Heston & Isleworth Urban District Council. 1928. 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, 1928. 1929. LOWE & SONS (PRINTERS) LTD. Whitton Road, Hounslow. *> 'Z? mi' ' - ' %: " 1928 REPORT on The Health of the HESTON & ISLEWORTIi URBAN DISTRICT FOR THE YEAR 1928. by ELWIN H. T. NASH, M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health. Public Health Department. Hounslow. July, 1929. To the Chairman and Members of the Heston and Isleworth 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 HESTON AND ISLEWORTH URBAN DISTRICT COUNCIL For the Year 1928—29. Members of the Council:— G. Newell, Esq. (Chairman). J. J. Clements, Esq. (Vice-Chairman). A. L. Lang, Esq., J.P., ex-officio (Chairman of the Council). E. W. Heath, Esq., ex-officio, (Vice-Chairman of the Council). E. W. Buckley, Esq. S. Carter, Esq. C. Crush, Esq. A. Dennis, Esq. R. B. Depledge, Esq. W. J. R. Divine, Esq. A. J. Fielder, Esq. C. J. Geary, Esq. R. Langdon, Esq. Medical Officer of Health:— Elwin H. T. Nash, m.r.c.s., I.R.C.P., D.P.H. MATERNITY AND CHILD WELFARE COMMITTEE. Members of the Council: W. J. R. Divine, Esq. (Chairman). F. W. Buckley, Esq. J. J. Clements, Esq E. W. Heath:, Esq. A. L. Lang, Esq., j.p. R. Langdon, Esq. Co-opted Members: Miss E. A. Ankritt. Mrs. E. Chedgey. 6 STAFF. The following persons constituted the Staff of the Health Department on the the 31st December, 1928 : — Medical Officer of Health— Elwin H. T. Nash, M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officer of Hmlth— Mrs. E. Louise Roberts, M.B., Ch.B., D.P.H. Assistant Medical Officer (Half-Time)— Duncan Gerard Leys, B.A., M.B., B.Ch., M.R.C.P. 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. G. Grieve, Cert, as S.I. and M.I. Disinfector and Laboratory Attendant— F. J. Cobb. Health Visitors and School Nurses— Mrs. C. E. M. Ottiey, Cert. C.M.B., H.Y. and S.N., M.C.W.W. Miss B. N. Tetley, S.R.N., Cert. C.M.B. Health Visitor's Diploma, 1928. Mrs. A. E. Tyrrell, Cert. C.M.B., H.Y. and S.N. Miss VV. E. Scott, S.R.N., Cert. C.M.B., H.V., S.N, M.C.W.W. Miss B. G. Sorlie, S.R.N., Cert. C.M.B., Cert. R.S.I. Health Visitor's Diploma, 1928. Miss M. G. Gribble, S.R.N., Cert. C.M.B., H.V. and S.N., A.R.R.C. Miss E. Anstis (half-time). Home Help— Mrs. E. Yates. Chief Cleric— B. W. Kilby, Cert. S.I.E.B. and R.S.I. (M.I.) Clerks— Miss R. Marshall, Cert. R.S.I. E. Cromwell. Miss G. E. Curtis. B. Garrod. K. I. Bisshopp. R. Bulport. 7 NATURAL AND SOCIAL CONDITIONS OF THE AREA. 8 EXTRACTS FROM VITAL STATISTICS OF THE YEAR 1928. Population— At the Census, 1921 46,664 Registrar-General's Estimate of nett.. 59,730 (Birth rate) Civil Population 58,910 (Death rate) Births— Male. Female. Total. Legitimate 502 478 980 Illegitimate 15 25 40 Birth rate (nett) 17.07 Deaths— Male. Female. Total. 338 286 624 Death rate (corrected) 9.86 Number of women dying in, or in consequence of, childbirth from sepsis 3 from other causes 2 Deaths of infants under one year of age per 1,000 births— Legitimate ... 55.1 Illegitimate ... 75 Infantile Mortality Rate 55.88 Deaths from Measles (all ages) 2 „ „ Whooping Cough (all ages) 0 „ „ Diarrhoea (under 2 year of age) 6 Area 6,851. acres Number of inhabited houses (Census, 1921) 8,790 „ of families or separate occupiers (1921) 9,893 Rateable value £380,831 Sum represented by a penny rate £1,357 Poor Law Relief. I am indebted to Mr. F. E. Harmsworth, Clerk to the Brentford Guardians, for information respecting the amounts paid in money and kind as out-relief to poor persons within the Parish of Heston and Isleworth during the years 1927-1928 : — 1927. 1928. £ s. d. £ s. d. Parish of Heston ,& Isleworth 5799 3 3½ 4929 15 8½ 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 305 medical orders during 1928. Some of these cases received also outrelief and institutional treatment. The Hounslow Hospital is the only voluntary Hospital within the district; it is a modern and well equipped institution with 60 beds, with a children's ward and X-Ray Department. During the year 1928, there were admitted 986 in-patients, whilst 3,686 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 (three centres). Ante-Natal Clinic. Three School Clinics (inspection and treatment of school children). Hospital provision at Mogden and M.A.B. Hospitals for infectious diseases. Staff. During the year it was found necessary, owing to the growth of the work, to provide increased medical, nursing and clerical 10 assistance. Dr. Leys was appointed as half-time Assistant, and an extra half-time Nurse was appointed as from 1st September and 1st October respectively, An additional Junior Clerk was also appointed. VITAL STATISTICS. Population. The Registrar-General's estimate for the population for 1928, is (Birth rate) 59,730-—(Death rate) 58,910, despite the fact that our building activities for the last four years particularly have been 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 1928 amounted to £2,004,6'86. 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 1218, but 673 of these did not belong to the district, while 79 residents died outside the district. Thus the number of deaths properly attributable to the district was 624. Adopting the basis of the population 11 estimated by the Registrar-General, the death-rate for the district comes to 10.59 per 1,800, which is comparable with the following figures :—11.7 for England and Wales, and 11.6 for London. The death-rate corrected by the Registrar-General's factor of .931 is 9.86. Births. The total number of births registered during the year was 1073, but 144 of these did not belong to this district, while 91 births properly belonging to this district occurred outside the district. The nett number of births thus attributable to the district is 1020. Adopting the population basis suggested by the Registrar-General for the calculation of the birth-rate, this comes to 17.07 per 1,000. The birth-rate of England and Wales was 16.7 per 1,000, and for London 15.9 per 1,000. Legitimacy. The following figures give the number of births :— Legitimate. Male. Female. Total. 502 478 980 Illegitimate. Male. Female. Total. 15 25 40 According to figures furnished by the Registrar-General. 12 Table of Causes of Deaths during 1928. Causes of Death. Civil Residents all ages. All causes Male. Female. 338 286 1 Enteric Fever 1 1 2 Small-pox ... 3 Measles 1 i 4 Scarlet Fever ... 5 Whooping Cough 6 Diphtheria 3 4 7 Influenza 4 3 8 Encephalitis Lethargica ... 2 9 Meningococcal Meningitis 2 10 Tuberculosis of Respiratory System 18 11 11 Other Tuberculous Diseases 2 4 12 Cancer, Malignant Disease 33 34 13 Rheumatic Fever 3 1 14 Diabetes 4 5 15 Cerebral Haemorrhage, &c. 11 21 16 Heart Disease 50 40 17 Arterio-sclerosis 23 10 18 Bronchitis 26 14 19 Pneumonia (all forms) 27 17 20 Other Respiratory Diseases 5 2 21 Ulcer of Stomach or Duodenum 4 22 Diarrhoea, etc. (under 2 years) 4 2 23 Appendicitis and Typhlitis 5 4 24 Cirrhosis of Liver 2 ... 25 Acute and Chronic Nephritis 7 12 26 Puerperal Sepsis ... 3 27 Other Accidents and Diseases of Pregnancy and Parturition 2 28 Congenital Debility and Malformation, mature Birth 15 13 29 Suicide 2 3 30 Other Deaths from Violence 19 11 31 Other Defined Diseases 67 66 32 Causes ill-defined or unknown 1 ... Infantile Mortality during the year 1928. Deaths from stated Causes at various Ages under 1 Year of Age. cause of Death. Under 1 week 1-2 weeks 2-3 weeks Total under 4 weeks. 4 weeks and under 3 mts. 3 mts. and under 6m 6 mts and under 9 mts. 9 mts. and under 12 mts. Total Deaths under 1 year. Certified 19 6 2 28 11 10 5 3 57 Smallpox Chickenpox Measles ... ... ... ... ... ... 1 ... ... 1 Scarlet Fever Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup Erysipelas Tuberculous Meningitis ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis Other Tuberculous Diseases Meningitis (not Tuberculous) ... ... ... ... ... ... 1 ... 1 2 Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis Bronchitis ... ... ... ... ... ... 1 2 ... 3 Pneumonia (all forms) 1 ... 1 ... 2 2 1 3 2 10 Diarrhoea Enteritis ... ... ... 1 1 ... 1 ... ... 2 Gastritis ... ... ... ... ... 1 ... ... ... 1 Syphilis Riokets Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations 1 2 ... ... 3 2 ... ... ... 5 Premature Birth 10 2 ... ... 12 2 1 ... ... 15 Atrophy, Debility and Marasmus 1 1 ... 1 3 2 2 ... ... 7 Other Causes 5 1 ... ... 6 2 2 ... ... 10 19 6 1 2 28 11 10 5 3 57 Nett Births Legitimate 980 Illegitimate 40 Nett Deaths Legitimate infants 54 Illegitimate infants 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 that the death-rate which is calculated on an estimated population. The rate for 1928 is 55.88 per 1,000 births. The rates for England and Wales and for London during the same period were 65 and 67 respectively. PHYSICAL FEATURES OF THE DISTRICT. The Urban District comprises an irregularly rectangular district of approximately eleven square miles, the average elevation lying between 16 and 104 above ordnance datum, the higher part being Osterley 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 comparatively 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 surrounding 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) Rubber Tyres, etc. (8) Pewterware, and Candle Machinery. (9) Pharmaceutical Chemistry. (10) Soaps and perfumes. (11) Sweets, Confectionery. (12) Wines. (13) Sawmills and Joinery. The district is rapidly developing in nearly all directions, the great majority of houses that a.re 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 and Isleworth, New Brentford, Old Brentford, 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 the Local Authority or by the County Council: — 1. Tuberculosis.— The County Council have an institution; The Bell Road Hospital, with 16 (9 female and 7 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 eases 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 60 beds, is entirely supported by voluntary contributions; a Children's Ward of 8 cots and 4 beds with a solarium has also been provided. The Mogden Hospital for Infectious diseases is Supported from the rates by the Councils of Heston and Isleworth and Richmond. The Council subscribe £100 to the Hounslow Hospital, £50 to the Royal Hospital, Richmond, and £25 to the West London Hospital. The local usefulness of the hospitals is seriously hampered by the number of motor accidents admitted from the Grealt- West Road. These cases do not contribute their proper quota to the funds of the hospital, but what is more 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 19 There is practically no difficulty in getting cases into the West Middlesex Hospital, but there is no out-patient department. The Hounslow Hospital has a staff of consultants, 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 Grt. 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. There is an ever increasing demand made by Local Hospitals for payment for services rendered, and these recurrent payments have a definitely deterring effect on the willingness with which patients seek advice, owing to the inroads on their small incomes. 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 fever. Arrangements have been concluded with the Metropolitan Asylums Board, through the County Authorities, for the admission of cases of small-pox to their Hospitals, as from 1st October, 1,928, and Dockwell Hospital was closed on that account, and arrangements were made for the disposal of the site. An arrangement exists also whereby cases of Ophthalmia Neonatorum can be admitted to the St. Margaret's Hospital of the Metropolitan Asylums Board. 20 AMBULANCE FACILITIES. (a) For Infectious Cases.— This is provided by the Joint Hospital Board. (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 outside the district. During the year 320 accident cases were removed to hospital, and 255 cases of non-infectious disease were removed to hospitals or nursing homes. CLINICS AND TREATMENT CENTRES IN THE DISTRICT. A new Maternity and Child Welfare Centre was opened at Heston in January, 1928. The three Maternity and Child Wefare Centres are kept almost entirely for consultation purposes, treatment being reduced to an absblute minimum so as not to clash in any way with local Medical Practitioners. An Ante-Natal Clinic is held at the Health Department on the first Wednesday in each calendar month. The only Day Nursery in the district was closed in 1920. There are now three School Clinics, an additional one having been opened at Heston on 1st October, 1928. At each School Clinic treatment for minor ailments is carried out on five mornings in the week A Medical Officer attends at Hounslow School clinic now twice a week, and at Isleworth once a week. The Tuberculosis Clinic which is part of the County machinery is situate in Hounslow in the centre of a populous district. Arrangements for the treatment of Venereal Disease are made through the County at various Hospitals in London and at the Richmond Hospital. 