EDM 23 LIBRARY Borough of Edmonton. REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1937 JOLLY THE PRINTER (T.U.; EDMONTON 80007 Borough of Edmonuton. REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1937 JOLLY THE PRINTER (T.U.: EDMONTON. 80007 Borongh of Edmonton. 1937. His Worship the Mayor Alderman T. J. Harington, J.P. Deputy Mayor Councillor G. T. W. Tott. PUBLIC HEALTH COMMITTEE. Chairman : Alderman J. Reid. Aldermen Mrs. M. M. Barrass, Mrs. E. A. Young. Councillors W. C. Handscomb, C. G. Lacey, Mrs. E. M. Moss, A. W. Pearce, W. B. Ward. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health, School Medical Officer, and Supervisor for the Maternity and Child Welfare Services: * D. Regan, B.A., B.Sc., M.B., Ch.B., D.P.H. (Lpool). Assistant Medical Officer of Health, and Assistant School Medical Officer: I. G. MacIntyre, B.A., M.B., B.Ch., B.A.O., D.P.H. Senior Sanitary Inspector: *abcd W. Tillcock, M.R.San.I. District Sanitary Inspectors: *abce G. H. Huckle, *abc J. P. Farrar, *abc E. Dodsworth, *abc H. W. Grieves. a F. Beilby, Inspector for the Housing Regulations. *a Mrs. H. Fowler, Woman Sanitary Inspector. Chief Clerk: F. J. Nash, Cert.R.San.I. J. L. A. Saunders, Infectious Disease Clerk. A. E. Clarke, Records Clerk. D. H. J. Newman, Correspondence Clerk. H. J. Weldon, Junior Clerk. S. Clayton, Shops Acts Inspector. *Moiety paid under Public Health Act, or by Exchequer Grants, a Certificated Sanitary Inspector. b Certificate of Meat and Food Inspector. c Inspector under the Petroleum Acts. d Inspector of Canal Boats. e Certificate of Smoke Inspector. 3 PREFACE. Public Health Department, Town Hall, Edmonton, N.9. His Worship the Mayor, Aldermen and Councillors of the Borough of Edmonton. Mr. Mayor, Ladies and Gentlemen, I have much pleasure in presenting my third Annual Report for the year 1937, on the Sanitary circumstances, Sanitary administration and Vital Statistics of the Borough of Edmonton. This is my first report since the Urban District of Edmonton was raised to the dignity of a Borough, and with this increase of dignity and wider outlook in public health matters we must go forward to make Edmonton second to none in the Country. The contents are compiled in accordance with Circular 1650 issued by the Ministry of Health. All the items adopted by the Council as the result of the special report in 1935, have now been accomplished with the one exception of office accommodation ; it is to be regretted that the Council have been slow in realising the development of their district, and the necessity of increased staff and increased facilities to deal with such increase. We have accomplished much during this year, but there still remains that touch of quality which is necessary to bring the Public Health Services up to date as a whole. A very large amount of work has been accomplished successfully, thanks to the whole-hearted co-operation of the combined professional and clerical staff; we look forward to the future with bright hopes to accomplish much on behalf of Public Health in all sections of the community. The amalgamation of the Maternity and Child Welfare and School Medical Services, completed a year ago, has borne much fruit, and it is pleasing to note that the officers concerned are very interested in their work. We might say that the duties entailed in these two departments are fraught with the greatest benefit for the future population and, together with the Public Health Department, are undoubtedly the most important functions associated with a local authority. It is still to be regretted that office accommodation is very inadequate. No real effort has been made by the Council during the year to deal with the serious conditions of overcrowding appertaining in the Town Hall; we are of opinion that it is no excuse that this should be neglected now because a new Town Hall is proposed to be built at some future date. We think it ought to be borne on the Council that overcrowding and working under cramped conditions with lack of facilities are circumstances that are fraught with many disadvantages, i.e., it leads to increased illness in the staff with consequent absence from duty, while the lack of facilities decrease the efficiency of those so employed. We hope that until the newTown Hall is built, additional accommodation will be acquired in order to obviate further difficulties. 4 I am pleased to be able to say that the co-ordination of work in the three sections of my Department is working very smoothly and gives quite good results. There is no doubt that this work can be greatly facilitated by a more complete combination, not only of the controlling element, but in the form of a more complete unity of clerical and professional staff. The separation of the medical staff of the Maternity and Child Welfare and School Medical Services under present administration cannot be of any further use. The Board of Education is emphasising the necessity of the School Medical staff being responsible for the "under five" section of the community. We have no doubt that this is a sound policy and obviates a large number of the defects which at present are found in the "entrants" class of School Medical children. The control and unification of clerical duties associated with these services cannot be much longer denied, in fact it would improve all the services if the members of the School Medical and Maternity and Child Welfare Departments were composed of one and the same personnel. On account of the unification of the services, a separate authority over the same members of the staff has proved in a few instances embarrassing, and it is to be hoped that such circumstances would be dealt with by the Staff Committee in the ensuing year. An endeavour is being made in regard to housing to perpetuate in a small degree the requirements of the Housing Act, 1936, i.e., a number of houses are being inspected in order to ascertain whether overcrowding has occurred since the investigation under the Housing Act, 1935. In this connection it is of interest to note that the circumstances associated with housing change rapidly over a short period of time within,the district, inasmuch as some houses, known to comply with the provisions of the Act when inspected, are now overcrowded. It is with pleasure that we can say Edmonton is entirely free from anything like slum property, but there is a good number of houses still of the border line type, some of which fall below the standard of what should be required for working class people to-day. We can also say that the circumstances in some conditions which are adverse are being slowly remedied from year to year. During the year 1937 we were happily free from serious incidence of infectious disease. Diphtheria especially seems to have fallen in recent years to a very low level, whilst Scarlet FeveV occurs more often than we should desire, although the type of disease appears to be of a very mild character. Measles was fairly prevalent and although it caused quite a number of exclusions from school only one death resulted from this disease. A few sporadic cases of Enteric Fever occurred during the early part of the year, but during the latter part we were entirely free. A very disturbing attack of Dysentery occurred towards the end of the year, which did not confine itself to one section of the population ; no deaths occurred, but at the time it caused a good deal of anxiety on account of the presence of Typhoid Fever in other areas. There was a high incidence of Influenza, chiefly among the aged, with a consequent increase of the death rate in this group. The Birth Rate (15.69) is still high, though slightly lower than last year. The Death Rate (9.74) is slightly higher than last year, but this figure is creditable in view of the continued increase in population. 