EDM 16 Edmonton Urban District Council. REPORT OF The Medical Officer of Health ON THE Sanitary Conditions & Vital Statistics AND Report of the Sanitary Inspector. Report to the Education Committee ON THE School Medical Service AND Medical Inspection of School Children FOR THE YEAR 1921. Crusha & Son, Tottenham, Enfield and Wood Green. 3 Edmonton Urban District Council, 1 92 1—1 9 2 2. Chairman Vice-Chairman W. G. Crouch, J.P. T. J. Harington. Mrs. Ithell. Mrs. Key. F. Arkle. A. E. Byrne. PUBLIC HEALTH COMMITTEE. P. F. Williams (Chairman). A. Deffee. W. C. Elms. G. W. Perry. J. Sanders. G. J. Stephens. G. Tott. H. Williams. MATERNITY AND CHILD WELFARE COMMITTEE. Councillors:—Mrs. Ithell (Chairman), Mrs. Key, F. Arkle, A. E. Byrne, H. Barrass, W. G. Crouch, W. C. Elms, T. J. Harington, W. Hatch, A. Hollywood, J. A. Kilbride, R. S. Lawrence, G. Rowe, J. Sanders, J. W. Shaw, G. J. Stephens, G. T. Tott, H. Williams and P. Williams. External Members:—Mesdames Coe, Crouch, Beer, Bowerman, Elms, Jenner, Stephens; Mr. Millns, Dr. Burton and Dr. Wilson. 4 CONTENTS AND SUMMARY. Page SEC. I.—General Statistics. Area, 3,894 acres 6 Population— Census 60,809 6 Est. by Registrar-Gen., 67,800 6 Houses, etc. 12,521 7 Rateable Value, £249,748 7 One Penny Rate produces £920 7 SEC. II.—Vital Statistics. Births, 1,665 8 Rate, 24.5 8 Deaths, 685 9 Rate, 10.1 9 Infantile Mortality, 69.6 10 Comparative Statistics 10 SEC. III.—Notifiable Diseases. Tabular Statement 11 Tuberculosis 12 Ophthalmia Neonatorum 14 Non-notifiable Infec. Diseases 14 SEC. IV.—Causes of Sickness. SEC. V. Nursing in the Home 15 Mid wives 16 Maternity and C.W. Work 17 Municipal Milk Supply 18 Day Nursery 20 School Clinic 21 Tuberculosis Dispensary 22 Venereal Clinic 22 Page SEC. Va .—Hospitals, pro vided, etc., by District or County. Tuberculosis 23 Maternity 23 Fever 24 Smallpox 24 Other Hospitals 24 Ambulance facilities:— (a) Infectious Diseases 25 (ft) Non-infectious Diseases 25 SEC. VI. Laboratory Work 26 Diphtheria Antitoxin 26 List of Adoptive Acts, etc. 26 SEC. VII. Sanitary Administration 28 SEC. VIII. Public Health Officers 32 SEC. IX. Housing 33 School Medical Service 1 (At end) 5 To the Chairman and Members of the Edmonton Urban District Council. Ladies and Gentlemen, I beg to present to you my Report for the year 1921 on the Sanitary Conditions and Vital Statistics for the Urban District of Edmonton. My predecessor resigned office on July 31st, 1921, and I commenced duties as Medical Officer of Health, School Medical Officer, and Supervisor of the Maternity and Child Welfare Clinic on November 1st. Dr. Strong, the Assistant School Medical Officer, carried out the duties of the combined post in the interval, and received, by resolution, the thanks of the Council for his services. The Report is made out on the lines suggested by the Ministry of Health in Circular 269, dated 28th December, 1921. Medical Officers of Health are asked to prepare a Report of a more simple character—referred to as an Ordinary Report—by omitting details as to conditions which do not vary from year to year, and the curtailment of the information asked for in certain years. It is hoped by this means to effect a reduction both in the time required by Medical Officers of Health for preparing the Reports, and in the cost of printing them, without detriment to the principal objects which the Reports are designed to serve. Annual Reports of a full and detailed character—referred to as Survey Reports—will normally be required at intervals of not more than five years. H. W. HARDING, Medical Officer of Health. 6 SECTION I.—GENERAL STATISTICS. Area (including 31 acres of water) 3,894 acres Population—Census of 1921, provisional estimate 66,809 As estimated by the Registrar-General 67,800 The census of 1921 was taken on the night of the 19th-20th June, instead of that of the 24th-25th April; and the above provisional figure is obtained from abstracts compiled by enumerators and local registrars. The figures compare with the census returns of 1911:— Males. Females. Total Census of 1911 32,432 32,365 64,797 Census of 1921 32,366 34,443 66,809 The ratio of increase is as 100 is to 103; Greater London has increased by the same percentage; the outer ring of London by 9.6, whilst the County of Middlesex has increased by 11 per cent. It is realised that the holiday movement from town to country and seaside had already commenced by the 19th June, so the Registrar-General has estimated the mid-year population of Edmonton at a figure higher than the census, namely, 67,800; and it is upon that figure that the birth and death rates are based. The following figures are, however, of interest, and suggest that our population is greater than the estimated one. They are taken from the records of notifications of scarlet fever and diphtheria for the year, and contain correct particulars regarding the number of families and number of residents in the infected houses. No house is counted twice. Total number of houses 749 Total number of residents 5,283 Average number of residents per house 7 Number of houses with one family 507 ,, ,, two families 203 ,, ,, three families 38 ,, ,, four families 1 The greatest numbers were 20 in a 9-roomed house and 23 in an 11-roomed house. It may be objected that the patients came from the poorer districts, hence the overcrowding, but that objection does not apply to the large majority. 7 The Census of 1911 gave the number of uninhabited houses as 846; inhabited as 12,516, and this latter figure, with a population of 64,797, give the average number of persons per house as 5.2. Number of Inhabited Houses.—The Overseer has kindly given me the following returns:— Houses— Tenements— East. West. East. West. Bury Street Ward 2,545 1,312 150 34 Church Street Ward 1,239 2,584 350 233 Fore Street Ward 1,510 2,375 15 81 Council's New Houses — 93 — — 5,294 6,364 515 348 making a grand total of 12,521 assessments. Number of Families or Separate Occupiers.—I am unable to give further particulars than those already given in the two previous paragraphs. It will be noted that according to the figures given, that 27 per cent. of the houses infected had two families, and that 5 per cent. had three families. New houses in the district are badly needed. Rateable Value.— For purposes of Poor Rate, October, 1921 £249,748 For purposes of District Rate, October, 1921 £235,858 Sum Represented by a Penny Rate.— For purposes of Poor Rate £930 For purposes of District Rate £920 Rates.— Poor Rate in April and October 6s. 2d. and 6s. 9d. District Rate in April and October 5s. 6d. 8 SECTION II. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Total. Male. Female Births—Legitimate 1,597 839 758 Illegitimate.. 68 41 27 Grand Total—1,665. The Birth Rate per thousand of population is 24.5. The total number of births registered in the District by the Edmonton Registrar for the 52 weeks ending December 31st, 1921, was 1,937—1,007 males and 930 females. This includes 385 births in the Edmonton Union, of which 88—52 males and 36 females—were of Edmonton residents. Expressed in tabular form, with other details:— All Births— Illegitimate— Male. Female. Total. Male. Female. Tota1. Gloss Births Registered 1,007 930 1,937 66 57 123 Union—Non-residents 148 149 297 35 34 69 Other Non-residents 8 11 19 1 0 1 Residents Outside District 6 8 14 0 0 0 Edmonton Births 857 778 1,635 30 23 53 We do not get to know of all births of residents outside the district, and this probably accounts for the difference in numbers between these figures and those given above, these latter being obtained from the Registrar-General. The births are "warded" as follows:— Males. Females. Total Bury Street Ward 285 278 563 Church Street Ward 289 253 542 Fore Street Ward 277 239 516 The nett total of births for 1920 was 1921; and based on an estimated population of 77,202, gave a birth rate of 24.9. Notification of Births Acts, 1907 and 1915.—During the year there were 1,968 births notified—1,025 males and 943 females; 16 were notified as stillborn, and the Superintendent of the Cemetery informs me that there were 41 children styled "stillborn" buried during 1921. 9 There were notified 32 pairs of twins. Deaths.—The following table of causes of death is given by the RegistrarGeneral. Causes of Death. Male. Female. Total. Enteric Fever — 1 1 Scarlet Fever — 2 2 Whooping Cough 2 3 5 Diphtheria 13 19 32 Influenza 4 5 9 Encephalitis Lethargica 3 1 4 Meningococcal Meningitis 1 1 2 Tuberculosis of Respiratory System 39 26 65 Other Tubercular Diseases 11 10 21 Cancer, Malignant Disease 40 25 65 Rheumatic Fever 2 1 3 Diabetes 6 1 7 Cerebral Haemorrhage, etc. 23 20 43 Heart Disease 33 43 76 Arterio-sclerosis 7 8 15 Bronchitis 21 20 41 Pneumonia (all forms) 26 21 47 Other Respiratory Diseases 4 2 6 Ulcer of Stomach or Duodenum 2 1 3 Diarrhoea, etc. (under 2 years) 7 10 17 Appendicitis and typhlitis 3 0 3 Cirrhosis of Liver 1 2 3 Acute and Chronic Nephritis 10 10 20 Puerperal Sepsis — 1 1 Other Accidents and Diseases of pregnancy and Parturition — 2 2 Congenital Debility and Malformation, and Premature Birth 31 26 57 Suicide 4 2 6 Other Deaths from Violence 18 3 21 Other Defined Diseases 58 50 108 Total 369 316 685 Deaths from the notifiable infectious diseases are analysed according to age under Section III. The Death-rate per 1,000 of population is thus 10.1. The gross total of deaths registered in the district was 1,350, but this includes deaths of non-residents in the North Middlesex Hospital and a few non-residents dying in the district. All deaths were certified, cither by the medical attendant or by the Coroner. 10 Inquests were held on 55 deaths—three less than last year. Zymotic Death-rate.—This is furnished by the number of deaths occurring from the seven diseases, smallpox, enteric fever, measles, scarlet fever, diphtheria, whooping cough at all ages, and diarrhcea (enteritis) under the age of 2. The total is 57, and gives the figure .84. It is an old-fashioned term, and really ought to embrace nearly half the complaints mentioned as the causes of death. It is synomymous with disease due to germs, and being preventable, has been regarded as an index of the healthiness or otherwise of a district. Infantile Mortality.—The number of children dying under the age of one year was 116; based on 1,665 births; this gives an infantile mortality figure of 69.6. The deaths of legitimate babies were 104; based on 1,597 legitimate births, gives 65 as the infantile mortality. Of the 68 illegitimate births, 12 died, giving a rate of 176.5. Comparative Statistics.—The Registrar General has forwarded provisional figures regarding England and Wales, etc., and I am thus enabled to show the following comparative tables:— Annual Death-rate per 1000 Population. All Causes Enteric Fever Measles Scarlet Fever WhoopingC'h. Diphtheria Influenza Vi'lnce England and Wales 12.1 .02 .06 .03 .12 .12 .23 .44 96 Great Towns 12.3 .01 .08 .04 .13 .15 .23 .40 148 Smaller Towns 11.3 .01 .05 .03 .11 .11 .26 .35 London 12.4 .01 .05 .06 .12 .25 .23 .42 Edmonton 10.1 .01 .00 .03 .08 .48 .13 .40 Birth-rate Population per 1,000 Rate per 1,000 Births— Diarrhoea and Enteritis. (under 2 years) Total Deaths under 1 year. England and Wales 22.4 15.5 83 96 Great Towns 23.3 19.3 87 148 Smaller Towns 22.7 15.6 84 London 22.3 21.3 80 Edmonton 24.5 10.2 70 It will be noticed that the death-rate from diphtheria was high, being nearly double that given for London and four times as high as that for England and Wales. On the other hand there were no deaths due to measles, and only five due to whooping cough. 