21 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 Association deals with the cases in the remaining area. 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 practicing in its area. In this district it is the practice of the Health Visitors not to visit the newly-born till 11 days after the birth, in order not to interfere with the Midwife. According to the County Medical Officer's last list, there are 14 Midwives practicing in the district. There is now very definite difficulty in the Isleworth end of the district owing to the shortage of midwives. One who had been there for some considerable time and built up a good connection, left the district and was succeeded by another who left shortly afterwards. A number of the births are attended from a Nursing Home outside the district, and from complaints received on various matters, things do not seem to be quite satisfactory in that direction. ADOPTIVE ACTS AND BYE LAWS IN FORCE. Adoptive Acts in force in the District. *Infectious Diseases (Prevention) Act, 1890. *Public Health Acts Amendment Act, 1.890, Part 111. *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, 1,925. Maternity and Child Welfare Act, 1918. Baths and Wash-houses Act, 1846-82. 22 Burial Acts, 1852-85. (Applicable to parts of the district only). Public Libraries Act, 1892. Private Street Works Act, 1892. Small Dwellings Acquisition Acta, 1899-1923. Local Government and Other Officers' Superannuation Act, 1922. Bye-Laws in force in District. "Common Lodging Houses (P.H.A. 1875, s. 80). , *Cleansing, etc., and Removal of Refuse (P.H.A. 1.875, 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. 189'0 s. 26). New Streets and Buildings (P.H.A. 1875, s. 157, and P.H.A.A.A. 1890, s. 23). Pleasure Grounds (P.H.A. 1875, s. 164). *Fish Frying (P.H.A. 1875, s. 113). Regulations made by Local Authority in force in District. 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 Committees of the Council. 23 SANITARY CIRCUMSTANCES. 24 SANITARY CIRCUMSTANCES. Water Supply. There were, as far as is known, at the end of the year 42 private wells from which the water was used for domestic purposes. In 14 other cases there are wells, but an alternative supply from the main exists for domestic purposes. In 123 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 improperly or 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 1928 :— Length in Yards. Sewers laid in Public Highways. Foul Sewers 309 Surface Water Sewers 1182 Sewers laid in Private Streets. Foul Sewers 7147 Surface Water Sewers 7090 Closet Accommodation. Accommodation on the water carriage system is almost general throughout the disltiict 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 1928, collection of house refuse has continued weekly as before, and was disposed of by means of a dump in the Staines Road. 25 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 215 new ashbins. Sanitary Inspection of District. See pages 27—34. Nuisances, Contraventions of Bye-Laws, Defective Drainage, etc. The number of premises on which nuisances were outstanding at the end of 1927 was 591. To these another 882 premises whereat nuisances were recorded in 1928 were added, giving a total of 1473 premises. Of these 1219 had the nuisances remedied, leaving 254 premises at which nuisances still existed at the end of the year. During the year, nuisances at 6 houses were reported to the Health Committee, which added to the 24 brought forward from 1927, made a total of 100. Before asking the authority to serve statutory notices, the premises are inspected by the Medical Officer of Health. Statutory notices were authorised and served in most of these cases, and by the end of the year, the nuisances were remedied in 27 of the houses, and in one ease it was decided to take no further action, leaving 72 cases to be carried forward to 1928. Comparative figures for the years 1926, 1927 and 1928, in connection with nuisances, are submitted herewith : — 1926 1927 1928 Number of complaints received 415 403 514 Premises at which nuisances were located 558 597 882 Informal notices sent— First 503 493 863 Second 114 63 158 Statutory notices served 43 17 39 26 The problem of dealing with property as I said before is extremely difficult, the Rents 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 exorbitant profit to more families, the wear and tear on the landlord's property is not in arithmetical progression, and he is in no way recompensed by the limited increase in the rent which he is allowed to charge. His tenant profiteers tmblushingly 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 jusltly between the tenant who has certain rights, and a harassed landlord who is in certain cases deprived of his rights by Statute. There is another class of property which is giving considerable difficulty, where the Landlord has done practically nothing for many years, particularly since the outbreak of war, and has sucked the property dry without doing anything to adequately maintain it. with the result that difficulty is experienced in getting repairs done owing to the amount that is necessary. Another class of property giving great difficulty is that in which there has been a life interest only and the property has come to the next-of-kin, where again the property has been sucked dry, and the unfortunate next-of-kin is faced with extensive repairs when the house has been inspected. Proceedings. Proceedings were taken during the year in respect of 27 (u) Non-compliance with a notice served, under Section 94 of the Public Health Act, 1875. .An order was made for defendant to comply with the terms of the notice within twenty-eight days, with costs amounting to 8/6d., and in default a daily penalty of £2 to be imposed. (b) Non-compliance with a notice served under Section 94 of the Public Health Act, 1875. An order was made for defendant to comply with the terms of the notice, and coats amounting to 12/6d. were imposed. SANITARY WORK, ETC. Inspections—General: Total number of inspections and re-inspections, etc.19203 Inspections, etc. re Nuisances, Contraventions, etc. : Number of premises, etc., inspected on complaint 608 Number of premises inspected in connection with in- infeCtious diseases189 Total number of premises, etc., primarily inspected in connection with nuisances 1186 Number of premises inspected under Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 1 Number of smoke observations made 37 Number of other visits made to premises, etc., in connection with nuisances, etc. 779 Number of visits made to works in progress 1048 Number of interviews with owners, builders, etc. 1020 Action taken (including action taken under Housing Act, 1925, Section 3). Number of premises, etc., whereat nuisances were recorded during the year 882 Number of premises, etc., on which defects, etc., were remedied— (a) by owners 1219 (b) by local authority in default of owner or occupier 5 28 Number of cautionary or intimation notices given— (a) verbal 222 (b) written 641 Number of second (informal) notices given 158 Number of letters re nuisances sent 525 Number of Statutory Notices issued 39 Number of proceedings taken 2 Number of convictions obtained 2 Number of proceedings withdrawn — Number of cases dismissed — Common Lodging Houses : Number registered 2 Number of inspections made 21 Number of contraventions outstanding from previous year 2 Number of contraventions found — Number of contraventions remedied 2 Number of contraventions outstanding at end of year — Canal Boats used as Dwellings : Number of inspections made 81 Number of contraventions outstanding from previous year — Number of contraventions found 14 Number of contraventions remedied 11 Number of contraventions outstanding at end of year 3 Movable Dwellings, Caravans, Tents, etc. Number of inspections made 80 Number of contraventions outstanding from previous year 62 Number of contraventions found — Number of contraventions remedied 16 Number of contraventions outstanding at end of year 46 29 Bakehouses : Number in district (a) factories 11 (b) workshops 12 Number of underground bakehouses in district 1 Number of inspections made 94 Number constructed 2 Number of contraventions outstanding from previous year 62 Number of contraventions found 7 Number of contraventions remedied 7 Number of contraventions outstanding at end of year— Slaughterhouses (including Knacker's Yard) : Number on register (a) registered premises 4 (I) licensed premises 4 Number of inspections and visits made 1463 Number of contraventions outstanding from previous year 4 Number of contraventions found 13 Number of contraventions remedied 12 Number of contraventions outstanding at end of year 5 Cowsheds : Number of persons registered 10 Number of premises registered 10 Number of cowsheds on register 10 Number of milch cows in district 75 Number of inspections made 68 Number of contraventions outstanding from previous year — Number of contraventions found 6 Number of contraventions remedied 6 Number of contraventions outstanding at end of year— Dairies and Milkshops : Number of persons registered 43 Number of premises registered 37 30 Number of inspections made 271 Number of contraventions outstanding from previous year - Number of contraventions found 12 Number of contraventions remedied 6 Number of contraventions outstanding at end of year6 Offensive Trades : Number of businesses established in district 19 Number of inspections made 118 Number of contraventions outstanding from previous year — Number of contraventions found 5 Number of contraventions remedied 5 Number of contraventions outstanding at end of year— Public Health (Meat) Regulations, 1924 : Number of inspections made 1535 No Notice of Slaughtering given 57 Improper notice of slaughtering given 57 Insufficient periodical cleansing of shops, counters, slabs, apparatus or utensils, etc., 1 No precautions taken for the prevention of contamination 12 Washable head coverings and/or overalls not used 1 Verbal notices given 65 Inspection of Food: Number of meat inspections 1985 Number of fish inspections 329 Number of provision inspections 662 Number of greengrocery and fruit inspections 585 Number of hawkers foodstuff inspections 566 Number of other food inspections 344 Unsound Food : Number of carcases and offal seized 1 Number of carcases and offal condemned by magistrate 1 31 Number of carcases and offal surrendered 13 Number of articles surrendered 26 Number of parcels suurendered 5 Number of organs or parts surrendered during slaughtering 796 Infectious Diseases, Disinfections, etc.: Number of visits made 775 Number of rooms disinfected (a) ordinary infectious diseases301 (b) Tuberculosis 69 (c) Other diseases 15 Number of rooms stripped and cleansed after infectious diseases— (a) by owners or occupiers 22 (b) by local authority 6 Number of articles disinfected or destroyed 2117 Water Supply : Number of supplies provided or re-instated 15 Number of cisterns cleansed, repaired, covered, etc. 12 Number of draw taps connected direct to main 123 Number of water service pipes or taps repaired 22 Approximate percentage of houses supplied on constant system 99.95 Number of samples taken for analysis from local wells2 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 14 Number of water closets provided in substitution for dry receptacles 3 Number of walls, etc., cleansed 18 Number repaired, supplied with water or otherwise improved 427 32 Number cleansed or unstopped 15 Approximate percentage of houses provided with water closets 99 Sinks: Number of new sinks provided 23 Number of sinks repaired or improved 50 Drains : Number examined, exposed, etc. 7 Number unstopped, repaired, trapped, etc 337 Number of waste pipes provided, dis-connected, repaired trapped or unstopped 28 Number of soil pipes fixed, repaired or improved 4 Number of ventilating shafts fixed, repaired or improved 17 Number of fresh air inlets provided, repaired or improved 42 Number of rain water pipes dis-connected from drain 27 Number of gully traps inserted or improved 112 Number of dis-connecting traps inserted 2 Number of inspection chambers inserted 17 Number of dis-connecting traps improved, sealed or cleansed 2 Number of inspection chambers repaired, improved sealed or cleansed 11 Number of drains constructed or re-constructed 21 Total length of drain pipes laid (4 in.—693 ft.) (6in.