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3428796d-5984-4ed2-97eb-84061ec8b70c	12 4 48.2 52.7 6 49.8 55.6 2 52 63.5 434 222 210 2 (GIRLS). Action Junior Mixed 20 7 47.7 49.5 11 49.8 53.2 2 53 59.6 Action well Junior 80 9 49 51.9 20 49.4 53.1 1 55.3 65.5 Action Wells Infants' 23 13 48.5 51.5 10 48.8 51.3 .... ... ... Beaum'nt Pk. Jnr. Girls' 80 56 49.2 51.2 24 49.9 52.9 ... ... ... Beaumont Park -Infants' 6 6 48.5 49.5 ... ... ... ... .... ... Berrymede Junior Girls.
82aed18b-e26b-469e-b1c9-c655b4be9618	96 57 48.1 51.8 39 46 51.7 ... ... ... Berrymede Infants' 6 6 48.7 51.8 ... ... ... ... ... ... Derwent water Junior 53 40 49.7 55.3 13 50.6 57.9 ... ... ... Derwet water Infants' .
01e40dc4-d8c5-49ff-a3d2-e1ca0daa4819	8 8 47.7 49.4 ... ... ... ... ... ... .Jhon Perryn Infants' 49 21 49.7 55.9 28 48.8 51.5 ... ... ... Priory Infants' 22 15 48.4 50.5 7 48.8 50.5 ... ... ... Rothschild Infants' 2 2 48.1 48.5 ... ... ... ... .... ... Southfield Junior 42 17 49.2 52.1 25 49.5 55 .... ... ... Southfield Infants' 4 4 47.3 54 ... ... ... ... .... ... Turnham Green R.C 15 7 48.4 52.4 6 53.4 68.2 2 54.7 62.4 456 268 183 5 78 TABLE SHOWING HEIGHTS AND WEIGHTS AT DIFFERENT AGES.
1496f120-9e49-4321-9124-2235fca61592	LEAVER (BOYS) No. Examined. Years of Age. 12—13 13—14 14—15 No. Height ins. Weight lbs. No. Height ins. Weight lbs. NoT . Height ins. Weight lbs. Acton Wells Senior 53 50 58.2 80.6 3 60.3 86.1 .... .... .... Central 56 56 57.9 81.5 .... .... .... .... .... .... John Perryn Snr. 56 56 58.4 81.4 .... .... .... .... .... .... Priory Boys' 190 189 57 72.3 1 57 83 .... .... .... Southfi'd Sr. Boys' 119 118 57.2 79.9 1 67.5 115.8 .... .... .... Turnham Gn. R.C.
d69ad23f-7a9e-4676-afc3-1d854b43d62f	21 19 57.2 78.4 2 55 73.2 .... .... .... 495 488 7 (GIRLS) Acton Wells Senior 55 49 59.2 86.6 5 58.8 80 1 63.8 122 B'm't Pk. Sn. Girls' 118 117 58.7 78.8 1 66 115.3 .... .... .... Central 55 55 59 87.7 .... .... .... .... .... .... John Perryn Snr. 79 77 58.8 83.3 2 59.1 82.5 .... .... .... Priory Girls' 193 192 57.7 80.3 1 56 70 .... ... .... Turnham Gn. R.C.
34b86266-d605-4b89-a79c-00cb6d4fcaaa	11 11 59 88.6 .... .... .... .... .... .... 510 501 9 1 During the year, 2,754 children were examined in the various age groups prescribed by the Board of Education. Table 2 includes a return of defects found at medical inspection. In Table 2b the number of individual children is given who were found at routine medical inspection to require treatment, excluding uncleanliness and dental defects. A comparison of this table with that for the year 1931, will show that the percentage of children found to require treatment during 1932 is much lower than that for the previous year. A cursory examination of the figures, and a comparison with those of former years, would make it appear that changes have occurred in the conditions which obtain among school children. This is not quite correct. It is true that small variations 79 Do occur, but these are not so marked as the diversity of views by the different persons who are responsible for the inspection.
2e0019a6-4817-4d82-b2cd-bee695ead0c7	This becomes apparent when a comparison is made between the fjgures of neighbouring areas. A few years ago we published certain figures culled from the annual reports of school medical officers of districts around London it was interesting to note to what extent the personal factor just have entered. Some might say that there is need of accepted standards, but it is difficult to set up any standards which will be accepted by all. The widest variation was noticed in the number cf children who were stated to be suffering from enlarged tonsils and adenoids and required tonsillectomy. Tonsils and Adenoids. During 1932, 58 children were operated on for removal of lonsils and adenoids under the Authority's scheme, as compared with 160 cases during 1931. This great difference in the numbers needs some explanation and the time seems ripe to enunciate the principles which have guided us in the selection of cases during the present year.
7def720b-607f-4989-b77a-9fb0b4ee74c4	It is also well to look back on some of our past cases, and try to assess the value which the children have received from the operation. 108 cases which had been operated on under the Authority's scheme were followed up. A large number of these children were generated on at the request of the family doctor, or on the advice of one of the hospitals. The reason why the operation was considered necessary was sought, and the parents were asked whether there was any improvement in the condition for which the operation performed. Of the 108 cases, 37 were improved, 41 were definitely no better, 6 were worse, and in the remaining cases the parents were so that in these cases there was evidently no outstanding benefit from the operation. The first thing that strikes us in the investigation is the diversity of symptoms for which the operation was performed. For instance, 34 children were operated on because they were subject to colds. Only 14 of these were improved in any way.
ea51e490-4f9a-492f-bd4b-9093dc66a8fc	14 were operated on for tonsillitis, many of them after one back only. 7 only, showed definite improvement and all of these were in the 11-12 age group. 80 11 cases were operated on for enlargement of tonsils alone, without any symptoms. In 2 of these cases the child was said to be brighter, in 7 cases no change was noticed by the parents, and the last child was definitely worse as he had frequent colds after the operation, whereas he had not suffered from colds previously. This child was found on examination to have very wide anterior nares and thus a larger air way than normal. Removal of lymphoid tissue from the post nasal space would be expected to aggravate the condition. In 9 cases, tonsils and adenoids were removed for mouth breathing and in only 2 of these cases was any improvement seen.
215c25c8-e26c-4aec-8d24-08b32210bef2	An interesting point in this connection is that the children in whom improvement occurred were 12 and 7 years of age respectively while the ages of the children in whom there was no improvement ranged from 5 years down to 3 years. In the 2 older children breathing exercises had been carried out after operation, and the benefit was probably largely due to this. 3 cases were operated on for tonsillitis and discharging ears. All were improved. 1 child had suffered from rheumatism and was better after the operation. 4 children were operated on for deafness and 2 of these were definitely better. Other reasons given for operation were, nerves, stomach trouble, and general irritability. None of the children in this group showed any improvement.
aa74af38-b221-4a63-9aa1-571b005ad93f	The number of cases in this investigation was not large, but the reasonable conclusion which one draws from a consideration of the cases is that removal of tonsils and adenoids without definite evidence that they are doing harm is obviously not worth the risk and unpleasantness which the child has to suffer. Comment on the cases quoted is almost unnecessary. In many of the cases we have no proof that the tonsils and adenoids were the cause of the child's ill health and in these cases no improvement resulted. Unfortunately, the operation has now come to be regarded by parents as almost a normal proceeding in the life of a child so that we frequently have difficulty in persuading parents that the operation is unnecessary for some trifling ill. 81 This year each child referred to us for operation has had a thorough examination of nose, throat and nasopharynx, and the general health, and home conditions as well have all been gone into.
831e0c0f-0041-410f-92a4-6751a0807e8e	Infection of the upper respiratory tract in children is extremely common, and the burden of this invasion by microbes is borne by the lymphoid or adenoid tissue, which becomes swollen temporarily. The swelling is a sign that the lymphoid tissue is needed and that it is dealing with the infection. When the infection is removed, the swelling of the adenoids will abate. The condition usually occurs in children living under bad hygienic conditions, generally associated with overcrowding. An operation for removal of tonsils and adenoids in this type of child is obviously not going to do any good, because the enlargement is nature's attempt to deal with massive infection. It is wiser to attempt to deal with the environmental conditions of the child. Broadly speaking, operative interference with the lymphoid tissue of the nose and throat will do good in cases where:— (1) It is causing difficulty in breathing through the nose, (2) It is definitely causing deafness, (3) The tonsils are diseased.
