111c. Mr. HALLETT. HES 22 BOROUGH of HESTON and ISLEWORTH 1935 Annual Report OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER FOR THE BOROUGH of HESTON and ISLEWORTH For the Year Ended 31st December, 1935 1935 REPORT ON THE HEALTH OF THE BOROUGH OF HESTON & ISLEWORTH FOR THE YEAR 1935 BY ELWIN H. T. NASH, m.r.c.s.. l.r.c.p.. d.p.h., Medical Officer of Health. Index Ambulance Facilities 14, 15 Ante-Natal Care 41 Birth Rates 9, 10 Canal Boats 24 Chicken Pox 35 Children Act (foster-children) 17 Cleansing of Verminous Persons 36 Clinics and Treatment Centres 15, 16 Deaths, Causes of 11 Death Rates 9, 10 Dentures for Mothers 43 Diphtheria 34, 35, 37, 38, 39 Diphtheria Immunisation 34, 35 Drainage and Sewerage 18, 21, 22 Encephalitis Lethargica 35 Enteric Fever 35 Erysipelas 35 Factory and Workshop Act, 1901 23 Food, Inspection and Supervision of 30-33 General Provision of Health Services in the Area 13 Home Help 44 Home Visiting 44 Hospitals 14 Housing 25-26 Industries, Local 9, 10 Infant Deaths 8, 9, 12 Infant Life Protection 17 Infectious Diseases 34, 39 Influenza . 35 Inspection and Supervision of Food 30-33 Laboratory Statistics 13, 14 Maternal Mortality 9, 41, 42 Maternity and Child Welfare—Attendances at Centres 40 „ „ Centres 16, 40 „ „ Dental Treatment 42, 43 „ „ General Arrangements 40-45 „ „ Grants of Milk 45 Measles 35 Meat 30 Midwives 13 Milk 30 „ Grants to Expectant and Nursing Mothers and to Children under three years ... 45 Mumps 35 Notification of Births 43 Nursing in the Home 13 Nutrition Research—Carnegie Grant 33 Ophthalmia Neonatorum 45 Pneumonia 35, 37, 38, 39 Population 9 Puerperal Fever 35, 37, 38, 39, 41 Puerperal Pyrexia 35, 37, 38, 39, 41 Sanitary Circumstances of the Area 18-29 Scarlet Fever 34, 37, 38, 39 Scavenging 18 Smallpox 35 Staff 7 Swimming Baths and Pools 24 Tuberculosis 36 Venereal Diseases 16 Vital Statistics 8, 9, 10 Voluntary Societies and Helpers 43 Water Supply 18 Whooping Cough 35 Public Health Department, 94a, Bath Road, Hounslow. June, 1936. To the Mayor, Aldermen and Councillors of the Borough of Heston and Isleworth: Gentlemen, The Annual Report this year is one designated by the Ministry as an Ordinary Report in contradistinction to the periodical Survey Report. I would particularly draw attention to the introductory summary on page 8. I wish to express my appreciation to the Council for the consideration shown to me by all members during the past year. I am, Gentlemen, Your obedient servant, ELWIN H. T. NASH, Medical Officer of Health. 5 THE HEALTH COMMITTEE OF HESTON AND ISLEWORTH BOROUGH COUNCIL as on the 31st December, 1935. Councillor J. E. DILLINGHAM (Chairman). „ J. OWNER (Vice-Chairman). Alderman J. J. BONNETT, O.B.E. C. L. LEWIS, J.P. G. R. SPEED, J.P. (ex-officio). Councillor H. COLLAR. H. G. HEARN. E. W. HEATH, J.P. A. W. LIDDELL. D. RHYS, M.A. R. SALISBURY. A. P. SNELLING. D. J. THOMAS. Medical Officer of Health : ELWIN H. T. NASH, m.r.c.s., l.r.c.p., d.p.h. MATERNITY AND CHILD WELFARE COMMITTEE Councillor A. C. TURNER (Chairman). Alderman G. R. SPEED, J.P. Councillor J. E. DILLINGHAM. H. G. HEARN. A. W. LIDDELL. Councillor J. OWNER. D. RHYS, M.A. R. SALISBURY. A. P. SNELLING. Co-opted Members : Miss E. A. ANKRITT. Mrs. E. CHEDGEY (Vice-Chairman). 6 STAFF The following persons constituted the Staff of the Health Department. Medical Officer of Health— ELWIN H. T. NASH, m.r.c.s., l.r.c.p., d.p.h. Deputy Medical Officer of Health— Mrs. EVA LOUISE ROBERTS, m.b., ch.b., d.p.h., Barrister-at-Law. Assistant Medical Officer of Health— VICTOR FREEMAN, m.r.c.s., l.r.c.p., d.p.h. Consultant in Puerperal Sepsis and Consultant in Obstetric Emergencies— J. W. BELL, l.r.c.p.i. and l.m., l.r.c.s.i. and l.m. (Part-time). Consultant to Ante-Natal Clinic— A. J. WRIGLEY, m.d. (lond.), f.r.c.s. (eng.) (Part-time). Diphtheria Immunisation Clinics : Medical Officer—G. W. J. BOUSFIELD, m.d., b.s. (Part-time). Dental Surgeons— I. COHEN, l.d.s., r.c.s. (eng.). W. A. LILLEY, b.d.s., l.d.s. (manc.). B. COOKE, l.d.s., v.u. (manc.) (Commenced June, 1935). Chief Sanitary Inspector— R. H. BUTLER, a.m.i.s.e., Cert as s.i. and m.i. Deputy Chief Sanitary Inspector and Housing Inspector— A. B. HAULDREN, Cert. as s.i. and m.i. Assistant Housing Inspector— F. G. DAVIES, Cert.as s.i. and m.i. (Commenced June, 1935). District Sanitary Inspectors— G. W. ASHWORTH, Cert. as s.i. and m.i. A. H. CORNHILL, Cert. as s.i. and m.i. G. LATIMER, Cert. as s.i. and m.i. K. J. SMITH, Cert. as s.i. and m.i. Disinfector and Laboratory Attendant—F. J. COBB. Assistant Disinfector and Laboratory Attendant—J. JOSEPH (Part-time). (Left May, 1935). „ „ „ „ „ F. S. J. ALLAWAY (Commenced May, 1935). Health Visitors and School Nurses— Mrs. C. E. M. OTTLEY, Cert., c.m.b., h.v., and s.n., m.c.w.w. Miss B. N. TETLEY, s.r.n., Cert., c.m.b., New Health Visitor's Diploma of the Royal Sanitary Institute. Mrs. A. E. TYRRELL, Cert., c.m.b., h.v. and s.n. Miss M. G. GRIBBLE, A.R.R.C., s.r.n., Cert., c.m.b., h.v. and s.n. Miss G. M. CLARE, s.r.n., Cert., c.m.b., New Health Visitor's Diploma of the Royal Sanitary Institute. Miss E. I. BARTLETT, s.r.n., Cert., c.m.b., New Health Visitor's Diploma of the Royal Sanitary Institute. Miss G. F. RICHARDSON, s.r.n., Cert., c.m.b.. New Health Visitor's Diploma of the Royal Sanitary Institute. Mrs. G. PRISSELL, s.r.n., Cert., c.m.b., h.v. and s.n. Miss B. P. MANNING, s.r.n., Cert., c.m.b., a.r.s.i., New Health Visitor's Diploma of the Royal Sanitary Institute. Miss L. B. YOUNG, s.r.n., Cert., c.m.b., New Health Visitor's Diploma of the Royal Sanitary Institute. Chief Clerk—B. W. KILBY, Cert. as s.i. and m.i. Clerks— Miss R. MARSHALL, Cert. as s.i. P. T. H. CRANDON. H. TOWLE. F. V. BELL, Cert. as S.I. and M.I. (Left May, 1935). H. L. LAW (Commenced August, 1935\ H. M. B. BURGE. C. PARRY. Miss D. M. DOWLING. E. E. FORREST. Miss V. D. NICHOLLS. R. MOORE (Left October, 1935). L. H. HAYWARD (Commenced October, 1935). ONE TEMPORARY JUNIOR. 7 8 SUMMARY OF COMPARABLE STATISTICS. England and Wales. 121 County Boroughs and Great Towns including London. 140 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). London Administrative County. Heston and Isleworth. Notes. Rates per 1,000 Population. Births : Live. 14.7 14.8 14.8 13.3 15.8 This is higher than last year for this district, and higher than the rest of the country generally. There were 128 more Births than the previous year, and despite the increased popuation this represented a slightly higher Birth Rate. Deaths : All Causes. 11.7 11.8 11.2 11.4 8.98 There were 85 less Deaths than the previous year, despite the increased population. Diphtheria. 0.08 0.09 0.07 0.06 0.03 The rate for this district is lower than any of the comparable rates in the groups shown. Scarlet Fever. 0.01 0.01 0.01 0.01 0.00 Although the numbers are small, the rates for Heston and Isleworth are also comparably lower. Whooping: Cough. 0.04 0.04 0.03 0.04 0.00 Influenza. 0.18 0.16 0.17 0.11 0.01 Notifications : Scarlet Fever. 2.96 3.19 2.75 2.64 2.34 With regard to notifications apart from Deaths, the incidence of Scarlet Fever and particularly Diphtheria in the Borough was also lower, as shown. Diphtheria. 1.60 1.96 1.34 2.25 0.79 Infantile Mortality : Rates per 1,000 Live Births. 57 62 55 58 40.77 The Minister of Health recently comments on the rate for England and Wales of 57 deaths per 1,000 births last year, which was the lowest on record, as a " striking fall," testifying " to the value of the work performed under Maternity and Child Welfare schemes." The rate for Heston and Isleworth, 40.77 was 17 lower than the very satisfactory figure for the whole country. This district's previous lowest record was 43.47 in 1933. Live Births- Total. M. F. Legitimate 1398 725 673 Birth rate per 1,000 of the estimated resident population 15.8 Illegitimate 49 19 30 Stillbirths 54 29 25 Rate per 1,000 total (live and still) births 35.97 Deaths 778 390 388 Death rate per 1,000 of the estimated resident population (Corrected) 8.98 Deaths from Puerperal Causes— Rate per 1,000 total Deaths. (live and still) births. Puerperal sepsis 2 1.33 Other puerperal causes 5 3.33 Total 7 4.66 Death rate of Infants under one year of age :— All infants per 1,000 live births 40.77 Legitimate infants per 1,000 legitimate live births 40.06 Illegitimate infants per 1,000 illegitimate live births 61.2 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under two years of age) 5 SOCIAL CONDITIONS. The greater part of the district is largely a dormitory for workers in London. The chief industries are :— (1) Beer, etc., brewing. (2) Boat building and repairing. (3) Colours and dyes. (4) Letterpress Printing. (5) Gravel quarrving. (6) Market Gardening. (7) Rubber Tyres, etc. (8) Pewterware and Candle Machinery. (9) Pharmaceutical Chemistry. (10) Soaps, powders and perfumes. (11) Sweets, confecticuery. (12) Wines. (13) Sawmills and joinery. (14) Fire extinguishers, etc. (15) Electrical and Wireless equipment Gramophones. (16) Motor Cars. (17) Fancy papers. (18) Aeroplanes. (19) Engineering works. (20) Disinfectants. (211 Laundries. (22) Linoleum. (23) Carbons, Stencils, Typewriter bons, etc. (24) Biscuit making. (25) Candle makine. 9: Statistics and Social Conditions of the Area EXTRACTS FROM VITAL STATISTICS OF THE YEAR, 1935. Area (in acres, including 42 acres of water) 7,261 Registrar-General's estimate of resident population (Mid-Year) 1935 90,970 Census Population, 1931 76,254 Number of inhabited houses (end of 1935) according to Rate Books 23,507 Rateable Value (at 31st December, 1935) £748,456 Sum represented by a penny rate (1934-35) £2,960 (26) Flour milling. (27) Pharmaceutical Manufacturing Machinery. . (28) Coach building and wheelwrights. (29) Dyeing and cleaning. (30) Pre-cast concrete works. (31) Celluloid works. (32) Artificial Manure. (33) Aluminium Solder. (34) Soldering Flux. (35) Scientific Instruments. The district is rapidly developing in nearly all directions, the great majority of houses that are going up being of the working class type, valued round about £600 to £700. Great use has been made of the Small Dwellings Acquisition Act, and of the Housing Act, particularly the former. VITAL STATISTICS. Population.—The Registrar-General's estimate for the population to the middle of 1935 is 90,970. The Census population in 1931 was 76,254, this being the revised figure as altered under the provisions of the Middlesex Review Order, 1933. Deaths.—The number of deaths registered in the district was 1,649, but 991 of these did not belong to the district, while 120 residents died outside the district. Thus the number of deaths properly attributable to the district was 778, a decrease of 85 on the figures for the previous year. Adopting the basis of the population estimated by the Registrar-General, the corrected death-rate for the district comes to 8.98 per 1,000, which is comparable with the following figures :— England and Wales 11.7 121 County Boroughs and Great Towns including London 11.8 140 Smaller Towns 11.2 London 11.4 Heston and Isleworth 8.98 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 definite figures (i.e., the actual number of births and infant deaths), it is more reliable than the death-rate, which is calculated on an estimated population. The rate for 1935 is 40.77 per 1,000 births, which is a record for this district. The rates for England and Wales and for London during the same period were 57 and 58 respectively. Births.—The total number of live births registered during the year was 1,777, excluding re-registrations, but 510 of these did not belong to this district, while 180 births properly belonging to this district occurred outside the district. The nett number of live births thus attributable to the district is 1447, an increase of 128 over last year's figures. Adopting the population basis suggested by the Registrar-General for the calculation of the birth-rate, this comes to 15.8 per 1,000. The birth-rate of England and Wales was 14.7 per 1,000 and for London 13.3 per 1,000. 10 Table of Couses of Deaths during 1935. Causes of Death. Civil Residents. all ages. All causes Male. Female 390 388 1 Typhoid and paratyphoid fevers 2 Measles — 3 Scarlet Fever 1 4 Whooping Cough — 5 Diphtheria 2 1 6 Influenza 1 7 Encephalitis Lethargica 4 1 8 Cerebro-Spinal Fever — 1 9 Tuberculosis of Respiratory System 25 19 10 Other Tuberculosis Diseases 4 5 11 Syphilis 1 — 12 General Paralysis of the Insane, Tabes Dorsalis 2 1 13 Cancer, Malignant Disease 60 60 14 Diabetes 7 9 15 Cerebral Haemorrhage, &c. 16 25 16 Heart Diseases 90 98 17 Aneurysm 2 1 18 Other Circulatory Diseases 20 16 19 Bronchitis 10 10 20 Pneumonia (all forms) 21 18 21 Other Respiratory Diseases 6 5 22 Peptic Ulcer 4 2 23 Diarrhoea, &c. (under 2 years) 3 2 24 Appendicitis 2 3 25 Cirrhosis of Liver 1 1 26 Other Diseases of Liver, &c. 27 Other Digestive Diseases 8 10 28 Acute and Chronic Nephritis 17 8 29 Puerperal Sepsis - 2 30 Other Puerperal Causes - 5 31 Congenital Debility, Premature Birth, Malformations, etc. 18 20 32 Senility 7 14 33 Suicide 2 6 34 Other Violence 24 11 35 Other Defined Diseases 34 32 36 Causes Ill-defined or Unknown Special causes (included in No. 35 above) - - Small-pox - - Poliomyelitis - - Polioencephalitis - - According to figures furnished by the Registrar-General. 11 INFANTILE MORTALITY DURING THE YEAR, 1935. Nett Deaths from stated Causes at various Ages under 1 Year of Age. Cause of Death. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks and under 3 mths. 3 mths. and under 6 mths. 6 mths. and under 9 mths. 9 mths. and under 12 mths. Total deaths under 1 year Smallpox ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ...... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 1 (Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... 1 1 Convulsions 1 1 1 ... 3 ... ... 1 ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... 1 ... 1 Pneumonia (all forms) ... ... ... ... ... ... 1 2 ... 5 Diarrhoea ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... 1 ... ... 1 Gastritis ...... ... ... ... ... ... 1 ... ... 2 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... 1 Injury at Birth 5 ... ... ... 5 ... ... ... ... 3 Atelectasis 1 ... ... ... 1 ... ... 1 ... 2 (Congenital Malformations 3 ... ... ... 3 3 2 ... ... 8 Premature Birth 9 1 3 ... 13 ... ... ... ... 13 Atrophy, Debility and Marasmus ... 1 1 ... 2 2 r\ 2 ... ... 6 Other Causes 4 1 ... ... 5 2 1 ... ... 8 23 4 5 32 11 8 6 2 59 12 General Provision ot Health Services in the Area Professional Nursing in the Home.—The Isleworth Nursing Association carries 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. No definite arrangements exist for nursing infectious diseases in the home, but emergency cases which may require it are dealt with as they arise. Suitably trained nurses are put in, if necessary for day and night duty. Midwives.—The inspection of Midwives is under the supervision of the County Council. It is, however, generally recognised that the authority administering a Maternity and Child Welfare Scheme should also exercise control over the Midwives practising in its area. In this district it is the practice of Health Visitors not to visit the newly bom 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 23 Midwives practising in the district. This figure does not include 10 Midwives on the staff of the West Middlesex County Hospital. There is still some difficulty in the Isleworth end of the district owing to the shortage of midwives. A number of the births are attended from a Nursing Home outside the district. No Midwife is employed or subsidised by this Council. LABORATORY WORK, 1935. We have still been dealing with the aftermath of the fire and its ravages in the office. The Laboratory work, since the fire, has been carried out by the Clinical Research Association, and a few minor matters by Dr. Murray, the Pathologist to the Richmond Hospital. 13 Now that it takes substantially longer to obtain reports on materials sent to the Laboratory the local Practitioners are realising what the advantage is to them of a Municipal Laboratory whereby when a swab is sent in one day they have the report first thing th'e following morning. Total. Positive Swabs for Diphtheria sent by Medical Practitioners 454 34 Taken from Schools, Clinics and from Contacts 683 14 Sub-Cultures 9 Sent from Staines Joint Isolation Hospital 180 40 Total cultures examined 1326 88 No. of Swabs, included in above total, which were examined by Clinical Research Association or at Other Laboratories 799 57 Virulency Tests (examined at Wellcome Physiological Research Laboratories 4, and by Clinical Research Association 2) 6 4 Blood examination for Enteric Widal Tests (sent to Clinical Research Association) 5 3 Specimens of Sputum for Tubercle Bacilli sent by Medical Practitioners (42 examined by Clinical Research Association) 74 15 Specimens of Sputum for Tubercle Bacilli taken at Clinics (1 examined by Clinical Research Association) 2 Hairs for Ringworm taken at Schools or Clinics (12 examined by Clinical Research Association) 26 13 Blood examination for Wassermann Tests (sent to Camberwell Research Laboratory) 5 Other Specimens— Urine 1036 Discharge (8 examined by Clinical Research Association) 19 Milk 1 Blood examinations for Anaemia 7 Preparation of Materials— Tubes of Serum 750 Throat Swab Outfits 1000 Sputum Outfits 30 The bacteriological work of the Staines Joint Isolation Hospital is dealt with through the Council Laboratory. HOSPITALS. The following are the Hospitals serving the general needs of the district:— General.—Hounslow Hospital, Staines Road. Royal Hospital, Richmond. West London Hospital, Hammersmith. West Middlesex County Hospital. The Corporation annually subscribe £300 to the Hounslow Hospital, and £50 to the Richmond Hospital. Maternity.—West Middlesex County Hospital, but a few cases are dealt with in the Hounslow Hospital and some at the large London hospitals. Venereal Disease.—West London Hospital, or at almost any London hospital. Tuberculosis.—County Council Dispensary, Bell Road, Hounslow (Out-Patients only). Orthopaedic.—Royal National Orthopaedic Hospital, London. Cases are referred through the Health Department from the various Qinics. The Corporation contributes £15 per annum. Puerperal Fever and Puerperal Pyrexia.—An agreement also exists between this Corporation and Queen Charlotte's Isolation Hospital Authorities, whereby cases of Puerperal Fever can be sent to their Isolation Block at Ravenscourt Park. A number of cases from this and other surrounding districts are also dealt with at the West Middlesex Hospital. Ophthalmia Neonatorum.—Cases requiring hospital treatment are sent by arrangement to St. Margaret's Hospital of the London County Council. Smallpox.—This district is included in the Middlesex County Council's scheme for dealing with Smallpox which arises in the County. The cases are admitted to the hospitals of the London County Council. Fevers.—Since the last report the South Middlesex and Richmond Joint Hospital Board is now functioning, and the arrangements for the hospital extension are progressing after prolonged conferences. During the year Dr. A. L. K. Rankin was appointed Medical Superintendent—a man of wide experience. Dockwell Hospital.—This old Smallpox Hospital situated at the western end of the district has been kept with a caretaker in residence, and ready at any time to deal with emergencies which might arise. At the time of writing this report it is being utilised in connection with the housing of families whilst their houses and belongings are disinfested, and plans are in view for improving the accommodation for this purpose. Maternity and Nursing Homes.