 79A M.W. 13 — 26A M.W. - 23 27 80A M.W. 21 0 0 26B M.W. 10, 12, 83A M.W. 9 7 wks. 4 6 20 29 M.W. - 19 22 83B M.W. 9 3 3 12 30 M.W. - 12 86B M.W. 3 11 16 4 17 0 33C M.W. 2 wks. 4 6 12 87 M.W. - 15 34A M.W. 11 15 17 8 19 88A M.W. 13 — 35A M.W. 3 7 12 8/12 5 9 95A M.W. - 18 36A M.W. - 18 22 96A M.W. - 4 10 13 38A M.W. - 11 14 18 96B M.W. 20 21 — 41A M.W. 11 13 18 — 97A M.W. 7 18 — 43A M.W. 17 — 98A M.W. 15 - 44A M.W. 7 4 11 13 99 M.W. - 23 48B M.W. 7 12 11 100 M.W. - 13 15 49A M.W. 13 13 18 — 49 Table 4-Continued. Man, Wife and Children oyer 12 sleeping in same room. Case No. Males Females Case No. Males Females 103 M.W. 13 — 169 M.W. 13 17 111 M.W. 14 — 170A M.W. 18 — 113 M.W. - 4 12 171 M.W. 5 12 114 M.W. - 6 20 172 M.W. 1 12 116 M.W. - 7 13 174 M.W. 13 119A M.W. 8/12 2 13 5 175 M.W. 21 119B M.W. 6 13 176 M.W. 18 120A M.W. 9/12 17 177 M.W. 24 121 M.W. 12 7 178 M.W. 15 122A M.W. 10 18 — 179 M.W. 14 18 19 125A M.W. 15 — 183A M.W. 24 — 126A M.W. 22 — 190A M.W. 13 18 — 131 M.W. 12 192 M.W. 5 14 — 133A M.W. 10 14 1½ 193A M.W l½ 10 13 — 134B M.W. 12 197 M.W. ½ 12 139A M.W. 2 4 7 — 198 M.W. 16 18 20 12 199 M.W. 12 143A M.W. 6 13 200 M.W. 17 26 152A M.W. 9 14 201 M.W. 15 153 M.W. 4 11 14 203 M.W. 16 24 155A M.W. 25 208A M.W. 12 163 M.W. 16 209A M.W. 16 — 166 M.W. 5 6 13 2 212 M.W. 4 13 — 60 Table 4-Continued. Four or more living and sleeping in one room. Case No. Males Females Case No. Males Females 8B M.W. 3 1½ 80B M.W. 2 3 11B M.W. 1½, baby expected January 1928. F. 11 82C M.W. 2 3 9/12 88B M.W. 1½ 4 6 23B M.W. 4 7 8 92B M.W. 2 2/12 24C M.W. 1½ 4 ½ 104 M.W. 2 4 6 26B M.W. 10, 12 105B M.W. 3½ 5 27B M.W. 3 6 8 (baby expected February 1928) 119B M.W. 6 1.3 124B M.W. 4 6 32B M.W. 10 11 - 33C M.W. 2 wks 4 6 12 127B M.W. 1 6 — 37C M.W. 1 2 3 5 140B M.W. 3½ 5 42B M.W. 5 7 1½ 160B M.W. 1 4 44B M.W. 1 2 161B M.W. 7 5 50B M.W. 5 3 195B M.W. 7/12 2 — 55B M. W 1½ 3 195C M.W. 4 6 — 55C M.W. 9/12 6 196C M.W. 4 8 11 — 64B M.W. 2 6 210B M.W. 1½ 3 51 Table 4-Continued. Males and Females over 12 sleeping in same room. Case No. Males Females Case No. Males Females 4 24 16 18 21 110A M.W Grandmother 9 11 17 20 112 12 17 14 24 20 21 115 10 16 19 16 13 16 19 21 117B 11 13 Mother Gr'mother 21 13 16 25 18 118 16 13 17A M.W. 10 18 4 14 142 13 11 17 22 32A 10 17 19 22 13 15 145 13 11 19 21 35B Widow24 21 146 13 16 21 39B Widow 30 48 40 147 22 12 18 21 45A 2 4 12 13 148 10 13 17 14 46A 16 19 14 149 11 16 6 18 47A 6 15 9 13 144A W 17 12 14 1 adult 53A 13 8 17 157A Grandfather 20 57A 16 14 162 14 15 18 19 62A 22 27 19 165 14 8 8 16 65 14 8 11 18 169 M.W. 13 17 70 10 17 18 8 1.3 15 21 173 W 13 11 14 71A M.W. 20 14 179 M.W. 14 18 19 72 16 20 184 15 8 12 73B M.W. 14 3 7 13 185 8 12 18 15 75A 14 19 20 186B Widow 18 7 12 15 81A 5 15 8 13 187 12 15 86A 13 18 15 20 191 16 11 14 86B M.W. 3 11 16 4 17 194 19 13 17 22 106 15 17 21 209C 5 15 13 17 108 2 3 13 13 211 14 16 52 Table 4—Continued. Five people or more sleeping In one roam Case No. Males Females Case No. Males Females 6 M.W. 10 3 6 12 40 W. 5 10 16 27 28 13A M.W. 10 13 15 41a M.W. 11 13 18 13B M.W. 6 1 5 42b M.W. 5 7 1½ 15B M.W. 6 15 18 — 44a M.W. 7 4 11 13 17A M.W. 10 18 4 14 48b M.W. 7 12 11 18A M.W. 6 2 10 (children T.B) 49a M.W. 13 13 18 - 18B M.W. 5 7 8 49b M.W. 8 3 7 19 M.W. 2 4 6 10 51b M.W 3 5 7 9 23B M.W. 7 8 52 M.W. 3 5 8 25B M.W. 2 3½ baby expected in November. 53b M.W. 10 4 4 54b M.W. 2 3 7 8 4 27B M.W. 3 6 8. Baby expected in February. 56a W. 7 13 18 20 56b M.W. 1 2½ 5 28B M.W. 4/12 5 3 59a 2 4 7 29 5 11 13 15 21 — 60 7 7 13 14 17 31B M.W. 3½ 7 9 5 wks. 1½ 61 M.W 10 16 28 33B M.W. 1½ 4 7 66 Widow 9 18 27 30 34A M.W. 11 15 17 8 19 67 M.W. 3 11 8/12 35A M.W. 3 7 12 8/12 5 9 68 12 12 14 17 24 37C M.W. 1 Baby 2 3 5 70 10 17 18 8 13 15 21 expected in Nov'ber. 73b M.W. 14 3 7 13 38A M.W. 11 14 18 74a M.W. 7/12 4 5 76b M.W 1 6 8 13 53 Table 4-Continued. Five people or more sleeping in one room. Case No. Males Females Case No. Males Females 78A M.W. 5 7 14 123B M.W. 9/ 12 4 5 75B M.W. 2 whs 2 5 6 12 128B M.W. ½ 2 5 9 10 129B M.W. 1 2 5 82B M.W. 2 5 7 9 130B M.W. 1½ 7 4 84 M.W. 5 2 6 131 13 16 20 21 24 25 89B M.W. 3/12 3 6 132 14 18 19 19 20 — 90C M.W. 7 3 3 133A M.W. 10 14 1½ 91b M.W. 2½ 3/12 7 135 12 13 18 18 20 — 93A M.W. 5 wks 6 9 136B M.W. ½ 3 3 6 — 94A 6 7 13 21 26 137 7 11 14 16 23 96A M.W. 4 10 13 138B M.W. 1½ 3 — 101 6 8 15 17 21 139A M.W. 2 4 7 12 — 102B M.W. ½ 3 0 7 141 3 12 14 16 17 107A M.W. 6/12 7 6 150B M.W. 2 4 3 5 109B M.W. 1 4 8 144A M.W. 7 10 2½ 5 119A M.W. 8/12 2 5 144A W. 17 12 14 1 adult 13 151 2 5 7 11 15 17 153 M.W. 4 11 14 54 Table 4-Continued. Five people or more sleeping in one room. Case No. Males Females Case No. Males Females 154B M.W. 9 3 7 189 M.W. 1 6 6 13 156 10 6 13 16 18 190B M.W. 3 9 5 157B M.W ½ 1½ 3 — 193A M.W. 1½ 10 13 — 158A M.W 3 3 7 196C M.W. 4 8 11 — 159 M.W 3 6 6 7 197 M. 2 5 7 13 — 164 M.W ½ 1½ 3 4 198 M.W. 16 18 20 166 M.W 5 6 13 2 202 M.W. 1½ 3 6 8 167 M.W 2 6 8 204 M.W. 4 6 9 180 6 n 13 8 9 205 M.W. ½ 3 5 7 181 M.W 6 8 10 5 206A M.W. 3 8 1 married daughter. 182 4 6 1C 20 3 8 188 W. — 3 6 16 20 207 M.W. 2 5 7 55 Four people or over who share one bed. Case No. Occupants 12 F.25, F.22, F.10, F.5 22 F.13, F.10, F.8, F.3. 23 Man, Wife, F.8, F.7, M.4. 27B Man, Wife, F.8, M.6. M.3, Baby expected in Feb. 37B Man, Wife, F.3, F.1½. 54B M.8, M.7. F.4, M.3. 56B Man, Wife, F.5, F.2½. 57A Man, Wife, F.6, M.2. 70 F.21, F.15, F.13, F.8, (one bed). M. 18, M. 17, M.10, (one bed.) 75B Man, Wife F.2, M.2 weeks, (one bed). M.10 M.9, F.6, F.12, F.5. 83B Man, Wife, F.3, F.3, (one bed). M.9, M.12. 85B Wife, F.17, F.13, M.9, (one bed). F.20. (one bed,). 86B Man, Wife, F.3 (one bed). F.17, F.4, M. 16, M.11, (one bed). 88B Man, Wife, M.4, M.l½, (one bed). M.6. 90C Man, Wife, F.3, F.3, (one bed). M.7. 93A M.26, M.19, M.17, M.15. 104 Man. Wife, M.4. M.2, (one bed). F.6, (cot). 119A Man, Wife, M.2, M.8/12,—one bed. M.13, F.5. 128B Man, Wife, M.2, M.1½, (one bed). M.5, (cot). 130B Man, Wife, M.7, .F.4, M.1½. 150B Man, Wife, M.4, M.2, (one bed). F.5, M.8, (one bed). 144A Wife, M.10, M.7, M.2½, (one bed). Man, F.5, (Sofa). 56 Four people and over who share one bed. Case No. Occupants. 153 M.l8, M.16, M. 13, M.9. 154b Man, Wife, F.3, F.7, (one bed). M.9, (Sofa). 161 Man, Wife, (one bed). FA, F.3, F.1½, M.½, (one bed). 168 M.27, .M.24, M.20, M.18. 189 Man, Wife, F.6, M.1, (one bed). F.13, F.6, (one bed). 190b Man, Wife, M.3, F.5, M.9. 202 Man, Wife, M.14½, M.3, (one M.6, F.8. 57 The plight of a family with children in their search for accommodation is now literally lamentable. They have only to mention the fact that there are children, and the door is closed on their enquiries. There is a long list waiting for Council houses as they become vacant, but it has been disappointment to those at the head of the list as ejectments of decent people keep occurring in de-controlled houses, or houses still controlled, where the house is required for the children of the owner within the section of the Act. In view of the fact that these people have no accommodation their case must be regarded as taking precedence over those who have a roof over their heads. In the meantime van dwellers increase and are becoming a great difficulty in the district. I am as I said last year constantly being appealed to, to assist in getting a "Council House." In almost every case the applicants are decent working class families with their own furniture and in steady work, who can afford to pay a reasonable rent, some have offered up to 20/- per week. These even if they can get rooms are at the mercy of the profiteering landlord. It is melancholy work listening to the tale of the many trampings of the mother of a family to whom every door is shut directly she admits the existance of a family. 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. (e) How far defects are due to lack of proper management and supervision by owners; 58 The defects found are in the main, due to owners neglecting to have repairs carried out. (2) Action taken as regards unfit houses under: (a) Public Health Acts See appendices. (b) Housing Acts „ (3) 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 the cost of labour as reasons for delay or neglect in the repair of repairable houses. (4) Conditions so far as they affect housing, as regards water supply, closet accommodation and refuse disposal, together with measures taken during the year in these matters: Water supply is on the whole satisfactory. Closet accommodation is generally adequate, bui: defective apparatus is frequently complained of, whilst in the outlying parts of the district are some houses not yet connected with the general sewerage system. Refuse disposal: —a weekly collection is made. II. Unhealthy Areas. Information as to complaints received or representations made and action taken in regard to unhealthy areas, under Part II. of the Housing Act of 1925. Nil. 59 III. Bye-laws relating to houses, houses let in lodgings, tents, vans, sheds, etc. (1) 4s to working of existing Bye-laws: For reasons given elsewhere it has been impracticable to maintain the inspection of houses let in lodgings, etc. Probably many houses are now technically houses let in lodgings owing to the abnormal housing conditions, but are not on the register. (2) As to need for new bye-hmvs and revision of existing bye-laws: Some difficulty has been experienced in dealing with caravan dwellers under the existing bye-laws with regard to the disposal of refuse, and closet accommodation, and a revision of these bye-laws is under consideration. IV. General and Miscellaneous. Other action taken in connection with overcrowding. Insanitary property and housing NIL. V. Appendices, Statistics for year ending 31st December, 1927. APPENDICES. Housing Conditions Statistics. Year ended 31st December, 1927. 1. GENERAL. (1) Estimated population Birth rate 55,870 Death rate 54,910 (2) General Death rate (corrected) 10.69 (3) Death rate from Tuberculosis (all forms) 0.98 (4) Infantile Mortality 67.93 (5) Number of dwelling-houses of all classes 12,356 Total number of new houses erected of all classes 1,071 60 Number of New Houses erected during the year: — (a) Total (including figures given below) 1071 (b) With State assistance under the Housing Acts:— (1) By the Local Authoity 16 (2) By other Bodies or Persons 103 2. UNFIT DWELLING HOUSES. I. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 452 (2) Number of dwelling-houses which were spected and recorded under the Housing Consolidated Regulations, 1925 2 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 274 (5) Number of houses, listed for inspection under the Housing Consolidated Regulations, 1925, at end of year 1539 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 279 61 III. Action under Statutory Powers. A. Proceedings under Section 3 of the Housing Act, 1925— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 3 (2) Number of dwelling-houses which were dered fit after service of formal notices— (а) by owners 3 (b) by Local Authority in default of owners 11 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intentions 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 4 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 1 (b) by Local Authority in default of owners 1 C. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925— (1) Number of representations made with a view to the making of Closing Orders 1 (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 62 (4) Number of dwelling-houses in respect of which Demolition Orders were made 4 (5) Number of dwelling-houses demolished in suance of Demolition Orders 4 D. Proceedings under Section 12 of the Housing Act, 1925— 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 12 (2) Number of dwelling-houses demolished voluntarily 11 3. UNHEALTHY AREAS. Areas represented by the Local Authority with a view to Improvement Schemes under Part II. of the Act of 1925 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. There it no officer appointed wholly for housing duties, which are carried out by the staff in conjunction with their other duties. Table 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 1926— ‡*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 ... 22/2/27 31/10/27 ... ‡14-34, London Road 11 12/5/19 22/7/19 ... ... ... ... †1-10, Syon Place, London Road 10 „ „ ... ... ... ... †65-75, Hanworth Road 6 12/1/20 23/11/20 ... ... ... ... 175, Twickenham Road 1 „ 26/4/21 ... ... ... ... 177, 1 „ ... ... ... ... ... 1 & 3, Wellington Road North 2 9/2/20 ... ... ... ... ... 