68c9d670-f44d-4ed2-a895-9a04a6f408c2	Difficulty in breathing through the nose, or mouth breathing, is one of the commonest symptoms for which children are brought along to the throat clinic. In a large number of these children there is no sign of nasal Obstruction and the condition is found to be associated with a general lack of tone. Here again operation is useless and it is our custom to suggest measures for improving the general condition together with regular breathing exercises. Difficulty in breathing through the nose is very commonly associated with swelling of the mucous membrane lining the nasal fossae with puddling of muco pus due to defective nasal hygiene, in older school children. It is surprising how many of these children have never learnt to blow the nose properly, and what a hemendous improvement results when regular and effective nose blowing, followed by breathing exercises, is established as a daily routine. Children who are put on this treatment are asked to return at the end of a month for further examination. 82 Many of the children are referred to the clinic on account of frequent colds.
db93f05e-d615-4436-8df1-39748bcb4ffe	Some of these children are found on examination to have wide anterior nares and a larger airway than usual. Have again, removal of adenoid tissue is particularly apt to aggravate the condition. Deafness is another symptom for which operation on the nose and throat is often demanded, and this again is a condition which may be made worse by indiscriminate removal of tonsilk and adenoids. If the child is deaf, and physical signs such as retraction of the drumhead are present, then a digital examination is necessary in order to find out whether adenoid growth is causes obstruction to the Eustachian tube. If this is found, the condition is usually improved if the otological adenoids only are removed leaving behind any adenoid tissue which is present in the mid line The same consideration must be exercised over the question of the removal of the tonsils.
5e9c2d6d-573d-4506-80f7-32a6c5fa7497	If the tonsils are a source of sepses they must be removed, but working on the principle that swelling of lymphoid tissue is a protective mechanism, tonsils should never be removed for enlargement alone, except in the very rare event of their causing mechanical obstruction. The explanation of the reduction in the number of cases operated on this year therefore, lies in our recognising that enlargement of tonsils and adenoids are due to many different causes that enlargement may be beneficial to the child temporarily, and removal detrimental. The number of cases remaining where the operation is needed are necessarily greatly reduced, as tonsils are only removed when diseased, and thus the lymphoid tissue of the upper respiratory tract is conserved during those years when the child most needs it A return of the defects found at medical inspection will be found on Table 2 at the end of the report. A full report Malnutrition and Otorrhoea appears below. Provision of Meals. Early in the year, the question of feeding necessitous children in.
4f26e6f6-830a-4931-9adf-b725157f53b4	the Borough was considered. A list of children who were considered necessitous was submitted, and the children were examined at the School Clinic. Although only a small percentage of children on the list was found to be malnourished, it was decided to extend the investigation and to consider the question of malnutrition all school children, whether necessitous or not. 83 167 children were reported by the Head Teachers to be in their opinion necessitous or undernourished. A few children who had been seen Ailment Clinic, or during a routine school inspection, were added to the list. Altogether, 175 children were preferred for examination. We used as a basis the relation between the height and weight of the child and singled out for special examination any child who fell below 7% of the standard weight for his height.
0bd459dc-f748-4861-94ec-987bfd98e27d	Of the 175 children who were first reported to us, 127 were weighed and measured at the Clinic, and the weight of each child was compared with the average standard normal weight for height. 48 of the children were absent from school for various reasons, so they were dealt with at the school on their return. 14 of the 127 children were found to be overweight, 7 came up to normal, 46 were less than 7% below weight, and 60 were made than 7% below weight. These 60 children were submitted to a Careful physical examination to determine the cause of malsituation. In most cases they were accompanied by a parent and a family accurate idea of the home conditions could be surmised. Of the 60 children, 5 were obviously suffering from physical defects. One child was suffering from acute rheumatism, another from heart disease, 3 children had threadworms and no attempt had been made to clear up the condition.
00e6e93e-dae0-4383-815e-79020229fde6	12 of the children were well cared for and the food they had was sufficient in quantity. None of them had any physical defect to ccount for the failure to gain in weight. In most of them the malnutrition was undoubtedly due to faulty health and food habits, want of rest, and overfatigue either singly or combined. Many of these children from the age of 6 years onwards never went to bed Unhl 9 or 10 o'clock at night. Faulty food habits were found not only in this group of children but also in many of the others, and they were practically always associated with other factors, such as over fatigue and poor mothering generally. We found that although sufficient money was spent food, it was badly spent and full value was not obtained from the outlay. In several cases both parents were at work, and the child hadto fendfor himself for the mid-day meal, which usually con.sidered of bread and butter.
eef98b4a-89e1-4b9f-9572-bdb99269e23d	We also found that meals were served regular intervals, but the most important factor was the total disgaurd paid by the mother to food values. 84 One outstanding fact was that the diet of these children consisted almost entirely of articles which required no cooking. Where the mother is employed outside the home, the difficulty of providing properly cooked meals can be appreciated, but in the cases now under review no such excuse could be offered. The cause was either ignorance or laziness. 4 of the children had tea and cake for breakfast and 2 were frequently given cream cakes and custard pies at this meal. 2 others had bread and butter and fish paste habitually for breakfast. Dinner in practically all the cases consisted of either bread and butter alone, or in addition one of the following,—fish paste, tinned salmon, german sausage, or corned beef.
4f40e85f-dc44-42cc-9d5d-66bd56d275df	Several of the children had bread and butter only for every meal, and this unbalanced diet would be enough to cause malnutrition, but lack of nutriment was enhanced by failure of appetite due to the monotonous dietary. No attempt seems to have been made to vary the diet according to the seasonal supply of a particular food. At the time of year when this enquiry was begun, eggs cost less than Id. each locally, yet in very few cases were they ever included in the diet. Wholesome inexpensive articles of food, such as fresh herrings, were seldom found in the diet, probably because of the necessity of cooking. More than half of the undernourished children had no milk in the diet except when it was taken in tea. In every case, the state of affairs was explained to the parents, and they were asked to co-operate with us in trying to improve the condition of the child.
4488942e-09b9-401d-9119-d9d4cf755c21	Suggestions were made regarding more rest for the child, the inclusion in the diet of foods of high food value and the correction of faulty food habits, such as irregular meals bolting of food, drinking with meals, etc., and they were urged tc have physical defects, such as carious teeth, dealt with. It was decided to provide morning milk and dinner at school to certain necessitous children, while other malnourished childrern were also provided with milk at school at the expense of their parents. In no case has a child received free milk or meals without the parents being interviewed, and a thorough physical examination being carried out, and physical defects remedied. Carious teeth have been dealt with, mouth-breathers investigated and suitable treatment suggested, in fact what began as an investigation into nutrition has now grown into a nutrition Clinic in the broad sense.
96558954-992e-44a7-ad70-c6515c0860c2	85 In the early days of the enquiry, it was realised that the standard of weight for height could not be used as a hard and fast rule, but that the general physical condition of the child must be taken into account. We therefore began to include children who showed symptoms of fatigue, anaemia, enlarged glands in the neck, and other signs of debility. All the children who are being provided with meals and milk, as well as all the school children who are considered to be undernourished, are weighed and measured at the Clinic once each month. Certain children have been added to those on the list of free meals from time to time, and in certain cases we have had to waive altogether the weight for height standard, and provide meals for the children temporarily, where they were obviously needed owing to lack of money in the home. Six months after the first examination and the commencement of school meals, the children were all examined again and any progress noted.
0268f8c4-2260-4124-9fbb-ef996786c218	Many of the children on free meals belong to a floating population as they discontinue school meals when home circumstances improve. We have chosen for special mention children who were under our care continuously during the first 6 months after the scheme came into operation. There were 80 such children receiving free meals and milk. In addition 2 received meals only, and 11 received milk only. 67 of these children had gained in weight satisfactorily and were better in every way. During the August holiday, 15 children actually lost weight, but one month after recommencing meals they had all gained weight. 4 of the children had not gained weight at all. One of these suffered from a severe form of heart disease and in spite of his failure to gain there was a definite general improvement. No cause for the stationary condition could be found in the other 3 but they still went to bed far too late and fatigue was probably the cause of the failure to gain.
974b47ba-4fa1-4e38-b229-5e3c712abf40	9 children continued to lose weight, and the reason appeared in most cases. 3 of them were obviously neglected. They small children who were sent to school in a dirty and ragged condition and there was no home care. Another girl who was in general condition was found to return home after her school dinner in order to run errands, and she was kept at home one day weekly for housework. Her mouth and teeth were in a very bad condition, and the mother refused dental treatment. The homes were visited and the children kept under stricter supervision, and wall cases some improvement resulted. 86 3 children had lost weight slightly and we could not account for the loss. The parents were very poor, but were doing their almost for the children and were most anxious to co-operate with us. We managed to send one of these children to the sea for a fortnight during the summer and he began to improve from that time.
ffa8a1f2-ed80-4bef-ad76-8b8e9f5d54aa	One child was frequently absent from school and we had some difficulty in securing a record of his weight. The last child was a girl who was receiving meals and milk and was gaining until the summer holidays. The parents refused to allow the meals when the schools re-opened. All the children who have failed to gain, or who have lost weight, have been re-examined at intervals, and the parents interviewed at the Clinic or the home visited. 11 of the children were having milk only, as their parents were able to provide dinner. 9 of these were putting on weight, one was losing, and the weight of the other was stationary. The parents of the last 2 cases were told of this, and urged to allow the children to remain for dinner. In 2 cases meals only were supplied, as the children could not be persuaded to drink milk at school. Both gained well Another child was considered to be necessitous, but the mother refused the offer of meals and milk when the scheme was started.
