RICH 9 BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1940. RICHMOND: J. H. BROAD AND CO., LTD., PRINTERS, 8, KING STREET. BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1940. RICHMOND: J. H. BROAD AND CO., LTD., PRINTERS, 8, KING STREET, 2 Public Health Department, Parkshot, Richmond, Surrey. July, 1941. 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, 1940. In view of the necessity for economy in the use of paper, the Ministry of Health suggests that interim reports should be made at this time. Arrangements are made for the preservation of all records in order that after the War a Report may be made dealing more fully with the period from the beginning of 1939 until the end of the last complete year. It is interesting to note that in the Public Health Department there are copies of the Annual Reports of the Medical Officer of Health for every year from 1874 to 1939. As this is my twentieth and last Annual Report, I should like to express my sincere thanks to the Council for their invariable kindness to me over a long period. I must also thank all my colleagues on the Council's staff, and particularly the members of my own staff, for their great assistance and loyalty. A great deal of excellent work has been done during the twenty years I have been your Medical Officer, but this has only been accomplished by the willing and earnest co-operation of every member of my staff. 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 1940) 34,690 Number of inhabited houses 9,930 Rateable value £605,763 Sum represented by a Penny rate £2,335 5s. 3.97d. Extracts from vital statistics of the Year. For calculating Birth Rate. Total. M. F. Live births (Legitimate) 320 181 139 Live births (Illegitimate) 42 17 25 For calculating Infant and Maternal mortality. Live births (Legitimate) 318 181 137 Live births (Illegitimate) 42 17 25 Birth rate per 1,000 of estimated resident population 10.4 Stillbirths Total 10 Males 6 Females 4 Deaths Total 668 Males 300 Females 368 Death rate per 1,000 of estimated resident population 19.2 Corrected death rate 15.9 Death rate from Puerperal Sepsis and other Puerperal causes 2.7 Death rate of Infants under 1 year of age. All infants per 1,000 live births 42 Deaths from Cancer (all ages) 84 „ „ Measles 2 „ „ Whooping Cough Nil. „ „ 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 I year 1. Injury at Birth 1 1 ... ... 2 ... ... ... ... 2 2 Congenital Debility and Malformation including Premature Birth 4 1 1 ... 6 2 ... ... ... 8 3. Asphyxia. Death by Misadventure ... ... ... ... ... 1 1 ... ... 2 4. Other defined diseases 1 ... ... ... 1 ... 1 ... 1 3 6 2 1 ... 9 3 2 ... 1 15 5 BIRTH RATE, DEATH RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1940. (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 Hate 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 14.6 0.55 14.3 0.00 — 0.02 0.00 0.02 0.06 0.32 4.6 55 126 County Boroughs and Great Towns, including London 16.0 0.64 15.8 0.00 — 0.02 0.00 0.02 0 07 0.29 5.9 61 148 Smaller Towns (Resident Population 25,000 to 50,000 at 1931 census) 15.7 0.55 12.8 0.00 — 0.02 0.00 0.02 0.05 0.30 4.4 54 London Administrative County 13.7 0 44 17.8 0.00 — 0.01 0.00 0 00 0.01 0.18 5.8 50 RICHMOND 10.4 0.29 15.9 0.00 — 0.05 0.00 0.00 0.00 0.63 0.00 42 The maternal mortality rates for England and Wales are as follows Per 1,000 Total Births Puerperal Infection. 0.52 Others 1.64 Total. 2.16 The maternal mortality rates for Richmond are as follows Per 1,000 Total Births 0.00 2.70 2.70 6 DEATHS. M. F. All Causes 300 368 1. Typhoid and Paratyphoid Fevers — — 2. Cerebro-spinal Fever 1 2 3. Scarlet Fever — — 4. Whooping Cough — — 5. Diphtheria — — 6. Tuberculosis of respiratory system 13 13 7. Other forms of Tuberculosis 1 1 8. Syphilitic diseases 6 — 9. Influenza 9 13 10. Measles 2 — 11. Acute polio-myelitis and polio-encephalitis — — 12. Acute inf : encephalitis — — 13. Cancer of b: cav: and oesoph: (M) uterus (F) 4 5 14. Cancer of stomach and duodenum 5 7 15. Cancer of breast — 12 16. Cancer of all other sites 34 17 17. Diabetes — 1 18. Intra-cran: vase: lesions 22 38 19. Heart disease 56 82 20. Other diseases of circulatory system 5 7 21. Bronchitis 17 20 22. Pneumonia 17 15 23. Other respiratory diseases 5 1 24. Ulcer of stomach or duodenum 9 3 25. Diarrhoea (under 2 years) — — 26. Appendicitis — 2 27. Other digestive diseases 3 13 28. Nephritis 5 7 29. Puer. and post-abort. sepsis — — 30. Other maternal causes — 1 31. Premature birth 4 1 32. Con: mal: birth inj: infant: dis: 4 3 33. Suicide 3 7 34. Road traffic accidents 2 1 35. Other violent causes 36 63 36. All other causes 37 33 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. 