5, „ „ „ 1 „ 28/7/20 24/5/27 ... ... ... Cottage situated in the Farm Buildings, Wood Lane Farm, Wood Lane, Isleworth 1 13/7/25 22/9/25 1927— Losley Cottage, Wellington Road South, Hounslow 1 12/12/27 *17/4/14 Notices served on tenants of Nos. I, 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. 31/12/27 Nos. 1, 2 and 3 occupied. †Closing Orders not served. ‡Demolition deferred. ††Closing Orders re-made. 63 65 INSPECTION AND SUPERVISION OF FOOD. 66 INSPECTION AND SUPERVISION OF FOOD. The following is the record of inspection of food premises: — No. of Inspections made. Meat 1820 Fish 363 Provisions 598 Greengroceries and Fruit 625 Hawker's Food Stuffs 515 Number of other Food Inspections 280 Milk. There has been a very definite improvement in milk vending. One large firm has supplied a new milk sterilizing and bottling plant in conformity with plans suggested by the Department, and another is just signing contracts for a still more up-to-date plant. The advent of branches of large concerns dealing with milk on up-to-date lines has set a standard which is being rapidly followed in the district. The sale of pasteurised milk wholesale to small dealers is raising a special problem. The milk is supplied in bulk, but there is apt to be—if not very carefully watched—no particular care taken with regard to the conditions under which it is retailed or bottled. Whatever the value may have been in the efficient pasteurisation, it is likely to be entirely nullified by the method in which it is handled by some of the small dealers. The standard of a milk shop is also steadily improving. The popular demand for a cream line is producing a simultaneous demand for efficient pasteurising owing to the lack of cream line as a result of flash pasteurising. Much of the advantage of a clean milk supply is lost by the decanting of the milk when delivered, from the bottle into unsterilised containers. It is far better in the smaller homes if they would retain the milk in the bottles as delivered, keeping something over the top to ensure the absence of flies and dust. 302 inspections were carried out in respect of cowsheds, dairies and milkshops. 67 Unofficial milk analyses are made by the Medical Officer of Health. The standard of the milk supply in the district on the whole has improved. Very little of the milk which is sold in the district now is not pasteurised, although only two firms have applied for a Licence to sell "pasteurised" milk under the Milk (Special Designations) Order, 1923. No. of firms in the district licensed to sell— "Certified" milk 4 (9 shops). "Grade A (Tuberculin Tested)." 2 (7 shops). "Grade A" — "Pasteurised" 2 (7 shops). All the milk shops are being brought up-to-date to ensure complete cleanliness in dealing with their utensils, and under the new Regulations it is to be hoped that a really satisfactory standard will be reached and maintained. Meat Inspection. 1. Meat Inspection.—This is still kept at a very high pitch of efficiency. The Chief Sanitary Inspector and the District Sanitary Inspectors hold special certificates for meat inspection. Slaughter-houses and butcher's shops are visited periodically. During the year no diseased meat was seized, but 3364 1/8 lbs. were surrendered. In January there were 7 slaughter-houses in use. During February one registered slaughter-house was altered, improved and re-opened; thus 8 slaughter-houses were in use during the greater part of the year. Each slaughter-house received on an average 14.7 visits per month. There are also 42 butchers shops in the district. 2. Public Abattoir.—There is no public abattoir in the district. Slaughtering may take place at any time, subject to the requisite notice being given. From time to time suggestions have been brought forward as to the possibility of establishing an abattoir. I have on every occasion advised against it, on the grounds that I 68 do not think that at the present time the expense is justified, owing to the fact that by far the greater part of the meat coming into the district is bought at Smithfield and insepcted there. There does not seem to be with the growth of the district any demand for further facilities for slaughtering at present. 3. Action under Section 117, Public Health Act, 1,876.— None during 1927. 4. Tubercular Meat.—There 'was none seized, but 2319f lbs. were surrendered during the year. 5. The following is a tabular statement on slaughter-houses : 1920. In January, 1927. In December, 1927. Registered 4 3 4 Licensed 4 4 4 Total 8 7 8 The slaughter-houses as a whole are unsatisfactory. The additional work thrown on the staff by the Public Health (Meat) Regulations, 1924, has been considerable and is best shown by the number of inspections as compared with previous years. Number of Inspections, etc. made. 1923 1924 1925 1926 1927 Meat—inspections made 960 556 1513 1790 1820 Slaughter-houses—Inspections and visits made 245 204 1131 1106 1400 The majority of butchers have loyally fallen into line with regard to giving notice of slaughtering, but in 79 instances insufficient notice of slaughtering was given, a large number of which could have been avoided 'with a little forethought. Further progress has been 69 made in some cases with regard to the provision of fixed windows to butchers shops, but in other instances there has been no improvement as a result of suggestions advanced by the department. INSPECTION OF OTHER FOODS. Section 72 of the Public Health Act, 1925, provides, in some measure, for the prevention of contamination of foodstuffs, (other than meat), when stored or kept on enclosed premises; but there appear to be no provisions made for dealing with the contamination of foodstuffs deposited for sale, in an open manner, on forecourts to shops and on stalls and barrows standing or moving about the roadways of a district. Sale of Food and Drugs Act. I am indebted to Dr. J. Tate, County Medical Officer, for the following report prepared by the Chief Officer of the Public Control Department, as to the samples purchased in this area during 1.927. Article Taken Adulterated Milk 151 12 Rabbit 1 -— Cream 4 — Butter 3 — Meat, cooked 1 — Meat 12 5 Fish Paste 1 — Jelly 1 — Rennet 2 1 Jam 3 — Food Preservative 5 5 Custard Powder 1 — Whiskey 2 — Bacon 1 — Sausages 25 8 Sausage, cooked 2 — Seasoning 2 — 217 31 70 The figures given for adulterated samples include some adulterated informal samples in respect of which no proceedings could be taken. Prosecutions for Milk 2 Convictions 1 Other prosecutions 5 Fines and Costs imposed £56: 0: 0. UNSOUND FOOD, 1927. Tons. cwts. qrs. lbs. Corned Beef 1 2 Fish 2 2 17¾ Fowls 1 0 17¾ Fruit 1 0 8¾ Meat 1 10 0 4 1/8 Rabbits 2 0 7 Total 1 17 1 0 5/8 71 Meat seized or surrendered in lbs-Meat Inspections- 73 INFECTIOUS DISEASES. 74 INFECTIOUS DISEASE. Scarlet Fever and Diphtheria. There were 6 "return" cases of Scarlet Fever and 1 of Diphtheria during the year. The usual period allowed when speaking of a "Return Case" is 28 days after the return home of a case from Hospital, or 28 days after the release of a case from Isolation at home. No cases of Diphtheria were notified from North Hyde School during the year. There does not appear to be any use made of the Dick reaction. Scarlet Fever serum is being used at the Isolation Hospital in emergencies. The Staff is not being Schick tested or immunized. Scarlet Fever. The following table shows the number of cases which have been notified, and the number and percentage of cases which have been removed to Hospital: — No. of civil cases notified 66 No. of civil cases removed to Hospitals 66 Percentage of cases removed to Hospitals 84.8 The incident rate of Scarlet Fever in the civil population was 1.2 per 1,000. No deaths took place from this cause during the year. Diphtheria. The following table shows the number of notifications received and the percentage of cases of Diphtheria removed to Hospital: — No. of civil cases notified 56 No. of civil cases removed to Hospitals 55 Percentage of cases removed to Hospitals 98.2 The incident rate per 1,000 of the civil population was 1.02 Nine cases occurred in institutions during the year. One death took place from this disease, i.e., a case mortality rate of 1.8 per cent. 75 Diphtheria Antitoxin. 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. During 1927, 9 vials of Antitoxin of 8,000 units each were supplied to medical practitioners. Enteric Fever. There were 17 cases notified during the year, the majority of which were Para-typhoid B. One death was recorded from this disease. Para-typhoid fever mostly of the B. type forms a definite and baffling problem which appears so far to be without solution. During 1927, cases of the Enteric group were notified as follows : Case No. 1 occurred in the south-easterly corner of the district in a large house occupied by a professional man and his family, the patient being the wife of the house-holder. In the next case the patient was about 15, the case occurring about the centre of the district. In both these eases there was a history of water-cress, and an interesting feature in the first case was that the water-cress was given to four tame birds. Two of these ate the water-cress and two would not touch it. The two that ate it both died of acute enteritis. In view of the fact that some Authorities consider that bacillus psittacosis is identical with bacillus para-typhosus this brought water-cress strongly under suspicion. ,About the same time that these cases occurred, I was called in in consultation to see a doubtful case, which despite the fact that it gave no typhoid reaction, had every appearance of para-typhoid. In this case also there was a history of water-cress being consumed. The case had been seen by one of the best-known London Consulting Physicians. I ascertained from him that he "was unable to come to any definite opinion as to the nature of her attack. I 76 thought it might have been one of those intestinal affairs of doubtful bacteriology one sometimes sees in children, which resembles the enteric group so closely in their symptoms." On going into the source of supply it was found that these cases were provided with their supply by one factor in a neighbouring market. The factor in question had two sources of supply; one in the western country and one north-west of London. The facts were communicated to the Medical Officer of the western county whose report on the water-cress beds was entirely satisfactory. I arranged to visit the nearer beds with the local Medical Officer of Health. I found that there had been a history of para-typhoid in the area previously. On inspecting the beds they were apparently entirely satisfactory and up-to-date. The beds were supplied by artesian wells, thus ensuring a satisfactory water supply. One weakness however, was that grazing of cattle was taking place on the grass land adjoining the water-cress beds, and the fences had been broken down, so that access was possible by the cattle. On investigating the matter closely, it was found that the water supply, though sufficient for meeting the day to day needs of the beds was inadequate when it came to washing out and replanting, and on the lower beds in order to meet this difficulty, a neighbouring and very polluted stream was tapped for this puropse, thus the whole security provided by the artesian supply broke down at this point. Samples of the water and water-cress were taken, and submitted to the Lister Institute with the following report:— "Report on examination of watercress.—Organisms of the group (non-indol producing B.Coli) were found in cultures from the cress. An organism having the biochemical characters of Morgans No. 1 bacillus was also found. The pathogenic significance of this organism is considered doubtful by most bacteriologists at the present time as although it was found in a large proportion of cases of summer diarrhoea examined by 77 Morgan and is occasionally the only suspicious organism found in the stools of patients suffering from enteritis it is not unfrequently found in the faces of healthy individuals. No typhoid or para-typhoid bacilli were found." "Report on examination of water from water-cress bed— Indol producing B. coli were readily isolated from small quantities of this water, but we understand the samples had been incubated before being sent to us so that it is not possible to form any opinion as to the number present when the sample was taken. No typhoid or para-typhoid bacilli were isolated." "Report on examination of mixed water from water-cress bed—No coliform organisms or any organisms of known pathogenic significance were found in this sample of water." The facts were communicated to the Ministry and it was arranged that Representatives should accompany us to the beds and take further samples. This was done, and the results were as follows:— A. Water. On upper set of beds (1) Emerging from deep well "L.O."