BOROUGH of HESTON and ISLEWORTH 1936 Annual OF THE MEDICAL OFFICER OF HEALTH SCHOOL MEDICAL OFFICER FOR THE BOROUGH of HESTON and ISLEWORTH For the Year Ended 31 lst December, 1936 1936 REPORT ON THE HEALTH OF THE BOROUGH OF HESTON & ISLEWORTH FOR THE YEAR 1936 BY ELWIN H. T. NASH, m.r.c.s., m.r.c.p, d.p.h.. Medical Officer of Health. Index Airport, Heston 41 Ambulance Facilities 14 Ante-Natal Care 43 Birth Rates 8, 9, 10 Blindness, Prevention of 41 Canal Boats 24 Chicken Pox 36 Children Act (foster-children) 16 Cleansing of Verminous Persons 36 Clinics and Treatment Centres 15 Deaths, Causes of 11 Death Rates 8, 9, 10 Dentures for Mothers 44 Diphtheria 8, 34, 35, 36, 37, 38, 39, 40 Diphtheria Immunisation 35 Drainage and Sewerage 17, 20, 21 Encephalitis Lethargica 36 Enteric Fever 36 Erysipelas 36 Factory and Workshop Act, 1901 23 Food, Inspection and Supervision of 33 General Provision of Health Services in the Area 13 Home Help 46 Home Visiting 45 Hospitals 14 Housing 25 Industries, Local 9, 10 Infant Deaths 8, 9, 10, 12 Infant Life Protection 16 Infectious Diseases 34, 39 Influenza 8, 36 Inspection and Supervision of Food 32 Laboratory Statistics 13, 14 Maternal Mortality 9, 43, 44 Maternity and Child Welfare—Attendances at Centres 42 „ „ Centres 15, 42 „ „ Dental Treatment 44, 45 „ „ General Arrangements 42, 46 „ „ Grants of Milk 46 Measles 36 Meat 19, 32, 33 Midwives 13 Milk 32 „ Grants to Expectant and Nursing Mothers and to Children under three years 46 Mumps 36 Notification of Births 42 Nursing in the Home 13 Nutrition Research—Carnegie Grant 47, 50 Ophthalmia Neonatorum 46 Pneumonia 36, 38, 39, 40 Population 9 Puerperal Fever 36, 38, 39, 40 Puerperal Pyrexia 36, 38, 39, 40 Sanitary Circumstances of the Area Scarlet Fever 8,34,38,39,40 Scavenging 17 Smallpox 36 Smoke Abatement 20,22 Staff 7 Swimming Baths and Pools Tuberculosis 37 Venereal Diseases 8,9,10 Vital Statistics 45 Voluntary Societies and Helpers 17 Water Supply 8,36 Whooping Cough 3 Public Health Department, 94a, Bath Road, Hounslow. June, 1937. 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, 1936. Councillor J. E. DILLINGHAM (Chairman). Councillor A. J. BALDWIN. J. OWNER (Vice-Chairman). „ H. COLLAR. Alderman J. J. BONNETT, O.B.E. „ H. G. HEARN. C. L. LEWIS. „ E. W. HEATH, J.P. (Mayor). F. E. KINSEY. A. W. LIDDELL. D. RHYS, M.A. R. SALISBURY. A. P. SNELLING. Medical Officer of Health : ELWIN H. T. NASH, m.r.c.s., m.r.c.p., d.p.h. MATERNITY AND CHILD WELFARE COMMITTEE Councillor A. C. TURNER (Chairman). Councillor J. OWNER. Alderman C. L. LEWIS. „ D. RHYS, M.A. Councillor J. E. DILLINGHAM. „ R. SALISBURY. H. G. HEARN. „ A. P. SNELLING. F. E. KINSEY. 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., M.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. Senior Assistant Medical Officer of Health— R. H. G. HECTOR DENHAM, M.D., D.P.H. (Appointed November, 1396. To commence duty February, 1937). Assistant Medical Officer of Health— VICTOR FREEMAN, M.R.C.S., L.R.C.P., D.P.H (Left September, 1936). JOHN TUDOR LEWIS, M.D., D.P.H. (Commenced August, 1936). 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). (Left January, 1936). K. BOWES, M.D., M.S., F.R.C.S. (Commenced February, 1936). Diphtheria Immunisation Clinics : Medical Officer—G. W. J. BOUSF1ELD, 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. (Mane.). B. COOKE, L.D.S., V.U. (Mane.). L. C. MANDEVILLE, L.D.S., R.C.S. (Eng.). 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. DA VIES, Cert, as S.I. and M.I. 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—F. S. J. ALLAWAY. Health Visitors and School Nurses— Mrs. C. E. M. OTTLEY, S.C.M., H.V., and S.N., M.CAV.W. Miss B. N. TETLEY, S.R.N., S.C.M. New Health Visitor's Diploma of the Royal Sanitary Institute;. Mrs. A. E. TYRRELL, S.C.M., H.V. and S.N. Miss M. G. GRIBBLE, A.R.R.C., S.R.N., S.C.M., H.V. and S.N. Miss G. M. CLARE, S.R.N., S.C.M., New Health Visitor's Diploma of the Royal Sanitary Institute. Miss E. I. BARTLETT, S.R.N., S.C.M., New Health Visitor's Diploma of the Royal Sanitary Institute. Miss G. F. RICHARDSON, S.R.N., S.C.M., New Health Visitor's Diploma of the Royal Sanitary Institute (Left December, 1936). Mrs. G. PRISSELL, S.R.N., S.C.M., H.V. and S.N. Miss B. P. MANNING, S.R.N., S.C.M., A.R.S.I., New Health Visitor's Diploma of the Royal Sanitary Institute. Miss L. B. YOUNG, S.R.N., S.C.M., New Health Visitor's Lliploma of the Royal Sanitary Institute. Miss S. McCARTHY, S.R.N., S.C.M., New Health Visitor's Diploma of the Royal Sanitary Institute. (Appointed November, 1936. To commence duty January, 1937). Miss M. O'SULLIVAN, S.R.N., S.C.M., New Health Visitor's Diploma of the Royal Sanitary Institute. (Appointed November, 1936. To commence duty January, 1937). Chief Clerk—B. W. KILBY, Cert, as S.I. and M.I. Clerks— Miss R. MARSHALL, Cert, as S.I. N. A. ROGERS (Commenced January, 1936). P. T. H. CRANDON. E. E. FORREST. H. TOWLE (Left June, 1936). R. POWELL (Commenced January, 1936). H. L. LAW. Miss V. D. NICHOLLS. H M. B. BURGE (Left January, 1936). Miss V. GOODBODY (Commenced August, C. PARRY (Left January, 1936). 1936)' J. W. DEAN (Commenced February, 1936). Miss M- GARRY (Commenced January, 1936). M. W. LANGFORD (Commenced October, 1936). L. H. HAYWARD. Miss D. M. DOVVLING (Left August, 1936). G. PITT (Commenced August, 1936). 7 SUMMARY OF COMPARABLE STATISTICS, YEAR 1937. England and Wales. 122 County Boroughs and Great Towns including London. 143 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. 14.8 14.9 15.0 13.6 15.7 As last year, this rate is higher than for the rest of the country generally. There were 45 more Births than the previous year, but with the increased population this represented a slightly lower Birth Rate than last year, when the rate was 15.8. Deaths: All Causes. 12.1 12.3 11.5 12.5 9.55 There were 87 more Deaths than the previous year, when the rate was 8.98. The death rates throughout the country were generally higher than the previous year. Diphtheria. 0.07 0.08 0.05 0.05 0.02 The rate for this district is lower than any of the comparable rates in the groups shown. Scarlet Fever. Whooping Cough. Influenza. 0.01 0.05 0.14 0.01 0.06 0.14 0.01 0.04 0.15 0.01 0.06 0.14 0.00 0.02 0.08 Although the numbers are small, the rates for Heston and Isleworth are also comparably lower. Notifications: Scarlet Fever. Diphtheria. 2.53 1.39 2.18 1.31 2.48 1.26 2.57 1.69 2.36 0.22 With regard to notifications apart from Deaths, the incidence of Scarlet Fever again compares very favourably, but is not the lowest of the comparative rates shown. Diphtheria notifications in this District were very much lower than throughout the country generally as shown by the comparative rates. Rates per 1,000 Live Births. Infantile Mortality: 59 63 55 66 48.25 The rate 48.25 is not so good as the record rate of 40.77 last year, but is still a very low figure and the lowest of the comparative rates as shown. 8 Statistics and Social Conditions of the Area EXTRACT FROM VITAL STATISTICS OF THE YEAR, 1936. Area (in acres, including 42 acres of water) 7,261 Registrar-General's estimate of resident population (Mid-Year) 1936 95,000 Census Population, 1931 76,254 Number of inhabited houses (end of 1936) according to Rate Books 25,600 Rateable Value (at 31st December, 1936) £811,980 Sum represented by a penny rate (1936-37) £3,226 Live Births— Total. M. F. Legitimate . 1452 750 702 Illegitimate .. 40 20 20 Stillbirths ... 46 23 23 Deaths 865 426 439 Birth rate per 1,000 of the estimated resident population 15.7 Rate per 1,000 total (live and still) births 29.9 Death rate per 1,000 of the estimated resident population (Corrected) 9.55 Rate per 1,000 total Deaths from Puerperal Causes— Rate per 1,000 total Deaths. (live and still) births. Puerperal sepsis 2 1.30 Other puerperal causes 1 0.65 Total 3 1.95 Death rate of Infants under one year of age:— All infants per 1,000 live births 48.25 Legitimate infants per 1,000 legitimate live births 45.45 Illegitimate infants per 1,000 illegitimate live births 150.0 Deaths from Cancer (all ages) 129 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under two years of age) 12 SOCIAL CONDITIONS. The greater part of the district is largely a dormitory for workers in London. The chief industries are:— (1) Beer, etc., brewing. (14) Fire extinguishers, etc. (2) Boat building and repairing. (15) Razors and razor blades. (3) Colours and dyes. (16) Motor Cars. (4) Letterpress Printing. (17) Fancy papers. (5) Gravel quarrying. (18) Aeroplanes. (6) Market Gardening. (191 Engineering. (7) Rubber Tyres, etc. (20) Disinfectants. (8) Pewterware and Candle Machinery. (21) Laundries. (9) Pharmaceutical Chemistry. (22) Linoleum. (10) Soaps, powders and perfumes. (23) Carbons, Stencils, Typewriter ribbons, etc. (11) Sweets, confectionery. (12) Wines. (24) Biscuit making. (13) Sawmills and Joinery. (25) Candle making. 9 (26) Pharmaceutical Manufacturing Machinery. (31) Artificial Manure. (27) Coach building and wheelwrights. (32) Aluminium Solder. (28) Dyeing and cleaning. (33) Soldering Flux. (29) Pre-cast concrete works. (34) Scientific Instruments. (30) Celluloid works. The district is still 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 1936 is 95,000. 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 1,892, but 1,168 of these did not belong to the district, while 141 residents died outside the district. Thus the number of deaths properly attributable to the district was 865, an increase of 87 on the figures for the previous ^ear. Adopting the basis of the population estimated by the Registrar-General, the corrected death-rate for the district comes to 9.55 per 1,000, which is comparable with the following figures:— England and Wales 12.1 122 County Boroughs and Great Towns including London 12.3 143 Smaller Towns 11.5 London Administrative County 12.5 Heston and Isleworth 9.55 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-raje, which is calculated on an estimated population. The rate for 1936 is 48.25 per 1,000 births, which is not as good as last year's record figure, of 40.77 but is still a very low comparative rate. The rates for England and Wales and for London during the same period were 59 and 66 respectively. Births.— The total number of live births registered during the year was 2,158, excluding re-registrations, but 827 of these did not belong to this district, while 161 births properly belonging to this district occurred outside the district. The nett number of live births thus attributable to the district is 1492, an increase of 45 over last year's figures. Adopting the population basis supplied by the Registrar-General for the calculation of the birth-rate, this comes to 15.7 per 1,000. The birth-rate of England and Wales was 14.8 per 1,000 and for London 13.6 per 1,000. 10 Table of Causes of Deaths during 1936. Causes of Death. Civil Residents, all ages. All causes Male. 426 Female. 439 1 Typhoid and paratyphoid fevers — — 2 Measles 0 2 3 Scarlet Fever — — 4 Whooping Cough 1 1 5 Diphtheria 1 1 6 Influenza 2 6 7 Encephalitis Lethargica — — 8 Cerebro-Spinal Fever — — 9 Tuberculosis of Respiratory System 24 25 10 Other Tuberculosis Diseases 6 6 11 Syphilis 1 1 12 General Paralysis of the Insane, Tabes Dorsalis 1 0 13 Cancer, Malignant Disease 60 69 14 Diabetes 1 6 15 Cerebral Haemorrhage, &c. 9 24 16 Heart Diseases 113 120 17 Aneurysm 6 1 18 Other Circulatory Diseases 21 17 19 Bronchitis 19 15 20 Pneumonia (all forms) 28 15 21 Other Respiratory Diseases 2 1 22 Peptic Ulcer / 2 23 Diarrhoea, &c. (under 2 years) 9 3 24 Appendicitis 1 3 25 Cirrhosis of Liver 1 0 26 Other Diseases of Liver, &c. 1 3 27 Other Digestive Diseases 12 11 28 Acute and Chronic Nephritis 11 13 29 Puerperal Sepsis ... - 2 30 Other Puerperal Causes - 1 31 Congenital Debility, Premature Birth, Malformations, etc. 17 19 32 Senility 10 17 33 Suicide 7 1 34 Other Violence 28 13 35 Other Defined Diseases 27 41 36 Causes Ill-defined or Unknown Special causes (included in No. 35 above) Small-pox - - Poliomyelitis - 1 Polioencephalitis - - According to figures furnished by the Registrar-General. It INFANTILE MORTALITY DURING THE YEAR, 1936. 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 ... ... ... ... ... 1 ... ... ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ...... ...... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 1 1 ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 2 ... ... ... 2 Pneumonia (all forms) ... ... ... ... ... 1 ... ... ... 13 Diarrhoea ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... 5 6 1 ... 12 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis 1 ... ... ... ... ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth 3 ... ... ... 3 ... ... ... ... 3 Atelectasis 3 1 ... ... 4 1 ... ... ... 5 Congenital Malformations 3 5 1 ... 9 5 ... 1 ... 16 Premature Birth 9 1 ... ... 10 1 ... ... ... 11 Atrophy, Debility and Marasmus ... ... ... ... ... 1 ... ... ... 1 Other Causes 1 ... ... ... 1 ... 3 ... ... 4 21 7 1 ... 29 18 16 6 3 72 Infantile Mortality. As we have no information transmitted to us with regard to some of the births which occur outside the district, and are subsequently transferred in, it is not possible with absolute accuracy to work out the comparative rates of infant mortality for each ward in the Borough, but as far as this is possible with the figures available, and they may be taken as a fairly reliable indication, the numbers of infant deaths and the rates per thousand of the births occuring within the various wards are appended. No. of Deaths. Heston. 10 Hounslow Central. 4 Hounslow Heath. 24 Hounslow South. 11 Hounslow West. 4 Isleworth North. 10 Isleworth South. 7 Spring Grove. 2 Rates per 1,000 Births. 45.24 36.36 70.58 58.21 26.32 79.36 46.66 16.94 The rate for the District as a whole was 48.25. 12 General Provision of 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 was under the supervision of the County Council during the year 1936. In December, 1936, the Council decided to make application to the Ministry of Health under Section 62 of the Local Government Act, 1929, for an Order constituting the Borough Council the Local Supervising Authority for the purposes of the Midwives Acts, 1902-1936 within the Borough of Heston and Isleworth. Preparations are in hand to go forward with the necessary duties in connection with the provision of the new Domiciliary Service of Midwives under the Midwives Act, 1936, which would come into operation next year. In this district it is the practice of Health Visitors not to visit the newly born till 11 days after the birth, in order not to interfere with the Midwife. According to the County Medical Officer's last list, there are 20 Midwives practising in the district. This figure does not include 11 Midwives on the staff of the West Middlesex County Hospital. No Midwife is employed or subsidised by this Council, but in necessitous cases the midwives' fees, or part thereof, may be paid by the Borough Council. LABORATORY WORK, 1936. The routine Laboratory work, since the fire, was carried out by the Clinical Researc Association, until 14th September, 1936, when a temporary Laboratory was established at th temporary premises occupied by the Department. Total. Positive. Swabs for Diphtheria sent by Medical Practitioners 241 12 Taken from Schools, Clinics and from Contacts 420 3 Sub-Cultures 7 1 Sent from Staines Joint Isolation Hospital 116 13 Total cultures examined 784 29 No of Swabs, included in above total, which were examined by Clinical Research Association or at Other Laboratories 575 20 Virulency Tests (examined by Clinical Research Association) 4 1 Blood examination for Enteric Widal Tests (sent to Clinical Research Association) 1 1 Specimens of Sputum for Tubercle Bacilli sent by Medical Practitioners (66 examined by Clinical Research Association) 94 16 Specimens of Sputum for Tubercle Bacilli taken at Clinics 2 - Hairs for Ringworm taken at Schools or Clinics (all examined by Clinical Research Association) 16 11 Blood examination for Wassermann Tests (sent to Camberwell Research Laboratory) 6 - Specimen of Faeces (examined by Clinical Research Association) 1 - Specimens of Cerebro-Spinal fluid (examined by Clinical Research Association) 2 - Swabs for organisms other than Diphtheria Bacilli 16 Other Specimens— Urine 1168 Discharge (6 examined by Clinical Research Association) 7 Milk — Blood examinations for Anaemia 1 13 Preparation of Materials— Tubes of Serum, 670. Throat Swab Outfits, 160. Sputum Outfits, 0. 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, Isleworth. 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 Clinics. 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 in 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.—Mogden Hospital, Isleworth, controlled by the South Middlesex and Richmond Joint Hospital Board. The hospital extension is rapidly approaching completion. 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. It is at present being utilised in connection with the housing of families whilst their houses and belongings are disinfested, and the accommodation has been improved during the year for this purpose. Maternity and Nursing Homes.—The County Council is the Supervising Authority under the Nursing Homes Registration Act, 1927. In December, 1936, it was decided to apply to the Middlesex County Council under Section 9 of the Nursing Homes Registration Act, 1927, for the delegation of the powers of the County Council under this Act to the Borough Council so far as they relate to the Borough. AMBULANCE FACILITIES. (a) 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. (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 837 accident cases were removed to hospital, and 640 cases of noninfectious disease were removed to hospitals or nursing homes. 14 CLINICS AND TREATMENT CENTRES, 1936. 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. 2.0 p.m. „ Thursday. 10.0 a.m. and 2.0 p.m. „ Friday. 2.0 p.m. „ Village Hall, Heston. 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 94a, Bath Road, Hounslow. Every week-day. 9.0 a.m. „ (Nurse attending) 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. Wednesday. 2.0 p.m. „ Thursday. 2.0 p.m. „ Isleworth Health Centre. Thursday. 2.0 p.m. „ School Clinics 94a, Bath Road, Hounslow. Tuesday. 10.0 a.m. and 2.0 p.m. „ (Medical Officer attending) Friday. 10.0 a.m. „ Village Hall, Heston. Thursday. 10.0 a.m. „ Isleworth Health Centre. Monday. 10.0 a.m. „ School Dental Clinics 35, Bath Road, and Monday. 9.30 a.m. and 2.0 p.m. „ Isleworth Health Centre. T uesday. 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. 2.0 p.m. „ Venereal Diseases Clinic West London Hospital, Hammersmith. Monday to Saturday. 7.30 a.m. to 7.30 p.m. „ Facilities are also provided at. Other London Hospitals. Sundays. 10.0 a.m. to 12 noon. „ 15 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 AMENDE^ BY PART V. OF THE CHILDREN AND YOUNG PERSONS ACT, 1932. The Infant Life Protection work has continued during the year without much change in the numbers on the register. At the end of the year there were 66 foster-mothers who were undertaking the care of 82 foster-children, compared with 62 foster-mothers and 90 fosterchildren, at the end of the previous year. It is unfortunate that I have to record the death of five foster-children during 1936. Four of these children had been in the care of a foster-mother who was a certified midwife and trained nurse who had come into the Borough from the County Area. The cause of death in one case was Broncho Pneumonia. (This child died whilst in the care of the foster-mother—two doctors were in attendance—no Inquest was held. The cause of death in the other three cases was Gastro Enteritis. In each case death took place in the West Middlesex County Hospital. The foster-mother in question had been under regular supervision by my Department and the children were always found to be clean and well cared for. The Coroner's Officer visited the home and as the result of his report, the Coroner decided that there was no need to hold an Inquest. This foster-mother's unfortunate experience resulted in her giving up altogether the care and maintenance of foster-children. The fifth death took place in another part of the area. No Inquest was held as death was considered to be due to natural causes (Congenital heart disease due to foramen ovale. Enlarged Thymus was a contributory cause of death). 