—The County Council is the Supervising Authority under the Nursing Homes Registration Act, 1927. AMBULANCE FACILITIES. fa) For Infectious Cases.—This is provided by the Joint Hospital Committee, except for Smallpox, Ophthalmia Neonatorum and Puerperal Fever cases which are removed to other Hospitals by special arrangements. 14 (b) For Non-Infectious and Accident Cases.—Two Ambulances have been provided for accident cases and removal of non-infectious cases to hospitals or nursing homes within or outside the district. During the year 966 accident cases were removed to hospital, and 825 cases of noninfectious disease were removed to hospitals or nursing homes. CLINICS AND TREATMENT CENTRES, 1935. The fire has made the central administration one of temporary expedients, which have made the work in many cases much more difficult. The plans for Busch House are in progress, and it is hoped that the end of 1936 will see the new Clinic open, and substantial progress has been made with the plans of the Central Qinic and Offices at Clipstone House. This is being designed to give adequate Clinic accommodation together with offices which will deal with the rapidly expanding services in this rapidly expanding area. Land has already been purchased at Cranford End for school purposes, and a site allotted on the site of the school grounds for a Clinic to deal with that end of the district. 15 16 CLINICS AND TREATMENT CENTRES, 1935. Clinics and Treatment Centres. Address. Day. Time. Provided by Ante-Natal Clinics Isleworth Health Centre, Busch House, Isleworth, Every Tuesday and Wednesday. 9.45 am. Heston and Isleworth Borough Council. Diphtheria Immunisation Clinics Congregational Hall, Douglas Road, Hounslow. Monday. 10.30 a.m. and 2.0 p.m. ,,,, Infant Welfare Centres Congregational Hall, Hounslow. Tuesday. 2.0 p.m. ,, Wednesday. 10.0 a.m. and 2.0 p.m. ,, Village Hall, Heston. Thursday. 10.0 a.m. and 2.0 p.m. ,, Tuesday. 2.0 p.m. ,, Friday. 10.0 a.m. ,, Isleworth Health Centre. Monday. 2.0 p.m. ,, Wednesday. 2.0 p.m. ,, Friday. 2.0 p.m. ,, Maternity and Child Welfare Dental Clinics 35, Bath Road, Hounslow. Isleworth Health Centre. As for School Dental Clinics (see below). ,, Minor Ailments Clinics (Nurse attending) 94a, Bath Road, Hounslow. Every week-day. 9.0 a.m. ,, Village Hall, Heston. Every week-day. 9.0 a.m. ,, Isleworth Health Centre. Every week-day. 9.0 a.m. ,, Ophthalmic Clinics 94a, Bath Road, Hounslow. Thursday. 2.0 p.m. ,, Friday. 2.0 p.m. ,, Isleworth Health Centre. Thursday. 10.0 a.m. ,, School Clinics (Medical Officer attending) 94a, Bath Road, Hounslow. Tuesday. 10.0 a.m. ,, Village Hall, Heston. Friday. Thursday. 10.0 a.m. 10.30 a.m. ,, Isleworth Health Centre. Monday. 10.30 a.m. ,, School Dental Clinics 35, Bath Road, and Isleworth Health Centre. Monday. 9.30 a.m. and 2.0 p.m. ,, Tuesday. 9.30 a.m. and 2.0 p.m. ,, Wednesday. 9.30 a.m. and 2.0 p.m. ,, Thursday. 9.30 a.m. and 2.0 p.m. ,, Friday. 9.30 a.m. and 2.0 p.m. ,, Saturday. 9.30 a.m. ,, Tuberculosis Dispensary Bell Road, Hounslow. Monday. 10.0 a.m. Middlesex C.C. Thursday. 2.30 p.m. ,, Venereal Diseases Clinic West London Hospital, Monday to Friday. 10.0 a.m. to noon and 3.0 to 7.0 p.m. ,, mersmith (facilities are also ,, provided at other London Saturday. 11.0 a.m. to noon and 5.30 to 6.30 p.m. ,, Hospitals). ,, The Maternity and Child Welfare Centres are kept almost entirely for consultation purposes, treatment being reduced to an absolute minimum so as not to clash in any way with the Local Medical Practitioners. The only Day Nursery in the district was closed in 1920. ADMINISTRATION OF PART I. OF THE CHILDREN ACT, 1908, AS AMENDED BY PART V. OF THE CHILDREN AND YOUNG PERSONS ACT, 1932. The work of Infant Life Protection has continued to increase and at the end of the year there were 62 foster-mothers on the Register who were undertaking the care of 90 foster-children, as compared with 51 foster-mothers and 68 foster-children at the end of the previous year. A further Health Visitor was appointed as Infant Protection Visitor during the year. There are now 9 such Visitors compared with 8 in the previous year. One death occurred during 1935 and this was due to Broncho-Pneumonia. Two doctors were in attendance at the time of the child's death and no Inquest was held. It was not necessary to take Proceedings during the year under either of the Acts. Particulars of the Law relating to this work are made known by notices in the local press from time to time, and information is also supplied at the Maternity and Child Welfare Centres, and the Public Health Department. All the Health Visitors are fully acquainted with the requirements of the Law, and they promptly investigate and report on such cases as come to their knowledge by verbal reports. By the decision of the Housing and Town Planning Committee foster-children are not allowed to be received by tenants of Council houses. When a foster-child removes to an address outside the area, full details are sent immediately to the appropriate Authority; and any foster-child arriving in this area, whether it is reported to have come to its parents or not, is visited to see that all is satisfactory. A list is kept of approved persons who wish to undertake the nursing and maintenance of a foster-child. No person is placed in this list until full details of her circumstances, etc., have been supplied, and the Health Visitor has found the condition of the home satisfactory. Every six months a full report on the work is submitted to the Maternity and Child Welfare Committee containing a list of all the foster-mothers and child in the area, details of any exceptional matters, and a statement as to any disciplinary action it has been necessary to take since the last report. 17 Sanitary Circumstances, Water Supply.—There were, as far as is known, at the end of the year, 31 private wells from which the water was used for domestic purposes. In 43 other cases there are wells, but an alternative supply from the main exists for domestic purposes. In 24 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. During the year the following extensions have been made to the sewers :—Foul water— 5 miles 1,051 yards : Surface Water—3 miles 825 yards. Work is still proceeding on a complete West Middlesex Sewage Scheme which will pick up the sewage of this district. Closet Accommodation.—Accommodation on the water carriage system is almost general throughout the district, approximately 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 1935 collection of house refuse has continued weekly as before, and was disposed of by " controlled tipping " on a site in the Staines Road, Hounslow. Eight electric vehicles and two petrol driven lorries undertook the transportation of the whole of the refuse of the district. During the year, as a result of action taken, there were supplied 87 new ashbins. Sanitary Inspection of the District.—See pages 18-28.—The district work has continued to grow during the year with the further increase of the population and I am pleased to report that all the extra demands made on the staff have, so far, been met. Towards the end of the year the Preliminary Survey of the district for overcrowding was undertaken, and I shall be in a position to report more fully on this matter next year. Nuisances, Contraventions of Bye-Laws, Defective Drainage, etc.—The number ot premises on which nuisances were outstanding at the end of 1934 was 423. To these another 618 premises whereat nuisances were recorded in 1935 were added, giving a total of 1,041 premises. Of these 643 had the nuisances remedied, leaving 398 premises at which nuisances still existed at the end of the year. During the year, nuisances at 59 houses were reported to the Health Committee, which, added to the 8 brought forward from 1934 made a total of 67. 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, 32 had been dealt with, leaving 35 cases to be carried forward to 1936. Comparative figures for the years 1933, 1934 and 1935, in connection with nuisances, are submitted herewith :— 1933 1934 1935 Number of complaints received 550 514 474 Premises at which nuisances were located 648 582 618 Number of First Informal Notices 612 559 648 Number of Reminders and Letters 589 567 667 Number of Statutory Notices 36 24 57 18 Proceedings.—During the year Court proceedings were instituted by the Corporation with respect to the following cases :— (1) Use of unlicensed building as a slaughter-house in contravention of Section 126 of the Towns Improvement Clauses Act, 1847—Owner fined £2. (2) Slaughter of a pig without notice in contravention of Article 8 of the Public Health (Meat) Regulations, 1924—owner fined £3. (3) Non-compliance with a notice served under Section 94 of the Public Health Act, 1875—owner ordered to abate the nuisance within twenty-eight days, fined £5 and to pay £5 5s. Od. costs. (4) Unregistered dairyman trading within the Borough—dairyman fined 5/-. An appeal involving 2 houses was made in the County Court by an owner against the Corporation's decision to make Demolition Orders and it was upheld on the grounds that the agent for the owner had not been given a quasi-judicial hearing by the Health Committee. Subsequently undertakings submitted by the freeholder, not to use the premises again for human habitation until they had been rendered fit for such purpose, were accepted by the Borough Council. SANITARY WORK, ETC. Inspections—General : Total number of inspections and re-inspections, etc. 30,675 Inspections, etc., re Nuisances Contraventions, etc. : Number of premises, etc., inspected on complaint 653 Number of premises inspected in connection with infectious diseases 188 Total number of premises, etc., primarily inspected in connection with nuisances 940 Number of premises inspected under Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-1933 — Number of other visits made to premises, etc., in connection with nuisances, etc. 3,062 Number of visits made to works in progress 4,367 Number of interviews with owners, builders, etc. ... 2,078 Action taken (including action taken under Housing Act, 1930, Section 17) : Number of premises, etc., whereat defects, etc., were recorded during the year 618 Number of premises, etc., on which defects, etc., were remedied— (a) by owners or occupiers 643 (b) by local authority in default of owner or occupier — Number of cautionary or intimation notices given— (a) verbal . 184 (b) written 464 Number of letters and reminders re nuisances sent 667 Number of Statutory Notices issued 57 Number of proceedings taken 4 Number of convictions obtained 4 Number of proceedings withdrawn — Number of cases dismissed — Number of appeals made against decision of Corporation 2 Number of appeals upheld 2 Common Lodging Houses : Number registered 2 Number of inspections made 20 Number of contraventions outstanding from previous year — Number of contraventions found . — Number of contraventions remedied — Number of contraventions outstanding at end of year — Canal Boats Used as Dwellings : Number of inspections made 83 Number of contraventions outstanding from previous year 14 Number of contraventions found 10 Number of contraventions remedied 6 Number of contraventions outstanding at end of year 18 19 Moveable Dwellings, Caravans, Tents, etc. : Number of inspections made 675 Number of contraventions outstanding from previous year 8 Number of contraventions found 4 Number of contraventions remedied 4 Number of contraventions outstanding at end of year 8 Bakehouses : Number in district (a) factories 20 (b) workshops 9 Number of underground bakehouses in district 1 Number of inspections made 325 Number of contraventions outstanding from previous year 3 Number of contraventions found 10 Number of contraventions remedied 12 Number of contraventions outstanding at end of year 1 Slaughterhouses (including Knacker's Yard) : Number on register (a) registered premises 4 (b) licensed premises (including one licensed knacker's yard) 5 Number of inspections and visits made 993 Number of contraventions outstanding from previous year Number of contraventions found 4 Number of contraventions remedied 3 Number of contraventions outstanding at end of year 1 Cowsheds : Number of persons registered 7 Number of premises registered 7 Number of cowsheds on register 9 Number of milch cows in district 54 Number of inspections made 99 Number of contraventions outstanding from previous year — Number of contraventions found Number of contraventions remedied 7 Number of contraventions outstanding at end of year — Dairies and Milkshops : Number of persons registered 106 Number of premises registered 37 Number of inspections made 844 Number of contraventions outstanding from previous year 3 Number of contraventions found 8 Number of contraventions remedied 8 Number of contraventions outstanding at end of year 3 Offensive Trades : Number of businesses established in district 18 Number of inspections made 182 Number of contraventions outstanding from previous year — Number of contraventions found Number of contraventions remedied 1 Number of contraventions outstanding at end of year — Ice Cream Vendors : Number on register 104 Number of inspections made 560 Number of contraventions outstanding from previous year — Number of contraventions found 2 Number of contraventions remedied 2 Number of contraventions outstanding at end of year — Public Health (Meat) Regulations, 1924 : Number of inspections made 802 No notice of slaughtering given 1 Improper notice of slaughtering given — Urinals, water closets, etc., communicating directly with shops, etc. — No precautions taken for the prevention of contamination 2 Washable head coverings and/or overalls not used 1 Written notices sent Verbal notices given 3 20 Inspection of Food : Number of meat inspections 1,592 Number of fish inspections 328 Number of provision inspections 250 Number of greengrocery and fruit inspections 398 Number of Hawkers' foodstuff inspections 104 Number of food preparation places inspected 582 Number of other food inspections 66 Unsound food : Number of articles seized — Number of articles condemned by magistrate — Number of parcels seized — Number of parcels condemned by magistrate — Number of carcases and offal surrendered 4 Number of carcases surrendered (excluding offal) — Number of articles surrendered 232 Number of parcels surrendered 8 Number of organs or parts surrendered during slaughtering 400 Infectious Diseases, Disinfections, etc. : Number of visits made 723 Number of rooms disinfected— (a) Ordinary infectious diseases 347 (b) Tuberculosis 127 (c) Other diseases 27 Smoke Abatement : Number of observations made 500 Number of nuisances found 47 Miscellaneous Inspections : Number of piggeries inspected 297 Number of stable premises inspected 389 Urinals inspected 3 Water Supply : Number of supplies provided or reinstated 4 Number of cisterns cleansed, repaired, covered, etc. 8 Number of draw taps connected direct to main 24 Number of water service pipes or taps repaired 7 Number of samples taken for analysis from local wells 1 Number of samples found polluted or impure — Number of instances where mains water supply substituted for well water — Approximate percentage of houses supplied on constant system 99.95 Drainage and Sanitary Arrangements, etc., of existing Buildings— Water Closets : Number of water closets constructed or reconstructed 12 Number of water closets cleansed or unstopped 30 Number of privies abolished — Number of walls, etc., cleansed 15 Number of new flushing apparatuses provided 14 Number of new water closet pans or pedestals provided 52 Number repaired, supplied with water or otherwise improved 230 Approximate percentage of houses provided with water closets 99 Earth or Chemical Closets : Number provided or reconstructed 2 21 Sinks : Number of new sinks provided 63 Number of sinks repaired or improved 37 Drains : Number examined, exposed, etc. 60 Number unstopped, repaired, trapped, etc. 113 Number of waste pipes provided, disconnected, repaired, trapped or unstopped 58 Number of soil pipes fixed, repaired or improved 3 Number of ventilating shafts fixed, repaired or improved 22 Number of fresh air inlets provided, repaired or improved 26 Number of rain water pipes disconnected from drain 3 Number of gully traps inserted or improved 127 Number of disconnecting traps inserted 1 Number of inspection chambers inserted 22 Number of disconnecting chambers improved, sealed or cleansed 3 Number of inspection chambers repaired, improved, sealed or cleansed 14 Number of drains constructed or reconstructed 36 Total length of drain pipes laid (4 in.-1,487 ft.) (6 in.-173 ft.) 1660 ft. Number of tests and re-tests applied 278 Number of other works executed 15 Approximate percentage of houses draining into Council's sewer 99 Cesspools : Number rendered impervious, emptied, cleansed, etc. 1 Number abolished and drains connected to sewer 1 Removal of Household Refuse : Number of new ashbins provided 87 Dampness: Number of roofs stripped, renewed or repaired 237 Number of gutters and rain water oipes provided, repaired or unstopped 169 Number of instances in which external brickwork, sills, etc., repaired, renewed or rendered impervious 587 Number of damp-proof courses provided 131 Number of sites covered with impervious material 10 Number of yards paved, repaired or drained 135 Number of forecourts paved, repaired or drained 17 Interior Work : Number of rooms stripped and cleansed 331 Number of floors, walls and ceilings repaired or renewed 1,241 Number of rooms in which ventilation provided or improved 51 Number of rooms in which lighting provided or improved 17 Number of staircases replaced, repaired or improved 32 Number of instances in which lighting to staircases provided or improved 55 Number of handrails and balustrades to staircases, etc., provided or repaired 36 Number of window frames and sashes provided, repaired or unfixed 974 Number of doors and/or other woodwork renewed, repaired or improved 176 Number of stoves or grates provided or repaired 316 Number of washing coppers provided or repaired 89 Number of instances in which ventilation under floors provided or improved 77 Number of foodstores provided, cleansed or improved 66 Number of other repairs 89 Sundry Nuisances, etc : Number of instances in which domestic cleansing enforced 19 Number of rooms sprayed for the removal of vermin by the Disinfector 194 Number of instances in which overcrowding abated 10 Number of instances of improper keeping of animals abated 17 Number of offensive accumulations removed 44 Number of pigstyes provided, repaired, cleansed or improved 7 Number of stables provided, repaired, cleansed, or improved 13 Number of urinals provided, repaired, cleansed or improved 4 Number of dung pits provided, repaired or improved 5 Number of other nuisances abated 54 22 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 Inspection made by Sanitary Inspectors. Premises. Number on Register. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) (S) Factories (including Factory Laundries) 155 447 10 Nil. Workshops (including Workshop Laundries) ... 153 455 5 Workplaces (other than Outworkers' premises) 65 132 4 Outworkers 37 125 — Total 410 1159 19 Nil. DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Outstanding Jan. 1st, 1935. Found during 1935. Remedied during 1935. Outstanding Dec. 31st. 1935. Referred to H.M. Inspector. Number of Prosecutions. 1 2 3 4 5 6 7 Nuisances under the Public Health Acts— Want of cleanliness 1 9 8 2 Want of ventilation ... 