— Unpolluted (B.Coli absent in 50 c.c.) (2) Emerging from deep well "N.O."— Idem. On lower set of beds (3) Emerging from deep well "L.S.H."— (drainage from upper sets of beds). Polluted (Typical B.Coli present in 1 c.c. (4) Emerging from deep well "D."— (drainage of neighbouring beds). Polluted (Typical B.Coli present in 1 c.c.). B. Water-cress. Lower set of beds (1) 4th Cross Bed (tops above water)— Unpolluted (B.coli absent). 78 (2) 5th Cross Bed (Stems below water)Polluted (typical B.coli present). Other beds round the district—which were possible sources of supply, were inspected by the Medical Officers superficially and a clear bill given, but in no case was any bacteriological examination undertaken. There seems to my mind to be a call for a definite report on the water-cress industry. For instance, one found in one case the farmer accompanied by a dog dashing hither and thither and fouling the banks. In view of the report by Dr. Cory Mann on the value of water-cress, it is being consumed in houses where previously it did not gain access, and it would seem that the time has come when something should be done to investigate and regulate the manner in which watercress is grown and marketed. The next case was notified from a hospital, having been admitted from an address from the borough bordering the eastern end of our district. The next case which occurred was at the extreme end of the western district in a child aged 12. Apart from ice cream from various sources, no article of food came under suspicion. The next case, a male aged 19, was notified from the Hounslow Hospital. The patient had been sent in with acute gastric intestinal disturbance from a neighbouring district, and the widal reaction showed it to be a case of para-typhoid B. In this case there was no history of shell fish or water-cress or lettuce, but a history of drinking from a pond which was probably polluted. The next case occurred on the 2nd August in the centre of the district, and there appeared to be nothing particular. The next case occurred on the 7th August at the north end of the district in a child aged 2. The only possible source in this case was lettuce. The case was bacteriologically para-typhoid B. The milk supply in this case was the same as the last, but this is a very large firm, and nothing so far had caused their supply to be suspected. 79 The next case occurred on the 12th September in a male aged 17. No shell fish or water-cress eaten. In this case the milk supply was from three different firms, one of which was the same as in the two previous cases. As a result of this samples of the milk were taken, which showed such a condition of supply that further investigation in the source of supply was undertaken. Samples were taken on delivery, both of the night and morning milk. These were submitted for analysis and the following figures were obtained. THE NATIONAL INSTITUTE FOR RESEARCH IN DAIRYING. Shinfield, Nr. Reading. 28th September, 1927. Bacteriological Report on Milk Samples. No. of Sample Remarks Temp. when Tested of No. of bacteria per 1 c.c. 1 C.C. bacillus coli in 1/1000 1/10 1/100 EN. 1 Tested 20/9/27 66 800,000 x x x x „ 2 „ „ „ 1,040,000 x x x x „ 3 „ „ „ 400,000 x x x — „ 4 „ „ „ 1,120,000 x x x x „ 5 „ „ „ 2,000,000 x x x — „ 6 „ „ „ 260,000 x x — — „ 7 „ „ „ 560,000 x x — — „ 8 „ „ „ 2,400,000 x x x x „ 9 „ „ „ 1,760,000 x x x x „ 10 „ „ „ 4,800,000 x x x x „ 11 „ „ „ 3,200,000 x x x x „ 12 „ „ „ 3,520,000 x x x x „ 13 „ „ „ 2,400,000 x x x x „ 14 „ „ „ 3,200,000 x x x x „ 15 „ „ „ 2,800,000 x x x x „ 16 „ „ „ 6,400,000 x x x x „17 „ „ „ 4,800,.000 x x x x „ 1.8 „ „ „ 1,600,000 x x x x „ 19 „ „ „ 5,000,000 x x x x „ 20 „ „ „ 3,200,000 x x x x „ 21 „ „ „ 4.800.000 x x x x X—Bacillus Coli Found. — Bacillus Coli not found. THE NATIONAL INSTITUTE FOE RESEARCH IN DAIRYING. Shinfield, Nr. Reading. 3rd October, 1927. Bacteriological Report on Milk Samples. No of Sample Remarks Temp. when Tested oF No. of Bacteria per 1 c.c. 1 C.C. Bacillus coli in 1/1000 1/10 1/100 EN. 1 Tested 29/9/27 62 456,000 x x - - „ 2 „ „ „ 7,000,000 x x x x „ 3 „ „ „ 5,500,000 x x x x „ 4 „ „ „ 4,500,000 x x x x „ 5 „ „ „ 20,000,000 x x x x „ 6 „ „ „ 5,000,000 x x x x „ 7 „ „ „ 3,500,000 x x x x „ 8 „ „ „ 800,000 x x x x „ 9 „ „ „ 720,000 x x x x „ 10 „ „ „ 650,000 x x x x „ 11 „ „ „ 280,000 x x - - „ 12 „ „ „ 448,000 x x x x „ 13 „ „ „ 1,280,000 x x x x „ 14 „ „ „ 6,000.000 x x x x x—Bacillus Coli Found —- Bacillus Coli not found. 82 As it was obvious from this that the conditions at the farm were unsatisfactory, the Medical Officer of Health of the districts in which the Farms were situated was communicated with, and steps were taken to improve the conditions. The next case arose on the 19th September in a male aged 9. No article of diet came under suspicion, the only possible thing being ice cream which was purchased from a firm who supply an enormous amount in the district surrounding, and whose methods of preparation are above suspicion. The next case occurred on 28th September in the centre of the district. In this case nothing incriminating could be found. Another case was notified on the 28th September from Hounslow Hospital, which arose in another district, the diagnosis being made as a result of bacteriological investigation. The next case occurred on the 30th September, in this case a history of water-cress, but there was no further article of food which could be viewed with suspicion. The next case which occurred on the 6th November, was the brother of the female patient, who was notified in the light of the previous case, his original illness having occurred three weeks before his sister. The father in this case had suffered from para-typhoid in India, but examination of his blood and stools was negative. Results of the investigation of the 2 cases revealed nothing which could be regarded as incriminating. The next case occurred on the 9th November, being notified from the West Midlesex Hospital, was admitted there from an adjoining area. A further case occurred on the 9th November, but diagnosis was not arrived at until after the child had been ill for some time and as a result of persistence of symptoms and bacteriological examination. In this case the mother had been under suspicion whilst living in Devonshire, as having been a case of typhoid fever, but 83 further bacteriological examination of the patient produced nothing to account for the child's infection. The next case occurred on the 21st November in a female aged 4. No food came under suspicion. The child had diarrhoea for three weeks. I was called in consultation with the medical man in attendance, and confirmed the diagnosis. These cases occurring in such numbers, give rise to considerable anxiety, and when no source of the trouble can be ascertained they are a perpetual worry. Erysipelas. 30 cases of this disease were notified, of whom 2'0 were West Middlesex Hospital cases. 16 were non-residents in this district. Ophthalmia Neonatorum. See page 114. Puerperal Fever. 9 cases of this disease were notified; 6 were notified from the West Middlesex Hospital, 5 of these patients were not resident in this district. Puerperal Pyrexia. 16 cases were notified, but no special action was required in any of these cases. Encephalitis Lethargica. There were 2 cases notified this year. 84 Cerebro-Spinal Fever. 1 ease of this disease was notified. The patient was an out district case notified from the West Middlesex Hospital. Acute Poliomyelitis. No cases were notified. Pneumonia. 130 cases were notified. 67 notifications were from the West Middlesex Hospital. 51 were non-resident in this district. Malaria. There were no cases notified during the year. 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 sets forth the numbers of such cases for the last five years: — 1923 1924 1925 1926 1927 Measles 3 563 239 497 35 German Measles 5 30 43 75 7 Chicken Pox 62 100 243 408 243 Mumps 111 308 266 246 352 Whooping Cough 63 67 213 131 157 Upon receipt of information of the existence of a case, inquiry is made by a School Nurse to obtain all necessary facts. 85 Influenza. The mortality from Influenza was 0.49 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. Notifiable Diseases during i927. DISEASE. TOTAL CASES NOTIFIED. TOTAL ALL AGES CASES ADMITTED TO HOSPITAL. under 1 year. 1-9, years 2-5 years 3-4 years 4-5 years 5-10 years 10-15 years 15-20 years 20-35 years 35-45 years 45-65 years 65 years and over. MOGDEN. OTHER HOSPITAL8 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... 2 2 4 3 4 ... 2 ... ... 17 8 4 Scarlet Fever ... 2 3 4 1 32 8 8 7 1 ... ... 66 55 1 Diphtheria ... 4 ... 6 4 21 12 2 6 1 ... ... 56 47 8 Erysipelas 1 ... ... ... ... ... 2 1 5 5 6 10 30 ... 20 Puerperal Fever ... ... ... ... ... ... ... ... 7 2 ... ... 9 ... 6 Puerperal Pyrexia ... ... ... ... ... ... ... ... 13 3 ... ... 16 ... 11 Ophthalmia Neonatorum 7 ... ... ... ... ... ... ... ... ... ... ... 7 ... 2 Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 Pneumonia 9 8 6 10 5 13 5 7 21 22 13 11 130 ... 89 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Legarthica ... ... ... ... ... ... ... ... ... 1 1 ... 2 ... ... For Tuberculosis Notifications-see other Table. Infectious Diseases, 1927. Cases Notified. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Erysipelas. Cerebro-spinnl Fever. Encephalitis Lethargica. Poliomyelitis. Pneumonia. Malaria. Respiratory Tuberculosis. Other forms of Tuberculosis. Ophthalmia Neonatorum. Dysentery. Puerperal Pyrexia. Small-pox. January 3 1 ... 1 1 ... 2 ... 32 ... 6 ... 1 ... ... ... February 2 2 ... ... ... ... ... ... 23 ... 8 4 ... ... ... ... March 5 4 ... ... ... ... ... ... 1 ... 9 3 1 ... 1 ... April 3 6 1 ... 1 ... ... ... 9 ... 6 1 ... ... 1 ... May 9 4 ... ... 3 ... ... ... 7 ... 7 1 ... ... 1 ... June 4 4 1 ... 3 ... ... ... 17 ... 7 1 2 ... 3 ... July 9 3 2 ... 2 ... ... ... 8 ... 6 4 2 ... ... ... August 2 4 4 2 3 ... ... ... 1 ... 4 ... ... ... 3 ... September 8 11 2 3 4 1 ... ... 3 ... 1 3 1 ... 1 ... October 6 8 3 ... 3 ... ... ... 5 ... 5 3 ... ... 1 ... November 10 6 3 2 3 ... ... ... 12 ... 2 1 ... ... 3 ... December 5 3 1 1 7 ... ... ... 12 ... 5 ... ... ... 2 ... Totals 66 56 17 9 30 1 2 ... 130 ... 66 21 7 ... 16 ... Deaths from Notifiable Infectious Diseases, 1927. 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 Total All Ages. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... 1 ... ... ... ... ... ... ... 1 Enteric Fever ... ... ... ... ... ... ... 1 ... ... ... ... 1 Puerperal Fever ... ... ... ... ... ... ... ... 2 ... ... ... 2 Pneumonia 15 7 3 4 ... ... 3 ... 5 3 12 10 62 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro Spinal Fever ... ... 1 ... ... ... ... ... ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... Total 15 7 4 4 1 ... 3 1 7 3 12 10 67 For Tuberculosis Deaths—see other Table. The table hereunder gives the number of cases of infectious diseases that were notified from the several Institutions in the district during 1927:— SMALL-POX. ENTERIC FEVER. SCARLET FEVER, DIPHTHERIA. PNEUMONIA (all forma). ERYSIPELAS. PUERPERAL FEVER. PUERPERAL PYREXIA CEREBRO SPINAL FEVER. OPHTHALMIA NEONATORUM. ENCEPHALITIS LETHARGICA. PULMONARY TUBERCULOSIS. OTHER TUBERCULOSIS. POLIOMYELITIS. TOTAL. West Middlesex Hospital ... 2 ... 9 67 20 6 11 1 2 ... 13 ... ... 131 Hounslow Hospital ... 2 2 ... 9 ... ... ... ... ... ... ... ... ... 13 Nazareth House ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 2 North Hyde Schools ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Borough Road College ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 4 9 78 20 6 11 1 2 ... 13 ... ... 