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 on 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 children 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. 16 Sanitary Circumstances Water Supply.— There were, as far as is known, at the end of the year, 29 private wells from which water was used for domestic purposes. In 34 other cases there are wells, but an alternative supply from the main exists for domestic purposes. In 28 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 water4,233 lineal yards ; Surface water—2,985 lineal yards. Work in connection with the West Middlesex Sewage Scheme, which will take all the sewage of this district, is now completed, with the exception of the Cranford area, and the scheme is in operation. 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 1936 collection of house refuse had continued weekly as before, and was disposed of by "controlled tipping" on a site in the Staines Road, Hounslow. Eight electric vehicles and four 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 was supplied 79 new ashbins. Sanitary Inspection of the District.— See pages 17-31. The district work has continued to grow during the year with the further increase of the population and a large amount of additional work has fallen to the lot of the Sanitary Inspectors through the overcrowding provisions of the Housing Act, 1935. I am pleased to report, however, that the extra demands made on ihc staff have, so far, been met. Nuisances, Contraventions of Bye-Laws, Defective Drainage, etc.—The number of premises on which nuisances were outstanding at the end of the year 1935 was 398. To these, another 603 premises whereat nuisances were recorded in 1936 were added, giving a total of 1,001 premises. Of these 538 had the nuisances remedied, leaving 463 premises at which nuisances still existed at the end of the year. During the year, nuisances at 52 houses were reported to the Health Committee, which, added to the 35 brought forward from 1935 made a total of 87. 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, 36 had been dealt with, leaving 51 cases to be carried forward to 1937. Comparative figures for the years 1934, 1935 and 1936, in connection with nuisances, are submitted herewith:— 1934 1935 1936 dumber of complaints received 514 474 738 Premises at which nuisances were located 582 618 603 Number of First Informal Notices 559 648 616 Number of Reminders and Letters 567 667 865 Number of Statutory Notices 24 57 46 17 Proceedings.— During the year Court proceedings were instituted by the Corporation ? respect to the following case:— (i) Non-compliance with a notice served under Section 94 of the Public Health Act, 1875. Owner ordered to do the work within 14 days. An appeal was made in the County Court by an owner against the Corporation's decision to make a Demolition Order but it was dismissed with costs. SANITARY WORK, ETC. Inspections—General: Total number of inspections and re-inspections, etc. 33,548 Inspections, etc., re Nuisances, Contraventions, etc.: Number of premises, etc., inspected on complaint 839 Number of premises inspected in connection with infectious diseases 182 Total number of premises, etc., primarily inspected in connection with nuisances 1,134 Number of premises inspected under Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-1933 13 Number of other visits made to premises, etc., in connection with nuisances, etc. 6,484 Number of visits made to works in progress 4,593 Number of interviews with owners, builders, etc. 3,121 Action taken (including action taken under Housing Act, 1930, Section 17): Number of premises, etc., whereat defects, etc., were recorded during the year ... 603 Number of premises, etc., on which defects, etc., were remedied— (a) by owners or occupiers 537 (b) by local authority in default of owner or occupier 1 Number of cautionary or intimation notices given— (a) verbal 160 (b) written 456 Number of letters and reminders re nuisances sent 865 Number of Statutory Notices issued 46 Number of proceedings taken Number of convictions obtained 1 Number of proceedings withdrawn Number of cases dismissed Number of appeals made against decision of Corporation 1 Number of appeals upheld Number of appeals dismissed 1 Common Lodging Houses: Number registered 2 Number of inspections made 8 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 39 Number of contraventions outstanding from previous year 18 Number of contraventions found 10 Number of contraventions remedied 10 Number of contraventions outstanding at end of year 18 Movable Dwellings, Caravans, Tents, etc.: Number of inspections made 590 Number of contraventions outstanding from previous year 8 Number of contraventions found Number of contraventions remedied 8 Number of contraventions outstanding at end of year 18 Bakehouses: Number in district (a) factories 23 (b) workshops 8 Number of underground bakehouses in district 1 Number of inspections made 114 Number of contraventions outstanding from previous year 1 Number of contraventions found 12 Number of contraventions remedied 10 Number of contraventions outstanding at end of year 3 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 875 Number of contraventions outstanding from previous year 1 Number of contraventions found 3 Number of contraventions remedied 4 Number of contraventions outstanding at end of year — Cowsheds: Number of persons registered 7 Number of premises registered 7 Number of cowsheds on register 8 Number of milch cows in district 62 Number of inspections made 35 Number of contraventions outstanding from previous year — Number of contraventions found 1 Number of contraventions remedied 1 Number of contraventions outstanding at end of year — Dairies and Milkshops: Number of persons registered 119 Number of premises registered 38 Number of inspections made 376 Number of contraventions outstanding from previous year 3 Number of contraventions found 12 Number of contraventions remedied 7 Number of contraventions outstanding at end of year 8 Offensive Trades: Number of businesses in district 18 Number of inspections made 75 Number of contraventions outstanding from previous year — Number of contraventions found 4 Number of contraventions remedied 4 Number of contraventions outstanding at end of year Ice Cream Vendors: Number on register 115 Number of inspections made 271 Number of contraventions outstanding from previous year — Number of contraventions found Number of contraventions remedied — Number of contraventions outstanding at end of year Public Health (Meat) Regulations, 1924: Number of inspections made 577 Improper use of slaughterhouse 1 Accumulations of solid or liquid refuse or filth in connection with shops, etc. 2 Insufficient periodical cleansing of shops and utensils, etc. 1 No precautions taken for prevention of contamination 1 No proper refuse and/or rubbish receptacles provided 3 Written notices sent 6 Verbal notices given 2 19 Inspection of Food: Number of meat inspections 1,197 Number of fish inspections 150 Number of provision inspections 74 Number of greengrocery and fruit inspections 201 Number of Hawkers' foodstuff inspections 32 Number of food preparation places inspected 245 Number of other food inspections 72 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 16 Number of parcels surrendered 29 Number of organs or parts surrendered during slaughtering 377 Infectious Diseases, Disinfections, etc.: Number of visits made 657 Number of rooms disinfected— (a) Ordinary infectious diseases 279 (b) Tuberculosis 119 (c) Other diseases 9 Smoke Abatement: Number of observations made 154 Number of nuisances proven 5 Shops Act, 1934: Number of contraventions outstanding from previous year 1 Number of premises whereat sanitary accommodation found to be insufficient 12 Number of premises whereat washing facilities found to be insufficient 2 Number of premises where additional sanitary accommodation provided 2 Number of premises where additional washing facilities provided — Number of Certificates of Exemption granted 9 Number of contraventions outstanding at end of year 4 Miscellaneous Inspections: Number of piggeries inspected 192 Number of stable premises inspected 187 Urinals inspected 29 Water Supply: Number of supplies provided or reinstated 13 Number of cisterns cleansed, repaired, covered, etc 3 Number of draw taps connected direct to main 28 Number of water service pipes or taps repaired 6 Number of samples taken for analysis from local wells 2 Number of samples found polluted or impure 2 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 Number of water closets cleansed or unstopped 17 Number of privies abolished — Number of walls, etc., cleansed — Number of new flushing apparatuses provided 24 Number of new water closet pans or pedestals provided 72 Number repaired, supplied with water or otherwise improved 206 Approximate percentage of houses provided with water closets 99 20 Earth or Chemical Closets: Number provided or reconstructed 1 Number provided with deodorants or repaired 1 Sinks: Number of new sinks provided 58 Number of sinks repaired or improved 33 Drains: Number examined, exposed, etc. 57 Number unstopped, repaired, trapped, etc. 142 Number of waste pipes provided, disconnected, repaired, trapped or unstopped 82 Number of soil pipes fixed, repaired or improved 6 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 — Number of gully traps inserted or improved 123 Number of disconnecting traps inserted 1 Number of inspection chambers inserted 24 Number of disconnecting chambers improved, sealed or cleansed 2 Number of inspection chambers repaired, improved, sealed or cleansed 27 Number of drains constructed or reconstructed 20 Total length of drain pipes laid (4 in.-1,767 ft.) (6 in.-148 ft.) 1915 ft. Number of tests and re-tests applied 340 Number of other works executed 10 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 2 Removal of Household Refuse: Number of new ashbins provided 79 Number of ashbins repaired 3 Dampness: Number of roofs stripped, renewed or repaired 278 Number of gutters and rain water pipes provided, repaired or unstopped 229 Number of instances in which external brickwork, sills, etc., repaired, renewed or rendered impervious 603 Number of damp-proof courses provided 100 Number of sites covered with impervious material Number of yards paved, repaired or drained 117 Number of forecourts paved, repaired or drained 26 Interior Work: Number of rooms stripped and cleansed 291 Number of floors, walls and ceilings repaired or renewed 1,127 Number of rooms in which ventilation provided or improved 75 Number of rooms in which lighting provided or improved 27 Number of staircases replaced, repaired or improved 38 Number of instances in which lighting to staircases provided or improved 33 Number of handrails and balustrades to staircases, etc., provided or repaired 26 Number of window frames and sashes provided, repaired or unfixed 876 Number of doors and/or other woodwork renewed, repaired or improved 165 Number of stoves or grates provided or repaired 249 Number of washing coppers provided or repaired 58 Number of instances in which ventilation under floors provided or improved 60 Number of food stores provided, cleansed or improved 76 Number of other repairs 52 Sundry Nuisances, etc.: Number of instances in which domestic cleansing enforced 16 Number of rooms sprayed for the removal of vermin by the Disinfector 120 Number of houses disinfected prior to demolition 56 'Number of instances in which overcrowding abated 25 Number of instances of improper keeping of animals abated 9 Number of offensive accumulations removed 51 Number of pigstyes provided, repaired, cleansed or improved 3 Number of stables provided, repaired, cleansed, or improved 3 Number of urinals provided, repaired, cleansed or improved Number of dung pits provided, repaired or improved 2 Number of other nuisances abated 86 21 SMOKE ABATEMENT. During the year 154 observations were made, resulting in five nuisances being proven in connection with four premises. The policy adopted has been on the lines of offering advice in the elimination of the nuisance rather than by legal action to obtain abatement, and this has been attended with a fair measure of success. In one case where a nuisance was proven, the chimney stack was raised an additional six feet to improve the draught, and a grit arrester and patent automatic ventilating door fitted to the furnace. In another case a large boiler was installed and a new high brick chimney substituted for a short metallic one. At one other premises a larger boiler was provided to meet the needs of business expansion and in the remaining case experiments with a mechanical stoker were still being carried out at the end of the year. Some of the owners of steam raising plants are now using a smokeless fuel such as coke, in place of raw coal, and where the demands on the plant are fairly constant and not excessive, no trouble from grit, etc., has been experienced when using such smokeless fuel. 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) (5) Factories (including Factory Laundries) 167 200 10 Nil. Workshops (including Workshop Laundries) 155 221 3 Workplaces (other than Outworkers' premises) 77 46 4 Outworkers 49 52 ... Total 448 519 17 Nil. DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Outstanding Jan. 1st, 1936. Found during 1936. Remedied during 1936. Outstanding Dec. 31st. 1936. Referred to H.M. Inspector. Number of Prosecutions. 1 2 3 4 5 6 7 Nuisances under the Public Health Acts—* Want of cleanliness 2 7 8 1 Want of ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors ... 1 ... 1 Other nuisances 4 13 14 3 Sanitary accommodation—† Insufficient ... 6 3 3 Nil. Nil. Unsuitable or defective 8 21 24 5 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) ... 7 6 1 Other offences:— Excluding offences relating to outwork ... ... ... ... ... Total 17 55 58 14 Nil. Nil. *Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act, 1901, and remediable under the Public Health Acts. †Section 22 of the Public Health Acts Amendment Act, 1890, has been adopted by the 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 BYELAWS OR REGULATIONS. There are 570 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 (nonfactory), Workshops, Workplaces, Outworkers Premises and Ice Cream Vendors' Premises. SCHOOLS. During the year two new schools were opened—Marlborough Infant School and Heston Junior School, both with accommodation for 400 children. There are now twenty-two 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 in the schools. In ten departments the accommodation has to be supplemented by the use of huts, and in seven further departments other types of temporary accommodation are being used. SWIMMING BATHS AND POOLS. The principal municipal bath at present is situated at Hounslow and this is provided with an up-to-date filtration and chlorination plant, and is in every way satisfactory. There is every prospect of the older Bath at Isleworth being shortly replaced by a new and larger one. The Council having considered proposals for the erection of two covered swimming baths with appurtenances on modern lines—one at Isleworth and the other at Heston and the proposals are under consideration by the Ministry of Health. The one privately owned Swimming Pool situated in the district is provided with a satisfactory chlorinating, cleansing and aeration plant, which is kept in continuous operation for the whole 24 hours during the summer season. CANAL BOATS. COPY OF REPORT FORWARDED TO THE MINISTRY OF HEALTH DATED 23rd JUNE, 1937. 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 31st December, 1936, as to the execution of the Canal Boats Acts, 1877, and 1884, and of the Regulations made thereunder, within the Borough of Heston and Isleworth, Middlesex. Inspectors Appointed under Canal Boats Acts, at 31st December, 1936:— 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 ... 39 Number of Canal Boats inspected 31 Number of boats found in order 21 Number of boats with one infringement 10 Nature of Contraventions, etc. :— Boats not conspicuously lettered and /or numbered 2 Certificates not produced 6 Boats used as dwellings and not registered 2 Legal Proceedings :— No legal proceedings have been taken during the year. Infectious Disease:— One case of infectious disease was 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. EXTERMINATION OF VERMIN. The disinfesting of dwelling-houses for the extermination of the bed bug (cimex lectularius) has received attention by the Department during the year and from the demands made on our services, it would appear that this is likely to become a prominent feature of the work of a Public Health Department. The problem of the verminous house is generally providing a basis for considerable scientific research into the best and most practical means for securing positive results, having regard to safety in use. 120 inhabited rooms were disinfested during the period of the report. In addition, 56 entire houses were disinfested prior to being demolished. Tenants who previously accepted bugs as part and parcel of their habitation are now taking a more enlightened outlook in the matter and to a greater extent are realising the possibilities of getting rid of their unwelcome company, hence the call for greater service from the Department. Owners and Agents are becoming equally concerned in the problem of exterminating bugs and now voluntarily seek the aid of the Department to disinfest property under their control. The rule has become established that before any assistance is given, steps must be taken to strip all papers from the walls and ease away or remove from their attachments, all skirting boards, architraves, picture rails and other woodwork. Except in special circumstances (chiefly for pecuniary reasons), a small charge is made to cover the actual cost of labour and material. Spraying with a well-known insecticide with comparatively low volatile properties has been the principal medium used and has proved by results to be the most suitable from the point of view of efficiency, safety and cost. It has been found in practice that the specious guarantees put forward by interested parties of total elimination in one application have, with the exception of "Hydrogen Cyanide", proved rather a myth owing to the difficulties attendant in rendering sterile the eggs and attacking the vermin secreted in deep cracks and pockets. To overcome this feature of the bed bug, resort has been had to a process of following up the infestation and spraying at intervals over a stated period. In most cases, this consists of three applications over a period of twenty-one days during the summer months. In certain cases it has been found necessary to continue the applications for a longer period. Fumigation, which necessitates the effectual sealing of the rooms and putting the rooms out of use for an excessive time can, on the grounds of cost, onlv be considered a factor if one application will prove effective. Results so far have not proved this to be the case. The disinfestation of personal clothing, bedding, etc., has received consideration for the purpose of finding a medium other than " Hydrogen Cyanide" or steam, to ensure greater safety and less risk of damage to the articles, but so far without any measure of success. In dealing with inhabited houses, there are several points which must be considered in using an insecticide— 1. It must have a lethal effect upon vermin, but at the same time be harmless to human beings and domestic animals, provided reasonable and simple precautions are taken. 