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and (k) children with speech defects. Special problems arise in the cases of children suffering
from two or more handicaps.
Busch House School for delicate pupils was opened in 1938. Since then there has been
a slow but steady change in the type of pupil admitted. Gone, to a large extent, are the
chronic chest infections,, the undernourished, the suspected tuberculosis, the debility following
acute illness, etc. and instead we have a large proportion of children whose illhealth
is associated with, or due to, emotional or psychogenic causes and an increased linkage
between the school and the Child Guidance Clinic is being developed. The organisation
of the school is being amended to permit the admission of slightly maladjusted pupils as
well as delicate pupils. The opening of Martindale School for the physically handicapped and
Heston School for the deaf in 1956 and their associated special diagnostic and advisory clinic
added much to the work, but also to the interest of the school health service. The demand
on these special clinics has been heavy. A new hearing clinic, a pioneer in design and equipment
was opened in 1962 and work on a new medical unit at Martindale School is in hand. These
special clinics have been available to all children in the western half of the county and their
future use will have to be considered in relation to the proposed local government changes.
The occurrence of lice and/or nits in school children is much less prevalent than it
used to be. Regular cleanliness surveys are no longer carried out in the schools by the school
nurses. Such surveys are now done at the request of the Head Teacher or whpre there are reasons
for considering such an inspection advisable. A hard core of infestation remains and
seems to be centred in certain families whose children are persistent offenders and in whom
no advice, persuasion or threat seems to have any effect.
Since the National Health Service started it has been difficult to recruit staff for
the local authority dental service. A study of the records of the service for 1939-43 and
1959-63 shows a slight fall in the treatment provided for school children and a marked fall
in that given to expectant and nursing mothers and children under school age. Many mothers
who previously looked to the local authority dental service for attention to their own and
their children's teeth are now using the general dental service provided by the National
Health Service. The Borough was the first local authority to provide orthodontic treatment
and this section of the service has continued without curtailment. Dental caries is
one of the failures of preventive medicine. Its causes are still a matter for discussion
and the preventive measures (tooth brushing, "end a meal with an apple", avoidance of
sweets, vitamins, school milk, etc.) advocated for many years have produced no visible effect.
At routine dental inspections, some 50-60 per cent. of pupils are still found to
need treatment, yet fluoridation of water, the only known method of reducing dental caries
in children is still awaited.
The home nursing service which used to be provided by the Heston and Isleworth District
Nursing Association was taken over by the County Council in 1948. These nurses
work in close association with the general medical practitioners and carry out general
nursing care, dressings, injections etc. in the homes of the patients. The average
number of visits made annually has risen from 31,292 in 1939-43 to 35,140 in 1959-63.
Disposable sterile needles and syringes are now in general use, but to an increasing extent
the nurses are giving general nursing care to the aged and infirm. By arrangement
with the County Council the British Red Cross Society maintains a depot from which items
of nursing and sick-room equipment may be issued on loan.
The demand on the services of domiciliary midwives has been influenced by the increasing
preference of mothers to be confined in hospital. The average annual number of
domiciliary confinements conducted by midwives has fallen from 607 in 1939-43 to 422 in
1959-63 and there has been a corresponding increase in the proportion of births occurring
in hospital. The pressure on maternity beds due to the rising birth rate will mean more
work for domiciliary midwives either directly through more confinements having to take
place at home or indirectly through maternity hospitals discharging patients after a few
days instead of retaining them for 10 to 14 days as used to be the custom.
The centenary of health visiting occurred in 1962. Initially, health visitors devoted
their time to advising mothers at home and in clinics on the care of children. The
introduction of the school health service extended the contact of health visitors with
families and since the introduction of the National Health Service the scope of health
visiting has been extended to include the handicapped and aged. Health visitors give
special attention to problem families. Their training in nursing, midwifery and social
work is long and in the increasing demand for social workers, some discussion has arisen
as to how to make the best use of health visitors. By the use of clinic nurses they have
been relieved of certain routine nursing work so that the maximum of time may be given to
the duties for which they have had special training. In some areas they have been attached
to the practices of one or more general practitioners, but this is difficult to arrange in
built-up urban districts. Here they are encouraged to maintain contact with general practitioners
re family problems found on their district visits, and on request from a general
practitioner a health visitor will co-operate in dealing with individual cases or families.
During the war four day nurseries were started in the Borough, but only one (Nantly
House) of these continues in operation. This nursery is approved for the training of nursery
nurses. It is open from 7.30 a.m. to 6 p.m. Mondays to Fridays and a charge is made
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