148 90 COUNCIL LABORATORY, 1927. Total. Positive. (a) Swabs for Diphtheria sent by Medical Practitioners 183 1.9 Sub-cultures 0 0 Taken from Schools, Clinics and from Contacts 541 17 Sub-cultures 12 11 Sent from Staines Joint Isolation Hospital 225 26 Sub-cultures 0 0 St. Mary's School, North Hyde 0 0 Total cultures examined 961 73 Virulency Tests 3 1 (b) Blood examination for Typhoid Widal Tests 24 7 (c) Cerebro Spinal Fluid Examinations 0 0 (d) Specimens of Sputum for Tubercle Bacilli: — Sent by Medical Practitioners 104 19 Total 128 26 (e) Hairs for Ringworm— Taken at Schools or Clinics 25 11 Sent from Staines Isolation Hospital 2 0 (f) Other Specimens— Urine 206 Discharge 6 Milk 93 Faeces 7 91 Preparation of Materials— Total. Tubes of Serum 1426 Throat Swab Outfits 1160 Sputum Outfits 100 Excreta Outfits 12 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 with Diphtheria Culture Tubes. The Virulency and Widal Tests were carried out for us by Dr. Harold Spitta at St. George's Hospital, and the Clinical Research Association. Some milk samples, and specimens of faeces were examined by the Clinical Research Association, and 85 of the milk samples were examined by the National Institute for Research in Dairying, Beading. TUBERCULOSIS. There is a definite need for an open air recovery school which will deal with convalescent, tubercular, pre-tubercular, and delicate children. I am convinced that money spent in this direction is money wisely expended. Pulmonary Tuberculosis. The number of new cases notified during the year was 66. Twenty-nine cases were notified from Institutions— Sanatoria 3, Poor Law Institutions '8, General Hospitals 16, T.B. Dispensary 2. There were 44 deaths from Tuberculosis of the Respiratory System. Of the new cases notified 49 received Institutional Treatment during the year. 92 Other Forms of Tuberculosis. The number of new cases notified during the year was 21. Sixteen of them were notified as receiving Institutional Treatment, and 4 died. Death from Tuberculosis. Tuberculosis of Respiratory System 44. (17 were primary notifications and 6 were not notified at all). Other Tuberculosis 10 (3 were not notified). For Table showing new cases notified and deaths in 1927 see next page. Cancer. Arrangements are being made for propaganda in connection with Cancer, the exact form of which is still under discussion. 93 TUBERCULOSIS 1927. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0 ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... ... 1 1 5 1 ... 3 4 ... ... ... ... 10 ... ... 1 2 ... ... ... 1 15 3 8 1 ... 3 5 1 ... 20 4 10 2 3 3 6 ... 1 25 13 4 2 ... 4 2 ... 1 35 5 6 1 1 5 4 1 ... 45 8 2 ... ... 4 1 1 ... 55 2 ... ... ... 4 3 ... ... 65 and upwards ... ... ... ... ... ... 1 ... Totals 36 30 10 11 23 21 5 5 Six of the deaths from Pulmonary Tuberculosis were not notified and three deaths from Non-Pulmonary Tuberculosis were not notified. 95 MATERNITY AND CHILD WELFARE. 96 MATERNITY AND CHILD WELFARE. The work is expanding steadily and satisfactorily. The scheme is as follows:— Two Clinics weekly at the Congregational Hall, Douglas Road. Hounslow, on Tuesday and Thursday afternoons. Two Clinics weekly at the Public Hall, Isleworth, on Monday and Wednesday afternoons. At each of these Clinics infant consultations are carried out, regular weighing, and the sale of dried milks, malt, virol, etc. The Mothers can obtain a cup of tea and biscuits at a cost of 1d. The attendances totalled 14,020 for the year as compared with 11,567 in 1926, 9843 in 1925, 8817 in 1924 and 8322 in 1923. The average attendance at the Douglas Road Centre was 86.75 and at the Isleworth Centre 40.9. The number of individual mothers and children attending the Clinics is shewn hereunder: — Douglas Road, Hounslow. 1925. 1926. 1927. Mothers 514 562 688 Children 608 765 880 Isleworth Public Hall. Mothers 288 326 305 Children 393 432 414 Sales at Clinics. Receipts. Quantity. £ s. d. Prescription Glaxo 1304 lbs. 127 18 8 Glaxo 4404 lbs. 278 0 0 Virol 858¾ lbs. 71 9 7 Malt 436 lbs. 16 2 6 Oil and Malt 679 lbs. 25 8 6 Lactagol 679 tins. 38 10 0 Almata 183 lbs. 15 13 0 Cow and Gate 2341 lbs. 177 14 5 Cod Liver Oil Emulsion 1497 bottles. 48 14 0 £799 10 8 97 The work is expanding rapidly, partly owing to the growth of knowledge of the work, and partly due to the rapid increase in the district. An estimate of the amount of work is shown by the fact that in December, 1927, the record of attendance was as follows: — Number of times open—19. Attendance of children- 980. For the previous three months the record was as follows : — September. Number of times open—17. Attendance of Children—1241. October. Number of times open—20. Attendance of Children—1300, November. Number of times open—22. Attendance of Children—1319. Average attendances at ClinicsDouglas Road, 86.75. Isleworth Public Hall, 40.9. During the year considerable progress has been made in various directions. In January an agreement was made with the Metropolitan Asylums Board for the admission of cases of Ophthalmia Neonatorum to St. Margaret's Hospital. Progress has been made in the Ante-Natal Work, in that Dr. Bell of Ealing was appointed to carry out the ante-natal work, ari l authority was given to utilise his services as an Obstetric Specialist in the cases of emergency. A scheme has also been put into operation for the provision of dental treatment and dentures for nursing and expectant mothers, and the extension of the school dental service to the provision oi treatment for all children attending the Clinics. The scheme is as follows:— 1. Persons covered by the Scheme. All Nursing and Expectant Mothers attending at the Council's Centres, and children under 5 years of age are eligible for treatment. 98 These cases will only be treated after having been seen by the Medical Officer, and referred by him to the School Dental Surgeon. 2. Procedure. After being referred for treatment, the general procedure will be as for School Cases. A consent form must be signed by the patient, parent or guardian. The appointments will be made by the School Dental Surgeon and Dental Nurse, and the cases will usually be treated in conjunction with the ordinary school cases at the School Dental Clinic. A dental record card will be made out for each case, similar to the existing School Dental Card. A charge of 1/- will be made for each patient, (mother or child) which will cover all ordinary treatment at the Clinic within the limits of the scheme, for a period of one year. 3. Provision of Dentures for Mothers. Following the extraction of a mother's teeth, the provision of dentures will be undretaken by the School Dentist where necessary, and the Matenity and Child Welfare Committee will be responsible to him for payment. In each case, before proceeding with the dentures the Dentist will furnish an estimate of the cost of same to the Medical Officer. The mother will then be informed of the cost, and will sign an undertaking to repay the cost of the dentures and necessary treatment to the Council. The repayment may, where the circumstances necessitate, be spread over a period of 1 year, by equal weekly instalments. In such cases the payments shall be made at the Public Health Department, or collected by the Health Visitors. In necessitous cases, where the mother is unable to pay the whole of the cost and makes a return showing the income and circumstances of the family, the case will be considered by the Maternity and Child Welfare Committee with a view to assistance being granted. In argent or exceptional cases the Chairman of the Maternity and Child Welfare Committee and the Medical Officer are authorised to deal with same and report at the next meeting. 99 Scale of Charges foe Provision of Dentures. £ s. d. For first two teeth on a denture 1 0 0 For each additional tooth 5 6 Fee for a full, or nearly full (ten teeth or more per denture) upper or lower denture 3 0 0 Fee for full, or nearly full (ten teeth or more per denture) upper and lower dentures 6 0 0 Scale of Repayments. Half set—Cost of dentures 30 0 To be repaid at the rate of l/3d. a week for 48 weeks, commencing from the week when treatment is started. Complete set—Cost of dentures 6 0 0 To be repaid at the rate of 2/6d. a week for 48 weeks, commencing from the week when treatment is started. Other charges in proportion. This is leading to a considerable number of toddlers being brought back who 'would otherwise have not come under our supervision until school age. The mothers are very grateful for the opportunity of obtaining skilled treatment for their teeth,, and in practically all the cases they volunteer to pay without assistance from the Committee contributions of 2/6d. per week towards repavment of the cost. The Dentist s report on the scheme for the year is as toilows : — Maternity and Child Welfare. Dental Clinic. Report for Year 1927. From 25th March (commencing date) to December 31st, 1927. Visits to the Clinic Mothers. Boys. Girls. Total. Appointments 46 70 77 193 Visits 37 59 63 159 Absents 9 11 14 34 % Attendance 80.43 84.28 81.81 82,38 100 Mothers. On December 31st December, 1927. There were : — 4. Waiting authority from the Committee. 7. Under Treatment. 1. Referred to O..D. by S..M..O. 1. Reported to S.M.O. as requiring gas and extractions only. 13. Total. Advice. Was given in 34 cases, re impending irregularities, and/or re Treatment. Under Treatment— 13. Under Treatment. 85. Finished. 98. Number of patients, who were all "1st Time" Cases. Extractions— 5. Teeth extracted, using local spray. 73. „ „ gas, etc. 78. „ Total. Fillings 20. Total. Impressions and models made : — 32. Upper. 32. Lower. Total 64. These are in the Clinic Museum for record and illustrative purposes. Objector :—One parent objected to fillings and extractions. Postponed Treatment :—One case till after Confinement. The Inspector of the Ministry in her report drew attention to the fact that the attendances at the Douglas Road Centre are too high to permit of the necessary individual attention being given to each child. The work at Douglas Road still remains at an impossible level. Not only is it impossible to give proper attention 101 to the cases, but the work is so arduous that the end of the day leaves one absolutely fagged out. The maximum number which I personally have seen at the Clinic is 46. During the year arrangements were made for the opening of a new Clinic at Heston, the Village Hall having been enlarged by Mr. Fenton. The extension was designed by my son Mr. E. T. Nash A.R.I.B.A., specially to suit the purposes of the Maternity and Child Welfare work, the plans of which I presented to Mr. Fenton as my contribution to the Maternity and Child Welfare work. The alteration was however, not completed in time for the new Centre to be opened during the year under report, but will be referred to mors fully in the next report. During the year, owing to the class of house which is being purchased in very large numbers in the district, the question of means of the parents attending the Clinic was raised and a resolution moved that a report should be made as to the possibility of reserving the use of the Council's Clinics to the poor. As a result an investigation was made with regard to a number of mothers attending both at Hounslow and Isleworth. Particularly in the new houses the amounts of income are no index of the financial position of the family, as owing to commitments of various kinds there is no margin left and many of these cases are really a great deal more in need of assistance than those whose income is less, and the following was the report submitted to the Committee. Means of Persons attending Clinics.—The Medical Officer submitted the following statement shewing the means, and kindred particulars, of persons attending the Council's clinics at Hounslow and Isleworth:— 105 First List of Particulars re Mothers attending Clinic. Hounslow Centre. Occupation. Wages. Rent. No. in family Occupation. Wage s. Ren . No. in family £ s. d. £ S. d. £ S. d. £ S. d. Printing Machine Minder £7—£8 1 5 0 3 Re-Rubberer Vulcanizer (Own Bus.) ... 