Spare copy RICH 8 BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1939. RICHMOND: J. H. BROAD AND CO., LTD., PRINTERS, 8, KING STREET, BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1939. richmond: j. h. broad and co., ltd., printers, 8, king street. 1 Public Health Department, Parkshot, Richmond, Surrey. December, 1940. To the Mayor, Aldermen and Councillors of the Borough of Richmond (Surrey). Ladies and Gentlemen, I have the honour to submit my Annual Report on the Health and Sanitary condition of the Borough for the year ended December 31st, 1939. The Minister of Health suggested in a Circular issued in February last that reports should be curtailed and in a further circular issued in July has stated that "in view of the increasing pressure of work in the Public Health Departments of Local Authorities and the need for strict economy in the use of paper the Minister considers that interim reports only should be made for the year 1939." Arrangements are to be made for the careful preservation of all records in order that after the termination of the war a Report could be made dealing more fully with the period from the beginning of 1939 to the end of the last complete year. This has been done and the report confined mainly to important statistics. The report shows that the Health of the Borough in the year under review was good, an outstanding feature being the Infantile Mortality Rate. This was the lowest on record viz: 25 per thousand births as compared with a rate of 50 per thousand births for England and Wales. I am, Ladies and Gentlemen, Your obedient Servant, C. S. BREBNER, Medical Officer of Health, 3 Statistics. Area (in acres) 4,243 Population (census 1931) 37,791 Population (estimated 1939) for Birth Rate 38,300 for Death Rate 37,290 Number of inhabited houses 10,430 Rateable value £595,466 Sum represented by a Penny rate £2,300 Extracts from vital statistics of the Year. For calculating Birth Rate. TOTAL. M. F. Live births (Legitimate) 362 193 169 Live births (Illegitimate) 31 17 14 For calculating Infant and Maternal mortality. Live births (Legitimate) 359 192 167 Live births (Illegitimate) 31 17 14 Birth rate per 1000 of estimated resident population 10.2 Still births Total 23 Males 12 Females 11 Deaths Total 472 Males 215 Females 257 Death rate per 1,000 of estimated resident population 12.6 Corrected death rate 10.8 Death rate from Puerperal Sepsis and other Puerperal causes Nil. Death rate of Infants under 1 year of age. All infants per 1,000 live births 25 Deaths from Cancer (all ages) 75 „ „ Measles Nil. „ „ Whooping Cough 3 „ „ Diarrhoea (under 2 years) Nil. 4 Causes of death 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 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year 1. Injury at Birth 1 1 .. ... 2 ... ... ... ... 2 2, Congenital Debility and Malformation including Premature Birth 5 1 ... ... 6 ... ... ... ... 6 3. Whooping cough ... ... ... ... ... ... 1 ... ... 1 4. Other defined diseases ... ... ... ... ... ... 1 ... ... 1 6 2 ... ... 8 ... 2 ... ... 10 5 BIRTH RATE, DEATH RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1939. (Provisional figures). (The mortality rates for England and Wales refer to the whole population but for London and the towns to civilians only). Rate per 1,000 total population. Annual Death Rate per 1,000 Population. Rate per 1,000 Live Births. Live Births. Still-births. All Causes. Typhoid and Paratyphoid Fevers. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under two years). Total Deaths under one year. England and Wales 15.0 0.59 12.1 0.00 - 0.01 0.01 0.03 0.05 0.21 4.6 50 126 County Boroughs and Great Towns, including London 14.8 0.59 12.0 0.00 - 0.01 0.00 0.03 0.05 0.19 6.3 53 148 Smaller Towns (Resident Population 25,000 to 50,000 at 1931 Census) 15.6 0.57 11.2 0.00 - 0.01 0.00 0.02 0.04 0.20 3.0 40 London Administrative County 12.3 0.44 11.0 0.00 — 0.00 0.00 0.03 0.02 0.18 8.2 48 RICHMOND 10.2 0.66 10.8 0.00 — 0.00 0.00 0.08 0.02 0.53 0.02 25 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales are as follows per 1,000 Live Births 0.77 2.16 2.93 „ „ Total Births 0.74 2 08 2.82 The maternal mortality rates for Richmond are as follows per 1,000 Live Births 0.00 0.00 0.00 „ „ Total Births 0.00 0.00 0.00 6  DEATHS. M. F. All Causes 215 257 1. Typhoid and Paratyphoid Fevers - - 2. Measles — — 3. Scarlet Fever — — 4. Whooping Cough 2 1 5. Diphtheria — 1 6. Influenza 3 17 7. Encephalitis Lethargica — — 8. Cerebro-Spinal Fever — — 9. Tuberculosis of respiratory system 6 6 10. Other tuberculous diseases — 2 11. Syphilis 1 — 12. General paralysis of the insane, tabes dorsalis — 1 13. Cancer, malignant disease 35 40 14. Diabetes 2 8 15. Cerebral hæmorrhage, etc. 