5 The Infantile Mortality Rate shows an increase this year and stands at the figure of 50.7. The Maternal Mortality Rate (3.0) remains the same as last year, which is fairly constant for Edmonton. The incidence of Puerperal Fever and Pyrexia continues to increase. In conclusion, I wish to record my thanks to the members of the Council and various Committees for the kindness and courtesy extended to me during the past year, and also to thank the staff for their loyal co-operation throughout the year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, D. REGAN, Medical Officer of Health. Section A. GENERAL STATISTICS. Area (in acres) 3,896 Population— Census of 1921 66,809 Census of 1931 77,652 Estimated by the Registrar-General for the mid-year, 1937 101,600 Number of inhabited houses and tenements at the end of 1937 24,829 Number of inhabited houses and tenements at the end of 1936 23,772 Rateable Value, April, 1937 £658,847 Estimated product of one penny in the £ for the year ending March 31st, 1938 £2,768 Hates in the £ for the year ending March 31st, 1938 13s. 0d. SOCIAL CONDITIONS. The extent of unemployment may be estimated by the following figures, relating to:— (1) the municipal milk supply to nursing mothers and young children, (2) the number of free dinners given to schoolchildren, and (3) the actual figures supplied by the Director of Public Assistance. Both (1) and (2) are given on purely economic grounds. (1) Municipal Milk Supply:— Number of pints granted at ¼ cost during 1936 6,454 Free „ 1936 82,929 1937 110,455 ,, ,, ,, at ¼ cost ,, 1937 2,583 (2) Number of free dinners during 1936 68,227 1937 68,052 (3) Figures re out-relief:— Persons. Amount. For the year 1936:— £ (a) Ordinary out-relief 3,918 42,238 (b) Unemployed out-relief 3,443 13,970 7,361 £56,208 6 Persons. Amount. For the year 1937:— £ (a) Ordinary out-relief 4,042 44,029 (b) Unemployed out-relief 2,340 4,919 6,382 £48,948 VITAL STATISTICS. Live Births. M. F. Total. Grand Total. Legitimate 821 727 1,548 Illegitimate 23 24 47 1,595 Birth-rate per 1,000 of population 15.69 Still-births. M. F. Total. Grand Total. Legitimate 28 22 50 Illegitimate — — — 50 Total of live and still births 1,645 Rate per 1,000 total births 30.4 Deaths. M. F. Total. Number 525 465 990 Rate per 1,000 population Deaths from Puerperal Causes. Rate per 1,000 total Deaths. (live and still births. Puerperal Sepsis 2 1.2 Other Puerperal causes 3 1.8 5 3.0 Death-rate of infants under one year of age. M. F. Total. Number 46 35 81 All infants per 1,000 live births 50.7 Legitimate infants per 1,000 legitimate live births 47.6 Illegitimate infants per 1,000 illegitimate live births 106.3 Deaths from cancer (all ages) 129 ,, measles (all ages) 1 ,, whooping cough (all ages) 1 ,, diarrhoea (under 2 years of age) 12 GENERAL INVALIDITY. Although there is still much to be done to bring the various figures in the vital statistics still lower we stand very favourably in relation to the figures for the rest of England and Wales. It will need very great and concentrated effort to further reduce the Maternal Mortality, as practically everything that can be done is being done for the mother and child in Edmonton. 7 The supply of milk at schools and the increased supplies granted under new orders in the Maternity and Child Welfare Department is bearing good fruit. There was an increase in the Death Rate amongst the older members of the population due to Influenza and complications occurring therefrom. The number of persons dying from Cancer, we regret to say, has increased, but, as in other years, the incidence is greater amongst the aged. The following causes of death are supplied by the Registrar-General and refer to deaths which were registered during the calendar year:— M. F. Total 1 .. 1 Typhoid and Para -typhoid Fevers 1 .. 1 Measles 1 .. 1 Scarles 1 .. 1 Whooping Cough 2 3 5 Diphtheria 10 16 26 Encephalitis Lethargica 2 1 3 Cerephalitis Lethargica 2 .. 2 Tuberculosis of the Respiratory System 49 29 78 Other Tuberculous Diseases 8 5 13 Syphilis .. .. .. General Paralysis of the Insane, Tabes Dorsalis 3 .. 3 Cancer, Malignant Disease 73 56 129 Diabetes 5 8 13 Cerebral Haemorrhage, etc. 19 24 43 117 119 236 Aneurysm 5 1 6 Other Circulatory Diseases 25 30 55 Bronchitis 17 18 35 Pneumonia (all forms) 49 34 83 Other Respiratory Diseases 6 4 10 Peptic Ulcer 10 .. 10 Diarrhœa, etc (under 2 yrs.) 6 6 12 Appendicillis 5 .. 5 Cirrhosis of Liver 2 1 3 Other Diseases of Liver, etc. 1 1 2 Other Digestive Diseases 7 12 19 Acute and Chronic Nephritis 12 14 26 Puerperal Sepsis .. 2 2 Other Puerperal Causes .. 3 3 Congenital Debility, Premature Birth, Malformations, etc. 21 15 36 Senility 4 13 17 suicide 6 5 11 Other Violence 19 12 81 Other Defined Diseases 35 33 68 Causes Ill-defined or Unknown 1 .. 1 Special Causes (included in " Other Defined Diseases "): — Smallpox .. .. .. Poliomyelitis .. .. .. Polio-Encephalitis .. .. .. Total Deaths 525 465 990 8 The following tables give the deaths of those registered during the 52 weeks ended 1st January, 1938, sub-divided as to age groups:— MALES. Causes of Death ALL AGES Under 1 year 1 & under 2 years 2 & under 5 years 5 & under 15 years 15 & under 25 years 25 & under 35 years 35 & under 45 years 45 & under 55 years 55 & under 65 years 65 & under 75 years 75 and over Typhoid Fever 1 .. .. .. .. .. .. 1 .. .. .. .. Measles 1 1 .. .. .. .. .. .. .. .. .. .. Scarlet Fever 1 .. .. 1 .. .. .. .. .. .. .. .. Whooping Cough 1 1 .. .. .. .. .. .. .. .. .. .. Diphtheria 2 1 .. 1 .. .. .. .. .. .. .. .. Influenza 10 .. .. .. .. .. 1 1 1 2 4 1 Encephalitis Lethargica 1 .. .. .. .. .. .. .. .. 1 •• .. Cerebro-spinal Fever 2 1 .. .. .. 1 .. .. .. .. .. .. Tuberculosis of the respiratory 47 .. .. .. .. 7 8 9 13 6 4 .. system .. .. .. .. .. .. .. .. .. .. .. .. Other T. B. Diseases 7 .. .. 1 2 2 1 .. .. 1 .. .. Syphilis .. .. .. .. .. .. .. .. .. .. .. .. General Paralysis of the Insane 3 .. .. .. .. .. .. .. 1 .. 2 .. Cancer 71 .. .. .. 1 .. 2 5 9 25 21 8 Diabetes 5 .. .. .. .. .. .. .. 1 2 2 .. Cerebral Haemorrhage 19 .. .. .. .. .. .. .. 1 4 10 4 Heart Disease 1 20 .. .. .. .. .. 4 1 14 25 37 39 Aneurysm 5 .. .. .. .. .. .. .. 2 2 1 .. Other Circulatory Diseases 25 .. .. .. .. .. .. .. .. 5 8 12 Bronchitis 17 1 .. .. .. .. 1 1 3 5 3 3 Pneumonia 49 11 2 2 1 5 2 4 8 8 4 2 Other Respiratory Diseases 6 .. .. .. .. .. .. .. 3 2 .. 1 Peptic Ulcer 10 .. .. .. .. .. .. .. 3 6 .. 1 Diarrhoea (under 2 years of age) 7 7 .. .. .. .. .. .. .. .. .. .. Appendicitis 5 .. .. .. 1 .. 1 1 .. 1 1 .. Cirrhosis of Liver 2 .. .. .. .. .. .. 1 .. 1 .. .. Other Diseases of the Liver 1 .. .. .. .. .. 1 .. .. .. .. .. Other Digestive Diseases 9 .. .. .. .. .. .. 2 .. 1 2 2 Acute and Chronic Nephritis 12 .. .. .. .. .. 3 .. .. 1 3 4 Congenital Debility, etc 21 20 .. .. .. 1 .. .. .. .. .. .. Senility 4 .. .. .. .. .. .. .. .. .. .. 4 Suicide 6 .. .. .. .. .. 2 .. .. 2 2 .. Other Violence 19 .. .. 2 2 4 3 1 .. 4 .. 3 Other Defined Diseases 15 1 .. 1 2 3 .. 5 6 8 7 2 Causes ill-defined or unknown 1 1 .. .. .. .. .. .. .. .. .. .. Totals 525 45 2 8 9 23 29 32 68 112 111 86 '9 FEMALES. Causes of Death ALL AGES Under 1 year 1 & under 2 years 2 & under 5 years 5 & under 15 years 15 & under 25 years 25 & under 35 years 35 & under 45 years 45 & under 55 years 55 & under 65 years 65 & under 75 years 75 and over Typhoid Fever .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 3 .. .. .. 3 .. .. .. .. .. .. .. Influenza 15 .. .. .. .. .. .. 2 1 2 .. 10 Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-Spinal Fever .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of the respiratory 29 .. 1 .. .. 13 7 5 1 1 .. 1 system .. .. .. .. .. .. .. .. .. .. .. .. Other T. B. Diseases 6 .. .. 2 1 1 .. .. 2 .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. .. .. General Paralysis of the Insane .. .. .. .. .. .. .. .. .. .. .. .. Cancer 54 .. .. .. .. .. 1 5 7 14 13 14 Diabetes 7 .. .. .. .. .. .. 1 2 .. 3 1 Cerebral Haemorrhage 23 .. .. .. .. .. 1 .. 2 2 9 9 Heart Disease 120 .. .. .. 2 4 4 4 8 12 27 59 Aneurysm 1 .. .. .. .. .. .. .. .. .. .. 1 Other Circulatory Diseases 27 .. .. .. .. .. .. 1 .. 2 9 15 Bronchitis 18 .. .. .. .. .. .. .. .. 3 3 12 Pneumonia 14 8 3 1 .. .. 1 2 2 3 5 9 Other Respiratory Diseases 5 .. .. .. .. .. 1 .. 3 .. .. 1 Peptic Ulcer 1 .. .. .. .. .. .. .. 1 .. .. .. Diarrhoea,etc.(under 2 yearsof age) 6 6 .. .. .. .. .. .. .. .. .. .. Appendicitis 1 .. .. .. .. .. 1 .. .. .. .. .. Cirrhosis of Liver 1 .. 1 Other Diseases of the Liver 1 .. .. .. .. .. .. .. .. 1 .. Other Digestive Diseases 12 .. .. .. 1 .. 2 .. 1 3 2 3 Acute and Chronic Nephritis 14 .. 1 .. .. 3 2 1 .. 3 3 1 Puerperal Sepsis 2 .. .. .. .. .. 