12 6 3 Labourer 3 0 0 10 0 5 Cinematograph Operator 3 0 0 17 6 3 Civil Servant 4 0 0 1 0 0 3 Green-Grocer 2 0 0 10 0 3 Painter's Labourer 2 18 0 6 0 4 Motor Engineer 3 10 0 10 0 3 Railwav Clerk 4 0 0 1 5 0 3 Engineer 8 0 0 10 0 4 Motor Driver (Master Man) 6 4 3 Mechanic (Aeroplane) 3 0 0 14 0 3 Chemical Engineer 6 5 o 1 10 0 6 Fitter 4 7 0 1 0 0 4 Clerk of Works £300 ("per ann.) Rates 3 Clerk 2 19 0 14 0 4 Grocer's Manager 4 '0 0 1 7 6 4 Book-Keeper 5 0 0 Rates 7 Sailor 1 16 0 15 0 2 Plaster Contractor Express Store Master Man 5 0 0 Rates 4 Accountant 4 0 0 48 0 0 3 (own bus.) (Per ann.) Civil Servant 3 0 0 1 10 0 3 Clerk 4 15 0 18 11 4 Provision hand 2 5 0 10 0 3 Fireman 3 6 0 10 0 3 Clerk 5 15 0 2 15 0 4 Builders' Clerk 4 10 0 3 15 0 4 month month Butcher 3 0 0 7 6 3 Motor Engineer 3 3 0 16 6 3 Railway Guard 3 15 0 16 6 8 Clerk (C. Service) 3 0 0 1 0 0 4 103 Occupation. Wages. Rent. No. family Occupation. Wages. Rent. No. in family £ s. d. £ s. d. £ s. d. £ s. d. Labourer 2 8 0 10 0 4 School Cartaker 2 2 0 — 4 Electrician 4 0 0 16 0 4 Labourer 3 2 0 7 6 6 Motor Driver 3 0 0 6 0 3 Labourer 2 17 0 7 6 3 Painter 3 0 0 12 0 3 Leather Worker, (Dis. Sold., Training) 2 0 0 7 3 7 Porter Shoe Shop 2 12 0 4 5 0 5 (month) Bus Driver 4 5 0 3 10 0 3 Carpenter 3 0 0 12 6 4 montn Fitter's Mate 3 5 0 10 0 3 Carpenter (Sports) 5 10 0 1 0 O 4 Ticket Collector 2 9 0 1 2 0 8 Painter 3 0 0 12 0 3 Commissionaire 3 0 0 1 8 0 3 Guard, Dist. Railway 3 5 0 9 0 4 Window Cleaner 1 15 0 15 0 3 Piano Tuner 4 0 0 5 0 0 3 Cutter (Tailor) 4 10 0 1 2 6 4 month Baker 2 5 0 10 0 4 Porter, Covent Garden 3 0 '0 8 6 5 Bank Clerk 6 0 0 6 5 0 5 Store Keeper 4 3 0 8 4½ 6 month Corpl., R.A.S.C. 2 2 6 9 0 3 Shop Manager 3 15 0 1 0 0 3 Engineer 2 19 0 2 16 10 3 Corp. Army 2 10 0 1 0 0 3 month & Rates Civil Servant 19 19 0 1 10 0 4 month Clerk 3 10 0 10 0 3 Private, Army 1 0 0 11 0 3 Railway Constable 3 0 0 1 0 0 6 Shipping Clerk 4 0 0 4 0 0 4 Labourer (Not PerPermanent) 2 10 0 16 6 3 month Cabinet Maker 3 10 0 7 0 4 Land Worker 1 15 0 6 0 4 10/- p.w. furniture. Odd man (furnishing) 2 0 0 1 0 0 4 Window Dresser 5 10 0 12 0 4 104 Occupation. Wages. Rent. No. in family Occupation. Wages. Rent. No. in f.amily. £ s. d. £ s. d. £ s. d £ s. d. Linotype Operator 5 0 0 4 15 3 3 Post Office Clerk 3 0 0 3 15 10 4 Civil Servant 18 10 0 15 4 4 month month G.P.O. Sorter 5 0 0 0 0 6 Tester L.G.O.C. 3 10 0 4 5 0 3 C.P. Checker 2 10 0 15 0 0 month Trper., Royal Dragoons 1 4 0 15 6 3 Gardener, Kew Railway Porter 2 8 0 10 0 3 Gardens 2 10 0 5 0 3 Agricultural Labourer 1 19 3 5 0 3 Government Clerk 4 0 0 1 5 0 3 Agricultural Labourer 1 18 0 10 0 4 Railway Clerk £160 (per ann.) 3 8 0 3 School Assistant 20 0 0 4 0 0 5 month month month Electrician 3 0 0 12 0 3 Casual Labourer 2 15 0 6 0 5 Painter & Decorator (Master Man) 3 0 0 6 0 4 Labourer 3 0 0 7 0 4 Plumber 4 0 0 9 6 4 Milkman 2 16 0 1 3 6 4 Painter 4 0 0 1 0 0 4 Army Pensioner 2 0 0 10 0 4 Labourer 4 0 0 7 6 4 Greengrocer (Master Man) 2 0 0 6 6 3 Labourer 3 0 0 10 0 5 Railway Clerk 4 19 0 3 14 8 8 Labourer 3 0 0 12 6 3 month Brick-layer (in Summer) 3 15 0 17 6 3 Motor Mechanic 3 0 0 10 0 4 Compositor 2 10 0 1 0 0 3 Road Sweeper 2 12 8 8 0 6 Commercial Traveller 3 0 0 1 0 0 3 Motor Mechanic 2 10 0 5 0 5 Railway Head Shunter 3 3 0 18 0 3 105 Isleworth Centre. Occupation. Wages. Rent. No. in family Occupation. Wages. Rent. No. in family £ s. d. £ s. d. £ s. d. £ s. d. Gardener 2 8 6 13 0 9 Engineer 2 10 0 12 0 3 Plumber 3 15 0 12 3 7 Porter 2 10 0 14 0 3 Motor Driver 3 10 0 9 8 5 Cashier £4— -£5 1 5 0 3 Labourer Out of Work 8 3 8 Labourer 2 10 0 5 6 4 Motor Driver 3 10 0 4 6 5 Police Sergt. 5 0 0 17 6 4 Labourer 3 0 0 14 6 6 Greengrocer's Roundsman 2 15 0 11 0 5 when in work. Out of work. Clerk 3 10 0 12 0 3 Civil Servant 4 0 0 13 0 4 Baker Does not know 9 0 7 Stoker 2 13 0 14 6 5 Mill Hand 2 16 0 8 0 3 Labourer 2 12 0 Living with mother 4 Labourer 2 12 6 11 6 5 Collector 2 10 0 4 0 4 Clerk 2 0 0 Own house 5 Bus Driver 4 0 0 16 0 3 (Pension 14/- week) Fish Shop Fryer 3 0 0 10 9 6 Labourer 2 8 0 10 0 11 Labourer 2 17 6 5 0 8 Labourer 2 5 0 7 6 5 Fish Fryer 3 0 0 7 6 9 Labourer 3 0 0 14 6 5 Caretaker 2 10 0 10 0 4 Motor Driver 3 10 0 14 6 3 Brewery hand 3 12 0 14 0 6 Sail Maker 3 0 0 9 0 6 Fitter, Engineer 3 0 0 17 6 4 General Hand 8 0 0 15 6 5 106 Occupation. Wages. Rent. No. in family Occupation. Wages. Rent. No. in family £ s. d. £ s. d. £ s. d. £ s. d. Auxiliary Postman 1 15 0 6 7 7 Labourer Out of Work 4 0 4 Shop (General) 1 10 0 1 room Railway Hand 2 9 0 15 0 4 Electrical Engineer 5 0 0 2 0 0 4 Labourer 2 15 0 5 6 3 Handyman 2 5 0 9 3 4 Engineer 4 0 0 18 6 3 Enginer 3 0 0 11 6 5 Police Constable 4 5 0 17 6 5 Cable Laying 3 0 0 14 6 6 Tailor 4 0 0 £80 (per ann.) 7 Labourer 2 8 0 10 0 5 Civil Engineer £6—£7 2 2 0 6 Domestic work 10 0 Living with mother Living with mother 2 Labourer Out of Work 6 0 5 3 Factory Hand 2 11 0 12 0 4 Signalman 1 15 0 Labourer 2 0 0 12 0 5 Aux. Postman 1 10 0 7 0 3 Shunter 2 12 0 7 6 4 Carpenter Housekeeping 12 0 3 Commissionaire 2 14 0 7 6 5 Painter Does not know 4 0 4 Electrician 5 0 0 15 0 3 Labourer 2 10 0 8 0 3 Engineer 2 10 0 4 0 3 Fitter, Railway 2 15 0 17 6 7 Baker 2 12 0 8 0 3 lAbourer Out of Work 6 11 5 Tramway 3 0 0 10 10 4 Motor Driver 2 8 0 9 0 3 Fitter 3 0 0 9 0 3 Stone Mason 3 10 0 1 5 0 3 not working, ill Tutor 2 14 0 1 0 0 8 Factory hand 1 0 0 4 0 6 107 Occupation. Wages. Rent. No. in famiiy Occupation. Wages. Rent. in family £ s. d. £ s. d. £ s. d. £ s. d. Clerk 3 0 0 Does not know 6 Labourer 2 5 0 3 0 5 Butcher 4 0 0 10 0 3 Clerk 3 10 0 1 0 0 3 Gardener 2 0 0 5 0 3 Clerk 5 0 0 18 0 4 Painter 2 9 0 12 6 3 Stoker 4 0 0 8 0 3 General hand 2 l5 0 10 0 4 Tailor 2 0 0 6 0 5 108 As a result the work has proceeded on the same lines as hitherto. At Douglas Road a Mothers' Committee has been active during the year. Sewing meetings have been held; maternity bags with complete outfits were provided for the use of the poorer members. The Committee granted the sum of £2 towards the original purchase of material. In order to assist the Mothers Committee in dealing with necessitous cases the Maternity and Child Welfare Committee agreed to provide a fund which contributes towards the various activities in equal shares by an addition of 1d. per packet on purchase prices of dried milk sold at the Clinics. Towards the end of the year, as a result of an address given to the fathers of the children attending the Douglas Eoad Clinic, a Fathers' Committee was formed to see in what way they could assist the more necessitous cases attending the Clinic. In November I was instructed to report on the desirability of the purchase of apparatus for affording sun-ray treatment, the report to deal particularly with— (a) Types of apparatus and their cost. (b) Accommodation for apparatus. (c) Maintenance and attendance; and (d) Arguments for and against sun-ray treatment. The arrangements with chemists for the dispensing of prescriptions on terms similar to those under the National Insurance Act, have been continued. In addition to the Infant Welfare Centre an Ante-Natal Clinic was held on the first Monday in the month at the Council House, and the attendance is steadily growing. There are possibilities that something can be done to replace satisfactorily the premises used for the Infant Welfare Clinic at Isleworth. There is no possibility of any instructive work so long as we are restricted to the present unsatisfactory premises. I am as convinced as ever of the value of a Consulting Obstetrician in the District. It has been urged and will be urged that if a 109 facility is provided it will create a demand. Personally I hope is will, because in return for that I can see the lives of many mothers infinitely improved. As I have said previously the whole happiness centres round the mother, and if the mother's health is undermined so that her work becomes a burden, then the 'whole happiness of the family is at stake. It affects not only the wife, it affects the husband; it affects the children. If by preventing a number of these accidents which occur during confinement, which has hitherto been regarded as the necessary heritage of parenthood, and thus preserving homes. from the disability which arises from a fretful invalid, then much will be done, particularly from the point of view of the care of children. Similarly I am as convinced as ever of the importance of the Ante-Natal Work being in the hands of an Obstetrician. Again it may be said that the provision of skilled advice will create further demand for service of the skilled adviser. Again I hope so, as from experience one sees how much can be done to prevent trouble at the confinement, and how much more easily these things can be done by those who make it their special vocation. Further if a person with a reputation in this particular class of work is conducting the Clinic, mothers will come with less reluctance, in fact with keenness because of the reputation of the Obstetrician concerned. We are gradually passing through a. new stage in which it is gradually dawning on the mothers that the disabilities—pains, back-aches and various other things which are regarded as almost part of their everyday life as a result of a family, are not their normal lot, but unfortunately it is difficult to make the men folk understand—unless they are medical men—how much can be done and how important is the doing of it. Notification of Births. Number of live births notified during the year 949 Number of still births notified 30 Notified by midwives 656 Notified by parents or doctors 326 110 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 and the Osterley, North Hounslow and Heston Nursing Association are the only Voluntary Societies 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 Mrs. Barker, Mrs. Bezer (a former member of the Committee, who unfortunately had to resign owing to ill-health) Mrs. Chadwick, Mrs. Cole, Mrs. Davis, Mrs. Hanks, Mrs. Simmonds, Mrs. Still, Mrs. Sweet, and Miss K. Theobald at the Hounslow Centre, and Mrs. E. Chedgey (Co-opted member of the Committee), Mrs. Evans and Mrs. Watson at Isleworth. Thanks are also due to the undermentioned for gifts of pramtoys, high chairs, clothing, etc., which are given to other mothers, and also for willing assistance in connection with the Christmas Bazaar organised by the Mothers' Committee : — Mrs. Archer. Mrs. Marston. „ Barnes. „ Martin. Miss Bartlett. „ May. Mrs. Bircher. „ Meades. „ Botvjer. „ Midmore. „ Butler. „ Moody. „ Carn. „ Mullins. „ Dearman. „ Neethan. „ Diamond. „ Palmer. „ Edgington. „ Parkes. „ Eaves. „ Payne. „ Gray. „ Prout. „ Hastings. Miss Prout. 111 Mrs. Fisk. Miss Rhodes. „ Fruin. Mrs. Walsh. „ Furnell. .. Sargeant. „ Gardener. „ Sharpe. „ Hankin. „ Skinner. „ Hunt. „ Spofforth. „ Leach. „ Thompson. Lindsay. „ Unwin. „ Laycock. „ Vince. Miss Rolfe. and to the gentlemen who assisted at the Bazaar—Mr. Edgington, Mr. Leach, Mr. May, Mr. Moody, Mr. Prout (Senr.), Mr. Prout (Jun.), Mr. Walsh, the 6th Brentford Scouts for a gift of tickets, and the Arcadian Dance Band. Home Visiting. The visits by the Health Visitors in connection with the Maternity and Child Welfare Work are shown in the following table:— 1923. 1924. 1925. 1926. 1927. 1st visits to babies under one year 803 754 888 1038 1020 Re-visits to babies and Children up to five years 4150 3594 3562 3190 4474 Inquiries made, elicitedFeeding—Natural 516 487 525 672 747 Artificial 61 59 104 102 41 Both 42 32 56 62 16 Sleeping with parents 282 248 288 202 200 Using Comforter 285 236 276 231 148 Mother working during pregnancy Year 1927. 44 37 84 75 36 Ante-natal. First visits 59 Subsequent visits 18 Infant Deaths. Visits paid 60 112 Ophthalmia Neonatorum and Discharging Eyes 89 Infantile Diarrhoea 2 Puerperal Fever and Puerperal Pyrexia 11 Measles and German Measles 2 Whooping Cough 22 Mumps 4 Children under 5 years. Chicken Pox 6 Pneumonia 54 Bronchitis 15 Chidren under 5 years. Milk and Food Cases 28 Home Help 27 Social Conditions 39 Other visits 309 Health Visitors attendances at the Maternity and Child Welfare Centres, Ante-Natal Clinics, etc., 585. The Health Visitors also paid 200 visits to Infectious Disease cases, and patients notified as suffering from Tuberculosis, etc. Home Help for Mothers. The Home Help paid 48 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. One is finding that the demand for a Home Help is not as great as it was some years ago, largely due to the work being undertaken by friendly neighbours. 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, 113 and the cleansing is not carried out by any officer of the department acting as such. There have been certain parents who have objected to going to the Home Help, but a considerable number of the 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 tine 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 a 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 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, 42 children have been cleansed. Grants of Milk. Milk is supplied free or at reduced rates to expectant mothers (during last three months 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 1/3 cost. 5/- to 7/6 per head parent pays 2/3 cost. Where the amount is over 7/6 per head, no grant is made. The number of grants made during the year was 103. 114 OPHTHALMIA NEONATORUM year 1927. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 7 5 2 5 1 ... 1 heston AND isleworth urban district education committee TWENTIETH ANNUAL REPORT OF THE School Medical Officer FOR THE Year ending 31st December. 1927. 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, 1927. I wish to express my thanks to the members of the Committee for the kindness and support they have shown me. I am, Ladies and Gentlemen, Your obedient servant, ELWIN H. T. NASH. Members of Education Committee, 1927-28 F. T. HART, Esq. (Chairman). A. A. Bergin, Esq. (Vice-Chairman). Members of the Council:— J. J. BONNETT, Esq., o.b.e. C. M. ROBINSON, Esq. A. DENNIS, Esq. S. CARTER, Esq. A. E. HALES, Esq. W. J. R. DIVINE, Esq. E. W. HEATH, Esq., ex-officio. H. J. NIAS, Esq., m.b.e., j.p A. l. LANG, Esq., j.p., ex-offcio.