2. It should not have any damaging effect upon the contents of the room. 3. It should possess considerable penetrating properties. 4. It should be relatively low in cost. 5. It should be easy of application and not require the engagement of specially trained staff. 6. It should be possible to carry out the process of disinfestation and the subsequent ventilation of the premises during the normal hours of daylight so that the bedrooms can be used again the same night. The ideal insecticide, capable of fulfilling all the above requirements is still to be produced. 25 A disquieting feature of some of the new houses erected is the readiness with we vermin can migrate from one house to the adjoining house or houses and this can be largely attributed to the manner of construction of party walls, which contain open joints below the floors and in the roof loft. It should be a necessary requirement of the new Building Byelaws that the joints of all party walls should be flushed in solid with mortar at every course of the brickwork during construction. It is a difficult problem to control the habit of certain people in purchasing or acquiring second-hand furniture, bedding, clothing etc. During the year I circularised the second-hand furniture dealers, furniture removers and owners of auction rooms and invited them to a meeting which I addressed on the subject. The poor response revealed a lack of interest and co-operation. However, an interesting discussion lasting about one and three-quarters of an hour ensued, from which it appeared that in connection with the businesses of the representatives present, the chance of infestation was likely to be very small owing to the standard of furniture they dealt with and their desire to ensure that their business was not affected in any way. It emerged in the course of the discussion that the probable source of the larger proportion of any infestation through second-hand furniture arose from that traded from house to house, of which, of course, the trade has no cognizance whatever. Though at first apparently somewhat hostile in their attitude, after the discussion had proceeded for some time there was an obvious desire on the part of those present to assist in any way they could. The use of the old Dockwell Hospital, situated in the Great South-West Road, Hounslow, for the purpose of a cleansing and disinfesting station in connection with the Council's Housing Schemes has continued during the year. In all 106 families took up temporary residence during the lime their furniture and effects were being treated with " Hydrogen Cyanide " gas in specially chartered vans, and prior to their removal into Council houses. Considerable improvements have been effected to increase the amenities of the Hospital, including the installation of central heating and a continuous supply of hot water for personal ablutions. HOUSING STATISTICS. 1. GENERAL. Number of New Houses erected during the year :— > Buildings. Number of Dwellings. (a) By private enterprise Houses and flats 1,568 1,754 (b) By the local authority 163 179 , 1,731 1,933 2. INSANITARY AND UNFIT DWELLING HOUSES. 1. Inspection of Dwelling-Houses during the Year. : 1 (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 731 (b) Number of inspections made for the purpose 795 (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 144 (b) Number of inspections made for the purpose 208 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 57 (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 115 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 269 26 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 23 (2) Number of dwelling-houses which were rendered fit after service of formal notices :- . (a) By owners 17 (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 18 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 6 (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 35 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 83 (3) Number of dwelling-houses rendered fit in consequence of undertaking given by owner 2 (4) Number of dwelling-houses in respect of which undertaking from owners accepted, not to re-let houses for human habitation 10 P. 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 — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — E. Housing Act, 1935.—Overcrowding :— (1) (a) Number of dwellings overcrowded at the end of the year 353 (b) Number of families dwelling therein 353 (c) Number of persons dwelling therein 2005 (2) Number of new cases of overcrowding reported during the year 374 (3) (a) Number of cases of overcrowding relieved during the year 21 (b) Number of persons concerned in such cases 137 (4) Particulars of any cases in which dwelling-houses have again become crowded after the Local Authority have taken steps for the abatement of overcrowding — F. Other matters :— (1) Number of dwelling-houses demolished voluntarily 30 3. RE DEVELOPMENT AREA. Area declared to be a proposed re-development area within the meaning of the Housing Act, 1935 1 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, Isleworth, 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. 27 The overcrowding survey commenced in November, 1935, was completed in March, 19[???] 24,076 houses were visited and particulars regarding 24,474 families were obtained and tabulated. 349 families or 1.42% were found to be overcrowded. Subsequently the Minister of Health fixed, for this district, the 1st July, 1936 as the appointed day for the purposes of section 6 of the Housing Act, 1935, and the 1st January, 1937 as the appointed day for the purposes of sections 3, 4, 8 and 68 of the said Act. At the end of the year 15 families, comprising 110 persons living in Council houses, either had been re-housed on our own estates or had removed to privately owned houses. The Housing Committee are making provisions for re-housing the remaining overcrowded families. 28 A 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 1935 :— 144-158b, Heston Road, Heston 11 13/6/32 ... ... 30/4/35 20/11/36 ... 19, London Road, Brentford End 1 12/12/32 ... ... 31/1/33 29/1/36 ... 21, London Road, Brentford End 1 12/12/32 ... ... 31/10/33 29/1/36 ... 34-44, Gloucester Road, Hounslow 6 9/5/33 ... ... 27/2/34 3/10/36 ... 12-18, Tivoli Road, Hounslow 4 9/5/33 ... ... 27/2/34 3/10/36 ... 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 28/5/36 .... 179 and 181, Hanworth Road, Hounslow 2 6/2/34 ... ... 27/3/34 ... .... 11, 13, 15 and 17, Church Street, Isleworth 4 5/6/34 ... ... 31/7/34 30/12/36 ... 78, South Street, Isleworth 1 6/3/34 ... ... 24/4/34 ..... ... 1, Church Street, Isleworth 1 5/6/34 30/11/36 ... ... ... 3, Church Street, Isleworth 1 5/6/34 30/12/36 ... ... ... ... 5, 7 and 9, Church St., Isleworth 3 5/6/34 ... ... 31/7/34 30/11/36 ... 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, Isleworth 2 5/6/34 ... ... 25/9/34 .... ... 11, North Street, Isleworth 1 5/6/34 ... ... 27/11/34 ... ... 6, The Square, Isleworth 1 5/6/34 ... ... 28/12/34 ... .... 7, The Square, Isleworth 1 5/6/34 ... ... 27/11/34 ... .... 64, High Street, Hounslow 1 10/7/34 ... ... 25/9/34 ... .... 185, 187, 189 and 191, Lampton Road, Hounslow 4 10/7/34 ... ... 25/9/34 1/9/36 ... 42, 44, 46 and 48, London Road, Brentford End 4 10/7/34 ... ... 25/9/34 ... ... 244 and 246, London Road, Isleworth 2 10/7/34 ... ... 25/9/34 ... ... 3, 5, 7 and 9, Tivoli Rd., Hounslow 4 4/9/34 ... ... 30/10/34 30/9/36 ... 179, Lampton Road, Hounslow 1 9/10/34 ... ... 28/12/34 19/5/36 ... 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 31/3/36 ... Gray's Cottage, Cranford Lane, Heston 1 13/11/34 ... ... 29/1/35 ... ... 6 and 8, Hartland Road, Isleworth 2 4/12/34 ... ... ... ... ... 16, South Street, Isleworth 1 4/12/34 ... ... 29/1/35 12/10/36 .... 18 and 20, South Street, Isleworth 2 4/12/34 ... ... 28/5/35 12/10/36 ... 29 Continuation of Table showing dwelling-houses represented as unfit for human habitatid 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 and 2, Hills Cottages, Bath Road, Cranford 2 * ... ... 23/1/34 30/9/36 ... 2 and 4, Fairfields Road, Hounslow 2 8/1/35 ... ... 30/4/35 ... ... 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10, Toynes Cottages, Toynes Alley, London Road, Isleworth 10 5/3/35 ... ... 25/6/35 ... ... 2, 3, 4 and 5, Field's Cottages, Toynes Alley, Isleworth 4 9/4/35 ... ... 25/6/35 ... ... 36, Magdala Road, Isleworth 1 4/6/35 ... ... 28/1/36 23/3/36 ... 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, Isleworth 5 9/7/35 ... ... 24/9/35 30/10/36 ... The Lodge. 110, Syon Lane, Isleworth 1 9/7/35 ... ... 29/10/35 1/7/36 ... 142, Linkfield Road, Isleworth 1 9/7/35 ... ... 24/9/35 ... ... 202, 204, 206 and 208, Martindale Road, Hounslow 4 8/10/35 ... ... 26/11/35 1/12/36 111, 113 and 115, St. John's Road, Isleworth 3 8/10/35 ... ... 26/11/35 ... ... 1, 2, 3, 4, 5 and 6, Syon Cottages, Syon Lane, Isleworth 6 8/10/35 ... ... 26/11/35 ... ... 60, 64, 72, 76 and 80, Upper Sutton Lane, Heston 5 8/10/35 ... ... 26/11/35 31/3/36 ... 68, Upper Sutton Lane, Heston 1 8/10/35 ... ... 26/11/35 ... ... 35a, Bell Road, Hounslow 1 12/11/35 ... ... 30/12/35 30/9/36 ... 139, 141, 143 and 145, Heston Road, Heston 4 12/11/35 ... ... 30/12/35 .... ... 54, 56, 58, 60, 62 and 70, South Street, Isleworth 6 12/11/35 ... ... 30/12/35 ... ... 157 and 159, Twickenham Road, Tsleworth 2 12/11/35 ... ... 30/12/35 ... ... 130, 132. 134. 136, 138, 140, 142 142a, 142b and 142c, Heston Road, Heston 10 10/12/35 ... ... 28/1/36 30/9/36 ... 64, South Street, Isleworth 1 10/12/35 ... 28/1/36 ... ... ... 72, South Street, Isleworth 1 10/12/35 ... ... ... ... ... 76, South Street, Isleworth 1 10/12/35 ... ... 28/1/36 ... ... 80, South Street, Isleworth 1 10/12/35 ... ... 25/2/36 ... ... 82, South Street, Isleworth 1 10/12/35 ... ... 28/1/36 ... ... *Transferred to this area from Hayes and Harlington. 30 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 Dealt with in 1936 : — 74, 76 and 78, Linkfield Road, Isleworth 3 7/1/36 ... ... ... ... ... 12, 14, 16, 18, 20, 22 and 24, North Street, Isleworth 7 7/1/36 ... ... ... ... ... Meadow View Bungalow, Speart Lane, Heston 1 7/1/36 ... ... 25/2/36 24/7/36 ... Orchard Bungalow, Speart Lane, Heston 1 7/1/36 ... ... 25/2/36 9/12/36 ... 11, The Square, Isleworth 1 7/1/36 ... ... ... ... ... Wharf Cottage, Hayes Road, North Hyde, Heston 1 4/2/36 ... ... 1/9/36 ... ... 725, London Road, Hounslow 1 10/3/36 28/4/36 ... ... ... 19 and 21, Grove Road, Hounslow 2 7/4/36 ... ... ... ... ... 108, 110, 112, 114 and 116, Sutton Road,, Heston 5 7/4/36 ... ... 26/5/36 ... ... 111, Wellington Road North, Hounslow 1 7/4/36 ... 26/5/36 ... ... ... 12, The Square, Isleworth 1 5/5/36 ... ... 29/12/36 ... ... 13, The Square, Isleworth 1 5/5/36 ... ... ... ... ... 14 and 15, The Square, Isleworth 2 5/5/36 ... ... 30/6/36 9/11/36 ... 109, Wellington Road North, Hounslow 1 5/5/36 ... ... 30/6/36 ... ... 53, Whitton Road, Hounslow ... 1 5/5/36 ... ... 29/9/36 ... ... 21 and 23, Heath Road, Hounslow 2 9/6/36 ... ... 28/7/36 ... ... 19, The Square, Isleworth 1 9/6/36 ... 28/7/36 ... ... ... 2 and 3, Swan Street, Isleworth 2 9/6/36 ... 24/11/36 ... ... ... 17 and 19, Heath Road, Hounslow 2 8/9/36 ... ... 29/12/36 ... ... 723, London Road, Hounslow 1 8/9/36 ... 27/10/36 ... ... ... 15 and 17, North Street, Isleworth 2 8/9/36 ... ... ... ... ... 1, Tivoli Road, Hounslow 1 8/9/36 ... ... 27/10/36 ... ... 2, 4, 6, 8, 10 and 12, Linkfield Road, Isleworth 6 6/10/36 ... ... ... ... ... 69 and 71, Staines Road, Hounslow 2 6/10/36 ... ... 24/11/36 ... ... " Somerset Lodge," North Street, Isleworth 1 6/10/36 ... ... ... ... ... 5, 6 and 7, Swan Street, Isleworth 3 6/10/36 ... 24/11/36 ... ... ... Bungalow adjoining " Lyndhurst," Green Lane, Hounslow 1 10/11/36 ... ... 29/12/36 ... ... 691, London Road, Hounslow 1 8/12/36 ... ... ... 22 and 23, The Square, Isleworth 2 8/12/36 ... ... ... ... ... 51, Whitton Road, Hounslow 1 8/12/36 ... ... ... ... ... 31 Inspection and Supervision of Food The following is the record of inspection of food premises : — Meat 1,177 Fish 150 Provisions 74 Greengroceries and Fruit 201 Hawkers' Food Stuffs 32 Food Preparation Places Inspected 245 Number of other Food Inspections 72 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 1936, 34 samples of milk were taken from retailers in the district. These samples were submitted to the Lister Institute for animal inoculation tests, but in no instance was the presence of tubercle bacilli demonstrated. Routine examination of milch cattle was carried out during the year by Mr. R. Wooff, M.R.C.V.S., the County Council's whole-time veterinary inspector, and 433 inspections of animals were made. Three cows were found to be suffering from tuberculosis and were slaughtered. 411 inspections were carried out in respect of cowsheds, dairies and milkshops. Unofficial milk analyses are made bv the Medical Officer of Health. Number of firms in the district licensed to sell :— "Certified" milk 5 (10 shops). "Grade A" (Tuberculin Tested) milk 9 (15 shops). " Grade A" milk — "Grade A" Pasteurised milk 2 (2 shops). *" Pasteurised" milk 10 (20 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 9 visits per month. There were 73 butchers' shops in the district at the end of 1936. 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 1935 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.—A total of 2,771 lbs. was surrendered during the year, including 1,304 lbs. of tubercular meat. 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. 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 32 tor 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 73 butchers' shops in the district, 55 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. 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 1936. Article. Taken. Adulterated., Milk 214 3 Cream Cakes 1 — Gin 5 — Rum 1 — Whisky 10 2 Sausages 5 — Lemon Sole 2 — Fish Paste 1 — Meat 1 — Minced Beef 1 — Hake 1 — Pepper 1 — . Sausages 6 — Wine 1 — 245 5 There were no prosecutions. UNSOUND FOOD, 1936 • Tons. cwts. qrs. lbs. ozs Fish 5 1 7 4 Meat 18 3 21 6 Poultry 1 19 15 Rabbit 6 8 Total 1 4 2 27 1 33 Infectious Diseases Scarlet Fever and Diphtheria.—There were 7 " return " cases of Scarlet Fever 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 the North Hyde School during the year. Use is made of the Dick reaction 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. 224 No. of civil cases removed to Hospitals 205 Percentage of cases removed to Hospitals 91.51 The incident rate of Scarlet Fever in the civil population (95,000) was 2.36 per 1,000. There were no deaths 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 . 21 No. of civil cases removed to Hospitals 21 Percentage of cases removed to Hospitals 100 The incident rate per 1,000 of the civil population was 0.22. Five cases occurred in institutions during the year. Two deaths occurred from this disease, i.e., a case mortality rate of 9.52 per cent. One child died in February and one in August. Both were between 5 and 10 years of age. For the last five years the deaths from Diphtheria have been as follows :— Year. Year. Year. Year. Year. 1932 3 1933 2 1934 4 1935 3 1936 2 It is interesting to record that the total number of cases of Diphtheria notified this year has been the lowest since 1895, i.e., for a period of 41 years, during which time the population has increased by roughly 70,000. It is interesting to note that the incidence of Diphtheria in the District compares with the rest of the County as follows :— Rates per 1,000 Cases. of Population. Deaths. England and Wales 1.39 0.07 122 County Boroughs and Great Towns including London 1.31 0.08 143 Smaller Towns 1.26 0.05 London Administrative County 1.69 0.05 Heston and Isleworth 0.22 0.02 34 Report on Diphtheria Immunisation Clinic Work during the year ended December 31st, 1936. As in recent years, two clinics have been held weekly on Monday morning and afternoon respectively. The attendances have been satisfactorily good, though the number of cases applying for treatment is not as high as in the past, and seems to indicate the employment of fresh means of bringing the advantages of Diphtheria Immunisation before the parents of children resident in the Borough. Advantage has been taken of the smaller number of new cases in that it is possible to form an opinion now on the success of work done in past years. Numbers of the children who were immunised between two and six years ago have been sent for, and have been re-tested, and the result of these re-tests after a comparatively long period from the time of protection are distinctly satisfactory. Investigations of other methods of using T.A.M. have been made, with the idea of securing the highest possible percentage of protected children and the highest degree of active immunity. The method has been to give an initial dose of Burroughs Wellcome T.A.M., of 1 c.c., followed 14 days later by an injection of 1.5 c.cms. A third dose of 1.5 c.cms. has been given a fortnight after the second. The figures for the results of this method are not yet available, as the work is not yet ready for analysis, but it is expected from preliminary observation that there will be some slight improvement on the method previously employed. This was two injections of 1 c.c. of T.A.M., at weekly intervals, followed by a third of 1.5 c.cms. 14 days after the second injection. The latter method yielded results of such a high order, viz., 95% success, that not much improvement can be hoped for. Preliminary observations on the new method show that about 97.1% of children are immunised by the routine course, an improvement of just over 2% on the old method. Plans are made for the investigation of Alum-precipitated Toxoid as a single injection and as a two injection procedure, one method to be adopted at the morning clinic, the other in the afternoon. The claims made for the effectivity of the A.P.T., to be employed are high, so thai the results should be awaited with confidence. As all cases are tested before and at an interval after immunisation, there is no fear of immunisation work not being satisfactorily completed owing to the adoption of a new type of prophylactic. Any cases still found susceptible at the re-test will receive further injections. Total attendances during the year amounted to 4,831 Number of primary tests. 641 Number of children immunised 564 Number of certificates issued 491 Naturally immune ... 26 Immunised cases ... 