8 Attendances at Clinics. Ante-natal. Number attended. Total attendances. 215 619 Attendances. Windham Road Mothers 3,506 Children 3,536 Trefoil House Mothers 841 Petersham Children 1,045 Doctor's Consultations 2,039 Toddlers 442 Health Visitors' Visits First visits Re-visits. 325 2,452 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, „ ,, 86, Mount Ararat Road, General Medical 19, Grena Road, „ „ 18, Mortlake 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 figures given below indicate the nature of the work carried out. In addition, the billeting and rehousing of Foreign War Refugees, evacuees' and homeless persons has been carried out by this Department. 9 In September, an influx of about 1,000 evacuees from the East End of London considerably interfered with the normal routine of the Department, on account of the extra work entailed. Inspections under the Housing and Public Health Acts. Total inspections 5,212 Nuisances discovered on 375 of the premises 1,129 Defects abated by the end of the year 987 Work in hand to remedy defects, at the end of the year 26 Outstanding defects at the end of the year 79 Action deferred until after the War 37 Visits paid to ascertain that the defects were being properly remedied 1,346 Inspections made under the Housing Acts 21 Sanitary defects remedied, and improvements made in accordance with the above 240 Unfit underground dwellings, contravening the Housing Regulations, reported during the year 3 Closing Orders made 3 Voluntary Undertakings given — Basements made fit voluntarily by owners — Closing Orders withdrawn 6 Undertakings withdrawn 13 Shops Acts. Number of shops on register at the end of the year 776 Special visits made 41 New additions to register 1 Changes of occupancy 5 Factories Act 1937. Factories on the register at the end of the year. Mechanical 106 Non-mechanical 54 Inspections made 26 Written notices served 18 Defects found 105 Defects (a) remedied 81 Defects (b) in abeyance 24 10 Service of Notices. Informal Notices Served 278 Statutory or Formal Notices Served 79 Number of dwelling-houses which were rendered fit after service of Formal Notice under the Housing Act— (a) By Owners 78 (b) By Local Authority in default of owners 1 Petroleum Acts 1928. Visits made during the year 81 Licences for which applications for renewal were made during the year 58 New licences issued during the year 2 Number of persons licensed to keep Petroleum 55 Slaughterhouses. There is one slaughterhouse in the district, but this is not now in use, as the slaughtering of animals has been centralised, and is carried out under the supervision of Government inspectors. The nearest slaughterhouse under this scheme is at Kingston. Diseases of Animals Acts. Foot and Mouth Disease Order, 1928 and Foot and Mouth Disease Amendment Order, 1938. During the year, two outbreaks of Foot and Mouth Disease have occurred in the district, one at Manor Farm, Petersham, and the other at Vale Farm, Petersham. The first outbreak—at Manor Farm—occurred on the 7th of April, and prompt measures were taken to deal with it. On Tuesday the 9th of April, I was informed that 47 head of cattle, 90 pigs and 5 goats, had been slaughtered, and the carcases of 49 pigs had been salvaged and passed for human food. The remainder of the animals were buried on the farm at a depth of 10', in quicklime. Cleansing and disinfecting operations were then carried out. 11 On the 27th of April, notification was received of an outbreak of Foot and Mouth Disease at Vale Farm. This was immediately dealt with, and the following morning 2 beasts and 3 calves were sent to the Destructor. Subsequently, a herd of 27 dairy cows, and 1 bull, were slaughtered at the farm and all were passed for human food with the exception of 1, which was sent