1 1 .. .. .. .. Other Puerperal Causes 3 .. .. .. .. .. 1 2 .. .. .. .. Congenital Debility 17 16 .. .. .. .. 1 .. .. .. .. .. Senility 13 .. .. .. .. .. .. .. .. .. 1 12 Suicide 5 .. .. .. .. 1 .. 1 2 .. 1 .. Other Violence 12 2 1 .. .. 1 .. .. .. 1 .. 7 Other Defined Diseases 29 2 .. 1 2 1 1 3 7 3 5 4 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. Totals 459 34 6 4 9 24 24 28 39 49 82 160 There is a slight difference in respect of the causes of death between these last two tables and the one supplied by the Registrar-General, who is probably in possession of additional information on the matter. 10 INFANTILE MORTALITY. The deaths of infants under one year of age were as follows:— M. F. Total Legitimate 44 32 76 Illegitimate 2 3 5 46 35 81 The death-rate of all infants per 1,000 live births was 50 7. A detailed sub-division of the causes, etc., of these infant deaths is as follows: — MALES. Causes ot Death Under 1 week Second week Third week Fourth week Total under 1 month 1—3 months 3—6 months 6—9 months 9—12 months Total under 1 year Measles .. .. .. .. .. .. .. .. 1 1 Diphtheria .. .. .. .. .. .. .. .. 1 1 Whooping Cough .. .. .. .. .. 1 .. .. .. 1 Bronchitis .. .. .. .. .. .. .. .. 1 1 Pneumonia 1 .. 1 .. 2 1 3 3 2 11 Cerebro-Spinal Fever .. .. .. .. .. .. i .. .. i Diarrhoea .. .. 1 .. 1 1 4 1 .. 7 Congenital Malformation 1 1 .. .. 2 1 .. .. .. 3 Congenital Debility .. .. .. .. 8 1 .. •• .. 1 Premature Birth 6 2 .. .. 1 .. .. .. 9 Injury at Birth 3 .. 1 .. 4 .. .. .. .. 4 Atelactasis 1 .. .. .. 1 .. .. .. .. 1 Other Disear.es of Eailv Infancy 1 1 .. .. 2 .. .. .. .. 2 Other Causes 1 .. .. .. .. .. l .. .. 2 Totals 14 4 3 .. 21 6 9 4 5 45 FEMALES. Causes of Death Under i week Second week Third week Fourth week Total under i month i—3 months 3—6 months 6—9 months 9—12 months Total under i year Pneumonia .. .. .. 1 1 1 2 2 2 8 Meningitis .. .. .. .. .. .. .. 2 .. 2 Diarrhœa .. .. .. .. .. .. 3 3 .. 6 Congenital Malformation 1 .. 1 .. 2 1 .. .. .. 3 Congenital Debility .. .. .. .. .. 1 .. .. .. 1 Premature Birth 4 1 5 5 Injury at Birth 2 .. .. .. 2 .. .. .. .. 2 Icterus Neonatorum 2 .. .. .. 2 .. .. .. .. 2 Suffocation .. .. .. .. .. 1 i .. .. 2 Other Diseases of Early Inlancy 1 .. 1 .. 2 1 .. .. .. 3 Totals 10 •• 3 1 14 5 6 7 2 34 11 COMPARATIVE STATISTICS. The Registrar-General has forwarded provisional figures relating to the Country as a whole, and to London, enabling the following comparisons to be made:— Birth-rate per 1,000 population Death-rate per 1,000 births. From diarrhoea, etc., under 2 years Total deaths under 1 year Live Still England and Wales 14.9 0.60 5.8 58 London 13.3 o.54 12.0 60 Edmonton 15 69 0.49 7.5 50.7 Annual Death Rate per 1,000 of Population. All Causes Enteric Fever Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Violence England and Wales 12.4 .00 .00 .02 .01 .O4 .07 45 .54 London 12.3 .00 .00 .01 .01 .06 .05 .38 .51 Edmonton 9.74 00 .00 .00 .00 .00 .04 .25 .41 The following table gives the number of births and deaths (registered) subdivided into the four wards of the Borough. It should be remembered that the births are only of those which occurred in Edmonton and of course of Edmonton addresses ; these are registered in Edmonton. Births which take place outside the Borough are not included ; this fact accounts for the difference between these figures and those supplied by the Registrar-General. The deaths include those taking place outside the Borough, the information being given us quarterly by the Registrar-General. Ward Births Deaths Infant Deaths M F M F M F Bury Street 272 213 166 123 22 14 Church Street 103 111 90 115 5 5 Angel Road 180 157 142 115 10 11 Silver Street 189 187 123 103 8 4 Vagrants •• .. 4 3 .. .. 744 668 525 459 45 34 12 Section B. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Laboratory Facilities. These are as described in previous reports. During the year much help was given in the examination of swabs, etc., by Dr. Maclntyre, our newly appointed Assistant Medical Officer of Health. We would like to point out here that further facilities are necessary in the widening scope of bacteriology appertaining to the Borough, and it is necessary to point out at this juncture that these facilities should be provided unless the Council make up their minds to spend quite a sum of money in rendering up-to-date the present rather obsolete plant. Many authorities are now transferring such services to the pathological departments of General Hospitals in their vicinity, and in this respect the advice of the Specialist Staff is considered invaluable. In the event of the Food and Drugs Act falling to the lot of the Council an extension of the facilities will be necessary and further help required. The following examinations were carried out during 1937:— Swabs for Diphtheria:— Positive. Negative. Total. From suspected cases 75 961 1,036 ,, contacts 32 536 568 ,, carriers and old cases 8 20 28 115 1,517 1,632 Not Present, found. Total. Sputa for the presence of tubercle baccillus 6 57 63 Hairs for the presence of the parasite of ringworm nil 1 1 Smears from the eyelids for the presence of the gonococcus was made in one case with a negative result. During the year the following material was sent to the Clinical Research Association for bacteriological examination:— Positive. Negative. Total. Swabs for virulence of Diphtheria organisms nil 2 2 Blood for presence of Typhoid organisms 2 4 6 Faeces for presence of Typhoid organisms nil 7 7 Faeces for presence of Dysentery organisms 17 3 20 Swabs for presence of haemolytic streptococci 1 5 6 Vaginal swabs for presence of Gonococci nil 8 8 Designated milks are sent to the Counties' Public Health Laboratories. The results of these examinations were:— Passed. Failed. Total. Tuberculin Tested Milk 29 8 37 Pasteurised Milk 20 3 23 13 Three samples of Pasteurised Milk and three samples of Tuberculin Tested Milk were submitted to the Laboratories for the presence of Dysentery organisms; all were negative. The Middlesex County Council is the Authority under the Sale of Food and Drugs Acts. Ambulance Facilities. The Council possess two ambulances, housed at the Fire Brigade Station, and the following figures, kindly supplied by the Superintendent, give some idea of the work carried out during the year:— Private cases 5,694 Accident cases 684 Maternity cases 108 Clinic (tonsil cases) 347 Special services 210 False alarms 9 Total 7,052 First aid was rendered on 248 occasions, whilst the resuscitating apparatus was in use 5 times. The bedside apparatus for the supply of oxygen was requested by 33 patients. With the increase in population, these two ambulances are in requisition to a greater extent—the corresponding figure for 1936 was 5,968. The total mileage of the vehicles was 44,162 miles. The Council's small bus conveys the deaf and dumb children to and from school, picks up a few other children in the morning, taking them to spot to meet the guide; also conveys school children to and from London railway terminii in connection with convalescent home treatment. Nursing in the Home. This has been fully described in previous reports. Hospitals. Infectious fevers are admitted into the Joint Enfield and Edmonton Isolation Hospital, situated in Enfield. Arrangements for the treatment of ear, nose and throat disorders amongst schoolchildren are made with the Prince of Wales's Hospital, Tottenham; ringworm is treated at, and ultra-violet light treatment given in, the North Middlesex County Hospital, Edmonton. Nursing Homes Registration. One maternity and two nursing homes are registered by the Authority, the Edmonton Council, and are kept under supervision by the Medical Officer of Health. No new application to be placed on the Register was received during 1937. 