1 1 ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 4 17 17 4 Sanitary accommodation— Nil. Nil. Insufficient 2 2 4 ... Unsuitable or defective 2 21 15 8 Not separate for sexes ... 3 ... 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) 1 1 2 ... Other offences : — Excluding offences relating to outwork ... ... ... ... Total 10 54 47 17 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. fSection 22 of the Public Health Acts Amendment Act, 1890, has been adopted by the Corporation, 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. OUTWORK. (a) Outwork in unwholesome premises, Section 108 ... ... ... Nil. (b) Outwork in infected premises, Sections 109-110 ... ... ... Nil. 23 PREMISES AND OCCUPATIONS CONTROLLED BY BYE-LAWS OR REGULATIONS. There are 517 known places in this district which call for periodical inspection as follows:— Houses let in Lodgings, Common Lodging Houses, Bakehouses, Slaughterhouses, Cowsheds, Piggeries, Stables, Dairies and Milkshops, Offensive Trades, Laundries (non- factory), Workshops, Workplaces, Outworkers' Premises and Ice Cream Vendors' Premises. SCHOOLS. There are now twenty-one schools with thirty-four departments in the Borough, including one Central School The influx of population continues to put a severe strain on the accommodation provided for in our schools and in eight departments the accommodation has to be supplemented by the use of huts. During the year one new school, the Wellington Junior and Infants' was opened. This School serves the Council Housing Estate at Sutton Lane and draws nearly all its 400 scholars from the Estate. SWIMMING BATHS AND POOLS. The principal Municipal Bath is provided with an up-to-date filtration and chlorination plant and is in every way satisfactory. The older Bath at lsleworth is being replaced by an up-to-date one, similar to that at Hounslow. The one Swimming Pool in the district is provided with an up-to-date cleansing and aeration plant, which is entirely satisfactory. CANAL BOATS. COPY OF REPORT FORWARDED TO THE MINISTRY OF HEALTH DATED 26th MAY, 1936. Canal Boats Acts, 1877 to 1884. In accordance with Section 3 of the Canal Boats Act, 1884, I beg to present herewith the Annual Report for the year ended 31jf December, 1935, as to the execution of the Canal Boats Acts, 1877, and 1884, and of the Regulations made thereunder, within the Borough of Heston and lsleworth, Middlesex. Inspectors Appointed under Canal Boats Acts, at 31st December, 1935 :— R. H. Butler (Chief Sanitary Inspector). G. W. Ashworth (District Sanitary Inspector). A. H. Cornhill (District Sanitary Inspector). G. Latimer (District Sanitary Inspector). K. J. Smith (District Sanitary Inspector). No special remuneration is paid for the position. Number of Inspections, etc. :— Number of Inspections made 83 Number of Canal Boats inspected 83 Number of boats found in order 74 Number of boats with one infringement 8 Number of boats with two infringements 1 Nature of Contraventions, etc.:— Cabins not weatherproof 3 Periodical painting of interiors not carried out 4 Cabins overcrowded 3 Legal Proceedings :— No legal proceedings have been taken during the year. Infectious Disease:— No cases of infectious disease were reported as occurring among the Canal Boat population during the year. 24 Housing The housing situation is steadily improving, and the Council have in view the erection of another large estate. As before, I have pursued throughout the year the policy I commenced last year of dealing with the representation and demolition of unfit houses as single individual units, and not under any clearance or improvement area. One of the things which are causing anxiety is the steps that must be taken to ensure that families entering Council Houses from verminous property do not transfer the vermin with them. In dealing with this problem, it must be borne in mind that for the vast majority of those who live in verminous houses, the fault is not theirs. They have been forced by circumstances to inhabit houses which were already verminous by reason of the financial burden of more expensive or newer property. Dockwell, the old Smallpox Hospital, is being increasingly used to house families whilst their houses and furniture are disinfested before they move into Council houses. HOUSING CONDITIONS STATISTICS. 1. GENERAL. Number of New Houses erected during the year :—1,378 2. INSANITARY AND UNFIT DWELLING HOUSES. 1. Inspection of Dwelling-Houses during the Year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts 616 (b) Number of inspections made for the purpose 719 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 208 (b) Number of inspections made for the purpose 311 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 97 (4) Number of dwelling-houses (exclusive to those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 156 2. Remedy of Defects during the Year without Service of Formal Notices :— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 223 3. Action under Statutory Powers during the Year :— A. Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 32 25 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners 19 (b) By local authority in default of owners — B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 10 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 4 (b) By local authority in default of owners - C. Proceedings under Sections 19 and 21 of the Housing Act, 1930 :— (1) Number of dwelling-houses in respect of which Demolition Orders were made 82 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 8 (3) Number of dwelling-houses rendered fit in consequence of undertaking given by owner - (4) Number of dwelling-houses in respect of which undertaking from owners accepted, not to re-let houses for human habitation 16 D. Proceedings under Section 20 of the Housing Act, 1930 :— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 3 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 2 G. Other matters:— (1) Number of dwelling-houses demolished voluntarily 26 3. UNHEALTHY AREAS. Area represented by the Local Authority with a view to Clearance or Improvement Schemes under Part I of the Act of 1930 Nil. Dwelling-houses represented as unfit for human habitation prior to the passing of the Housing Act, 1930. There is only one house outstanding under this heading—No. 15, South Street, lsleworth, which was represented as unfit for human habitation in January, 1915, and a Closing Order made in April of the same year. A Demolition Order was made on the 23rd November, 1915, but demolition has been deferred pending the widening of the street by the County Council to whom the property belongs. 26 Table showing dwelling-houses represented as unfit for human habitation since the passing of the Housing Act, 1930. Premises. No. of houses represented as unfit. Dates of representations. Dates houses rendered fit in accordance with undertakings. Dates undertakings accepted that houses would not be re-let for human habitation. Dates Demolition Orders made. Dates Demolition Orders obeyed. Dates Demolition Orders enforced. Brought forward from 1934: — 144-158b, Heston Road, Heston 11 13/6/32 ... ... 30/4/35 ... ... 19, London Road, Brentford End 1 12/12/32 ... ... 31/1/33 ... ... 21, London Road, Brentford End 1 12/12/32 ... ... 31/10/33 ... ... 34-44, Gloucester Road, Hounslow 6 9/5/33 ... ... 27/2/34 ... ... 12-18, Tivoli Road, Hounslow 4 9/5/33 ... ... 27/2/34 ... ... 1-14, Crosby Terrace, Station Road, Hounslow 14 5/9/33 ... ... 28/12/33 ... ... 7-27, Vine Place, Hounslow 11 14/11/33 ... ... 27/2/34 ... ... 179 and 181, Hanworth Road, Hounslow 2 6/2/34 ... ... 27/3/34 ... ... 11, 13, IS and 17, Church Street, lsleworth 4 5/6/34 ... ... 31/7/34 ... ... 78, South Street, lsleworth 1 6/3/34 ... ... 24/4/34 ... ... 1 and 3, Church Street, lsleworth 2 5/6/34 ... ... ... ... S, 7 and 9, Church St., lsleworth 3 5/6/34 ... ... 31/7/34 ... ... 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10, The Parade, Lampton Rd., Lampton 10 5/6/34 ... ... 31/7/34 ... ... 5 and 7, North Street, lsleworth 2 5/6/34 ... ... 25/9/34 ... ... 11, Nortli Street, lsleworth 1 5/6/34 ... ... 27/11/34 ... ... 6, The Square, lsleworth 1 5/6/34 ... ... 28/12/34 ... ... 7, The Square, lsleworth 1 5/6/34 ... ... 27/11/34 ... ... 64, High Street, Hounslow 1 10/7/34 ... ... 25/9/34 ... ... 66, High Street, Hounslow 1 10/7/34 ... 5/2/35 ... ... 68 and 70, High St., Hounslow 2 10/7/34 ... ... 26/3/35 26/8/35 ... 185, 187, 189 and 191, Lampton Road, Hounslow 4 10/7/34 ... ... 25/9/34 ... ... 42, 44, 46 and 48, London Road, Brentford End 4 10/7/34 ... ... 25/9/34 ... ... SO, London Road, Brentford End 1 10/7/34 ... ... 25/9/34 27/5/35 ... 244 and 246, London Road, lsleworth 2 10/7/34 ... ... 25/9/34 ... ... Basement Flats, 79 and 81, Lampton Road, Hounslow 2 4/9/34 30/9/35 1/10/35 ... ... ... ... 3, 5, 7 and 9, Tivoli Rd., Hounslow 4 4/9/34 ... ... 30/10/34 ... ... 179, Lampton Road, Hounslow 1 9/10/34 ... ... 28/12/34 ... ... 83, 85, 87, 89, 91, 93, 95, 97, 99 and 101, London Rd., Brentford End 10 9/10/34 ... ... 28/12/34 ... ... 131, 133 and 135, New Heston Road, Heston 3 9/10/34 ... ... 28/12/34 ... ... 27 Continuation of Table showing dwelling-houses represented as unfit for human habitation since the passing of the Housing Act, 1930. Premises. No. of houses represented as unfit. Dates of representations. Dates houses rendered fit in accordance with undertakings. Dates undertakings accepted that houses would not be re-let for human habitation. Dates Demolition Orders made. Dates Demolition Orders obeyed. Dates Demolition Orders enforced. Gray's Cottage, Cranford Lane, Heston 1 13/11/34 ... ... 29/1/35 ... ... 6 and 8, Hartland Road, lsleworth 2 4/12/34 ... ... ... ... 16, South Street, lsleworth 1 4/12/34 ... 29/1/35 ... ... 18 and 20, South Street, lsleworth 2 4/12/34 ... ... 28/5/35 ... ... Transferred to this area from Hayes and Harlington:— "Cranbrook," Bath Road, Cranford 1 ... ... ... 23/1/34 29/4/35 ... Ansley's Cottage, Park Lane, Cranford 1 ... ... ... 23/1/34 29/4/35 ... 1 and 2, Hills Cottages, Bath Road, Cranford 2 ... ... ... 23/1/34 ... ... 1, 2 and 3, Whitty Cottages, Park Lane, Cranford 3 ... ... ... 23/1/34 29/4/35 ... Dealt with in 1935 :— 2 and 4, Fairfields Road, Hounslow 2 8/1/35 ... ... 30/4/35 ... ... 1 and 2, Studds Cottages, Hayes Road, North Hyde 1 8/1/35 ... 5/2/35 ... ... ... 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10, Toynes Cottages, Toynes Alley, London Road, lsleworth 10 5/3/35 ... ... 25/6/35 ... ... 1 and 2, Young's Cottages, South Street, lsleworth 2 5/3/35 ... 9/4/35 ... • •• ... 2, 3, 4 and 5, Field's Cottages, Toynes Alley, lsleworth 4 9/4/35 ... ... 25/6/35 • •• ... 36, Magdala Road, lsleworth 1 4/6/35 ... ... ... ... ... 1, 2, 3 and 4, Quinion's Cottages, Fern Lane, Heston 4 9/7/35 ... ... 24/9/35 ... ... 1, 2, 3, 4, 5 and 6, Williams Place, Ivy Lane, Hounslow 6 9/7/35 ... ... 24/9/35 ... ... 44, 46, 48, 50 and 52, South Street, lsleworth 5 9/7/35 ... ... 24/9/35 ... ... The Lodge. 110, Syon Lane, lsleworth 1 9/7/35 ... ... 29/10/35 ... ... 142, Linkfield Road, lsleworth 1 9/7/35 ... ... 24/9/35 ... ... 30, The Grove (Basement Flat), Hounslow 1 3/9/35 Closing Order made 29/10/35 ... 2 and 4, Belgrave Road, Hounslow 2 8/10/35 ... 26/11/35 ... ... ... 202, 204, 206 and 208, Martindale Road, Hounslow 4 8/10/35 ... ... 26/11/35 ... ... 1, 2 and 3, Osterley Park Gardens, Heston 3 8/10/35 ... 26/11/35 ... ... ... Ill, 113 and 115, St. John's Road, lsleworth 3 8/10/35 ... ... 26/11/35 ... ... 28 Continuation of Table showing dwelling-houses represented as unfit for human habitation since the passing of the Housing Act, 1930. Premises. No. of houses represented as unfit. Dates of representations. Dates houses rendered fit in accordance with undertakings. Dates undertakings accepted that houses would not be re-let for human habitation. Dates Demolition Orders made. Dates Demolition Orders obeyed. Dates Demolition Orders enforced. 1, 2, 3, 4, 5 and 6, Syon Cottages, Syon Lane, lsleworth 6 8/10/35 ... ... 26/11/35 ... ... 60, 64, 68, 72, 76 and 80, Upper Sutton Lane, Heston 6 8/10/35 ... ... 26/11/35 ... ... 35a, Bell Road, Hounslow 1 12/11/35 ... ... 30/12/35 ... ... 139, 141, 143 and 145, Heston Road, Heston 4 12/11/35 ... ... 30/12/35 ... ... 54, 56, 58, 60, 62 and 70, South Street, lsleworth 6 12/11/35 ... ... 30/12/35 ... ... 157 and 159, Twickenham Road, lsleworth 2 12/11/35 ... ... 30/12/35 ... ... 161, 163, 165, 167 and 169, Twickenham Road, lsleworth 5 12/11/35 • •• 30/12/35 ... ... ... 185 and 187, Twickenham Road (Basement Flats), lsleworth ... 2 12/11/35 Closing Orders made 30/12/35 ... 130, 132, 134, 136, 138, 140, 142 142a, 142b and 142c, Heston Road, Heston 10 10/12/35 ... ... ... ... ... 64, 72, 76, 80 and 82, South Street, lsleworth 5 10/12/35 ... ... ... ... ... 29 Inspection and Supervision of Food The following is the record of inspection of food premises :— Meat 1,592 Fish 328 Provisions 250 Greengroceries and Fruit 398 Hawkers' Food Stuffs 104 Food Preparation Places Inspected 582 Number of other Food Inspections 66 Milk. In addition to a note of the number of samples of milk taken under the Food and Drugs Act for analysis, I have received the following report from the County Medical Officer with regard to the action taken to safeguard the milk supply of the district:— During the year 1935, 48 samples of milk were taken from retailers in the district. These samples were submitted to the Lister Institute for animal inoculation tests, and in four cases the presence of tubercle bacilli was demonstrated. In three of these cases the samples were traced to farmers in Berkshire, and in the remaining instance to a farm in Oxfordshire. The County Medical Officer of Berkshire subsequently informed me that after examination of the herds at the first two farms concerned one cow from each farm was found to be suffering from tuberculosis and was slaughtered. The results of the examination in the third case have not yet come to hand. With regard to the sample traced to the County of Oxfordshire, I was informed by the County Medical Officer that five cows, suffering from tuberculosis were discovered and dealt with under the Tuberculosis Order. One cow was reported by its owner as showing symptoms suspicious of tuberculosis and was examined by one of the County Council's veterinary surgeons. The veterinary surgeon reported that the illness was found to be due to a chill and that the animal had recovered at the time of his examination. Routine examination of milch cattle was carried out during the year by Dr. Wooff, M.R.C.V.S., the County Council's whole time veterinary inspector and 526 inspections of cows were made. Two cows were found to be suffering from tuberculosis and were slaughtered. 943 inspections were carried out in respect of cowsheds, dairies and milkshops. Unofficial milk analyses are made by the Medical Officer of Health. Number of firms in the district licensed to sell :— "Certified" milk 8 (9 shops). " Grade A" (Tuberculin Tested) milk 13 (15 shops). " Grade A" milk — " Grade A" Pasteurised milk 2 (2 shops). *" Pasteurised " milk 13 (18 shops). (*one of these is a licensed producer of " Pasteurised " milk). Meat Inspection. 1. Meat Inspection.—This is still kept at a very high pitch of efficiency. The Chief Sanitary Inspector and the District Sanitary Inspectors hold special certificates for the meat inspection. Slaughter-houses and butchers' shops are visited periodically. There are now 8 slaughter-houses (4 registered and 4 licensed), in use in the district, and each slaughter-house received on an average 10 visits per month. There were 67 butchers' shops in the district at the end of 1935. 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. In the early part of the year the Public Health Committee considered the question of providing a public abattoir. After consideration of information obtained from Authorities where public abattoirs are established it was resolved that consideration of the question of the establishment of a public abattoir in this district be adjourned sine die. 3. Action under Section 117, Public Health Act, 1875 :—No unsound meat was seized during the year. 4. Diseased Meat.—There was none seized, but a total of 2,337 lbs. was surrendered during the year, including 1,067 lbs. of tubercular meat. 30 The slaughter-houses on the whole are kept, so far as their construction will allow, in a fairly satisfactory condition. The butchers still continue to buy mainly in the London wholesale meat markets. The Public Health (Meat) Regulations, 1924, continue to cause a considerable amount of work, and the amount slaughtered has become to a large extent stabilised. The slaughtering is often continued well into the evening to suit the personal convenience of the butchers. Most of the butchers continue to accept the restrictions imposed by the Regulations in the right spirit. In one instance a pig was slaughtered without notice and proceedings were instituted against the owner. A fine of £3 was imposed. There has been established a feeling of confidence in the decisions given and this is shown by the fact that the whole of the unsound and diseased meat dealt with during slaughtering was surrendered. When new butchers' shops are opened every effort is made to obtain fixed windows, but with the absence of positive power to demand fixed windows, there is a tendency on the part of some of the butchers to adopt a standstill attitude with regard to this most desirable method of preventing contamination of the meat exposed for sale. The provision of fixed glazed windows to many of the shops in the district has proved beneficial both from the point of view of preventing contamination and maintaining longer the saleable qualities of the meat. Having regard to this improvement in certain instances, the reason for the absence of a positive policy on the matter in the Regulations is rather obscure and I venture to suggest in fairness to those butchers who have provided fixed windows on request, that provisions should be made, in the near future, for enforcing compulsorily, that all meat shall only be exposed and sold behind fixed glazed windows without any qualifications. Out of a total of 67 butchers' shops in the district, 46 are provided with fixed windows, 3 other shops are 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. INSPECTION OF OTHER FOODS. I have drawn attention in previous reports, to the want of perspective with regard to butchers' windows, and the way in which sweets, dates, figs, and other sticky things are exposed to contamination without let or hindrance. The large open multiple stores which are now coming into being provide a very definite problem in this direction. We are fortunate in this district in that one of the large multiple Stores have an extremely progressive and enlightened Manager. I have discussed this matter with him on various occasions, and he has moved to get something done. The result of his enthusiasm is the first covered sweet stall in any of the firm's establishments. The result from a public health point of view is excellent; the display is brighter and better than it ever was before; the sweets look fresh and there is no bloom on them such as exists on all exposed sweets. The way in which it has been carried out is certainly a triumph for public health, and also for the Manager, and it in no way interferes with service behind the display. The psychology of the public in the matter of food protection is extraordinary. Whilst we are trying our utmost to protect their health, they on the other hand are doing their utmost to defeat the efforts which we make. Dealing with the biscuits