42811439-1980-4fde-946b-85bf38844768	This child however was found to have gained in weigh each month, and the mother was providing meals of higher food value. 12 children were considered undernourished, but were not necessitous. The parents were interviewed individually, and the diet, food habits, and health habits of the child discussed. In mam cases; diets of higher food value were suggested, defects wen corrected, and more rest at home, and sometimes also at schooi was advised. Our efforts were evidently responded to, for all these children gained weight steadily and were better in every way. During the year, 155 children received milk and dinners 3 children received dinners only, and 12 received milk only. Each malnourished child is weighed monthly and a record kept. Any loss of weight, or failure to gain is noted, and the child is brought up for review again.
9490d7df-68aa-4588-88eb-a1c0cf0ff677	87 The meals are prepared at the various Cookery Centres at the schools by the Domestic Science Mistresses and their pupils, and our acknowledgements and thanks are due to these Mistresses for their interest, enthusiasm, and very hard work, without which the working of the scheme would have been impossible. Below we give a list of the Centres at which meals are provided, together with the number of meals and the number of bottles of milk supplied during the year. Number of Free Meals supplied at the Various Centres—January to December, 193'2. Acton Wells 644 Priory 1869 Beaumont Park 2647 Southfield 880 Central 761 John Perryn 2568 Total 9369 Number of bottles of Milk supplied at the Schools. Acton Wells Senior 81 John Perryn Junior 797 Acton Wells Junior 242 John Perryn Infants 1100 Acton Wells Infants 438 Priory Boys 327 Beaumont Pk. Senr.
9829009d-ae35-405c-85ea-46ece243d1a7	Girls 223 Priory Girls 304 Beaumont Pk. Junr. Girls 219 Priory Infants 270 Beaumont Pk. Infants 308 Rothschild Junior 90 Berrymede Junior Boys 626 Rothschild Infants 350 Berrymede Junior Girls 1344 Southfield Infants 5 Berrymede Infants 2094 Turnham Green R.C. 425 Central 104 Derwentwater Junior 111 Derwentwater Infants 186 Total 10,353 John Perryn Senior 709 Otorrhoea. During the year, 77 children were examined at the Clinic account of ear disease. In the majority of cases the children sent up to the Clinic on account of discharging ears, the & large being due to disease of the middle ear. j An analysis of the figures will give a clear idea of the conns found, and the treatment which was considered appropriate.
9fa047b5-d3c9-45e0-9a79-9b4db2a21ed6	88 5 of the cases were acutely ill with middle ear disease at the first attendance. In 2 of these cases the infection had already spread to the mastoid and an immediate operation was necessary. These cases were referred to the family Doctor, and through him to Hospital, where they were operated on. The other 3 cases were sent home, and the parents advised to call in a doctor. All these cases were cured. The remaining cases were all cases of middle ear disease and there was a perforation in the drum head. Our method of dealing with these cases needs a little explanation. We are convinced that the most important point in the treatment of these ear conditions is the attention given to the external auditory meatus during the first week of the discharge. The influence that care of the external auditory meatus has upon the middle ear is indirect. (1) The removal of discharge from the meatus leaves room for fresh discharge to take its place.
24667bb0-fa35-4322-abee-0fc4d16a9400	(2) The toilet of the meatus prevents the secondary infection of the middle ear by the organisms present in the external ear. Inflammation of the middle ear becomes chronic when a second microbe gets in, and the most frequent source of this secondary infection is from the skin of tthe external ear. The organisms require moisture in which to grow, and their growth is prevented by keeping the skin of the external ear dry and free from discharge. This part of the treatment then, depends on getting the ear dry and keeping it so. It was decided to make each child over 7 years of age take a part in the treatment of his ear disease. It was uphill work and occasionally disheartening, but the results have justified our faith in the intelligence of the school child, and confirmed our views on the cause of the chronicity, in many cases, of middle ear disease. 58 cases were referred to the Clinic for treatment.
caca2bd5-a123-4eba-bb43-c4e29884347a	Each child over 7 years was taught to make mops for himself by twiddling pieces of cotton wool firmly round special sticks, and then by means of these mops to dry his ear thoroughly. He was also told to do this at home at least 4 times a day, scrubbing his hands before and after dealing with his ears, and burning the mops after they had been used. There was a little difficulty in getting the scheme to work at first, chiefly because the children did not want to be bothered, and in some cases because the parents were afraid of the child doing some damage to his ears.
ae71d571-dd39-40fc-8d02-925124f32d7a	89 At first, the ears of these children were examined with each week at the Clinic, and very soon they understood that they were ixpected to come up with no discharge in their ears at all A few children who were rather refractory were made to come daily and in '2 or 3 cases we had to ask one of the parents to come along in order to explain the matter to them and insist on the treatment being carried out. Finally the scheme was firmly established 58 cases attended the Clinic for treatment. 5 caves were acute-as mentioned above and were referred elsewhere. It were fresh cases of transient ear discharge which cleared up very quickly on routine treatment. In 32 cases the ear discharge had been present from a week to 3 months. In 5 of these cases there was a considerable degree of external otitis and the ear disease ceased very soon after this condition had been cured. The method of dealing with these cases was as follows.
fd9c33e2-80de-4f31-a1b7-e5ad3e07ca11	On the first attendance at the Clinic, the ear was cleaned out with a little peroxide of hydrogen for the purpose of examining the drum head. The condition of the drum head was noted on the medical card. The ear was then dried out with a little methylated spirit and the external meatus lightly coated with Ung.Hyd.Ox.Flav B.P. The child was.then instructed in mopping his ear and was given Mime of the special sticks to take home. This procedure was fllowed on each subsequent visit of the child to the Clinic and them provement noted until finally the child was discharged. The 32 cases were cured. There were 11 old cases in whom the discharge had been present for over 6 months. These in turn were made to come up daily for a week, some of them for longer until they were well on the way to recovery and were carrying out the treatment faithfully 3 of the children were too young to treat themselves and were done by their parents.
8a00cb49-d3e7-48b2-b481-e123ab5e0172	One child had a large polyous protruding through the perforation in the drum head and was preferred to Hospital for currettage. 4 of the cases had a severe and offensive external optics which appeared to be chiefly responsible for the discharge and they cleared up on the routine treatment of dry mopping but with the ox Fla.v. applied 4 times daily. In one child who was very resistant and had a large old Perforation, we instilled silver nitrate once daily for 3 day and then carried on with the routine treatment. The discharge cased and the perforation is practically healed. 90 In one child removal of Tonsils and Aednoids was considered necessary in view of their unhealthy nature. All these cases are now well. 10 cases still continue to have ear discharge. 6 of these cases are probably due wholly to neglect. They are very young children and attend the Clinic only occasionally and always have to be fetched. Their ears are always in an extremely dirty condition.
6e9c40be-ce4a-4edd-a386-d42fe8446d5b	The parents have been visited time and again, but improvement only results for a short time. In 3 cases the perforation in the drum head is small and there is insufficient drainage from the middle ear. A secondary paracentesis would probably help in clearing these cases, and in one of them removal of Tonsils and Adenoids has also been suggested but the parents refused the operation. We do not feel justified in suggesting further operative measures until secondary paracentesis has been performed. The last case is a small boy who is now nearly well. He is a child whom we had difficulty in getting along to the Clinic. On examination he was found to have a piece of paper firmly wedged against the drum head causing irritation and infection. On the whole these results are satisfactory considering the short time that the scheme has been in operation. We were helped of course, to a very large extent, by the fine summer.
7c500d80-72d9-4555-b967-f00c7213f527	Th parent of every child attending the Ear Clinic was asked to send the child out into the sunshine as much as possible, and to see that the child ran about, in order to improve the circulation. Many of them responded by allowing sun bathing. Our thanks are due to the teaching staff who have given us every assistance. We realise how trying it must be to allow a child to miss a class daily for a week in order to come to the Clinic, but we believe that in treating these cases intensively from the beginning we are preventing the chronic ear case which is a constant source of offence in a classroom. RETURN OF EXCEPTIONAL CHILDREN. On Table 3 is given a return of all exceptional children in the area. The figures in many instances are the same as those given in last year's report, but the following notes give further information on the cases. 91 Multiple Defects.
cc3f951d-679d-47d9-b4ae-ea5c56045de8	One boy who is mentally defective and is also suffering from tuberculosis of the bones of foot and hand, is resident in the Stanmore branch of the Royal National Orthopaedic Hospital. The second boy, who is also a mental defective, suffers from deformity of the spine and chest, and birth palsy. He is in attendance at the Acton Special (M.D.) School. The third case, a girl, is blind and mentally defective. She was at Swiss Cottage Blind School, but was discharged from there on account of her mental defect and an increasing tendency to fits. She has been notified to the Board of Education, and is now awaiting admission to a suitable school or home. Blind. Two boys attend schools maintained by the London County Council. One boy suffering from a high degree of myopia attends a private school, another boy suffering from optic atrophy attends Southfield Senior Boys' School, while a third partially blind child, 3 girl, is being taught at home.