—73ft.) 766ft. Number of tests and retests applied 54 Number of other works executed 13 Approximate percentage of houses draining into Council's sewer 99 Cesspools : Number rendered impervious, emptied, cleansed, etc 3 33 Removal of Household Refuse : Number of new ashbins provided 215 Number of ashbins abolished 1 Dampness: Number of roofs stripped, renewed or repaired 381 Number of gutters and rain water pipes provided, repaired or unstopped 340 Number of instances in which external brickwork, sills etc., repaired, renewed or rendered impervious 314 Number of damp-proof courses provided 57 Number of yards paved, repaired or drained 178 Interior Work : Number of rooms stripped and cleansed (other than in connection with infectious disease) 438 Number of floors, walls and ceilings repaired or renewed 959 Number of rooms in which ventilation provided or improved 36 Number of window frames and sashes provided, repaired or unfixed 796 Number of stoves or grates provided or repaired 170 Number of instances in which ventilation under floors provided or improved 84 Number of other repairs 79 Sundry Nuisances, etc. : Number of instances in which domestic cleansing enforced 16 Number of foodstores provided, cleansed or improved 9 Number of washing coppers provided or repaired 149 Number of rooms sprayed for the removal of vermin by the Disinfector 42 Number of instances in which overcrowding abated 31 Number of instances of improper keeping of animals abated 36 Number of offensive accumulations removed 33 Number of black smoke emissions abated 4 34 Number of urinals provided, repaired, cleansed or improved 11 Number of dung pits provided, repaired or improved 4 Number of other nuisances abated 28 River Crane : During the Summer, repeated complaints were received with regard to the condition of the River Crane, although the greater part of the trouble arose just outside our district in the Staines Rural area. By arrangement with Dr. Urquhart, the Medical Officer of Health of the Staines Rural District, I took a series of photographs of the river, and samples of the water at different places. The river at the time the photographs were taken was in places covered from bank to bank with a film of oil which would certainly entirely do away with any aeration of the river. The bays in the backwater of Cranford Park on the western shore were covered with a thick scum, much like that 'which is found on the top of a septic tank. In addition the banks showed traces of oil as did the mud which was cleared out from the bed of the river. The smell from the river during the hot weather was so bad that on one occasion, when a Fete was being held in an adjoining field, the Band had to be moved away owing to the noisome smell. One of the farmers on the eastern side of the bank complained bitterly of the condition, owing to the fact that his cattle, apart from refusing to drink, used to get into the water and cover themselves with the oily scum, which definitely interfered with the milking. 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. (i) (2) (3) (4) (5) Factories (including Factory Laundries) 76 247 10 Forkshops (including Workshop Laundries) 74 611 6 Nil. Workplaces (other than Outworkers' premises 36 239 2 Outworkers 30 106 ... Total 316 1203 18 Nil. DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Number of Defects. Number of Prosecutions. Particulars. Outstanding Jan. 1st. 1928. Found during 1928. Remedied during 1928. Outstanding Deo. 31st, 1928. Referred to H.M. nspector. 1 2 8 4 5 6 7 ffuisances under the Public Health Acts:-* Want of cleanliness ... 5 4 1 ... ... Want of ventilation Overcrowding Want of drainage of floors Other nuisances ... 13 10 3 Sanitary accommodation—† Insufficient Nil. Nil. Unsuitable or defective 3 28 30 1 Not separate for sexes 1 3 1 3 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s.101) Breach of special sanitary requirements for bakehouses (ss. 97-100) ... 2 2 Other offences:— Excluding offences relating to outwork Total 4 51 47 8 Nil. Nil. *Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act. 1901, and remediable under the Public Health Acts. {Section 22 of the Public Health Acts Amendment Act, 1890, has been adopted by the 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. (a) Outwork in unwholesome premises, Section 108 Nil. (b) Outwork in infected premises, Sections 109-110 2 PREMISES AND OCCUPATIONS CONTROLLED BY BYE-LAWS OR REGULATIONS. There are 339 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, 4, Staines Road, Hounslow, 22nd January, 1929. Sir, Canal Boats Acts, 1877 to 1884. In accordance with Section 3 of the Canal Boats Act, 1884, 1 beg herewith to present the Annual Report for the year ended 31st December, 1928, ais 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). G. Grieve (District Smiitary Inspector). No special remuneration is paid for the position. Number of Inspections, etc.— Number of Inspections made 81 Number of Canal Boats inspected 72 Number of boats found in order 59 Number of boats with two infringements 1 Number of boats with one infringement 12 Nature of Contraventions, etc.— Overcrowding 1 Cabins not in a cleanly and habitable condition 5 No proper water vessels provided 2 Defective water vessel 1 Bilge water not removed 1 Registration Certificate not produced 2 Registration certificate dilapidated and not legible 2 Legal Proceedings.— No legal proceedings have been taken during the year. 35 Infectious Disease.— No cases of infectious disease were reported .is occurring among the Canal Boat population during the year. I am, Sir, Your obedient servant, ELWIN H. T. NASH, Medical Officer of Health. The Secretary, Ministry of Health, Whitehall, S'.W. 1. 39 HOUSING. 10 Housing conditions are improving as a result of the policy of the Council which is to replace those in houses which have been closed as unfit, and those shown to be overcrowded as a result of last year's report. In all, up to the end of the year 360 houses have been built by the Council to let. At the same time, rapid progress has been made with building houses for sale, the total number purchased during the year under the Small Dwellings Acquisition Act was 848, and the total amount of loans under the Small Dwellings Acquisition Act up to the end of 1928 was £2,004,686. The plight of a family with children in their search for accommodation is still 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. With respect to Van Dwellers, the time is rapidly approaching in my opinion, when the comparative immunity which this class of population has secured must be re-considered. I have yet to meet the Medical Officer of Health who has had much to do with this class of population, who does not regard them as an unmitigated nuisance. True there is a certain proportion of the better class who are law abiding citizens, but there is a considerable number subversive of discipline, rowdy, threatening to those who interfere with them, dirty in their habits, and generally undesirable in any district. 41 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: The general standard is steadily improving. (b) General character of defects found to exist in unfit houses: Dampness due to want of proper damp-proofing, inadequate lighting and ventilation and general dilapidation are the main defects found. (c) How far defects are due to lack of proper management and supervision by owners: The defects are found 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 taJcen mid any suggestions in the matter: Landlords give the price of materials and the cost of labour as reasons for delay or neglect in the repair of reparable 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: 42 Water supply is on the whole satisfactory. Closet accommodation is generally adequate, but defective apparatus is frequently complained of, whilst in the outlying parts of the district are some houses not yet connected with the general sewerage system. Refuse disposal:—a weekly collection is made. II. Unhealthy Areas. Information as to complaints received or representations made mid action taken in regard to unhealthy areas, under Part II. of the Housing Act of 1925. Nil. III. Bye-laws relating to houses, houses let in lodgings, tents, vans, sheds, etc. (1) As to working of existing Bye-laws: For reasons given elsewhere it has been impracticable to maintain the inspection of houses let in lodgings, etc. Probably many houses are now technically houses let in lodgings owing to the abnormal housing conditions, but are not on the register. (2) As to need for new bye-laws and revision of existing bye-laws: Some difficulty has been experienced in dealing with caravan dwellers under the existing bye-laws with regard to the disposal of refuse, and closet accommodation, and a revision of these bye-laws is under consideration. IV. General and Miscellaneous. Other action taken in connection with overcrowding. Insanitary property and housing NIL. V. Appendices, Statistics for year ending 31st December, 1928. 43 APPENDICES. Housing Conditions Statistics. Year ended 31st December, 1928. . I. GENERAL. (1) Estimated population Birth rate 59,730 Death rate 58,910 (2) General Death rate (corrected) 9.86 (3) Death rate from Tuberculsois (all forms) 0.59 (4) Infantile Mortality 55.88 (5) Number of dwelling-houses of all classes 13,669 Total number of new houses erected of all classes 1,313 Number of New Houses erected during the year : — (a) Total (including figures given below) 1313 (b) With State assistance under the Housing Acts :— (1) By the Local Authority — (2) By other Bodies or Persons — 2. UNFIT DWELLING HOUSES. I. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 757 (2) Number of dwelling-houses which were spected and recorded under the Housing Consolidated Regulations, 1.925 53 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 (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 408 44 (5) Number of houses, listed for inspection under the Housing Consolidated Regulations, 1925, at end of year 1529 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 445 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 9 (2) Number of dwelling-houses which were dered fit after service of formal notices— (a) by owners 4 (b) by Local Authority in default of owners Nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations b y 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 15 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 13 (b) by Local Authority in default of owners 5 45 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 4 (2) Number of dwelling-houses in respect of which Closing Orders were made 3 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil. (4) Number of dwelling-houses in respect of which Demolition Orders were made 1 (5) Number of dwelling-houses demolished in suance of Demolition Orders Nil. 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. Others matters— (1) Number of dwelling-houses closed voluntarily 15 (2) Number of dwelling-houses demolished voluntarily15 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 displaced — 46 (5) Staff engaged oil housing work with, briefly, the duties of each officer. The Inspectorial staff of the Health Department consists of one Chief Inspector and three District Inspectors. There is no officer appointed wholly for housing duties, which are carried out by the staff in conjunction with their other duties. 47 Table showing dewlling-houses represented as unfit for human habitation. Premises. No. of houBes 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 1927— ‡*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 † 14-34, London Road 11 12/5/19 22/7/19 †1-10, Syon Place, London Road 10 ,, ,, †65-75, Han worth Road 6 12/1/20 23/11/20 175, Twickenham Road 1 ,, 26/4/21 177 ,, ,, 1 ,, ... 1 & 3, Wellington Road North Cottage situated in the Farm Buildings, Wood Lane Farm, 2 9/2/20 ... Wood Lane, Isleworth 1 13/7/25 22/9/25 Losbey Cottage, Wellington Road South, Hounslow 1928— 1 12/12/27 24/1/28 335, London Road, Isleworth 1 5/4/28 22/5/28 ... 27/11/28 4, Barnfield Cottages, Springwell Road, Heston 1 7/5/28 26/6/28 17, Bell Road, Hounslow 1 10/12/28 Cottage, Brentside, London Road, Brentford End 1 10/12/28 17/4/14 Notices served on tenants of Nos. 1, 2 and 3 and complied with. 16/3/16 Demolition ordered in default of owner. 16/10/17 Notices served on new tenants of Nos. 1 and 3. 31/12/27 Nos. 1, 2 and 3 occupied. †Closing Orders not served. ‡ Demolition deferred. 49 INSPECTION AND SUPERVISION OF FOOD. 50 INSPECTION AND SUPERVISION OF FOOD. The following is the record of inspection of food premises No. of Inspections made. Meat 1985 Fish 329 Provisions 662 Greengroceries and Fruit 585 Hawker's Food Stuffs 566 Number of other Food Inspections 344 Milk. There has been a very definite improvement in milk vending. Another large firm has supplied a new milk sterilizing and bottling plant in conformity with plans suggested by the Department. 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 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. The demand for the cream line produces difficulties, particularly with infant feeding, as unless the bottle is very well shaken and can be shaken after each time it is set aside to stand, there is a very definite deterioration in the cream content of the later samples in the bottle. 