5 15 16. Heart disease 66 78 17. Aneurysm 2 — 18. Other circulatory diseases 14 14 19. Bronchitis 4 6 20. Pneumonia (all forms) 7 5 21. Other respiratory diseases 4 1 22. Peptic Ulcer 2 2 23. Diarrhœa, etc. (under 2 years) — — 24. Appendicitis 3 1 25. Cirrhosis of liver 2 — 26. Other diseases of liver, etc. 2 — 27. Other digestive diseases 5 6 28. Acute and chronic nephritis 8 8 29. Puerperal sepsis — — 30. Other puerperal causes — — 31. Congenital debility, premature birth, malformations, etc. 4 3 32. Senility 6 7 33. Suicide 3 1 34. Other violence 6 9 35. Other defined diseases 20 24 36. Causes ill-defined or unknown 2 1 7 Treatment Centres and Clinics. Address. By whom provided. Minor Ailments Clinic Windham Road, Richmond. For Elementary School Children Education Committee. Dental Clinic Ditto Ditto. Ditto. Do. do. Ditto M. and C.W Committee. Eye Clinic Ditto (1 session per fortnight). Education Committee. Ante-Natal Clinic Ditto (1 session per week). M. and C.W Committee. Diphtheria Immunisation Ditto Health Committee. Tonsils and Adenoids Richmond Royal Hospital. By arrangement with Education Committee. Ringworm (X-rays) Dr. D. B. I. Hallett, 2, Old Palace Terrace, Richmond. When required. Education Committee. Maternity and Child Welfare Treatment Richmond Royal Hospital. Once weekly. By arrangement with M. & C. W. Committee. Tuberculosis Treatment 38, Sheen Rd., Richmond. Once weekly. County Council. In spite of the disturbed conditions the various Clinics continued to function with the exception of the Welfare Centre at Petersham. This was closed for a few months until a suitable Air Raid Shelter could be provided. This was completed in March and the Centre re-opened. 8 Attendances at Clinics. Ante-natal. Number attended. Total attendances. 172 717 Attendances. Windham Road Mothers 3,164 Children 3,188 Trefoil House Mothers 744 Petersham Children 1,030 Doctor's Consultations 2,095 Health Visitors' Visits First visits Re-visits. 366 2557 Nursing Homes. The Surrey County Council have registered seven Nursing Homes. 44, Onslow Road, General Medical and Maternity 22, Cardigan Road, „ „ 25, West Park Road, „ „ 2, The Green, „ „ 86, Mount Ararat Road, General Medical 19, Grena Road, „ „ Beaconsfield, Kew Green, Maternity only All these Homes have been visited during the year. SANITARY INSPECTION OF THE AREA. Report of Chief Sanitary Inspector. The many and varied duties carried out by the Department under the varied Acts, Orders and Regulations, have all received strict attention throughout the year. Routine house-to-house inspections have been made, and visits to meat stores and other shops, dairies, cowsheds, milk shops, bakehouses, factories and stables, have been carried out. Premises licensed in accordance with the Petroleum Acts have been systematically inspected to see that the special conditions embodied in the licences were being complied with. 9 The figures given below indicate the nature of the work carried out. Inspections under the Housing and Public Health Acts. Total inspections 8,739 Nuisances discovered on 748 of the premises 4,821 Defects abated by the end of the year 2,741 Work in hand to remedy defects, at the end of the year 65 Outstanding defects at the end of the year 2,015 Visits paid to ascertain that the defects were being properly remedied 2,981 Inspections made under the Housing Acts 193 Sanitary defects remedied, and improvements made in accordance with the above 3,953 Unfit underground dwellings, contravening the Housing Regulations, reported during the year 26 Closing Orders made 8 Voluntary Undertakings given 9 Basements made fit voluntarily by owners 6 Action deferred until 1940 3 Shops Acts. Number of shops on register at the end of the year 753 Special visits made 1,000 New additions to register 94 Changes of occupancy 177 Contraventions. Half Holiday Notices not exhibited 1 Early Closing Notices not exhibited 1 Exemption Notice (Section 4 Shops (Sunday Trading Restriction) Act 1936) not exhibited 1 Provision of Seats for Female Assistants (Form K) not exhibited 1 10 Factories Act 1937. Factories on the register at the end of the year. Mechanical 106 Non-mechanical 60 Inspections made 201 Written notices served 9 Defects found 30 Defects remedied 30 Service of Notices. Informal Notices Served 513 Statutory or Formal Notices Served 44 Number of dwelling-houses which were rendered fit after service of Formal Notice— (a) By Owners 8 (b) By Local Authority in default of owners Nil. Petroleum Acts 1928. Visits made during the year 215 Licences for which applications for renewal were made during the year 65 New licences issued during the year 3 Number of persons licensed to keep Petroleum 55 Slaughterhouses. Visits of inspection made 89 Number of animals inspected after slaughter 231 11 Carcases Inspected and Condemned. Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed (if known) 35 1 1 147 47 Number inspected 35 1 1 147 47 All Diseases except Tuberculosis. Whole carcases condemned ... ... ... ... ... Carcases of which some par or organ was condemned 1 ... ... ... ... Percentage of the number inspected affected with diseases other than tuberculosis 2.8% ... ... ... ... Tuberoulosis only. Whole carcases condemned ... ... ... ... ... Carcases of which some part or organ was condemned 3 ... ... ... 1 Percentage of the number inspected affected with tuberculosis 8.5% ... ... ... 2.1% Visits made to meat shops or stores, and other premises where food is prepared or exposed for sale 382 Eradication of Bed Bugs. Disinfestation methods were applied to the following properties:— Council Houses 28 Other Houses 64 12 Disinfection of Premises. Reason. Houses. Rooms. Bedding disinfected. Infectious Fevers 30 32 29 Tuberculosis 20 23 15 Other Diseases 9 15 5 Vermin 92 198 91 Housing Statistics for the year. Number of new houses erected during the year— (a) Total (including numbers given separately under (b) ) Houses Nil 147 Flats Nil 74 (1) By the Local Authority Houses 104 Flats 8 (2) By other Local Authorities Nil (3) By other bodies and persons Houses 43 Flats 66 (b) With State assistance under the Housing Acts :— (1) By the Local Authority:— (a) For the purposes of parts 2 and 3 of the Housing Act 1936 Houses 104 Flats 8 (2) By other bodies or persons Nil Complaints. Number received and dealt with during the year 526 (Signed) GEORGE LAWS, F.R. San.I., F.S.I.A. Chief Sanitary Inspector, and Officer under the Housing Acts. 13 SURREY COUNTY COUNCIL. SALE OF FOOD AND DRUGS ACTS. Particulars of samples taken in the Borough of Richmond during the year ended December 31st, 1939:— Articles. Analysed Adulterated or Deteriorated Prosecutions Convictions. Formal Informal Total Formal Informal Total Milk 40 ... 40 ... ... ... ... ... Butter 6 ... 6 ... ... ... ... ... Cheese 1 1 2 ... ... ... ... ... Meat 1 ... 1 ... ... ... ... ... Tea 1 1 2 ... ... ... ... ... Sugar 1 ... 1 1 ... 1 ... ... Sausages 5 ... 5 ... ... ... ... ... Jam 1 ... 1 ... ... ... ... ... Spirits 6 ... 6 ... ... ... ... ... Other Articles 1 4 5 ... ... ... ... ... Totals 63 6 69 1 ... 1 ... ... PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notifiable Diseases during the year. Disease Total Cases Notified. Cases Admitted to Hospital. Total Deaths. Smallpox ... ... ... Scarlet Fever 20 17 ... Diphtheria 4 4 1 Enteric Fever 1 1 ... Puerperal Pyrexia 11 8 ... Pneumonia 35 23 12 (all forms) Cerebro-Spinal Fever ... ... ... Ophthalmia Neonatorum 2 ... ... Erysipelas 3 1 ... Dysentery 1 1 ... *Measles 1 ... ... *Whooping Cough 2 ... ... Total 80 55 13 * After the coming into force of the Measles and Whooping Cough Regulations, 1939. 14 SOUTH MIDDLESEX FEVER HOSPITAL. ADMISSIONS CLASSIFIED. Disease. No. of Patients Admitted from Richmond. Scarlet Fever 17 Diphtheria 4 Erysipelas 1 Typhoid Fever 1 Measles 3 Whooping Cough 5 Other Diseases 7 Total 38 DIPHTHERIA IMMUNISATION CLINIC. Total number of children seen during the year 594 Total number of attendances 1271 Total number of children who received primary Schick test 87 Total number of children naturally immune 19 Percentage of children naturally immune 22% Number of certificates given 136 Number of children who required additional injections for complete immunity 4 Number of children due for re-test, after 2 years 217 Number re-tested after 2 years 179 Number of children who were still immune 168 Number of children who required further injections 9 Total number of children due for re-test after 4 years 177 Number re-tested after 4 years 128 Number of children who were still immune 119 Number of children who required further injections 1 Total number of certificates given after immunisation. (a) Pre-school children 59 (b) School children 77 15 As previously mentioned, Bacteriological Examinations for Infectious Disease are carried out by the Pathologist at the Royal Hospital, Richmond. During the year the number of specimens, etc., sent up for examination was as follows:— Disease Suspected. Nature of Specimen. Result. Total. Positive. Negative. Diphtheria Swabs from Throat and Nose 2 126 128 Tuberculosis Sputa 11 53 64 Typhoid ... - 1 1 Other Diseases ... 8 24 32 Total 21 204 225 TUBERCULOSIS. It has not been necessary to take action under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 172 of the Public Health Act, 1936. Respiratory Tuberculosis (Phthisis). Forty-five cases of this disease were notified during the year (29 males and 16 females). Of these 37 (24 males and 13 females) were removed to Hospital or Sanatorium. There were 45 cases notified in 1938. There were 12 deaths from this disease during the year. Non-Respiratory Tuberculosis was responsible for three 2 deaths while 9 cases were notified during the year. 16 Tuberculosis. Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M F M F M F M F 0 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 5 1 ... ... 1 ... ... ... ... 15 4 8 1 3 ... 3 ... 2 25 9 4 1 ... ... 1 ... ... 35 5 3 ... 1 1 ... ... ... 45 5 ... ... 1 2 1 ... ... 55 4 ... ... 1 3 ... ... ... 65 and upwards ... 1 ... ... ... 1 ... ... Totals 29 16 2 7 6 6 ... 2 BOROUGH OF RICHMOND (SURREY). Education Committee. ANNUAL REPORT OF THE School Medical Officer 1939. RICHMOND I J. H. BROAD & CO., LTD., 8, KING STREET. 2 Staff. School Medical Officer: C. S. Brebner, D.S.O., M.D., D.P.H., Barrister-at-Law. Ophthalmic Surgeon (part time): C. Longworth Blair, M.R.C.S., L.R.C.P. Dental Surgeon: Miss Evelyn Russell, L.D.S., R.C.S. (Eng.). (part time). School Nurses: Miss J. D. Law, R.R.C. (S.R.N., S.C.M.). Called for war service, September, 1939. (Health Visitors Cert.). Miss A. Petersen, (S.R.N., S.C.M.). Resigned February, 1939. (New Health Visitors Cert.). Miss E. D. Steuart, (S.R.N., R.F.N., S.C.M.). (New Health Visitors Cert.). Miss N. H. Jones, (S.R.N., S.C.M.). (New Health Visitors Cert.). (Tuberculosis Certificate). Temporary Staff: Miss E. M. Mortimer, (S.R.N., S.C.M.). (New Health Visitors Cert.). Dental Assistant (part time): Miss M. D. Banks. Called for war service September, 1939. Dental Assistant (temporary staff): Miss J. Ayland. Appointed September, 1939. Clerks: Miss O. W. Ponsford (part time). Miss L. Higgin (part time). Resigned April, 1939. Temporary Staff: Miss M. O'Connor (part time). Appointed October, 1939. 3 BOROUGH OF RICHMOND (SURREY). Report on the Medical Inspection and Treatment of Elementary School Children for the year ended December 31st, 1939. To the Chairman and Members of the Education Committee. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Report on the work of the School Medical Department during the year 1939. It is the nineteenth Annual Report as your School Medical Officer. The Board of Education, in their Form 6 M, have suggested that owing to the abnormal conditions and because of the urgent need of economy it will be impossible for School Medical Officers to present Reports for the year 1939 on as comprehensive a scale as in previous years. The Board will therefore accept for the year 1939, School Reports of a comparatively simple nature. I have, therefore, cut out a good deal of the usual report which after all is merely repetition. It should be noted that Richmond is a Neutral area and therefore there was no wholesale evacuation of school children or reception of evacuees. A certain amount of private evacuation occurred but this had very little effect on the District. In July last the Education Committee decided to provide trench shelters for the various schools, so that when war actually was declared on 3rd September, it was not very long before the schools were open after a slightly extended summer holiday. All children over the age of 8 years were back at school by 25 th September and the infants went back at various periods up to 6th November. From 25th September therefore all the school medical services were working as usual with the exception that Tonsil and Adenoid Operations were held up owing to the emergency service of 4 the Royal Hospital, Richmond. This was a minor matter as very few cases were seen requiring operation. The Tables at the end of the Report have to be sent to the Board by 1st February and this year the Board asked that Table II.B should only include the figures from 1st January to 31st August" "partly because routine medical inspection has been to a large extent suspended during that period." As I have mentioned there has been practically no break as far as this Borough is concerned and in this Report therefore I have given the figures of Table II.B as submitted to the Board, viz., from January to August inclusive and I have also given the figures for the whole year. During 1939 the Committee considered the provision of free milk for certain children and approval of the scheme has now been given by the Board. Figures relating to this arrangement will be given in the Report for 1940. Two members of the staff are on active service. Miss J. D. Law, R.R.C., one of the School Nurses, was called up in connection with Queen Alexandra's Nursing Service. A temporary School Nurse and Health Visitor (Miss Mortimer) has been engaged in her place. Miss M. D. Banks, the Dental Assistant and Clerk, joined the