465 Investigation of cases immunised from 2 to 6 years previously yielded the following interesting figures :— Number of immunised children re-tested 646 Number positive 31 Number still negative 615 Percentage still immune 95.2% The above result must be considered as extremely satisfactory and constitutes a high testimony to the efficiency of Messrs. Burroughs Wellcome's T.A.M., in producing a durable immunity. The fact remains, however, that three injections of this substance are necessary, and if it can be shown that two (or even possibly one) injections will produce as good a result when A.P.T. is employed, there will be a marked advantage in the diminution of the number of injections required to produce immunity. The total number of applications for immunisation treatment during the year amounted to 693 GUY BOUSFIELD, M.D., B.S., Lond. 35 Diphtheria Antitoxin.—Boxes containing a Sterile Antitoxin syringe, and the neCessai^ dressings, etc., are kept at the Hounslow Police Station so as to be available in case of emergency. During 1936, 19 vials of Antitoxin of 8000 units each were supplied to medical practitioners. Smallpox.—No cases were notified during the year 1936. Enteric Fever—Two cases were notified. One was notified from the West Middlesex Hospital, and was not a resident in this district. Erysipelas.—Fifty-one cases of this disease were notified, of whom 32 were of cases in the West Middlesex Hospital. Twenty-six were non-residents in this district. Ophthalmia Neonatorum.—(See page 46). Puerperal Fever.—Twelve cases were notified. Ten of these cases were notified from the West Middlesex Hospital, of whom 7 were not usually resident in this district. One case confined at home was removed to Queen Charlotte's Isolation Hospital with which Hospital we have an agreement, for treatment, and made a good recovery. One case was confined and nursed'at home. Two deaths occurred from Puerperal Sepsis. Puerperal Pyrexia.—Sixty-six cases were notified ; 62 of these were notified from the West Middlesex Hospital, including 45 who were not usually resident in this district. Encephalitis Lethargica.—No cases were notified during the year 1936. Cerebro-Spinal Fever.—One case of this disease was notified from West Middlesex Hospital in the person of a non-resident. Acute Poliomyelitis.—Eight cases were notilied. Two eases were notified from the West Middlesex Hospital and were not usually resident in this district. Pneumonia.—There were 70 cases notified—38 notifications were from the West Middlesex Hospital. Twenty-eight 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 :— 1931 1932 1933 1934 1935 1936 Measles 9 952 108 901 10 1352 German Measles 5 25 13 66 6 15 Chicken Pox 233 194 362 417 537 161 Mumps 132 122 940 153 113 306 Whooping Cough 242 260 287 144 232 366 Upon receipt of information of the existence of a case, inquiry is made by a School Nurse to obtain all necessary facts. Measles. For the full report on Measles see the report of the School Medical Officer, pages 20-22. Influenza.—There were eight deaths from Influenza during the year, the mortality being 0.08 per 1000 of the population. Cleansing of Verminous Persons.—Particulars are asked for as to the facilities available in the district for the cleansing and disinfection of verminous persons and their belongings. Neither the Education Authority nor the Sanitary Authority possesses a Cleansing Station. See also pages 25-26. 36 TUBERCULOSIS, 1936. I am glad to be able to report the fact that the Open-Air School is; now jrising above the horizon and bids fair to take shape at a comparatively early date. Pulmonary Tuberculosis.—The number of new cases notified including transfers from other districts during the year was 99 ; of the new cases, 43 were receiving institutional treatment at the time of notification, and 18 died. There were 49 deaths from Tuberculosis of the Respiratory System. Twelve cases were transferred into the area, after notification in other districts. J i Other Forms of Tuberculosis.—The number ot' new cases notified qluring the year including transfers was 13. Of the new cases, eight were notified as receiving institutional treatment, and one died. The total deaths were 12. Deaths from Tuberculosis of non-notified Cases.—Seventeen deaths rjccurred in nonnotified cases. Six deaths occurred elsewhere, and were transferred to this district. The following Table gives further particulars of new cases notified and deaths in 1936. Age Periods. New Cases. Deaths Pulmonary. Non-Pulmonary. Pulmonary., Non-Pulmonan . M. F. M. F. M. F M. #] 0-1 ... ... 1 ... ... ... ... ... 1-5 ... ... 1 ... ... ... 2 5-10 2 3 1 ... ... 1 3 1 10-15 2 ... 1 2 1 ... 1 15-20 4 6 1 ... 1 2 ... 20-25 8 11 4 5 ... 1 25-35 14 14 2 2 5 11 1 ... 35-45 7 7 2 ... 7 7 ... 1 45-55 12 4 ... ... 5 ... ... 55-65 4 ... ... ... ... 1 ... ... 65 and upwards 1 ... ... ... 1 ... ... ... Totals 54 45 8 5 24 25 6 : 6 Ten of the deaths from Pulmonary Tuberculosis were not notified and seven deaths from Non-Pulmonary Tuberculosis were not notified. The number of cases of Tuberculosis on the register at the end of 1934 was 359 ; at the end of 1935 there were 390, and at the end of 1936, 407. Although these figures show an increase it does not necessarily indicate an increase of Tuberculosis within the district, as in the same period the population has gone up from 87,797 to 95,000, 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 come down from 76 in 1933 ; 72 in 1934 ; to 53 in 1935, and 61 in 1936, the death rates per 1000 of population from Tuberculosis for these years being as follows :— 1933 0.89 1934 0.82 1935 0.58 1936 0.64 The rate for England and Wales for the year 1936 was 0.69. 37 INFECTIOUS DISEASES, 1936. 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. Encephalitis January 22 4 ... 1 7 ... ... ... 3 7 ... ... 5 ... February 10 4 ... 1 8 ... ... ... 11 8 2 ... 6 ... March 15 3 ... ... 7 ... ... ... 9 12 1 ... 6 ... April 18 3 ... ... 3 ... ... ... 7 9 ... ... 7 ... May 21 ... ... ... 2 ... ... 1 1 8 3 ... 4 ... June 18 ... 1 2 2 ... ... ... 5 14 2 ... 2 ... July 23 ... ... 1 3 ... ... ... 6 7 1 1 4 1 August 13 2 ... 2 4 ... ... 2 12 1 ... 4 ... September 26 1 ... 2 3 ... ... 1 1 8 ... ... 8 ... October 17 4 1 1 1 ... ... 4 13 6 1 I 6 ... November 22 ... ... 2 5 1 ... ... 3 4 2 ... 9 ... December 19 ... ... ... 6 ... ... ... 11 4 ... ... 5 ... Totals 224 21 2 12 51 1 ... 8 70 99 13 2 66 1 In addition 1 Military case of Scarlet Fever was notified. DIPHTHERIA, 1936. (including Bacterial cases, 4 in number). WARD. Elem. School Chldren Other School Chldren Cases Month Total Hstn. Houn. Cent. Houn. Hth. Houn. Sth. Houn. West Islewth N. Islewth S. Spng. Grve. Jan. 4 1 1 1 ... ... 1 ... ... ... ... 4 Feb. . 4 ... 1 3 ... ... ... ... ... 1 ... 3 Mar. 3 ... 1 ... ... 1 ... 1 ... 1 ... 2 Apr. 4 ... 3 ... ... ... ... ... ... 2 ... 2 May ... ... ... ... ... ... ... ... ... ... ... ... June ... ... ... ... ... ... ... ... ... ... ... ... July ... ... ... ... ... ... ... ... ... ... ... ... Aug. 2 1 ... ... ... ... 1 ... ... 1 ... 1 Sept. 1 ... ... ... ... ... 1 ... ... ... ... 1 Oct. 7 ... ... ... 2 ... 2 3 ... 2 3 2 Nov. ... ... ... ... ... ... ... ... ... ... ... ... Dec. ... ... ... ... ... ... ... ... ... ... ... ... Totals 25 2 6 4 2 1 6 4 ... 7 3 15 38 39 o Notifiable Diseases during 1936. Disease. Total Cases Notified. 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. Total all ages. Joint Board Hospitals Other Hospitals Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... 1 1 ... ... ... 2 1 ... Scarlet Fever ... 3 12 13 17 111 38 6 17 5 2 ... 224 198 7 Diphtheria ... ... 1 2 1 8 2 1 4 1 1 ... 21 21 ... Erysipelas 1 ... ... ... ... ... 2 1 6 9 16 16 51 2 36 Puerperal Fever ... ... ... ... ... ... ... ... 9 3 ... ... 12 ... 11 Puerperal Pyrexia ... ... ... ... ... ... ... 4 54 7 1 ... 66 ... 65 Ophthalmia Neonatorum 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 Poliomyelitis ... ... 1 ... 1 3 3 ... ... ... ... ... 8 ... 7 Cerebro Spinal Fever 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Pneumonia 4 4 3 1 2 8 1 6 9 14 15 3 70 ... 49 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Polio Encephalitis ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 For Tuberculosis Notifications—see other Table. In addition 1 Military case (20 years) of Scarlet Fever was notified. DEATHS FROM NOTIFIABLE INFECTIOUS DISEASES, 1936. 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 ... ... ... ... ... ... ... ... ... ... ... ... ••• Diphtheria ... ... ... ... ... 2 ... ... ... ... ... ... 2 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... 2 ... ... ... 2 Puerperal Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia 13 3 1 ... ... ... ... 1 2 2 12 9 43 Poliomyelitis ... ... ... ... ... ... 1 ... ... ... ... ... 1 Polio- Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fevet ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... 2 2 Total 13 3 1 ... ... 2 1 1 4 2 12 11 50 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 1936:— Enteric Fever Scarlet Fever Diphtheria Pneumonia (all forms) Erysipelas Puerperal | Fever Puerperal Pyrexia Cerebro-Spinal Fever Ophthalmia Neonatorum Pulmonary Tuberculosis Other Tuberculosis Encephalitis Lethargica Acute Poliomyelitis Polio- Encephalitis Total West Middlesex Hospital 1 11 5 38 32 10 62 1 ... 11 2 ... 2 1 176 Hounslow Hospital ... 7 ... ... 1 ... ... ... ... 3 4 ... 2 ... 17 Hounslow Barracks ... *2 ... ... ... ... ... ... ... ... ... ... ... ... 2 St. Mary's School ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1 20 5 38 33 10 62 1 ... 14 6 ... 4 1 195 *Includes 1 military case. 40 Hesion Airport. During the year the Heston Airport developed into one where it was necessary to appoint the Medical Officer of Health as a Port Medical Officer, in view of the precautions to be taken at aerodromes used by foreign aircraft to prevent the dissemination of infectious disease ,by persons arriving or departing by air. The proprietors of the Airport are required to inform the Medical Officer of Health:— fa) If any person arrives from abroad whose condition of health indicates or suggests that he is suffering from an infectious disease (other than tuberculosis), or who, to the knowledge or belief of the proprietor, has been in contact with a case of plague, cholera, yellow fever, typhus fever, or smallpox, or any other disease specified from time to time by the Medical Officer of Health; (b) If to the knowledge or belief of the proprietors of the Airport there has been a case of infectious disease (other than tuberculosis) on board during the voyage, or the aircraft has, within the preceding fourteen days, left a locality infected with a disehse mentioned above or has had a case of these diseases on board and has not since undergone sanitary measures at an aerodrome; (c) If any person seeks to go abroad whose condition indicates or suggests that he is suffering from the above mentioned diseases or who has, to the knowledge or belief of the proprietors, been in contact with a case of any of these diseases; and (d) To grant all facilities to the Medical Officer of Health and to comply with any instructions given by him relating to the control of infectious diseases. As a result, the following resolution was passed by the Council:— That the Medical Officer of Health be empowered to take such measures as he deems requisite upon receipt of an intimation from the proprietors of the Heston Airport of the arrival thereat, or intended departure therefrom, of any person who to the knowledge or belief of the proprietors is suffering from an infectious disease or who has been in contact with a case of plague, cholera, yellow fever, typhus fever, or small pox or any other disease specified from time to time by the Medical Officer of Health, or of any aircraft that has had persons on board suffering from an infectious disease or has left an area infected with the foregoing diseases and has not undergone sanitary measures, and that the Medical Officer of Health be empowered to prepare and furnish to the proprietors of Heston Airport, a list of localities affected with the diseases referred to. Fortunately it has only been necessary in one case to hold up an aeroplane coming from abroad, which had arrived from Marseilles at a time when there was an outbreak of typhus in that port. Prevention of Blindness (Public Health Act, 1925, Section 66). From the point of view of prevention of blindness, the Council is taking the attitude that it is important " to turn off the tap rather than mop up the mess and have arrangements for the admission of cases of ophthalmia neonatorum to St. Margaret's Hospital of the London County Council. So far, with the exception of one case of very slight scarring, every case has emerged with its vision unimpaired. 41 Maternity and Child Welfare. The attendances of children at all the Centres during the last six years have been as follows:— Year. 1931. 1932. 1933. 1934. 1935. 1936. No. of attendances 27,318 31,656 35,110 33,102 36,635 36,567 The average attendances per session during the year 1936 were as follows:— Douglas Road No. 1. Douglas Road, No. 2. Isleworth Centre. Heston Centre. 87.6 64.2 65.4 65.37 Approximately 82.7 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 Centres is shown hereunder. Douglas Road, Hounslow No. 1— 1932 1933 1934 1935 1936 Mothers 1085 860 820 998 998 Children 1741 1078 953 1146 1199 Douglas Road, Hounslow No. 2— Mothers 132 467 513 491 554 Children 153 557 569 602 778 Isleworth Health Centre— (Busch House) Mothers 690 685 562 596 647 Children 763 824 726 729 847 Heston— Mothers 451 435 330 444 482 Children 534 550 387 537 631 Sales at Clinics. Quantity. Receipts. £ s. d. Dried Milks 12666 lbs. 884 14 7 Virol 1244 lbs. 90 14 8 Sugar of Milk 309 lbs. 17 10 0 Oil and Malt 2022 lbs. 56 5 0 Lactagol 1101 tins 56 3 6 Cod Liver Oil Emulsion 7356 bottles 206 4 0 Bemax 2140 tins 42 7 6 Adexolin 1492 phials 56 7 0 Total ... £1410 6 3 Notification of Births. Number of births notified in the area during the year, as adjusted by transferred notifications. Live births 1422 Still births 41 Total 1463 By Midwives 1191 By doctors and parents ... 272 Ante-Natal Clinic. During the year the County Council Authorities put forward a scheme of co-operation between the County Council Maternity Department and the local Ante-Natal Centres. The effect of this is that we take over at our Ante-Natal Clinic the routine examinations and supervision of expectant mothers who have been referred by the Medical Officer of the West Middlesex 42 Hospital as a result of his preliminary examination, and who will subsequently be admitted in;o a County Hospital for their confinements, transmitting the necessary records and following up patients by visiting as required. There is no doubt that this will very considerably expand the work at the Ante-Natal Clinic, but will also no doubt prove a very valuable link between the County Council and the local Maternity and Child Welfare Schemes. Ante-Natal Clinic. The following are the figures of attendances at the Clinic :— 1933 1934 1935 1936 Attendances by Expectant Mothers during the year 738 831 1208 1251 Average Attendance per Session 14.2 14.0 11.5 12.1 Number of Sessions 52 59 105 103 No. of Mothers attending Ante-Natal Clinic shown as a percentage of total notified live and still births 28.0 31.8 32.8 31.2 Total number of expectant Mothers who attended the Clinic during the year 373 419 464 444 There were in addition 15 Post-Natal Cases, who made 16 attendances. During the year Dr. A. J. Wrigley, M.D., F.R.C.S., resigned his appointment as Obstetric Specialist to the Borough on his appointment to the post of full Obstetric Physician to St. Thomas's Hospital. His place has been taken here by Dr. R. K. Bowes, M.S., M.D., F.R.C.S., who also succeeds to the post which was his as Physician in charge of the Out-Patients at St. Thomas's Hospital. I want to place on record my very deep appreciation of the way in which Dr. Wrigley handled the Ante-Natal Clinic whilst he was in charge of it. He entered fully into the Public Health aspect of the work and never allowed anything to stand in the way if he could possibly avoid it, to prevent him taking a responsible and active share in the work, and it is undoubtedly due to his ability to gain the confidence of the mothers of the district that the Clinic has accomplished the excellent work it has done in the years gone by. The mantle of Dr. Wrigley has fallen on Dr. Bowes whose vision is as keenly set on the Public Health side of the work as was that of his predecessor. The link with St. Thomas's Hospital makes a lot of difficulties which would loom large, disappear into thin air. The liaison between St. Thomas's and ourselves is very very valuable to the district, be it special investigations, special radiographic reports and things of that kind, they are all accomplished with the minimum of trouble and maximum of efficiency. Toddler's Clinics. The question of Toddlers' Clinics is foreshadowed when accommodation is available. The opening of the new Isleworth Health Centre at Busch Corner it is hoped will be made the occasion for instituting in the following Autumn a definite Toddlers' Clinic. 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 is required, (e) Sterilized maternity outfits for very poor mothers confined at home. 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 iur parturient women. 43 Maternal deaths arc investigated by the Medical Officer of Health as far as possible, in junction 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 1,538. The incidence of deaths of mothers following confinements in 1936, was 3 mothers died out of 1,538 or 1.95 per 1,000. The rates for the previous years were 1933—4.89; 1934—2.93; 1935—4.0. The rate for England and Wales was 3.65. The rate for 1936 which was 1.95, is lower than for 1935, and the previous years. The causes of death were as follows:— 1. Myocarditis, Acute Arthritis, Puerperal Pyaemia. 2. Myocardial Failure, Toxaemia, Puerperal Sepsis. 3. Peritonitis, Gastro enteritis, extra uterine pregnancy of about 7 months maturity. All three died in Institutions. Although there is no Municipal Maternity Home included in the foregoing arrangements made by the Borough Council, there are 78 maternity beds at the West Middlesex County Hospital, 31 of which were added in 1936, providing a service which would otherwise 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, 1936. Supply of Cases.—There was an increase in the number of patients dealt with. Net attendances increased from 2,303 in 1935, to 3038. Comparative figures :— Year. Mothers. Children. Total. Appointments were 1934 ... 2061 1935 ... 3003 1936 ... 4103 Attendances were 1934 ... 1576 1935 1245 1058 2303 1936 1662 1376 3038 Mothers. Permanent teeth. Children. Deciduous teeth. Total. Fillings 337 339 676 Extractions— Gas 1715 822 2537 2567 Local Anaesthetic 19 11 30 Dentures supplied to mothers. Year. Upper. Lower. 1935 77 70 1936 96 88 The number of individual mothers supplied with dentures during 1936 was 100. (84 had both upper and lower dentures, 12 upper only, 4 lower only. 44 Details of other work, years 1935 and 1936. 