14 Section C. SANITARY CIRCUMSTANCES OF THE AREA. The information re water supply, rivers and streams and public cleansing has been given in previous reports. Work on the plans in connection with the Main Drainage Scheme is progressing This scheme provides for new trunk sewers in Town Road, Church Street, Victoria Road, and Silver Street, as far as Gloucester Road. The existing Southern and Northern Outfall Sewers will be picked up at Bounces Road and Gloucester Road respectively, and excess flows temporarily diverted to the existing sewers. The Southern Flood Relief Scheme was completed during the year and had operated successfully during heavy rainfall. A commencement has been made with the widening of Montagu Road, between Goodwin Road and Salmon's Brook, including the culverting of Sadlers Mill Stream. As in previous years the Council are directing their efforts to the development of open spaces and children's playing fields. During the year the following open spaces have been completed and opened : Bury Lodge Recreation Ground, Tatem Recreation Ground and the Children's Boundary Playing Field, while a start has been made with the Jubilee Park layout. The Galliard Road Estate of 128 houses has been completed and a commencement made with the "Slipes" Housing Scheme of 114 houses. The first house on this scheme was officially opened by the Chairman of the Housing Committee on the 18th September, 1937. Plans are in course of preparation for 354 houses on the Hoe Lane Estate, Enfield. I am indebted to the Borough Engineer and Surveyor for the information which he has supplied me. SANITARY INSPECTION IN THE AREA. Four District Sanitary Inspectors are engaged in the Sanitary supervision of the Borough, working under the supervision of the Senior Sanitary Inspector. The additional Inspector appointed in 1936 is now fully occupied with the increased duties that have fallen to this Department on account of the increase of population. The Housing Inspector carries on a general house-to-house inspection. The Woman Sanitary Inspector looks after Outworkers' premises, the sanitary condition of factories where women are employed, the investigation of notifiable infectious illnesses, including Tuberculosis. She also assists the Senior Sanitary Inspector in the supervision of women's public conveniences. The Senior Sanitary Inspector supervises the work of the Borough and is Inspector under the Canal Boats Acts. 15 The following tabular statement gives the number and the nature of the inspections made during the year:— Complaints 1686 Infectious disease 500 Tuberculosis 245 House-to-House 95 Factories 206 Workshops 25 Workplaces 10 Outworkers 204 Schools 15 Offensive Trades 84 Shops and Stalls 197 Shops Act (Primary) 71 Shops Act (Re-inspections) 21 Smoke Observations 48 Sanitary Conveniences, Urinals 882 Stables 18 Piggeries 28 Gipsies 39 Petroleum 144 General Inspections 658 Re-inspections 5751 Sundry Visits 1674 Cinemas and Halls 42 Visits to Canal 33 Inspections of Places where Food is Prepared. Butchers 259 Fish Shops 115 Coffee Shops 6 Ice Cream Shops 62 Dairies and Mllkshops 125 Slaughterhouses 120 Bakehouses 39 Number of Notices Served. Preliminary or Informal Notices 1406 Statutory Notices 299 Defects Remedied. Houses repaired, cleansed, etc. 762 D.W. Cisterns repaired, covered 20 Water Fittings repaired 58 Drains, examined, tested, etc. 200 Drains, cleared, trapped, repaired 216 Drains re-constructed 95 Chambers inserted 66 Chambers sealed down 15 Soil and Vent pipes repaired 40 W.C.'s repaired, cleansed, etc. 352 Flushing cisterns repaired 105 Waste pipes repaired, etc. 104 Sinks repaired or renewed 37 16 Roofs repaired 410 Gutters and R.W.P.'s repaired 262 Yards paved or repaved 186 Scullery floors repaired 65 Spaces under floors ventilated 55 Dampness lemedied 260 Floors repaired 141 Coppers and Stoves repaired, etc. 253 New dustbins supplied 218 Accumulation of refuse removed 47 Gipsies removed 39 Other nuisances abated 310 Rooms cleansed after infectious disease 9 Overcrowding abated 5 Sanitary Conveniences. There arc now five Public Conveniences in the Borough, which are kept under constant supervision by the Public Health Department. The Conveniences at Victoria Road and Sunken Gardens, Bush Hill Park, were opened during the year, and the Convenience at Angel Road re-sited. Up to the end of the year no commencement had been made with regard to the erection of two new Conveniences at Weir Hall and Tramway Avenue. Van Dwellers. These are now very rare in Edmonton, owing to the fact that the Borough is almost fully developed and very little vacant land is available. Offensive Trades. There are 37 businesses under this heading in the Borough, comprising 1 gut scraper, 1 fat boiler and 35 fish fryers and curers. With regard to the gut scraping factory referred to in my previous report, this was still receiving the attention of the Council at the close of the year. As the result of a High Court Action the occupier of the above factory was given 12 months to remove from the present site. Permission was refused to three applicants to carry On the trade of fish frying, and one applicant for rag dealing. Two applicants appealed to the Petty Sessions against the Council's refusal and the Court granted the appeals, thereby allowing them to establish the trade of fish frying. With regard to the refusal to the rag dealer, the applicant gave "Notice of Appeal." Pig Keeping. This business is rapidly disappearing in Edmonton, due to the absence of suitable sites. Rat and Mice Destruction Act, 1919. The Middlesex County Council is the Authority for this Borough under the Act, which places the responsibility upon the Occupier of the premises infested, but the Rat Destruction Officer of the County Council is always 17 The report from the Chief Officer, Public Control Department, County Council of Middlesex, is as follows:— "During the year the Council's Inspector of Rat Destruction paid 216 visits to rat-infested premises in Edmonton, and the work of rat destruction was continued by the County rat-catchers throughout the year at your Council's Sewage Farm and Refuse Dump." The Inspectors of the Public Health Department often examine the drainage of premises where it might be possible that the infestation is due to the defective house drainage system. Smoke Abatement. Considering the large number of factories in the Borough it is rarely necessary to employ any legal pressure as to smoke nuisance. Forty-eight observations were made during the year and six cautions were administered. Disinfection and Disinfestation. The following table gives some idea of the work carried out:— Number of journeys to collect bedding 288 ,, ,, ,, return ,, 275 Rooms disinfected after infectious disease 713 ,, ,, ,, Phthisis 191 ,, ,, ,, Cancer 32 Disinfestation carried out for vermin 228 Number of articles (bedding, clothing, etc.) disinfected after infectious disease 3,267 Ditto after Phthisis 841 Ditto after other illnesses 471 Articles of bedding, etc., destroyed 132 The Council distribute a disinfectant powder and fluid to residents who apply for the same at the Town Hall yard. During the year the applicants numbered 35,215, an increase of nearly 3,000 over last year. One hour daily is allowed for such distribution with the exception of Fridays and Saturdays. A Formalin Chamber is used for the disinfection of books, leather goods, etc.—articles that would be damaged by steam. The number of books and other articles thus disinfected was 297. In 1936 the Council agreed to the supply of Izal in half-pint tins to those applicants who desired it in lieu of the disinfectant fluid above referred to. Very little advantage was taken of this service, as only 318 applicants availed themselves of this disinfectant. Again there was a slight decrease in the number of cases of disinfestation for vermin, and it is to be hoped that this decrease will be maintained. Ten Council Houses and 121 other houses were found to be infested and the total number of rooms disinfested was 228, which includes 13 houses from which families were rehoused in Council houses—the disinfestation being carried out prior to removal. The whole of the work is carried out by the Department, the materials used being Block Disinfestators combined with the use of Insecticides such as Pyagra, etc. 18 Petroleum (Regulations) Acts, 1928 and 1936. During the year 14 new licences and 110 renewals were granted by the Council. The following is a list of particulars of quantities, etc., affected by these licences:— Petroleum spirit 348,300 gallons. Petroleum mixtures 5,495 ,, Carbide of calcium 1 ton 9 cwts. 19 lbs. The figures for petroleum spirit and mixtures again show an increase over those of last year. Mortuary. During the year 83 bodies were deposited in the Mortuary, 70 by order of the Coroner, and 13 for sanitary reasons. Canal Boats Acts. During the year 33 visits were paid to the canal and 15 boats were seen, but of this number, none were fitted or used as dwellings or registered under the Acts. Places of Public Entertainment. Forty-two inspections of cinemas and other places of entertainment were made in accordance with the Circular of the Ministry of Health of 1920. Conditions were found to be generally satisfactory. Nuisances. There were no summonses taken out against persons failing to comply with Notices served under the Nuisance Sections of the Public Health Acts. FACTORY AND WORKSHOP ACTS. The following work has been carried out under the Factory and Workshop Act: — 1—Inspection of Factories, Workshops and Workplaces. Premises Number of Inspections Written Notices Prosecutions Factories (including Factory Laundries) 206 20 .. Workshops (including Workshop Laundries) 25 1 .. Workplaces (other than Outworkers' Premises) 10 1 •• Totals 241 22 •• 19 2.