51 What so often happens is that the first user in the morning has a surplus of cream in the milk and that those using the bottle (particularly quart bottles) get progressively less and less as the bottle empties. From the point of view of general utility, there would appear to be no doubt that homogenisation would definitely improve things by giving a milk with practically a standard fat content, but the trade value of the cream line would probably be the chief obstruction to getting an homogeneous milk. 339 inspections were carried out in respect of cowsheds, dairies and milkshops. 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 three 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 5 (13 shops). " Grade ,A (Tuberculin Tested ") 3 (12 shops). " Grade A "— "Pasteurised" 3 (12 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 Inspecton.—This is still kept at a very high pitch of efficiency. The Chief Sanitary Inspector and the District Sanitary Inspectors hold special certificates for the meat inspection. Slaughter-houses and butcher's shops are visited periodically. 52 During the year 3671bs. of diseased meat were seized, and 64395/8lbs. were surrendered. There are 7 slaughter-houses in use in the district and each slaughter-house received on an average 17.4 visits per month. There were 42 butchers' shops in the district at the end of 1928. 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 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 inspected 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, 1875.— None during 1928. 4. Tubercular Meat.—There was none seized, but 3029£ lbs. were surrendered during the year. 5. The following is a tabular statement on slaughter-houses: 1920. In January, 1928. In December, 1928. Registered 4 4 4 Licensed 4 3 3 Total 8 7 7 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 : — 53 Number of Inspections, etc. made. 1924 1925 1926 1927 1928 Meat—Inspections made 556 1513 1790 1820 1985 Slaughter-houses — Inspections and visits made 204 1131 1106 1400 1463 The majority of butchers has loyally fallen into line with regard to giving notice of slaughtering, but in 65 instances no notice or insufficient notice of slaughtering was given, a large number of which could have been avoided with a little forethought. Further progress has been made in some cases with regard to the provision of fixed windows to butchers shops. There are in all 42 Butchers shops in the district. Up to the present, 25 have been provided with fixed windows, of which number 4 were new shops in 1928, 1 is provided with one fixed window and one window made to open, 2 have one fixed window and two windows made to open, and the remainder have windows made to open. It is very remarkable how certain of what one may call better class butchers are reluctant to depart from ancient methods of display, despite the fact that it is admitted on all hands that the display made by the shops with the fixed windows is far more attractive in every way than the meat exposed in the open windows, apart altogether from the question of hygiene. 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 54 shops and on stalls and barrows standing or moving about the roadways of a district. I wish again to draw attention to the want of perspective in the way in which meat is dealt with, and such things as figs, dates sweets and biscuits, which are eaten raw, are exposed in open shop fronts, barrows, and on street vendors' trays, on which horse dung and other filth has blown, whereas meat is cooked before being eaten. The time has come when legislation should be provided to insist that all such foods should be kept inside, and if possible under cover. 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 1928. Article. Taken. Adulterated. Remarks. Milk 194 1 Informal sample. Cakes 11 — Cream 6 — Cake Mixture 1 — Minced Beef 1 — Meat 6 1 Vendor cautioned. Cream Pastry 1 — Jam 2 — Bacon 2 — 224 2 UNSOUND FOOD, 1928. Tons. cwts. qrs. lbs. Corned Beef 6 Fish 2 1 7 Meat 2 17 1 275/8 Rabbits 1 0 7 Vegetables 4 Total 3 0 3 235/8 55 INFECTIOUS DISEASES. 56 INFECTIOUS DISEASE. Scarlet Fever and Diphtheria. There was 1 " return " case 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 122 No. of civil cases removed to Hospitals 105 Percentage of cases removed to Hospitals 86.07 The incident rate of Scarlet Fever in the civil population was 2.07 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 99 No. of civil cases removed to Hospitals 96 Percentage of cases removed to Hospitals 96.9 57 The incident rate per 1,000 of the civil population was 1.67 Thirteen cases occurred in institutions during- the year. 7 deaths took place from this disease, i.e., a case mortality rate of 7.07 per cent. 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 1928, 36 vials of Antitoxin of 8,000 units each were supplied to medical practitioners. Enteric Fever. There were 7 cases notified during the year, the majority of which were Para-typhoid B. Erysipelas. 41 cases of this disease were notified, of whom 23 were West Middlesex Hospital cases. 15 were non-residents in this district. Ophthalmia Neonatorum. See page 81. Puerperal Fever. 12 cases of this disease were notified; 3 were notified from the West Middlesex Hospital. 2 of these patients were not resident in this district. Puerperal Pyrexia. 9 cases were notified, but no special action was required in any of these cases. Encephalitis Lethargica. There were 4 cases notified this year. 58 Cerebro-Spinal Fever. 2 cases of this disease were notified. One patient was notified from the West Middlesex Hospital. Acute Poliomyelitis. No eases were notified. Pneumonia. 136 cases were notified. 81 notifications were from the West Middlesex Hospital. 74 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. School Attendance Officers. The undermentioned table sets forth the numbers of such cases for the last five years :— 1.924 1925 1926 1927 1928 Measles 563 239 497 35 668 German Measles 30 43 75 7 9 Chicken Pox 100 243 408 243 265 Mumps 308 266 246 352 138 Whooping Cough 67 213 131 157 171 Upon receipt of information of the existence of a case, inquiry is made by a School Nurse to obtain all necessary facts. 59 Influenza. The mortality from Inflenza was 0.11 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 1928. DIsEA8E. TOTAL CASES NOTIFIED. TOTAL ALL AGES CASES ADMITTED TO HOSPITAL. under 1 year. 1-2 years 2-3 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 G5 years and oyer. mogden. OTHER HOSPITALS Small-pox ... ... ... ... ... ... ... l 1 4 4 9 19 ... 19 Enteric Fever l ... ... ... ... 1 ... l 2 2 ... ... 7 3 2 Scarlet Fever l ... 1 6 4 57 30 16 7 ... ... ... 122 95 10 Diphtheria ... ... 1 4 8 44 22 8 6 1 2 ... 99 90 6 Erysipelas 1 ... ... ... ... 3 ... 4 5 4 15 9 41 ... 25 Puerperal Fever ... ... ... ... ... ... ... ... 10 2 ... ... 12 ... 10 Puerperal Pyrexia ... ... ... ... ... ... ... 1 5 3 ... ... 9 ... 7 Ophthalmia Neonatorum 7 ... ... ... ... ... ... ... ... ... ... ... 7 ... 2 Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro Spinal Fever 1 1 ... ... ... ... ... ... ... ... ... ... 2 ... 2 Pneumonia 8 11 14 4 3 18 4 5 21 14 24 10 136 ... 94 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethareica ... ... ... ... 1 ... ... 1 ... 1 1 ... 4 ... 3 Infectious Diseases, 1928. Cases Notified. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Erysipelas. Cerebrospinal Fever. Encephalitis Lethargica. Poliomyelitis. Pneumonia. Malaria. Respiratory Tuberculosis. Other forms of Tuberculosis. Ophthalmia Neonatorum. Dysentery. Puerperal Pyrexia. Small-pox. January 4 5 ... 1 7 1 ... ... 5 ... 2 ... ... ... ... 1 February 7 12 ... 2 3 ... ... ... 14 ... 4 2 ... ... ... ... March 7 8 ... ... 6 ... ... ... 11 ... 9 1 1 ... ... 14 April 7 5 ... 1 3 ... ... ... 7 ... 7 1 1 ... 1 1 May 10 5 1 1 4 ... 1 ... 11 ... 6 ... ... ... 1 2 June 6 8 ... 1 2 ... ... ... 3 ... 4 ... ... ... 1 1 July 5 9 1 1 1 ... 1 ... 9 ... 7 ... 2 ... ... ... August 5 4 5 2 3 ... ... ... 6 ... ... ... ... ... ... ... September 9 5 ... ... 3 ... ... ... 1 ... 2 ... ... ... ... ... October 22 18 ... 2 5 ... ... ... 19 ... 5 1 3 ... 4 ... November 14 11 ... ... 2 1 ... ... 24 ... 2 ... ... ... 1 ... December 16 9 ... 1 2 ... ... ... 16 ... 3 ... ... ... 1 ... Totals 122 99 7 12 41 2 4 ... 136 ... 51 5 7 ... 9 19 Deaths from Notifiable Infectious Diseases, 1928. Age Groups. Under 1year. 1 year. 2 years. 3 years. 4 years. 5 year3. 10 years. 15 years. 20 years. 35 years. 45 years. 65 years and over Total All Ages. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... 1 ... ... 4 ... ... 1 ... l ... 7 Enteric Fever ... ... ... ... ... ... ... ... 2 ... ... ... 2 Puerperal Fever ... ... ... ... ... ... ... ... 2 1 ... ... 3 Pneumonia 10 2 1 ... ... 3 1 ... 6 3 6 11 43 Encephalitis ... ... ... ... 1 ... ... 1 ... ... ... ... 2 Lethargica Cerebro Spinal Fever ... 1 ... ... ... ... ... 1 ... ... ... ... 2 Erysipelas ... ... ... ... ... ... ... ... ... ... ... l 1 Total 10 3 2 ... 1 7 1 2 11 4 7 12 60 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 1928 small-pox. enteric fever. scarlet fever, diphtheria. pneumonia (ail forms). erysipelas. puerperal fever. puerperal pyrexia cerebro pinal fever. ophthalmia neonatorum. encephalitis lethargica. pulmonary tuberculosis. other tube rculosi8. poliomyelitis. TOTAL. West Middlesex Hospital 16 3 6 10 81 22 3 4 1 1 2 7 ... ... 156 Hounslow Hospital ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Hounslow Barracks ... ... 2 1 ... ... ... ... ... ... ... ... ... ... 3 Mogden Isolation Hospital 1 ... 3 1 ... 1 ... ... ... ... ... ... ... ... 6 Collingwood College ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 17 3 13 13 81 23 3 4 1 1 2 7 ... ... 168 64 COUNCIL LABORATORY, 1928. Total. Positive. (a) Swabs for Diphtheria sent by Medical Practitioners 299 35 Sub-cultures 0 0 Taken from Schools, Clinics and from Contacts 749 27 Sub-cultures 7 4 Sent from Staines Joint Isolation Hospital 606 87 Sub-cultures 0 0 Swabs examined by Clinical Research Association 46 7 Total cultures examined 1707 1.60 Virulency Tests 0 0 (b) Blood examination for Typhoid Widal Tests 7 2 (c) Cerebro Spinal Fluid Examinations 0 0 (d) Specimens of Sputum for Tubercle Bacilli:Sent by Medical Practitioners 71 8 Total 78 10 ( e) Hairs for Ringworm— Taken at Schools or Clinics 19 12 (f) Other Specimens— Urine 152 Urine examined by Clinical Research Association 2 Discharge 8 Milk 22 Faeces 7 Preparation of Materials— Total. Tubes of Serum 1950 Throat Swab Outfits 1900 Sputum Outfits 140 65 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 Widal Tests were carried out for us by the Clinical Research Association. Specimens of faeces were also examined by the Clinical Research Association. 66 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 51. Twenty-seven cases were notified from Institutions— Sanatoria 5, Poor Law Institutions 6, General Hospitals 14, T.B.. Dispensary 2. There were 29 deaths from Tuberculosis of the Respiratory System. Of the new cases notified 32 received Institutional Treatment during the year. Other Forms of Tuberculosis. The number of new cases notified during the year was 5. Four of them were notified an receiving Institutional Treatment, and 2 died. Deaths from Tuberculosis. Tuberculosis of Respiratory System 29. (11 were primary notifications and 8 were not notified at all). Other Tuberculosis 6 (4 were not notified). For Table showing new cases notified and deaths in 1928 see next page. 67 TUBERCULOSIS 1928. 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 ... ... ... ... ... ... 1 10 1 ... ... 1 ... 1 1 ... 15 ... 2 ... ... 2 ... ... ... 20 5 9 ... 1 1 5 ... ... 25 9 8 ... ... 4 4 ... 2 35 7 2 ... 2 6 1 ... ... 45 4 1 ... ... 2 ... ... ... 55 1 ... ... ... 2 ... ... ... 65 and upwards ... 1 ... ... ... ... ... ... Totals 28 23 1 4 18 11 2 4 Eight of the deaths from Pulmonary Tuberculosis were not notified and four deaths from Non-Pulmonary Tuberculosis were not notified. 69 MATERNITY AND CHILD WELFARE. 70 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. One Clinic weekly at Heston Parish Hall, on Tuesday 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 Id. The attendances totalled 16,625 for the year as compared with 14,020 in 1927, 11,567 in 1926, 9843 in 1925 and 8817 in 1924. The average attendances were as follows :— At Douglas Road Centre 89.37 At Isleworth Centre 47. 9 At Heston Centre 54. 