11 SECTION III. NOTIFIABLE DISEASES DURING 1921. The following table gives the number of notifications of infectious disease, the number removed to hospital, the deaths and the age at death from these diseases:— Disease. Total No. of Cases. Under 1 year 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years 5 to 10 years 10 to 15 years 15 to 20 years 20 to 35 years 35 to 45 years 45 to 65 years 65 and over No. of cases Removed to Hosptl. Diphtheria— Cases 404 4 23 13 20 31 204 75 20 11 2 1 — 379 Deaths 32 — 4 1 1 6 14 5 1 — — — — 30 Scarlet Fever— Cases 424 3 6 13 18 20 207 109 30 16 2 — — 418 Deaths 2 — — — — — 2 — — — — — — 2 Enteric Fever— Cases 6 — — — — — 2 1 1 — — 2 — 4 Deaths 1 — — — — — — 1 — — — — — 1 Puerperal Fever Cases 10 — — — — — — — — 9 — 1 — 4 Deaths 3 — — — — — — — — 3 — — — 3 Pneumonia— Cases 38 1 9 — 1 1 2 1 5 5 5 6 2 — Deaths 39 8 9 1 2 — 1 — 1 2 2 8 5 — Erysipelas— Cases 40 — 2 — — — — 4 4 7 9 11 3 — Deaths 1 — — — — — — — 1 — — — — — Poliomyelitis— Cases 1 — 1 — — — — — — — — — — — Deaths 0 — — — — — — — — — — — — — Encephalitis Lethargica— Cases 4 — — — — — — — — 1 3 — — — Deaths 4 — — — — — — — 1 — 2 1 — 1 Malaria— Cases 1 — — — — — — — — 1 — — — — Deaths 1 — — — — — — — — 1 — — — — Cerebro-spinal Fever— Cases 1 — — — — — — — — 1 — — — — Deaths 0 — — — — — — — — — — — — — Ophthalmia Neonatoriuin— Cases 8 8 — — — — — — — — — — — — Deaths 0 — — — — — — — — — — — — — Dysentery— Cases 1 — — — — — — — — 1 — — — — Deaths 0 — — — — — — — — — — — — — Four cases of encephalitis lethargica (or sleepy sickness) were notified this year; of these, two cases recovered. The other two deaths were furnished by a case notified in 1920 and a case dying in a London Institution and not notified. 12 Scarlet Fever and Diphtheria occurred in the three wards as follows:— Scarlet Fever. Diphtheria. Bury Street Ward 139 204 Church Street Ward 178 116 Fore Street Ward 101 83 Institutions 6 1 424 404 The following table gives in greater detail the notifications of, and deaths from, pulmonary and other forms of tuberculosis. Age. Pulmonary. Non-Pulmonary. Notifications Deaths. Notifications. Deaths. M. F. Total M. F. Total M. F. Total M. F. Total Under 1 year — — — — — — 0 1 1 0 3 3 1 to 2 years — — — — 1 1 3 1 4 3 1 4 2 to 3 years — — — — — — 0 1 1 1 2 3 3 to 4 years — — — — — — — — — — — — 4 to 5 years — — — — — — — — — — — — 5 to 10 years 2 2 4 — — — 1 0 1 1 1 2 10 to 15 years 0 2 2 1 0 1 1 3 4 1 1 2 15 to 20 years 10 11 21 4 6 10 3 3 6 3 1 4 20 to 35 years 26 27 53 12 10 22 3 4 7 1 1 9 35 to 45 years 11 2 13 10 4 14 1 1 2 1 1 2 45 to 65 years 9 6 15 11 4 15 1 1 2 0 0 0 65 and over 0 0 0 0 0 0 0 0 0 0 0 0 Total 58 50 108 38 25 63 13 15 28 11 11 22 Of the 63 deaths occurring from pulmonary tuberculosis, three took place prior to notification; of the 22 deaths from non-pulmonary tuberculosis, 9 took place prior to notification. There is a tendency to delay or neglect the notification of tuberculosis as shown by the above. The practitioner in fault is reminded of his duty, and this has to be done sometimes in cases where the sputum has been examined and the result "T.B. present" has been forwarded to him. Cases dying of tuberculosis prior to notification:— Males. Females. Total. Pulmonary 2 1 3 Non-Pulmonary 5 4 9 7 5 12 13 Primary notifications of Pulmonary Tuberculosis were received from the following:— Males. Females. Total General Practitioners 32 24 56 School Medical Inspector 0 0 0 Hospital 12 15 27 Poor Law 1 1 2 Tuberculosis Medical Officer 13 10 23 58 50 108 The Non-Pulmonary forms of Tuberculosis were:— Males. Females. Total Meningeal 1 2 3 Bones and joints.. 8 2 10 Peritoneum 2 1 3 Glandular 2 8 10 Other forms 0 2 2 13 15 28 Of the above 136 cases of Tuberculosis notified this year, 87 were received into Sanatorium or Hospital. Pulmonary— Non-Pulmonary— Grand Total Males Females Males Females Hospital 13 11 6 9 39 Sanatorium 22 23 2 1 48 35 34 8 10 87 One-third the time of the Woman Sanitary Inspector is devoted to work in connection with Tuberculosis. During the year, 325 visits were paid to homes after notification, removal or death, and 1,175 visits to investigate all cases notified during the last nine years. These latter visits were necessary in order to bring the Register of Notifications up to date and in accordance with instructions from the Ministry of Health. 14 Disinfection of room, or bedding, etc., or both, was carried out as a routine preventive measure after removal of the patient or death, and during the year 124 disinfections were carried out. The work of the Tuberculosis Dispensary and the arrangements for Sanatorium treatment are given under Section 5. Details of Ophthalmia Neonatorum are given in the subjoined table:— Cases: Vision Unimpaired. Vision Impaired Deaths Notified Treated— At Home At Hospital 8 5 3 8 0 0 NON-NOTIFIABLE INFECTIOUS DISEASES. The following figures have been taken from the monthly reports of the School Nurse, whose duty it was to "follow up" these diseases and, of course, only refer to children of school ages:— Children excluded for Measles 35 ,, ,, ,, Whooping Cough 90 ,, ,, ,, Chicken Pox 203 ,, ,, ,, Mumps 429 The incidence of the latter complaint was very heavy during the first six months of the year and then abated. As mentioned previously, there were no deaths from Measles. SECTION IV. CAUSES OF SICKNESS. In the opinion of the local medical men with whom I have conversed on the subject, there appears to have been less sickness during the year than usual, and there appears to have been no special form of complaint attracting attention. 15 SECTION V. NURSING ARRANGEMENTS, HOSPITALS, AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. Professional Nursing in the Home. In February, 1921, the Council made an agreement with the Cottage Benefit Nursing Association, of Dennison House, Vauxhall Bridge Road, S.E., whereby the latter supplies, through its local branch at Bury House, the services of a fully trained nurse for those infectious illnesses which are not usually received into an infectious fever hospital, such as measles and whooping cough, and such other cases as may be selected by the Medical Officer of Health. The Council pays a retaining fee of £20 per annum, and in addition a fee for each visit by the nurse at the following rate: 1s. for each of the first three visits and 6d. for each subsequent visit. The Council also pays the cost of dressings required and supplied. The M.O.H. is responsible for all orders given for home nursing, and accounts are rendered quarterly. The cost of the arrangement from April, 1921, when the first order was issued to the end of the year was £24 4s. 3d. This home nursing arrangement was very necessary, as the Council has had an agreement with the Guardians since 1915, the latter paying £540 3s. 4d. yearly, and the former undertaking to isolate and if necessary on account of destitution, to maintain all persons within the Parish while suffering from infectious disease without inquiring whether any such cases are or are not pauper cases. This provision does not apply to cases occurring within the premises of the Edmonton Union Workhouse, Infirmary, or any other building provided or maintained by the Guardians. Maintenance includes medical treatment. Though the duties of the School Nurse do not include nursing, yet her visits to the homes of scholars suffering from measles, and whooping cough more particularly, ought to be productive of good. An insistence on the strictest isolation possible, a knowledge of preventive measures, the danger of lung complications, a general outline of treatment— these are measures which the School Nurse should impart to the mother in the absence of other medical treatment; and in a large number of these diseases no doctor is in attendance. The cases visited by the Bury House Nurse were as follows:— Erysipelas, 5 cases; Ophthalmia Neonatorum, 3 cases; Post-diphtheritic Paralysis, 1 case; Puerperal Fever, 2 cases; Lobar Pneumonia, 1; Nasal Diphtheria, 1 case; making a total of 13 cases. 16 Midwives. The following particulars have been given me by the County Medical Officer of Health:— Number of midwives at the end of the year 10 Number giving up during the year— Died 1 Left District 2 Number of new midwives settling in District 1 Offences under the Act 1 breach of rules Action taken re the above Verbal caution given Number of occasions on which doctors were called 123 There were 44 applications for payment of fees to doctors when called in by midwifes, and the total amount of fees paid was £54 19s. 6d. The Local Authority does not employ nor subsidise practising midwives. An arrangement is made with the Maternity Department of the North Middlesex Hospital, however, for the reception of paying patients. The Council is responsible for the payment at the rate of 6s. per day, minimum payment, four guineas; this sum is to be paid (by instalments) by the patient to the Maternity and Child Welfare Committee before the order is given. When more than fourteen days' treatment in hospital is necessary, the Council bear the expense and, if possible, recover the extra cost. CLINICS AND TREATMENT CENTRES. Situation Accommodation Authority. Maternity and Child Welfare Centres St. Michael's Hall, Hertford Road; and Central Hall, Fore Street 1 session weekly 2 sessions weekly; 1 ante-natal clinic Urban District Council. Day Nursery Fore Street For 40 children Private. School Clinic Pymmes Park Minor Ailments; Dentist, Oculist Edmonton Education Committee. Tuberculosis Dispensary in Silver Street, Edmonton County of Middlesex. Venereal Diseases None in District Nearest is Prince of Wales's Hospital, Tottenham County 17 The following gives an abstract of the work:— Maternity and Child Welfare Centres.—There are two centres, one in the northern and the other towards the southern part of the District. In the latter, the Central Hall, the ante-natal clinic is held once weekly, and the Child Welfare twice. At St. Michael's Hall, the Child Welfare is held once a week. The attendances at these two centres for the year is as follows:— New Cases. Total Attendance. Central Hall—Child Welfare 250 5,393 St. Michael's Hall—Child Welfare 167 4,089 Central Hall—Ante-Natal Clinic 96 310 The number of sessions for Child Welfare respectively for the two centres were 96 and 46. This gives an average number per session of 56 for the Central Hall and 89 for St. Michael's. There were 48 sessions for the Ante-Natal Clinic. There are three Health Visitors associated with the work of infant welfare. They each attend every clinic, and their other duties can be seen by the subjoined list of visits paid by them during the year:— Visits re Notification of Births 1,467 Visits in connection with Still-births and the deaths of babies under one year 81 Re-visits at the end of six months 526 Re-visits at the end of twelve months 598 Special visits to cases attending Welfare 523 Visits re application for milk, free or part cost, under the Municipal Milk Scheme 396 Visits to cases of Ophthalmia Neonatorum 25 Visits to cases of Puerperal Fever 20 Educational work carried on at the Centres includes a talk to the mothers on common ailments, etc., by the Superintendent Health Visitor of about 15 minutes' duration; the cutting-out and making of garments; and the knitting of woollen garments. Keen interest in Welfare Work is shown by the voluntary workers, and their help is appreciated by the Maternity and Child Welfare Committee. Though the applications for municipal milk come before a sub-committee of the Public Health Committee, yet the actual work is carried out by the Health Visitors and the half-time Clerk to the Maternity and Child Welfare Committee. The distribution of 200 pints of milk daily involves a good deal of clerical work: the checking of goods sold at the Welfare, the checking of 18 monies received, the keeping of a stock book, etc.