66e02c6e-4a02-4b88-8aff-a29fb2c71180	all 1 .,■■■• v " ■■■: f Deaf. One girl is at Oak Lodge Residential School, and 2 others attend the Ackmar Road Special School. Two boys who have recently attained the age of 7 years, are still in attendance at elementary schools but are awaiting admission to a special school. Epileptics. One boy was in December at the Lingfield Colony for Epileptics. This child has given us a great deal of trouble, and one month after admission to Lingfield his mother removed him and refused to allow him to return. Arrangements have now been made for the child to be taught at home. Another severe case, a girl, is at home awaiting admission to the Colony. Two mild cases, a boy and a girl, are in attendance at the ordinary elementary schools. Tuberculosis.
61a46ad3-a82e-4189-9ab9-86317d7755e0	Two children, a boy and a girl, suffering from active Pulmonary tuberculosis are respectively at Harefield and at 92 i Brompton. Two boys suffering from tubercular glands are at public elementary schools. One boy suffering from abdominal tuberculosis is at a sanitorium at Lymington, while three boys suffering from tuberculosis of bones and joints, are at certified Hospital schools at Margate. One girl who has been at the Treloar Cripples' Home at Alton is now at home. Crippled Children. One girl is at St. Mary's Home, Dover. Two boys and one girl attend Physically Defective Schools maintained by the London County Council. Seven boys and three girls with a minor degree of deformity attend the public elementary schools, and 1 girl with severe birth palsy is being retained in an Infants' department until a transfer can be arranged to a P.D. School. Heart Disease. Two boys and two girls are at Certified Hospital Schools.
8d3acac8-95cf-4450-93dd-8c59390a103f	One girl is at home, under the care of the family doctor. DEFECTS TREATED. Report of the. School Oculist. The work of the Ophthalmic Clinic has been carried on regularly during the year. Last year the Board of Education circulated a report of the Committee of Inquiry into problems connected with the prevention of defective eyesight in school children. As an initial attempt to deal with the large amount of work involved, we suggested that a more thorough and searching eye test at the routine medical inspection should be made, and that the younger children should have their vision tested more regularly. These recommendations have resulted in a considerable increase of work at the Ophthalmic Clinic. Over 100 more children have been examined than in the previous year, the parents advised as to the care of their eyes, and, where necessary, glasses prescribed. These extra examinations have been mainly among the younger children and the parents have been asked to return with the children to the Clinic for re-examination sooner than formerly.
7d996494-b04f-4e84-8c61-df6fd9677124	Treatment at any early age is most necessary in the prevention of serious defects of vision in later life. 93 In addition, 7 cases of external eye disease have been continuously treated at the Clinic, one being sent into the West Middlesex Hospital for more thorough treatment than was possible at home. Two mothers from the Welfare Centres have been examined and glasses provided, and 13 babies from centres have been treated, mainly for early squint. (,Sd.) G. BANHAM. REPORT OF THE SCHOOL DENTAL SURGEON. 8,261 school children were examined during the year, and 5.036 of these were referred for treatment. These figures show an increase on last year. The number of cases actually treated has, however, decreased. Probably the chief factor governing this decrease was a change in the scale of charges which increased the payment for the bulk of our patients, with the effect of slightly raising the number of refusals, although these are fewer than in 1930.
b5211ef1-f35c-4d69-95fd-16e6bf6f1c23	I understand that steps are being taken to remedy this. The epidemics of Scarlet Fever and Diphtheria had also an unfortunate influence on the attendance for treatment. In spite of this however, the number of permanent fillings has increased, showing that more conservative work is being done on the permanent dentition. The average number of extractions per child remains about the same. It is gratifying to note that the percentage of children who do not require treatment, shows an increase of about 2% on 1931. The number of parents present at inspections is increasing, and in some districts the general condition of the childrens mouths is improving considerably. Treatment for mothers and infants from the Welfare Centres has been continued throughout the year, and there is a slight increase in the number of mothers and a decrease in the number of infants dealt with.
328fd552-68ac-40d5-83f5-1be321ff331d	94 The following are the figures for the Welfare work:— Number of mothers examined 39 ,,,,,, referred for treatment 39 „,,„ treated 49 infants examined 171 ,,,,,,referred for treatment 114 ,,,,,, treated 147 ,,,,Temporary Fillings 25 ,,,,,,Extraction 360 ,,,, Permanent Fillings 21 ,,,,,,Extractions 296 ,,,,Dressings—Permanent teeth 13 „„,,Temporary teeth 28 ,,,, Scalings and Gum Treatment 9 „,,Anaesthetics (N20) 191 ,,,,Dentures supplied 14 „,,Attendances 281 The usual lectures have been given at the Welfare Centres, and the attendances were better than in the previous year. I should like to add a word of warm appreciation of the indispensable help and co-operation of the Head Teachers and the Clinic staff. (Sd.) P. H. SLATER CONTROL OF INFECTIOUS DISEASES.
c849d705-de11-44f2-9ef7-9a7606d9edf2	There was a marked increase in the incidence of most of the infectious diseases. A fuller report upon these diseases will be found in the report of the Medical Officer of Health, but certain details which concern the attendance at the schools more directly, are given here. It is disappointing that so little progress can be reported in the prevention of outbreaks of infectious diseases in schools, it is true that we have modified our methods, and by such means we have reduced the mortality from the diseases but with the possible exception of Diphtheria and Small-pox, we have not discovered the means of preventing the spread of the principal infectious disease in the schools. 95 During the early part of the year, there was an outbreak of Measles in our districts, and it is doubtful if our efforts were in any way successful in limiting the spread of the epidemic. We have gained considerable knowledge of the epidemiology of the disease, and as a result we have avoided many of the mistakes which were formerly made.
60394558-09c4-4450-aa64-c1d45edcfd31	We have given up school closure, as we know that such a procedure is useless. Even when it is resorted to, it was more for financial reasons than with any hope of ending an outbreak. An epidemic may be slowed down in its progress, but it cannot be definitely stopped. An epidemic of Measles begins when sufficient children have accumulated who have not previously had the disease. It was formerly thought that the outbreak terminated when this surplus of susceptibles has been depleted, but this is doubtful, or at any rate, it does not follow that the depletion occurs because all the susceptibles have suffered from an attack of Measles. An epidemic of Measles may result in a transient immunization of some of the contacts, which may last about a year, whilst it is known that a clinical attack usually confers immunity for a lifetime. Our methods depend upon an appreciation of the importance of these facts.
3fb71cb5-efc5-4e43-a12a-a8516d710042	Most of the children in the Junior and Senior departments have already suffered from an attack of Measles, and we find that the disease does not spread in these departments. Junior and Senior contacts who have had Measles are not excluded from school attendance, and so we are able to concentrate our attention on the Infants' departments. The earlier cases were reported in January, 1932. On the re-opening of the schools after the Christmas holidays three cases were reported, one from Silver Crescent, one front Kingswood Road, and one from Weston Road. All attended the Infants' department of the Rothschild Road School, and had been taken towards the end of December, the rash in one of the cases appearing on December 28th, and in the other two on January 1st.
e8e54638-f356-4135-a7a8-e6d880a67940	From the distibution of the 3 cases and the history, the source f the infection would probably be in school, but on enquiry no children had been absent with any suspicious symptoms in the week ending December 19th, which would be the period of infection of the 3 cases. In the second week in January two other cases occurred, both children lived in Antrobus Road, and were pupils at Rothsinfants' School. These two cases, though, were not infected in school as the probable date of infection would be the last few 96 days of December, or the early days of January, i.e., during the school holidays. They were instances of home infection and were possibly infected by one of the 3 cases previously mentioned. Although the case was not traced, it appears probable that a mild unrecognised case occurred in the school during the week ending December 19th, and that the 3 cases which occurred in the holidays were the first crop.
96a1c3da-4bb5-451a-a5bf-9cb1f3897fbe	The first crop thus falling during the vacation, it was hoped that the second crop would not be a heavy one, and that an epidemic would be postponed for a few months. Other cases however were reported in Rothschild Infants department, and in the week ending January 23rd, several cases occurred in Beaumont Park Infants department. During the Spring Term the outbreak spread to other schools, and before the end of the Summer all the schools had been attacked. Whooping Cough was also prevalent during the year, but its greatest incidence was a little later than that of Measles. The serious aspect of the disease is still under-rated by the public, and very little attention has been paid to the disease in the field of public health. At ages 0-5 years, Whooping Cough took fifth place during the decade 1921-30 in the list of causes of mortality.
55be01a3-e0e4-48f0-aa81-db1c1ab3d833	More school time is lost through Whooping Cough than through Measles, but more important than this, is the toll of impaired physique and the cardiac damage which cannot even be estimated. A question of educational interest is the possibility of psychological trauma in severe cases to which attention has recently been drawn. It is possible that the incessant terrifying paroxysms with their sense of impending suffocation may have a lasting effect upon the child. Diphtheria, In the Annual Health Report will be found an. account of the outbreak of Diphtheria which occurred in the Autumn of the year. It is now recognised that Diphtheria is a disease which is largely associated with school life. The usual swabbing of contacts and isolation of the patients was followed, but it was decided to offer immunisation to all those who desired to avail themselves of this method of protection. 97 A start was made in Southfield School and the following tables give the result of the Schick testing in the Southfield Road departments.