4 The number of individual mothers and children attending the Clinics is shewn hereunder:— Douglas Road Hounslow 1926 1927 1928 Mothers 562 688 605 Children 765 880 802 Isleworth Public Hall. Mothers 326 305 356 Children 432 414 460 Heston- Mothers — — 1.57 Children - - 213 71 The comparative drop in the numbers at Douglas Road Centre is due to the opening of the Heston Clinic as the Heston people previously had to attend at Douglas Road as the nearest centre. Sales at Clinics. Quantity Receipts. £ s. d. Prescription Glaxo 1262 lbs. 119 18 0 Glaxo 1570 lbs. 121 12 1 Virol 572 lbs. 47 5 0 Malt 376 lbs. 14 0 6 Oil and Malt 439 lbs. 16 7 0 Lactagol 454 tins. 25 9 10 Half-Cream Cow & Gate 52 lbs. 4 2 4 Cow and Gate 6164 lbs. 478 13 2 Cod Liver Oil Emulsion 2537 bottles 83 8 0 Total £910 15 11 The work is expanding partly owing to the growth of the knowledge of the work, and partly due to the rapid increase in the district. An agreement exists with the Metropolitan Asylums Board for the admission of cases of Ophthalmia Neonatorum to St. Margarets Hospital. Dr. Bell of Ealing attends at the Ante-Natal Clinic which is held on the first Wednesday morning in each month at the Health Department. The attendances during 1928 were as follows :— Number of sessions held 11 Number of expectant mothers who attended 59 Total number of attendances 97 Maternity and Child Welfare Dental Clinic. Report for Year 1928. The Dental Surgeon's report on the scheme for the year is as follows:— 72 Visits to the Clinic Mothers. Boys. Girls. Total. Appointments 186 124 136 446 Visits 143 92 93 328 % Attendance 74.14 74.19 68.38 73.54 Advice. Was given in 34 cases, re impending irregularities, and/oi re Treatment. Extractions— 29 Teeth extracted, using local spray Administrations of— Gas 134 599 Teeth extracted, using gas etc. Local anaesthetic 15 628 „ Total. 149 Fillings—55 Scaling—11 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 3 0 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. per week for 48 weeks, commencing from the week when treatment is started. Other charges in proportion. An increasing number of toddlers are being brought back who would otherwise have not come under our supervision until school age. 73 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 repayment of the cost. The work at the Douglas Road Centre, as shown by the attendances is still impossible. One cannot do duty to the cases as they arise owing to the continuous pressure. The Nurses have no time to give any instruction, and the average Clinic leaves one at the end of the afternoon absolutely dog tired. The wonder to me is that the parents still continue to attend in such numbers, in view of the scanty time one has to give to the cases, and the crowding of the waiting hall. 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. During the year I reported on the question of the installation of an Artificial Sunlight Clinic, and the matter was deferred for a periods of six months. Minor Ailments of Children under School Age. The question of dealing with the minor defects in children under school age was considered during the year, when I made the following report, as a result of which arrangements now exist whereby children can be seen at the daily Clinics, and eye cases dealt with when they arise. Co-ordination of Medical Treatment of Minor Ailments of Children up to School Leaving Age. The number of cases at present attending the Maternity and Child Welfare Clinics which require treatment is small; a few cases of impetigo, mostly occuring in Isleworth, a certain number of discharging ears which require day to day attention, and also a few, but very troublesome, cases of sores and rashes on the body and limbs 74 which require expert attention. In addition there are a number of chronic eye conditions which if dealt with ewrly, can be comparratively easily cured. A certain number of these—owing to lach of facilities for treatment—come into the school with a condition more or less established, and very difficult, if not impossible to treat. There are also a number of commencing squints due to defect of vision. If these are dealt with in time and proper spectacles provided, in the majority of cases the squint can be avoided. There is no need to stress the great importance of the prevention of squint to a man, much more so to a woman. These cases are few, butt their importance is great. If arrangements are made for the extra assistance which we require, it will be possible to deal with these at the Eye Clinic. With regard to the provision of glasses the present contract for school cases would provide all that is required in the way of glasses at the price of 4/6 per pair, and they will usually be paid for by parents; but there will be ai certain number to be provided either free or at reduced cost in oases of poverty. So far as I can see at present a sum of £2 : 0 : 0 would be sufficient to cover this contingency for the first year. Speaking from experience, it is doubtful if we undertook the minor ailments work in the existing Clinics whether it would male an average addition to the work throughout the year of one case per day. The importance of these cases however is much greater than their numbers would indicate, ais often these younger members of a family are a imirce of infection or reinfection to the elder members of the family who are dealt with through the School Clinics. On these grounds facilities have been provided for some considerable time for the treatment of cases of ringworm, in children under school age, occurring in families where there are children who attend school, and it only seems logical to extend these same facilities for treatment to other cases where contagion may spread. 75 With regard to the ear cases; a certain proportion of these, if not attended to become chronic, and produce definite changes in the ear drum, which have serious effects in impairing the hearing in after life. It may not be evident during school life, or even in young adult life, but they have a very definite influence towards middle age, and may seriously impair the earning capacity in later life. I would suggest that, subject to the approval of the Ministry of Health and of the Board of Education, facilities be given for treatment of these oases at the existing Clinics. These cases should only be treated on the recommendation of the Officer carrying out the Maternity and Child Welfare work. Notification of Births. Number of live births notified during the year 1066 Number of still births notified 42 Notified by midwives 103 Notified by parents or doctors 403 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. Certain difficulties arise at Infant Welfare Clinics with regard to weighing the children, particularly those who come for the first time as toddlers, who are apt to be nervous of the larger scales which wobble when they are put on them, and give a sense of insecurity. The accompanying photographs show the design of two forms of weighing machine, which have been made to my design by Messrs. Avery. The first it will be seen, gives an absolute sense of security to the mother, in that the child is well housed, as compared with the older type of scales. The ends of the pan are open so that a child can be easily picked up and placed into position. The base is large so that there is no insecurity by top heaviness, and 76 in addition, there are no loose weights, both the large and the small weights being adjustable on a sliding bar, with an adjustable tare bar beneath the pan. With the older child who can sit up, the high sides gives the child something to hold on to, as is shown in the photograph, and this all makes for a sense of security and lack of nervousness. On the toddlers machine, the addition of a gallery around the platform has made all the difference in the world. The child shown in the photograph is a particularly nervous little person, but we are finding that not only are we doing away with the difficulties that have existed, but the weighing machines are becoming if we are not careful, playthings for the toddlers. The gallery shown was added to the ordinary weighing machine as it was supplied to us. 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 Miss Ankritt (Co-opted member of the Committee) Mrs. Crutchett, Mrs. Davies, Mrs. French, Miss K. Theobald, Mrs. Midmore, Mrs. Robertson, Mrs. Simmons, Mrs. Stone and Mrs. Sweet at the Hounslow Centre. Mrs. E. Chedgey (Co-opted Member of the Committee) Mrs. Evans and Mrs. Watson at Isleworth. Mrs. Carter. Mrs. Drane, Mrs. Marshall and Mrs. Snare at Heston. Thanks are also due to the undermentioned for gifts of prams, toys, 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 at Hounslow: — 77 Mrs. Allan. Mrs., Adams. Mrs. Barratt. Miss Blight. Mrs. Bottjer. Mrs. Brant. Miss Dallaston. Mrs. Day. Mrs. Edgington. Mrs. Leach. Msr. Madge. Mrs. Parkes. Mrs. Smith. Mrs. Goff. Miss Goff. Mrs. Hill. Mrs. Johnson. Mrs. May. Mrs. Moody. Miss Rolf. Mrs. Walsh. Mrs. Marchant. Mrs. McDonald. Mrs. Payne. Mrs. Waide.. Mrs. Atkins. Mrs. Cole. Mrs. Dade. Mrs. Dove Mrs. Evans. Mrs. Padwick. Mrs. Seax. Mrs. Wood. Mrs. Griffen. Mrs. Guthrie. Mrs. Hoddinott. Mrs. Midmore. and Mrs. Lane, Mrs. Fielder, and Mrs. Sims, of Isleworth. At Isleworth Centre, Mrs. Kenyon and party kindly gave a Concert at Christmas, which was much appreciated. Home Visiting. The visits by the Health Visitors in connection with the Maternity and Child Welfare Work are shown in the following table:— 78 1924 1925 1926 1927 1928 1st visits to babies under one year 754 ... 888 ... 1038 ... 1020 ... 1125 Re-visits to babies and Children up to five years 3594 ... 3562 ... 3190 ... 4474 ... 4204 Inquiries made, elicited— Feeding—N atural 487 525 672 747 806 Artificial 59 104 102 41 47 Both 32 56 62 16 40 Stillbirths — — — — 23 Sleeping with parents 248 288 202 200 247 Using Comforter 236 276 231 148 154 Mother working during pregnancy 37 84 75 36 51 Year 1928. Children under 5 years. Ante-natal. First visits 92 Subsequent visits 13 Infants Deaths, and Stilbirths. Visits paid 74 Ophthalmia Neonatorum and Discharging Eyes 117 Infantile Diarrhœa 6 Puerperal Fever and Puerperal Pyrexia 19 Measles and German Measles 16 Whooping Cough 3 Mumps 1 Chicken Pox 4 Pneumonia 47 Bronchitis 10 Milk and Food Cases 34 Home Help 6 Social Conditions 43 Other Visits 292 Health Visitors attendances at the Maternity and Child Welfare Centres, Ante-Natal Clinics, etc., 537. 79 The Health Visitors also paid 311 visits to Infectious Disease cases, and patients notified as suffering from Tuberculosis, etc. Home Help for Mothers. The Home Help paid 27 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 Sackers' combs and the necessary shampoo and towels. A fee of 1/- is charged for each case. By. this means any child who is excluded from school, can be back within two days, and the cleansing is not carried out by any officer of the department acting as such. There have been certain parents who 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 in another way, in that if a case is taken before the Magistrates the fine is considerably heavier now that means are at the disposal of the parents, whereby the child can be re-admitted to school within 48 hours. There is 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, 31 children have been cleansed. 80 Grants of Milk. Milk is supplied free or at reduced rates to expectant mothercuring 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 ⅓ cost. 5/- to 7/6 per head parent pays ⅔ cost. Where the amount is over 7/6 per head, no grant is made. The number of grants made during the year was 1,37. 81 OPHTHALMIA NEONATORUM year 1928. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 7 5 2 7 ... ... ... heston and isleworth urban district education committee TWENTY-FIRST ANNUAL REPORT OF THE School Medical Officer FOR THE Year Ending 31st December, 1928 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, 1928. 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, 1928-29 A. A. BERGIN, Esq., j.p., c.c. {Chairman). Members of the Council-.