Land Army and her place has been filled temporarily by Miss J. Ayland. A summary of the statistics is as follows:— Average number of children on the registers during 1939 2,976 Average attendance at Elementary Schools during 1939 2,669 Number of Routine Medical Inspections 784 Number of attendances at Minor Ailment Clinic 2,037 Number of children obtained glasses after tion by specialists 136 Number of children operated on for Tonsils and Adenoid conditions 12 5 Number of attendances at Dental Clinic 1,828 Number of children given general anaesthetics (Gas or Ethyl Chloride) 62,0 I should like to thank the Staff of the Department for their loyal work during the year, to my Colleagues in the Education Office and to the Teachers for their co-operation. I am, Ladies and Gentlemen, Your obedient Servant, C. S. BREBNER. 6 Medical Inspection. (Table I., page 12). Medical Inspections were carried out during the year as follows: — 1. Routine Inspections required by the Board of Education. (a) Entrants; (b) Intermediates; (c) Leavers. 2. Other Inspections : (a) Special children not in the above groups but who are examined, usually at the request of the Head Teacher. (b) Children seen at the Clinic, sent by Parents, Head Teachers or the School Nurses. (c) Re-inspections of children previously found with a defect of some kind. There were 153 entrants examined at the Routine Inspections and 112 parents or guardians attended. 272 children of the intermediate age were inspected and 298 leavers, i.e., children aged 12 years. There were 61 other Routine Inspections made during the year, so that the total number of children examined was 784 as compared with 858 in 1938. It was not possible to complete all the Routine Medical Inspections which were due in 1939. Other inspections include children seen as "specials." These are generally children brought forward by the Head Teachers, or they may be seen by one of the School Nurses and deemed suitable cases for a special examination. 32 of these cases were examined during the year. Included in the Special Inspections in Table I. are the cases seen at the Inspection and Minor Ailment Clinic, so that there is a total of 476 special inspections. From the table on page 12 it will be seen that re-inspections totalled 520. While visiting Schools for Routine Inspections, re-inspections 7 are made of children who have previously been found with defects and also of children who have been placed "under observation." Parents are also asked to bring children to the Inspection Clinic and advice is given there. Age Groups Inspected. The Board of Education requires Local Authorities to make provision for the Medical Inspection of all children admitted to school during the year ending March 31st, and of all children between 12 and 13 years of age, together with children over 13 who have not been inspected after reaching the age of 12. An intermediate group, children between 8 and 9 years of age, must also be examined. The 153 entrants comprised 81 boys and 72 girls. „ 272 intermediates „ 142 „ 130 „ „ 298 leavers „ 124 „ 174 „ The number inspected and re-inspected under the heading "Other Inspections" is 996 as compared with 1,668 in 1938. Findings at Medical Inspections. Uncleanliness. The degree of cleanliness of both head and body is noted at the Medical Inspections and only two children were found at these inspections who had to be referred for treatment for verminous or "nitty" heads. The School Nurses pay periodical visits to the schools for the purpose of inspecting heads, particularly after a holiday period. During the year under review the average number of visits per school by the Nurses for these cleanliness inspections was 12. The total number of examinations during these inspections was 4,464 as compared with 7,888 in 1938. 185 individual children were found either to be verminous or to have so many nits in their hair that notices had to be sent to the parents. When children are found to be unclean they are excluded and a notice is sent to the Education Secretary. A warning is sent by him to the parent that if the child is not made clean within 7 days, a prosecution will follow. The children have to attend at the Clinic until they can be certified as being fit to attend school. 8 Minor Ailments and Diseases of the S\in. (Table IV., page 18). During the year 432 minor ailments were referred for treatment as compared with 444 in 1938. Children suffering from these minor ailments were either seen at the Routine Inspections or were sent to the Clinic by parents or teachers. The ailments consist of skin diseases, such as Ringworm, Impetigo, Ear diseases and External Eye diseases. The method of dealing with these are referred to later. During 1939 there were no cases of Ringworm of the scalp. Two cases of Body Ringworm were seen at the Clinic during the year. Four cases of Scabies were seen during the year as compared with 8 last year. Visual Defects and External Eye Disease. 