}. WEATHERS, Esq. Selected Members: — Miss E. A. ANKRITT. Mrs. S. SPOONER. E.W. GOODE, Esq. P. MURPHY, Esq., j.p. D. RHYS, Esq , m.a. Sthool 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). Miss R. Marshall. E. Cromwell. Miss G. E. Curtis. B. P. Garrod. K. I. Bisshopp. School Nurses— Mrs. C. E. M. Ottley. miss B. N. Tetley (Dental Nurse). Miss B. G. Sori.ie. Dental Surgeon—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. Comprising the whole Clerical Staff of the Public Health Department, part of whose duties art concerned with the School Medical Service. 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. Conference with the Education Office is facilitated, as it is housed 111 the same building as the Health Department. (a). Infant and Child Welfare. There are two centres in the District, and all record cards are available for school medical purposes. Until recently the School Clinics and Welfare Centres shared the same medical and nursing staff, but now the Welfare Centres are in the charge of the Medical Officer of Health, assisted by Nurses doing only Maternity and Child Welfare and Public Health Work, whilst the duties of the School Clinics and Medical Inspections are carried out by the Assistant School Medical Officer with School Nurses. Occasionally a case of ringworm receives x-ray treatment by arrangement with the Education Committee. During the year a scheme has been put into operation for the treatment by the School Dentist, of dental defects in children under five years, and in nursing and expectant mothers. There is still however no provision for the remedying of visual or other defects 111 children under school age. (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 A complete survey of the schools is made from time to time, and a considerable number of minor defects are dealt with. The lighting in some of the schools, chiefly the older ones, is not altogether satisfactory, though efforts are being made to effect an improvement in this direction. In no school in the area is there any arrangement for the drying of the children's clothes and boots in wet weather. This is a matter which affects considerably the health of the children, particularly those subject to Rheumatism and Bronchitis. If such provision were made, it would be possible for many more delicate children to attend school during bad weather than do at present, and there would be a decrease of sickness during the winter months. Dinner Hour Arrangements. In one school only, Spring Grove Central, where there is a Cookery Centre attached, are children able to obtain a hot dinner at a low cost. It is fortunate that the Cookery Centre should be here, because the children at this school are of necessity drawn from all parts of the district, making it impossible in many cases for them to return home for a midday meal. At the other schools in the district it is only a few children who come from a distance, and in these cases the teachers are most helpful in supervising the children's tood, and warming milk, etc., when required. MEDICAL INSPECTION. 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 with a view to treatment being obtained. (a). Age Croups Inspected. Following the Board's Regulations the children examined were: — 1. All new entrants, 5 year old children; 2. Children of 8 years of age; 3. Children of 12 years of age ; 7 together with those children absent at the previous medical inspection, giving secondary groups of 6, o and 13 years of age. The first routine medical inspection of the newly formed Central School was held in 1925, in which case all the children at the school were examined, the ages ranging from 11 to 15. (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. Owing to the increased number of children in the schools, due to the expansion of the district, considerable inconvenience has again been experienced this year in some of the schools by the holding of the medical inspection. In order to provide a room for the inspection, two classes have had to be held in one room, often only large enough for the original class. In spite of deficient accommodation however it still seems better to hold the inspection at the school. An experiment was tried a few years ago, by the Board's permission. Inspections were held at a nearby hall with better accommodation, but it did not prove satisfactory, and was discontinued in 1925. The necessary co-ordination between the Head Teacher and the Medical Inspector was lacking, as it was often impossible for Head Teachers to be present at an inspection held outside their own schools. With the provision of increased school accommodation which is to be carried out shortly, much of the difficulty should disappear. FINDINGS OF MEDICAL INSPECTION, 1927. Uncleanliness. Out of 2,318 children examined at routine medical inspection, 138 were found to have nitty or verminous condition of the head, 326 children were also seen at the school clinics. The total number of children excluded on account of nits and vermin during 1927 8 was 205. Further reference to this subject will be found on pages 23, 24, and Table IV. (p. 36). Tonsils and Adenoids. Out of 2,318 children examined at the routine inspections, 59 had enlarged tonsils, 23 of which were referred for treatment, 36 being kept under observation. 75 children had adenoids only, of which 34 required treatment, and 41 were for observation, whilst 48 children had both enlarged tonsils and adenoids, 23 requiring treatment, and 25 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 12 other children were found to have enlarged tonsils, 5 adenoids only, whilst 7 suffered from both conditions. Tuberculosis. Out of 2,318 children examined at the routine inspections, there was one case of suspected pulmonary tuberculosis requiring to be kept under observation. There were 3 definite cases of pulmonary tuberculosis found at the special clinics and 14 were found to be suffering from suspected pulmonary tuberculosis, whilst 4 children had tubercular glands, 2 tubercular hip, I tuberculosis of the bones, and I other form of tuberculosis. Skin. At the routine inspections, out of 2,318 children examined, 15 were found to be suffering from skin trouble. At the special clinics there were 645 children suffering from various skin complaints, including scabies and impetigo (see Table II. for analysis of figures), 12 cases of ringworm of scalp and 16 cases of ringworm of body. 9 Externa Eye Disease. Out of 2,318 children examined at the routine inspections, 8 were found to have minor eye diseases including blepharitis and conjunctivitis, whilst I had a squint. In addition 53 were found at the special clinics to suffer from the " minor " eye diseases, whilst 2 had squint. Vision. Out of 2,318 children examined at the routine inspections, 182 were found to have defective vision, 128 of which were referred for treatment, 54 being kept under observation. At the special clinics 48 children were referred for treatment for defective vision, 4 being kept under observation. Ear Disease and Hearing. Out of 2,318 children examined at' the routine inspections, 86 were found to be suffering from defective hearing or ear disease, whilst an additional 88 were discovered at the special clinics. Dental Defects. Out of 2,318 children examined at the routine inspections 690 had carious teeth and were referred for treatment, whilst 8 had slighter caries and were marked for observation. At the special clinics a further 102 were discovered and referred for treatment. Dental inspections, 3,364 children were referred for treatment out of 5,015 inspected (for further particulars see Table IV., Group 4). Deformity. Out of 2,318 children examined at the routine inspections, there were 15 found with some deformity. At the special clinics I was found to be suffering from rickets, but 2 other forms of deformity were referred for treatment, whilst 8 other forms of deformity, and 2 of spinal curvative were kept under observation. Physique and Nutrition. This year no special analysis has been made of the height and weight of children examined at Medical Inspection although tabulated records of such figures have been kept. 10 Dr. Roberts states that the general impression is that the children examined are better nourished than formerly, and it is undoubtedly true that parents show more interest in the question of suitable diet than was formerly the case. 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 brings to light unsuspected diphtheria. All infectious cases and contacts are excluded from school till they are deemed free from infection on the general lines laid down in the Joint Memorandum issued by the Ministry of Health and the Boaid of Education, 1927. During the year 1927, the following cases of infectious disease occurred among children attending public elementary schools in this district: — Scarlet Fever 31 Diphtheria 29 Measles 35 Rubella 7 Mumps 352 Chicken Pox 243 Whooping Cough 157 854 The non-notifiable diseases, Measles, Rubella, Mumps, Chicken Pox and Whooping Cough, are visited by the School Nurses, 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." Infectious visiting takes up a considerable part of the Nurse s visiting time. To be effective it must be done as soon as the notification arrives, and cases may be some distance apart, thus taking much 11 longer that the "Following up" visits, which a nurse arranges according to their proximity. Sometimes the cases prove to he not infectious, and often on visiting no one is found at home, so that the number of actual cases does not represent all the visits paid. In some districts Attendance Officers do this work, but it must be considered more satisfactory to send a nurse who can give the mothers advice as to the management of the illness. Also in cases where no doctor certifies, and these r.ases are vastly in the majority, it does not seem fitting that it should be left to an Attendance Officer to decide as to the nature of the illness. But this visiting does cut right across the orderly planning of the nurse's visiting, and as it takes precedence, other visiting suffers accordingly. This is particularly so during epidemics, when practically all other visits have to be sacrificed to meet the emergency. 12 Cases of infectious disease have occurred during the year among school children as follows : — SCHOOL. SCARlET FEVER. DIPHTHERIA MEASLES GERMAN MEASLES MUMPS. CHICKEN POX WHOOPINC COUGH Alexandra Boys 1 ... 2 ... 53 4 17 ,, Girls ... 1 ... ... 10 4 15 Brentford End Infants ... ... ... ... 9 2 3 Grove Road Boys 2 1 ... 1 13 3 1 ,, ,, Girls ... 1 1 1 2 3 3 ,, ,, Infants 5 ... 21 1 80 9 22 Heston Mixed and Infants 6 2 2 1 4 67 1 Hounslow Heath Boys 1 2 1 ... 3 ... 3 Girls 2 6 ... ... 1 1 6 ,, ,, Infants 1 6 6 ... 3 2 10 Hounslow R.C. Mixed &t Infants 1 ... ... ... 2 1 12 Hounslow Town Boys 3 ... ... ... 15 2 1 ,, ,, Girls and Infants 3 1 ... ... 50 28 20 Isleivorth Blue Boys ... ... ... ... 10 2 ... ,, ,, Girls & Infants 3 1 ... ... 12 6 ... Isleworth Toivn Boys ... ... ... ... 11 ... 1 ,, ,, Girls & Infants ... 3 ... 1 9 4 15 St. Mary's Boys ... ... ... ... 18 1 ... ,, Girls & Infants 1 ... ... ... 16 3 ... Spring Grove Central ... ... ... ... 5 2 ... Junior 1 ... 2 ... 3 35 14 Woodlands St. John's Infants ... ... ... ... 1 1 2 Worple Road Mixed and Infants 1 5 ... 2 22 63 11 T otal 31 29 35 7 352 243 157 13 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 Nurse 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, or the case closed by the Medical Officer. Summary of the work undertaken by the School Nurses: — 1. They are in attendance at the Inspection (Minor Ailment) and Special Clinics, and undertake the daily treatments at each centre. 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 follow up cases absent or attending the clinics irregularly. Summary of work by the School Nurses during 1927. 87 attendances at School Inspection Clinics. 262 ,, ,, Dental Clinics. 55 ,, ,, Eye Clinics. 425 ,, ,, Minor Ailments Clinics. 5 ,, ,, School Sports. 133 visits to schools for medical inspections. 25 ,, ,, ,, ,, re-inspections. 36 ,, ,, ,, dental inspections. 13 ,, ,, ,, cleansing surveys. 6 ,, ,, ,, swabbing. 14 7 other visits (Scholarship exams, Swimming Gala, etc.). 1106 visits to homes in connection with following-up. 1211 ,, ,, ,, ,, Infectious diseases. 223 ,, re Clinic absentees. 683 dental visits. 