8507d0e8-23d3-4702-80e6-83545a1e0add	Southfield Senior Boys. Year la lb lc 2a 2b 3a 3b Total Positive 12 9 8 5 3 9 4 50 Negative 8 15 7 14 7 7 9 67 Total tested 20 24 15 19 10 16 13 117 Age groups of boys tested. Years 11 12 13 14 Positive 23 14 9 4 Negative 24 26 15 2 = 57.2% Negative. Southfield Junior Mixed.
5b90404b-3a78-4373-ac30-f11f5b2aba4d	Standard 1 lb 2 2a 2b 3 3a 3b 4a Total Positive 27 15 21 23 23 27 21 19 20 196 Negative 3 4 9 8 6 2 5 8 13 58 Total tested 30 19 30 31 29 29 26 27 33 254 Age groups. Years 7 8 9 10 11 Total Positive 38 46 46 60 6 196 Negative 5 15 12 20 6 58 = 22.8% Negative. Southfield Infants. Class 1 2 3 4 5 Total Positive 23 17 14 22 19 95 Negative 7 5 3 1 1 17 Total tested 30 22 17 23 20 112 Age groups.
b59d2b42-aedc-42f1-aba5-f2e24d3f4aeb	Years 4 5 6 7 Totsl Positive 17 31 41 6 95 Negative 1 2 10 4 17 = 15.1% Negative, 98 The results obtained were very similar to those obtained in other districts. The number of positive re-actors gradually diminished as the ages of the children increased. In the Infants department the percentage of positive re-actors is so high as to render it almost unnecessary to carry out the test. In some districts the preliminary Schick-testing of children under 7 years of age has been abandoned. In spite of the suggestion that the immunisation could be arranged for privately, only 14 took advantage of the opportunity. The first immunisation was given on the 17th October, the second on the 2nd November, and the third on the 30th November. It is satisfactory to note that in no instance did any of the pupils who were immunised in the school suffer any adverse reaction, local or constitutional.
448ede20-da05-452b-9a1d-8138b961c8b3	Although protection is not expected until a certain period has elapsed after the 3rd immunisation, there have been only 0 cases of Diphtheria notified from the school, and these have all been pupils who were absent at that time or whose parents objected to immunisation. The pupils at the Acton County School were Schiek Tested on November 14th and 16th. It was hoped that the work at the County School would be done by the County Council, but the County Authorities stated that the responsibility was not theirs. The Ministry of Health expressed the opinion that the responsibility lay upon the local sanitary authority. The results in the County School were as follows: — County School.
7ada1077-fd0d-4c22-a0dd-41ebe14400d8	Form 1 lb 2a 2b 3a 3b 4a 4b 5 6 Total Positive 12 12 15 15 13 17 11 15 27 4 141 Negative 14 18 9 9 9 9 13 8 18 9 116 Total tested 26 30 24 24 22 26 24 23 45 13 257 Age groups. Years 11 12 13 14 15 16 17 Total' Positive 11 39 25 31 14 17 4 141 Negative 16 30 15 24 16 11 4 116 = 45.1% neg The next school dealt with was the Derwentwater Infants and Junior departments. Five cases of Diphtheria occurred in October and November in the Infants' department and one in the Junior department.
3ec08089-65c2-4e96-9ad8-af4bd057de98	99 The Schick test results at John Perryn Junior are given below:- John Perryn Junior. Standards la lb 2a 2b 2c 3a 3b 3c Total Positive 18 11 13 9 5 15 5 6 82 Negative 5 10 4 6 9 10 11 9 64 Total tested 23 21 17 15 14 25 16 15 146 Age Groups 8 9 10 11 Total Positive 27 26 27 2 82 Negative 13 20 25 6 64 = 43.8% Negative. In the Derwentwater Infants' department, it was not considered necessary to Schick test the children, and 109 pupils received the first imunising dose on November loth. The second imunisation took place on November 27th, and the third on December 20th.
f224a1d6-ed4e-4a78-accb-80b86f7fafde	The Derwentwater Junior department was Schick tested on 26th November and the immunisations were given on December 6th,. and 20th, and January 26th, 1933. The following is the table of the Derwentwater Junior results of Schick testing:— Derwentwater Junior. Standards la lb 2a 2b 3a 3b 4a 4b 5a 5b Total Positive 15 11 12 14 9 14 11 13 14 15 128 Negative 7 9 10 11 12 9 9 12 9 8 96 Total tested 22 20 22 25 21 23 20 25 23 23 224 Age Groups.
32a2a90f-fcc7-41bb-8004-9b8de2992484	Years 7 8 9 10 11 Total Positive 26 28 42 25 7 128 Negative 17 20 30 21 8 96 =42.8% Negative. The next school dealt with was the John Perryn. In vptember 2 cases occurred in the John Perryn Infants', in October one, and one in the Senior department. In November 2 cases occurred in the Infants', 1 in the Junior, and 3 in the Senior. In December 2 cases occuned in the Senior department. The first inoculation took place on the 19th December, the second on the 27th January, 1933, and the third on the 24th February, 1933. Since December we have only had one case from the John Perryn School. This was in a child who had received one inoculation. The disease was mild and the patient was soon out of hospital.
93532ea8-c6b3-428a-a3ef-1e4ccecff31d	100 In the Rothschild Infants' School the children were not immunised at the School, but about 50 of them came to the Clinic and were immunised there before the Christmas holidays. 4 cases of Diphtheria had occurred there in October, 7 in November, and one in December. 4 cases which occurred in Rothschild Infants' department during February, 1933, were among children whose parents had refused immunisation in the Autumn. 2 of these proved fatal. One case occurred in this school in November in which the child had received one immunisation. The case was a very severe one but the child recovered. Immunisation was again offered at Rothschild Infants' department in February 1933, and larger numbers of parents took advantage of this offer. At the same time Schick testing and immunisation took place in the Junior department. In Beaumont Park, 2 cases occurred in September, 1 in October, and 1 in November.
888e029e-38d8-4b03-881c-1b731075556a	In January 1933, 3 cases occurred, and Schick testing and immunisation commenced on the 6th February. In Turnham Green R.C. School, one case occurred in October, one in November, and 2 cases early in the New Year. Schick testing and immunisation took place in March. In the Junior departments of Berrymede School, one case occurred in October and one in November, and in the Infants' department, one case in November, and one in January, 1933. Schick testing and inoculation was commenced at this school in February. It was not possible in 1932 to arrange for the work in all the schools, but many requests were received from parents that their children should be Schick tested and immunised.
4d6a7318-3395-4bf9-84e3-b748bce3b48e	It was therefore decided to carry out the work for these, and also children from the Welfare Centres, on Saturday mornings at the School Clinic, and at these sessions 228 children were Schick tested, and 800 immunisations were given. 101 The following table gives the school distribution of Schick testing and immunisation. It has not been possible to tabulate the results as they stood on the 31st December, but these figures show the amount of work done up to mid-February. School. Schick Schick tested. Positive re-actors. Number of attendances for 1st Inoc. 2nd Inoc. 3rd Inoc. Acton Wells Senior 3 1 1 1 1 Acton Wells Infants 2 2 7 7 5 Beaumont Pk. Senr. Girls 9 6 7 6 4 Beaumont Pk. Junr.
6cd4ac48-cc8c-46b9-b89c-76f22926ef06	Girls 122 52 52 10 6 Beaumont Pk. Infants 3 1 77 11 8 Berrymede Junior Boys 195 90 72 5 5 Berrymede Junior Girls 182 83 80 5 5 Berrymede Infants 1 1 107 1 — Central 5 4 5 3 3 Derwentwater Junior 242 135 136 130 121 Derwentwater Infants 1 — 130 128 122 John Perryn Senior 2 2 3 1 1 John Perryn Junior 166 93 86 69 2 John Perryn Infants 4 2 202 147 4 Priory Girls 4 3 3 2 2 Priory Infants 4 4 7 6 6 Rothschild Junior 137 63 61 8 8 Rothschild Infants 32 23 77 45 33 Southfield
03c66e27-57a4-457b-a176-e9cd46b12b15	Senior Boys 129 56 55 55 52 Southfield Junior 264 206 198 195 188 Southfield Infants 121 104 107 102 86 Turnham Green R.C. 1 — 1 1 — Acton County 269 151 138 133 126 Chiswick County 4 3 3 2 2 Other Schools 19 18 6 4 4 Welfare Children 1 — 142 107 83 Scarlet Fever Patients in Isolation Hospital — — 146 128 103 1922 1102 1909 1312 980 It will therefore be seen that up to the 18th February, 1922 children had been Schick tested. Of these 1102 were positive, and 820 were negative re-actors. Of these 1102,—36 refused inoculation or went to their own doctors, leaving 1066 whom we immunised.