— J. J. BONNETT, Esq., o.b.e. A. DENNIS, Esq. H. COLLAR, Esq. E. W. HEATH, Esq. Ex-0fficio. A. L. LANG, Esq., J.p. Ex-0fficio. A. J. FIELDER, Esq. J. J. CLEMENTS, Esq. S. CARTER, Esq. W. J. R. DIVINE, Esq. H. J. NIAS, Esq., m.b.e., J.p F. T. HART, Esq. Co-opted Members. E. W. GOODE, ESQ. (Vice-Chairman). Miss E. A. ANKRITT. P. MURPHY, Esq., J.p. Mrs. S. SPOONER. D. RHYS, Esq., m.a. School Medical Officer :— ELWIN H. T. NASH, m.r.c.s., l.r.c.p., d.p.h. STAFF Clerical Staff— B. W. Kilby (Chief Clerk). Miss R. Marshall. E. Cromwell. Miss G. E. Curtis. B. P. Garrod. K. I. Bisshopp. R. W. Bulport. Comprising the whole Clerical Staff of the Public Health Department, part of whose duties are concerned with the School Medical Service. School Nurses— Mrs. C. E. M. Ottley. Miss B. N. Tetley (Dental Nurse). Miss B. G. Sorlie. Miss E. J. Anstis (half-time). Dental Surgeon—I. Cohen, L.D.S., R.c.S., Eng. Radiographer—D. Arthur, M.D., D.P.H. Assistant School Medical Officers - Mrs. Eva Louise Roberts, M.B., Ch. B., D.P.H. Duncan Gerard Leys, B.A., M.B., B.Ch., M.R.C.P. (half-time) School Medical Officer— Elwin H. T. Nash, M.R.C.S., L.R.C.P., D.P.H. 5 CO-ORDINATION. The administrative work of the School Medical Service is carried out in the Health Department, under the supervision of the School Medical Officer who is also Medical Officer of Health with charge of the Council's scheme for Maternity and Child Welfare. The Assistant Medical Officer, whose duties are mainly in connection with school children, also gives assistance in public health matters and acts as Deputy in the absence of the M.O.H. Conference with the Education Office is still made easy although the departments are no longer in the same building. (a). Infant and Child Welfare. There are three centres in the District, and all record cards are available for school medical purposes. Formerly 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. Last year a scheme was put into operation for the treatment by the School Dentist, of dental defects in children under five years, and in nursing and expectant mothers. During the year, arrangements have been made and approved by the Ministry of Health and the Board of Education, whereby children under school age suffering from visual defects or minor ailments, can be treated at the School Clinics. Such children are those seen at the Child Welfare Clinics and referred by the Medical Officer of Health as requiring treatment. (b). Nursery Schools. There are none in the district. (c) The Care of Debilitated Children under School Age. Children up to the age of five years have access to the centres above mentioned. Arrangements have also been made with the Isleworth Nursing Association for the nursing of measles, whooping cough, etc. 6 The School Medical Service in relation to Public Elementary Schools. School Hygiene. The school buildings and the sanitary arrangements are periodically inspected. A complete survey of the schools is made from time to time, and a considerable number of minor defects are remedied. Improvements have been made in the lighting of the schools, and electric light has been installed in an old school hitherto very badly lit by gas. During the year, 1928, a new system of heating was installed at Hounslow Town Schools and which extends to all rooms including cloakrooms. The installing of the new heating system was also begun at Spring Grove Central School, and will shortly be completed. It will also be installed at Grove Road Schools next Summer. 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 food, 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, 9 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. Children at this school are examined each year. (b). Board's Schedule. In all cases the Board's Schedule of medical inspection has been followed. (c). Disturbance of School Arrangements. The accommodation available for the purpose of medical inspection varies in different schools. In some, the head teachers' rooms are used, but as a rule they are insufficiently large for vision testing; in others a class room or part of a class room, more or less screened off has to serve. In most schools it is true to say that the provision of a room for Medical Inspection upsets the existing arrangements of the school—although there is not the same inconvenience since additional school accommodation has been provided during the year. Usually, however, in order to free a room for the Inspection, two classes have to be taken in one classroom, which naturally does not tend to popularise Medical Inspection with the teachers. I should like to put on record, however, that the inspecting Medical Officer is always made as comfortable as circumstances permit—and that it is the schools which suffer the greater inconvenience from having no extra room in which inspections can be carried out. In spite of these drawbacks, however, it still seems better to hold the inspections at the schools—past experience showing that in ,any other arrangement the necessary co-ordination between Medical Officer and Head Teacher is lacking. FINDINGS OF MEDICAL INSPECTION, 1928. Uncleanliness. Out of 2,849 children examined at routine medical inspection, 78 were found to have nitty or verminous condition of the head, 8 189 children were also seen at the school clinics. The total number of children excluded on account of nits and vermin during IQ28 was 120. Further reference to this subject will be found on pages 28 and 29 and Table IV. (p. 40). Tonsils and Adenoids. Out of 2,849 children examined at the routine inspections, 250 had enlarged tonsils, 122 of which were referred for treatment, 128 being kept under observation. 74 children had adenoids only, of which 32 required treatment, and 42 were for observation, whilst 94 children had both enlarged tonsils and adenoids, 76 requiring treatment, and 18 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 42 other children were found to have enlarged tonsils, 5 adenoids only, whilst 11 suffered from both conditions. The figures for enlarged tonsils, and enlarged tonsils and adenoids found in the current year are very considerably larger than those in 1927. For comments see p. 19, 20 and 21. Tuberculosis. Out of 2,849 children examined at the routine inspections, there was one case of suspected tuberculosis of the glands requiring to be kept under observation. There were 4 definite cases of pulmonary tuberculosis found at the special clinics and 8 were found to be suffering from suspected pulmonary tuberculosis, whilst 7 children had tubercular glands, 2 tuberculosis of the bones, and 1 other form of tuberculosis 8kln. At the routine inspections, out of 2,849 children examined, 26 were found to be suffering from skin trouble. 9 At the special clinics there were 674 children suffering from various skin complaints, including scabies and impetigo (see Table II. for analysis of figures), 9 cases of ringworm of scalp and 23 cases of ringworm of body. External Eye Disease. Out of 2,849 children examined at the routine inspections, 20 were found to have minor eye diseases including blepharitis and conjunctivitis, whilst 9 had a squint. In addition 57 were found at the special clinics to suffer from the " minor " eye diseases, whilst 3 had squint. Vision. Out of 2,849 children examined at the routine inspections, 289 were found to have defective vision, 215 were referred for treatment, 74 being kept under observation. At the special clinics 81 children were referred for treatment for defective vision. It will be seen therefore that Routine Medical Inspection still remains the way in which most of the visual defects are discovered. Below are tables shewing an analysis of the findings at the Routine Medical Inspection for this year as regards vision. The total number examined for vision is not precisely the same as the total number of children medically examined. In many cases infants are unable to have their vision tested at their first inspection—this is done at a subsequent re-inspection, but the findings have not been included, as all the re-inspections have not yet been made. The numbers in the accompanying tables, therefore, refer to the children whose vision was tested at their Routine Medical Inspection in 1928. A few five years old children were examined, but the number is so small that they have not been included in the tables. All testing is done with the standard Snellens Test type— infants being tested with my modification of Snellens test type using only the five vowels in lower case type (as opposite) so that the child is tested on the first letters it is familiar with exhibited in the first type with which it is familiar. The conditions for testing in the different schools are not strictly comparable—light 10 and distance varying, but the method is sufficient to detect errors of vision requiring treatment or observation—and in actual fact there is usually no important difference in the result of a test in the school from that obtained when the child is seen at the Eye Clinic and tested under perfect conditions. Table I. shows the total examined with numbers requiring treatment and percentages—and the same total analysed according to age and sex. Table II. shews the numbers analysed according to sex and school. It is impossible to draw conclusions from such small numbers, but it is proposed to analyse the figures for several years, so that later conclusions may be drawn. It should be pointed out that these figures relate to children requiring treatment or observation for visual defect as found at the Medical Inspection. They are not an index of the amount of visual defect existing amongst the school children of this district as materially children with a defect satisfactorily corrected are not included. Ages 11, 14, 15, 16, relate only to children at the Spring Grove Central School, where every child is examined each year. The numbers, are, therefore very small. At the other schools where the children leave at 14. the usual age groups, 5, 8, 12, were examined together with those absent at the previous Medical Inspection giving the secondary and smaller groups of 6, 9, 13. 11 Results of Vision Testing done at the Routine Medical Inspection in 1928. TABLE I. Total number examined. Total number requiring treatment or observation Percentage requiring treatment or observation Percentage analysed according to age. 6 8 9 11 12 13 14 15 16 Boys & Girls 2566 294 11.45 3.90 2.88 1.86 0.03 1.48 1.21 0.05 0.07 0.02 Girls 1235 145 11.7 4.01 2.82 1.74 — 1.41 1.68 0.04 0.08 0.04 Boys 1331 149 11.2 3.79 2.95 1.99 0.07 1.56 0.74 0.07 0.07 — 12 Results of Vision Testing done at the Routine Medical Inspection in 1928. TABLE II. CIRLS. School. No. Inspected. No. requiring Treatment or for Observation. Percentage requiring treatment or Observation. Percentage analysed according to age. 6 8 9 11 12 13 14 15 16 G.R.G 106 12 11.3 — .94 2.82 7.53 — — G.R.I 111 10 9.0 7.20 — — — — — — — — A.G 130 10 7.7 0.77 — 3.08 — 1.54 2.31 — — — W.S.J.I. 5 — — - — — — — — — — H.H.G. 139 16 11.5 - 5.03 1.44 — 3.51 1.44 — — — H.H.I. 18 2 11.1 11.1 — — — — — — — — H.R.C.M. 40 6 15.0 - 10.0 — — — 5.00 — — S.G.C. 153 9 5.9 - — — — 1.31 1.96 0.65 1.31 0.65 W.R.M. 37 4 10.8 - 10.8 — — — — — — — W.R.I. 39 1 2.6 2.6 — — — — — — — — S.M.G. & I. 36 5 13.9 2.78 2.78 2.78 — 2.78 2.78 — — — Heston 65 13 20.0 1.55 6.20 6.20 — 0.20 — — — — I.T.G. & I. 110 18 16.4 0.91 4.55 2.73 — 2.73 5.46 — — — I.B.G. & I. 58 10 17.2 — 6.88 5.16 — 5.16 — — — — S.G.J. 35 4 11.4 11.4 — — — — — — — — H.T.G. & I. 147 24 16.3 6.12 0.68 5.44 — 0.68 2.04 — — — B.E.I. 6 1 16.7 16.7 - - - - - - - 13 Results of Vision Testing done at the Routine Medical Inspection in 1928. TABLE II. BOYS. School. No. Inspected. No. requiring Treatment or for Observation. Percentage requiring treatment or Observation. Percentage analysed according to age. 6 8 9 11 12 14 *5 16 G.R.B 127 7 5-5 1.58 1.58 2-37 G.R.I 96 4 4-2 1.02 A.B 129 '7 >3-2 1.56 3-9° 3.12 — 2-34 1.5b — — — W.S.J.I 5 1 20.0 20.0 H.H.B 148 23 >5-64 — 8.16 3-4° — 3-4« 0.68 — — — H.H.I 16 5 31 -3 18.78 H.R.C.M. 32 5 15.6 — 6.24 3.12 3.12 ; 3'2 — — — S.G.C 164 12 7-32 — — — 1.22 3-05 ! O.fH 1.22 1.22 — VV.R.M S3 4 7.60 — 5-7o 1.90 W.R.I 38 1 2.60 2.60 S.M.B. & I. ... 49 10 20.4 2.04 12.24 2.04 — 4.08 — — Heston 95 ■5 15.8 2.10 8.40 4.20 — 1.05 — — — I.T.B. & I. 112 16 *4-3 8.01 1.78 1.78 — — i/8 — — — I.B 63 5 7-9 — 3.16 1.5# — 3.16 — — — — S.G.J 5' 4 9.8 4.9 4.9 H.T.B 85 "4 16.5 1.18 3-54 8.26 — 2.36 1.18 — — — H.T.I 65 6 0.2 6.12 — — B.E.I 3 0 14 Ear Disease and Hearing. Out of 2,849 children examined at the routine inspections, 70 were found to be suffering from defective hearing or ear disease, whilst an additional 113 were discovered at the special clinics. Dental Defects. Out of 2,849 children examined at the routine inspections, 1,254 had carious teeth and were referred for treatment, whilst 8 had slighter caries and were marked for observation. At the special clinics a further 122 were discovered and referred for treatment, and 1 kept under observation. Dental inspections, 4,402 children were referred for treatment out of 6,096 inspected (for further particulars see Table IV., Group 4). Deformity. Out of 2,849 children examined at the routine inspections, there were 16 found with some deformity. At the special clinics 2 were found to be suffering from rickets, 10 other forms of deformity were referred for treatment, and 2 were kept under observation. INFECTIOUS DISEASES. Cases of infectious diseases are occasionally met with at routine inspections or at one of the school clinics. Systematic swabbing of sore throats and suspicious nasal discharges 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 Board of Education, 1927. During the year 1928, the following cases of infectious disease occurred among children attending public elementary schools in this district: — Scarlet Fever 51 Diphtheria 54 Measles 688 Rubella 9 Mumps 138 Chicken Pox 265 Whooping Cough 171 1376 15 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 longer than the "Following up" visits, which a nurse arranges according to their proximity. Sometimes the cases prove to be 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 & nurse who can give the mothers advice as to the management of the illness. Also in cases where no doctor certifies, and these cases 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. 