133 other visits. 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.—10 Cases were successfully treated by the application of X-rays, and one by Thallium. The treatment by Thallium was carried out at the West London Hospital. The X-ray treatment is carried out by Dr. D. Arthur, of Ealing, at his own surgery, a fee of £1 : 1 : o per case being paid to him. A charge of 2/6 per case is made, except in necessitous cases, when free treatment may be obtained on application to the Education Committe. Treated at the School Clinic. Ringworm of the Body 11 Cases Impetigo 320 ,, Scabies 10 ,, Other skin diseases, chiefly septic sores 21 ,, Ear Disease and Hearing. At the School Clinic 62 cases of Ear Disease or Defective Hearing were seen and treated. 15 Ear Disease. Middle ear disease, resulting often in long continued discharge from the ears, remains the most unsatisfactory ailment dealt with at the School Clinic. Only a few slight cases are cured, in others the discharge ceases for a time, to begin again later. In many, the treatment is merely palliative, the cells of the mastoid bone are already infected, and nothing short of a fairly severe operation is going to permanently cure the condition. So long as this condition persists, the child is always in danger, in that any minute, any further extension of the disease to the upper plate of bone covering the inner ear, may lead to suppuration within the brain cavity and death. Continuous suppuration of the middle ear always causes impairment of hearing, and further affects the general health of the child, the glands in the neck behind the ear frequently become enlarged, and a general debility results. Considerable loss of attendance at school is caused by this ailment, and when in school the child does not benefit to the full by the education provided. Ionization seems to offer one of the best forms of treatment for early cases. Unfortunately such treatment is not at present available in this district, and parents often find it difficult to take the children to London. Eye Disease. 22 Cases of Eye Disease have been treated at 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 101 children referred for treatment, 36 received treatment either privately or through a hospital, whilst 20 were treated under the Eduction 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 for the fee. Re-payments are claimed from the parents in accordance with the following scale: — 16 Weekly family income Amount per head per case Under 8/- nil. From 8/- to 10/- 5/- From 10/- to 12/- 10/- Above 12/- 21/- The number of cases treated this year shows an improvement —the figures representing one half of those requiring treatment, as against one third in 1926. The treatment of this condition, however, still remains unsatisfactory. Parents object to operative treatment chiefly on the grounds of: — 1. The unpleasantness of the operation. 2. The cost, which in many cases amounts to the full charge of £1 : i : o. 3. The fact that the local hospitals are unable to keep the children as In-patients for the night following the operation. This latter is a very real objection, and many mothers experience difficulty in getting their children home after the operation, and in giving them after care. This is particularly the case in the poorer homes, where there is much overcrowding, and often the mother goes out to work. No scheme for the treatment of Tonsils and Adenoids can be considered really satisfactory which does not provide for the treatment of the child in the 24 hours following the operation. Dr. Roberts states that the figure 101 represents only the well marked cases—there are many others with unsatisfactory conditions of the Naso Pharynx, but of a slighter degree. Such cases could usually have been prevented by proper attention to Nasal Hygiene from infancy. The most common fault with young children is a failure to keep the nasal passages clear. Handkerchiefs are not properly used, and alas! in many cases are not provided, when the poor child is left to sniff back the nasal secretion. Years of this practice inevitably produce irritation and overgrowth of the lymphoid tissue of the Naso Pharynx, and the resulting mouth breathing accentuates the trouble, forming a vicious circle. 17 In a few cases "Sneezing " has been tried, being carried out at home, in conjunction with breathing exercises. This combined with attention to the general health, and the taking of Cod Liver Oil, has proved successful. But such cases are limited in number, and necessitate a careful and intelligent mother. A clinic where such treatment and instruction could be given would undoubtedly save some of the earlier cases from the need of operation. It would also be useful in helping to establish nasal breathing after operation. Unfortunately the establishment of such a clinic is at present impossible owing to the Nurses' time being fully occupied with other work. The results of operation have been in the main very encouraging. Improvement is not seen immediately, but at a subsequent inspection, months or even a year or two later, general improvement has been noted in physique and nutrition, and in the absence of enlarged glands of the neck. Mothers often volunteer the statement that the child has been much better since the operation, eating and sleeping better, and Head Teachers usually report improvement in school work. An essential feature in the success of operative treatment of Tonsils and Adenoids is the after treatment. This consists in giving the child a good environment, fresh air and good food, and—most important—in establishment of nasal breathing. Alas in many cases poverty and overcrowding make it difficult to obtain the first two, and the ignorance or carelessness of the parents prevents the latter. It is in these cases that there is little improvement noted after the operation, and it is here that a Clinic as mentioned above would do good work. Vision. Dr. Roberts, the Assistant Medical Officer, continues in charge of the Refraction Clinic, which is held weekly. From time to time extra clinics have been necessary in order to keep the work up to date. The attendances at the Clinic remain satisfactory. There has been a very definite improvement in the way in which the Eye cases are followed up, and kept up-to-date. 18 This is mainly due to the fact that the Assistant School Medical Officer has charge of the work and sees the children from two points of view; not only as medical inspector in the schools, but also as the Medical Officer in charge of the Eye work. In addition to this the teachers have been asked to report at once any cases where children are not using their glasses or where they notice any difficulty in reading, or where the glasses may seem out of shape. 289 Cases of visual defect were submitted for refraction at the Clinic, whilst 13 children were treated privately or at hospitals. In 219 cases spectacles were prescribed and in 213 cases were provided by the Education Authority, and 11 children obtained spectacles privately. Spectacles are provided at an all round price of 5/6'a pair, and a definite scale of charges for repairs is issued when spectacles are prescribed. Necessitous cases are referred to the Medical Inspection Sub-Committee, and spectacles are supplied free or at a reduced cost, according to the circumstances. Dental Defects. 1,977 Children were treated by the School Dentist under the Local Education Authority's Scheme and 884 re-treated. Further, 12 attended the Dental Clinic and were referred elsewhere for treatment, e.g., hospital, and 9 attended the Clinic but refused treatment. Dental Work. (See pages 37 to 39). 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 considerble 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 with which it is very difficult at present to deal. They cannot attend an ordinary day school and hope to cops with its curriculum. Their power of concentration is sadly lacking, and one feels that on the whole, the child is better running 19 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 children and would not entail much organisation or expense. It is mainly a question of co-operative buying 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 parents inviting their attendance on the occasion of their children undergoing Medical Inspection. They may also attend Dental Inspections. During 1927, one or other parent or relative attended in 1,638 instances, representing a percentage of 70.6 as against 64.8 for 1926. 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. The School Medical Work in this District is greatly helped by the interest and friendliness of the Teachers. Not only are all facilities given for the necessary inspections at the Schools but the Teachers shew active interest in the health of the children, and encourage the parents and children to obtain treatment. 20 Often the Teacher's influence is the paramount one in a child's life, and the parents come to them for advice, hence it is of great importance to the School Medical Service to have the Teachers as allies. Much of the improvement in the cleanliness of the school children is due to the Teachers' zealous work in this direction. CO-OPERATION OF SCHOOL ATTENDANCE OFFICERS. There are now three Attendance Officers in this district and they have at any time the right to ascertain from the Health Department the condition and fitness of any school child. In the course of maintaining attendances they render valuable assistance to the Medical Department by referring to the School Clinic children who are absent from school on account of alleged illness, and who are not under private treatment. Prompt notification by these Attendance Officers of a suspicious sore throat or rash has 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. Help is also obtained for some cases from the Hounslow, Heston and Whitton Philanthropic Society, the Isleworth, Spring Grove and St. Margaret's Philanthropic Society, the Shaftesbury Society and Ragged School Union, and the United Services Fund. 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 1927, examinations were conducted in respect of 60 mentally abnormal children. There are no schools in this District for the defective. An attempt, however, is being made to provide a joint school for Mental Defectives which would serve the Education Authorities in the western part of Middlesex. A conference of the authorities was held at the end of the year when the proposal for a joint scheme was agreed upon. Such a scheme would solve the problem of the education of the Mental Defectives in this district, and it is to be hoped that it will materialise. 21 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. (1) Employment of Children. The conditions of the employment of children and young persons in this area are regulated by Bye-Laws. 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 the School Medical Officer to the effect that such employment will not be prejudicial to their health or physical development and will not render them unfit to obtain proper benefit from their education. 79 Children were examined and were granted the necessary certificates of fitness for work, except in four cases where the certificates were withheld. (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. Medioal Examination of Teachers. During the year 20 medical examinations were made of teachers, in connection with their appointment under the Authority. 22 Holiday Home for Children. All children recommended for the King Edward VII Memorial Home, Herne Bay, are medically examined before being sent away. CRIPPLE CHILDREN. By the Education Act, 1921, Section 55, the Local Education Authority are required to ascertain what children in their area are physically defective and to make provision for them. (See Table III.). 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 is one clinic day at the Council House and one 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. As was reported last year the two School Clinics held at the Council House and Isleworth Public Hall were reduced to one a week at each place. This was done in an effort to economise but it is found that the work is so onerous that it is imperative that in the near future the two clinics shall be reinstated. The time taken with the number of patients attending is such that a large proportion of the mothers are unable to get home in time to get the mid-day meal for the children so that they can return to school by 1.30 p.m. in the winter months. In addition to this there is the husband's mid-day meal to be considered, and clinics which run on till after one o'clock meet with considerable disapproval if not antagonism on the part of the mothers, also it makes it impossible for the nursing staff to clear up after the clinic, get their mid-day meal and get to other parts of the district in time for the afternoon work. If the clearing up has to be postponed until after the finish of the afternoon's work, it means delay in getting out the notices to the schools with regard to exclusions and re-admissions and this often makes for difficulty in administration between the departments. School children come under the notice of the Medical Officers in one of the following ways:— 23 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 SubCommittees 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. 