—these are duties which could be carried out by the Clerk, thus liberating the Superintendent from routine office work. A whole-time clerk for the Maternity and Child Welfare work is needed. MUNICIPAL MILK SUPPLY. The Council's scheme came into force in December, 1921. The details are:— 1. Milk to be supplied at less than cost price in necessitous cases to:— (a) Nursing mothers actually suckling their children. (b) Expectant mothers in the last three months of pregnancy. (c) Mothers who are not suckling their children, for one month from the date of confinement. (d) Children up to three years of age, and exceptionally to children between three and five years of age. 2. The quantity of milk supplied shall not ordinarily exceed one pint per day per person, but in the case of infants between three months and eighteen months, in exceptional cases, one and a half pints a day may be supplied. 3. Milk be given only where the Medical Officer of Health (or in certain cases the Medical Officer of the Centre) be satisfied that the supply is essential on grounds of health, and in the case of children between three and five years of age, and where more than one pint is supplied for infants between three and eighteen months, a special medical certificate be required. 4. That a special sub-committee, consisting of five members, be appointed to control procedure, to review all authorisations for supply, and that such committee meet at intervals of one month. 5. Every application for milk be made on a printed form (which will be supplied to applicants) and must show clearly the income of the family from all sources. This form must be signed as correct, where practicable, by both parents. 6. On receipt of an application, investigation be made to ascertain that the particulars given by applicant are correct, and care taken to prevent overlapping with other bodies. 7. Pending the result of these investigations, which will be completed as promptly as possible, milk be not distributed, except on a medical certificate that an immediate supply is necessary on grounds of health. Where the 19 result of the investigation is satisfactory, a supply be given for not more than one month at a time. If at the end of the month application is made for a renewal of the supply, the case be reviewed and investigations made if necessary. 8. That invoices and milk cards, on the lines suggested in Appendices (b) and (c) to Ministry of Health Circular 185, be adopted. 9. That milk must be obtained from approved dairymen only, and that every endeavour be made to see that the milk supplied is of good quality and the quantity as specified. / 10. Where dried milk or preparations of milk are used, the quantity supplied be such as would, when properly reconstructed, approximate to the quantities of fresh milk given above, and the conditions under which dried milk is supplied at less than cost price, be the same as for the supply of fresh milk. 11. Stock books and properly authorised vouchers showing receipts and issues be kept, and that the stock be checked at regular intervals. 12. That every endeavour be made to encourage women receiving milk to attend the Council Infant Welfare Centres. That the administration of this scheme be carried out at the Council's offices. TARIFF. Number of Persons in Family. Net Income per Family after deducting Rent. Free Supply. Supply at 25% Cost. Supply at 50% Cost. 2 25s. 26s. 27s. 3 30s. 31s. 6d. 33s. 4 34s. 36s. 38s. 5 37s. 6d. 40s. 42s. 6d. 6 42s. 45s. 48s. 7 49s. 52s. 6d. 56s. 8 56s. 60s. 64s. 9 63s. 67s. 6d. 72s. 10 70s. 75s. 80s. 11 77s. 82s. 6d. 88s. 12 84s. 90s. 96s. 20 DAY NURSERY. The Edmonton Day Nursery is situated in the main road, practically about the centre of the district. A short report of its activities during the year has been given me by Mr. A. E. Beer, the Hon. Secretary and Treasurer. This is given in extenso, and my opinion as to the value of the Nursery to the District coincides with that of the Secretary. EDMONTON DAY NURSERY. SHORT REPORT OF WORK FOR YEAR ENDED DECEMBER 31st, 1921. The Day Nursery was opened in 1918 for the daily care of the children of working mothers. The charge to mothers is 5s. per week for a whole week, or 1s. per day for a lesser period. If there are two children in one family the charge is 9s. per week. The Nursery is open from 8 a.m. to 6 p.m., and closes at 2 p.m. on Saturdays . It is open all the year round, closing only on Sundays and Bank Holidays, and for a few days in the summer for cleaning purposes. The Nursery is also provided with an Isolation Section. The Matron, Miss E. E. Biggs, is a capable and fully trained nurse. She also has under her direction a nurse and two probationers. The Nursery is fitted with all the necessary appliances for the promotion of absolute cleanliness and hygienic conditions. The health standard of the children is high, and in spite of the sickness prevalent during 1921, the Nursery was not closed down for illness, except for one day, in consequence of a child who had come in with diphtheria, not diagnosed. The child was isolated and the Nursery closed for a day, while the rooms were sprayed. There were no cases of summer diarrhoea. It is common knowledge that the children improve in health while at the Day Nursery. When the weather conditions are satisfactory they practically live in the open air, having their food, and also sleeping, in the garden. 21 One child in particular was brought to the Nursery suffering from rickets and wearing splints. He made a good recovery and is now able to walk. Several other children have also been admitted, suffering more or less from this complaint, and have been satisfactorily treated. The children are carefully examined on arrival in the morning, and any suspicious case is immediately isolated and a doctor sent for. The Nursery provides splendid training for girls, two or three probationers being always employed. Two of these probationers have recently left and gone into private families, one especially doing particularly well. The two present probationers are also working with this end in view. A Christmas party was held in December, the mothers being invited and entertained to tea. The total attendances for the year (details on slip attached) were 5,114, which works out at nearly 17½ children per day. This would be much higher but for the exceptional distress and unemployment during 1921, which has militated against this, as against all kindred institutions, during the year. The expenditure in 1921 was £865, which was met in the following way:— Payments by Mothers £225 Grant from Ministry of Health £320 Voluntary Contributions £320 £865 SCHOOL CLINIC. There is one School Clinic, situated in Pymmes Park. During 1921 it was open from 9 till 5, Monday to Friday, and from 9 till 1 on Saturday. The Assistant School Medical Officer attended for an hour or so in the morning and an hour at the end of the afternoon to see new cases, whilst two nurses were in attendance the whole time. Minor ailments were treated here; the School Oculist and Dental Surgeon also carried out their work here. Full details, as well as the arrangements made with the local hospital for the treatment of tonsils and adenoids and the X-ray treatment of ringworm, are given under the School Medical Officer's Report. 22 TUBERCULOSIS DISPENSARY. This is situated in Upper Edmonton, convenient of access. I am indebted to Dr. Young, the County Medical Officer of Health, for the following particulars which relate wholly to Edmonton patients:— Number of new cases seen during the year 287 Number of new cases definitely diagnosed as suffering from Tuberculosis 93 Number of cases sent to Sanatorium 82 Number of cases sent to Hospital 36 Number of cases sent to Surgical Hospital 2 Number of cases sent to Training Colony 4 Number of cases sent to Observation Hospital 3 Number of sputa examined 137 Number of sputa found positive 52 VENEREAL DISEASES—TREATMENT CLINICS. The County Council of Middlesex are responsible for putting into operation the Regulations of 1916 for the prevention and treatment of venereal diseases, and has made arrangements for (1) the diagnosis and treatment of persons as in-patients or out-patients; (2) laboratory facilities for aid in diagnosis and treatment. The patient has a choice of thirty hospitals, going as far afield as Richmond, in Surrey, and the Seaman's and Miller's Hospital at Greenwich. The nearest is the Prince of Wales's Hospital at Tottenham, a threepenny tram ride. The County Medical Officer of Health informs me that "information as to the number of cases from each separate district in the County is not available." The total number of Middlesex patients treated at the Prince of Wales's Hospital, Tottenham, as given in the annual report of the County Medical Officer of Health for the year 1920 is as follows:— Suffering from Syphilis 142 Suffering from Soft Chancre 10 Suffering from Gonorrhoea 169 Not suffering from Venereal Disease 110 Total Attendances 8,459 Number of "In-Patient" days of treatment 304 Number of doses of Salvarsan substitutes given 795 23 SECTION Va. HOSPITALS PROVIDED OR SUBSIDISED BY THE LOCAL AUTHORITY OR BY THE COUNTY COUNCIL. 1. Tuberculosis.—The County Council of Middlesex acquired, two years ago, a site at Harefield, in Middlesex, upon which an extensive military hospital of wooden buildings had been erected. These had to be adapted for the purpose of a sanatorium, and in October, 1921, some beds (for female and children) were opened. It is proposed to provide an institution of about 320 beds for males, females and children. In the absence of its own building, the County Council had entered into agreements with the authorities of various institutions for the reservation of beds for Middlesex patients. The total number reserved, including 16 at one of the dispensaries, was 365. These include beds for all forms of tuberculosis, medical and surgical, etc. In addition to these, many Middlesex patients are received into institutions with which there is no definite agreement. The following table is given in the Report of the County Medical Officer of Health for the year 1919:— NO. OF BEDS RESERVED AND CLASS OF CASE (PRESENT CONDITION). Institutions. Sex. Sanatorium Cases. Hospital Cases. Advanced Cases. Surgical & other Cases Clare Hall, South Minims M. & F. 139 54 — — Fairlight, Hastings M. 16 — — — Oak Bank, Sevenoaks Boys & Girls 20 — — — Victoria Home, Margate ,, — — — 6 Chilton Hill House, Sudbury F. 6 — — — Merivale, Chelmsford F. 6 — — — County Council Hospital. Isleworth M. — — 40 — County Council Dispensary, Hounslow M. — — — 16 187 54 40 22 The agreement with the Northern Hospital, Winchmore Hill (30 beds) and St. George's Home, Chelsea (32 beds) terminated March 31st, 1921. 2. Maternity.—The Council make arrangements with the Guardians (North Middlesex Hospital), as previously mentioned. 24 3. Children.—There are no hospitals provided or subsidised by either Council. 4. Fever.—The Enfield and Edmonton Joint Isolation Hospital is situated in Enfield, on its Winchmore Hill border. The following are taken from the Report of the Medical Superintendent, Dr. R. Haldane Cook, for the year ending March 31st, 1921:— Number of Beds 161 Total number of Patients 1,100 Daily average number 122.64 Greatest number resident on one day 205 Smallest number resident on one day 57 Average duration of residence for scarlet fever 45.62 days Average duration of residence for diphtheria 37.22 days General mortality rate:— Number. Deaths. Percentage Scarlet Fever 556 8 1.39 Diphtheria 467 39 7.76 Enteric 4 1 25 The Report states that anti-diphtheritic serum was used in all cases when none or an insufficient quantity had been administered previous to admission. In most cases from 4,000 to 12,000 units were given, but some received as much as 72,000 units. 5. Smallpox.—The Middlesex Districts Joint Smallpox Hospital is at South Minims. This provides for 23 of the 37 districts in the County of Middlesex. Edmonton's contribution for the past year was £360, equivalent to a rate of three-eight's of a penny. It is at present used for tuberculous patients. There are 14 beds at Pickett's Lock, Edmonton, available for sporadic cases. 