exposed in this class of store, I tried to get these covered, but 1 was brought up against the hard fact that the purchasing public in these stores will not buy goods unless they are freely exposed, although they do not handle them. Again, I want to pay my tribute to the attempts which the Manager made to see what could be done to packet and cover the biscuits in his store. It was found that only two varieties of biscuits could be sold packeted in the ordinary way, namely, Cream Crackers and Ginger Nuts. Attempts were made to introduce a celophane window with little or no result, and entire celophane packing was introduced, with little better result—the public simply would not buy packeted biscuits. Ultimately, by persistent efforts six varieties of biscuits were on sale, and those more or less satisfactorily, with complete impervious covering. As far as the tins were concerned, a great improvement was made by a loose sheet of plate glass which fitted the 7 lb. tins and covered the biscuits so that they were exposed for sale as visible as if they were not covered in. The psychology, as I have said before, is extraordinary. The position is summed up in a letter from one of the Directors of the firm, which is illuminating. " We have in some sections been able to get the shopping public converted to the idea fairly quickly, but in other sections where we have experimented the results have been disastrous as far as sales are concerned We can assure you that we have ourselves explored this question from almost every angle, and so far with only moderate success, but it is something which we always have before us and can only await the time when the public are sufficiently educated to understand more thoroughly that what is being done is being done for their benefit .... We are fully alive to the position in every respect, but we must admit that the pioneering in this particular instance resolves itself into very hard going without very much success to show for the effort made up to date." The firm have tried their utmost to carry out the methods which their manager has to a certain extent succeeded in carrying through in this district, but the records of their sales when these public health measures have been put into force, have dropped so enormously that short of 31 legislation compelling all vendors to cover their goods, it is not a proposition which they can face in the interests of their business. A second firm of multiple stores has followed the lead of the first mentioned, and they have managed to progress even further than the first named. Whilst their covering for the sweets is not so complete as in the first named, in that it does not go far enough back from the counter, they have utilised the same method of covering for biscuits which is a definite improvement on that of the first mentioned firm. I make a point of visiting every one of the multiple stores of this tyoe in every town I go to, to see what the practice is. In most cases there is nothing and and I am bound to say that, so far as we are concerned in this district, the two firms to which I have referred, are far ahead of the country generally. Sale of Food and Drugs Act.—I am indebted to Dr. J. Tate, County Medical Officer, for the following report, as to the samples purchased in this area during 1935. Article. Taken. Adulterated. Milk 222 11 Cream Pastry 4 4 Gin 3 1 Rum 1 — Whisky 3 3 Sausages 5 — Lemon Sole 1 — Lobster 1 1 Meat 3 — Minced Beef 2 — 245 20 Number of Convictions 3 Number of Prosecutions 3 All the adulterated samples of milk were taken in course of delivery from provincial farmers. One farmer was prosecuted and fined £3 and £2 5s. Od. costs. UNSOUND FOOD, 1935. Tons. cwts. qrs. lbs. Fish 3 19 Meat 1 0 3 13 Poultry 3 13 Fruit 13 2 2 Total 1 16 0 19 32 Nutrition No Public Propaganda has been undertaken to disseminate public knowledge of nutrition since the demonstration under the Carnegie Trustees auspices at lsleworth in November, 1934. A few Lectures have been given at Busch House in the Maternity and Child Welfare Clinic, and two lectures have been given to different Societies in the District. It is proposed next Winter, when the new Clinic at Busch House is completed, to have a definite series of Cookery Lectures with a nutritional basis to be given at the Maternity and Child Welfare Clinics. The year 1935 has seen the conclusion of the Carnegie Trust Nutritional Research and progress towards the report and the writing of the Cookery Book as suggested by the Trustees. This work has finally been hampered by the appointment of Miss Hook by the Board of Education to the post of Inspector, a post well deserved in view of her experience. Miss Bruce took up other work and her assistants have had to be intermittent. The results, however, when finally published should be of real value in helping to economise, and at the same time provide an adequately nutritious diet to those with limited means. 33 Infectious Diseases Scarlet Fever and Diphtheria.—-There were 8 "return" cases of Scarlet 1'ever and none 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. Some use is made of the Dick reation in connection with query cases of Scarlet Fever at Mogden Hospital. Scarlet Fever serum is used in nearly all cases at the hospital. The Staff of Mogden Hospital is Schick tested and immunised. 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 213 No. of civil cases removed to Hospitals 183 Percentage of cases removed to Hospitals 85.92 The incident rate of Scarlet Fever in the civil population (90,970) was 2.34 per 1,000. There was one death 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 72 No. of civil cases removed to Hospitals 69 Percentage of cases removed to Hospitals 95.8 The incident rate per 1,000 of the civil population was 0.79. Fourteen cases occurred in institutions during the year. Three deaths occurred from this disease, i.e., a case mortality rate of 4.16 per cent. The deaths occurred in the following age groups : — 3—4 years 1 5—10 years 2 And in the following months :— February 1 December 2 For the last five years the deaths from Diphtheria have been as follows :— Year. 1931 4 Year. 1932 3 Year. 1933 2 Year. 1934 4 Year. 1935 3 Details of the Immunisation work for 1935 are set out in the following report. Schick testing has been resorted to in practically every case, and every effort has been made to ensure that the work is as scientifically accurate as it is possible to make it. It is interesting to note that the incidence of Diphtheria in the District compares with the rest of the Country as follows :— Rates per 1,000 of Population. Cases. Deaths. England and Wales 1.60 .08 121 County Boroughs and Great Towns including London 1.96 .09 140 Smaller Towns 1.34 .07 London Administrative County 2.25 .06 Heston and lsleworth 0.79 .03 The total number of new consents to immunisation was 691, of which 340 were in respect of children under 5 years of age. 34 The total attendances during the year amounted to 4,529. The cases concluded and issued with certificates of apparent immunity during the year amounted to 808. Of these 746 persons had been successfully immunised. 62 were found to be naturally immune. Immunisation Centre.—It is interesting to see how the demands for immunisation is increasing in respect of the younger children. With regard to the investigation which we published last year, researches are still being carried out with regard to the further increased dose of T.A.M., when it is hoped to be able to show that the gap of 5 per cent., which we recorded last year, has been almost, if not entirely, closed. Diphtheria Antitoxin.—Boxes containing a Sterile Antitoxin syringe, and the necessary dressings, etc., are kept at the Hounslow Police Station so as to be available in case of emergency. During 1935, 28 vials of Antitoxin of 8000 units each were supplied to medical practitioners. Smallpox.—No cases were notified during the year 1935. Enteric Fever.—Four cases were notified. Two were notified from the West Middlesex Hospital, one was not a resident in this district. Erysipelas.—Twenty-five cases of this disease were notified, of whom 16 were of cases in the West Middlesex Hospital. Twelve were non-residents in this district. Ophthalmia Neonatorum.—(See page 45). Puerperal Fever.—Twenty-three cases were notified. Twenty of these cases were notified from the West Middlesex Hospital, of whom 18 were not usually resident in this district. Two cases confined at home were removed to Queen Charlotte's Hospital for treatment. One case was confined in a Nursing Home. Two deaths occurred from Puerperal Sepsis. Puerperal Pyrexia.—Thirty-three cases were notified; 31 of these were notified from the West Middlesex Hospital, including 26 who were not usually resident in this district. Encephalitis Lethargica.—Two cases were notified during the year. One was from the West Middlesex Hospital not usually resident in this district. Cerebro-Spinal Fever.—One case of this disease was notified from Hounslow Hospital in the person of a non-resident. Pneumonia.—There were 116 cases notified—71 notifications were from the West Middlesex Hospital. Fifty were non-resident in this district. Non-Notifiable Diseases.—Information respecting non-notifiable infectious diseases is usually gained through notifications by the Head Teachers and School Attendance Officers. The undermentioned table sets forth the numbers of such cases for the last six years :— 1930 1931 1932 1933 1934 1935 Measles 799 9 952 108 901 10 German Measles 38 5 25 13 66 6 Chicken Pox 392 233 194 362 417 537 Mumps 381 132 122 940 153 113 Whooping Cough 144 242 260 287 144 232 Upon receipt of information of the existence of a case, inquiry is made by a School Nurse to obtain all necessary facts. Influenza.—There was 1 death from Influenza during the year, the mortality being 0.01 per 1000 of the population. 35 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 Geansing Station. See also page 25. TUBERCULOSIS, 1935. I repeat what I said last year, that in my opinion an open-air recovery school is a real need in this district. It is impossible for those who have not been in close personal contact with open-air recovery schools to appreciate what an open-air recovery school really means. There is so much uninformed opinion with regard to what such a school means and does. Pulmonary Tuberculosis.—The number of new cases notified including transfers from other districts during the year was 105; of the new cases, 38 were receiving institutional treatment at the time of notification, and 17 died. There were 44 deaths from Tuberculosis of the Respiratory System. Twelve cases were transferred into the area, after notification in other districts. Other Forms of Tuberculosis.—The number of new cases notified during the year including transfers was 24. Of the new cases, thirteen were notified as receiving institutional treatment, and four died. The total deaths were 9. Deaths from Tuberculosis of non-notified Cases.—Twelve deaths occurred in non-notified cases. Five deaths occurred elsewhere, and were transferred to this district. The following Table gives further particulars of new cases notified and deaths in 1935. Age Periods. New Cases. Deaths Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0—1 ... ... ... ... ... 1 1 ... 1—5 ... ... 1 3 ... ... ... 2 5—10 1 2 4 ... ... ... 1 ... 10—15 1 2 3 ... 1 1 2 15—20 3 8 3 1 2 ... ... 20—25 6 7 2 1 1 4 ... ... 25—35 14 26 2 3 8 5 ... ... 35—45 6 10 2 ... 3 3 1 1 45—55 10 4 ... ... 10 ... ... ... 55—65 3 2 ... ... 2 3 ... ... 65 and upwards ... ... ... ... ... ... ... ... Totals 44 61 14 10 25 19 4 5 Eight of the deaths from Pulmonary Tuberculosis were not notified and four deaths from Non- Pulmonary Tuberculosis were not notified. TUBERCULOSIS. The number of cases of Tuberculosis on the register at the end of 1933 was 342; at the end of 1934 there were 359, and at the end of 1935, 390. Although these figures show an increase it does not necessarily indicate an increase of Tuberculosis in the district, as in the same period the population has gone up from 84,460 to 90,970, and in addition to some increase in the numbers on this account, there is evidence that a number of people move into this district who may be suffering from Tuberculosis in order to get more open conditions of living than is possible in some of the London Boroughs. It is, however, satisfactory to record that the deaths from Tuberculosis in this district have dropped in the last three years from 76 in 1933; 72 in 1934; to 53 in 1935, and the death rate from Tuberculosis for this area has dropped as follows :— 1933 .89 1934 .82 1935 .58 36 INFECTIOUS DISEASES, 1935. CASES NOTIFIED. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Erysipelas. Cerebro-Spinal Fever. Encephalitis Lethargica. Poliomyelitis. Pneumonia. Respiratory Tuberculosis. Other forms of Tuberculosis. Ophthalmia Neonatorum. Puerperal Pyrexia. January 19 7 ... 2 2 ... ... ... 22 9 2 ... 4 February 23 6 ... 3 1 ... ... ... 15 13 4 1 ... March 19 7 ... 4 2 ... ... ... 19 7 2 2 8 April 28 4 ... 2 4 ... ... ... 11 2 3 1 2 May 18 8 ... 2 2 ... ... ... 12 9 2 ... 3 June 10 5 ... ... 2 ... ... ... 5 13 1 ... 3 July 19 2 1 1 3 1 ... ... 6 9 1 ... 1 August 12 1 1 ... 1 ... 1 ... 4 7 1 ... 6 September 13 4 2 1 1 ... ... ... 4 9 3 ... 1 October 14 10 ... 1 2 ... ... ... 1 8 1 1 2 November 21 11 ... 5 3 ... 1 ... 11 10 1 1 1 December 17 7 ... 2 2 ... ... ... 6 9 3 ... 2 Totals 213 72 4 23 25 1 2 ... 116 105 24 6 33 DIPHTHERIA, 1935 (including Bacterial cases, 10 in number). Month WARD. Elem. School Chldren Other School Chldren Other Cases Total Hstn. Houn. Cent. Houn. Hth. Houn. Sth. Houn. West Islewth N. Islewth S. Spng. Grve. Jan. 11 2 ... 4 ... 1 3 ... 1 4 ... 7 Feb. 6 1 ... ... 1 1 1 1 1 2 1 3 Mar. 7 ... ... ... ... ... 2 3 2 3 ... 4 Apr. 6 ... ... 2 ... ... 3 1 ... 1 ... 5 May 8 1 ... 2 2 ... 1 2 ... 4 ... 4 June 5 1 ... 3 ... 1 ... ... 4 ... 1 July 2 1 ... ... 1 ... ... ... ... ... ... 2 Aug. 2 ... ... ... 1 ... ... 1 ... 2 ... ... Sept. 4 1 1 ... 1 1 ... ... ... 3 ... 1 Oct. 12 3 ... 3 1 5 ... ... ... 6 1 5 Nov. 12 ... ... 5 ... 3 2 2 ... 5 ... 7 Dec. 7 ... 1 1 ... 2 2 ... ... 1 2 4 Totals 82 9 3 17 10 13 15 10 5 35 4 43 37 Notifiable Diseases during 1935. Disease. 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. 65 years and over. Joint Board Hospitals Other Hospitals Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... 1 3 ... ... ... 4 4 ... Scarlet Fever ... 2 16 9 16 116 17 10 19 6 2 ... 213 178 5 Diphtheria ... 2 4 2 7 30 18 5 3 1 ... ... 72 59 10 Erysipelas 1 ... ... 1 ... ... ... ... 2 2 16 3 25 ... 20 Puerperal Fever ... ... ... ... ... ... ... ... 20 3 ... ... 23 ... 22 Puerperal Pyrexia ... ... ... ... ... ... ... 1 29 3 ... ... 33 ... 32 Ophthalmia Neonatorum 6 ... ... ... ... ... ... ... ... ... ... ... 6 ... 4 Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro Spinal Fever ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Pneumonia 3 2 2 5 1 15 6 7 25 16 28 6 ... ... 78 Dysentry ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... 1 Polio Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... For Tuberculosis Notifications—see other Table. 38 DEATHS FROM NOTIFIABLE INFECTIOUS DISEASES, 1935. Age Groups. Under 1 year. 1 yr- 2 yrs. 3 yrs. 4 yrs. 5 yrs. 10 yrs. 15 yrs. 20 yrs. 35 yrs. 45 yrs. 65 yrs. and over. Total all Ages. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... 1 ... ... ... ... ... ... ... ... ... 1 Diphtheria ... ... ... ... 2 1 ... ... ... ... ... ... 3 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... 1 1 ... ... ... 2 Puerperal Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia 5 3 ... ... ... 1 1 ... 5 2 13 9 39 Poliomyelitis .. ... ... ... ... ... ... ... ... ... ... ... ... ... Polio- Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... 2 ... ... 3 5 Cerebro-Spinal Fevei 1 ... ... ... ... ... ... ... ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... Total 6 3 1 ... 2 2 1 1 8 2 13 12 51 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 1935 :— Enteric Fever Scarlet Fever Diphtheria Pneumonia (all forms) Erysipelas Puerperal Fever Puerperal Pyrexia Cerebro-Spinal Fever Ophthalmia Neonatorum Pulmonary Tuberculosis Other Tuberculosis Encephalitis Lethargica Total West Middlesex Hospital 2 11 10 71 16 20 31 ... 2 17 5 1 186 Hounslow Hospital ... 4 4 ... 2 ... ... 1 ... 3 5 ... 19 Hounslow Barracks ... ... ... ... ... ... ... ... ... ... ... ... ... St. Mary's School ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 2 15 14 71 18 20 31 1 2 20 10 1 205 39 Maternity and Child Welfare The attendances of children at all the Centres during the last six years have been as follows :— Year. No. of attendances. Year. No. of attendances. 1930 19,222 1933 35,110 1931 27,318 1934 33,102 1932 31,656 1935 36,635 The average attendances per session during the year 1935 were as follows :— At Douglas Road Centre No. 1 91.2 At Clipstone House, Bath Road, Centre and later Douglas Road No. 2 71.3 At lsleworth Centre 62.1 At Heston Centre 63.0 Approximately 70.5 per cent, of the notified live births attended at one of the Infant Welfare Centres before they were a year old. The number of individual mothers and children attending the Clinics is shown hereunder :— 1931 1932 1933 1934 1935 Douglas Road, Hounslow, No. 1— Mothers 1087 1085 860 820 998 Children 1232 1741 1078 953 1146 Clipstone House, Bath Road, Hounslow, and later Douglas Road, No. 2.