to the Destructor. Visits made to meat shops or stores, and other premises where food is prepared or exposed for sale 114 Eradication of Bed Bugs. Disinfestation methods were applied to the following properties:— Council Houses 31 Other Houses 21 Disinfection of Premises. Reason. Houses. Rooms. Bedding disinfected. Infectious Fevers 30 34 50 Tuberculosis 13 36 15 Other Diseases 10 12 8 Vermin 52 113 14 Public Shelters Disinfected (Comprising 161 compartments) 19 Housing Act, 1936. Contravention of Closing Order or Written Undertaking. On the 24th of May, 1935 a written undertaking was given by the owner of No. la, Duke Street that the premises would be closed and not again occupied. The tenants of the first floor rooms were subsequently rehoused in a Corporation dwelling. 12 On the 9th of March, 1940, it was found that the rooms were again occupied, and a rental of 30/0d. per week being paid for them. The owner was notified of the contravention, and the matter was reported to the Town Clerk. On the 26th of April, 1940, a report on the conditions was submitted to the Health Committee and a Closing Order was made by the Council on the 14th of May. The premises were later vacated, and have not since been occupied. Complaints. Number received and dealt with during the year 435 (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, 1940:— Articles. Analysed Adulterated or Deteriorated Prosecutions Convictions. Formal Informal Total Formal Informal Total Milk 44 ... 44 ... ... ... ... ... Butter ... 1 1 ... ... ... ... ... Cocoa 1 ... 1 ... ... ... ... ... Sausages 6 ... 6 ... ... ... ... ... Jam 3 9 12 1 1 2 1 ... Preserved Sausages 2 ... 2 ... ... ... ... ... Sultanas 2 ... 2 ... ... ... ... ... Raisins 1 ... 1 ... ... ... ... ... Totals 59 10 69 1 1 2 1 ... PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notifiable Diseases during the year. Disease Total Cases Notified. Cases Admitted to Hospitals. Total Deaths. Smallpox ... ... ... Scarlet Fever 17 11 ... Diphtheria 20 20 ... Paratypoid Fever 1 1 ... Puerperal Pyrexia 4 2 ... Pneumonia 24 11 32 (all forms) Cerebro-Spinal Fever 9 9 ... Ophthalmia Neonatorum ... ... ... Erysipelas 8 2 ... Measles 255 3 2 Whooping Cough 3 1 ... Total 341 60 34 14 SOUTH MIDDLESEX FEVER HOSPITAL. ADMISSIONS CLASSIFIED. Disease. No. of Patients Admitted from Richmond. Scarlet Fever 10 Diphtheria 20 Cerebro-Spinal Meningitis 4 Measles 2 Whooping Cough 1 Other Diseases 14 Total 51 DIPHTHERIA IMMUNISATION CLINIC. Total number of children seen during the year 713 Total number of attendances 1,639 Total number of children who received primary Schick test 61 Total number of children naturally immune 16 Percentage of children naturally immune 26% Number of certificates given 247 Number of children who required additional injections for complete immunity 9 Number re-tested after 2 years 61 Number of children who were still immune 58 Number of children who required further injections 3 Number re-tested after 4 years 183 Number of children who were still immune 170 Number of children who required further injections 6 Total number of certificates given after immunisation. (a) Pre-school children 103 (b) School children 144 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 13 102 115 Tuberculosis Sputa 3 38 41 Typhoid ... — — — Other Diseases ... — 5 5 Total 16 145 161 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). Thirty-six cases of this disease were notified during the year (23 males and 13 females). Of these 19 (10 males and 9 females) were removed to Hospital or Sanatorium. There were 45 cases notified in 1939. There were 26 deaths from this disease during the year. Non-Respiratory Tuberculosis was responsible for 2 deaths while 5 cases were notified during the year. 16 Tuberculosis. Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. 0 M F M F M F M F ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... 5 1 ... ... 1 ... ... ... ... 15 6 5 ... ... 2 4 ... 1 25 7 2 ... 1 3 1 ... ... 35 4 1 ... 1 3 2 ... ... 45 2 3 ... ... 3 3 ... ... 55 2 1 ... ... 1 1 ... ... 65 and upwards 1 1 ... 1 1 2 ... ... Totals 23 13 1 4 13 13 1 1 BOROUGH OF RICHMOND (SURREY). Education Committee. ANNUAL REPORT OF THE School Medical Officer 1940. J. H. BROAD & CO.., PRINTERS. 