6. Other Hospitals.—The North Middlesex Hospital (Guardians) is in Edmonton and available for the needs of the District. A general hospital, the Prince of Wales's, is in Tottenham, and is easily available by tram. In addition, the London hospitals are also used by Edmonton residents. Institutional provision for unmarried mothers, illegitimate infants, and homeless children.—Beyond the provision made by the Guardians at the North Middlesex Hospital and the workhouse (both in the district), there is no institution. 25 AMBULANCE FACILITIES. (1) For Infectious Diseases. The Local Authority maintain a motor ambulance for the removal of cases of scarlet fever, diphtheria and enteric fever to the Joint Enfield and Edmonton Isolation Hospital, a distance of three miles. A horse ambulance is in readiness in case of trouble with the motor, and has had to be requisitioned fairly frequently during the year. The Council at the time of writing (March) are inviting tenders for a new ambulance. The Council also provide a motor bus capable of holding six persons' and this serves a double purpose: (1) to carry parents from the Town Hall to the Hospital when the child is fit to be discharged, and to take both back to the home; and (2) to take up parents or relatives when patients are on the dangerously ill list and are asked by the Medical Superintendent to visit. After office hours at night, for example, the services of a motor lorry from the Fire Station can be obtained for this latter purpose. Enfield maintains its own horse ambulance for the removal of infectious cases to the hospital. A good working arrangement would be to have two ambulances, and house both them and the drivers at the Isolation Hospital, and thus undertake the removal of patients from the two districts directly from the hospital. 2. For Non-Infectious and Accident Cases. Previous to June, 1921, a horsed-ambulance, housed at the Fire Station, was used for the above. Since that time, it has been replaced by a motor ambulance, subscribed for by residents during the war and used by the V.A.D. until 1920. The Superintendent of the Fire Brigade gives me the following information: Total number of removals for the year, this including 36 accident cases 510 Number of journeys to the Isolation Hospital—visits to urgent cases 30 Distance covered for the year in miles 4,267 The cost of the motor ambulance for the last six months, exclusive of wages, housing and cleaning material £221 Of which the Expenditure on Petrol and Grease £48 15s. 26 SECTION VI. LABORATORY WORK. During the year, 456 swabs for diphtheria and 25 specimens of sputa were sent for examination to a private firm in London. A messenger called at the Town Hall every day at 5 and took them up by train. No other pathological examinations were made. Of the 456 swabs examined, 123 were found to be positive; and of the 25 sputa, 9 were found to contain the bacillus of tuberculosis. In December, the Council put in order the Laboratory at the Town Hall and its instruments, etc., as the incoming M.O.H. had agreed to undertake the bacteriological work. By the middle of January, 1922, the Council's Laboratory was in working order, and since that time no further material, etc., has been sent to town. Antitoxin for the treatment of diphtheria is stored at the Fire Station and the Town Hall. During the year, 54 phials were obtained by medical practitioners from the former, and 91 from the latter. 156 phials of antitoxin, 4,000 units, were ordered during the course of the year. Sterilised syringes are also kept at each place, and medical practitioners are paid 3s. 6d. for the administration of the serum. No other serum has been supplied during the year. LIST OF ADOPTIVE ACTS, BYE-LAWS, ETC., IN FORCE IN THE DISTRICT. Date of Adoption. Infectious Disease Notification Act, 1899 13-1-1891 Infectious Disease Prevention Act, 1890 13-1-1891 Baths and Wash ho uses Acts of 1847-78-82 26-2-1901 Public Health Acts (Amendment) Act, 1890:— Parts 2 and 3 9-12-1890 Part 5 23-4-1895 The Order of the Public Health Acts (Amendment) Act, 1907, Sec- L.G.B. made Dec. tions 35, 36, 37, 38, 39, 40, 41, 42, 43, 46 to 51 24th, 1909, declarinclusive, comprising Part 3 relating to Sani- ing these sections tary Provisions, the whole of Part 4 relating to be in force in to Infectious Diseases, and the whole of Part Edmonton, came 5 relating to Common Lodging Houses. into operation Feb. 11th, 1910. 27 Date when Confirmed by the Board (L.G.B.). Bye-laws with regard to removal of house refuse and with respect to nuisances 31-8-1903 Bye-laws with respect to Slaughter-houses 21-4-1904 Bye-laws with respect to Pleasure Grounds 13-9-1904 Bye-laws with regard to Houses let in Lodgings 19-10-1906 Bye-laws with respect to the Management of Sanitary Conveniences and Lavatories 23-1-1909 Bye-laws for the Regulation for the offensive trade of a Gut-scraper 15-9-1913 28 SECTION VII. ARRANGEMENTS FOR DISINFECTION AND THE EXTENT OF THE USE OF DISINFECTANTS. Disinfection of the room infected is carried out after Diphtheria, Scarlet Fever, Erysipelas, and after the removal or deaths of consumptives. The room itself is sprayed with a solution of formalin, whilst the bedding, etc., is removed to be disinfected by steam. Two bedding vans are used, one for infected and the other for clean goods. Leather goods, books, etc., are disinfected in a special formaldehyde chamber. Disinfectants are supplied liberally to those who apply. The applicants, during the week, run into hundreds. This policy of giving disinfectants wholesale might be reviewed from two points of view: (l)The modern conception of infectious disease is that the personal factor is predominant; for instance, that diphtheria is caught from some person and not from the emanations of drains; and (2) to put a disinfectant down a drain because it smells is a mistake: a drain properly constructed and kept clean gives no smell. When a gully or drain is offensive, it should be seen to and cleansed. Disinfestation. The Cleansing Station in the Town Hall Yard is nearing completion. It comprises two separate baths, a sink with a shower (combined hot and cold) for the head, and a current steam disinfector heated by gas and easily workable . The Council's Baths, etc., are adjacent and supply the necessary hot water. The following figures, and those in Section IX., have been given me by the Sanitary Inspector, Mr. Butland:— Rooms disinfected after Infectious Disease 1,037 Rooms disinfected after Phthisis. 175 Rooms stripped and cleansed 416 Articles disinfected after Infectious Disease 4,891 Articles destroyed after Infectious Disease 14 Articles disinfected after Phthisis 490 29 Factories and Workshops. One hundred and fifty-one visits were made to these premises, and the following work has been carried out:— Inspectors. Male. Female. Bakehouses limewashed 12 — Bakehouse floor cleansed 1 — New floor to bakehouse 1 — Accumulation of refuse under bakehouse troughs removed 1 — Dairy limewashed 1 — Workshops limewashed 2 1 Workshops floor repaired 1 — W.Cs. limewashed 2 — Urinals limewashed 2 — W .C. pan and seat cleansed 1 — New flushing cistern fixe 1 — Flushing cisterns repaired 3 3 W.C.s lighted and ventilate 1 1 Intervening ventilated space provided to interior of W.C 2 — W.C.s screened — 1 New roof to W.C 1 — Sanitary accommodation provided 1 — Drains cleared 1 — New branch drains 2 — Inspection chamber provided 1 — New drain ventilating shaft 1 — Water fittings repaired 1 — Overcrowding abated — 1 1 new urinal provided and 2 W.C.s 3 — Total 42 7 Grand Total 49 Number of visits to places where food is prepared—Coflee shops and eating houses 28 Slaughter-houses. There are five slaughter-houses in the District, one registered and four are licensed annually. 30 The one registered is very old, and the access is bad; but very little killing takes place here. The periodical limewashing was carried out, and repairs have been effected from time to time. The whole are in a very fair condition as to repairs. Dairies, Cowsheds and Milkshops. Seventy-six visits were made to these premises, and attention was paid to the cleansing, whitewashing, etc. Two persons were summoned for contravening the Order. Summary of Work done:— Inspections Made. Complaints 1,154 Infectious disease 816 House-to-house 483 Factories 36 Workshops 93 Bakehouses 39 Laundries 2 Schools 102 Dairies and milkshops 60 Cowsheds 16 Offensive trades 32 Slaughter-houses 236 Butcher shops 138 Shops and stalls 112 Common lodging-houses 46 Urinals, sanitary conveniences 70 Gipsies 168 Stables 11 Piggeries 42 Houses let in lodgings 159 Petroleum 50 General inspections 469 Shops Act 38 Re-inspections 8.009 Sundry visits 1,058 3l Work Done. Houses or parts of houses repaired or cleansed 1,133 D. W. cisterns covered, cleansed or repaired 66 Water fittings repaired 143 Water taken from main 12 Drains examined, tested or exposed 711 Drains unstopped, trapped, repaired 507 Drains reconstructed 56 Chambers inserted 10 Chambers sealed down 40 New soil and vent, pipes fixed 29 Soil and vent, pipes repaired 30 W.C.s cleansed or improved 481 Flushing cisterns repaired 231 Waste pipes repaired, renewed 195 Sinks repaired 22 Sinks, new, fixed 7 Roofs repaired 602 R.W.Ps. and gutters repaired 395 Yards repaved or repaired 228 Scullery floors repaired 134 Air-spaces under floors ventilated 81 Ventilation improved 11 Dampness remedied 88 Coppers and stoves repaired 342 Floors repaired 133 New dustbins supplied 492 Accumulations of refuse removed 21 Nuisances from animals abated 9 Gipsies removed 81 Sundry defects remedied 896 Rooms cleansed after infectious disease 416 Preliminary notices served 5,707 Statutory notices served 1,810 32 SECTION VIII. WHOLE TIME PUBLIC HEALTH OFFICERS OF THE COUNCII Medical Officer of Health. * H. W. HARDING, M.D. (Lend.), D.P.H. Chief Sanitary Inspector. *R. J. BUTLAND, M.R.S.I. Assistant Sanitary Inspectors. abJ. E. WINTER. a&G. H. HUCKLE. abW. TILLCOCK. aA. EDE. aMiss G. M. SHINER, C.M.B. Health Visitors. * Miss A. BINTCLIFFE, C.M.B. (Superintendent). *Miss A. NAYLOR, C.M.B. *Miss E. DANIELS, C.M.B. Infectious, Fever and Ambulance Nurse. Mrs. J. A. HOBBS, C.M.B. (Three years' fever training). * Moiety paid under Public Health Act, 1875 or by Exchequer Grants. a Certificated Sanitary Inspectors. b Certificate of Meat and Food Inspector. 33 SECTION IX. HOUSING. 1.—Number of New Houses erected during the Year. (a) Total 93 (b) As part of a municipal housing scheme 93 2.—Unfit Dwelling-Houses. I. Inspection :— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,453 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 483 (3) Number of dwelling-houses found to be in a state so Number in this dangerous or injurious to health as to be unfit for state but temhuman habitation porarily dealt with. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 2,117 II. Remedy of Defects without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,829 34 III. Action under Statutory Powers:— A. Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 10 (2) Number of dwelling-houses which were rendered fit— (а) By owners 1 (b) By Local Authority in default of owners — Three work in hand. Six notices not expired at end of year. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,751 (2) Number of dwelling-houses in which defects were remedied— (a) By owners 1,720 (b) By Local Authority in default of owners Nil. 35 C. Proceedings under Sections 17 and 18 of the Housing, Town-Planning, etc., Act, 1919:— (1) Number of representations made with a view to making Closing Orders (2) Number of dwelling-houses in respect of which Closing Orders were made (3) Number of dwelling-houses in respect of which Closing Orders were determined the dwelling-houses have been rendered unfit (4) Number of dwelling-houses in respect of which Demolition Orders were made — At present cannot proceed owing to lack of housing accommodation . (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 3.