20 cases of external eye disease were referred for treatment during the year, all of these being treated at the Clinic. 67 children were referred for treatment for defective vision and squint. 187 children received treatment during the year, 10 of these being cases referred from inspection in 1938. 55 cases were discovered at the routine inspections, and the remaining 122 were sent to the Clinic by parents or teachers owing to evidence of eye strain. J\lose and Throat Defects. (Table IV., page 18). 17 children were found to be suffering from enlarged Tonsils, Adenoids, or both defects. 12 received operative treatment; 22 Hospital Vouchers were actually given. Of the 17 children referred for treatment, 8 were operated on at Richmond Royal Hospital. Eight cases are awaiting operation. Dental Defects. (Table V., page 20). During 1939, children of all age groups, i.e., 4—16, were examined by the School Dentist. Miss E. Russell, L.D.S., the School Dental Surgeon, examined 2,061 children of all age groups and found 1,475 to require treatment. 9 Arrangements for Treatment. Arrangements have been made for the treatment of: — (a) Minor Ailments. (b) Enlarged tonsils and adenoids. (c) Defective Vision. (d) Dental Defects. (e) Ringworm. Minor Ailments. The treatment of these diseases is carried out each morning at the Health Centre. The School Medical Officer is present four mornings a week (including Saturdays) to see new cases and cases requiring supervision. The dressing of the various cases is carried out by one of the School Nurses. The number of children who attended the Clinic for actual treatment during the year was 313 (as compared with 377 in 1938), and the total number of defects treated was 424. Also 272 children attended for inspection only, i.e., dirty heads, sore throats, etc. The total number of attendances was 2,037 as compared with 2,805 in 1938. Tonsils and Adenoids. Arrangements have been made with the Richmond Royal Hospital authorities to undertake the operative treatment of these conditions. The Education Committee pay an agreed sum per operation. Some parents prefer to have treatment by their own doctor, or to go to a London Hospital. In every case the parents are advised to bring the child to the Clinic as soon as possible after the operation, so that they may be advised as to the necessary after-treatment by means of breathing exercises, etc. During the year 17 children were referred for treatment after inspections. 22 Vouchers were given for the Hospital. External Eye Diseases. 20 cases were seen during the year. Defective Vision. These cases are treated at a special Eye Clinic which is held at the Health Centre, once a fortnight. Mr. Blair attends on these occasions, and prescribes glasses when necessary. The Committee pay a fee per case seen and Mr. Blair sees all cases twice and sometimes three times. 10 During the year under review, 177 cases were referred for treatment. In all, 187 cases were treated (10 of these being cases referred from the previous year), and in 134 cases glasses were prescribed. Actually 134 children obtained glasses. Arrangements have been made whereby the glasses can be purchased by the parents from a local optician at a contract rate. The Education Committee pays the whole or part of the cost of glasses in necessitious cases. Dental Treatment. During the year 2,061 children were inspected by the Dental Surgeon, and 1,475 were referred for treatment. In addition 234 were referred for treatment from the inspections of the School Medical Officer, or were sent up to the Clinic by Head Teachers, making a total of 1,709 as compared with 1,352 in 1938. It will be noted that 1,475 children were found to require treatment and 1,511 were actually treated during the year. This latter number includes all those children out of the 1,475 who accepted the offer of treatment and who were actually treated, together with over 36 children inspected during 1938 but unable to have their treatment carried out during that year. It also includes casual cases (sent up by parents or teachers), generally on account of toothache. A branch of the dental work not mentioned in the Table on page 22 is Treatment for Regulation. The number of cases treated only for Regulation during the year was 40 and 53 were treated partly for Regulation. In the years 1932-39 inclusive 803 children have had dental treatment for Regulation only. When it is found necessary to extract several teeth, a general anesthetic is given, either Nitrous Oxide Gas or Ethyl Chloride. A special Dental Clinic is held once a week for this purpose, and the School Medical Officer administers the anaesthetics. During 1939 I administered anaesthetics to 620 children, as compared with 567 in 1938. 