— Mothers — 132 467 513 491 Children — 153 557 569 602 lsleworth Health Centre, Busch House— Mothers 578 690 685 562 5% Children 757 763 824 726 729 Heston— Mothers 392 451 435 330 444 Children 478 534 550 387 537 Sales at Clinics. Quantity. Receipts. Dried Milks 11371 lbs. 782 17 9 Virol 630| lbs. 48 10 5 Sugar of milk 153 lbs. 8 7 6 Oil and Malt 1490 lbs. 47 2 9 Lactagol 1423 tins 73 5 4 Cod Liver Oil Emulsion 6648 bottles 182 15 4 Bemax 1736 packets 35 10 10 Adexolin 580 phials 39 12 10 Total £1218 2 9 40 Ante-Natal Clinic. The following figures of attendances at the Clinic:— 1933 1934 1935 Attendances by Expectant Mothers during the year 738 831 1208 Average Attendance per Session 14.2 14.0 11.5 Number of Sessions 52 59 105 No. of Mothers attending Ante-Natal Clinic shown as a percentage of total notified live and still births 28.0 31.8 32.8 Total number of expectant Mothers who attended the Clinic during the year 373 419 464 There were in addition 12 Post-Natal Cases, as against 31 in 1934. Dr. Wrigley's report is as follows:— "ANTE-NATAL SERVICES, 1935. The feature of the year's work, in spite of a most serious set-back, about which reference will be made later, is the further large increase in the number of patients who made use of the Clinic, and the huge increase in the number of attendances. Toward the end of 1934, the numbers presenting themselves for examination became so great that the work was of necessity hurried, and this was least of all to be desired in that branch of medicine, known as Pre-Natal Care. The Maternity and Child Welfare Committee kindly allowed the employment of an Assistant Medical Officer, and at once a great improvement was noticed. However, within a few weeks the numbers rose so rapidly, that even with additional help, no time could be wasted. Relief, in a sense not to be desired, came with the disastrous fire at Clipstone House, and it was many weeks before patients became thoroughly acquainted with the fact that bi-weekly Clinics are now held at Busch House. This site is not perfect, and it involves a long and tedious journey from the Heston end of the borough. Further, the accommodation is far from satisfactory, but there are prospects of better times ahead. The previous routine of the work was followed exactly with the exception that more extensive use has been made of the excellent Maternity and X-Ray Department at the West Middlesex Hospital, adjacent to Busch House. The Authorities of this institution have rendered every help, and their co-operation is greatly appreciated. Cases of Toxaemia of Pregnancy requiring in-patient treatment, cases of malposition of the foetus requiring Correction under anaesthesia, etc., etc., have been directed down the road with the result that much probable illness and trouble have been avoided. Co-operation has also increased enormously between the Clinic and Midwives, who practise in the borough. No fewer than 150 attendances were made by these women, and on many occasions the midwife had arranged that four or five of her cases should be present and examined at the one session in her presence. It can now be said that every midwife in the district, with two exceptions, makes a full use of the Services. It seems not unlikely that in the near future nearly a hundred per cent, of the "Mothers" in the Borough will be under the care of the Municipal Ante-Natal and PostNatal Services. A. J. WRIGLEY, m.d., f.r.c.s. Last year I reported the result of a broadcast for a patient with carinoma of the cervix. I have seen her recently and she is in tip-top health. Owing to her husband's unemployment she has been working hard, and it is now over two years since her operation. She has been examined by the Specialist, who has reported "All well." Again to the B.B.C. I tender my most grateful thanks. MATERNAL MORTALITY. There is now available for every pregnant woman in the area:— (a) An Ante-Natal Specialist, (b) An Obstetric Specialist in case of difficulty at the confinement, (c) A Specialist in case of Puerperal Fever, (d) Beds provided at Queen Charlotte's Hospital, in case further treatment is required, (e) Sterilized maternity outfits for very poor mothers confined at home. 41 In addition to this, from the dental side there is provision of everything that can ensure that the mother's mouth is cleaned before her confinement. Where this necessitates the removal of large numbers of teeth, there is the provision subsequently of dentures. Where the extractions are numerous, in order that the expectant mother shall get the least possible upset, an arrangement exists with the Royal Free Hospital (Eastman Dental Clinic), to admit the patients to their beds for one or two nights, as may be necessary, for which we pay at the rate of 15s. per night. Thus, I think without fear of contradiction, we can say that in this area we have one of the most complete schemes, if not the most complete, in the country for ensuring the safety of our parturient women. These deaths are investigated by the Medical Officer of Health as far as possible, in conjunction with the medical practitioner in attendance, and the report is made on the prescribed form to the Maternal Mortality Committee of the Ministry of Health. Some difficulty is experienced in getting reports which are of any substantial value. The maternal mortality rate is based on the number of deaths of mothers per 1,000 live and still births. The number of live and still births during the year was 1,501. Excluding the death following abortion, the incidence of deaths of mothers following confinements in 1935, was 6 mothers died out of 1,501, or 4 per 1,000. The rate for the two previous years were, year 1933—4.89; year 1934—2.93. The rate for 1935 was 4.66, which is higher than for 1934 but lower than for 1933. Seven deaths were recorded; five of these took place in Institutions. The causes of death were as follows:— Cause of Death. Institution or Private. 1. Septicaemia following abortion Institution. 2. Septicaemia, General Peritonitis following full term delivery of first living child ,, 3. Obstetric Shock, Exhaustion ,, 4. Shock, Manual removal of Placenta ,, 5. Syncope, Haemorrhage, Adherent Placenta Private. 6. Eclampsia Institution. 7. Pulmonary Embolus Private. The rate for England and Wales was 3.93. Although there is no Municipal Maternity Home included in the foregoing arrangements made by the Borough Council, the erection of a first-class Maternity Block for 31 mothers and their infants in the West Middlesex County Hospital, provides a service which otherwise would become the duty of the Borough Council. DENTAL CLINIC. The following is from the Dental Surgeon's Report for the year:— MATERNITY & CHILD WELFARE DENTAL SCHEME, 1935. General Comments. Supply of Cases.—There was an increase in the number of patients dealt with. Net attendances increased from 1,576 in 1934 to 2,303 in 1935. Evaluation of the above figures.—They do not altogether give a full value of the work they have entailed, because in dealing with the youngest of the young and the "all sorts" conditions of the Mothers, greater difficulty is experienced in disposing of these cases. Comparative figures :— Year. Mothers. Children. Total Appointments were 1933 717 807 1524 1934 ... ... 2061 1935 ... ... 3003 42 Attendances were 1933 548 568 1116 1934 ... ... 1576 1935 1245 1058 2303 Mothers. Permanent teeth. Children. Deciduous teeth. Total. Fillings 237 469 706 Extractions— Gas 828 759 1587 1620 Local Anaesthetic 16 17 33 Dentures supplied to mothers. Year. Upper. Lower. 1934 42 39 1935 77 70 The number of individual mothers supplied with dentures during 1935 was 80. Details of other work, years 1934 and 1935. 1934 1935 Administrations of General Anaesthetics 307 476 Advice 76 113 Dresings 59 128 Impressions taken 86 181 Charting and Estimating 179 279 Silver Nitrate Treatment 183 178 Scaling and Polishing 38 57 Treatment of Gums — 17 I. COHEN, l.d.s., r.c.s. (eng.), Dental Surgeon. Notification of Births. Number of live births notified during the year 1369 Number of still births notified 43 Notified by midwives 1021 Notified by parents or doctors 391 No special measures exist for dealing with unmarried mothers or illegitimate children of such, but cases not wholly destitute have derived benefit through the Council's scheme for grants of food and milk. VOLUNTARY SOCIETIES AND HELPERS. The lsleworth 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 undermentioned for services rendered at the Welfare Clinics, and also for o-ifts of prams, toys, clothing, etc., which are given to the other mothers:— Mrs. Goff, Miss Goff, Mrs. Northcote, Mrs. Adams, Mrs. Jones, Mrs. Steele, Mrs. Jacklin, Mrs. Shirley, Mrs. Bartholomew, Mrs. Knight, Mrs. Scances, Mrs. Amon, Mrs. Buckingham, Mrs. Powell, Mrs. Bull and Mrs. Gould, at the Hounslow (No. 1) Centre; Mrs. Chadwick, Mrs. Biggers, Mrs. Zimmerman, Mrs. Hunt and Mrs. Beal, at the Hounslow (No. 2) Centre; Mrs. Chedgey, Mrs. Newman, Mrs. Jones, Mrs. Griffen, Miss Adams, Mrs. Ebutt, Miss Beale, Mrs. Boakes, Mrs. Widdowson, Mrs. Bates, Mrs. Bryant, Mrs. Howard, Mrs. Jones, Mrs. Middleton, 43 Mrs. Whitten, Mrs. Harris, Mrs. Coeshall, Mrs. Gunning, Mrs. Hutchings, Mrs. White, Mrs. Bush, Mrs. Sinclair, Mrs. Kennedy, Mrs. Clarke, Mrs. Curwood, Mrs. Naish, Mrs. Janes, Mrs. Staplehurst, Mrs. Jennings, Mrs. Boyer, Mrs. Jupe, Mrs. Gates, Mrs. Horton, Mrs. Johnstone, Mrs. Forster, Mrs. Watson and Mrs. Jones, at the lsleworth Health Centre; Mrs. Colbrook, Mrs. Brierley, Mrs. Rose, Mrs. Munday, Mrs. Pegwell, Mrs. Andrews and Mrs. Cooper, at the Heston Centre. At Hounslow No. 2 Centre it has been the custom for the mother in better circumstances to provide the layette and useful baby clothing for the expectant mother who has found it a difficult matter owing to the unemployment of the husband, etc. Home Visiting.—The visits by the Health Visitors in connection with the Maternity and Child Welfare Work were as follows :— 1st visits to babies under 1 year 1368 Other visits to babies and children up to 5 years 5425 Other visits to mothers 486 Inquiries made elicited— Feeding—Natural 1031 Artificial 100 Both 63 Sleeping with parents 115 Using comforter 180 Mother working during pregnancy 51 Summary of Nurses' Visits. Total to expectant mothers 260 Total to other mothers 226 Total to children under 1 year of age 4206 Total to children between the ages of 1 and 5 years 2587 Visits re Public Health matters, infectious diseases, tuberculosis, etc. 802 Total 8081 (The above numbers include 878 visits in connection with infant life protection). Health Visitors' attendances at the Maternity and Child Welfare Centres, Ante-Natal Clinics, etc., 778. Health Visitors' attendances at Diphtheria Immunisation Clinics, 174. Home Help for Mothers.—Persons entitled to the assistance of a Home Help are those whose income is less than 8/- per head per week after the rent has been deducted, but in very exceptional circumstances, at the discretion of the Medical Officer of Health, this may be extended up to 10/- per head. No charge is made to the applicant for the services of the Home Helo. Usually the Home Help attends at a case for two weeks after the birth of the infant, but in some cases, i.e. where the husband is unemployed, etc., a Home Help is sent in for half days only. This enables the husband who can help in the home, to sign on at the Employment Exchange and also look for employment. The rate of payment of the Home Help is £2 per week. The number of cases at which the Home Helps have been called upon to attend during the year, was 31. 44 Grants of Milk.—Milk is supplied free or at reduced rate to expectant mothers (during the last three months of pregnancy), to nursing mothers, and to children under three. The number of grants made during the year was 1,329, against 1,181 for the previous year. OPHTHALMIA NEONATORUM, Year 1935. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Removed from District and Deaths. Notified. Treated. At Home. In Hospital. 6 1 5 3 — — 3 An agreement exists with the London County Council for the admission of Ophthalmia Neonatorum to St. Margaret's Hospital when necessary. 45 BOROUGH of HESTON and ISLEWORTH EDUCATION COMMITTEE TWENTY-EIGHTH Annual Report OF THE SCHOOL MEDICAL OFFICER FOR THE YEAR ENDED 31st DECEMBER, 1935 CONTENTS. Arrangements for Treatment 10 Blindchildren 24, 28 Co-ordination 7 Deafchildren 24, 28, 29 Deformities 27 Dental defects and treatment 9, 15-20, 33 Dental Surgeon's Report 15-18 Ear disease and hearing 9, 15, 27, 32 Emergency Dental Cases 18 Epileptic children 24, 27, 29 Eye defects 8, 13-14, 27, 32 Findings of medical inspection 8, 26 Following up 9 Health Education25 Heart Disease and Rheumatism 9, 20, 27, 30 Infectious disease 20-22 Malnutrition 8, 10 Medical inspections 7, 26 Medical treatment 10, 32 Mentally defectives 24, 29, 31 Milk, Supply of 23 Minor ailments 8, 11, 32 Nose and Throat defects 8, 14, 27, 33 Nurses' work in schools 9, 34 Occupation Centre, see under Miscellaneous on page 25 Open Air Education 22 Orthodontic work (Report of the Orthodontic Consultant) 18-20 Orthopaedic and Postural defects 9, 20, 33 Parents, Co-operation of 23 Parents' Payments 25 Physical Training 22 Playground Classes 22 Prosecutions 11 Provision of Meals 22-23 Ringworm 12, 32 School Attendance Officers, Co-operation of 23 School Clinics, see under Minor Ailments on page 11 School hygiene 7 School journeys 22 School Nurses' work 9, 34 Schools in the Area 6 Secondary Schools 25, 34 Skin diseases 8, 11, 26, 32 Special Enquiries 25 Spectacles 13-14, 32 Staff 5 Statistical tables 26-35 Teachers, Co-operation of 23 „ Medical Examination of, see under Miscellaneous on page 25 Tonsils and Adenoids 8, 14, 27, 33 Tuberculosis 9, 20, 27, 29 Uncleanliness 11, 34 Visual defects and External Eye disease 8, 13-14, 27, 32 Voluntary Bodies, Co-operation of 23 To the Chairman and Members of the Borough of Heston and Isleworth Education Committee. Ladies and Gentlemen, I beg to present the Annual Report of the School Medical Service for the year ended 31st December, 1935. I wish again 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 The Right Worshipful the Mayor (Alderman G. R. SPEED, J.P.) (Chairman). Councillor D. RHYS, M.A. (Vice-Chairman). Alderman A. A. BERGIN, J.P. „ C. L. LEWIS, J.P. „ F. C. GREEN. Alderman H. J. NIAS, M.B.E., J.P. „ G. N. SHACKLETON. Councillor A. J. FIELDER. „ E. W. HEATH, J.P. „ A. W. LIDDELL. „ R. H. MANNING. „ G. RAVENHILL. „ W. F. J. RICHARDSON. Councillor F. SARD. „ D. J. THOMAS. „ F. J. THOMAS. „ A. C. TURNER. „ R. WRIGHT, M.C, Co-opted Members—- Miss E. A. ANKRITT. „ K. LIDDELL. J. V. BACKES, Esq, A.R.C.S., A.I.C., D.I.C. E. R. HAMILTON, Esq., M.A., B.SC. Dr. O. WARDMAN. School Medical Officer— ELWIN H. T. NASH, M.R.C.S., L..R.C..P, D.P.H. STAFF School Medical Officer—ELWIN H. T. NASH, M.R.C.S., L..R.C..P, D.P.H. Deputy School Medical Officer— Mrs. EVA LOUISE ROBERTS, M.B., CH.B., D.P.H., Barrister-at-Law. Assistant School Medical Officer—VICTOR FREEMAN, M.R.C.S., L..R.C..P, D.P.H. Dental Surgeons—I. COHEN, L.D.S., R.C..S., ENG. Orthodontic Consultant—H. R. EVANS, L.D.S., R.C..S., ENG. Orthodontic Demonstrator, Children's Department, Royal Dental Hospital. Certifying Ophthalmic Surgeon—J. D. M. CARDELL, F.R.C.S. Health Visitors and School Nurses— Mrs. C. E. M. OTTLEY, Cert., C.M.B., H.V., and S.N., M.C.W.W. Miss B. N. TETLEY, S.R.N., Cert., C.M.B., New Health Visitor's Diploma of the Royal Sanitary Institute. Mrs. A. E. TYRRELL, Cert., C.M.B., H.V. and S.N. Miss M. G. GRIBBLE, A.R.R.C., S.R.N., Cert., C.M.B., H.V. and S.N. Miss G. M. CLARE, S.R.N., Cert., C.M.B., New Health Visitor's Diploma of the Royal Sanitary Institute. Miss E. I. BARTLETT, S.R.N., Cert., C.M.B., New Health Visitor's Diploma of the Royal Sanitary Institute. Miss G. F. RICHARDSON, S.R.N., Cert., C.M.B., New Health Visitor's Diploma of the Royal Sanitary Institute. Mrs. G. PRISSELL, S.R.N., Cert., C.M.B., H.V. and S.N. Miss B. P. MANNING, S.R.N., Cert., C.M.B., A.R.S.I., New Health Visitor's Diploma of the Royal Sanitary Institute. Miss L. B. YOUNG, S.R.N., Cert., C.M.B., New Health Visitor's Diploma of the Royal Sanitary Institute. Clerical Staff— B. W. KILBY (Chief Clerk). Comprising the whole Qerical Staff of the Public Health Department, part of whose duties are concerned with the School Medical Service. P. T. H. CRANDON. Miss R. MARSHALL. H. TOWLE. H. L. LAW (Commenced August, 1935). F. V. BELL (Left June, 1935). H. M. B. BURGE. C. PARRY. E. E. FORREST. Miss D. M. DOWLING. Miss V. D. NICHOLLS. R. MOORE (Left October, 1935). Grade 'A' Clerkship vacant 31.12.35. O. E. GIBSON (Left December, 1935). L. H. HAYWARD (Commenced October, 1935). Dental Attendant—Miss M. L. MADDICK (Commenced July, 1935). Apprentice Dental Attendant—Miss M. B. MABBS. Dental Clinic Clerk Attendants—Miss C. J. JOTHAM. Miss E. J. BEMMER. Miss A. M. FRAMPTON. Miss A. A. PHILLIPS (Commenced June, 1935). Miss V. J. REDGEWELL (Commenced June, 1935). Dental Mechanic (part time)—T. CHENEY. W. A. LILLEY, B.D.S., L.D.S. B. COOK, L.D.S., R.C..S., ENG. (commenced June, 1935). 5 ELEMENTARY SCHOOLS IN THE AREA. School. Department. *Accommodation. Number on *Registers. Alexandra Junior 428 375 „ Infants' 388 386 Berkeley Junior Mixed and Infants' 500 501 Bulstrode Senior Boys' 480 418 „ „ Girls' 480 460 Chats worth Infants' 400 396 Cranford Temporary Junior 100 98 „ C. of E. Infants' 133 130 Grove Road Junior Mixed 572 512 „ Infants' 326 260 Heston Senior Mixed 400 365 „ Junior Mixed 430 402 „ Infants Infants' 249 257 Hounslow Heath Senior Mixed 480 512 „ „ Junior Boys' 446 423 „ „Junior Girls' 398 402 „ „ Infants' Infants' 388 408 Hounslow R.C. Mixed and Infants' 330 291 Hounslow Town Junior Boys' 286 306 „ Junior Girls' and Infants' 488 410 Isleworth Blue Boys' 177 115 „ Girls' and Infants' 284 166 Isleworth Town Junior Mixed 550 541 „ Infants' 418 422 Marlborough Senior Mixed 640 633 „ Infants' Infants' 400 338 St. Maiy's R.C Boys' 180 130 „ Girls' and Infants' 226 187 Spring Grove Central 436 414 „ Junior Mixed and Infants' 240 276 Wellington Junior Junior 400 401 Woodlands St. John's Infants' 75 64 Worple Road Junior Mixed 260 252 „ Infants' 226 215 Total 11905 11228 *These numbers are for December, 1935, except in the case of Marlborough Infants' School, which was opened in January, 1936 in place of Brentford End Infants' School. Since December, 1930, the number of children attending elementary schools in this district has increased by nearly 3,000, and the effect of this continuing increase is being steadily felt in the demands made on the various branches of the School Medical Service. 6 2.—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. Dr. Roberts and Dr. Freeman are engaged in school medical work as well as the other health services. This applies also to the nursing and clerical staff, so that co-ordination of all the services is complete. The popularity and success of our Maternity and Child Welfare work continues to increase, and whereas in 1926 there were two Centres each open for two afternoon sessions per week, there are now four Centres with a total of ten sessions weekly. Children may attend these Centres until they reach school age, and upon the recommendation of the Medical Officers, may, before they reach school age, attend the School Clinics for treatment of visual and dental defects and minor ailments. X-ray treatment for Ringworm can also be arranged. The service of the health of pre-school children is, at present, entirely on a voluntary basis. They come to the Infant Welfare Centres as a result of the good work done there, but even there it falls very far short of what is in the interests of the children. Personally, I see no hope for dealing adequately with the two to five years age group which provides us with many untreated defects, except through Nursery Schools, where with compulsory attendance goes compulsory medical inspection. 3.—THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. The School buildings and sanitary arrangements are periodically inspected, and a complete survey of the schools is made from time to time. Every school in the district is visited at least twice a year by a Medical Officer. During the year under review however, there were no special efforts made for critical reporting on the matters under the headings detailed in the memorandum Form 6M. (Schedule) from the Board of Education, issued as a guidance for the Reports of School Medical Officers on the year's work. It may be stated however that there are no official arrangements for drying children's clothes or boots other than spreading them in the recognised cloakrooms. 4.—MEDICAL INSPECTION. The age groups selected for inspection are those laid down by the Board of Education. viz:— 1. All new entrants (5 year old children). 2. Second Age Group (8 year old children). 3. Third Age Group (12 year old children). 4. Other Routine Inspections. Every school in the Borough has been visited twice by a Medical Officer during the year— once for a routine medical inspection, and subsequently for the re-examination of children who had been found to need treatment or observation. The total number of routine medical inspections carried out during the year was 3,878. It has been necessary to engage extra medical assistance regularly throughout the year, and the pressure in all other sections of School Medical Work, particularly in the School Clinics, has continued unabated. 7 Disturbance of School Arrangements. No one supposes that the ordinary school curriculum is not disorganised to some extent by the needs of medical inspection especially where all the available accommodation is required for educational purposes. The Head Teachers of the district, however, are to be congratulated upon the arrangements they make under such difficult conditions, and I should like to place on record once again my appreciation of the fact that the inspecting Medical Officer is always made as comfortable as circumstances permit. 