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 Visitor's Cert.). Miss E. D. Steuart, (S.R.N., R.F.N., S.C.M.). (New Health Visitor's Cert.). Miss N. H. Jones, (S.R.N., S.C.M.). (New Health Visitor's Cert.). (Tuberculosis Certificate). Temporary Staff: Miss E. M. Mortimer, (S.R.N., S.C.M.). (New Health Visitor's Cert.). Dental Assistant (part time): Miss M. D. Banks. Called for war service, September, 1939. Dental Assistant (temporary staff): Miss J. Ayland. Clerks: Miss O. W. Ponsford (part time). Resigned July, 1940. Miss M. M. O'Connor (part time). Temporary Staff: Miss L. M. Johnson (part time). Appointed July, 1940. 3 BOROUGH OF RICHMOND (SURREY). Report on the Medical Inspection and Treatment of Elementary School Children for the year ended December 31st, 1940. 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 1940. It is the twentieth Annual Report as your School Medical Officer. The Board of Education in a circular in 1939 desired that Reports should be curtailed owing to abnormal conditions and the same request has been made this year. Consequently the report has been cut down but shows that a considerable amount of work was done during the year under review. A summary of the statistics is as follows:— Average number of children on the registers during 1940 2,786 Average attendance at Elementary Schools during 1940 2,366 Number of Routine Medical Inspections 633 Number of attendances at Minor Ailment Clinic 2,325 Number of children obtained glasses after examination by specialists 96 Number of children operated on for Tonsils and Adenoid conditions 39 Number of attendances at Dental Clinic 1,772 Number of children given general anaesthetics (Gas or Ethyl Chloride) 678 4 I should like to thank the staff of the Department for their excellent and loyal service in a particularly difficult time. Additional duties which meant extra work outside normal hours were cheerfully undertaken. I have also to thank my Colleagues in the Education Office and the Teachers for their kindly Co-operation. I am, Ladies and Gentlemen, Your obedient Servant, C. S. BREBNER. 5 Medical Inspection. (Table I., page 11). 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 241 entrants examined at the Routine Inspections and 205 parents or guardians attended. 132 children of the intermediate age were inspected and 201 leavers, i.e., children aged 12 years. There were 59 other Routine Inspections made during the year, so that the total number of children examined was 633 as compared with 784 in 1939. It was not possible to complete all the Routine Medical Inspections which were due in 1940. 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. 86 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 700 special inspections. From the table on page 11 it will be seen that re-inspections totalled 815. While visiting Schools for Routine Inspections, re-inspections 6 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 241 entrants comprised 115 boys and 126 girls. „ 132 intermediates „ 47 „ 85 „ „ 201 leavers „ 47 „ 154 „ The number inspected and re-inspected under the heading "Other Inspections" is 1,515 as compared with 996 in 1939. Findings at Medical Inspections. Uncleanliness. The degree of cleanliness of both head and body is noted at the Medical Inspections and only four 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 5,020 as compared with 4,464 in 1939. 243 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. 7 Minor Ailments and Diseases of the Skin. (Table IV., page 16). During the year 382 minor ailments were referred for treatment as compared with 432 in 1939. 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 1940 there were no cases of Ringworm. Sixteen cases of Scabies were seen during the year as compared with 4 last year. Visual Defects and External Eye Disease. 24 cases of external eye disease were referred for treatment during the year, all of these being treated at the Clinic. 41 children were referred for treatment for defective vision and squint. 137 children received treatment during the year, 14 of these being cases referred from inspection in 1939. 