11 Immunisation of School Children against Diphtheria. Total number of children seen during the year 441 Total number of attendances 964 Total number of children who received primary Schick test 84 Total number of children naturally immune 17 Percentage of children naturally immune 2.0% Number of certificates given 77 Number of children who required additional injections for complete immunity 4 Number of children due for re-test after 2 years 177 Number of children re-tested after 2 years 152 Number of children who were still immune 142 Number of children who required further injections 9 Total number of certificates issued at the Clinic since 1934 1,979 Number of children due for re-test after 4. years 173 Number of children re-tested after 4 years 126 Number of children who were still immune 117 Number of children who required further injections ... 1 Mentally Defective Children. The Special School for mental defectives with accommodation for 30 children was carried on until the summer holidays of 1939. After the holidays, owing to the illness of the Teacher and the utilisation of the Clinic buildings for Air Raid Precautions, it was decided not to open this Special School at present. Miscellaneous. Employment of Children. Bye-laws under the Employment of Children Act, 1903, have been adopted by the Education Committee, and children attending school who wish to obtain employment (part-time) must be examined as to their fitness by the School Medical Officer. Before the examination the Head Teachers concerned are asked to give their views as to the prejudicial effect of the proposed employment on the children's education. During the year 77 boys have been examined in connection with medical certification as to their fitness for employment. 73 certificates were granted. Of the 73 children granted certificates, 35 were employed in the delivery of newspapers and 38 as errand boys. 12 TABLE I. A—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups— Entrants 153 Second Age Group 272 Third Age Group 298 Total 723 Number of other Routine Inspections 61 Grand Total 784 B.—OTHER INSPECTIONS. Number of Special Inspections 476 Number of Re-Inspections ... 520 Total 996 C.—CHILDREN FOUND TO REQUIRE TREATMENT. Number of individual children found at Routine Medical Inspection to require treatment (excluding defects of nutrition, uncleanliness anc dental diseases). Group. (1) For defective vision (excluding squint) (2) For all other conditions recorded in Table Ila. (3) Total. (4) Entrants – 5 5 Second Age Group 16 8 24 Third Age Group 30 2 32 Total (prescribed Groups) 46 15 61 Other Routine Inspections 5 1 6 Grand Total 51 16 67 13 Table II.—A. Return of Defects found by Medical Inspection in the year ended 31st December, 1939. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requ ring Treatment. Requiring Treatment,. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Skin 'Ringworm — Scalp – — – — Body – — – — Scabies – — – — Impetigo – — – — mother Diseases (Non– Tuberculous) 1 — – — Eye Blepharitis – 4 – Conjunctivitis – — – — Keratitis – — – — Corneal Opacities – — – — Other Conditions (excluding Defective Vision & Squint) – 1 – — Defective Virion (excluding Squint) 51 45 12 9 Squint 4 3 — 1 Ear Defective Hearing — 4 2 . Otitis Media — 1 1 — Other Ear Diseases — – 1 1 1 Nose & Throat 'Chronic Tonsillitis only 6 54 8 24 Adenoids only 1 3 — 2 Chronic Tonsillitis and Adenoids – 3 – 3 Other Conditions — 4 2 2 Enlarged Cervical Glands (Non– Tuberculous) — 1 — — Defective Speech — 11 — 3 Heart & Circulation Heart Disease : — Organic — — — 1 Functional 1 9 — 3 Anaemia — 1 — x 14 Table II.—continued. Defect or Disease. (1) Routine Inspections Special Inspections. No. of Defects. No of Defects. (2) Requiring Treatment. (3) Requiring to be kept under observation, but not requiring Treatment. (4) Requiring Tieatment. (5) Requiring to be kept under observation, but not requiring Treatment. Lungs CBronchitis _ Other Non Tuberculous Diseases — — — 2 Tuberculosis ['Pulmonary: — Definite — — — 1 Suspected — — — — Non-Pulmonarv: — Glands _ 1 _ Bones and Joints — — 1 Skin — — Other Forms — — — — Nervous Systkm Epilepsy _ — 1 Chorea — 1 — Other Conditions — — 1 1 Deformities Rickets Spinal Curvature — — 1 Other Forms 1 5 - 2 Other Defects and Diseases (excluding defects of nutrition, uncleanliness and dental diseases) 2 9 388 7 Total 67 162 417 65 15 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 