—Unhealthy Areas. Areas represented to the Local Authority with a view to Improvement Schemes under (a) Part I., or (b) Part II. of the Act of 1890:— (1) Name of area (2) Acreage Nil. (3) Number of working-class houses in area (4) Number of working-class persons to be displaced 4. Number of houses not complying with the building byelaws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, etc., Act, 1919 Nil. 5. Staff engaged on housing work with, briefly, the duties of each officer One. Other Inspectors make house-tohouse inspections when not otherwise engaged. 37 EDMONTON URBAN DISTRICT COUNCIL. REPORT OF THE Chief Sanitary Inspector For the YEAR 1921. Public Health Department, Town Hall, Edmonton. To the Chairman and Members of the Edmonton Urban District Council. Ladies and Gentlemen, I have the honour to present to you my report on the work done in the Public Health Department for the year 1921 by your Inspectors and staff. As the Ministry of Health have asked the Medical Officer of Health for detailed particulars of the work done by your inspectors, to be included in his report, I have endeavoured to avoid repetition as far as possible. In May last the three horse-drawn vehicles of the Public Health Department were replaced by Ford motor vehicles; two of them are Ford motor vans, lined inside with zinc, one for collecting infected bedding for disinfection, and one for returning the bedding, etc., after disinfection. The old horse-drawn brougham, that was used to convey patients from hospital to their homes after recovery, has also been replaced by a Ford motor bus. The disinfecting station was removed from the Town Hall Yard to Clavering's Farm in April last, and although it necessitates several more miles each day for the vehicles to cover, the motors have overcome the matter of distance and are certainly far more expeditious, The old motor ambulance (Deasev) has caused me much anxiety, owing to its many breakdowns, and the horse ambulance has had to be brought / 38 into use on many occasions, and I sincerely hope, in the coming year a new motor ambulance will be in evidence. No of journeys of motor ambulance to remove patients to hospital 293 No. of journeys of horse-drawn ambulance to hospital 313 No. of journeys of bedding van to remove infected bedding 360 No. of journeys of bedding van to return bedding 350 No. of journeys of horse brougham to fetch patients from hospital 155 No. of journeys of motor bus 179 No. of patients returned to their homes 752 No. of rooms and bedding disinfected for vermin 84 No. of books disinfected 138 For other work in connection with infectious disease, factories, workshops, etc., general work and inspections, see Medical Officer of Health's Report. DISINFECTANTS. The number of applicants during the year for fluid and powder was 52,490. The address of every applicant is recorded, and every year the number increases. The increase over the previous year was 9,740. The disinfectants are also supplied from the Public Health Department for disinfecting and deodorising house refuse, cleansing of street gullies, flushing of sewers, watering roads in hot weather, and for all other purposes reuired by the Council. MORTUARY. During the year 99 bodies were received into the mortuary, of these 20 were deposited by the undertaker to await burial; 49 inquests were held, and 48 post-mortem examinations were made; 27 were deposited owing to being of an infectious nature. One body I had deposited as the parents were not in a position to bury it, and it was eventually buried by the Parish. PUBLIC LAVATORIES, DRINKING FOUNTAINS, Etc. I regret to have to again record the fact that much wilful damage is constantly being done to the fountains, etc., although we have done all in our power to catch the offenders. Some of the fountains have been so mutilated that what remained had to be taken away, and the fountains dis continued. 39 The whole of the public urinals connected with public-houses require much attention to keep them in a cleanly condition, and have been very much abused. The amount collected from Angel Road lavatories during 1921 was £4-14 2s Id.—a decrease of £16 17s. Id. on the previous year. The amount collected from the Green Lavatory was £397—an increase of £22 6s. 8d. GIPSIES. During the year there were 168 vans seen and 81 removed, but in many cases they either returned the same day or in the course of a day or two. They politely tell you they have no land of their own, so must live on someone's. We shall have to again resort to Police Court proceedings. Some few years ago seven were summoned in one year, and at that time we had 48 committals awaiting them; very few of the fines were ever paid. Why these people are still allowed to roam the country scot free, I cannot understand. There are a few clean respectable gipsies who give very little trouble, but the majority recently visited are filthy, and overcrowded, and their vans are nothing but boxes on four wheels. To see five or six vans together is a common occurrence, and this means at least 20 to 30 human beings without water supply or lavatory convenience of any kind, and the children not receiving any education. In my opinion every responsible owner of a van should be registered and be compelled to have a registered number on the van and a certificate identifying the owner and the number of the van, similar to canal boats used as dwellings. This filthy class of so-called gipsies are a menace to health, and to the bona-fide showmen and hawker. SLAUGHTERHOUSES, BUTCHERS' SHOPS AND FOOD INSPECTION. There are only five slaughter-houses in the district. Four licensed from year to year under the Public Health Acts (Amendment) Act, 1890. One is very old and registered a great many years ago. Very little killing takes place here, and then only sheep and pigs. They are regularly inspected, and kept in a cleanly condition and in compliance with the Bye-laws. Repairs 40 have been effected from time to time. Many of the butchers have altered their premises so as to make a special room to enable them to instal a cold storage plant. The small shops have a small ice safe for meat storage. There are three stallholders selling meat. One has provided a store with a large ice box, another has provided a small ice safe at the back of the stall, and in another case there is no cold store of any kind. Indeed, I have noticed very little meat on sale at any time at this last-mentioned stall. During the year the following unsound foods were condemned and destroyed :— January.—One box of apples, 18 imported rabbits, 1 case of skinned rabbits, 2 tins of corned beef, 14 tins of condensed milk, 5 boxes of kippers, 1 box of skate wings, 1 barrel of apples, 1 box of haddock. February.—Thirty-seven tins of condensed milk, 4 tins of crab, 1 tin of red salmon. March.—One box of mixed fish roes, 1 box of tomatoes. April—One box of mackerel, 4 boxes of tomatoes, 1 box of skate. May.—One box of coal fish, 1 leg and loin of mutton, 2 bags of winkles. July.—One box of mackerel, 12 boxes of apples, 1 kip of crabs, 2 boxes of mackerel, 12 stone skate, 1 box of fresh herrings, 2 boxes of plums. August.-—Four and a half stone skate, 3 boxes of haddock. October.—One box skate, 1 boar's head. December.—Five stone skate. Generally speaking, retailers purchasing from wholesale dealers buy from samples opened for their inspection. In many cases on the articles arriving in the district they have been found unfit for human food. In such cases the retailers bring the goods to the Town Hall, where they are examined, and, if found unfit for food, are taken before a magistrate and ordered to be destroyed. A certificate to the owner, stating the food has been condemned and destroyed, is given to the retailer. This enables him to recover the amount paid for the goods, and prevents the tendency that would otherwise exist to expose such food for sale. One wholesaler refused to refund the money for goods condemned, and the retailer summoned him, and recovered the costs and his expenses. 41 DAIRIES, COWSHEDS AND MILKSHOPS AND ICE CREAM VENDORS. These premises were regularly inspected. There is only one cowkeeper in the district, one having given up keeping cows during the year under report. We had some considerable trouble with two milk sellers, and although cautioned on several occasions they surreptitiously carried on the business. However, they were kept under close observation, and in one case the milk was found stored in a bedroom. Both were summoned, and fines of £2 and £5 were inflicted. In my opinion, no person should be allowed to sell milk except under special conditions, and under a certificate granted from year to year by the Sanitary Authority, who should have power to absolutely refuse or permit any person to establish and carry on any milk business upon any premises, unless the same were suitable, and the persons handling the milk were of cleanly habits. OFFENSIVE TRADES. The business of rag, bone and skin dealers have considerably decreased, and no serious cause for complaint has been found during the year. The fried fish business that was established during the year, and for which the Council gave permission, I am pleased to say, has been carried on free from any nuisance. We need bye-laws badly for dealing with some of the old-established businesses, and I hope to see these in force during the new year. The gut-scraping business that was established some years ago, previous to the Council having power to prevent the establishment thereof, is becoming a very serious nuisance, and cannot go on much longer under the present conditions. However, the matter is now before the Council, and I trust that in the coming year this business will be either cleared out of the district, or constructed so as not to be the serious nuisance it is to the people living in the vicinity. THE SHOPS' ACT. Very few complaints have been received during the year. The Act. during the year, has been fairly well observed, there being always a few who are anxious to exceed the limit. The traders generally seemed to be agreed that early closing is a benefit. Indeed, a certain section have arranged amongst themselves to close earlier than the Act provides. 42 CANAL BOATS' ACT. There were 15 registered boats inspected during the year, and there were three contraventions found, i.e., two cabins required painting, and one registration marks were obliterated. These have since been remedied. The registered boats seen ore mostly from Ware and Hertford, and generally found is good condition. SALE OF FOOD AND DRUGS' ACT. For the Council's information, and by the courtesy of the Chief Officer of the Middlesex County Council Public Control Department, I herewith append a statement of the work done under the above Aot:— Particulars relating to samples purchased during the year 1921 :— Articles. Taken. Adulterated. Milk 116 23 Separated Milk 1 — Butter 5 — Sweets 3 — Jelly crystals 2 — Viregar 2 — Dripping 1 — Egg substitute powder 1 — 131 23 Number of prosecutions 3 Number of convictions 3 Fines and costs imposed £5 12 0 The figures of adulterated samples given above include a number of samples slightly below the standard. SCHOOLS. The whole of the schools have been inspected. At two schools defects were found in the drainage. At one the defects were remedied, but there remains much yet to be carried out at the other school. There are several schools where the old closet known as the "trough closet " still exists. The whole of these should be taken away and a more sanitary class of closet should be substituted. 