—Defects found in the above. Particulars Number of Defects No. of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts- Want of cleanliness 29 28 .. .. Want of ventilation 1 1 .. .. Overcrowding .. .. .. .. Want of drainage of floors .. 1 .. .. Other Nuisances 18 16 .. .. Sanitary Accommodation Insufficient 1 1 .. .. Unsuitable or defective 59 60 .. .. Not separate for sexes 1 1 .. .. Offences under the F. & W. Acts- Illegal occupation of underground bakehouses .. .. .. .. Other Offences .. .. .. .. Total 109 108 •• •• 20 3.—Outwork in Unwholesome Premises. Nature of Work. Instances. Served. Prosecu- Notices tion. Wearing Apparel ' ArtSflowers' I I Nil' Hi. Nil. Brushmaking FACTORIES AND WORKSHOPS, ETC. Defects Remedied. W.C.'s and urinals cleansed ... ... ... ... 31 W.C. cisterns repaired ... ... ... ... ... 12 W.C. seats repaired or new fixed ... ... ... ... 23 Drains cleared ... ... ... ... ... ... 6 Drains re-laid ... ... ... ... ... ... 1 Sanitary accommodation extended ... ... ... 2 Ventilation improved ... ... ... ... ... 1 Accumulations of refuse removed ... ... ... ... 1 Limewashing ... ... ... ... ... ... ... 28 Roofs repaired ... ... ... ... ... ... 2 Inspection chambers inserted ... ... ... ... 1 Outworkers. During 1937 there were added to the register the names of 57 new outworkers; the total number on the register is 198. Schools. The exclusion of children suffering from infectious diseases and their contacts is dealt with in accordance with the Memorandum issued jointly by the Ministry of Health and the Board of Education. No schools were closed during the year on account of infectious diseases. Section D. HOUSING. Overcrowding. Work in connection with the Survey is still being carried out, and applications are still being received for "Permitted Number" Certificates, and in the majority of cases it would appear to affect houses sold, owneroccupied houses, sub-let, sold and re-let. Up to the end of the year the total number of houses dealt with for "Permitted Number " Certificates was approximately 9,000. The number of Notices served under Section 62 of the Housing Act for failure to insert "Permitted Numbers" in rent books was 66. The recording of measurements of rooms, etc., in different types of houses has entailed a considerable amount of work, and in order to keep the information already obtained in connection with the Housing Survey as up-to-date as possible it will be necessary to retain the services of the Housing Survey Clerk. Housing Act, 1936. There were no clearance areas dealt with during the year under review. Individual Unfit Houses. During the year, Demolition Orders have been made in respect of 5 houses and 7 have been demolished. The Council re-houscd the affected families. 1.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,742 (b) Number of inspections made for the purpose 5,478 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 90 (b) Number of inspections made for the purpose 95 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (4) Number of dwelling-houses (exclusive of those referred to above under the preceding sub-head) found not to be in all respects reasonably fit for human habitation1,158 2.—Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 862 21 3.—Action under Statutory Powers during the Year:— A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 114 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 112 (b) By Local Authority in default of owners 1 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 41 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 42 (b) By Local Authority in default of owners — C.—Proceedings under Sections 11 and 13 of Housing Act, 1936:— (1) Number of dwelling-houses in respect of which tion orders were made 5 (2) Number of dwelling-houses demolished in pursuance of demolition orders 7 D.—Proceedings under Section 12 of the Housing Act, 1936: — (1) Number of separate tenements or underground rooms in respect of which closing orders were made — (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit Section 9 of the 1936 Act. One hundred and nine Notices were served under this Section during the year, and in only one case was the Council called upon to executc the work owing to the default of the persons having control of the premises, although such authority was asked for in a number of instances. Section E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. There are no cowkeepers in the Borough. The number of milk retailers on the register at the end of the year was 77, of which 18 were added during the year. A total of 125 visits were paid to these during the course of the year. No contravention of the Milk & Dairies Order, 1926, has come to the knowledge of the Staff. With respect to the Milk (Special Designations) Order, 1936, samples of designated milks are sent to the Counties' Public Health Laboratories for bacteriological examination; the results are tabulated previously under "Laboratory Facilities." 22 Various licences were granted as under:— Primary. Supplementary. Pasteurised13 6 Tuberculin Tested21 4 Accredited — 1 34 11 Three of the above retailers bottle Tuberculin Tested milk and two firms pasteurise and bottle the milk on their premises. Supplementary licences are granted to milk retailers who live outside the Borough, but who sell milk in the Borough; the primary licence is granted them by the Authority of the area in which they reside. Meat and other Foods. 'The following is a list of the visits paid by the inspectors during the year:— Butchers' shops 259 Fish shops 115 Coffee shops 6 Ice-cream shops 62 Shops and stalls 197 Slaughterhouses 120 Bakehouses 39 Dairies and milkshops 125 The following carcases were examined during or shortly after slaughter:— Oxen 62 Sheep and lambs 228 Pigs 208 There are two slaughterhouses in the Borough (both licensed) and visits are made when slaughtering is carried on; the figures shown above are not very large, consequent upon the fact that the majority of the meat sold in this Borough is bought from the London markets. Slaughter of Animals Act, 1933. No application was received during the year for "Licence as Slaughterman " ; those at present in force were granted by the Council for a period of three years. Unsound Food. The following is the list of food surrendered for examination and retained as unfit for human consumption:— Carcase and organs of 1 pig. 2 boxes of dog fish. 1 box of cod fillets. 1 box of roe. 1 box of coal fish. ½ box of skate knobs. 4 ox livers. 6 tins of ox tongues. 6 bottles of plums. 1 barrel of vinegar. Veal and ham pie. Custard tarts. 