5.—FINDINGS OF MEDICAL INSPECTIONS. Malnutrition. After nearly nine years crying in the wilderness and being asked again and again what is all the fuss about, it is grim satisfaction that at last the Board of Education is coming to adopt the view which one has been advocating for so long and that statistical returns with regard to nutrition, as now set out, are likely to serve something better than those of former days. It is joy indeed to find in the Board's Administrative Memorandum No. 124 (31st December, 1934) the following statement, in view of the ink which has been spilt on boosting mathematical indices, " experience appears to show that, generally speaking, a clinical classification is more reliable than one based only upon a height-weight-age ratio." As I have repeated over and over again, the assessment of malnutrition in its early stages is a matter of difficulty and can only be done with any approximation to accuracy as a result of long clinical observation. Even now it is melancholy reading, to see that one of the principal Paediatricians in the Country refers to these nutritional matters as a "stunt." Facts like the following should be rammed down the throat of the "stunt" supporters in this matter of malnutrition. There are two adjacent schools in this area, one catering for a population mainly clerks in Government Offices and people in regular employment, the other chiefly for casual labourers and people of smaller wages and broken time. As far as housing is concerned however, in both cases the houses are first class and up-to-date, so there is nothing to choose between the housing of the two populations, but in the latter school, the Headmaster who has come from another area, is worried because his children cannot last at anything. They have no stamina or resistance. As he puts it, they go pretty well to half-time of a game and then fade out. It is true this school has not had the same experience as the other and is slightly smaller, but that is no index to the conditions which led to the defeat in a recent Netball Match by twentythree goals to one. The same thing appears in their dancing. There is lack of spring and agility, which is quite a marked feature, and after a short time their feet fail to rise from the floor and they shuffle about. The same thing happens with their lessons. Concentration is all right for the first part of the lesson and then it fades out. In my opinion, the underlying condition here is largely a nutritional one. There is little or no difference in the incidence of disease and yet there are certain people in high places who refer to these claims as " stunts." Minor Ailments and Diseases of the Skin. A total of 432 cases of various skin diseases were reported during the year, and with the exception of 5 cases, all were referred for treatment. As usual, impetigo was the commonest disease. Table II. shows that there were 153 cases of "other skin disease"; these include such conditions as eczema, alopecia, seborrhœa, etc. Visual Defects and External Eye Disease. Routine medical inspections revealed 175 cases of defective vision, 170 being referred for treatment. Seven case of squint were also discovered, 6 being referred for treatment. At the Special Clinics, 87 cases of defective vision and 19 of squint were referred for treatment. Five cases of minor disease of the eye were discovered at routine medical inspections, and 191 cases were discovered at the Special Clinics. Nose and Throat Defects. Two hundred and sixty seven children were found to be suffering from chronic tonsillitis, and of these 206 were referred for operation. Twelve children had Adenoids only, 6 being referred for treatment and 6 for observation. 8 In a further 203 cases both conditions were present, 145 children being referred for operation and 58 for observation. Ear Disease and Defective Hearing. Amongst children examined at the routine medical inspections, 5 cases of defective hearing were found, 3 of these being referred for treatment. Special examinations at the Clinics account for 18 cases of defective hearing, and 136 cases of ear disease. Dental Defects. One thousand eight hundred and twenty-seven cases of dental caries were discovered at routine medical inspection, and a further 141 cases were found by examination at the Special Clinics. At the routine dental inspections in the schools, a total of 8,187 children were found requiring treatment. Table IV., Group V,.on page 33 gives further statistics in this connection. See also Statistical Table on page 16. Orthopaedic and Postural Defects. Fifty-three cases of deformity of varying degrees were discovered by inspections at the schools and at the Special Clinics. Heart Disease and Rheumatism. Sixteen cases of heart trouble were found during the year to need treatment, whilst 66 cases were marked for observation. Tuberculosis. No case of Tuberculosis was found by medical inspection during the year. Other Defects and Diseases. Eight defects which could not be classified under any other heading in Table II. were marked for observation during routine medical inspection. The number of "other defects and diseases" found by special inspection was 1368. Of these, 1,267 were referred for treatment. They were almost entirely minor ailments (minor injuries, bruises, sores, etc). 6.—FOLLOWING UP. Every possible care is taken that no child requiring treatment shall be allowed to continue without it. Parents are notified in writing of all physical defects discovered in their children during routine medical inspection, and those parents who take advantage of our invitation and attend the inspection, receive verbal advice also. A special " Following-up " card is then made out, and one of the School Nurses visits the home and explains how treatment can be obtained. Further visits are paid from time to time as may be necessary. The Following-up card is " kept alive " until the condition for which it was made out is remedied. Nurses paid 429 visits in this connection during the year. The most difficult feature of this work is the wilful neglect of certain parents whose obstinacy fails to respond to persuasion. Such cases have to be referred to the Committee, who generally decide to pass them on to the National Society for the Prevention of Cruelty to Children. The following is a list of the School Nurses' duties, with brief statistics relating to their activities during the year under review. 9 Duties. 1. Attend Routine Medical Inspections at schools with the Medical Officer, and assist in weighing and measuring children, etc. 2. Attend Re-inspections at schools with the Medical Officer. 3. "Following-up" as outlined above. 4. Attend Eye Clinics. 5. Attend Minor Ailments Inspection Qinics with Medical Officer. 6. Attend Minor Ailments Treatment Clinics and undertake daily treatments. 7. Attend Dental Qinics. 8. Attend Dental Inspections at Schools. 9. Visit Schools and inspect all children for uncleanliness (Cleanliness Survey). 10. Attend Clinics for re-inspection of dirty children (Cleanliness Qinics). 11. Visit children's homes for enquiries in cases of non-notifiable infectious disease. 12. Visit homes of children who fail to attend Qinics or attend irregularly. Summary of School Nurses' work during 1935. Attendances. Routine Medical Inspections 213 Re-inspections 38 Eye Clinics 128 Minor Ailments Inspection Clinics (with Medical Officer) 220 „ „ Treatment Clinics 907 Dental Qinics 1094 Cleanliness Surveys 66 Cleanliness Clinics 54 Other Attendances (Special Clinics, Med. Exam, of Teachers, School Sports, etc.) 95 Visits. Re Infectious Disease 1220 Following up 429 Other Visits Nil 7.—ARRANGEMENTS FOR TREATMENT. (a). Malnutrition. Milk is supplied twice daily at school, free or at part cost, to children who have been recommended for this on medical grounds. Further reference to this will be found on page 23. Cod Liver Oil and Malt is sold at cost price at the School Clinics for children recommended by the School Medical Officer. In necessitous cases it can be supplied free. 10 (b). Uncleanliness. The Cleanliness Survey is a most important factor in maintaining cleanliness amongst school children, and although it was not found possible during the year to attain the standard of one cleanliness survey per term at each school, it has been possible to increase the number of examinations to 11,240, compared with 10,175 in 1934. Number of visits to schools by Nurses 67 Total number of children examined 11240 „ „ „ „ given warning notices 527 „ „ „ „ excluded as verminous 61 Found to have nits— 1. (Few) 379 2. (Bad) 164 3. (Very Bad) 45 The nurse's visit is a " surprise " visit, and every child in school is examined privately. Those children who are found to have nitty or verminous conditions are given a sealed envelope, addressed to the parent, containing (1) instructions as to the best method of cleansing the head, (2) the name and address of the woman employed by the Education Committee, who would cleanse the head in one sitting for a fee of 1/-, and, (3) a warning that the child will be excluded from school if the head is not properly cleansed. Two clear days after the Survey, a Special Clinic is arranged for the re-examination of these children. Those who have not been properly cleansed are excluded from school. If at the expiration of seven days they are still unclean, the parents render themselves liable to prosecution under the School Attendance Bye-Laws. Mrs. Yates resumed the work of cleansing heads in October. The Committee supplies the Sacker's Comb and Shampoo, and Mrs. Yates receives the 1/- fee per case in oayment for her services. Ninety children were cleansed under the Authority's arrangements during 1935. During 1935 it was found necessary to take legal proceedings in 10 cases, with the following results:— One case Withdrawn. One case Dismissed on payment of costs. Two cases Adjourned Sine Die. Six cases Fined 5/- each. (c). Minor Ailments and Diseases of the Skin. The Minor Ailments Qinics have again proved to be a very active feature of the School Medical Service, and here, as in other branches of our work, the results of an increasing school population continue to be much in evidence. The Qinics are open at 9 a.m. every week-day throughout the year for the treatment of minor ailments at the following centres:— Hounslow—94a, Bath Road. Heston—The Village Hall. Isleworth—Busch House, Busch Corner. A Medical Officer attends the Qinics on the following days:— Hounslow—Tuesdays and Fridays at 10 a.m. Heston—Thursdays at 10.30 a.m. Isleworth—Mondays at 10.30 a.m. 11 Cases are referred to the Qinics from school medical inspections, or are sent in by Head < Teachers, School Attendance Officers, and Health Visitors. The majority of the cases, however, are sent in by Head Teachers, who doubtless realise the value of prompt treatment in maintaining a good school attendance. 886 cases of minor injuries, bruises, sores, chilblains, etc., and 396 cases of skin disease, were treated during the year at the School Clinics. Since the middle of 1929 the Minor Ailments Qinics have been kept open during school holidays (except such general holidays as Christmas Day, Bank Holidays, etc.), but there is always a considerable drop in the attendance when schools are closed, which points to the fact that, but for the vigilance of Teachers and Attendance Officers during term time, many of the cases of minor ailments would go untreated and neglected. The following comparative figures are interesting:— Year. No. of individual children attending Minor Ailments Clinics. Total attendances for treatment. 1930 2,036 8,349 1931 2,413 10,803 1932 2,761 11,057 1933 2,914 10,225 1934 2,695 7,925 1935 2,711 8,691 In addition to providing daily treatment for minor ailments, these Qinics also serve as centres for the more detailed examination of special cases than is possible at routine medical inspections at schools. The following figures show the increase in the number of examinations at School Clinics by Medical Officers:— Year. Total number of Special examinations and Re-examinations by Medical Officer. 1930 2,532 1931 3,534 1932 3,802 1933 3,957 1934 4,646 1935 4,785 Ringworm of the Scalp. In January, 1935, the Education Authority came to an agreement with the St. John's Hospital for Diseases of the Skin, Leicester Square, for the treatment of Ringworm cases. Ten cases were X-rayed there during the year, and eight cases received other forms of treatment. I am able to report that the treatment provided has been in every way satisfactory. One old standing Ringworm case which had failed to clear up after two applications of X-rays was referred to the Hospital. Further X-rays was not advisable, and the child was eventually admitted to the London County Council's Goldie Leigh Hospital, where he remained for two months as an in-patient. On his return home epilation was found to be perfectly satisfactory, and two examinations under the Wood Glass failed to reveal any fluorescent hairs. He was thereupon re-admitted to school. No children are re-admitted to school until they have had two negative examinations at an interval of one week. After re-admission they are kept under observation and re-examined under the Wood's glass filter until the Medical Officer is satisfied that there is no return of the infection. 12 (d). Visual Defects and External Eye Disease. Six hundred and fifteen cases were submitted to refraction. Spectacles were prescribed in 574 cases and obtained before the end of the year in 563 cases. Seven other cases were treated by private arrangement of the parents. Spectacles were prescribed and obtained in six of these cases. A total of 163 external eye defects were treated at the School Qinics during the year. These were chiefly conjunctivitis, blepharitis, with some phlyctenular ulcers and suppurating conditions of the lids. I am indebted to Dr. Roberts, who is in charge of the Refraction Qinic, for the following report:— VISION AND THE REFRACTION CLINIC. Arrangements remain the same as at the latter half of 1934, viz., two sessions weekly at Hounslow and one at Isleworth. In April the Middlesex County Council's Scheme became operative for providing treatment for Secondary Scholars at the local Eye Clinics. During the year 32 Secondary Scholars attended. During May a fire at the Health Department, Hounslow, made it necessary to hold all Eye Clinics at the Isleworth Centre for the following two months, and cut down the sessions to two weekly during that period. In spite of our difficulties however it is pleasant to record that the number of appointments showed a slight increase over 1934 and that the total percentage attendance also improved, being 93.15 against 92.37 last year. The following figures show the work done at the Clinic. TOTAL APPOINTMENTS 2321 TOTAL ATTENDANCES 2162 TOTAL PERCENTAGE ATTENDANCE 93.15 Hounslow Children. Appointments 1620 Attendances 1508 Percentage attendance 93.09 Isleworth Children. Appointments 611 Attendances 564 Percentage attendance 92.31 Secondary Scholars. Appointments 90 Attendances 90 Percentage attendance 100 TOTAL REFRACTIONS 647 SPECTACLES PRESCRIBED 604 SPECTACLES OBTAINED BY END OF YEAR 593 13 Children under Local Authority. Refractions 615 Spectacles prescribed 574 Spectacles obtained by end of year 563 Secondary Scholars. Refractions 32 Spectacles prescribed 32 Spectacles obtained by end of year 30 One hundred and twenty-six sessions were held during the year which gives an average of 18 appointments per session with an average attendance of 17. This figure includes several sessions held during the holidays for the purpose of handing out spectacles prescribed at the end of the term, when the numbers were necessarily smaller than at an ordinary session. Isleworth sessions are definitely smaller than the Hounslow ones, because the numbers consenting to treatment are fewer. At Isleworth the work is always up-to-date and appointments can usually be given within a week of the consent being received, whereas at Hounslow there is always a waiting list and 4-6 weeks is an average delay before the child can be seen. Excluding the 16 sessions held at Isleworth after the fire when Hounslow and Isleworth children were called together, the number of sessions at each centre was:— HOUNSLOW 74 sessions ISLEWORTH 36 sessions Appointments (excluding Secondary Scholars). Hounslow 1451 giving an average of 19.60 per session. Isleworth 459 giving an average of 12.75 per session. Attendances (excluding Secondary Scholars). Hounslow 1358 giving an average of 18.35 per session. Isleworth 423 giving an average of 11.75 per session. E. L. ROBERTS, Deputy School Medical Officer. (e). Nose and Throat Defects. Four hundred and seventy-five children were referred for treatment on account of nose and throat defects. Of this number, 110 were operated on under the arrangements made by the Authority with the Hounslow and Richmond Hospitals in 1921, 45 received operative treatment by private arrangement of the parents, and 7 cases received other forms of treatment. Our methods of arranging operative treatment for tonsils and adenoids remain the same as in past years. A child must be referred for treatment by one of the Medical Officers and the parents are then given an application form on which they are asked to state details of their income and outgoings, number in family, etc. As soon as this form is completed and returned, it is forwarded to the Education Secretary who fixes the amount the parents shall be asked to contribute towards the cost of the operation. The parents are then asked to give their written consent to the operation, and when this is received the child's name and address is sent to the appropriate Hospital. The hospitals make the appointment for treatment, and the Authority pays one guinea for each case operated on. The scale of parents' repayments is as follows:— Weekly family income per head, after deducting rent. Parents' contribution towards cost of operation Under 8/- nil. From 8/- to 10/- 5/- From 10/- to 12/- 10/- Above 12/- 21/- 14 This scale of repayments does not apply to parents who are members of the Hospital Saving Association or the Hospital Saturday Fund. In these cases the parents send in a Voucher in lieu of a contribution, and the Hospital Saving Association and the Hospital Saturday Fund pay an agreed sum per case to the Education Committee. (f). Ear Disease and Defective Hearing. One hundred and sixty cases of ear disease or defective hearing were dealt with at the school clinics, and 7 were treated bv private arrangement of the parents. B.I.P. Paste is still used extensively in the three school clinics and the results are extremely satisfactory. (g). Dental Defects. The progress in the Dental section is still not as rapid as could be desired. The fire at the Health Department in May entailed the removal of the Dental Clinic to the Isleworth Health Centre for a short period. Early in July, however, the tenancy of 35, Bath Road was obtained and the Dental Clinic was installed there. The following additional appointments were made about the same time and the officers commenced duty during the months shown:— Mr. Cook—Third Dental Surgeon—June. Miss Maddick—Dental Attendant—July. Miss Phillips—Dental Clinic Qerk Attendant—June. Miss Redgewell—Dental Clinic Clerk Attendant—June. It was still necessary in 1935 to engage temporary Dental Surgeons and for the whole year the work done by the various Dental Surgeons amounted in terms of sessions to approximately three whole time officers. The following is extracted from the Dental Surgeon's report:— Inspections. The number of routine dental inspections amounted to 8,928. In 1934 the figure was 5,949, and in the previous year, 2,745. With regard to the Board's Table IV., Group V. (Dental Defects, page 33), it should be noted that the number of "Specials," 2219, represents special "Inspections" of various kinds at the Clinic and not individual children. Some of these Specials will also have had a Routine Dental Inspection and be included in these figures. They also may have had to be referred more than once as Specials, and will thus have been recorded on each occasion as a special inspection. The 2,219 are made up of the following types of cases :— (1) Referred for Gas, or Gas and Ethyl Chloride Hounslow. Isleworth. (2) Advice given 1,643 576 (3) Treatment postponed (4) Inspection after Gas—required further treatment Total 2,219 15 Conservative Treatment. It may be said that the chief aim of the treatment here is towards conserving the teeth, keeping extractions down to a minimum. This is indicated by the fillings figure—8,486, which works out at 155 fillings per 100 children treated, whilst the number of permanent teeth filled— 7,204 works out at 133 permanent teeth filled per 100 children treated. Extractions. The number of teeth extracted was 9,257 (1,839 Permanent; 7,418 Temporary). This works out at 33 permanent teeth extracted per 100 children treated. Statistics. A plea is here entered to all those colleagues upon whom the duty of reporting lies, to make their statistics on the lines here attempted, or alternatively, to suggest a better standard by which the activities of various Clinics can be better compared. The form of the Board's Table IV. showing dental defects has again been amplified (see below) in order to show items of information which may help towards the proper comparison of the dental statistics of different Authorities. A better appreciation of their import is conveyed to the reader if opposite certain figures percentages and notes are given throughout the whole table, where possible and applicable. DENTAL INSPECTION AND TREATMENT—YEAR 1935. Number of Elementary School children on registers at middle of year, June—11,284. Age. No. Remarks. 