43 RATS AND MICE DESTRUCTION ORDER. We have kept this under close observation during the year, and have again found many defective inspection chamber covers on drains from which rats have made their appearance. However, we have had the necessary repairs carried out, and have laid down a large quantity of various poisons. The crusade against the rats on the Council's Sewage Farm and Buildings has met with good results, but the operation requires to be regular and systematic to keep these pests down. MUSIC HALL, CINEMAS, Etc. During the year the places of public entertainment were inspected, and with the exception of a few slight defects found, they were in a good condition. The defects have since been remedied. HOUSE-TO-HOUSE INSPECTION. The house-to-house inspection is not proceeding so fast as one might wish, but in view of the enormous number of defects that exist on some of the property, this is easily accounted for. If work was undertaken under the Housing and Town Planning Act, 1919, Section 28, we should get a great deal more done, and wake up some of the owners who seem very slow to move. I am glad to take the opportunity afforded by the Report to acknowledge and thank the Officers and Staff of the Public Health Department for their hearty co-operation throughout the year, and the interest displayed in their work. I am, Ladies, and Gentlemen, Your obedient Servant, RICHARD JOHN BUTLAND, Chief Sanitary Inspector. School Medical Seruice, Cdmonton Education Committee. Chairman - G. W. PERRY. Councillors Mrs. Ithell, Mrs. Key, F. Arkle, H. Barrass, W.C. Elms, W. Frost, W. Hatch, A. Hollywood, J. A. Kilbride, W. F. Middleton, G. Rowe, C J. Stephens, G. Tott. Co-optative Members Mrs. Hill and Miss Seward. 2 General Information. NUMBER OF SCHOOLS AND ACCOMMODATION. Department. Accommodation. Boys. Girls. Infants. Mixed. Boys. Girls. Infants. Mixed. Provided 7 7 7 3 3508 3009 3464 1121 Non-provided 2 2 3 1 518 662 755 248 Totals 9 9 10 4 4026 3671 4219 1369 Mar. 1921. Mar. 1922. Number of Children on Rolls 12,193 11,690 Average Attendance 11,006 10,745 Mid-year Population (Census), 1921 66,809 £ s. d. Total Cost of Medical Inspection and Treatment for Year ending March 3lst, 1922 4,306 7 6 Net Cost, after Deducting Receipts 4,224 12 7 Receipts from, Parents:— Provision of Surgical Appliances 9 10 9 Provision of Spectacles 52 13 4 Dental Treatment 19 10 10 Cost per Child at the Mentally Defective Centre 51 0 0 Cost per Child at the Deaf and Dumb Centre 52 0 0 Cost per Child at the Residential Blind Home 75 0 0 3 Report of the Work of the School Medical Service. 1.—STAFF. The Staff consists of the School Medical Officer, the Assistant School Medical Officer, Dr. R. H. Strong; an Ophthalmic Surgeon, Dr. Lizzie Smith Clark (one session weekly); a Half-time Dentist, Mr. W. H. Willis, L.D.S.; Five School Nurses; a Clinic Clerk, and a Half-time Clerk for the S.M.O. With the exception of the first-named, who is also Medical Officer of Health, and the Half-time Clerk, the Staff carry out their duties at an old Mansion situated in Pymmes Park, and near the junction of Lower and Upper Edmonton. 2 —CO-ORDINATION. The School Medical Officer is also Medical Officer of Health and Supervisor of the Maternity and Child Welfare work. Nursery Schools have not been established in the District. Debilitated Children.—If the debility is associated with malnutrition, an order for dinner at one of the Centres is given; if necessitous, the dinners are free. The Committee are willing to give Cod-liver oil to suitable cases, and are waiting the sanction of the Board of Education. 3.-SCHOOL HYGIENE. Under this heading would be considered the site and surroundings of the school, the aspect, warming, ventilation and lighting—natural and artificial—of the Class-rooms and Central Hall; the situation, warming, etc., of Cloak-rooms, and the arrangements for hanging clothes; the provision of drinking water and lavatory accommodation; the provision of staff-rooms with indoor sanitary accommodation for staff; the playground, size, surface, drainage; the covered playground; w.c. and urinal accommodation for the children. Equipment usually resolves itself into the question of desks. The schools will be taken seriatim, and any marked departure from the usual will be noted. 4 A11 Saints' (Non-Provided) School. Infants' Department.—Dual desks in all except two class-rooms; in these latter are long forms with backs. No drying arrangements (heat) in cloak-rooms. Girls' Department.—Three class-rooms, partly furnished with dual desks; otherwise old pattern desks, with no back support. No heat in cloak-room. Stone steps badly worn. Brettenham Road Schools. When first built, a single storey; then second storey added and additional buildings. Boys' Department.—Dual desks in two rooms only; otherwise long desks, cut in two—no backs. No Central Hall. Some of the rooms cold in the cold weather, and difficult to heat. Only one staff-room. Girls' Department.—Old forms cut in two—no backs; not all suitable sizes, and some damaged. Only one staff-room. Infants' Department.-—Dual desks in all class-rooms, except one where there are some old forms. Cloak-room accommodation crowded. Croyland Road Schools. Boys.—Some class-rooms with old forms, with no backs, and splintered. No Central Hall. 5 No indoor sanitary accommodation for staff, and no lavatory accommodation. Only one staff-room. Playground uneven, resulting in big puddles. Girls.—Dual desks in one class-room only: others have long desks with no backs. No Central Hall. One small staff-rcom. Indoor sanitary accommodation has recently been passed by Education Committee. Infants.—Staff—one small room. Eldon Road School. Dual desks in one room in the Boys, and one room in the Girls, and none in the Junior Mixed Department. In the Infants' Department, all the desks are the old form, with no back support. St. Edmund's (Non-Provided). Has two departments, Infants and a Senior Mixed. An attractive interior, and hygienic arrangements, etc., satisfactory. St. James' (Non-Provided). Boys.—Two class-looms with dual desks; three with the old form— no backs. No Central Hall. No proper staff accommodation. Cloak-room, no heating. Playground, gravel. Interior requires renovating. Girls.—Dual desks in three class-rooms and mixed desks in the fourth. No Cential Hall or proper staff accommodation. 6 Stone stairs leading to playground badly woru. Playground, gravel. Infants.—No Central Hall. One staff-room, a converted lobby. No indoor sanitary accommodation. Playground, gravel, and dirty in bad weather. Latymer (Boys only). No Central Hall. Four of the six class-rooms have old type of form— no backs. No size of desk suitable for small boys. One staff-room. No indoor sanitary accommodation. Playground, gravel; was coated with tar last year, but requires asphalting. Montagu Road (Three Floors). Boys.—No Central Hall, but two class-rooms separated by partition. Girls1 and Junior Mixed Departments, similar. Infants' Department.—A separate building. Hygienic conditions satis factory. Houndsfield School. This is similar to Montagu Road Schools. Raynham Road (Three Floors). Boys.—Class-rooms have no dual desks. The north-east room difficult to heat; on one occasion the temperature never rose above 44 degs. during the day; the north-west room is similar. On January 25th of this year the temperatures of these two rooms at 11 a.m. were respectively 38 degs. and 39 degs. One staff-room, and no indoor sanitary accommodation. 7 Girls. — Similar to Boys' Department. Infants.—The north-east room is difficult to heat; a temperature of 46 degs. at 11 a.m. is noted for December 1st. Silver Street (Three Floors). Boys' Department.—All old desks—no backs. Girls' Department.—Modern desks in two class-rooms. Infants.—Dual desks throughout. Some of the above defects cannot be remedied without rebuilding; one expects to meet them in an old school. The old desks are unsuitable for two reasons : the seat is too far away from the desk, and there are no supports for the backs; in some of the schools, they were splintered. The general cleanliness of the schools was satisfactory, and the same remark applies to the playgrounds and the offices. The w.c. accommodation in most of the schools is the trough forms with seats and automatic flush. Some have separate pedestal seats with automatic flush; very few have a separate pedestal and separate hand-flushing cistern. I should suggest, as opportunity affords, that all trough closets be abolished and pedestal closets be installed. 4—MEDICAL INSPECTION. Description of the arrangements made and methods adopted for the medical inspection of children. About a week prior to the inspection, the Head Teacher is informed and asked to make the necessary arrangements. Parents are invited to be present at the inspection, and to obviate any unnecessary waiting five children are arranged for every half-hour. About 25 children were examined each morning and afternoon. As Dr. Strong, the Medical Inspector, had to attend the school clinic every morning, it is obvious that on occasion he would be detained, and there would be a delay in the arrangements. One nurse did nothing but work in connection with routine inspection. Her duties were the usual ones, taking height and weight, recording chest measurements, testing vision, etc., and assisting in the clerical work of the inspection. All defects, as well as the names of absentees, are entered in a book kept at the School. 8 Inspection cards are also kept at the School. Each child has a record card, giving height and weight, and naming defect, if any. If the parent is not present, the nature of the defect is notified to her. Re-inspection was carried out at the end of the year. 4a. During the year, all the age groups have been inspected, that is, the entrants, the leavers (over 12 years of age), and an intermediate group, age 8—9 years. 4b. The Board's schedule of medical inspection has been adopted. 4c. The early ascertainment of crippling defects is secured by (1) bringing forward any child at the routine examination, whether the age group or not; (2) by the Head Teacher sending the child to the clinic for advice. 4d. The inspection is always conducted on the school premises, either in a staff-room or a class-room. In seme of the schools the accommodation for this purposes is extremely cramped. The average time that a child might be away from the class would probably be under half an hour. The disturbance of school arrangements is not great. Exclusions during routine inspection were very few; 1 for impetigo, 2 for body vermin, 1 for follicular tonsillitis, and 1 for ringworm. These children were excluded under Article 53 (b). 5—REVIEW OF THE FACTS DISCLOSED BY MEDICAL INSPECTION. In Table II. are given particulars of all defects found during the year, and divided into two columns. By routine medical inspection is meant the inspection of the three definite age groups. A child seen apart from this routine examination, whether seen at the School or at the School Clinic is termed a " special." 5a. UNCLEANLINESS.—Verminous heads were found during routine inspection in 41 children, and verminous bodies in 22 children. In addition there were 51 head cases and 2 body eases specially sent by the teachers. During the year one nurse has devoted the whole of her time to the inspection 9 of heads and clothing of scholars in the Schools, and the following is a summary of the findings :— Total number of examinations 19,352 Number where verminous heads found 945 Number of children with nits 3,858 Number of children with body vermin 36 Number of exclusions 43 Number of prosecutions 0 Part of the duty of this nurse is to effect the necessary cleansings when home conditions, as, for example, an invalid mother, are unsatisfactory. 5b MINOR AILMENTS.—The majority of these come under skin and external eye affections, and are referred to later under Sections 5e and 5f. 5c. TONSILS AND ADENOIDS.