7f86beca-bf95-4d7d-9895-80e42550a0db	21 refused the second inoculation, and 16 refused the third. In addition, 843 children were immunised without the preliminary Schick testing. 102 Distribution of Diphtheria. The school distribution of cases of Diphtheria was as follows : Acton Wells 3 Beaumont Park 11 Central 2 Derwentwater 7 John Perryn 12 Priory 3 Rothschild 15 Berrymede 6 Southfield 24 Turnham Gn. R.C. 6 89 55 Diphtheria patients, and 225 contacts were examined before their return to school. Scarlet Fever. There was a considerable increase in the incidence of Scarlet Fever during the year. The cases were distributed as follows:— Acton Wells Mixed 2 Acton Wells 9 Beaumont Park 87 Central 15 Derwentwater 31 John Perryn 24 Priory 35 Rothschild 55 Berrymede 56 Southfield 30 Turnham Gn.R.C.
ce2090cf-0723-4981-ad25-8775355434ec	16 Acton Special 1 361 274 Scarlet Fever convalescent patients, and 795 contacts were examined before returning to school. EMPLOYMENT OF CHILDREN. The following Tables give the number of children employed in the various registered occupations. 103 TABLE SHOWING THE NUMBER OF CHILDREN ATTENDING ACTON SCHOOLS EMPLOYED IN THE VARIOUS REGISTERED OCCUPATIONS AS ON THE 31st DECEMBER, 1932. SCHOOL.
0dddb0ad-1690-4571-b889-55786c0c5536	Delivering Goods or Parcels Delivering Newspapers Delivering Milk Totals Boys Girls Boys Girls Boys Girls Boys Girls Acton Wells 1 .... 13 .... 2 .... 16 .... John Perryn 3 .... 2 .... 1 .... 6 .... Central 5 .... 15 .... 6 .... 26 .... Acton County 3 .... 5 .... 4 .... 12 .... Roman Catholic .... 2 .... .... .... 2 .... Southfield 16 .... 20 .... 1 .... 37 .... Beaumont Park .... 1 .... .... .... 1 Priory 29 .... 28 .... 13 .... 70 .... Totals 57 .... 85 1 27 .... 169 1 104 TABLE SHOWING THE NUMBER OF CHILDREN EMPLOYED OUTSIDE SCHOOL HOURS AS ON 31st DECEEMBER, 1932. SCHOOL. Registered Occupations in Acton. Ages. 12 — 13 Ages.
147662a3-30a0-4017-8a25-560e2023b385	13 — 14 Totals 12 — 14 Acton Wells 6 10 16 John Perryn 1 5 6 Central 10 16 26 Acton County 2 10 12 Roman Catholic 1 1 2 Southfield 13 24 37 Beaumont Park 1 — 1 Priory 24 46 70 Totals 58 112 170 105 TABLE SHOWING THE DISTRIHUTION OF ALL CHILDREN EMPLOYED DURING THE PERIOD 1st JANUARY 1932, TO 31st DECEMBER, 1032. SCHOOL. BOYS GIRLS John Perryn Acton Wells Central Priory Southfield Roman Catholic Acton County Others Special Totals Beaumont Park Totals (1)—Registered Occupations :— (a) Carrying or delivering goods or parcels 5 3 12 53 31 1 6 5 . 116 . .
f1d3d48b-9091-474d-8c6e-e3d4a0cdbfcd	(b) Delivering newspapers 3 19 32 50 35 5 8 10 . 162 1 1 (c) Delivering Milk 3 3 7 18 5 . 6 3 1 46 . . (2)—Employed in Other Areas:— . . . . . . . . . . . . Totals 11 25 51 121 71 6 20 18 1 324 1 1 Corresponding Figures for 1931 9 25 57 142 93 8 16 16 . 366 . . 108 EXAMINATION OF TEACHERS AND OFFICE STAFF. 7 Candidates were examined during 1932. CONVALESCENT HOMES AND COUNTRY HOLIDAYS. 14 children (of whom 2 were granted free places), were sent to the Middlesex Edward VII. Memorial Hostel, Bexhill. MOTHERCRAFT CLASSES.
a3248002-496c-41e3-8f83-f5e62935e51e	The schools which sent classes to the Day Nursery were as follows:— Acton Wells 6 Priory 5 Beaumont Park 6 Turnham Green R.C. 2 Central 5 John Perryn 5 Total 29 MEDICAL INSPECTION RETURNS. A.—Routine Medical Inspections. Number of Code Group Inspections:— Entrants 858 Second Age Group 890 Third Age Group 1006 Total 2754 Number of other Routine Inspections 22 B.—Other Inspections. Number of Special Inspections 2479 Number of Re-Inspections 2297 Total 4776 109 Pages 106-107 blank TABLE II. 4 —Return of Defects found by Medical Inspection in the Year ended 31st December, 1932. 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.
2a1c3645-7200-4b9c-aa09-ec5ffa459685	Requiring Treatment Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition 26 85 176 4 Skin:— Ringworm: Scalp 1 — 9 — Body 1 — 28 — Scabies 6 — 32 — Impetigo 6 — 401 — Other Diseases (Non-Tuberculous) 10 — 103 — Eye:— Blepharitis 15 — 86 — Conjunctivitis 2 — 34 — Keratitis — — 1 — Corneal Opacities — — 1 — Infective Vision (excluding Squint) 108 — 78 — Squint 9 — 10 — Other Conditions 2 — 56 — Ear:— Defective Hearing 9 — . .
8c7aa912-221a-485e-8d6e-441763d986dc	Otitis Media 11 — 5 — Other Ear Diseases 7 1 91 10 Nose and Throat:— Enlarged Tonsils only — — — 8 Adenoids only — — — 4 Enlarged Tonsils and Adenoids 42 3 15 4 Other Conditions 2 — 16 201 Cervical Glands NonTuberculous) — 89 — 5 Defective Speech 4 — — — Heart and Circulation :— Heart Disease: Organic — 8 — — Functional — 37 — — Anaemia — 9 — 1 Rangs:— Bronchitis — 3 — 1 Other Non-Tuberculous Diseases — 8 — — 110 TABLE II.—Continued. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defect. Requiring Treatment Requiring to be kept under observation, but not requiring Treatment.
a0402f5f-60d8-4acb-9936-898029924b15	Requiring Treatment Requiring to be kept under observation, but not requiring Treatment. Tuberculosis:— Pulmonary: Definite — — 3 — Suspected — 3 — — Non-Pulmonary: Glands — — 2 — Spine — 2 — — Hip — — 1 — Other Bones and Joints — — — — Skin — — — — Other Forms — — 1 — Nervous System:— Epilepsy — 2 — — Chorea 2 1 — — Other Conditions — 1 — — Deformities:— Rickets — 13 — — Spinal Curvature — 3 — — Other Forms — 11 — — Other Defects and Diseases (excluding Uncleanliness and Dental Diseases 6 35 998 — B.—Number of Individual Children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Group Number of Children Percentage of Children found to require Treatment Inspected Found to require Treatment.
562eb8bf-a0ac-45b6-9392-6dd67440248f	1 2 (3) (*) - Code Groups:— Entrants 858 55 6.4% Second Age Group 890 86 9.6% Third Age Group 1006 79 7.8% Total (Code Groups) 2754 220 7.9% Other Routine Inspections 22 — — 111 table III. Return of all Exceptional Children in the Area. Boys. Girls Total. Multiple Defects 2 1 3 Blind—(including partially blind): Suitable for training in a School for the totally blind: At Certified Schools for the Blind 2 — 2 At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Suitable for training in. a School for the partially Blind: At Certified Schools for the Blind or Partially Blind — — — At Public Elementary School 1 — 1 At other Institutions 1 — 1 At no School or Institution — 1 1 Deaf—(including
23c9f986-1fb6-41ff-a274-d982604e6ca5	deaf and dumb and partially deaf): Suitable for training in a School for the totally deaf or deaf and dumb: At Certified Schools for the Deaf — 3 3 At Public Elementary Schools 2 — 2 At other Institutions — — — At no School or Institution — — — Suitable for training in a School for the partially deaf: At Certified Schools for the Deaf or Partially Deaf — — — At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Mentally Defective: Feebleminded : At Certified Schools for Mentally Defective Children 26 16 42 At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Notified to the Local Mental Deficiency Authority during the year — — — Epileptics: Suffering from severe epilepsy: At Certified Schools for Epileptics 1 — 1 At Certified Residential Open Air Schools — — — At Public Elementary Schools — — — At other Institutions — — — At no School
14a59c3d-a6b7-4e90-9ef1-cb36ccf4fdda	or Institution — 1 1 Suffering from epilepsy which is not severe: At Public Elementary Schools 1 1 2 At no School or Institution — — — Physically Defective : Active pulmonary tuberculosis (including pleura and intrathoracic glands): At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 1 2 At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — 112 Quiescent or arrested pulmonary tuberculosis (including pleura and intrathoracic glands): An Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 1 3 4 At other Institutions 1 — 1 At no School or Institution — — — Tuberculosis of the peripheral glands: At Sanatoria or Sanatorium Schools approved by
aaf2e220-c66a-41a6-a8fc-24d113f3f67c	the Ministry of Health or the Board — — — At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 2 — 2 At other Institutions — — — At no School or Institution — — — Abdominal tuberculosis: At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 — 1 At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Tuberculosis of bones and joints (not including deformities due to old tuberculosis): At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 4 1 5 At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — 1 1 Tuberculosis or other organs (skin, etc.