1935 1936 Administrations of General Anaesthetics 476 625 Advice 113 116 Dressings 128 160 Impressions taken 181 219 Charting and Estimating 279 339 Silver Nitrate Treatment 178 454 Scaling and Polishing 57 79 Treatment of Gums 17 111 I. COHEN, l.d.s., r.c.s. (eng.), Dental Surgeon. VOLUNTARY SOCIETIES AND HELPERS. The Isleworth Nursing Association and the Osterley, North Hounslow and Heston Nursing Association are the only Voluntary Societies in direct contact with the Council's Maternity and Child Welfare Scheme. Special mention must be made of the undermentioned for services rendered at the Welfare Clinics, and also for gifts of prams, toys, clothing, etc., which are given to the other mothers:— Mrs. Gould, Mrs. Waters, Mrs. Knight, Mrs. Buckingham, Mrs. Bull, Mrs. Scanes, Mrs.O'Sullivan, Mrs. Jacklin, Mrs. Goff, Mrs. Northcote, Mrs. Jones, Mrs. Bartholomew, Mrs. Hunt and Mrs. Silburn at the Hounslow (No. 1) Centre; Mrs. Chad wick, Mrs. Biggers, Mrs. Zimmerman and Mrs. Ball at the Hounslow (No. 2) Centre0; Mrs. Lesley, Mrs. Huffle, Mrs. Dowling, Mrs. Gates, Mrs. Griffin, Mrs. Squires, Mrs. Fitt, Mrs. Broughton, Mrs. Roach, Mrs. King, Mrs. Ebbutt, Mrs. Bates, Mrs. Cannon, Mrs. Morley, Mrs. Widdowson, Mrs. Whitten, Mrs. Bardell, Mrs. Tucker, Mrs. Gorringe, Mrs. Short, Mrs. Conway, Mrs. Huntingford, Mrs. Curtis, Mrs. Chance, Mr. Wordsworth, Mrs. Newman, Mrs. Clover, Mrs. Child, Mrs. Nicholls, Mrs. Chedgey and Mrs. Jones at the Isleworth Health Centre; Mrs. Appteford, Mrs. Woodman, Mrs. Yorke, Mrs. Williams, Mrs. Baumberger, Mrs. Colbrook, Mrs. Brearley and Mrs. Rose and several people who wished to remain anonymous at the Heston Centre. Also one helper from Heston Branch of the British Red Cross attends each Friday morning at the Heston Centre. Home Visiting.—The visits by the Health Visitors in connection with the Maternity and Child Welfare Work and Public Health work were as follows:— 1st visits to babies under 1 year 1469 Other visits to babies and children up to 5 years 5290 Visits to mothers 438 Inquiries made elicited— Feeding—N*atural 1077 Artificial 125 Both 80 Sleeping with parents 90 Using comforter 149 Mother working during pregnancy 43 Summary of Nurses' Visits. Total to expectant mothers 185 Total other visits to mothers 253 Total to children under 1 year of age 3959 Total to children between the ages of 1 and 5 years 2800 Visits re Public Health matters, infectious diseases, tuberculosis, etc. 741 Total 7938 (The above numbers include 1089 visits in connection with infant life protection). Health Visitors' attendances at the Maternity and Child Welfare Centres, Ante-Natal Clinics, etc., 844. 45 Health Visitors' attendances at Diphtheria Immunisation Clinics, 187. 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 Help. 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 30. 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 1,182, against 1,329 for the previous year. OPHTHALMIA NEONATORUM, Year 1936. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Removed from District and Deaths. Notified. Treated At Home. In Hospital. 2 1 1 2 — — ; — '■ An agreement exists with the London County Council for the admission of Ophthalmia Neonatorum to St. Margaret's Hospital when necessary. One case was sent to this Hospital and made a complete recovery. 46 Nutrition. The writing of the Cookery Book* has been a much more extended and tiresome task than was anticipated. It has been based entirely on research and will, I trust, be a definite contribution to the dietetic pleasures and efficiency of those whose means have to be watched carefully. In order to save the housewife's time the instructions have been set out fully under each recipe, very often being repeated in recipe after recipe. This has been done in view of the fact that this Cookery Book is, I hope, going to be used by people whose time is valuable and who cannot be bothered to keep referring back to page this and page that, for each and every detail of the recipe. These references have been reduced to an absolute minimum. Everything has been done to make the book as complete and as easy in its understanding and reference as it possibly can be. I have laid great emphasis on the use of deep fat frying as a method of cookery. One finds that whilst the majority of the mothers one comes across in one's work utilise or frequent the fish and chip shop, by reason of the tastiness of its products as much as for its convenience, that deep fat frying, as far as their home life is concerned, is one of the most neglected forms of cookery. Whilst it is, as I have said, one of the most neglected forms, it should be one of the most used forms (a) by reason of the healthiness of the food through lack of grease and (b) byreason of the tastiness of the result. The difficulty is the dietetic ruts into which people get, and get so easily. As I have said elsewhere, it is almost as hard to get people to change their dietetic habits as i their religion. It is becoming increasingly difficult to get time spent on good cookery, as not only in this country are they utilising tinned foods more and more, but the habit has even got into the French housewife's mind and the old-fashioned, thrifty housewife of France, who marketed with an economy which we used to admire so much, is rapidly becoming a thing of the past. Criticism may be levelled at the recipes in the Cookery Book by reason of the number of things which are included in the majority of them, but I have done this deliberately in order to produce flavour in the dish itself. As Sir Isidore Salmon, the Head of the great Lyons organisation put it to me once," You can't get the flavour out unless you put the goods in." I want to try and overcome the habit which is so ingrained in many of our lower paid workers, the habit of covering everything hot or cold with strong sauce. They might just as well devour pieces of their doormat soaked with sauce for all the pleasure they get out of their food. Their whole week's food, in many cases, is merely something or other covered with the particular sauce they fancy. Whilst sauce can be introduced into the diet for flavouring purposes it;should be used in very small quantities just to tickle up the flavour in a certain direction. These numerous additions may be criticised as making it unduly extravagant or unduly complicated. It is really neither. As far as complication is concerned it is very easy to get into the habit of using the various materials; whilst as far as expense is concerned, in view of the fact that the food materials used cost less than half the price of those in general use, there is ample margin to make the food really palatable and at the same time save money. I want to emphasise the word which was used over and over again at the exhibition and demonstration I gave at the Isleworth Public Hall. It resolved itself into one word, and one word only which was " Delicious. I want very much to inculate the habit of cooking properly because I feel from the children's point of view it is so important. An immense amount of time and thought has been spent on this Cookery Book and now that it is complete with the information as to the actual value of the different dishes contained in it, I trust that it will be a real contribution not only towards the nutrition of those who use it, but a real source of pleasure. After all, a good meal is as much a matter of harmonious blending of materials and flavours as a well harmonised piece of music, and the result to the palate should be the same as the result of harmonies to the ear. The basis of the Cookery Book has been a careful research utilising the cheaper cuts of meat such as clod and sticking piece, flank of beef and other bye-products of ordinary diet such as scrap bacon, biscuit dust and various other things, all of which are palatable and produce a highly nutritious diet at low cost. It is a matter of regret that the scientific details which led up to the production of the Cookery Book cannot be printed in this Report, but it is hoped that other arrangements may be made for their publication. The Cookery Book of course gives no idea of the amount of work which went into each recipe in order to come out at the price at which it is published, giving no space for the setting out of the protein and vitamin contents of the various ingredients and the actual cost of the dishes and their constituent items which go to show the thoroughness with which the work was done. *(Dr. Nash's Cookery Book, 6d. net, Published by Simpkin, Marshall, Ltd., Stationers' Hall Court, London, E.C.4). 47 As my chief research worker had been trained in America naturally the Vitamin B compx was put down as in the American fashion and subsequently had to be altered. Below is an actual copy of an investigation card showing how things were carried out. Front of Card. No. 159. Fuel—Gas. Main ingredients—Sticking ; Vegetables. Name of prepared food. Hash. Materials. Measure. Weight. Cost. Calories. Vitamin. Totals. Sticking, Beef l Ib. 6d. 1453.2 A. D. Pro: 87.335 per Id.—10.28 Onions ½ lb. ½d. 106.4 B. Cho: 87.96 Carrots ½1b. Id. 100.33 B. Fat: 157.33 Worcester See. 1 tsp. P. & S. Weight loss in cooking Water 1 pt. ½d. Actual Flour 2 ozs. 202.36 Per Cent. Dripping 1 oz. 255.1 Total Browning ½tsp. Calories: 2117.09 Time Taken. Hours. Minutes Fuel Consumption. Calories per Id.—249.0 Preparation 15 Amount: 43.5 (159-161) Initials. Cooking 2 00 Cost 1.871d. Allow ¾ Remarks Cost—Food : 7¾d. Fuel: ¾d. Total Cost: 8½d. E.H. Back of Card. . Method of preparation. Utensils. Cut meat into neat pieces and fry in dripping. Add vegetables cut in blocks and fry, then flour and brown it a little. Add water or stock and simmer till nearly done. Add salt and pepper and Worcester sauce, also a little browning if necessary, and finish cooking. Report on cooked food by samplers. A. Excellent. This amount of sauce is perfect. Gravy right and meat tender. B. c. D. Comments. Suggestions. 48 1 had been for over two years trying to find the right person for this particular piece of work as not only did it require someone whose knowledge of dietetics and cookery was adequate, but who also had the personality to teach individuals in the homes and also to address audiences of considerable size. i Miss Hook, my chief research worker possessed all the attributes I required and the only regret was that the Beard of Education saw her value and appointed her one of their Inspectors before I had finished the year's work. My No. 2 was Miss Bruce who had been trained at Mrs. Marshall's School of Cookery, generally regarded as the highest class one in the country. After that she had experience in mass cookery in St. Charles' Hospital kitchen, and later was one of two in dietetic ,charge of the Women's Hostel in Malet Street, attached to the University of London. > , My No. 3 for part of the time was my own cook who had been absorbing nutritiopal knowledge from Professor Mottram's writings. > As I have pointed out, one had to bear in mind the fact that the ideas of the smaller wageearners with regard to food flavourings are quite different to those whose means are more ample. They are much more used to strong flavours. ,, \ It is only those who understand cooking who realise the art of bringing out flavours, oft^n delicate but very appreciable, which can be easily accomplished and are inexpensive to attain., but which need small amounts of a number of different kinds during the actual .preparation. By reason of having two unemployed samplers, one man, and the wife of another unemployed man, one was able to get criticism of the way in which the flavours produced fell short of what would be the custom amongst the smaller wage earner, but speaking generally; the number of times on which criticism of an adverse character was made by those who were critically sampling was very small. This was due to the fact that one started off with the definite idea of catering for the ingrained habit of the utilisation of stronger flavours than are normal, to those better situated financially. The following letter from the unemployed man who criticised will show how far I succeeded in what I had set out to do. " With reference to the Cookery Research carried out by Dr. Elwin Hi T. Nash, I take pleasure in giving testimony as to the results of this work, which I consider most useful to the working-class people, especially those with large families. ; I My wife, five children and myself sampled most, if not all of the various dishes prepared in the Food Kitchen at the Hounslow Health Clinic, and we can honestly say that such were very appetising, extremely palatable'and most economical in cost, every scrap was eaten and enjoyed by all of us. Having been handed recipes, my wife is only too glad to make use of them, as they are certainly a great improvement on the usual working-class dishes. We appreciate the care and trouble taken in the matter by our Medical Officer of Health, and it is our hope that all will take advantage of it." Except when I was away from the office in the middle of the day I personally sampled every dish. One of the criticisms I heard so often in discussing this research was that the apparatus that would be required would be beyond the means of those I was trying to help. It was for that reason I had set out to make quite sure that this was not the case and accordingly, with the exception of two of the necessary things, no article cost more than sixpence. Things are changing. Even since this work was commenced the changes have increased. The multiplication of tinned foods, against which noi criticism can be levelled, is enormous and has been brought about by the perfection to which the canning industry has brought the manufacture of the cans and the elimination of the " hydrogen blow ". The number of foods which are preserved in tins is going up by leaps and bounds. Amongst the smaller wage earners one finds so often that the housewife's idea of a meal is to wait until her husband comes in and then rush round to the corner shop and buy something in a tin. Habits are changing and the fact has to be faced, but I am sure that much more can be done for nutrition in the families if they would learn the art of economical cookery. 49 It is scarcely appreciated what the position is with regard to the fish trade. The consumption of herrings, which at their price are one of the most valuable and economical of foods, has gone down by about 50% in the last eight years. The fishermen are in a parlous plight, their boats can hardly be kept in repair and many of them are in the thralldom of mortgages on everything connected with their craft. Every fishmongers' shop betrays the fact that the public are wanting things which give no trouble. The popular fishmongers' slabs are covered with filleted this and filleted that. Children will not eat herrings or bloaters because of the bones. If it is understood how a herring or a bloater can be properly boned before it" is cooked this difficulty can be got over. I produced a film to illustrate an address 1 gave to the Nutrition Committee in the House of Commons which shows how a herring or a bloater can be entirely freed from bones before it is cooked. I was unable to show it owing to a ban on films in the precincts of the House and I have presented it to the Herring Industry Board for propaganda purposes. As the results of one's experience at a demonstration, and during the work I am convinced that much might be done by peripatetic lecturers with the capacity to deal with popular audiences (this is most important) who would go throughout the country particularly in the distressed areas teaching how money can be saved and nutrition improved by cookery and economical shopping. It must be borne in mind that half the knowledge of nutrition is the knowledge of how to buy. As an example, some three years ago a lecture was given in London by Professor X on nutrition. The last slide which was thrown on the screen showed the number of calories which could be bought for 1/-. At the head of this was beef at 1/- per pound. After the lecture was over I said to him "That is no use to me, my price is 6d." His immediate reply was " You can't get it at 6d. I went to my butcher and that is what he told me." I suggested that if he went to his gardener's butcher he might have got a better idea. Some 4 or 5 days afterwards I was passing a shop where during my researches I used to get a large amount of meat, and I saw a large joint of ribs of beef, a beautiful joint from the grazier's point of view, Argentine of course, at 6d. per pound. The joint weighed 8½ lbs. I bought the lot and sent it down to him by train. A few days later I received a card from him to say " We had the beef on Sunday. It was excellent." [ have used that class of meat all through these researches and it is excellent if it is properly cooked. Last Autumn I opened the winter session of the Westminster Health Society with a lecture and demonstration Gn nutrition and cookery. In order to demonstrate the non-transmission of flavours in deep fat frying I put a large fillet of cod covered with a simple flour and water batter at the bottom of the frying basket unknown to the audience and then on the top of this fried apples fritters and jam and bread and butter fritters, both of them cooked with batter identical with that used for the fish. I handed the apple and jam fritters round the audience and when they had all expressed their approval without anyone noticing any other flavour, I produced from the fat the frying basket with the fish in it to the great surprise of the audience. This trick demonstration I heard was used at the Ideal Home Exhibition afterwards. It is because one knows and has seen all the trials and tribulations of small incomes that one is so keen to try and do something not only to ensure nutrition, but, with that nutrition, enjoyment in the food that goes to provide it. 50 BOROUGH of HESTON and ISLEWORTH EDUCATION COMMITTEE TWENTY-NINTH Annual Report OF THE SCHOOL MEDICAL OFFICER FOR THE YEAR ENDED 31st DECEMBER, 1936 CONTENTS. Arrangements for Treatment 10 Blind children 25, 30 Co-ordination 7 Deaf children 25, 30 Deformities 28 Dental defects and treatment 8, 13-18, 35 Dental Surgeon's Report 13-16 Ear disease and hearing 8, 13, 28, 33 Emergency Dental Cases 16 Epileptic children 25, 28, 30 Eye defects 8, 12, 28, 33, 34 Findings of medical inspection 8, 28 Following up 9 Health Education 26 Heart Disease and Rheumatism 8, 19,28,31 Infectious disease 19-24 Malnutrition 10 Measles 20-22 Medical inspections 7, 27 Medical treatment 10, 33 Mentally defectives 25, 30, 32 Milk, Supply of 25 Minor ailments 8, 11,33 Nose and Throat defects 8, 13, 28, 34 Nurses' work in schools 9, 35 Occupation Centre, see under Miscellaneous on page 26 Open Air Education 24 Orthodontic work (Report of the Orthodontic Consultant) 18 Orthopaedic and Postural defects 8, 19, 34 Parents, Co-operation of 25 Parents' Payments 17 Physical Training 24 Playground Classes 24 Prosecutions 10, 35 Provision of Meals 24 Ringworm 11, 33 School Attendance Officers, Co-operation of 25 School Clinics, see under Minor Ailments on page 11 School hygiene 7 School journeys 24 School Nurses' work 9, 35 Schools in the Area 6 Secondary Schools 26, 36 Skin diseases 8, 11,28,33 Special Enquiries 26 Spectacles 12-13, 34 Staff 5 Statistical tables 27-37 Teachers, Co-operation of 25 „ Medical Examination of, see under Miscellaneous on page 26 Tonsils and Adenoids, see under Nose and Throat 8, 13, 28, 34 Tuberculosis 9, 19, 28-31 Uncleanliness 10, 35 Visual defects and External Eye disease 8, 12, 28, 34 Voluntary Bodies, Co-operation of 25 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, 1936. 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 Councillor D. RHYS, M.A. (Deputy Mayor), (Chairman). Councillor R. WRIGHT, M.C. (Vice-Chairman). Alderman C. L. LEWIS. Alderman H. J. NIAS, M.B.E., J.P. G. N. SHACKLETON. Councillor A. J. BALDWIN. Councillor G. RAVENHILL. A. J. FIELDER, C.C. „ W. F. J. RICHARDSON. H. G. HEARN. „ F. SARD. E. W. HEATH, J.P. (Mayor). „ D. J. THOMAS. A. W. LIDDELL. „ F. J. THOMAS. R. H. MANNING. „ A. C. TURNER. E. H. WALLACE. Co-opted Members— Miss E. A. ANKRITT. E. R. HAMILTON, Esq., m.a., b.sc. Mrs. M. BALDWIN. Dr. O. WARDMAN. J. V. BACKES, Esq., a.r.c.s., a.i.c., d.i.c. School Medical Officer— ELWIN H. T. NASH, m.r.c.s., m.r.c.p., d.p.h. STAFF School Medical Officer—ELWIN H. T. NASH, m.r.c.s., m.r.c.p., d.p.h. Deputy School Medical Officer— Mrs. EVA LOUISE ROBERTS, m.b., ch.b., d.p.h., Barrister-at-Law. Senior Assistant School Medical Officer—R. H. G. H. DEN HAM, m.d., d.p.h. (appointed November, 1936. To commence duty February, 1937). Assistant School Medical Officer—J. T. LEWIS, m.d., d.p.h. (Commenced 31st August, 1936). Dental Surgeons—I. COHEN, l.d.s., r.c.s., eng. W. A. LILLEY, b.d.s. (manc.) B. COOKE, l.d.s. (manc.) L. C. MANDEV1LLE, l.d.s., r.c.s., eng. (Commenced June, 1936). 