23 Once again I record the willing assistance rendered by Mr. J. E. Hill, J.P., to the Public Health Department, when Orders of Condemnation and destruction of foodstuffs have been sought. Ice Cream. Premises used for the sale or manufacture of ice-cream must be registered in accordance with the provisions of the Council's Act of 1929, and such premises are visited periodically. No legal action was necessary against any of the vendors during the year. Sale of Food and Drugs Act. The Middlesex County Council is the Authority for the administration of this Act, and I am indebted to the Chief Officer of the Public Control Department for the following information, which relates to foodstuffs purchased in Edmonton. List of samples taken during 1937:— Taken. Adulterated. Milk 233 8 Butter 14 2 Brandy 2 — Gin 3 1 Hake 3 — Lamb's liver 2 2 Sheep's liver 4 2 Whisky 18 2 279 17 Number of prosecutions 2 „ „ convictions 2 Shops Act, 1934. The three items (1) ventilation, (2) temperature, and (3) sanitary conveniences, in connection with the shops which come within the sphere of the Sanitary Inspector's duties, have been dealt with. Ninety-two visits have been paid during the year, and in no case was it found necessary to evoke any legal action, the various items being dealt with by informal action only. Shops Acts. The Shops Acts Inspector submits a monthly report to the Public Health Committee, and the following is a short summary:— Visits to shops, licensed street traders, etc. 2,664 Number of contraventions 21 Proceedings were taken against 5 traders, and fines of 2 of 20s. each, 1 of 10s., 1 of 5s., and 1 of 4s. respectively were inflicted. Chemical and Bacteriological Examination of Food. The only examinations carried out by the Council are those for designated milks; these are sent to the Counties' Public Health Laboratories. The matter is discussed previously. 24 Nutrition. An effort was made during the year to survey the malnourished children at school, and it was found that more children were affected than was at first thought to be the case. There are so many things which present themselves for attention, that it is very difficult to do systematic medical work without further assistance, mere inspection of school-children is quite enough nowadays without the necessary following-up, and the carrying into effect of any recommendations that are to be made; in short, our medical and clerical staff still need to be further augmented. Section F. PREVALENCE OF INFECTIOUS DISEASE. Measles and whooping cough are still the predominant infectious diseases amongst young children; in fact, they seem to be a heritage in Edmonton. The incidence of diphtheria, although higher than last year, is still comparatively low, but in a few cases we seem to get a very virulent type. Scarlet fever is fairly prevalent, although low in comparison with the rest of the country, and mild in type. "Return" cases numbered nine, allowing for an interval of 28 days between a patient coming home from the Isolation Hospital and an inmate of the house going down. Smallpox. No cases of smallpox were notified during the year. Enteric Fever. Nine cases of this disease were notified during the year, as compared with 14 last year. Despite exhaustive investigation, we were unable to trace the source of infection. Immunisation against Diphtheria. The demand for immunisation against diphtheria continues; practically all the children brought for immunisation are under 10 years of age. The preparation used is T.A.F., and three injections are given at weekly intervals. Puerperal fever, puerperal pyrexia, and ophthalmia neonatorum are referred to later on, under the heading of Maternity and Child Welfare. Food Poisoning. This disease is notifiable in Edmonton, but no cases have been reported during the year. Rheumatism. A special rheumatic clinic was commenced during the year and, as forecast in my last Annual Report, the numbers discovered were high, so much so that we have a waiting list. Pneumonia. The number of cases of primary and influenzal pneumonia notified remains about the same, although it is felt that a number of cases still go without notification. 25 Infantile Diarrhoea. The death-rate per 1,000 live births for London as a whole was 12.0, whilst that for Edmonton was 7.5 as compared with 14.4 and 6.2 respectively last year. The following table gives the age incidence, etc., of those suffering from notifiable diseases, excluding tuberculosis, which is dealt with separately. Disease Total No. of Cases No. Removed to Hospital Deaths Under 1 year of age 1—2 years 2—3 years 3—4 years 4—5 years 5—10 years 10—15 years 15—20 years 20—35 years 35—45 years 45—65 years 65 and over Scarlet Fever 282 265 1 .. 4 10 16 20 122 45 29 24 9 3 .. Diphtheria 109 109 5 3 2 3 6 16 48 19 3 6 3 .. .. Enteric Fever 9 9 1 .. .. .. .. .. 2 .. 1 5 1 .. .. Puerperal Fever 8 8 2 .. .. .. .. .. .. .. .. 7 1 .. .. Puerperal Pyrexia 53 52 .. .. .. .. .. .. .. .. 4 41 8 .. .. Pneumonia 78 31 83 2 1 2 3 1 8 4 12 14 7 20 4 Erysipelas 45 23 .. 3 .. .. .. .. 1 .. 1 7 6 22 5 Cerebro-Spinal Fever 4 4 2 1 .. .. .. .. .. .. 2 1 .. .. .. Ophthalmia Neonatorum 20 18 .. 20 .. .. .. .. .. .. .. .. .. .. .. Acute Polio-myelitis 4 4 .. .. .. .. .. 2 1 .. .. 1 .. .. .. Dysentery 28 8 .. 2 .. 4 2 .. 8 2 1 4 1 3 1 It must be noted that the figures in the second column as being removed to hospital includes those already under treatment at a hospital—for instance, the North Middlesex County Hospital. This remark applies more particularly to the infections associated with parturition and include puerperal fever, puerperal pyrexia and ophthalmia neonatorum. The following table indicates the wards from which the various cases were notified:— Disease Bury Street Ward Church Streeet Ward Angel Road Ward Silver Street Ward North Middlesex County Hospital Other Institutions Total Scarlet Fever 77 39 58 85 19 4 282 Diphtheria 36 8 22 36 6 1 109 Enteric Fever 2 — 6 1 — — 9 Puerperal Fever 2 1 1 1 3 — 8 Puerperal Pyrexia 11 3 2 8 29 — 53 Pneumonia 23 9 19 25 1 1 78 Erysipelas 14 4 16 11 — — 45 Cerebro-spinal Fever 2 - — 1 1 — 4 Ophthalmia Neonatorum 3 2 1 2 12 — 20 Acute Polio-myelitis 1 — — 1 2 — 4 Dysentery 6 1 8 8 5 — 28 26 CANCER. The incidence of cancer relative to the various organs of the body is given as under:— Males. Females. Respiratory 15 — Œsophagus 5 1 Stomach 11 15 Large intestine 18 14 Genito-urinary 2 4 Breast — 10 Liver 3 1 Uterus — 7 Buccal cavity 5 — Other organs 12 2 71 54 PREVENTION OF BLINDNESS. Cases of ophthalmia neonatorum are promptly visited and, if thought necessary, are removed to St. Margaret's Hospital for treatment. No cases of blindness have arisen during the year due to this cause. TUBERCULOSIS. The following table gives details as to age and sex of new cases of tuberculosis, also deaths from the disease, this latter figure including the deaths of non-notified cases. Age Periods. New Cases Deaths Respiratory Non-respiratory Respiratory Non-respiratory M F M F M F M F Under 1 year .. .. .. .. .. .. .. .. 1— 5 years 1 .. 3 2 .. 1 1 2 5—15 „ 1 .. 4 2 .. .. 2 1 15—25 „ 17 15 3 4 7 13 2 1 25—35 „ 22 11 .. 2 8 7 1 .. 35—45 „ 15 5 .. 2 9 5 .. .. 45—55 „ 12 2 .. .. 13 1 .. 2 55-65 „ 4 .. .. 1 6 1 1 .. 65 years upwards .. 1 .. .. 4 1 .. .. Totals 72 34 10 13 47 29 7 6 In addition, 22 cases of pulmonary tuberculosis and 3 cases of nonpulmonary tuberculosis previously notified in other areas, moved into Edmonton. 27 The total number of names thus added to the register during the year excluding, of course, non-notified deaths, was:— Males. Females. New cases—Respiratory 72 34 „ „ Non-respiratory 10 13 Transferred cases—Respiratory 16 6 „ „ Non-respiratory 1 2 Totals 99 55 The cases dying of tuberculosis and not previously notified were:— Males. Females. Respiratory 3 3 Non-respiratory 3 3 There were thus 12 non-notified deaths out of a total of 91 persons registered as dying of tuberculosis. (Registrar's figures.) Regarding the non-notification of the above cases, there was no suggestion of wilful neglect or of refusal to notify. The non-respiratory forms of tuberculosis notified were:— Males. Females. Miliary 1 — Spine — 1 Other bones and joints 3 3 Meningeal 4 3 Glands 2 — Abdomen — 2 Kidney — 2 Breast — 1 Skin — 1 The Public Health (Prevention of Tuberculosis) Regulations, 1925, relate to tuberculous employees in the milk trade; whilst Section 172 of the Public Health Act, 1936, gives power to the Local Authority to remove to hospital certain cases of tuberculosis who are dangerous to other people. No occasion during the year has occurred in which it has been necessary to invoke these powers. Public Health (Tuberculosis) Regulations, 1930. The number of cases of tuberculosis on the register at the end of 1937 was:— Males. Females. Total. Pulmonary forms 266 192 458 Non-pulmonary forms 70 68 138 Totals 336 260 596 28 The corresponding figures at the end of 1936 were:— Males. Females. Total. Pulmonary forms 247 191 438 Non-pulmonary forms 68 61 129 Totals 315 252 567 Corresponding figures for previous years were:— Males. Females. Total. 