22 cases were discovered at the routine inspections, and the remaining 115 were sent to the Clinic by parents or teachers owing to evidence of eye strain. Nose and Throat Defects. (Table IV., continued page 17). 23 children were found to be suffering from enlarged Tonsils, Adenoids, or both defects. 39 received operative treatment; 36 Hospital Vouchers were actually given. Of the 23 children referred for treatment, 19 were operated on at Richmond Royal Hospital. Two cases are awaiting operation. Dental Defects. (Table V., page 18). During 1940, 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 2,645 children of all age groups and found 1,733 to require treatment. 8 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 232 (as compared with 313 in 1939), and the total number of defects treated was 382. Also 328 children attended for inspection only, i.e., dirty heads, sore throats, etc. The total number of attendances was 2,325 as compared with 2,037 in 1939. 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. Thirty-six vouchers were given for the Royal Hospital for the treatment of these conditions. External Eye Diseases. 24 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. 9 During the year under review, 123 cases were referred for treatment. In all, 137 cases were treated (14 of these being cases referred from the previous year), and in 96 cases glasses were prescribed. Actually 96 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 necessitous cases. Dental Treatment. During the year 2,645 children were inspected by the Dental Surgeon, and 1,733 were referred for treatment. In addition 266 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 1,999 as compared with 1,709 in 1939. It will be noted that 1,733 children were found to require treatment and 1,448 were actually treated during the year. A branch of the dental work not mentioned in the Table on page 18 is Treatment for Regulation. The number of cases treated only for Regulation during the year was 106 and 74 were treated partly for Regulation. In the years 1934-40 inclusive 544 children have had dental treatment for Regulation only. When it is found necessary to extract several teeth, a general anaesthetic 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 1940 I administered anaesthetics to 678 children, as compared with 620 in 1939. Immunisation of School Children against Diphtheria. Total number of children seen during the year 489 Total number of attendances 1,146 Total number of children who received primary Schick test 60 Total number of children naturally immune 16 Percentage of children naturally immune 27% 10 Number of certificates given 144 Number of children who required additional injections for complete immunity 8 Number of children re-tested after 2 years 55 Number of children who were still immune 52 Number of children who required further injections 3 Total number of certificates issued at the Clinic since 1934 2,123 Number of children re-tested after 4 years 181 Number of children who were still immune 168 Number of children who required further injections 6 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 27 boys have been examined in connection with medical certification as to their fitness for employment. 22 certificates were granted. Of the 22 children granted certificates, 15 were employed in the delivery of newspapers and 7 as errand boys. Employment of Children in Entertainments Rules, 1933. One certificate was granted to a girl under the above Rules. 11 TABLE I. A.—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups— Entrants ... 241 Second Age Group ... 132 Third Age Group ... 201 Total 574 Number of other Routine Inspections ... 59 Grand Total 633 B.—OTHER INSPECTIONS. Number of Special Inspections ... 700 Number of Re-Inspections ... 815 Total 1,515 C—CHILDREN FOUND TO REQUIRE TREATMENT. Number of individual children found at Routine Medical Inspection to require treatment (excluding defects of nutrition, uncleanliness and dental diseases). Group. (1) For defective vision (excluding squint) (2) For all other conditions recorded in Table IIa. (3) Total. (4) Entrants – 14 14 Second Age Group 5 1 6 Third Age Group 16 — 16 Total (prescribed Groups) 21 15 36 Other Routine Inspections 1 2 3 Grand Total 22 17 39 12 Table II.