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, s.c.m., h.v., and s.n., m.c.w.w. Miss B. N. TETLEY, s.r.n., s.c.m., New Health Visitor's Diploma of the Royal Sanitary Institute. Mrs. A. E. TYRRELL, s.c.m., h.v., and s.n. Miss M. G. GRIBBLE, A.R.R.C., s.r.n., s.c.m., h.v., and s.n. Miss G. M. CLARE, s.r.n., s.c.m., New Health Visitor's Diploma of the Royal Sanitary Institute. Miss E. I. BARTLETT, s.r.n., s.c.m., New Health Visitor's Diploma of the Royal Sanitary Institute. Mrs. G. PRISSELL, s.r.n., s.c.m., h.v., and s.n. Miss B. P. MANNING, s.r.n., s.c.m., a.r.s.i., New Health Visitor's Diploma of the Royal Sanitary Institute. Miss L. B. YOUNG, s.r.n., s.c.m., New Health Visitor's Diploma of the Royal Sanitary Institute. Miss S. McCARTHY, s.r.n., s.c.m.. New Health Visitor's Diploma of the Royal Sanitary Institute (appointed November, 1936. To commence duty January, 1937). Miss M. 0'SULLIVAN, s.r.n., s.c.m., New Health Visitor's Diploma of the Royal Sanitary Institute (appointed November, 1936. To commence duty January, 1937). Clerical Staff— B. W. KILBY (Chief Clerk). E. E. FORREST. P. T. H. CRANDON. R. POWELL. Miss R. MARSHALL. Miss V. D. NICHOLLS. H. L. LAW. Miss V. GOODBODY. J. W. DEAN. Miss M. GARRY. M. W. LANGFORD. L. H. HAYWARD. N. A. ROGERS. G. PITT. Dental Attendant—Miss M. B. MABBS. Apprentice Dental Attendants-—Miss E. J. BEMMER. Miss A. M. FRAMPTON. Dental Clinics Clerks— Miss C. J. JOTHAM. Miss M. A. DIXON. Miss E. L. ATKINSON. Miss J. DODD. Miss V. J. REDGEWELL. Miss M. I. BULL. Miss D. A. DOCKRILL. Miss V. FLOWER. Dental Mechanic (part time)—T. CHENEY. 5 ELEMENTARY SCHOOLS IN THE AREA. School. Department. * Accommodation. Number on *Registers. Alexandra Junior 428 362 " Infants' 388 355 Berkeley Junior Mixed and Infants' 596 570 Bulstrode Senior Boys' 480 416 " Girls' 480 411 Chatsworth Infants' 400 408 Cranford Temporary Junior 100 99 „ C. of E Infants' 133 152 Grove Road Junior Mixed 572 512 if ... ... ... ... Infants' 326 273 Heston Senior Mixed 440 357 Junior Mixed 600 470 „ Infants Infants' 323 269 Hounslow Heath Senior Mixed 480 469 „ Junior Boys' 446 436 Junior Girls' 448 418 „ „ Infants' Infants' 436 391 Hounslow R.C. Mixed and Infants' 330 283 Hounslow Town Junior Boys' 286 313 >> •** *"* Junior Girls' and Infants' 488 457 Isle worth Blue Boys' 177 104 >> * * * Girls' and Infants' 284 147 Isleworth Town Junior Mixed 560 565 JJ ••• ••• ••• ••• Infants' 338 215 Marlborough Senior Mixed 640 583 „ Infants' Infants' 400 365 S. Mary's R.C. Boys' 180 122 » ... ... ... ... Girls' and Infants' 226 203 Spring Grove Central 436 453 „ Junior Mixed and Infants' 240 266 Wellington Junior Junior 450 398 Woodlands St. John's Infants' 75 77 Worple Road Junior Mixed 260 270 „ Infants' 226 236 Total 12672 11425 * These numbers are for December, 1936. Since December, 1930, the number of children attending elementary schools in this district has increased by over 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. Lewis 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 the age of five years, 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. It is true however, that these children are followed up by the Health Visitors as far as time will allow. Special attention is paid to those who are likely to become Table III cases and when they attain school age they are called to the School Clinics and are kept under observation there. 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. 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. 7 The total number of routine medical inspections carried out during the year was 3,649. W 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. 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. Minor Ailments and Diseases of the Skin. A total of 533 cases of various skin diseases were reported during the year, and with the exception of 7 cases, all were referred for treatment. As usual, impetigo was the commonest disease. Table II shows that there were 200 cases of "other skin disease"; these include such conditions as eczema, alopecia, seborrhoea, warts, etc. Visual Defects and External Eye Disease. Routine medical inspections revealed 203 cases of defective vision, 181 being referred for treatment. Eight cases of squint were also discovered, 6 being referred for treatment. At the Special Clinics, 100 cases of defective vision and 9 of squint were referred for treatment. Sixteen cases of minor disease of the eye were discovered at routine medical inspections, and 232 cases were discovered at the Special Clinics. Nose and Throat Defects. Five hundred and eighty six children were found to be suffering from chronic tonsillitis, and of these 406 were referred for operation. Thirteen children had Adenoids only, 10 being referred for treatment and 3 for observation. In a further 211 cases both conditions were present, 95 children being referred for operation and 116 for observation. Ear Disease and Defective Hearing. Amongst children examined at the routine medical inspections, 31 cases of defective hearing were found, 14 of these being referred for treatment. Special examinations at the Clinics account for 49 cases of defective hearing, and 215 cases of ear disease. Dental Defects. A total of 7,651 children were found requiring treatment at routine dental inspections in the schools. Table IV., Group V, on page 35 gives further statistics in this connection. Orthopaedic and Postural Defects. Thirty-eight cases of deformity of varying degrees were discovered by inspections at the schools and at the Special Clinics. Heart Disease and Rheumatism. Twenty-seven cases of heart trouble were found during the year to need treatment, whilst 72 cases were marked for observation. 8 Tuberculosis. No case of Tuberculosis was found by medical inspection during the year. Other Defects and Diseases. Twenty-seven defects which could not be classified under any other heading in Table I] were found during routine medical inspection. The number of "other defects and diseases" found by special inspection was 1,920. Of these, 1,769 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 416 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. 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 Clinics with Medical Officer. 6. Attend Minor Ailments Treatment Clinics and undertake daily treatments. 7. Attend Dental Clinics. 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 Clinics). 11. Visit children's homes for enquiries in cases of non-notifiable infectious disease. 12. Visit homes of children who fail to attend Clinics or attend irregularly. Summary of School Nurses' work during 1936. Attendances. Routine Medical Inspections 202 Re-inspections 30 Eye Clinics 124 Minor Ailments Inspection Clinics (with Medical Officer) 223 ,, „ Treatment Clinics 974 Dental Clinics 911 Cleanliness Surveys 63 Cleanliness Clinics 56 Other Attendances (Special Clinics, Med. Exam, of Teachers, School Sports, etc). 56 9 Visits. Re Infectious Disease 2977 Following up 416 Other Visits 67 7.—ARRANGEMENTS FOR TREATMENT. (a). Malnutrition. Milk is supplied twice daily at school, free or at part cost, to children who have beer. recommended for this on medical grounds. Further reference to this will be found on page 25. In November, the following preparations were placed on sale at the School Clinics for children recommended by the Medical Officers. These preparations can be supplied free in necessitous cases. Cod Liver Oil and Malt; Cod Liver Oil Emulsion; Cod Liver Oil and Malt with Parrish's Food; Bemax; Adexolin, and Kalzana. (.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 15,135, compared with 11,240 in 1935. Number of visits to schools by Nurses 71 Total number of children examined 15,135 „ „ „ „ given warning notices 600 „ „ „ „ excluded as verminous 49 1.. (Few) 420 Found to have nits— - 2. (Bad) 173 3. (Very Bad) 56 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 continued to do the work of cleansing heads. The Committee supplies the Sacker's Comb and Shampoo, and Mrs. Yates receives the 1/- fee per case in payment for her services. Seventy-one children were cleansed under this arrangement during 1936. During 1936 it was found necessary to take legal proceedings in 10 cases, with the following results :— One case . Withdrawn. Three cases Adjourned Sine Die. Five cases Fined 5/- each. One case Fined 7/6d. 10 (c). Minor Ailments and Diseases of the Skin. The Minor Ailments Clinics 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. In September it was found necessary to open a minor ailments treatment centre at the Cranford Temporary School to serve the growing area in that part of the Borough. The Clinics 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. Cranford—Temporary School, High Street (this Treatment Centre will be transferred to the new Cranford Junior School when it is ooened). A Medical Officer attends the Clinics 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. Cases are referred to the Clinics 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. Since the middle of 1929 the Minor Ailments Clinics 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. Table IV, Group 1, on page 33 shows that 2,163 cases of minor ailments were treated under the Authority's schemes. 2,146 of these were treated at the school clinics where they made 12,091 attendances during the year. In addition to providing daily treatment for minor ailments, these clinics also serve as centres for special examinations by medical officers, and during the year, 4,964 special examinations and re-examinations were carried out. Ringworm of the Scalp. All children accepting treatment by the Authority are sent to St. John's Hospital for Diseases of the Skin, Leicester Square, for X-ray treatment under an agreement made with this hospital in January, 1935. There have been seventeen cases under treatment by the Authority during the year, six of which were infected prior to 1936. Two of these (brother and sister) were old standing cases infected in 1934 in which the original X-ray treatment failed to effect a cure. Further X-ray treatment was refused and since January, 1935, these children have been under other treatment at St. John's Hospital. In both cases the infection proved very resistant to treatment—the boy cleared up in July of his year—but the girl is still infected. Both these cases occurred during the troublesome epidemic (47 cases) in 1934 when many of the cases took an abnormally long time to clear. The loss of school attendance of these two' children has been serious—the Authority offered to send them to a resident institution where they could be educated whilst treatment was proceeding, but unfortunately the parents would not agree to the children leaving home. Of the remaining fifteen cases, four were infected in December. 1935, whilst eleven were new cases occurring during the year. All fifteen were successfully treated with one application of X-rays at St. John's Hospital, the average time between X-ray and being passed as clear at the cchool Wood Glass Clinic being fifty days. 11 In addition to the above seventeen cases there were four other children who were treated^/ privately without X-ray. One infected in May, 1934 was not cured by the end of 1936. One infected in November, 1934 was still infected at the end of 1936. One infected in November 1934 was clear in March, 1936. One infected in May, 1935 was clear at end of 1936. 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 Glass filter until the Medical Officer is satisfied that there is no return of the infection. (d). Visual Defects and External Eye Disease. I am indebted to Dr. Roberts, who is in charge of the Refraction Clinic, for the following report :— VISION AND THE REFRACTION CLINIC. Two sessions have been held weekly during the school terms at the Hounslow Centre and one at Isleworth with an occasional extra session at the beginning of the holidays in order to complete the term's work. Since September, Dr. Lewis, the newly appointed Junior Assistant School Medical Officer, has done the Eye work at the Isleworth Centre. This year I am able to report that all children for whom spectacles were prescribed obtained them—hitherto our numbers in this respect have been very good, but this is the first year that a hundred per cent has been achieved. This has been possible on account of a new arrangement—but since this has only been working for the last quarter, I am not reporting on it in detail, but hope to discuss it more fully next year. The drawing stereoscope continues to be used with considerable benefit in the training of binocular vision and I wish to acknowledge with gratitude the help given to me in this work by the Head Teacher of Bulstrode Senior Boys' School. The Secretary for Education gave me permission to get some wooden plaques made at the school—I consulted the Head Teacher explaining what I wanted and within forty-eight hours he sent me a number of most excellent plaques made in the Handicraft class which have proved extremely satisfactory and have greatly '"^xeased the usefulness of the stereoscope. As will be seen by the figures given below the work of the Refraction Clinic continues to increase : there were 363 more appointments than the previous -ear and 291 more attendances. The percentage attendance however has not been quite so good, probably due to the large amount of illness, but an attendance of 91.39% is a fairly satisfactory figure—though disappointing after the figure achieved in 1933 viz., 95%. Isleworth still lags behind in its response to the treatment facilities offered, and the number of consents received is only just enough to warrant a session weekly. In spite of the fact that Isleworth children are usually seen within a week of the consent form being received, the attendance is poorer than at Hounslow where there is always a waiting list and an average delay of four to six weeks before a child is seen. The following figures show the work done at the Clinics in 1936. Total Appointments 2684 (1935—2321) Total Attendances 2453 (1935—2162) Total Percentage Attendance 91.39 (1935—93.15) HOUNSLOW CENTRE. Number of sessions 90 Average number of appointments per session 21.58 Average number of attendances per session 19.91 Elementary School Children. Secondary School Children. Total for Centre. Appointments 1776 166 1942 Attendances 1633 159 1792 Percentage attendance ... 91.95 95 78 92.28 12 ISLEWORTH CENTRE. Number of sessions 43 Average number of appointments per session 17.26 Average number of attendances per session 15.37 Elementary School Children. Secondary School Children. Total for Centre. Appointments 682 60 742 Attendances 604 57 661 Percentage attendance ... 88.56 95.00 89.08 REFRACTIONS. Elementary School Children. Secondary School Children. Total. Refractions 691 81 772 Spectacles prescribed ... 477 63 540 Spectacles obtained by end of year 477 63 540 Note.—Elementary includes a few children under school age. E. L. ROBERTS, Deputy School Medical Officer. (e). Nose and Throat Defects. Six hundred and seventy three children were referred for treatment on account of nose and throat defects. Of this number, 95 were operated on under the arrangements made by the Authority with the Hounslow and Richmond Hospitals in 1921, 71 received operative treatment by private arrangement of the parents. 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. Owing to the difficulties which so frequently arise in connection with the operation, for Tonsils and Adenoids, I felt it necessary to see if something could be done to ensure that the children were retained in hospital for at least one night after the operation. I found that the County Council Authorities were anxious to help as far as possible, and arrangements are in progress between their Committee and myself for obtaining what 1 require. I have no- doubt that in the early part of the coming year we shall have satisfactory arrangements for the children of the area. (/). Ear Disease and Defective Hearing. One hundred and ninety two cases of ear disease or defective hearing were dealt with at the school clinics, and 13 were treated by private arrangement of the parents. B.I.P. Paste is still used in the three school clinics and the results are extremely satisfactory. (g). Dental Defects. The following paragraphs are extracted from the Dental Surgeon's report:— " The work of the Dental Section during 1936, is set out, in detail, in Table IV. 13 The number seen at routine Dental Inspections amounted to 9511 Number absent from routine Dental Inspections 1310 Number under treatment at time of Inspection 1981 Total accounted for 12802 Total number of children on registers 12825 This, of course, includes secondary schools. Apparently it is a custom for most clinics to show secondary school statistics under separate headings, but as the inspection of these schools is done in conjunction with the whole of the schools during the year, and no special session is set aside for the treatment of pupils in secondary schools, no purpose is served by keeping separate statistics. Nevertheless, these statistics, for comparative reasons, are shown on another page. All schools were inspected during the year. Outstanding Features in the clinic's work during this year were:— (a) The near by completion of the Busch Clinic with its accommodation for dental work greatly increased. (b) The decision of the Committee in dealing with the chronic and absentee cases. For the information of Dental Officers of other clinics, the scheme which is chiefly based on the method in use in the Dental Clinics in the County Borough of Croydon, is here given in detail:— 1. The dentist visits school with clerk. Cases are charted. Clerk fills in form M.l for cases needing treatment. This form which also gives advice re dental matters to parents, is sent under cover by Head Teacher to the parent. The parent returns form to Head Teacher within 7 days with the signed statement that either (a) I am obtaining private treatment for my child and from whom to be obtained or (b) I wish my child to be treated by the School Dental Surgeon. The Head Teacher is asked to obtain the return of all Forms. Form Ml. BOROUGH OF HESTON & ISLEWORTH EDUCATION COMMITTEE Memorandum from the TO THE PARENT OR GUARDIAN OF SCHOOL MEDICAL OFFICER, 94a, BATH ROAD, HOUNSLOW. DATE OF BIRTH 193 SCHOOL The Dental Surgeon finds that your child's teeth need attention. Dental decay, if left untreated may affect your child's health seriously, by the constant absorption of poison into the system. Neglect of the milk teeth may produce decay which will cause the second teeth, as they come through, to become decayed. You are therefore urged, in the child's interests to seek early treatment. This treatment may either be obtained by you privately, or at the Council's Dental Clinics. If you desire that the treatment should be carried out at the Dental Clinic, kindly sign the agreement at the foot of this form, or state whether private treatment is to be obtained. The charge for treatment is One Shilling for a period of one year from the date of payment whilst the child is in an elementary school in the Borough of Heston and Isleworth and it includes, if necessary, the administration of an anaesthetic but does not include orthodontic treatment. Please complete either A or B below. ^ I am obtaining private treatment for my child g I wish my child to be treated by the School and give below the name and address of my Dental Surgeon and will pay the charge of 1/- Dentist. at the time of treatment. Name of Dentist Address Signed Parent or Guardian. Parent or Guardian. Section A or B must be completed and the form returned to the HEAD TEACHER within SEVEN DAYS. 14 2. The forms M.l are then divided into consents, for which appointments will be made, refusals, private treatments. The private treatment cases may be followed up and checked in about three months' time. 3. Form M.2 is mainly the duplicate of form M.l and is used by the Attendance and Enquiry Officer when calling at the homes of those who will not return consent on M.l to Head Teacher. If there is still a refusal, the case should then be referred to the National Society for the Prevention of Cruelty to Children on the ground of neglect to provide necessary treatment (Section 1 (2) (a), Children and Young Persons Act, 1933). If the child can be shown to be absent from School suffering with dental trouble, the case may be dealt with by the Attendance Sub-Committee, who may refer the case for action under the Children Act. Form M2. BOROUGH OF HESTON & ISLEWORTH EDUCATION COMMITTEE Memorandum from the SCHOOL MEDICAL OFFICER, 94a, BATH ROAD, HOUNSLOW. Date of Issue of M.l 193 Date of Birth Date of Issue of M.2 193 Date of Return 193 School Consent Form not returned within seven days. The School Attendance Officer is requested to call and report within seven days. REPORT: Please obtain signature of parents to either A or B below. A I am obtaining private treatment for my child g I wish my child to be treated by the School and give below the name and address of the Dental Surgeon and will pay the charge of 1/- Dentist. at the time of treatment. Name of Dentist Address Signed Signed Parent or Guardian. Parent or Guardian. 