16 Cases of infections disease have occurred during the year among school children as follows:— SCHOOL SCARLET FEVER DIPHTHERIA MEASLES GERMAN MEASLES MUMPS CHICKEN POX WHOOPING COUGH  Alexandra Boys 1 2 72 ... 7 11 9 ,, Girls 1 I 33 1 3 7 12 Brentford End Infants ... 3 1 ... 1 1 ... Grove Road Boys ... 2 2 ... 5 6 ... „ Girls 2 1 1 ... 2 2 1 „ ,, Infants 2 6 93 ... 3 1 39 Heston Mixed and Infants 1 1 101 ... 1 5 19 Hounslow Heath Boys ... 2 ... ... 9 16 ... „ ,, Girls 4 ... 2 ... 3 10 6 „ ,, Infants 5 4 33 1 52 105 37 Hounslotv U .C. Mixed and ,, ,, Infants 5 ... 51 1 3 20 1 Hounslotv Town Boys 3 4 11 ... 1 ... ... ,, „ Girls and ... ... ... ... ... ... ... Infants 4 1 61 ... 1 5 13 Isleworth Blue Boys 1 1 ... ... 1 1 ... „ ,, Girls & Infants ... 5 ... 2 7 ... ... Isleworth Town Boys 1 2 17 ... 4 3 ... ,, Girls & Infants. 5 4 75 ... 5 2 3 St. Mary's Boys ... 3 1 ... ... 1 ... „ Girls Infants ... 9 5 ... 3 3 4 Spring Grove Central ... ... 5 1 2 ... ... „ ,, Junior 12 ... 32 2 8 45 ... Woodlands St. John's Infants ... 1 ... ... ... ... 9 Worple Road Mixed and Infants 4 2 76 1 17 2 18 Total 51 54 688 9 138 265 171 17 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 1928. 119 attendances at School Inspection Clinics. 410 ,, „ Dental Clinics. 66 ,, ,, Eye Clinics. 518 ,, ,, Minor Ailments Clinics. 3 ,, ,, School Sports. 157 visits to schools for medical inspections. 24 ,, ,, ,, ,, re-inspections 37 ,, ,, „ dental inspections. 7 ,, ,, ,, cleansing surveys. 18 1173 visits to homes in connection with following-up. 1784 ,, ,, ,, ,, Infectious diseases. 98 ,, re Clinic absentees. 162 dental visits. 95 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 (one under school age) were successfully treated by the application of X-ray. The X-ray treatment is carried out by Dr. D. Arthur, of Ealing, at his own surgery, a fee of £1: 1:0 per case being paid to him. A charge of 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 23 Cases Impetigo 308 ,, Scabies 10 ,, Other skin diseases, chiefly septic sores 26 ,, Miscellaneous, minor injuries, bruises chilblains, etc. 291 ,, Ear Disease and Hearing. At the School Clinic 88 cases of Ear Disease or Defectivf Hearing were seen and treated. 19 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. 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. 34 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 287 children referred for treatment, 44 received treatment either privately or through a hospital, whilst 23 were treated under the Education Authority's scheme. Arrangements have been in force since 1921, whereby children requiring operative treatment for enlarged tonsils and adenoids, can obtain this either at the Hounslow or Richmond Hospital, the Education Committee accepting all responsibility for the fee. Re-payments are claimed from the parents in accordance with the following scale:— 20 Weekly family income per head Amount per case Under 8/- nil. From 8/- to 10/- 5/- From 10/- to 12/- 10/- Above 12/- 21/- Operative treatment of tonsils and adenoids in this district still remains unsatisfactory— the numbers receiving treatment are small and the conditions under which operative treatment is offered could be greatly improved. The greatest objection is that under the arrangement with the local hospitals, children are sent home after operation. The second is the cost—which deters many. No scheme can be considered really satisfactory which does not provide for the treatment of the child in the 24 hours following the operation. In this district the difficulty of getting the children home after the operation is great. If the child is tiny, a pram can be usedotherwise it means walking or a public conveyance. Neither is right—and one cannot blame parents from shrinking from having treatment under such circumstances. Also the immediate after care of the child at home presents another problem—in many cases there is overcrowding, and often the mother goes out to work. The actual number treated this year is only 70 out of 287 marked for treatment, making 25% against 50% last year and 33% in 1926. The number marked for treatment is, however, very considerably larger than last year. This does not necessarily imply a large increase in those suffering from the condition. Probably it is due to a difference in the standard adopted, as there have been a multiplicity of Medical Officers examining, chiefly owing to the illness of Dr. Roberts the Assistant School Medical Officer and Medical Officer of Health. For the past few years it has been the practice to refer only well marked cases for operative treatment, although there have been many children with unsatisfactory conditions of the 21 pharynx. In such cases advice is given as to the carrying out of proper nasal hygiene, and to improving the general health of the child. "Sneezing" has been tried with success in a few cases, but without the intelligent co-operation of the mother it is useless. 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. I his 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. 22 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. 297 Cases of visual defect were submitted for refraction at the Clinic, whilst 10 children were treated privately or at hospitals. In 257 cases spectacles were prescribed and in 250 cases were provided by the Education Authority, and 8 children obtained spectacles privately. Spectacles are provided at an all round price of 4/6 a pair, and a definite scale of charges for repairs is issued when spectacles are prescribed. 113 pairs of glasses were sent for repair during the year. Necessitous cases are referred to the Medical Inspection SubCommittee, and spectacles are supplied free or at a reduced cost, according to the circumstances. Dental Defects. 3,132 Children were treated by the School Dentist under the Local Education Authority's Scheme and 1,419 re-treated. Further, 90 attended the Dental Clinic and were referred elsewhere for treatment, e.g., hospital and 22 attended the Clinic but refused treatment. Dental Work. (See pages 39-44). Open Air Education. There is no open air school in the district, the only open air education being comparatively few classes held in the playground in the summer. There is a great demand for an open air school, as there are a considerable number of children who would 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 cope with its curriculum. Their power of concentration is sadly lacking, and one feels that on the whole, the child is better running about in the fresh air, and even mud larking under what might 23 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 still no machinery for enabling delicate school children to obtain milk free or at moderate prices. During the year, however, the Committee allowed Cod Liver Oil and Malt to be sold at cost price at the School Clinics, in cases where it was ordered by the Medical Officer. This, however, though useful, only helps a few, and there are many cases who would benefit by Cod Liver Oil who do not obtain it. 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 1928, one or other parent or relative attended in 1997 instances, representing a percentage of 70 as against 70.6 for 1927. 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 24 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. 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. In cases where further help is needed the following societies render all possible assistance: 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 1928, examinations were conducted in respect of 60 mentally abnormal children. There are no schools in this District for the defective. 25 Last year a proposal to provide a joint school for Mental Defectives in the western part of Middlesex was agreed upon by the Authorities concerned, and the proposal was submitted to the Board of Education by the Middlesex Education Committee. At the Board's request further consideration of the scheme was deferred until the Report of the Special Committee dealing with this subject was published, and therefore nothing further has yet been done. NURSERY SCHOOLS. There are no nursery schools in this district. SECONDARY SCHOOLS. CONTINUATION SCHOOLS. The School Medical Service of the Local Education Authtority does not at present extend to these. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. (i) Employment of Children. The conditions of the employment of children and young persons in this area are regulated by Bye-Laws. 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. 38 Children were examined and were granted the necessary certificates of fitness for work, except in one case where the certificate was 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 26 summoned to the Inspection Clinics and the necessary data obtained. These represent the limits of the services renedered bv the School Medical Staff. I am unable to say what relationship exists between the Juvenile Employment Committee and the Certifying Factory Surgeon for the District. MISCELLANEOUS. Medical Examination of Teachers. During the year 28 medical examinations were made of teachers, in connection with their appointment under the Authority. Holiday Home for Children. All children recommended for the King Edward VII Memorial Home, Heme 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. (Set Table III.). There is no provision in the district for such children. SCHOOL CLINICS. During the year the second weekly Clinic at which the Doctor attends was reinstated at Hounslow. At the beginning of the Autumn a new Clinic was opened at Heston where a nurse attends daily at 9 a.m. to treat minor ailments, but at present no Medical Officer attends there. The Clinics therefore are treatments daily by a nurse at the Public Hall, Isleworth, the Health Department, Hounslow, and the Parish Hall, Heston. The Medical Officer attends once a week at Isleworth and twice at Hounslow. In spite of the extra Hounslow Clinic the numbers are still very large and the Clinics unduly prolonged, and it will be necessary to arrange for a Medical Officer to attend at Heston once a week, which should relieve some of the Hounslow congestion, as well as making it easier for children living at Heston. 27 School children come under the notice of the Medical Officers in one of the following ways:— 1. They are discovered at Routine Medical Inspections and are perhaps marked for treatment or it may be merely for observation. 2. Parents may apply to the teachers for authority to attend the clinic. 3. The teachers may on their own initiative, refer children to the clinic either because of illness, uncleanliness, or as urgent dental cases. 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.—4/6 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 from date of payment, 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 28 verminous conditions and their parents fail to cleanse them within the period of 7 days allowed by by-law, a prosecution may be ordered. CLEANLINESS SURVEYS, 1928. Number of visits by Nurses 7 Total number of children examined 975 ,, ,, ,, ,, given warning notices 71 ,, ,, ,, ,, excluded as verminous 6 ,, ,, ,, ,, 1. (Few) 34 2. (Bad) 18 Found to have nits— ( 3. (Very Bad) 19 Few Surveys have been possible during the year owing to pressure of work arising from infectious disease in the schools. The seventy of the incidence of infectious disease is impossible to forecast and during the outbreak non-infectious matter sinks into the background. The number examined leaves much to be desired. The standard to be aimed at should be one survey per term in each school. 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. 29 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. 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, 31 children have been cleansed. No cleansing has been carried out by the school nurses. During the year 1928, legal proceedings were instituted against the parents of I child, who were ordered to pay costs. 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. 30 TABLE 1.- RETURN OF MEDICAL INSPECTIONS A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 915 Intermediates 1052 Leavers 565 Total 2532 Number of other Routine Inspections 317 B.—Other Inspections— Number of Special Inspections 1107 Number of Re-Inspections 1895 Total 3002 31 TABLE II. A. RETURN OF DEFECTS found by Medical Inspection In the Year ended 31st December, 1928. Defects or Diseases. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. i 2 3 4 5 Malnutrition 6 16 2 3 Uncleanliness 78 ... 180 ... (See also Table IV Group V.). Skin— Ringworm— Scalp ... ... 9 ... Body ... ... 23 ... Scabies 1 ... 10 ... Impetigo 14 ... 321 ... Other Diseases tuberculosis) 10 ... 333 10 Eye— Blepharitis 9 3 15 ... Conjunctivitis 3 ... 22 1 Keratitis ... ... 1 ... Corneal Opacities ... ... ... ... Defective Vision (excluding squint) 215 7 4 81 ... Squint 6 3 3 ... Other Conditions 4 1 17 2 Ear— Defective Hearing 34 28 18 1 Otitis Media 1 ... 37 ... Other Ear Diseases 3 4 52 5 Nose and Throat— Enlarged Tonsils 122 128 41 1 Adenoids 32 42 5 ... Enlarged Tonsils and Adenoids 76 18 11 ... Other Conditions 4 9 28 36 Enlarged Cervical Glands (non-tuberculous) 12 39 35 1 Defective Speech ... ... ... 1 32 TABLE II.—Continued. Routine Inspections. Special Inspection' No. of Defects. No. of Defects. Defects or Diseases. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. Requiring treatment. Requiring to be kept under observation, but n«>t re- 1 2 3 4 5 Teeth—Dental Diseases (see also Table IV., Group IV.) 1254 8 122 1 Heart and Circulation— Heart Disease— Organic 8 42 5 14 Functional ... ... 3 2 Anaemia 6 13 2 3 Lungs— Bronchitis 2 7 16 1 Other Non-Tuberculous Diseases ... 8 9 4 Tuberculosis— Pulmonary— Definite ... ... 2 2 Suspected ... ... 2 6 Non-Pulmonary— Glands ... 1 2 5 Spine ... ... ... ... Hip ... ... ... ... Other Bones and Joints ... ... 2 ... Skin ... ... ... ... Other Forms ... ... 1 ... Nervous System— Epilepsy ... ... 5 3 Chorea ... 4 9 4 Other Conditions 7 9 8 6 Deformities— Rickets ... ... 2 ... Spinal Curvature ... ... ... ... Other Forms 7 9 10 2 Other Defects or Diseases 10 31 89 74 33 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 915 169 18.5 Intermediates 1052 212 20.1 Leavers 565 102 18.1 Total (Code Groups) 2532 483 19.1 Other Routine Inspections 317 27 8.5 34 TABLE III. RETURN of all Exceptional Children in the area. Boys Girls Total Blind (including partially blind). (i.) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 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 ... 1 1 Attending Public Elementary Schools ... 2 2 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 3 2 5 Attending Public Elementary Schools 1 ... 1 At other Institutions At no School or Institution ... ... ... (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf ... ... ... Attending Public Elementary Schools 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 Attending Public Elementary Schools 6 4 10 At other Institutions ... ... ... At no School or Institution 1 2 3 Notified to the Local Control Authority during the year. Feebleminded 1 ... 1 Imbeciles 1 1 2 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 1 2 Suffering from Epilepsy which is not severe. Attending Public Elementary Schools 5 3 8 At no School or Institution 1 ... 1 35 TABLE III.— Continued Boys Girls Total Infectious Pulmonary and Glandular Tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 ... 1 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 ... ... ... At Certified Residential OpenAir Schools ... ... ... At Certified Day Open-Air Schools ... ... ... At Public Elementary Schools ... ... ... At other Institutions ... ... ... At no School or Institution 1 ... 1 Physically Defective. Delicate children ( e.g. pre- or latent Tuberculosis, Malnutrition, Debility, Anaemia, etc.) At Certified Residential OpenAir Schools ... ... ... At Certified Day Open-Air Schools At Public Elementary Schools 24 29 53 At other Institutions i 2 29 53 At no School or Institution 2 2 I 4 3 Active nonpulmonary Tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board At Public Elementary Schools ... At other Institutions At no School or Institution I I i i 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 15 14 29 At other Institutions ... ... At no School or Institution 2 1 3 36 TABLE IV. Return of Defects treated during the year ended 31st December, 1928. Group 1.—Minor Ailments (excluding Uncleanliness, for whic see Croup V.). Diseases or Defects. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. 1 2 3 4 Skin— Ringworm, Scalp 9 9 Ringworm, Body 23 1 24 Scabies 10 ... 10 Impetigo 308 12 320 Other Skin Diseases 26 8 34 Minor Eye Defects— (External and other, but excluding defective vision and squint) 34 9 43 Minor Ear Defects 88 2 90 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 291 18 309 Total 789 50 839 37 TABLE IV.— Continued. Group II DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments—Group 1). Defact 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 a 3 4 5 Errors of Refraction (including squint) (Operations for squint should be recorded separately in the body of the Report). 297 8 305 Other Defects or Disease of the eye (excluding those recorded in Group I.) ... 2 8 10 Total ... 297 10 8 315 Total number of children for whom spectacles were prescribed(a) Under the Authority's Scheme ... 257 (b) Otherwise 9 Total number of children who obtained or received spectacles— (a) Under the Authority's Scheme 250 (b) Otherwise 8 38 TABLE IV.—Continued. Croup III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 23 44 67 3 70 39 (i). Number of children who were : (a) Inspected by the Dentist: Aged : Routine age groups 5 571 Total 5416 6 808 7 825 8 745 9 485 10 481 11 501 12 411 13 453 14 112 15 24 Specials 680 Grand total 6096 (b) Found to require treatment 4402 (c) Actually treated 3132 (d) Re-treated during the year as the result of periodical examination 1419 (2). Half-days devoted to Inspection 37 Total 351 Treatment 314 (3). Attendances made by children for treatment 3850 (4). Fillings Permanent teeth 3699 Total 3901 Temporary teeth 202 (5). Extractions Permanent teeth 453 Total 5047 Temporary teeth 4594 (6). Administrations of general Anaesthetics for extractions 1119 (7). Other operations Permanent teeth 387 Total 387 Temporary teeth — 40 TABLE IV.—Continued. Croup V.- UNCLEANLINESS AND VERMINOUS CONDITIONS, (i.) Average number of visits per school made during the year by the School Nurses 5 (ii.) Total number of examinations of children in the schools by the School Nurses 975 (iii.) Number of individual children found unclean 77 (iv.) Number of children cleansed under arrangements made by the Local Education Authority 31 (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 - (b) Under the School Attendance Bye-laws 1 School Dental Service YEAR 1928 STATISTICS from the Report of the School Dental Surgeon 42 INSPECTIONS FOR THE YEAR, 1928. Age last Birthday. No. Examined No. Requiring Treatment. % Requiring Treatment. 5 571 375 65.67 6 808 621 76.85 7 825 715 86.66 8 745 661 88.72 9 485 402 82.83 10 481 376 78.17 11 501 413 80.09 12 411 346 84.18 13 453 383 84.54 14 112 92 82.14 15 24 18 75.0 Specials 680 6096 4402 72.21 THE INSPECTION RESULTS (TOTALS ONLY) FOR THE PAST SIX YEARS—1923, 1924, 1925, 1926, 1927 and 1928. (Age Groups). Year. 5 6 7 8 9 10 11 12 13 14 15 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 1928 571 808 825 745 485 481 501 411 453 112 24 680 6096 The average inspected in each of the above 6 years = 4098. The average number of children inspected last year per session was 146. WORK OF THE DENTAL CLINIC, 1923-4-5-6-7-8. Derived from the School Inspections in each of the past six 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 67.07 58.76 1928 72.21 70.26 43 FILLINGS. Teeth Filled. Year Permanent Temporary Total. 1925 1423 52 1475 1926 1665 25 1690 I927 2339 283 2622 1028 3699 202 3901 EXTRACTIONS. Teeth Extracted. year. Perm. Temp. Total Extracts Administration Ethyl Chloride & Gas No. of Gas Sessions Gas Local Anaesthetic I925 118 2446 2564 542 — — 41 1926 221 2840 3061 719 1 IO 140* 54 I927 95 3155 3350 784 317 141* 59 1928 453 4594 5047 1119 670 340* 89 * These ngures 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 £12 17 6 In 1926 the fees amounted to 57 19 0 In 1927 the fees amounted to 64 10 0 In 1928 the fees amounted to *99 11 0 * Includes £5 5s. paid by M. and C. W. Cases. DENTAL APPOINTMENTS SENT TO EACH SCHOOL AND DEPARTMENTS, WITH ATTENDANCES AND SOME PERCENTAGES. School Departments Total, and whole school percentage of attendance INFANTS. UPPER M. F. Boys Girls Alexandra. Appointments 65 44 323 300 732 Attendances 51 26 227 217 521 %Of attendances 78.46 59.09 70.27 72.33 71.17 Brentford End. Appointments 14 26 40 Attendances 2 9 21 %Of attendances 14.28 73-07 52.50 44 School Departments Total, and whole school percentage of attendance INFANTS UPPER M. F. Boys Girls Grove Road. Appointments 95 147 291 312 845 Attendances 65 121 171 181 538 %Of attendances 68.42 82.31 58.76 58.01 63.66 Heston Mixed. Appointments 21 39 207 195 462 Attendances 14 33 123 129 299 %Of attendances 66.66 84.61 57.97 66.15 64.71 Hounslow Heath. Appointments 136 130 329 304 899 Attendances 102 98 201 186 587 %Of attendances 75.0 75.38 61.09 61.15 65.29 Hounslow Roman Cath. Appointments 11 5 63 98 177 Attendances 3 4 32 63 102 %Of attendances 27.27 80.0 50.79 64.28 57.62 Hounslow Town. Appointments 63 94 281 288 726 Attendances 26 53 205 210 494 %Of attendances 41.26 56.38 72.95 81.39 68.04 lsleworth Town. Appointments 71 71 177 196 515 Attendances 57 48 86 88 279 %Of attendances 80.28 67.60 48.58 44.89 54.17 lsleworth Blue. Appointments 12 19 177 197 405 Attendances 8 11 82 82 183 %Of attendances 66.66 57.89 46.32 41.62 45.18 45 School Departments Total, and whole school percentage of attendance INFANTS UPPER M. F. Boys Girls St. Mary's R.C. Appointments 26 22 108 141 297 Attendances 11 8 26 69 114 %Of attendances 42.30 36.36 24.07 48.91 38.38 Spring Grove Central Appointments 141 108 249 Attendances 93 68 161 %Of Attendances 65.95 62.96 66.42 Spring Grove Jnr. Appointments 59 38 95 109 301 Attendances 48 23 68 82 221 %Of attendances 81.35 60.52 71.57 75.22 7342 Woodlands St. ]ohns Appointments 10 17 27 Attendances 1 15 16 %Of attendances Worple Road. 10.00 88.23 59.25 Appointments 101 78 145 133 457 Attendances 53 44 96 88 281 %Of attendances 52.47 56.41 66.20 66.16 61.48 Note.—No order of merit is implied, nor attempted in this Table. For the first time the whole of the school population has been under survey so that from now onwards, there will be definite statistics which are comparable. The time has surely come when there should be dental inspectors, appointed by the Board of Education on the same lines as the medical inspectors. We who have not been trained in the dental work beyond a certain point, are not in a position to assist or criticise the treatment carried out, and unless there is some common basis on which statistics can be framed a large proportion of them are fallacious. 46 For example, it is found that in caries discovered by examination in the age groups 5, 6, 7, 8, 9 and 10, there is an increased 9% in the entrants in 1928 over 1927, and 10.7% in the 8-year olds dropping again to 4.4% in the 10-year olds but a definite all round increase, which is probably due entirely to stricter inspection methods whereby pinhole cavities are included as apart from any definite increase in caries. At first sight these figures would appear thoroughly unsatisfactory, in that instead of there being definite decrease in th amount of caries as a result of dental treatment, there would appear to be the reverse. With the greater time available under the whole-time serve of the Dental Surgeon, more attention can be given to each case and as I said before, there should, from now onwards, be a definite base-line on which comparative statistics can be based. At the same time, dental statistics are made up of so many variables that unless the matter is dealt with by an expert statistician, there is always a danger that conclusions may be draw which have no real foundation in fact. There is a very definite difficulty in getting the poorer children from lsleworth to the Dental Clinic on the grounds of distance and expense, and it is hoped that the institution of a Dental Clinic at Redlees will make a considerable difference in this respect. For the first time arrangements had been made for emergency cases to be dealt with every day without previous appointment. The scheme has only been working since 31/10/28, but the results have been entirely satisfactory. Only 41 cases have been sent down so far, but of these 39 were genuine cases requiring treatment. It is interesting to find that practically a quarter of these case were children whose dental record from the point of view of absenteeism and refusals, could only be classed as bad. The arrangement was that the first half hour of every after noon session from the 31st October, should be set aside for emergency cases, and it has been found that a quarter of an hour has been sufficient to deal with the cases sent in.