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.—5/6 per pair. Ringworm.—Free in cases considered necessitous. Other elementary school cases, 2/6. Cases from other schools according to circumstances of parents. Dental.—1/- for each child, which covers all necessary treatment within the limits of the Committee's scheme, for a period of one year, including the administration of gas when considered necessary. Minor Ailments.—Free. TREATMENT OF UNCLEANLINESS. 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 by by-law, a prosecution may be ordered. 24 CLEANLINESS SURVEYS, 1927. Number of visits by Nurses 13 Total number of children examined 1734 „ „ „ „ given warning notices 134 „ „ „ „ excluded as verminous 9 1. (Few) 96 2. (Bad) 23 Found to have nits— 3. (Very Bad) 15 Two hundred more children were examined this year than in 1926. The total seen, however, represents only about one quarter of the school population. This is not enough. Every school should have at least one cleanliness inspection during the year. It seems, however, impossible to achieve this with the present staff without sacrificing other work. Visiting has been cut down to a bare minimum. Usually only two "Following Up" visits are paid per case except in very bad cases, the Medical Officer deciding which cases must have more extensive visiting. The work of the cleanliness survey is not only that of the actual inspection at the school. It includes also the action taken with regard to those found with dirty heads. This necessitates attendance at the clinic until the children are clean, and means a large addition to the attendance at a treatment clinic. The survey is important because— 1. The parents have no warning, and therefore, the findings are a true indication of the cleanliness of the school. 2. Everyone in the school is examined, instead of only a certain group as at Routine Medical Inspection. 3. It is of great help to the Teacher in maintaining cleanliness in the school. Since no one knows when the Nurse may come, it is necessary for the children to be always clean if their school is to get good marks at a Survey. Mrs. Yates, the Home 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. 25 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, 42 children have been cleansed. No cleansing has been carried out by the school nurses. During the year 1927, legal proceedings were instituted against the parents of 8 children. Fines were imposed as follows:— 6 of 5/-; and 1 of 4/-; 1 was ordered to pay costs. There continues to be 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. 26 TABLE 1. RETURN OF MEDICAL INSPECTIONS A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 920 Intermediates 645 Leavers 488 Total 2053 Number of other Routine Inspections 265 B.—Other Inspections— Number of Special Inspections 1052 Number of Re-Inspections 2165 Total 3217 27 TABLE II. A. RETURN OF DEFECTS found by Medical Inspection In the Year ended 31st December, 1927. Defects or Diseases, 1 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. 2 3 4 5 Malnutrition ... ... ... 1 Uncleanliness (See also Table IV., Group V.). 137 1 326 ... Skin— ... ... ... ... Ringworm— ... ... ... ... Scalp ... ... 12 ... Body ... ... 16 ... Scabies 1 ... 12 ... Impetigo 10 ... 329 ... Other Diseases (non- tuberculous) 4 ... 301 3 Eye— Blepharitis 1 2 19 ... Conjunctivitis ... ... 16 ... Keratitis ... ... 1 ... Corneal Opacities ... ... ... ... Defective Vision (excluding squint) 128 54 48 4 Squint 1 ... 2 ... Other Conditions 4 1 17 1 Ear— Defective Hearing 3i 40 17 3 Otitis Media 4 . . . Other Ear Diseases 11 4 56 8 Nose and Throat— Enlarged Tonsils 23 36 12 Adenoids 34 41 5 ... Enlarged Tonsils and Adenoids 23 25 4 3 Other Conditions 4 7 20 19 Enlarged Cervical Glands (non-tuberculous) 1 13 26 2 Defective Speech ... ... 2 2 28 TABLE II.—Continued. Defects or Diseases. Routine Inspections. No. of Defects. Special Inspections. 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 (see also Table IV., Group IV.) 690 8 102 ... Heart and Circulation— Heart Disease— Organic 2 26 6 12 Functional ... ... ... 2 Anæmia ... 5 6 ... Lungs— Bronchitis 1 ... 13 ... Other Non-Tuberculous Diseases 1 6 3 2 Tuberculosis- Pulmonary- Definite ... ... 2 1 Suspected ... 1 ... 14 Non-Pulmonary- Glands Spine ... ... Hip ... ... ... 2 Other Bones and Joints ... ... j Skin ... 1 Other Forms ... ... 1 Nervous System— Epilepsy ... ... 7 Chorea ... ... 9 7 Other Conditions ... I 3 4 Deformities- Rickets ... ... 1 ... Spinal Curvature ... ... ... 2 Other Forms 3 12 2 8 Other Defects or Diseases 4 13 47 100 29 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 920 73 7.9 Intermediates 645 93 14.4 Leavers 488 62 12.7 Total (Code Groups) 2053 228 11.1 Other Routine Inspections 265 33 12.45 30 TABLE IN. 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 ... 3 3 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 ... I I At other Institutions ... ... ... At no School or Institution ... 1 1 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 1 1 2 (ii.) Suitable Attending Certified Schools or Classes for the Deaf ... ... ... for training in a School or Class for the partially deaf. Attending Public Elementary Schools 1 1 2 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 1 1 2 Attending Public Elementary Schools 9 4 13 At other Institutions ... ... ... At no School or Institution 1 2 3 Notified to the Local Control Authority during the year. Feebleminded ... ... ... Imbeciles ... ... ... 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 1 ... I Suffering from Epilepsy which is not severe. Attending Public Elementary Schools 3 2 5 At no School or Institution ... 1 1 31 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 ... 1 At Certified Residential OpenAir Schools ... ... ... At Certified Day Open-Air Schools ... ... ... At Public Elementary Schools ... ... ... At other Institutions ... ... ... At no School or Institution ... ... ... Delicate children (e.g. pre- or latent Tuberculosis, Malnutrition, Debility, Anæmia, etc.) At Certified Residential OpenAir Schools ... ... ... At Certified Day Open-Air Schools ... ... ... At Public Elementary Schools 29 26 55 At other Institutions ... ... ... At no School or Institution 1 2 3 Active nonpulmonary Tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 1 2 3 At Public Elementary Schools ... 1 1 At other Institutions ... ... ... At no School or Institution ... 2 2 Crippled Children (other than those with active Tuberculous disease) e.g. children suffering from paralysis, &c., and including those with severe Heart Disease At Certified Hospital Schools ... ... ... At Certified Residential Cripple Schools ... ... ... At Certified Day Cripple Schools ... ... ... At Public Elementary Schools 13 11 24 At other Institutions ... ... ... At no School or Institution 2 2 4 32 TABLE IV. Return of Defects treated during the year ended 31st December, 1927. Group 1.—Minor Ailments (excluding Uncleanliness, for which see Croup V.). Diseases or Defects. 1 Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. 2 Otherwise. 3 Total. 4 Skin— ... ... ... Ringworm, Scalp 11 ... 11 Ringworm, Body 11 5 16 Scabies 10 2 12 Impetigo 320 10 330 Other Skin Diseases 21 11 32 Minor Eye Defects— ... ... ... (External and other, but excluding defective vision and squint) 22 12 34 Minor Ear Defects 62 6 68 Miscellaneous- (e.g., minor injuries, bruises, sores, chilblains, etc.) 213 27 240 Total 670 73 743 33 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). 288 13 2 303 Other Defects or Disease of the eye (excluding those recorded in Group I.) 1 6 7 Total 289 13 8 310 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 219 (b) Otherwise 12 Total number of children who obtained or received spectacles - (a) Under the Authority's Scheme 213 (b) Otherwise 11 34 TABLE IV.—Continued. Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. Received other forms of Treatment. Total number treated. (1) (2) (3) (4) (5) 20 36 56 ... 56 35 TABLE IV.—Continued. Group IV. DENTAL DEFECTS. (1). Number of children who were: (a) Inspected by the Dentist: Aged: Routine age groups 5 602 Total 4770 6 700 7 782 8 493 9 458 10 493 11 494 12 491 13 257 14 - Specials 245 Grand total 5015 (b) Found to require treatment 3364 (c) Actually treated 1977 (d) Re-treated during the year as the result of periodical examination 884 (2). Half-days devoted to Inspection 32 Total 242 Treatment 210 j)- Attendances made by children for treatment 2231 (4). Fillings| Permanent teeth 2339 Total 2622 Temporary teeth 283 (5). Extractions Permanent teeth 195 ) Total 3350 Temporary teeth 3155) (6). Administrations of general Anæsthetics for extractions 784 (7). Other operations ( Permanent teeth 159 Total 159 Temporary teeth — TABLE IV.—Continued. Group V. UNCLEANLINESS AND VERMINOUS CONDITIONS. (i.) Average number of visits per school made during the year by the School Nurses 1 (ii.) Total number of examinations of children in the schools by the School Nurses 1734 (iii.) Number of individual children found unclean 143 (iv.) Number of children cleansed under arrangements made by the Local Education Authority 42 (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 — (6) Under the School Attendance Bye-laws 8 36 School Dental Service YEAR 1927 STATISTICS from the Report of the School Dental Surgeon 38 INSPECTIONS FOR THE YEAR, 1927. Age last Birthday. No. Examined No. Requiring Treatment. % Requiring Treatment. 5 602 390 64.78 6 700 494 70.57 7 782 579 74.04 8 493 380 77.07 9 458 347 75.98 10 493 363 72.63 11 494 329 66.59 12 491 330 67.20 13 257 152 59.14 Specials 245 - - 5015 3364 67.07 THE INSPECTION RESULTS (TOTALS ONLY) FOR THE PAST FIVE YEARS—1923, 1924, 1925, 1926, 1927. (Age Groups). Year. 5 6 7 8 9 10 11 12 13 14 Specials. Total 1923 278 427 481 559 538 533 372 213 40 2 392 3835 1924 315 375 487 474 495 291 — — — — 399 2836 1925 468 388 373 417 457 488 261 — — — 393 3245 1926 399 534 339 367 403 401 479 179 — — 460 3561 1927 602 700 782 493 458 493 494 491 257 — 245 5015 The average inspected in each of the above 5 years = 3968 1925 1926 1927 Due for Inspection 3498 3663 5423 Inspected 2852 3101 4770 In round numbers: Inspected 81% 84% 88% Absentees, etc. 19% 16% 12% The average number of children inspected last year per session was 149. WORK OF THE DENTAL CLINIC, 1923-4-5-6-7. Derived from the School Inspections in each of the past five years. Year. Percentage Required treatment. Percentage actually treated. 1923 80.70 26.46 1924 68.72 47.20 1925 65.17 52.90 1926 61.30 53.09 1927 67.09 58.76 39 As far as treatment is concerned, taking the country as a whole, the number of cases treated compared with those inspected works out as follows:— Year England and Wales Heston and Isleworth 1926 37.51 35.86 1927 38.50 41.44 FILLINGS. Teeth Filled. Year Permanent Temporary Total. 1925 1423 52 1475 1926 1665 25 1690 1927 2339 283 2622 EXTRACTIONS. Teeth Extracted. Year. Perm. Temp. Total Extracts Administration Gas Local Anæsthetic Ethyl ide & Gas No. of Gas Sessions 1925 118 2446 2564 542 — — 41 1926 221 2840 3061 719 110 140* 54 1927 193 2840 3033 784 317 141* 59 * These figures are included in the "Gas" totals. FINANCE. In 1925 the fee for treatment was 6d. a time; in December, 1925, the system was re-organised, 1/- being charged, which covered all treatment for the period of one year from date of payment. In 1925 the fees amounted to £32 17 6 In 1926 the fees amounted to 57 19 0 In 1927 the fees amounted to 64 10 0 The schools order of merit for attendances for treatment at the Dental Clinic. No. School. % 1. Spring Grove 79 2. Brentford End 73 3. Alexandra 72 4. Heston 71 5. Hounslow Town 65 6. Grove Road 64 7. Worple Road 63 8. Woodlands St. Johns 62 9. Hounslow Heath 57 Isleworth Town 57 St. Mary's 57 10. Isleworth Blue 51 11. Hounslow Roman Catholic 40