4. About two months after the general inspection at the School, the state of affairs is reviewed and a list of the refusals in bad cases sent to the Head Teacher with instructions that emergency tickets may be refused in these cases. This policy of giving no emergency treatment to cases that have refused, until after the next routine inspection is a common one and is supported by the Board :— " The broad fact is that the purpose of school dentistry is not to provide a scheme of extraction for a never ending stream of casuals so large that the dentists cannot tackle the greater and more far-reaching problem of good health resulting from sound dentition. The scheme should be educational and that alone is its justification. The School Clinic is not to be regarded as an out-patient dental department for casual work, although arrangements should be made for emergency work." (Page 55, Report of the Board of Education, 1932). 5. If parents refuse treatment for more than two years in succession, then the children should be eliminated from the dental clinic treatment scheme and if the dental needs are such as to demand treatment, the case should be referred to the National Society for the Prevention of Cruelty to Children on the authority of the chairman. If, however, the parents who have refused treatment in the circumstances outlined above, in paragraphs 4 and 5. become penitent, sign the Form M.l or M.2, then refusal of treatment is not justified and such cases should be received back into the fold with joyful censure, provided they undertake to have the necessary treatment fully carried out. It must be understood that orthodontic cases are excepted from this proviso. 15 6. It is essential to the success of the Scheme to get the co-operation of the parents from the beginning. It is, therefore, suggested that when the five year olds are first inspected at an Infants' School, the inspecting Dental Surgeon should give a short general nontechnical talk to the parents assembled for the purpose, and who should be formally invited by the Education Committee on the notice making the inspection appointment at the School. Further, it is desired to obtain the Head and Assistant Teachers' whole-hearted cooperation—in these days parents are so often led by their children; and, the teacher's influence on children is often far greater than that o>f the home. Further, a complete dental scheme should include provision for educating children in the need for care of the teeth. In such work teachers have a definite place in addition to dentists and nurses. At the initiation of the scheme (in January, 1937), it would be useful to hold a meeting of Head Teachers to explain procedure and to secure their help. Emergency Tickets. Everything possible has been done to keep a check on the abuse of these tickets, especially in view of the decision of the Chief Medical Officer of the Board of Education that casual work, which after all is only what these emergency tickets mean, is the very worst propaganda for any dental clinic." (During 1936, 947 cases were referred by Head Teachers). X-Rays. We are still getting this work done at the West London Hospital, but they have notified us that they will not be able to continue this work indefinitely. The question of X-ray apparatus must be clearly considered, but in view of the other services for which an X-ray plant could be utilised to great advantage, it would be manifestly uneconomic to saddle the Authority with the expense of two individual outfits when one could be made to serve all the purposes that the Public Health, School Medical and Dental Work may require. Empire Dental Conference. The Senior Dental Surgeon and the Assistant Dental Surgeon were sent as delegates to the Empire Dental Conference. Statistics. 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 1936. Number of Elementary School children on registers at middle of year, June—11,463. Age. No. Remarks. 1. No. of children who were inspected at Routine Dental Inspections 5 734 « (a) 6 939 7 928 8 972 9 898 10 939 11 790 12 870 13 743 14 354 8167 No. of Special Inspections 2726 (b) No. of Children found to require treatment at Routine Dental Inspections 7651 (b) This equals 93.68 per cent, of the children inspected at Routine Inspections. 16 Remarks. (c) No. of Children actually treated 6568 (c) In arriving at this figure each child is only counted once even though it attended several times during the year for treatment. 2. Half days devoted to Inspection 66 1965 2. Average number inspected per session-— 123. Included in the 1612 ordinary treatment sessions are 69 sessions which were entirely devoted to Orthodontic Treatment. These sessional figures are for approximately 4 whole time dental surgeons. Treatment—Ordinary 1612 do. Gas 192 Administration 95 3. Attendances made by children for treatment 21400 3. This is the gross attendance of children at the Dental Clinic, but children were not always physically treated, for various reasons, every time they attended. 4. Fillings— 10002 4. The ratio of fillings in permanent teeth to extractions of permanent teeth was 504 fillings to 100 extractions. Permanent Teeth 8615 Temporary Teeth 1387 5. Extractions— Perm. Temp. 8659 At Treatment Sessions 13 735 At Gas Sessions 1698 6213 Total 6. Administrations of general thetics anaes- 2676 6. The percentage of attendances for "Gas," 2,676, of total attendances for treatment, 21,400, was 12.5. 7. Other Operations 7299 The 2,676 " 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 192. Dentures for School Children. In eight 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—7,299—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 1636 Dressings 1447 Scaling and Polishing Teeth 163 Treatment of Gums 256 Destroying the Pulp 14 Orthodontic Cases (Advice) 388 Impressions taken 642 Orthodontic Appliances fitted 225 Orthodontically treated 2528 7299 Attendances made by Children for Treatment. The figure 21,400 shown in the Board's Table is the gross figure of school children's attendances at the Dental Qinic, but actually physical treatment was not given in every instance, as in some cases treatment was postponed, or an appointment was given for ' gas '. 17 ANNUAL REPORT OF ORTHODONTIC CONSULTANT. The activities of the Orthodontic Section during 1936 have been marked by a continuation of that smooth and satisfactory working which is happily a feature of the general undertakings at the Clinic. I am, therefore, again glad to be able to state that the creditable results achieved in previous years have been fully maintained throughout the past twelve months. I should like to take this opportunity of once more expressing my thanks to the Dental Staff for the kind and understanding support which they have unfailingly given me. H. R. EVANS, l.d.s., r.c.s., eng., Orthodontic Consultant. Orthodontic Demonstrator, Children's Department, Royal Dental Hospital. As an instance of the importance of the correction of orthodontic deformities at the proper time, the following case illustrates the tragedy of the condition not being dealt with. This child came into our district at the age of 13J from a County Council area where she has been dentally inspected in the ordinary routine way. The child's personal appearance as can be gathered from the accompanying illustrations, was ruined. The deformity gave her an unintelligent appearance and its presence very seriously affected the child's general outlook on life. The casual observer would have put the child down as wanting in intelligence, whereas the Head Mistress of the school in our district to which the child ultimately came, reported that her standard of intelligence was such that she had no doubt that had she had the child at the proper time she would have obtained a County Scholarship. I tried to get something done before the child left school but this was defeated at first by the child leaving and being rushed into employment. However, I got the mother to bring the child back on a Saturday morning and four teeth were removed from the upper jaw, and two from the lower jaw, with the hope that nature would do something to remedy the gross overcrowding which had produced the deformity. Unfortunately at this age teeth do not move into new places as easily as they would have done had we had her somewhere about the age of ten. 18 (h). Orthopaedic and Postural Defects. Although handicapped by the absence of a Clinic for the supervision of crippling defects, we have been able to secure expert advice for the cases, and one can only place on record one's gratitude for the manner in which the Royal National Orthopaedic Hospital has co-operated with us in remedying the defects we found amongst our school children during the year under discussion. Thirty-three school children attended from this area as Out-patients. Three children received in-patient treatment at the Royal National Orthopaedic Hospital, the Education Authority accepting responsibility for the Hospital charges. The conditions for which these children were treated were :— Post fracture deformity left hip. Old Poliomyelitis. Congenital dislocation both hips. Three other children obtained in-patient treatment at the Royal National Orthopeedic Hospital by private arrangement of the parents. The conditions were respectively :— Knock knees. Ganglion, left foot. Left Sterno-mastoid Torticollis. Thirty-one children received non-residential treatment of various forms, e.g., Exercises; Manipulation and Special Boots. (i). Heart Disease and Rheumatism. Whilst we have no arrangement for the treatment of Heart Disease and Rheumatism within the ambit of the local School Medical Service, such cases as are recommended for institutional treatment are sent by the Committee to West Wickham or other places according to the nature of their needs. Other cases are kept under observation at the School Clinics, and, with the co-operation of Head Teachers, receive modified schooling and periods of rest. (/). 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. The scheme introduced last year for following up certain cases of infectious disease has continued to operate. 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 Clinic. The expected outbreak of Measles occurred and we have had the greatest incidence for a number of years, 1,352 cases being recorded. The visitation and supervision by the Health Visitors over cases notified, has had a beneficial effect. The use of Measles serum in both cases and hospitals is set out in full in the following report which was made on the request of the Committee, on the possibility of dealing with Measles on a large scale. 19 Measles. I wish to bring to the attention of the Committee the services again rendered by the Rover Scouts of the District in the prevention of Measles. The names I wish to present are H. Bennett, 115, Cambridge Road. L. Gaydon, 283, Martindale Road. Philip King, 30, Midsummer Avenue. I wish to place on record my great appreciation of the services rendered by these individuals in the prevention of Measles in the area of the Borough Council, particularly to Mr. Bennett and Mr. King who have been blood donors on this occasion for the second time. Measles for 1936 has come and gone, and again I have to report that we have been able, through the action of the above-mentioned Rover Scouts, to keep both the Hounslow Hospital and Mogden Isolation Hospital open throughout the outbreak, and in addition prevent a number of cases of Measles in the private practices of the area. The mortality has been negligible. Again I want to draw attention to what Measles really means. Before the War when I was M.O.H. at Wimbledon I had 43 deaths from Measles in that area. I had 4 children dead in one house, two in the flat upstairs and two in the flat downstairs. The house in question was a comparatively modern house with ample air space surrounding it, wide streets and from the point of view of external sanitation a satisfactory house. The condition there was undoubtedly one of which the secondary cause was subnormal nutrition. Had these 43 deaths been Smallpox the country would have been in uproar from end to end, but as it was Measles nobody took much notice. Measles has to be considered not only as a death dealing disease which will be found year after year to head the list of deaths from infectious diseases in the country, always outnumbering those from Diphtheria and Scarlet Fever, but it also leaves behind it a trail of damaged lives and it is not fully appreciated what the extent of the damage really is Amongst the better class schools mastoids occur in some epidemics in large numbers but deaths are very few as nutrition is good. 1 remember one of the ablest Headmasters 1 have ever come across taking me round one of the schools in Wimbledon after the outbreak referred to and saying " I cannot tell you how it is, what it is or why it is except that it is Measles, but I can point out a number of children who have never been the same since they have had Measles. They cannot concentrate in the same way, their intelligence seems somehow at fault, in fact they are totally different children, and yet it is difficult to put one's finger on exactly what is wrong." He took me round the school and pointed out child after child. As far as clinical observation was concerned there seemed to be nothing for one to put one's finger on and yet his shrewd observation had found a legacy of damage which, in his opinion, was from the child's point of view, serious. The present position with regard to prevention is that there are three main methods of dealing with an outbreak. It must be first understood that it is quite impossible to prevent every case by widespread inoculation. The first method in use is Convalescent serum prepared from the blood of children who are recovering from an attack of Measles. This is not a practical Proposition as the parenls of small children are very averse to having their children bled in order to provide serum for safeguarding some other stranger's child. As the majority of cases of Measles occur round about 5, it is quite understandable that the parents object to children of this tender age being bled. The second method is by using convalescent serum from young adults who have had Measles. This is available from volunteers who have no connection with the patient but should be available in the case of every young married couple in connection with their own children. The efficiency of Convalescent Serum was considered to be some 20-30% higher than that of Adult Serum which was put as low as 60%. However, more recent research in the London County Council Fever Hospitals has shown that the Adult Serum approximates much more closely than was originally thought to that of Convalescent Serum which is somewhere in the region of 80-90%. It must be clearly understood that there is not the same efficiency with Measles Serum as there is with protection from Diphtheria by means of immunisation with the preparations that have been in use for some time. Unfortunately the reputation of the immunising substances has had a bad shock by reason of a preparation which was forced on the market for one shot purposes, which only gave an efficiency of some 65%. In this district with the preparation which wp are using for Diphtheria Immunisation we are now getting some 97-98% efficiency. 