42116b54-11a0-4582-822a-1516cbfbd9f7	): At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board — — — At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Delicate Children, i.e. all 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 Residential Cripple Schools — — — At Certified Day Cripple Schools — — — At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 6 11 17 At other Institutions — — — At no School or Institution — — — 113 Physically Defective (continued): Crippled Children (other than those with active tuberculous disease) who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life: : At Certified Hospital Schools — — — At Certified Residential Cripple Schools — 1 1 At Certified Day Cripple Schools 2 1
261d7694-42ed-4281-bb13-cea7d03ce1ac	3 At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 7 4(1) 11(1) At other Institutions — — — At no School or Institution 1 2 3 Children with heart disease, i.e. children whose defect is so severe as to necessitate the provision of educational facilities other than those of the public elementary school: At Certified Hospital Schools 2 2 4 At Certified Residential Cripple Schools — — — At Certified Day Cripple Schools — — — At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At other Institutions — — — At no School or Institution — 1 1 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1932. Treatment Table. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.) Disease or Defect.
d885008d-36b6-4e18-a4d0-f9e08cc9d2b6	Number of Defects treated, or under treatment during the year. Under the Authority's Scheme Otherwise Total (1) (2) (3) (4) Ringworm-Scalp 4 — 4 Ringworm-Body 22 6 28 Scabies 29 3 32 Impetigo 378 15 393 Other skin disease 94 6 100 (External and other, but excluding cases falling in Group II) Minor Eve Defecs 177 2 179 Minor Ear Defects 105 2 107 Miscellaneops (e.g., minor injuries, bruises, sores, chilblains, etc.). 948 50 998 Total 1757 84 1841 114 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease. No. of Defects dealt with.
a8236eda-eb41-4fd2-900b-532e208ea255	Under the Authority's Scheme Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme Otherwise Total (1) (2) (3) (4) (5) Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report) 426 11 — 437 Other Defect or Disease of the Eyes (excluding those recorded in Group I-). 7 — — 7 Total 433 11 — 444 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 323 (ft) Otherwise 11 Total number of children who obtained or received spectacles— (a) Under the Authority's Scheme 323 (b) Otherwise 11 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment.
3c547c8f-ebf9-445d-8f76-cc4dbdbab42e	Received other forms of Treatment Total number treated Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme Total (1) (2) (3) (4) (5) 59 5 64 — 64 115 TABLE IV.—Continued. Group IV.—Dental Defects.
61b9ed96-9eb7-467b-93af-4048c9c2391b	1)Number of Children who were :— (2) Half-days devoted to:— (a) Inspected by the Dentist: Inspection 36 Treatment 421 Aged: Total 477 5— 673 6— 818 (3) Attendances made by children for treatment 3822 7— 768 8— 891 9— 976 (4) Fillings:— Coutine Age Group 10—974 Permanent teeth 1703 11—1029 Temporary teeth 59 12— 963 Total 1762 13— 610 14— 193 (5) Extractions:— Total 7895 Permanent teeth 770 Specials 366 Temporary teeth 4018 Grand Total 8261 Total 4788 (b) Found to require treatment 5036 (6) Administrations of general anaesthetics for extractions 2178 (7) Other operations:— Actually treated 2811 Permanent teeth 136 Temporary teeth 133 Total 269 Group V.
9b2409dd-9e5a-4726-9840-8ccc37b3d90f	—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 18301 Number of individual children found unclean :— Vermin and Nits86 Slightly infested 597 Number of children cleansed under arrangements made by the Local Education Authority 2 Number of cases in which legal proceedings were taken:— (a) Unnder the Education Act, 1921. — (b) Under School Attendance Byelaws — 116 STATEMENT OF THE NUMBER OF CHILDREN" NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1932, BY THE LOCAL AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY Total number of children notified 11 Analysis of the above Total. Diagnosis. Boys. 1.
d41ac214-c11a-43b8-b736-124a7fcc8180	(i) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots 2 1 (b) Imbeciles 2 1 (c) Others — — (ii) Children unable to be instructed in a Special School without detriment to the interests of other children : (а) Moral defectives — — (B) Others — — 2 Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 1 — 3. Feeble-minded children notified under Article 3, i.e., "special circumstances" cases — — 4. Children who in addition to being mentally defective were blind or deaf — 1 Grand Tota 5 6 We are, Your obedient servants, D. J. THOMAS, N. G. HOWELL. wi 69
4ddf08ab-7db3-4e1f-8229-441f4b28db5d	' ; : - — ••••• t:;:r : • •••.; .ynii,,,., . ;k =; ::::::::: ■ •••.»»■• • ACT 36 Borough or Acton. ANNUAL REPORT OF THE Medical Officer of Health TOGETHER WITH THE Report on the Medical Inspection of Schools FOR THE YEAR 1933. Woodgates & Sons Ltd., Printers, South Acton, W.3. Borough of Acton. ANNUAL REPORT OF THE Medical Officer of Health TOGETHER WITH THE Report on the Medical Inspection of Schools FOR THE YEAR 1933. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1933. Public Health Department, Municipal Offices, Acton, W.3. To the Mayor, Aldermen and Councillors of the Borough of Acton.
04f4b82d-464b-4031-9d64-ddc2ab1726cc	Ladies and Gentlemen, I herewith submit the Annual Report required by the Ministry of Health, together with the Annual Report on the School Medical Services. The Annual Report has followed the lines outlined in Circular 1346 of the Ministry of Health issued on the 2nd October, 1933. Area.—There was no change in the boundaries of tha Borough during the year, and the area is the same as that of previous years, viz.:—2,305 acres. Rateable Value.—The rateable value of the district on October 1st, 1933, was £730,040, and the sum represented by a penny rate was £2,880 13s. 10d. (year ending 31st March, 1933). The number of inhabited houses, according to the Rate Books at the 31st March, 1933 was 16,060. Extracts from Vital Statistics.—The following table gives the extracts from the vital statistics required by the Ministry of Health Total.
b08ea992-2f34-474f-b004-2fd5e48955e2	M. F. Live Births. Birth-rate per Legitimate 846 446 400 1,000 of estimated Illegitimate 40 23 17 population—12.6 886 469 417 4 Still Births. Legitimate 31 19 12 Rate per 1,000 Illegitimate 2 — 2 births—37.1 33 19 14 Deaths 784 Death-rate per 1,000 inhabitants— 11.1 Deaths from Puerperal causes 5 Rate per 1,000 births—5.6 Deaths Rate per 1,000 births Puerperal Sepsis 3 3.4 Other Puerperal causes 2 2.2 Death-rate of Infants under 1 year of age.
2f2cd544-ad53-4841-9748-12d0240c8574	All infants per 1,000 births 45 Legitimate infants per 1,000 legitimate births 42 Illegitimate infants per 1,000 illegitimate births 100 Deaths from Measles—all ages 1 Deaths from Whooping Cough 2 Deaths from Diarrhoea—under 2 years of age 7 POPULATION. The Registrar General estimated the population at the end of June, 1933 to be 70,300. This is a decrease of 340 as compared with the estimated population at the end of June, 1932. As this figure is used for other official purposes it has to be adopted for this report, but I may be permitted to express the opinion that the Registrar General has probably made an error.
d38b9853-fdd8-4761-a4d2-f4b071caabf2	In ordinary circumstances, it would be presumption on my part to differ from him, as he is able to take a wider view of the subject, but as we have a comparatively recent instance in which the Registrar General was wrong and the local estimates more correct, I may give some of the facts on which my opinion is based. It will be recollected that before the last Census the Registrar General supplied estimates of our population which turned out to be much below the actual figure revealed at the Census. The Registrar General estimated the population in 1929 and 1930 at 65,200. The population at the Census was 70,510. The first comparison is that of the parliamentary electors. In his memorandum, the Registrar-General warns us that in the general population at the present time, while the number of adults is increasing, the numbers below the age of 21 are declining.