—329 children, or nearly 10 per cent. of the routine inspections, were found to be suffering from enlarged tonsils or adenoids, or from both. 62 of these, or just under 2 per cent. of the whole, were advised to secure operative treatment. The remainder were kept under observation. Among the " specials," 67 cases were found, of which 63 were advised to secure further treatment. 5d. TUBERCULOSIS.—There was no definite case of pulmonary tuberculosis detected during routine inspection, but two doubtful cases were advised to secure treatment. Among the special cases, 10 were diagnosed as suffering from the complaint, whilst 24 had doubtful symptoms and signs. The six cases of non-pulmonary tuberculosis met with during the year included one of the glands, two of the spine and two of the hip. 5e. SKIN DISEASES.—During routine inspection were found 2 cases of ringworm of the head and 36 cases of impetigo. The special cases include 69 cases of ringworm of the head, 60 of ringworm of the body, 52 cases of scabies, and 412 cases of impetigo. The other skin diseases enumerated include the non-contagious affections such as eczema, the ervthemata, chilblains, etc. 5f. EXTERNAL EYE DISEASE.—The majority of these cases are inflammatory affections of the lids. Two cases of keratitis and 10 of corneal ulcer were met with during the year. 5g. DEFECTS OF VISION AND SQUINT.—Of the 2,190 leavers and intermediate age group, 95 children were found to be suffering from defective vision requiring remedial treatment, whilst 98 children were kept 10 under observation. 62 children amongst the total number of routine examinations were found to be suffering from squint. Amongst the specials, 200 children required treatment for defective vision, and 88 for squint. 5h. DEAFNESS AND EAR DISEASE.—121 cases of deafness and 202 . cases of ear disease, or otorrhoea, were seen during the course of the year. This includes 61 cases of deafness and 64 of ear disease found during the course of routine medical inspection. This is a large number of cases of otorrhoea, and apart from a real danger to life, may result in a permanent deafness of varying degree. These cases are dealt with daily at the clinic. 5i. DENTAL DEFECTS.—Out of a total of 3,478 children examined in routine fashion, 2,245 were advised to secure dental treatment. The result of the dentist's findings and his work is recorded in Form IV D. 6. INFECTIOUS DISEASES. Scarlet fever and diphtheria have been prevalent during the year, and account for a correspondingly large number of exclusions from school, both for the actual cases, and the contacts of school age. Mumps was also prevalent during the first five months of the year, but has since practically ceased. There were not many cases of whooping cough or chicken-pox, whilst the incidence of measles was extremely slight. No action was taken during the year under Article 57 of the code; the necessary exclusions were made under 53b. The number of school children excluded from school suffering from scarlet fever was 278; the corresponding number suffering from diphtheria, 244. NUTRITION.—The results of routine medical inspection are given in the following figures :— Boys. Girls. Good nutrition 1,573 1,580 Fair „ 184 141 Bad „ 0 0 1,757 1,721 11 7. FOLLOWING UP. A large proportion of parents are anxious to have defects in their children remedied, but there are a few who do not show such anxiety. It is to get in touch with these latter that visits to the home by the School Nurse are necessary, and during the year a total of 1,556 visits were paid. They were for the following defects, etc. :— Ringworm 51 Defective Vision 60 Teeth 55 Ear cases 14 Skin diseases 151 Tonsillitis 39 Surgical appliances 43 Notifiable diseases 191 Non-notifiable diseases 281 Other visits 885 Total 1,556 The above, as will be seen, includes cases seen at the Clinic and sent home; for example, tonsillitis, also cases under treatment. like ring-worm, who fail to turn up for treatment, etc. 8. MEDICAL TREATMENT. 8a. MINOR AILMENTS.—Practically skin and external eye diseases and a few accidents. These are treated daily at the Clinic, the scholars from one half of the district in the morning, and from the other half in the afternoon. Two nurses were in constant attendance at the Clinic. 8b. TONSILS AND ADENOIDS.—The operative treatment of these is carried out at the Prince of Wales's Hospital, Tottenham, at a cost to • he Committee of 10s. per case. 98 such oases were so treated during the year. The Assistant S.M.O. gives the order and sees all cases after treatment. This hospital is ten to twenty minutes' tram-ride from the district. 8c. TUBERCULOSIS.—Ten cases of definite pulmonary tuberculosis came under observation during the year, whilst 26 cases had indefinite signs. These cases are referred to the County's Tuberculosis Dispensary, in Silver Street. The Tuberculosis Officer also examines all contacts of phthisis. The six non-pulmonary forms of Tuberculosis included one of glands, two of spine, and two of the hip. 12 8d. SKIN DISEASES are treated mainly at the School Clinic. The exceptions referred to are six cases of ringworm of the head, and treated by X-rays at the Prince of Wales's Hospital, Tottenham, at a cost of 25s. per case. 8e. EXTERNAL EYE DISEASE.—These are treated at the School Clinic. Cases of squint are referred to the oculist. 8f. VISION.—The oculist attends weekly at the School Clinic, and an optician attends at the same hour to take measurements. The following is the Report for the year from Dr. (Miss) Smith Clark :— " The School Clinic, " Pymmes Park, " Edmonton, N. 18. " 15th March, 1922, " To Dr. Harding. " ANNUAL REPORT ON OPHTHALMIC SECTION FOR 1921. " The Ophthalmic Surgeon attended one half-day per week, except from week ending June 4th, to week ending July 23rd, when she attended twice weekly, and week ending July 30th, when she attended three times during the week, making 52 occasions in all during 1921. Total number of new cases seen were 383 Average number of new cases per session was 7 Average number of attendances per week was 15 Total attendances were 762 " I am glad to say that the interest of the parents, which was commenced under Dr. Joll, continues. Especially may this be said in connection with the squint cases, where the parents of the children make several visits to the Clinic, over a long period, and make every effort to carry out instructions, and endeavour to help the Doctor in every way, and thus have done much valuable work to save the squinting eye of the child, which is threatened with blindness. There is also an increasing desire of the parents to have glasses ordered to relieve eye-strain, and they are also very grateful to the S.M.O., the Nurses and the Optician for the success of the treatment carried out. The work of the 13 Clinic tends to increase, because parents now ask that their children's eyes may be examined, with a view to provision of glasses if necessary. Cases dealt with were as follows:— Simple errors of refraction 282 Errors of refraction, with concomitant strabismus 128 Corneal Nebulae (marked) 11 Adherent Leucoma 2 Congenital Amplyopia 2 Blepharitis 3 Conjunctivitis.. 3 Phlyctenular Keratitis 2 Error of refraction, one eye removed 1 Nystagmus 1 Interstitial Keratitis 2 Ptosis 1 Corneal Ulcer 3 Optic-atrophy 1 Retino-chorioiditis 2 Discharging socket 1 Foreign body in eye 1 Accident to eye 1 Phthisis Bulbi.. 1 Coloboma Iridis and refraction 1 Congenital Cataract 1 Marginal Blepharitis 1 Total 451 I,. M. SMITH CLARK, Oculist to Education Committee. 8g. EAR DISEASE AND HEARING.—Cases of otorrhoea are treated at the Clinic daily, and sometimes, when thought necessary, twice daily. The Education Committee recently suggested that their scheme of treatment should include the necessary arrangements whereby appropriate cases could have a mastoid operation ; this was, however, refused by the Board of Education. 8h. DENTAL DEFECTS.—A whole-time dentist was employed at the School Clinic until the end of July, 1921. After the holidays, Mr. Willis, L.D.S., was appointed as part-time officer, six mornings of 2½ hours each, 14 and he started his duties September 12th. No general anaesthetics have been given during the year. Table IV (d) gives tabular statements of the work accomplished. 8i. CRIPPLING DEFECTS AND ORTHOPEDICS.—During the past year the Education Committee have made grants to enable parents to purchase surgical appliances, etc., to enable the child to attend school. The S.M.O. certifies as to the condition and necessity for the appliance and also sees the latter when fitted, to see that it is satisfactory. The father, when in work, is expected to contribute towards the expense, and the parents frequently get financial help from other quarters—the Samaritan Society, etc. Remedial exercises are not carried out, but a few cases receive massage at the school clinic. 9. OPEN AIR EDUCATION. 9a.—Classes are held in the open air at various schools when the weather conditions are satisfactory, but there is no systematic method and no open-air class-rooms or open-air schools. 9b. SCHOOL JOURNEYS, CAMPS, Etc.—These have not been undertaken during the past year. 10. PHYSICAL TRAINING. There is no Area Organiser of Physical Training. The individual teacher., take their own class, and the Syllabus of the Board of Education on physical training is used. 11. PROVISION OF MEALS. A representative Care Committee meet monthly, and upon which the School Medical Officer and the Assistant S.M.O. have seats. There are three centres for meals, two of which have been open the whole year, whilst the third was closed from the end of May till the end of September. The full accommodation of the three is for 530 children. 15 Two centres are under the direct control of the Education Committee; the third centre is contracted out, but the menu is supervised. A sub-committee of the Central Care Committee, together with the school doctors, arranges the menu. Voluntary helpers assist in the serving and supervision of the meals, whilst a special officer, called the Children's Welfare Supervisor, acting under the instructions of the Secretary to the Education Committee, is responsible for the general supervision and arrangements for the provision of all meals. Applications for free meals by the parents come before the School Care Committee concerned. The scale of family income adopted is as follows, after deducting rent and fares:— Number of persons in family:— £ s. d. 4 1 13 0 5 1 19 0 6 2 4 9 7 2 9 9 8 2 13 11 9 2 17 9 10 3 0 9 The total number of individual children fed was 755, and the total meals were:— Breakfasts. Dinners. Accommodation. Fore St. Centre (Contract) . 4,054 28,090 100 St. Michael's Hall — 53,896 230 Parish Room — 30,282 200 The cost per head was: Fore Street, 7.2 pence; St. Michael's, 5.3 pence; Parish Room, 5.4 pence. 16 A few cases of children suffering from malnutrition have been ordered meals by the Assistant S.M.O., though the cases were not necessitous ans the expense recovered from the parents; otherwise, all cases were necessitoud. 12. SCHOOL BATHS. The elder children go to the public baths to learn swimming. There is an instructress for the girls. There is no charge to the child. 13. CO OPERATION OF PARENTS. This is quite satisfactory. The great majority of the parents show their interest in either being present at routine inspection or in their readiness to have defects remedied: also they avail themselves of the facilities offered by the School Clinic. 14. CO OPERATION OF TEACHERS. This is accorded willingly, though it means additional clerical work for the Head Teacher and Staff, and absence of scholars from school to attend School Clinic. 