20 Both Convalescent and Adult Serum can be given in two ways, one by giving a full dose to produce an immediate immunity which only lasts a few weeks to tide over the present outbreak, or by giving a smaller dose to produce a modified attack which will be in most cases little more than a passing inconvenience for 36 hours or so, but which will give a permanent immunity to the individual injected. During the current outbreak I have used Adult Serum with 100% efficiency but it must be realised that in every outbreak there is going to be a certain number of children who are not going to get Measles. The individual children who are going to escape cannot be ascertained beforehand. In the Public Schools the figure is round about 3 to 4%. In other outbreaks where there is no possibility of control the figure is not accurately known, so that although the figure of 100% which 1 am giving sounds almost incredible, it is the only way in which the figures can be presented. In our own area in the two hospitals we have had complete prevention, that method being definitely one of election. Outside in private practice both systems have been adopted, where there have been young children in the family where a case has arisen. In some cases there has been a deliberate policy of attenuation with a view to permanent protection. Apart from our own district I have had the same complete success. During the last outbreak over two years ago, in one of the oldest and largest preparatory schools in the country, of which my son was Headmaster for some time, the)' had had 10 mastoids amongst 86 boys. I promised that during the next outbreak, that is the present one, I would help if they would let me know in time. I received a telephone message one morning to say that the previous night a case of Measles had arisen. I had been trying for some time to arrange with Dr. O'Brien, the Head of the Wellcome Research Laboratories, to get into operation some scheme whereby adult serum was available at once on the outbreak of the case. We had arranged that it should be obtainable from his pool, provided that the individuals requiring it furnished from suitable cases sufficient adult blood to provide the same amount of serum as was asked for. In this case, Dr. O'Brien provided the necessary serum and the staff provided the necessary blood. The 37 non-immune contacts were injected and no> further case has arisen. In the case of this school I definitely advised giving a full dose for complete temporary prevention rather than a smaller dose with a view to permanent immunity, by reason of the fact that the outbreak occureed in the middle of the summer term when the boys were preparing for scholarship examinations. Even a modified attack produced deliberately, whilst giving permanent immunity, might irretrievably damage the boy s prospects in life by reason of not being able to sit for his scholarship. I speak very feelingly as exactly the same thing happened to me when my chance of a scholarship was as near certain as anything in this world can be, a sharp attack of measles shortly before an examination being an absolute bar to entrance. In a school of 50 boys a little further along the south coast, during the last outbreak they had a record of 10 mastoids out of a total of 50 boys. There is no need to stress what these abscesses, which occur in the cells behind the ear just below the brain, mean to the Headmaster. His anxiety is ever present, the parents either living in or near the school or are everlastingly on the telephone, and it can be but dimly appreciated by those who are not responsible for a school what it means to the Headmaster in question to be absolutely freed from any further cases of Measles. Shortly afterwards I took a deputation from the Council to Lord Mayor Treloar's Home. Sir Henry Gauvain informed me he thought he had a case of Measles. There is no need to stress what Measles means in an institution of that kind with a number of T.B. cases and cripples of all kinds. There is nothing which lights up old tubercular troubles in the same way that Measles does in children. The following morning I received a telephone message to say that the case was undoubtedly one of Measles and he had 17 non-immune contacts. There were 16 doses of serum left over from the school mentioned above and I was able to obtain one dose of convalescent serum through Dr. O'Brien from the London Fever Hospital. The contacts were duly inoculated and no further case arose. Later on 1 was approached by the Medical Officer of one of our Public Schools as Measles had broken out and there were 100 non-immune contacts. Owing to the season of the year, it was advisable to try for permanent immunity with modified attacks rather than immunising the whole number with a view to temporary immunity. At the time of writing the inoculation is proceeding and beyond slight temporary upsets in some of the older boys, everything is proceeding satisfactorily. Whilst the immunity which I have been able to obtain is 100%, this must not be regarded as normal, nor can I hope that it is likely to occur again, but for its occurrence I am grateful. The third method is one which is being practised in America particularly and is by the use of globulins from the blood extracted from fresh afterbirths. Personally I do not think that this method, although the report is that the percentage immunity offered is high, is going to 21 supplant, anyhow for some considerable time in this country, the use of adult serum. The sentimental objection will, in my opinion, militate against its use, however efficient, for some time to come, and so long as volunteers to supply adult serum can be obtained from outside sources or from young parents, it will be long before the use of placental globulins becomes a day-to-day occurrence in this country. One cannot be too grateful to the Rover Scouts for their public spirited sacrifice. It is time that something more general was done in the country and if volunteers can be obtained from this great organisation, I do commend it to other authorities, particularly those where poverty is greater than it is in our own area, as a contribution towards diminution, if noi obliteration, of deaths from Measles. The following table shows the infectious disease which occurred among children attending public elementary schools during 1936 and the five previous years. 1936 1935 1934 1933 1932 1931 Small-pox — — — — — — Scarlet Fever 119 124 210 186 105 106 Diphtheria 8 37 44 17 30 26 Measles 1352 10 901 108 952 9 German Measles 15 6 66 13 25 5 Mumps 306 113 153 940 122 132 Chicken-pox 161 537 417 362 194 233 Whooping Cough 366 232 144 287 260 242 2327 1059 1935 1913 1688 753 22 This table shows the incidence of infectious disease in, each school during 1936:— school. scarlet fever diphtheria. measles german measles mumps chicken pox whooping cough Alexandra Junior 3 1 — — 10 7 3 „ Infants 15 1 108 2 3 7 35 Berkeley Junior Mixed & Infants 12 1 44 — 10 7 25 Bulstrode Senior Boys 4 1 4 — 9 — 2 ,, ,, Girls 1 — — — 5 — — Chatsworth Infants 9 — 109 — 67 5 27 Cranford C. of E. Infants 10 — 92 — — — 15 „ Temporary Council Junior 2 — 8 — — — 5 Grove Road Junior Mixed 3 — 4 — 11 — 4 „ „ Infants 5 — 111 1 18 3 48 Heston Senior Mixed — — — — 1 1 — „ Junior Mixed 2 — 11 1 1 4 — „ Infants 2 — 128 6 1 2 29 Hounslow Heath Senior Mixed 2 — 4 — 5 — 1 „ „ Junior Boys 2 — 4 — — 2 6 „ „ Junior Girls 3 — 8 — 4 5 1 „ „ Infants 4 — 190 — 11 10 32 Hounslow R.C. Mixed & Infants 6 — 27 — 10 1 8 Hounslow Town Junior Boys 3 — — 5 — — „ „ Junior Girls & Infants 6 — 65 11 20 23 Isleworth Blue Boys 1 1 — 1 2 1 — „ „ Girls & Infants 1 — 14 — 1 9 3 Isleworth Town Junior Mixed 1 1 3 2 7 2 2 „ „ Infants 1 — 61 — 7 7 10 Marlborough Senior Mixed 3 — 2 — 5 1 — „ Infants 5 1 108 1 29 16 31 St. Mary's Boys 2 — 4 — 5 1 — „ Girls & Infants 1 — 25 — 5 1 4 Spring Grove Central 1 — 2 — 4 — — „ „ Junior Mixed & Infants 2 1 38 — 8 23 — Wellington Junior 5 — 58 — — — 23 Woodlands St. John's Infants — — 40 — 15 3 1 Worple Road Junior Mixed 2 — 1 — 18 7 5 „ „ Infants — — 79 1 18 16 23 119 8 1352 15 306 161 366 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. In the following schools the percentage attendance fell below 60 and certificates were issued in the terms of the Board's administrative memorandum No. 51, (January, 1927) to the effect that the fall in attendances might reasonably be attributed to the prevalence of infectious disease. Date (week ending). School. Infectious Disease. 24th April, 1936. Grove Road Infants'. Measles, Mumps and Whooping Cough. 12th June, 1936. Cranford C. of E. Infants'. Measles. 12th June, 1936. Woodlands St. John's Infants'. Measles. 19th June, 1936. Woodlands St. John's Infants'. Measles. 26th June, 1936. Woodlands St. John's Infants'. Measles. 4th December, 1936. Heston Infants'. Measles. 11th December, 1936. Heston Infants'. Measles. 17th December, 1936. Heston Infants'. Measles. 23 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. 9—OPEN-AIR EDUCATION. (a). Playground Classes. These are arranged in most of the schools. All the newer schools have fields on the site which are fully used during the summer for teaching purposes. (b). Open-Air Classrooms in Public Elementary Schools. The newer schools e.g., Heston Junior, Marlborough and Cranford have almost completely open-air classrooms. (c). School Journeys and Camps. School Journeys :—These are encouraged by the Committee and take place for Senior Schools between Easter and October. Parties consist of 30-40 children, usually of the same age group. The Committee pay 10s. 0d., per head, or 50% of the cost per child, plus travelling and maintenance charges of the teachers. During the year the following journeys were made:— 1 party of 30 girls—Bulstrode Senior Girls' School. To Ryde, Isle of Wight. 1 party of 40 girls—Marlborough Senior Mixed School. To Nutbourne Holiday Camp, Hambrook, Chichester. 1 party of 40 boys—Marlborough Senior Mixed School. To Nutbourne Holiday Camp, Hambrook, Chichester. School Camps :—A camp site at Ham Island, near Windsor has been used by the Hounslow Heath Senior School for a School Camp—held in term time and under the conditions applying to school journeys. 10.—PHYSICAL TRAINING. There is no area organiser of Physical Training but the question of the appointment of organisers has been carefully considered recently. In each Senior School a fully qualified Physical Training specialist has been appointed and suitable apparatus has been provided. A new gymnasium with showers and changing rooms is in course of construction at Spring Grove Central School and the Hall at Marlborough Senior School has recently been equipped with wall bars, ropes, etc. 11.—PROVISION OF MEALS. Dinners. Selection of Children.—Children are selected on application to the Head Teacher or on notification by the School Medical Officer. The Head Teacher is authorised to grant two tickets and the case is then referred for assessment. Approval of Dietaries.—Meals are provided in five cafes and are subject to periodic inspection by the School Medical Officer's staff. Specimen menus are provided to caterers for their guidance. The full cost of the meals is 7d. per day. Dinners only are provided, and the scheme has recently been extended to holidays. One is up against the constant difficulty that the caterers have with regard to the number of children who will not eat greens. Part of this, in the poorer families, is due to the fact that greens mean extra cooking and extra work and it is not sufficiently realised by the parents that they are doing the children harm, from the nutrition point of view, by depriving them of green foods. I find that the children who have school dinners have been leaving the greens on their plates, and I have given orders that unless they consume the amount of greens which are given as their portion, they will be deprived of their pudding. By degrees these children are being educated up and one is finding that they are consuming their greenstuff apparently with relish. 24 Milk. On the 1st October, 1936 (the date of the Board's Return-Form 208.M.), 4,835 children were having milk daily at school. One hundred and thirty four of these were having milk free, and 4,701 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 1936 a parent or other relative attended in 3,018 instances, representing 80.3 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 lime 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 iliness. 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 TeacheTS 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. At the end of 1936 there were 29 children being maintained bv the Education Committee at institutions outside the district. Four children were in Schools for the Blind, and two were in a School for the Partially Sighted. In addition to these 6 children who are in Special Schools, we have 18 children attending elementary schools in the area who suffer from a high degree of myopia. Nine of these have been supplied with special desks. Each of the 18 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. One of the children has vision so defective that in accordance with the Board of Education's definition in Table III., he must be classified as partially sighted. This child should be in a special school or class for such cases. 25 Seven children were in schools for the Deaf. Two were in schools for the Mentally Defective. Five were in schools for Epileptics. Three were in Schools for Cripples, and two were at the Royal National Orthopaedic Hospital's Country Branch, Stanmore. Four 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. 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 which came into force on the 1st April, 1935, has continued to work smoothly. During the vear 1526 children were dentally inspected, and of these 1194 were found to need treatment. 532 children received treatment before the end of the year. 81 Ophthalmic cases were dealt with. 63 were found to need spectacles and in each case the spectacles were obtained before the end of the year. See Statistical Tables on pages 36 and 37. 17.—PARENTS' PAYMENTS. There has been no change in the details set out in my reports for 1934 and 1935. 18.—HEALTH EDUCATION. During the year four parties of girl " leavers " from the Spring Grove Central School visited the Douglas Road M. & C. W. Centre. 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-four children were examined during 1936. 26 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 1301 Second Age Group 1362 Third Age Group 986 Total 3649 Number of other Routine Inspections — Grand Total 3649 B.—Other Inspections. Number of Special Inspections 2207 Number of Re-Inspections 4287 Total 6494 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 241 Second Age Group 216 Third Age Group 123 Total (Prescribed Groups) 580 Other Routine Inspections — Grand Total 580 27 TABLE II. A. RETURN OF DEFECTS found by Medical Inspection in the Year ended 31st December, 1936. Defect or Disease Routine Inspections. No. of Defects. Special Inspections. No. of Defects. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. 1 2 3 4 5 (1) Ringworm—Scalp ... ... 17 ... (2) „ Body ... ... 10 ... (3) Scabies ... ... 32 l (4) Impetigo l ... 271 1 (5) Other Diseases (Non-Tuberculous) ... 2 195 3 TOTAL (Heads 1 to 5) l 2 525 5 Eye (6) Blepharitis 3 7 48 ... (7) Conjunctivitis ... 1 71 ... (8) Keratitis ... ... ... ... (9) Corneal Opacities ... ... ... ... (10) Other Conditions (excluding Defective Vision and Squint) 4 1 111 2 TOTAL (Heads 6 to 10) 7 9 230 2 (11) Defective Vision (excluding Squint) 181 22 91 9 (12) Squint 6 2 9 ... Ear (13) Defective Hearing 14 17 43 6 (14) Otitis Media 6 4 123 5 (15) Other Ear Diseases 4 5 82 5 Nose and Throat (16) Chronic Tonsillitis only 233 148 173 32 (17) Adenoids only 2 1 8 2 (18) Chronic Tonsillitis and Adenoids 63 112 32 4 (19) Other Conditions 7 35 155 34 (20) Enlarged Cervical Glands (Non-Tuberculous) 3 43 33 12 (21) Defective Speech 2 1 1 Heart and Circulation Heart Disease : (22) Organic 1 2 3 9 (23) Functional 2 30 7 22 (24) Anaemia ... 9 14 ... Lungs (25) Bronchitis 1 22 91 21 (26) Other Non-Tuberculous Diseases 1 49 49 22 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 1 (34) Chorea ... 3 3 5 (35) Other Conditions ... 2 14 5 Deformities (36) Rickets ... 1 ... 2 (37) Spinal Curvature 1 2 3 1 (38) Other Forms 3 9 13 3 (39) Other Defects and Diseases (excluding Uncleanliness and Dental Diseases 9 18 1769 151 Total number of Defects 547 547 3473 359 28 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 1301 11 0.85 910 69.94 369 28.36 11 0.85 Second Age-group 1362 3 0.22 945 69.38 402 29.52 12 0.88 Third Age-group 986 8 0.81 784 79.51 191 19.37 3 0.31 Other Routine Inspections – – – – – – – – – TOTAL 3649 22 0.6 2639 72.32 962 26.37 26 0.71 29 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 31. BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 3 — — — 3 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 01 Institution. Total. 1 2 1 — 2 6 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 7 — — — 7 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 14 — 14 30 EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 5 — 1 1 7 30 TABLE III.—continued. 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. — — 1 4 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. 3 — — 3 6 B. Delicate Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 4 132 2 2 140 C. Crippled Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 4 25 — 2 31 D. Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 2 2 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. 31 STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1936, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. Total Number or Children notified 7 Analysis of the above Total. Diagnosis. Boys. . 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School : (a) Idiots 1 — (b) Imbeciles 4 2 (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 — — 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 5 2 32 TABLE IV.—RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1936. TREATMENT TABLE. GROUP I.—MINOR AILMENTS (excluding Uncleanliness, for which see Group VI) Disease or Defect. (1) No. of Defects treated, or under treatment during the year Under the Authority's Scheme. (2) Otherwise (3) Total. (4) Skin— Ringworm-Scalp. (l) X-Ray Treatment 15 — 15 (2) Other 2 4 6 Ringworm-Body 10 — 10 Scabies 27 2 29 Impetigo 266 4 270 Other skin disease 145 32 177 Minor Eye Defects 174 19 193 (External and other, but excluding cases falling in Group II). Minor Ear Defects 192 13 205 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc). 1332 55 1387 Total 2163 129 2292 33 TABLE IV.—continued. GROUP II.—DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments—Group I.) Defect or Disease 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) (1) (i) Under the Authority's Scheme (ii) Otherwise (i) Under the Authority s Scheme (ii) Otherwise Errors of Refraction (including squint) 691 1 692 477 1 481 * 1 Other defect or disease of the Eyes (excluding those recorded in Group i). – 1 1 – – – – Total 691 2 693 * Note.—4 of these had spectacles prescribed at the end of last year. 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 (1) 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 — 94 — 11 1 59 — 12 1 153 — — 166 (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 4 — 11 3 — 20 37 34 TABLE IV .—continued. 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 734 939 928 972 898 939 790 870 743 301 53 8167 (b) Specials 2726 (c) TOTAL (Routine and Specials) 10893 (2) Number found to require treatment 7651 (3) Number actually treated 6568 (4) Attendances made by children for treatment 21400 (5) Half-days devoted to :— Inspection 66 ( Ordinary 1612 Treatment (Gas 192 Administrative Clerical 86 Administrative Committee Meetings 9 1965 (6) Fillings :— Permanent Teeth 8615 Temporary Teeth 1387 Total 10002 (7) Extractions :— Permanent Teeth 1711 Temporary Teeth 6948 Total 8659 (8) Administrations of general anaesthetics for extractions 2676 (9) Other Operations :— Permanent Teeth 7299 Temporary Teeth Total 7299 GROUP VI.— UNCLEANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 2.15 (ii) Total number of examinations of children in the Schools by School Nurses 15,135 (iii) Number of individual children found unclean 649 (iv) Number of children cleansed under Section 87 (2) and (3) of the Education Act, 1921 Nil* (v) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws 10 * Note.—71 children had their heads cleansed—by parents' request—under arrangements made by the Local Education Authority (see page 10). 35 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) 81 – 81 Other defect or disease of the eyes (excluding those recorded in Group I) — — — Total 81 — 81 Under the Authority's Scheme Otherwise Total No. of Children for whom spectacles were (a) Prescribed 63 — 63 (b) Obtained 63 — 63 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 16 17 18 TOTAL Number 3 224 247 307 246 191 91 33 2 1344 (b) Specials 182 (c) TOTAL (Routine and Specials) 1526 (2) Number found to require treatment 1194 (3) Number actually treated 532 (4) Attendances made by children for treatment 1796 36 (5) Half-days devoted to :— Inspection 14 Treatment * Total 14 (6) Fillings :— Permanent Teeth 1257 Temporary Teeth 1 Total 1258 (7) Extractions :— Permanent Teeth 335 Temporary Teeth 61 Total 396 (8) Administrations of general anaesthetics for extractions 160 (9) Other Operations :— Permanent Teeth 331 Temporary Teeth Total 331 * 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. 37