1. No. of children S 945 (a) who were inspected at Routine Dental Inspections 6 989 7 971 8 1000 9 1034 10 966 11 1001 12 785 13 917 14 248 15 42 — 8898 No. of Special Inspections 2219 (b) No. of Children found to require treatment at Routine Dental Inspections 8187 (b) This equals 92 per cent, of the children inspected at Routine Inspections. (c) No. of Children actually treated 5463 (c) In arriving at this figure each child is only counted once even though it attended seveial times during the year for treatment. 2. Half days devoted to Inspection 68 2. Average number inspected per session— 130. Included in the 1109 ordinary treatment sessions are 60 sessions which were entirely devoted to Orthodontic Treatment. These sessional figures are for approximately 3 whole time dental surgeons. (see below). Treatment—Ordinary 1109 do. Gas 188 Administration—Clerical 35 Dental Committee Meetings 8 — 1408 3. Attendances made by children for treatment 15565 3. The Gross attendances made by children at the Dental Clinic were 17,965, but children were not always physically treated, for various reasons, every time they attended. 16  No. Remarks. 4. Fillings— 4. The ratio of fillings in permanent teeth to extractions of permanent teeth was 391 fillings to 100 extractions. Permanent Teeth 7204 Temporary Teeth 1282 — 8486 5. Extractions— Perm. Temp. At Treatment Sessions 17 981 At Gas Sessions 1822 6437 Total 9257 6. Administrations of general anaesthetics % 2686 6. The percentage of attendances for "Gas," 2,786, of total attendances for treatment, 15,565, was 17.8. 7. Other Operations 6109 The 2,786 "administrations of general anaesthetics for extractions" represents the number of times gas was given, and not the number of sessions devoted to extractions under gas, which was 188. Staff responsible for the above work:— 1 Senior Dental Surgeon whole time (whole year). Equivalent, in terms of sessions, to just over three whole time Dental Surgeons for whole year. I Junior „ „ „ „ „ „ 1 Junior „ „ „ „ (from June). Temporary Dental Surgeons on Sessional basis. 1 Approved Dental Nurse. 2 Clerk Attendants. 2 Junior Clerk Attendants. Plus some clerical assistance from the Office of the School Medical Officer. Extra Staff for each Gas Session. 1 Anaesthetist. 1 Trained Nurse (Recovery Room). For Orthodontic Sessions. Orthodontic Consultant—1 session per month. Dental Mechanic—Once a week. Dentures for School Children. In three cases dentures were supplied for school children where the state of the mouth left by the necessary extractions was such that it was imperative to supply dentures to replace the teeth removed. These are charged for on the same scale as for dentures supplied to mothers under the Maternity and Child Welfare Dental Scheme. Other Operations. The figure shown in the Table—6109—is made up as follows, and is, of course, considerably augmented by the Orthodontic scheme, as this work in statistical form cannot be shown elsewhere in the Board's Table :— Silver Nitrate Treatment 626 Dressings 723 Scaling and Polishing Teeth 83 Treatment of Gums 152 Separating Teeth 4 Destroying the Pulp 3 17 Orthodontic Cases (Advice) 410 Impressions taken 1881 Orthodontic Appliances fitted 187 Orthodontically treated 2040 6,109 Attendances made by Children for Treatment. The figure 15,565 shown in the Board's Table is not the gross figure of school children's attendances at the Dental Clinic, which was 17,965, all of which were nominally " attendances for treatment," but, although making such attendances, only 15,565 were treated physically, the remainder being referred for gas, inspected, treatment postponed, etc., which latter classes of attendances were counted as special inspections. It will be seen that the number of attendances made by children for treatment showed an appreciable increase over the figures for 1934. Emergency Cases. This branch of the dental service has now been running for five years and is much appreciated. In order to save children from suffering pain, a scheme was devised whereby any urgent dental case could be referred by any Head Teacher to the Clinic at 1.45 p.m. on any day when the schools were open. On coming into the Clinic these cases are dealt with in addition to the normal appointments, and lake precedence over them. During the year 1935, 869 cases were so referred by Head Teachers. These facilities prove a great boon for teachers and children, and teachers are now using the greatest care in only sending us cases of children in pain. Here and there a parent gets an emergency ticket for a child not in pain, and in these cases, the teacher is always informed and left to deal with the parent concerned. I am very happy to be able to state at the outset that my experience as Consultant during the past year permits me, without hesitation to endorse the several satisfactory statements which I brought to your notice in my reports dealing with earlier years. Throughout 1935 there has been maintained that increase in the number of new cases treated, to which I drew your attention in my report for the year 1934. The total number of patients passing through my hands during the last year equalled the number received in 1934. Once again all prospective patients have received treatment with the minimum of delay, no matter whether their attendance was the result of an earlier examination by the Clinic Staff in the course of their normal routine dental inspections, or whether they were children who had been brought direct to the Clinic voluntarily by their parents. This comprehensiveness in the work carried out by the Orthodontic Section whereby all cases of mallocclusion are ensured speedy treatment has always been a notable and exceptional feature of the organisation of your Clinic. Looking back on the past year I find it once more a matter for satisfaction to be able to place on record the fact that this desirable state of affairs continues. I. COHEN, L.D.S., R.C.S., ENG. School Dental Surgeon. ANNUAL REPORT OF ORTHODONTIC CONSULTANT. Comprehensiveness of Treatment. 18 Dental Routine Undisturbed. Thanks to the willing and intelligent co-operation of the entire Dental Staff it has been a simple matter to handle the large number of cases encountered throughout 1935 without loss of time or derangement of the regular routine and working schedule of the ordinary dental procedure. Neither the normal programme nor the regular time table of the Dental Clinic has been upset or interrupted in any way by the additional and specialised treatment carried out at the weekly orthodontic sessions. Reduction in Fees. The question of fees is always a matter of paramount importance in clinic administration. I think it is therefore opportune to point out how gratified I was to find that during 1935 it became possible to introduce a reduction in the fees charged by the Orthodontic Section. The flat rate for orthodontic cases has been lowered to 25/- per patient, viz:— 15/- per consultation, with an additional charge of 10/- in those instances where use of an appliance has been deemed necessary. Moreover this rate has been made adjustable in order to suit the circumstances of the patient's parents. Indeed where it has been obvious that there was a condition of extreme poverty, both consultation and treatment have been provided free of all charge whatsoever. Parents' Co-operation. Mention of parents prompts me to say that the progressive increase in " orthodontic mindedness " amongst the parents (which I was pleased to remark in previous years) has developed in a most satisfactory manner during 1935. Without the parents' recognition of and confidence in the Orthodontic Section it would be difficult to make much headway in the execution of that preventitive treatment which is always the aim and ambition of orthodontia. Given the support and interest of the parents it becomes a matter of comparative certainty that all cases of malocclusion discovered amongst the children attending the Borough Schools will be brought before the Qinic in ample time to enable full and final treatment to be completed well before the patients arrive at the school leaving age. Aim of Treatment. In carrying out the treatment on the cases passing through the Qinic during last year I have continued to employ removable appliances only. The use of fixed apparatus entails higher costs and necessitates a longer period of treatment, neither of which is desirable at clinic centres. Careful attention has also been paid to preventitive treatment in the early stages of malocclusion, thereby lessening the possibilities of serious developments at a later date. In those instances where extraction has been adjudged expedient as a preventitive measure the importance of the subsequent use of splint plates has not been lost sight of. Such after treatment is almost invariably successful in checking the travelling of other teeth which condition, if allowed to occur, would in all probability result in overcrowding at a subsequent stage. In Conclusion. I consider that the continued success of the weekly orthodontic session during 1935 is a success not only from the point of view of the beneficial results achieved in the treatment of a large number of cases, but is also practical proof of the ability of the Dental Clinic to incorporate in its annual programme the treatment of malocclusion without sacrificing efficiency in its other branches. The arrival at such a conclusion after my experience at your Clinic in 1935 affords me no small measure of satisfaction, a satisfaction which must perforce be shared by all concerned in the organisation and execution of the year's work at this pioneer Clinic. 19 I am therefore more than ever convinced that the preventitive treatment afforded by orthodontics must eventually lead to a reduction in the amount of normal dental work which would otherwise fall on the Clinic. This being granted, it appears to me that in the long run orthodontic sections cannot cause interference with routine dental procedure at any Clinic, and such sections should therefore be instituted throughout the Country. I would even go so far as to state that in my opinion it is a far better thing to countenance the risk of caries provided orthodontic treatment is carried out if by so doing the child's future general good health is assured. H. R. EVANS, L.D.S., R.C.S., ENG. Orthodontic Consultant. Orthodontic Demonstrator, Children's Department, Royal Dental Hospital. (h). Orthopaedic and Postural Defects. Although handicapped by the absence of a Clinic for the supervision of crippling defects, we have, nevertheless, been able to secure expert advice for such cases as have been found to require it. This is due entirely to the co-operation of the Royal National Orthopaedic Hospital, at whose Out-patient Department 29 school children from this area attended during the year. Seven children were admitted to the Royal National Orthopaedic Hospital for in-patient treatment, the Education Authority accepting responsibility for the Hospital charges. The conditions for which these children were treated were:— Torticollis. Thickening of Os Calcis. Structural Scoliosis. Left Club Foot. Septic Arthritis Left Hip. Old Infantile Paralysis. Old Poliomyelitis. Two other children obtained in-patient treatment at the Royal National Orthopaedic Hospital by private arrangement of the parents. The conditions were respectively:— Post fracture deformity. Congenital dislocation left hip. Seventeen children received non-residential treatment of various forms, e.g., Exercises ; Manipulation and Special Boots. (i). Heart Disease and Rheumatism. We have no arrangements for the medical treatment of cases of heart disease and rheumatism, but all cases which we discover are referred to Hospitals for expert opinion and advice. These cases, however, are kept under observation at the school clinics, where they attend regularly. Many cases attend school half-days for a period, or have otherwise modified curricula. (j). Tuberculosis. The treatment of tuberculosis is in the hands of the Middlesex County Council. Any suspicious case is immediately referred to the County Tuberculosis Officer, with whose Dispensary in Bell Road we are in constant touch. 8.—INFECTIOUS DISEASE. The rules as to the exclusion of infected children and contacts as laid down by the Ministry of Health and Board of Education in the joint Memorandum of 1927, have been carefully followed. Early in the year a scheme was evolved for following up cases of infectious disease. By agreement with the Medical Superintendent of Mogden Isolation Hospital we are notified of every case where there are special conditions that require supervision after discharge. These cases are seen by a member of the Authority's Medical Staff and are kept under observation at the Qinic. 20 The following table shows the infectious disease which occurred among children attending public elementary schools during 1935 and the five previous years. 1935 1934 1933 1932 1931 1930 Small-pox — — — — — 2 Scarlet Fever 124 210 186 105 106 77 Diphtheria 37 44 17 30 26 88 Measles 10 901 108 952 9 799 German Measles 6 66 13 25 5 38 Mumps 113 153 940 122 132 381 Chicken-pox 537 417 362 194 233 392 Whooping Cough 232 144 287 260 242 144 1059 1935 1913 1688 753 1921 This table shows the incidence of infectious disease in each school during 1934:— school. scarlet fever diphtheria. measles german measles mumps chicken pox whooping cough Alexandra Junior 2 1 — — — 11 — „ Infants 22 1 — — 4 26 4 Berkeley Junior Mixed & Infants 2 2 — — 2 43 22 Brentford End Infants 1 — — — — 1 3 Bulstrode Senior Boys 2 2 — — — — — „ „ Girls 1 1 1 — 2 1 — Chatsworth Infants 17 1 — — 2 11 27 Cranford C. of E. Infants 2 — — — 1 15 22 „ Temporary Council Junior — — — — — 2 — Grove Road Junior Mixed 3 7 — — 3 3 — „ „ Infants 6 1 — — 6 83 2 Heston Senior Mixed — — — — — 5 — „ Junior Mixed 4 1 — — 1 75 — „ Infants 19 — — 3 2 46 65 Hounslow Heath Senior Mixed 2 1 — — — 1 — „ „ Junior Boys 2 1 — — 2 13 2 „ „ Junior Girls 1 — — 1 2 10 1 „ „ Infants 3 2 2 2 3 76 21 Hounslow R.C. Mixed & Infants 3 — — — 5 2 — Hounslow Town Junior Boys 1 1 — — 9 2 — „ „ Junior Girls & Infants 17 3 2 — 20 10 20 Isleworth Blue Boys — — — — .2 — — „ „ Girls & Infants 1 — — — 22 — 2 Isleworth Town Junior Mixed 1 — — — 2 1 1 „ „ Infants 2 1 3 — 1 5 1 Marlborough Senior Mixed — — 1 — 2 3 1 St. Mary's Boys — — — — 1 1 — „ Girls & Infants — — — — — — — Spring Grove Central 2 2 — — 1 2 — „ „ Junior Mixed & Infants 2 2 — — — 73 20 Wellington Junior 1 — 1 — — 1 2 Woodlands St. John's Infants 1 — — — 1 1 11 Worple Road Junior Mixed 1 1 — — 7 1 — „ „ Infants 3 6 — — 10 13 5 124 37 10 6 113 537 232 The School Nurses continue to visit all cases of non-notifiable infectious disease, and, as has been pointed out in previous years, this work takes up a considerable part of the nurses' visiting time, and when the number of cases is large the other work suffers to some extent. 21 As usual in cases of Diphtheria, all home contacts have been swabbed, and in cases where it was thought that the infection might be in the school, all school contacts have also been examined. The campaign in regard to immunisation against Diphtheria has been continued during the year, and a full report of this work will appear in my Annual Report as Medical Officer of Health. (a). Playground Classes. A number of playground classes are held during the summer months and an encouragement to the holding of these classes has been that a number of classrooms in Schools have been provided with additional doors opening directly on to the playground and all obsolete furniture in Infants' Schools has been replaced by tables and chairs so that the children can easily take their chairs out into the playground. (b). Open-Air Classrooms in Elementary Schools. The Schools planned during last year and where building has already commenced or about to commence have open air classrooms, i.e., the whole of one side is formed of French windows in two cases and in the third case two sides can be completely thrown open with a two feet wall below. (c). School Journeys and Camps. Three School Journeys took place, one for a week to Surrey, one for a week to Swanage, one for 10 days to Ryde and in addition a party of boys went to camp at Lyme Regis during the holidays. Approval of the Board of Education has been given to the building of a gymnasium for Spring Grove Central School to be used also for Evening Institute work and two fully trained gymnastic teachers are now working at this School. The facilities for Swimming have increased and attendances at the Baths have increased from 14,000 in 1923 to 23,000 in 1934 and 23,600 in 1935. There has been an alteration in Swimming Tests during the year increasing the difficulty of the Second Test and bringing in backstroke swimming. The Schools' Swimming Gala has been split into two, one for Senior Schools and one for Junior Schools to the great benefit of both. (a). Dinners. The scheme for the provision of dinners for school children has continued throughout the year. The dinners are served at five cafes. The cafes and the meals have been inspected periodically by the medical staff to ensure that they are up to the necessary standard. The following menus were supplied to the caterers for their guidance:— 9.—OPEN-AIR EDUCATION 10.