1935 330 265 595 1934 339 281 620 1933 320 281 601 1932 363 284 647 1931 382 311 693 1930 381 311 692 1929 421 352 773 COUNCIL'S EMPLOYEES. During 1937 the Medical Officer of Health paid a total number of 212 visits to those employees who had been on the sick list longer than a fortnight and, when necessary, at fortnightly intervals. Of these 43 were "not at home," and 9 had already resumed duty. Visiting the homes of the employees seems to be a very futile occupation in so far as the patients are oftentimes either away convalescent, attending hospitals, or their private doctors when visits are made. In fine weather they are out in the parks, as they should be when convalescing. A good purpose is served, however, in so far as the Medical Officer of Health has an opportunity of seeing the actual circumstances under which the Council's workmen live. Nothing is done, however, in the shape of social work amongst these workmen, and it is to be regretted that this is so, and seems likely to remain so. Also during the year he examined 62 persons prior to their appointment to permanent posts. 29 MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor C. G. Lacey. Aldermen T. J. Harington, Mrs. M. M. Barkass, Mrs. E. A. Young, Councillors L. E. Berridge, W. H. Coleman, Mrs. E. M. Moss, A. W. Pearce, G. T. Tott, J. A. Ward. STAFF. D. Regan, B.A., B.Sc., M.B., Ch.B., B.A.O., D.P.H. (L'pool). I. McIntyre, B.A., M.B., B.Ch., B.A.O., D.P.H., Assistant Medical Officer of Health and Assistant School Medical Officer. Mrs. G. F. Fleetwood-Outram, M.B., Ch.B. (Glas.), Medical Officer, Maternity and Child Welfare. H. J. Seddon, F.R.C.S. (Eng.), Orthopædic Surgeon. R. Leslie Dodds, F.R.C.S., Consulting Specialist, Ante-Natal and Post-Natal Service. E. Underhill, L.D.S., R.C.S., Dentist. Health Visitor School Nurses (Combined Service). abde Miss A. Bintcliffe, Lady Superintendent, Health Visitor School Nurses. de Miss A. Naylor. bcd Miss V. Garrett. d Mrs. C. Boothby. bcd Miss J. Paterson. bcd Miss M. R. Hazelton. bd Miss M. Druce. acd Miss J. Anderson. bcd Miss R. Bullock. bcd Miss M. E. Bishop. c Miss A. Fahy (School Work only). Masseuse. Miss M. F. Cozens-Walker, Chartered Masseuse, Orthopaedic Clinic. (Part-time.) Municipal Midwives. d Miss F. G. Browne. d Mrs. A. J. Griffiths. cd Mrs. D. S. C. Gazzard. cd Miss D. L. Noakes. d Mrs. E. M. Sims. a Maternity and Child Welfare Committee. b New Health Visitors' Certificate. c State Registered Nurse. d State Certified Midwife. e Sanitary Inspector's Certificate. CLERICAL. Miss R. Saunders, Senior Clerk. Miss N. A. Eyres, 1st Assistant. Miss C. Churchley, 2nd Assistant. Miss V. Slater, 3rd Assistant. Clinic Workers. Miss E. Boyle. Miss A. Watson. Mrs. F. Chandler. 30 DAY NURSERY. cd Miss W. J. Vigar, Matron. f Miss E. A. Weller, Staff Nurse. f Miss E. Martin Assistant Nurses. f Miss D. Sawdon. c State Registered Nurse. d State Certified Midwife. f Certificate of Day Nursery Training. The year 1937 marks a year of progress. The Clinics already established in 1936 and the two extra Clinics, St. John's and St. Alphege Church Halls, have proved to be of immense value. The attendances at these two extra Clinics varied at first between 50 and 60 per session, but by the end of 1937 the average attendances were 80 per session. Taking into account the extra Clinics and the increased attendances, it can be readily seen that our Service is now more widespread and patronised by a greater number of mothers. On account of this it naturally follows that there is a demand for increase of Staff. It is the intention of the Council to establish yet another Clinic at Weir Hall, and other Clinics as the circumstances demand. It is also hoped at some future date to replace the Church Halls by permanent buildings, and permanent Clinics will allow a greater degree of welfare and propaganda work to be carried out. The Toddlers' question, which was scarcely touched a few years ago, is gradually receiving more attention, and the mothers are responding to the call in this direction. It is very important to impress upon the mothers the necessity of children over two years of age attending the Clinics, and it is no mean task to induce the majority to bring their children once they have reached the Toddler stage. The idea is still too prevalent amongst our mothers that once a child is walking it does not need any further attention, and this fact clearly shows the necessity for propaganda. The dental and orthopaedic work amongst the children is still very difficult, on account of the irregular attendances of the Toddlers. There is a tendency to an increase in the demand for the services of the dentists amongst the mothers and children, and in a short time we shall need another session in order to adequately perform these very important duties. We have more than once mentioned that quite a large percentage of the difficulties experienced in school dentistry is due to lack of attention during the pre-school child period. The proportion of visits to the homes this year are somewhat restricted, instructions having been issued to the Health Visitors that where they are satisfied that a mother is good and careful and regular in her attendance at the Clinic, there is not the same necessity to visit her home as there is in the case of the careless mother. More attention has been given to the latter type, but we are yet far from attaining perfection amongst a small number. It is often, however, the father who causes difficulty rather than the mother, and it is to be hoped that, with the addition of Staff, a Paternity and Child Welfare Service could be started in the Borough. We could introduce 31 this by circulating pamphlets through the medium of the Infant Welfare Centres for the information of the parents at home, otherwise in a workingclass district such as this it will be very difficult to get hold of the fathers. We have further increased our Ante-Natal Service, and the scheme of co-operation with the North Middlesex County Hospital (whereby mothers who intend to enter that Institution for their confinements can continue their Ante-Natal supervision in the Council's Clinics) has proved a great success. A Post-Natal Clinic has been established and, judging by the initial numbers, it appears likely to amply justify its existence. In both the Ante-Natal and Post-Natal Sessions the mothers are taking a greater and more lively interest in the work done, and this is indicated by the increased number of attendances made by each mother. We must, however, continue this good work to a greater extent and to more real perfection. The Consultant Service is now fully established, and not only do we find it of great benefit to the mothers attending our Clinics, but some of the general practitioners have also used it with good results. This Service has fully justified all the confidence placed in its establishment. The continuity of the Service throughout the holiday period is much appreciated by the mothers, and the attendances showed no decrease from that of ordinary periods during the year. The Nurses formerly employed for Education purposes only and now partly employed in Health Visiting, appreciate the Service very much, and we are of the opinion that the amalgamation will in time prove of great benefit to the children. Smaller districts have not yet been allocated to the Nurses, but it is hoped that these will be established in the near future, thereby giving more time to the Health Visitor to do her area thoroughly, with shorter distance to travel. On the 1st October, 1937, the first Midwives under the Midwives Act, 1936, took up their duties for the Council. Judging by the bookings and the results achieved, this Service shows indications of a very bright future. Some apprehension was at first experienced in this Service as it was something entirely new, but the work taken in hand and its accomplishment has justified its existence, and I think great credit is due to the Midwives employed by our Authority. The following information gives details of the Maternity and Child Welfare Clinics at the end of 1937:— (1) Ante-Natal Clinic at Brookfield House, Fore Street (adjoining the Town Hall). Three sessions weekly. (2) Child Welfare:- (a) At Brookfield House. Five sessions weekly. (b) At St. Stephen's Church Hall, Bush Hill Park. One session weekly. (c) At St. Alphege Church Hall, Tramway Avenue. Two sessions weekly. (d) At St. John's Church Hall, Dysons Road. One session weekly. 