—A. Return of Defects found by Medical Inspection in the year ended 31st December, 1940. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Skin Ringworm Scalp — — — — Body — — — — Scabies — — — — Impetigo — — — — Other Diseases (NonTuberculous) — — — – Eye Blepharitis — — 1 1 Conjunctivitis — — — — Keratitis — — — — Corneal Opacities — — — — Other Conditions (excluding Defective Vision & Squint) 1 – – Defective Virion (excluding Squint) 22 9 19 13 Squint — — — — Ear Defective Hearing — 2 1 3 Otitis Media — 4 2 1 Other Ear Diseases — — 1 — Nose & Throat Chronic Tonsillitis only 4 30 7 25 Adenoids only 4 5 2 2 Chronic Tonsillitis and Adenoids 5 5 1 1 Other Conditions 1 — — — Enlarged Cervical Glands (NonTuberculous) — 1 — — Defective Speech — — — 5 Heart & Circulation Heart Disease :— Organic — — — 1 Functional — 1 — 7 Anæmia — — — — 13 Table II.—continued. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Lungs Bronchitis – – – Other Non-Tuberculous Diseases — — — 1 Tuberculosis' Pulmonary :— Definite — — — — Suspected — — — — Non-Pulmonary:– Glands — 1 — — Bones and Joints Skin — – — – — – 1 – Other Forms — — — — Nervous System Epilepsy – — — Chorea — — 1 — Other Conditions – — — 1 Deformities Rickets – – Spinal Curvature 1 — — 1 Other Forms 1 1 — 3 Other Defects and Diseases (excluding defects of nutrition, uncleanliness and dental diseases) – 2 385 12 Total 39 61 420 78 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 241 14 5.81 216 89.62 11 4.57 — — Second Age-group 132 18 13.64 95 71 97 19 14.39 — — Third Age-group 201 45 22.39 149 74.13 7 3.48 – — Other Routine Inspections 69 7 11.86 48 81.36 4 6.78 — — Total 633 84 13.27 508 80.25 41 6.48 — — 14 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. — — — — Nil 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 I.–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 II.–Children Suffering from Non-Pulmonary Tuberculosis. (This category includes tuberculosis of all sites other than those shown in (I) above). At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 3 — — 3 15 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 Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 4 — — 4 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. Epileptic and feeble-minded – – – – Nil Crippled and feeble-minded — — — — Nil 16 Table IV.—Return of Defects Treated during the year ended 31st December, 1940. 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 — — — Scabies 16 — 16 Impetigo 2 — 2 Other Skin Disease 25 1 26 Minor Eye Defects— (external and other) 24 — 24 Minor Ear Delects 13 — 13 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, &c.) 300 1 301 Total 380 2 382 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) Other defect or disease of the eyes (excluding those recorded in Group 1) 137 – Nil – 137 – Total 137 Nil 137 No. of Children for whom spectacles were— (a) Prescribed Under the Authority's Scheme. Otherwise. Total. 96 Nil 96 (b) Obtained 96 Nil 96 17 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) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 4 — 34 — 1 — — — 6 — 34 – – 39 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids. (iv) Other defects of the nose and throat. Group 4—Orthopædic 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 orthopædic clinic. (iii) Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopædic clinic. (iii) Number of children treated. — — — — — 3 3 18 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 123 203 252 262 280 295 267 302 308 239 114 2,645 (b) Specials 266 (c) Total (Routine and Specials) 2,911 (2) Number found to require treatment 1,733 (3) Number actually treated 1,448 (4) Attendances made by children for treatment 1,772 (5) Half-days devoted to Inspection 27 Treatment 210 Total 237 (6) Fillings Permanent Teeth 934 Temporary ' 73 Total 1007 (7) Extractions Permanent Teeth 551 Temporary „ 2,319 Total 2,870 (8) Administrations of general anaesthetics for extractions 678 (9) Other Operations Permanent Teeth 232 Temporary " Nil Total 232 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 5,020 Number of individual children found unclean 243 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 (b) Under School Attendance Byelaws Nil