85385292-d9f3-45e5-b2fc-1adda250b7eb	Speaking generally, a high rate of electoral increase in a given area usually denotes a much lower rate of population increase; a stationary 5 or declining electorate almost certainly indicates a fall or much larger fall in total population ; it is not safe to assume that there is a decline in the population whilst there is an increasing electorate. The number of parliamentary electors in Acton has been as follows:— 1931 47,865 1932 48,126 1933 48,245 These figures do not indicate that there is a fall in population ; possibly the increase at the present time is a very small one. Similarly an examination of the number of houses erected points to the same conclusion. The following table gives the number of houses erected in the last 3 years :— 1930-31 449 1931-32 257 1932-33 188 It is true that populations cannot be regarded as changing in simple relationship with the changes in the numbers of dwellings available.
ae909820-4430-4e22-a7bd-0e3eace04c24	The decline in the size of families is a feature which has been noted in the Census records of almost every area in the country; and no estimate of population movement could be regarded as valid which, while taking account of the occupants of new dwellings, ignored the equally important, if less tangible, decline that is taking place in the population of the older houses. In spite of this fact a comparison of the number of houses built in the inter-censal period and since the 1931 Census, justifies the assumption that there is still a slight increase in the population of the district. The number of inhabited houses at the end of 1933 according to the Rate Books was 16,060. SOCIAL CONDITIONS OF THE DISTRICT. It will be more convenient to discuss the social conditions of the district when the complete Census returns have been published.
79c6db59-f046-4450-ac92-a7878623442b	It is doubtful if these returns will disclose the gradual but constant changes which are taking place in the social conditions, but it is obvious that the sub-letting of the larger houses which has been taking place, must result in changes which have already taken place and which will still proceed in the near future. AMBULANCE FACILITIES. The ambulance facilities are similar to those described in previous reports. 6 A new motor ambulance has been provided for the removal of infectious cases to the hospital. There are two ambulances provided for accident and noninfectious cases. These are housed at the fire station and are available at all hours. Last year the ambulance was called out to 422 street accidents, and on 532 occasions to private cases. Fees amounting to £101 8s. 6d., were paid for the use of the ambulance for private cases. There has been no development or marked changes in the services provided in the area under the following heads :— Laboratory facilities. A mbulance facilities.
69e4e503-30ba-4f3d-86bf-6f40c3027ca6	Nursing in the home. Clinics and Treatment Centres. Hospitals—Public and Voluntary. HOSPITAL PROVISION. General.-The only General Hospital in the district is the Acton Hospital, Gunnersbury Lane, which has an accommodation of 64 beds. During the year 1,209 in-patients were admitted ; this is a decrease of 89 on the previous year. Of these 171 were in for only 1 day and 148 for 2 or 3 days. The Fducation Committee has an agreement with the Hospital for payment for the removal of tonsils and adenoids and the patients are kept in the Hospital for at least 1 night. 7,395 out-patients were treated during the year, an increase of 177 and the out-patient attendances were 30,822, a decrease of 620 as compared with 1932. The Hospital supplies a great need in the District, is greatly appreciated and most of the beds are continuously occupied.
c01b88a1-cfd2-4682-80d3-e9a1b7b7aa50	Last year the average number of beds in daily occupation was 53.13. Fever.—Acton Council Fever Hospital. Small-Pox.—Acton was one of the constituent bodies which formed the Middlesex Joint Small-Pox Board. Under the Provisional Order Confirmation Act of 1929, the Joint Board was dissolved from the 1st April, 1929, and the duties of the Board transferred to the Middlesex County Council. 7 Tuberculosis.—The Tuberculosis scheme is administered by the Middlesex County Council which has sanatoria at Clare Hall and Harefield. Child Welfare Consultation Centres. (a)—47, Avenue Road—Every Monday, Tuesday, Wednesday and Thursday afternoon at 2 p.m. (b)—Noel Road—Every Thursday afternoon at 2 p.m. (c)—East Acton—Every Monday afternoon at 2 p.m. (d)—Steele Road—livery Tuesday afternoon at 2 p.m.
c4908a4c-367f-4139-814e-6f66e4abc7e4	Ante-Natal Consultation Centre.—School Clinic every 2nd and 4th Wednesday. Day Nursery.—169, Bollo Bridge Road. School Clinic.—45, Avenue Road. (The above are provided and maintained by the Borough Council). Tuberculosis Dispensary.—School Clinic on Tuesdays at 5 p.m. and Thursdays at 10.30 p.m. Treatment Centres for Venereal Diseases.—Various Hospitals in London. (The two latter are provided by the Middlesex County Council). SANITARY CIRCUMSTANCES OF THE AREA. These have been noted in previous reports. All the inhabited houses are supplied from the mains of the Metropolitan Water Board. A few industrial works and the Public Baths obtain their water supply from deep wells. By arrangement with the London County Council the sewerage is discharged into the London Sewers. Storm water is filtered and emptied into the Thames. All the inhabited houses are provided with water closets and are drained into the main sewerage system.
4c67a037-7fc8-447e-80f9-d52002eaa22a	The house refuse is collected by the Council and burnt in the Destructor. Last year 19,624 tons of house refuse were collected and burnt. 8 PROFESSIONAL NURSING IN THE HOME. General.—There are two district nurses employed by the Acton Hospital, who visit the homes of both the poor and those who are able to pay. There are also nursing associations which provide nurses for different classes of cases. Midwives. —The Supervising Authority under the Midwives Act is the Middlesex County Council and from the County Council I understand that there are 23 certified midwives practising in the Borough. SWIMMING BATHS. The most important development has been the installation of a filtration plant, and the following description of the plant has kindly been supplied by the Borough Engineer.
88921012-f7c4-4dfd-8ba4-ef7a9725699e	The water is drawn from the deep end of each bath through cast iron suction pipes, passes through a grid strainer upon which the larger solids such as buttons, pieces of costumes, etc., are retained and then enters the pre-aeration chamber where it is subjected to an intensive oxidation on the self induction principle befor entering the pump suction. Centrifugal pumps in duplicate, each driven by a steam engine of 13 B.H.P. are installed to pump the water to the filters. On its way it passes through a heater which preserves any temperature loss which would otherwise be sustained in circulation. Immediately before being distributed over the filters, the water is dosed with alumina which coagulates the impurities in solution and Soda Ash as necessary to preserve the required degree of alkalinity. The filters are four in number, vertical pressure type, constructed of ¼-inch and 7/16-ins. mild steel plate, 8-ft. 9-ins. diameter and filled to a dept of 3-ft. 6-ins.
bc6f2f66-59f5-4f03-bfe6-7e51e2a25255	with Leighton Buzzard sand on a 6-in. bed of large pebbles. The water passes downward through the sand leaving the impurities behind in the form of a gelatinous film. Before re-entering the pools at the shallow end the water is finally aerated, then sterilised by the injection of chlorine gas in solution in such proportion that about .4 and 1 parts per million can be determined by the orthotolidin test at the shallow and deep ends respectively. The total capacity of the pools is approximately 166,000 gallons, the whole passing through the complete process of filtration once every four hours, giving a rate of filtration equal to 173 gallons per square foot of filtering media per hour. 9 The filters are cleaned out by reversing the flow of water, agitating the media and discharging the foul water to the sewer. The frequency of the cleansing operation is dependent upon the number of bathers using the baths. LEGISLATION IN FORCE.
7bad22ed-c49d-46af-8b52-faf7b51aa4a5	The following local acts, special local orders, general adoptive acts and byelaws relating to Public Health are in force in the district. Adopted Infectious Diseases (Notification) Act, 1889 1889 Public Health (Amendment) Act, 1890 1890 Infectious Diseases Prevention Act, 1890 1899 Notification of Births Act, 1907 1907 Public Health Act, 1907 (Clause 50) 1921 Public Health Act, 1925 (Parts 2, 3,4 and 5) 1920 The Acton Improvement Act, 1904 - New Streets and Buildings 1925 Removal of House Refuse 1899 Common Lodging Houses 1898 Slaughter Houses 1924 Nuisances, &c.
9c725620-e3ac-4d58-8cc6-fd4c65cd52d4	1924 Offensive Trades 1903 Tents, Vans and Sheds 1906 Removal of Offensive or Noxious Matters 1908 Houses Let in Lodgings 1925 Cleansing of Cisterns 1912 Employment of Children 1920 Fouling of Footpaths by Dogs 1929 Smoke Abatement 1930 HOUSING. I have in almost every Annual Report commented upon the Housing question, but certain events which have occurred during the year make it necessary to review the position. The partial repeal of the Rent Restrictions Acts and the issue of Circular 1331 have marked a change of policy on the part of the Central Authorities, and the present time is an opportune one to review the Housing efforts since the war, as they effect this district. In every district after the war, there was a great shortage of houses. Building during the war had ceased, and private enterprise was unable to meet the shortage. The main responsibility 10 for grappling with the scheme fell to the lot of Dr.
cc3b978f-9732-40a7-8407-d44371d0986f	Addison, and under the Addison Scheme of 1919, subsidies were paid to local authorities. Under Dr. Addison's scheme, throughout the kingdom, 176,000 houses were built, and the Exchequer bore all the losses in excess of the product of a penny rate. Under all subsequent schemes the exchequer's share of subsidy has been a fixed contribution, so that the local authority has had full incentive to see that no losses were incurred. Under the Chamberlain Act of 1923, a subsidy was given amounting to £6 annually for 20 years for each house built. This Act was very successful in getting houses for sale built by private enterprise. Over 400,000 houses were erected from its inception to its repeal in 1929. The 1923 Act was the charter of private enterprise and out of the 438,047 houses built under it, only 75,000 were by local authorities.

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