153 30 19.6 116 75.8 7 4.6 — — Second Age-group 272 48 17.7 206 75 7 18 6.6 - — Third Age-group 298 82 27.5 201 67.5 15 5.0 - — Other Routine Inspections «1 20 32.8 40 65.6 I 1.6 - — Total 784 180 23.0 563 71.8 41 5.2 — — B. Classification of the Nutrition of Children Inspected during the year in the Routine Age Groups up to 31st August, 1939, as submitted to the Board. Age-groups. Number of Children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No % No. % Entrants 67 10 14 9 54 80.6 3 4 5 — — Second Age group 130 22 16 9 98 75.4 10 7.7 — — Third Age-group 240 56 23.3 172 71.7 12 5.0 — — Other Routine Inspections 30 15 50.0 14 46.7 1 3.3 — — Total 467 103 22.1 338 72.4 26 5.5 — — 16 Table III. Return of all Exceptional Children in the Area 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. 11 — " — — 11 EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — Nil T.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra thoracic glands). At Certified Special Schools. At Public Elementary Schools At other Institutions. At no School or Institution. Total. — 1 — — 1 IT.--Children Suffering from Non-Pulmonary Tuberculosis. (This category includes tuberculosis of all sites oilier than those shown m (I) above). At Certified Special Schools. At Public Elementary Schools. Ai other Institutions. At no School or Institution. Total. — 3 1 — 4 17 Table III.—continued. B. Delicate Children. This Section is confined to children (except those included in other groups) whose general health renders it desirable that they should be specially selected for admission to an Open Air School. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — Nil C. Crippled Childben. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 4 1 — 5 Children Suffering from Multiple Defects. nation of Defect. At Certified Special Schools. At Public Elementary Schools. At other Institutions At no School or Institution. Total. Epileptic and feeble-minded — — — — Nil Crip: led and feeble-minded — — — — Nil 18 Table IV. Return of Defects Treated during the year ended 31st December, 1939. TREATMENT TABLE. Group I.— Minor Ailments (excluding Uncleanliness). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. Skin — Ringworm—Scalp— (1) X-Ray Treatment— If none, indicate by dash – – – (2) Other Ringworm—Body 2 2 Scabies 4 — 4 Impetigo 5 — 5 Other Skin Disease 7 1 8 Minor Eye Defects— (external an>t other) 20 – 20 Minor Ear Delects 9 —. 9 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, &c.) 379 5 384 Total ... 424 8 432 Group 2—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) 187 3 190 Other defect or disease of the eyes (excluding those recorded in Group 1) — — — Total 187 3 190 Under the Authority's Scheme. Otherwise. Total. No. of Children for whom spectacles were— (a) Prescribed 134 2 138 (b) Obtained 134 2 136 19 Table IV.—continued. Group 3—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 Authority's Scheme. (2) Total (3) (i) («) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 12 — — ;o — — 2 — — 12 — (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids, (iv) Other defects of the nose and throat. Group 4—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) Nonresidential treatment at an orthopaedic clinic, (iii) Residential treatment with education. (i) Residential treatment without educ ition (ii) Nonresidential treatment at an orthopaedic clinic, (iii) Number of children treated. — — — — — 6 6 20 Table V.—Dental Inspection and Treatment. (1) Number of Children inspected by the Dentist:— (a) Routine age-groups— Age ... 5 and under 6 7 8 9 10 11 12 13 14 Over 14 Total Number ... 124 157 181 226 258 289 256 208 18? 148 32' 2001 (6) Specials 340 (c) Total (Routine and Specials) 2,401 (2) Number found to require treatment 1,475 (3) Number actually treated 1,511 (4) Attendances made by children for treatment 1,828 (5) Half-days devoted to (6) Fillings (7) Extractions /Inspection 151 I Treatment 200 r Pe.manent Teeth (Temporary ,, I Permanent Teeth (Temporary „ Total 215 1,009 49) Total 1,058 1558 2,068 Total 2,624 (8) Administrations of general anaesthetics for extractions ... ... 620 ... r, .. Permanent Teeth ... 1711 n, . i ,<9t Other Operations Temp0rary 4) Total - 17& Table VI. Uncleanliness and Verminous Conditions. Average number of visits per school made during the year by the School Nurses . . 12 Total number of examinations of children in the Schools by School Nurses 4,464 Number of individual children found unclean 185 Number of children cleansed under arrangements made by the Local Education Authority Nil Number of cases in which legal proceedings were taken— (a) Under the Education Act, 1921 ... Nil (6) Under School Attendance Byelaws Nil