—PHYSICAL TRAINING. 11.—PROVISION OF MEALS. Dinners—Summer. First Week. Second Week. Sunday. Corned Beef or Roast Beef. Salad. Potatoes. Jam Tarts and Custard. Cold Boiled Ham. Salad Potatoes. Baked Swiss Apple Pudding. Monday. Shepherds Pie and Haricots. Rice Pudding. Mixed Vegetable Soup. Baked Ginger Pudding. 22  First Week. d Week. Tuesday. Lentil and Tomato Roast. Potatoes and Brown Gravy. Custard and Stewed Gooseberries. Roast Beef and Yorkshire Pudding. Potatoes and Greens. Raw Fruit. Wednesday. Roast Leg of Mutton. Potatoes. Flageolets. Raw Fruit Salad. Egg and Cheese Salad. Bread and Butter. Boiled Apple Pudding. Thursday. Dutch Roll. Greens and Potatoes. Boiled Raisin Pudding. Stewed Steak and Savoury Balls. Thick Brown Gravy and Carrots. Baked Bread Pudding. Friday. Salmon Salad. Potatoes. Eve's Pudding. Baked Fish. Potatoes and Beans and Parsley Sauce. Ground Rice Pudding and Stewed Plums. Saturday. Steak and Kidney Pie. Potatoes and Greens. Fruit Mould. Baked Sausages and Onions. Tomatoes and Potatoes. Lemon Pudding. Dinners—W inter. Sunday. Roast Beef. Yorkshire Pudding. Greens, Potatoes. Raw Fruit. Roast Mutton. Greens and Potatoes. Stewed Gooseberries and Custard. Monday. Shepherds Pie and Haricots. Rice Pudding. Mixed Vegetable Soup. Baked Ginger Pudding and Treacle Sauce. Tuesday. Irish Stew. Peas. Eve's Pudding. Dutch Roll. Greens and Potatoes. Boiled Apple Pudding. Wednesday. Vienna Steaks. Mashed Turnips and Potatoes. Ground Rice Pudding. Roast Beef and Suet Pudding. Potatoes and Greens. Apples or Figs. Thursday. Toad in the Hole. Greens and Potatoes. Stewed Plums and Custard. Stewed Steak and Savoury Balls. Thick Brown Gravy and Carrots. Baked Bread Pudding. Friday. Lentil Soup. Boiled Raisin Pudding. Baked Fish, Parsley Sauce. Potatoes and Butter Beans. Jam Roly Poly. Saturday. Steak and Kidney Pudding. Potatoes and Parsnips. Raw Fruit. Baked Sausages and Onions. Tomatoes and Potatoes. Rice Pudding These meals can be supplied at 7d. a day to any elementary school child. During December 119 necessitous children received dinners free, 9 at quarter cost, and 4 at half cost. (b). Milk. On the 1st October, 1935 (the date of the Board's Return-Form 208.M.) 5,275 children were having milk daily at school. One hundred and twenty of these were having milk free, and 5,155 were paying part or full cost. 12—CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. Every effort is made to secure the co-operation of parents in the work of the doctors, dentists and nurses. Parents are invited to attend all routine medical inspections and during 1935 a parent or other relative attended in 3,131 instances, representing 80.7 per cent. Parents are urged also to attend the Treatment Clinics and it is gratifying to find that an increasing number of parents do attend and show their desire to obtain, and assist in the treatment of their children. The assistance given by teachers is of the greatest value to the School Medical Service. They make all arrangements for routine medical inspections, and help us considerably in referring cases to the Clinics, by ensuring regular attendance there, and in their reports on backward and defective children. It is realised that this assistance involves considerable trouble and is frequently given when time is short. The Attendance Officers are able to render considerable assistance to the School Medical Service, and frequently refer children who are brought to their notice on account of alleged 23 illness. Prompt notification by an Attendance Officer of a suspicious sore throat, or rash, has frequently directed early attention to a case of Infectious Disease. They also undertake the verification of returns of income made by parents when applying for various forms of assistance. The Public Assistance Committee has very kindly given assistance in one or two cases during the year, and the Invalid Children's Aid Association has, we know, dealt with some of our school children. The Middlesex Edward VII. Memorial Fund from time to time provides a seaside holiday or convalescence for a few necessitous children. The National Society for the Prevention of Cruelty to Children has continued to render valuable assistance in cases of parental neglect, several cases having been referred to the Society during the year. The following Societies render all possible assistance where required:—Hounslow, Heston and Whitton Philanthropic Society; The Isleworth, Spring Grove and St. Margaret's Philanthropic Society; The Shaftesbury Society and Ragged School Union; The United Services Fund, and the British Legion. 13—BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Every effort is made to keep the list of these cases up-to-date. The Health Visitors are able to report some cases before they reach school age, others are discovered at the Infant Welfare Centres, and we never lose sight of them afterwards. Head Teachers inform us of cases, and we rely on the School Attendance Officers to bring to our notice those defective children who do not attend school. There are no Special Schools in the district. All mentally abnormal children, other than those who have been notified to the Local Mental Deficiency Authority, are re-examined frequently and in any case not less than once in twelve months. Psychological cases, as I mentioned last year, keep dropping in and present their problems for elucidation. At the end of 1935 there were 36 children being maintained by the Education Committee at institutions outside the district. Six children were in Schools for the Blind, and two were in a School for the Partially Sighted. In addition to these 8 children who are in Special Schools, we have 26 children attending elementary schools in the area who suffer from a high degree of myopia. Ten of these have been supplied with special desks. Each of the 26 children has special consideration at school, and the Head Teachers and Class Teachers are supplied with instructions as to the best position for the child in the class-room ; the type of work that can be allowed, etc. The teachers are asked to pass the leaflet of instructions on as the child is promoted. Four of the children have vision so defective that in accordance with the Board of Education's definition in Table III., they must be classified as partially sighted. These four children should be in a special school or class for such cases. Ten children were in schools for the Deaf. Two were in schools for the Mentally Defective. Six were in schools for Epileptics. Three were in Schools for Cripples, and one was at the Royal National Orthopaedic Hospital's Country Branch, Stanmore. Six were at Residential Open-Air Schools. 14.—FULL-TIME COURSES OF HIGHER EDUCATION FOR BLIND, DEAF, DEFECTIVE AND EPILEPTIC STUDENTS. Nothing has been done under this heading by the Authority during the year. 15—NURSERY SCHOOLS. There are no nursery schools in the area. 24 16.—SECONDARY SCHOOLS AND OTHER INSTITUTIONS OF HIGHER EDUCATION. The Middlesex County Council's scheme for the Dental Inspection and Treatment and Ophthalmic treatment of Secondary School children by this Authority came into force on the 1st April, 1935. The arrangement, which we have accepted in common with other Local Education Authorities in Middlesex, provides for Dental Inspection at a fee of £2 2s. 0d., per session, with an average of 80 to 100 children inspected per session ; and treatment at a fee of 6s. 8d., per pupil. The selection of pupils to be referred to the Eye Clinic rests with the Middlesex Education Committee's Inspecting Medical Officer. A fee of 7s. 6d., is paid per pupil submitted to refraction, plus a flat rate of 5s. 0d., per pair cf spectacles. We have found this scheme simple to operate, and before the end of the year a Dental Inspection was held at all the Secondary Schools in the Borough. 1180 children were inspected, and of these 1125 were found to need dental treatment. 374 children received treatment before the end of the year. 32 Ophthalmic cases were dealt with and all were found to need spectacles. 30 children obtained spectacles under the scheme during the year. One child obtained them privately, and the remaining case obtained spectacles early in January, 1936. See Statistical Tables on page 34. 17.—PARENTS' PAYMENTS. There has been no change in the details set out in my report for 1934—except that the Education Committee now accept Hospital Saturday Fund Vouchers in connection with tonsillectomy and the supply of spectacles. Mrs. Yates has now resumed the cleansing of heads, and receives the 1/- fee in the same way that Mr. Arnell did in payment for the work done. 18.—HEALTH EDUCATION. During the year eight parties of girl "leavers" visited the Douglas Road M. & C. W. Centre. Four of these parties were from the Spring Grove Central School and four from the Bulstrode Senior Girls' School. Each party was received by the Health Visitor who explained the activities of the Centre, and the Medical Officer in charge gave a talk on the work and objects of the Maternity and Child Welfare Scheme. 19.—SPECIAL ENQUIRIES. No special enquiries have been carried out during the year. 20.—MISCELLANEOUS. Seven teachers were medically examined during the year in connection with their appointments on the teaching staff of the Authority . Under an arrangement with the Middlesex County Council and the Central Association for Mental Welfare we have undertaken the annual medical inspection of the children attending the Hounslow Occupation Centre. Twenty-five children were examined during 1935. 25 ELEMENTARY SCHOOLS STATISTICAL TABLES TABLE I—MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups— Entrants 1293 Second Age Group 1383 Third Age Group 967 Total 3643 Number of other Routine Inspections 235 Grand Total 3878 B.—Other Inspections. Number of Special Inspections 2119 Number of Re-Inspections 4598 Total 6717 C.—Children found to require Treatment. Number of individual children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Prescribed Groups— Entrants 193 Second Age Group 132 Third Age Group 92 Total (Prescribed Groups) 417 Other Routine Inspections 16 Grand Total 433 TABLE 11. A. RETURN OF DEFECTS found by Medical Inspection in the Year ended 31st December, 1935. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. 1 2 3 4 5 Skin (1) Ringworm—Scalp ... ... 7 ... (2) „ Body ... ... 18 ... (3) Scabies ... ... 22 1 (4) Impetigo ... ... 231 ... (5) Other Diseases (Non-Tuberculous) 1 3 148 1 TOTAL (Heads 1 to 5) 1 3 426 2 26 TABLE II.—continued. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. Requiring treatment Requiring to be kept under observation, but not requiring treatment. 1 2 3 4 5 Eye (6) Blepharitis 1 3 35 ... (7) Conjunctivitis ... ... 61 1 (8) Keratitis ... ... ... (9) Corneal Opacities ... ... 1 ... (10) Other Conditions (excluding Defective Vision and Squint) ... 1 94 ... TOTAL (Heads 6 to 10) 1 4 191 1 (11) Defective Vision (excluding Squint) 170 5 87 ... (12) Squint 6 1 19 ... Ear (13) Defective Hearing 3 2 17 1 (14) Otitis Media ... ... 81 ... (15) Other Ear Diseases ... ... 52 3 Nose and Throat (16) Chronic Tonsillitis only 111 42 95 19 (17) Adenoids only 2 1 4 5 (18) Chronic Tonsillitis and Adenoids 97 52 48 6 (19) Other Conditions 1 39 117 17 (20) Enlarged Cervical Glands (Non-Tuberculous) 35 59 39 10 (21) Defective Speech ... ... ... ... Heart and Circulation Heart Disease: (22) Organic ... ... 7 9 (23) Functional 1 31 5 18 (24) Anaemia ... 7 3 1 Lungs (25) Bronchitis 1 4 22 10 (26) Other Non-Tuberculous Diseases 3 33 32 15 Tuberculosis Pulmonary:— (27) Definite ... ... ... ... (28) Suspected ... ... ... ... Non-Pulmonary:— (29) Glands ... ... ... ... (30) Bones and Joints ... ... ... ... (31) Skin ... ... ... ... (32) Other Forms ... ... ... ... TOTAL (Heads 29 to 32) ... ... ... ... Nervous System (33) Epilepsy ... ... 2 ... (34) Chorea ... ... 2 1 (35) Other Conditions ... 3 7 5 Deformities (36) Rickets ... ... 1 1 (37) Spinal Curvature ... 2 2 1 (38) Other Forms 1 9 25 11 (39) Other Defects and Diseases (excluding Uncleanliness and Dental Diseases ... 8 1267 101 Total 431 298 1934 235 27 B. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Age-groups Number of Children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Entrants 1293 7 0.5 1116 86.3 170 13.2 — — Second Age-group 1383 8 0.58 1160 83.87 215 15.55 — — Third Age-group 967 3 0.31 784 81.08 180 18.61 - — Other Routine Inspections 235 5 2.13 192 81.7 38 16.17 - — TOTAL 3878 23 0.61 3252 83.85 603 15.54 - — TABLE III.—RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Children suffering from Multiple Defects, i.e., any combination of Total Blindness, Total Deafness, Mental Defect, Epilepsy, Active Tuberculosis, Crippling, or Heart Disease 2* *See details on page 30. BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 5 — — — 5 PARTIALLY SIGHTED CHILDREN. At Certified Schools for the Blind. At Certified Schools for the Partially Sighted. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 1 2 4 — — 7 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 10 — — — 10 28 TABLE III.—continued. PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — — — — — — MENTALLY DEFECTIVE CHILDREN. Feeble-Minded Children. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 2 18 1 6 27 EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 6 — 1 2 9 PHYSICALLY DEFECTIVE CHILDREN. A. Tuberculous Children. I.—CHILDREN SUFFERING FROM PULMONARY TUBERCULOSIS. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 3 — — 2 5 II.—CHILDREN SUFFERING FROM NON-PULMONARY TUBERCULOSIS. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 2 — — 4 6 B. Delicate Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 9 219 1 - 229 29 TABLE III.—continued. C. Crippled Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 5 23 1 9 38 D. Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — — — 3 3 Children Suffering from Multiple Defects:— Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School, or Institution. Total. Mental Defect (Feeble Minded) and Severe Epilepsy. 1 1 *Mental Defect (Feeble Minded) and suspected Epilepsy. 1 1 * Three Special Schools have rejected this case. 30 STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1935, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. Total Number of Children notified 8 Analysis of the above Total. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots 2 1 (b) Imbeciles — 4 (c) Others — — (ii) Children unable to be instructed in a Special School without detriment to the interests of other children: (a) Moral defectives — — (b) Others — — 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 — 1 3. Feeble-minded children notified under Article 3, i.e., "special circumstances " cases — — 4. Children who in addition to being mentally defective were blind or deaf — — Grand Total 2 6 31 TABLE IV.—RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1935. TREATMENT TABLE. GROUP I.—MINOR AILMENTS (excluding Uncleanliness, for which see Group VI.). Disease or Defect. No. of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise Total. (1) (2) (3) (4) Skin— Ringworm-Scalp. (1) X-Ray Treatment 10 — 10 (2) Other 8 — 8 Ring worm-Body 18 — Scabies 21 3 24 Impetigo 224 2 226 Other skin disease 133 10 143 Minor Eye Defects 163 7 170 (External and other, but excluding cases falling in Group II). Minor Ear Defects 160 7 167 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc). 886 38 924 Total 1623 67 1690 GROUP II.—DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease (i) No. of defects dealt with No. of children for whom spectacles were Under the Authority's Scheme (2) Otherwise (3) Total (4) Prescribed (1) Obtained (2) (i) Under the Authority's Scheme (ii) Otherwise (i) Under the Authority's Scheme (ii) Otherwise Errors of Refraction (including squint) 615 6 621 574 6 563 6 Other defect or disease of the Eyes (excluding those recorded in Group I). - 1 1 - - - - Total 615 7 622 32 TABLE IV.—continued. GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. NUMBER OF DEFECTS Received Operative Treatment. Received other forms of Treatment (4) Total Number Treated (5) Under the Authority's Scheme in Clinic or Hospital (i) By Private Practitioner or Hospital, apart from the Authority's Scheme. (2) Total (3) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) — 1 109 — 7 — 37 1 7 1 146 1 7 162 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. GROUP IV—ORTHOPAEDIC AND POSTURAL DEFECTS. Under the Authority's Scheme. (1) Otherwise (2) Total number treated. Residential treatment with education. (i) Residential treatment without education. (ii) Non-residential treatment at an orthopaedic clinic (iii) Residential treatment with education. (i) Residential treatment without education. (ii) Non-residential treatment at an Orthopaedic clinic. (iii) Number of children treated 7 — 17 2 — 12 37 GROUP V.—DENTAL DEFECTS. (1) Number of children inspected by the Dentist (a.) Routine age-groups. AGE 5 6 7 8 9 10 11 12 13 14 15 TOTAL Number 945 989 971 1000 1034 966 1001 785 917 248 42 8898 (b) Specials 2219 (c) TOTAL (Routine and Specials) 11117 (2) Number found to require treatment 8187 (3) Number actually treated 5463 (4) Attendances made by children for treatment 15565 (5) Half-days devoted to:— Inspection 68 Ordinary 1109 Treatment Gas 188 Administrative Clerical 35 Administrative Committee Meetings 8 1408 (6) Fillings (see note (g)):— Permanent Teeth 7204 Temporary Teeth 1282 Total 8486 (7) Extractions:— Permanent Teeth 1839 Temporary Teeth 7418 Total 9257 (8) Administrations of general anaesthetics for extractions 2686 (9) Other Operations:— Permanent Teeth 6019 Temporary Teeth Total 6109 33 GROUP VI.—UNCLEANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 2.05 (ii) Total number of examinations of children in the Schools by School Nurses 11,240 (iii) Number of individual children found unclean 587 (iv) Number of children cleansed under arrangements made by the Local Education Authority 90 (v) Number of cases in which legal proceedings were taken (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws 10 SECONDARY SCHOOLS STATISTICAL TABLES TABLE IV.—OPHTHALMIC TREATMENT AND DENTAL INSPECTION AND TREATMENT OF SECONDARY SCHOOL CHILDREN. GROUP II. DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments). No. of Defects Dealt with. Under the Authority's Scheme Otherwise Total ERRORS OF REFRACTION (including squint) 32 — 32 Other defect or disease of the eyes (excluding those recorded in Group I) — — — Total 32 — 32 Under the Authority's Scheme Otherwise Total No. of Children for whom spectacles were (a) Prescribed 32 — 32 (b) Obtained 30 1 31* The one outstanding case obtained glasses early in January, 1936. TABLE V.—DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist (a) Routine age-groups AGE 10 11 12 13 14 15 TOTAL Number 3 59 297 224 265 332 1180 34 (b) Specials 257 (c) TOTAL (Routine and Specials) 1437 (2) Number found to require treatment 1125 (3) Number actually treated 374 (4) Attendances made by children for treatment 1327 (5) Half-days devoted to:— Inspection 15 Treatment * Total (6) Fillings:— Permanent Teeth 1255 Temporary-Teeth 5 Total 1260 (7) Extractions :— Permanent Teeth 311 Temporary Teeth 5 Total 366 (8) Administrations of general anaesthetics for extractions 157 (9) Other Operations:— Permanent Teeth Temporary Teeth 206 Total 206 *Separate treatment sessions have not been arranged exclusively for Secondary School children. The children have been treated at the ordinary sessions at which Maternity and Child Welfare and Elementary School cases attend. 35 G.W. BARBER & CO (T.U.) 77, Hanworth Road, Hounslow. %