15. THE SCHOOL ATTENDANCE OFFICERS. The Attendance Officers get duplicate copies of the names and particulars of children excluded from school, and also corresponding notices when the child is fit to return. They notify the School Medical Officers when they come across cases of measles, whooping cough, etc. 16. CO OPERATION OF VOLUNTARY BODIES. There are no voluntary bodies interested directly in the work of the School Medical Service. 17. BLIND, DEAF AND DEFECTIVE CHILDREN. Table III. gives the number of the above known to the Attendance Department. 17 There is no school for the myope or the partially blind, but there are four children, two boys and two girls, in residence at the East London Home for the Blind, Clapton. Boys. Girls. Number in residence, March 31st, 1921 1 2 Number admitted during the year 1 1 Number left during the year — 1 Number in residence, March 31st, 19202 2 2 The cost per child is £75 per annum. Mentally Defective Children. The special school is at Nassau House, Enfield, and the children travel to and from school by tram under the care of two guides. The accommodation of the school is for 66, and there are three teachers on the staff. The usual handicraft work is carried out, and the school is fortunate in possessing a nice garden. The cost is £51 per head per annum. The following gives details regarding the children attending:— Boys. Girls. Number of Edmonton children, March 31st, 1921 14 5 „ „ admitted during year 5 3 „ „ left during year 3 3 „ „ March 31st, 1922 . 16 5 There is no after-care committee in connection with the above. Deaf and Dumb Children. These attend the Tottenham Deaf Centre, travelling by train under the care of a guide. The cost is £52 per child. The Edmonton children attending are as follows:— Boys. Girls. Attending March 31st, 1921 9 7 Admitted during the year — 2 Left during the year 3 2 Attending March 31st, 1922 6 7 18, 19, 20.—There are no nursery schools (18), nor continuation schools (19); the local Education Authority is not responsible for the work of medical inspection in the Secondary School (20). This latter paragraph does not refer to the arrangements made for 1922. 18 21. EMPLOYMENT OF CHILDREN OF SCHOOL AGE. During the year, Dr. Strong has examined 119 children under the byelaws in connection with the above. The following six tables are in accordance with the wishes of the Board of Education. On Table I., by routine medical inspection is meant the systematic inspection of the three specified groups of children—entrants, leavers (as soon as they reach 12 years of age), and an intermediate group, those aged between 8 and 9 years. All other children seen are "specials." The re-examinations are those of children found to have a defect at the routine examination. Table II. gives a detailed list of all defects which have been met with during the year, and wherever seen, whether at school or at the Clinic. Table III. gives, as far as is known, a tabulated list of "exceptional" children in the area. Table IV. is divided into four sections, and gives a detailed account of the treatment received by those having defects. It is satisfactory to note the large percentage of those who have received appropriate treatment. Table V. is a summary of Table IV. Table VI. is a summary of the defects found during routine inspection. I am indebted to Dr. Strong and the Staff at the Clinic for the figures in all the tables, except Table III.—this latter being prepared by the Attendance Department. 19 TABLE I. (of Board of Education). NUMBER OF CHILDREN INSPECTED, 1st JANUARY, 1921 to 31st DECEMBER, 1921. A.—ROUTINE MEDICAL INSPECTION. Age. Entrants. 3 4 5 6 Other ages. Total Boys 555 58 6 619 Girls 575 62 32 669 Total — — 1,130 120 38 1,288 Age. Intermediate Group. 8 Leavers. Grand Total. 12 13 14 Other Ages. Total. Boys 570 503 29 — 36 568 1,757 Girls 471 498 16 — 67 581 1,721 Totals 1,041 1,001 45 — 103 1,149 3,478 20 B.—SPECIAL INSPECTION. Special Cases. Routine re-examinations No. of children re-examined.) Boys 1,354 612 Girls 1,483 518 Totals 2,837 1,130 C.—TOTAL NUMBER OF INDIVIDUAL CHILDREN INSPECTED BY THE MEDICAL OFFICER, WHETHER AS ROUTINE OR SPECIAL CASES (no child being counted more than once in one year). No. of individual children inspected:— Routine 3,478 Special 2,837 Total 6,315 21 TABLE II. (Board of Education.) RETURN OF DEFECTS FOUND IN THE COURSE OF MEDICAL INSPECTION, 1921. Defects or Disease. Routine. Special. Number referred for treatment. Number requiring to be kept under observation, but not referred for treatment. Number referred for treatment. Number requiring to be kept under observation, but not referred for | treatment. (1) (2) (3) (4) (5) Malnutrition – 323 – 8 Uncleanliness– Head 3 38 50 1 Body – 22 1 1 Skin– Ringworm: Head 2 – 69 – Body – – 60 – Scabies – – 52 – Impetigo 36 – 412 7 Other diseases (non-tubercular) 1 2 391 45 Eye- Blepharitis 33 – 129 – Conjunctivitis – – 32 – Keratitis 1 – 1 – Corneal Ulcer 2 – 8 – Corneal Opacities – – – – Defective vision 95 98 200 10 Squint 46 6 88 – Other conditions 4 3 38 – Ear– Defective hearing 35 29 55 2 Otitis Media 62 2 138 – Other ear diseases – – 10 4 Nose and Throat– Enlarged Tonsils. 50 249 58 3 Adenoids 1 2 2 1 Enlarged Tonsils and Adenoids 11 16 3 – Other conditions 8 2 140 90 Enlarged Cervical Glands (non-tubercle) – 13 35 11 Defective speech – 22 – 3 Heart and Circulation– Organic Heart Disease 7 6 12 2 Functional Heart Disease 2 31 – 5 Angemia 1 4 8 7 Lungs– Bronchitife G 31 44 17 Other Non-tubercular Diseases 2 – 3 1 Tuberculosis– Pulmonary: Definite – – 1 9 Suspected 2 – 4 20 Non-Pulmonary: Glands – – 1 – Spine – 1 – 1 Hip – – 2 Other bones & joints – – – – Skin – – – – Other forms – 1 – – Nervous System– Epilepsy 2 2 3 9 Chorea – – 25 10 Other conditions 2 16 12 22 Deformities– Rickets 2 1 – 2 Spinal Curvature – – – 2 Other forms 5 3 2 5 Other defects and diseases 3 8 510 608 No. of individual children having defects which required treatment or to be kept under observation 4,127 22 TABLE III. NUMERICAL RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA IN 1921. Boys Girls Total Blind (including partially blind) within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893 Attending public elem schools 9 13 22 Attending certified schools for the blind 3 3 6 Not at school — — — Deaf and Dumb (including partially deaf) within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893 Attending public elem. schools 21 21 42 Attending certified schools for the deaf 9 8 17 Not at school — — — Mentally Deficient:— Feeble-minded Attending public elem. schools 30 18 48 Attending certified schools for mentally defective children 16 7 23 Notified to the Local Control Authority by Local Education Authoritv during year 1 — 1 Not at school 1 4 5 Imbeciles Attending public elem. schools — 1 1 Notified to the Local Control Authority by Local Education Authority during year 1 2 3 Not at school — — — Idiots Notified to Local Control Authority 1 — 1 Epileptics Attending public elem. schools 8 13 21 Attending Certified Schools for Epileptics — — — In institutions other than certified schools — — — Not at school 2 2 23 TABLE III—continued. Boys. Girls. Total. Physically Defective:— Pulmonary Tuberculosis Attending public elem. schools 16 24 40 Attending certified schools for physically defective children — — — In institutions other than certified schools — — — Not at school 7 3 10 Crippling Due to Tuberculosis Attending public elem. schools 5 7 12 Attending certified schools for physically defective children — — — In institutions other than certified schools — — — Not at school 7 3 10 Crippling due to causes other than Tuberculosis (i.e., Paralysis, Rickets, Traumatism) Attending public elem. schools 31 21 52 Attending certified schools for physically defective children — — — In institutions other than certified schools — — — Not at school 6 7 13 Other Physical Defectives [e.g., delicate and other children suitable for admission to open-air schools; children suffering from severe heart disease Attending public elem. schools 30 61 91 Attending open-air schools — — — Attending certified schools for physically defective children, other than open-air schools.. — — — Not at school — 7 7 Dull or Backward Retarded 2 years 309 120 429 Retarded 3 years 87 47 134 24 TABLE IV. (Board of Education.) TREATMENT OF DEFECTS OF CHILDREN DURING 1921. A —TREATMENT OF MINOR AILMENTS. Disease or Defect. Number of Children. Referred for Treatment. Treated— Under Local Education Authority's Scheme. Otherwise. Total. Skin:— Ringworm : Head 71 51 20 71 Bodv 60 50 10 60 Scabies 52 41 11 52 Impetigo 449 423 25 448 Minor Injuries 196 162 34 196 Other Skin Diseases 392 331 61 392 Ear Disease 300 278 22 300 Eve Disease (external and other) 248 229 19 248 Miscellaneous 649 250 396 646 B.—TREATMENT OF VISUAL DEFECTS. Number of Children:— Referred for Refraction 418 Submitted to Refraction— Under Local Education Authority's Scheme, Clinic or Hospital 412 By Private Practitioner or Hospital — Otherwise — Total 412 For whom glasses were prescribed 370 For whom glasses were provided 370 Recommended for treatment other than by glasses 31 Received other forms of treatment 31 For whom no treatment was considered necessary 11 C.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Number of Children:— Referred for treatment 135 Received operative treatment— Under Local Education Authority's Scheme—Clinic or Hosp. 98 By private practitioner or hospital 27 Total 125 Received other forms of treatment — 25 D.—TREATMENT OF DENTAL DEFECTS. 1.—Number of Children dealt with. Age Groups. Specl. Total. 5 6 7 8 9 10 11 12 13 14 (a) Inspected by Dentist — 413 466 535 — — — — — — 1302 2716 (i) Referred for treatment 1255 1292 2547 (c) Actually treated 637 930 1567 (d) Re-treated (result of periodical inspection) — — — 2.—Particulars of time given and of operations undertaken. No. of half-days devoted to inspections 30 No. of half-days devoted to treatment 376 Total No. of attendances made by the children at the Clinic 3221 No. of permanent teeth— Extracted 56* Filled 448 No. of temporary teeth— Extracted 3289* Filled 953 Total No. of Fillings 1401 No. of administrations of general anaesthetics included in those marked * — No. of other operations— Permanent teeth 44 Temporary teeth 30 26 TABLE V. (Board of Education.) SUMMARY OF TREATMENT OF DEFECTS AS SHOWN IN TABLE IV. Disease or Defect. No. of Children. Referred for Treatment. Treated— Under Local Education Authority's Scheme. Otherwise. Total. Minor Ailments 1768 1565 202 1767 Visual Defects 418 412 — 412 Defects of Nose and Throat 135 98 27 125 Dental Defects 2547 1567 — 1567 Other Defects 649 250 396 646 Total 5517 3892 625 4517 The total number of attendances at the School Clinic for the year 1921 was 30,517 for the Minor Ailments section alone. 27 TABLE VI. (Hoard of Education.) SUMMARY RELATING TO CHILDREN MEDICALLY INSPECTED AT THE ROUTINE INSPECTIONS DURING THE YEAR 1921. (l) The total number of children medically inspected at the routine inspections 3478 (2) The number of children in (1) suffering from:— Malnutrition 323 Skin Disease 41 Defective Vision (including squint) 245 Eye Disease 43 Defective Hearing 64 Ear Disease 64 Nose and Throat Disease 339 Enlarged Cervical Glands (non-tuberculous) 13 Defective Speech 22 Dental Disease 2245 Heart Disease:— Organic 13 Functional 33 Anaemia 5 Lung Disease 39 Tuberculosis:— Pulmonary Definite – Pulmonary Suspected 2 Non-pul nary 2 Disease of the rvous System 22 Deformities 11 Other Defects and Diseases 11 (3) The number of children in (1) suffering from defects (other than uncleanliness or defective clothing or footgear) who require to be kept under observation (but not referred for treatment), excluding Dental Disease 871 (4) The number of children in (1) who were referred for treatment (excluding uncleanliness, etc.), excluding Dental Disease 419 (5) The number of children in (4) who received treatment for one or more defects (excluding uncleanliness, etc.), excluding Dental Disease 413