32 (3) Post-Natal Clinic at Brookfield House. One session weekly. (4) Dental Clinic at Pymmes Park School Clinic. One session weekly. (5) Orthopædic Clinic at Methodist Central Hall, Fore Street. Two sessions weekly. Births. The number of births notified during 1935, 1936 and 1937 were as follows:— 1935. 1936. 1937. Live births notified by midwives 2,101 2,300 2,462 „ „ „ doctors and parents 359 359 288 Stillbirths notified by midwives 98 107 109 „ „ „ doctors 10 9 6 Totals 2,568 2,775 2,865 These figures include births which have taken place in the North Middlesex County Hospital, both of Edmonton and non-Edmonton residents; excluding these latter, the notified births of Edmonton residents are:— 1935. 1936. 1937. Live births notified by midwives 1,051 1,114 1,142 „ „ „ doctors and parents 355 345 286 Stillbirths notified by midwives 42 39 37 „ „ „ doctors 10 8 6 Totals 1,458 1,506 1,471 Number of live Edmonton babies born in outlying Institutions:— 1935. 1936. 1937. 165 172 160 The following table includes births of Edmonton residents registered in other districts:— 1935. 1936. 1937. Male Female Total Male Female Total Male Female Total Live births 791 775 1,566 809 808 1,617 838 734 1,572 Stillbirths 30 22 52 31 24 55 26 20 46 Totals 821 797 1,618 840 832 1,672 864 754 1,618 VISITS PAID BY THE HEALTH VISITORS. The following tables will give details as to the visits paid by the Health Visitors during the years 1935, 1936 and 1937, but in the future the Ante-Natal visits might reasonably be handed over to the Midwives, and in this way the Health Visitors could be relieved for other visiting. It would in this way give the Midwife a first-hand knowledge of both the home circumstances of her patient and the patient herself. 33 These can be tabulated as follows:— 1935. 1936. 1937. To expectant mothers:— (1) First visits 216 5 461 (2) Total visits 320 14 586 Visits to children under 1 year:— (1) First visits 1,725 1,673 1,620 (2) Total visits 10,194 10,426 7,938 Visits to children 1 to 5 years 6,343 5,224 7,700 Infant protection visits to children 5 to 9 years 135 169 135 Grand Totals 16,992 15,833 16,359 Ante-Natal Clinic. This Clinic was held three times weekly, and the following are the figures for the last three years, showing a very encouraging increase in the work. 1935. 1936. 1937. Total number of sessions in the year 73 99 128 Number of prospective mothers 264 346 588* Total number of attendances 1,176 1,382 2,630 Number of consultations 719 1,088 2,479 Average number of attendances:— (1) Per session 16.1 13.9 20.54 (2) For consultation 10 11 19.36 *Included in this total are 198 cases referred from the North Middlesex County Hospital under the Scheme of Co-operation with that hospital. Post-Natal Clinic. This Clinic was started on October 8th, 1937, and it is therefore in its early days, but when firmly established will be a very valuable service. The figures from the 8th October until the 31st December, 1937, were as follows:— Number of sessions 11 Actual number of mothers who attended 26 Number of consultations 39 Average attendance per session 3.54 Specialist's Clinic. The Consulting Specialist made 20 visits during the year and saw 114 cases, making an average per session of 5.7. Child Welfare Clinics. There are five sessions at Brookfield House, one at St. Stephen's Church Hall, two at St. Alphege Church Hall and one at St. John's Church Hall. 34 The figures relating to attendances are:— Brookfield House. St. Stephen's. St. Alphege. St. John's. Number of sessions 241 50 94 46 New cases:— (a) Under 1 year 600 105 240 129 (b) 1 to 5 years 264 48 141 55 Attendances:— (a) Under 1 year 10,691 2,143 3,709 2,026 (b) 1 to 5 years 9,785 1,260 3,772 1,666 Total attendances 20,476 3,403 7,481 3,692 Doctor's consultations 4,416 847 1,755 845 Average attendances 84.96 68.06 79.58 80.26 The following comparisons of attendances with the years 1935 and 1936 will show the rapid increase in the attendances at the Infant Welfare Centres:— Total attendances at all clinics:— 1935. 1936. 1937. (a) Under 1 year 13,175 16,459 18,569 (b) 1 to 5 years 14,297 15,863 16,483 27,472 32,322 35,052 Orthopædic Clinic. The Clinic is held at the Methodist Central Hall, Fore Street, twice a week and the Surgeon visits once monthly. That this Clinic serves a useful purpose is shown by the following figures which deal with the work:— 1935. 1936. 1937. Number of sessions 95 98 87 New cases seen 154 144 149 Attendances:— Surgeon's days 444 480 390 Treatment days 696 704 659 Total attendances 1,140 1,184 1,049 In-Patient Treatment. Ten children were admitted to the Royal National Orthopaedic Hospital at Brockley Hill, Stanmore, during 1937, and of this number three were still away on December 31st, 1937. Four children, who were sent to Stanmore in 1936, were away in part of 1937. The average number of days during 1937 spent in Stanmore was 66.5 days. 35 Dental Clinic. This is held once weekly at the school dental clinic at Pymmes Park. Details of the work carried out there are:— 1935 1936 1937 Mothers Children Mothers Children Mothers Children Number of attendances 435 198 443 288 462 267 Total number treated 415 182 420 272 448 257 Fillings 30 39 41 38 42 5 Dressings 1 51 16 143 24 207 Scalings 13 — 10 — 7 — Extractions (number of teeth) Under gas 1,049 396 780 588 1,052 548 Local Anæsthetic 10 — 22 — 8 — Number of gas cases 241 141 197 195 256 185 Number supplied 28 37 27 (17 assisted by Committee). (13 assisted by Committee). (14 assisted by Committee). Municipal Milk Supply. The growth of this work has been very rapid during the past three years, and it should be placed on record that a far greater number of employed men, in receipt of low wages, are now able to obtain the help available from this Service for their wives and children. During 1937 the Council revised the Milk Scale, making it possible for all applicants who come within the Municipal Milk Scale to receive supplies free of charge. Details regarding the supply of milk to the recipients are:— 1935. 1936. 1937. Number of applications 2,104 2,214 2,779 „ recipients 2,027 2,101 2,667 „ pints granted at ¼ cost 31,297 6,454 2,583 „ pints granted free 53,006 82,929 110,455 Actual number of people who applied for milk 404 452 579 Number of expectant mothers who applied 48 75 117 Free Supplies of Dried Milk Foods, Cod Liver Oil and Malt, etc. 1935. 1936. 1937. Trufood — 48 1,554 Lactogen — 6 18 Cow and Gate — — 56 Ostermilk — — 5 Cod Liver Oil and Malt 2,304 2,504 2,826 Pure Cod Liver Oil — 119 383 Numol 1,068 800 1,168 Halycalcyne 60 17 46 Ferrofax 24 4 32 Glucose — — 728 Farex — — 70 Liquid Malt and Iodine — — 214 36 Convalescent Cases. Although this is at the present time a very small service it is an exceedingly valuable one to the mothers and children who are able to take advantage of it. 1935. 1936. 1937. Number of mothers sent 1 7 10 Number of mothers who took babies with them Children. 1 5 6 Number sent away through I.C.A.A. 7 9 7 Tonsils and Adenoids. Arrangements are made with the Prince of Wales' Hospital, Tottenham, for the operative treatment of tonsils and adenoids. The numbers treated were as follows:— 1935. 1936. 1937. 3 3 10 Home Helps. This service is gradually becoming more popular with the mothers as will be seen from comparative figures given below:— 1935. 1936. 1937. Number of cases where Home Helps were sent 9 18 27 Artificial Sunlight. This treatment is carried out at the North Middlesex County Hospital, and during the course of the year nine children received treatment and the report submitted from the Hospital Authorities was as follows:— 2 children improved and were discharged. 1 child improved and was sent convalescent. 2 showed signs of improvement and are still having treatment. 3 improved but were discharged as absentees. 1 attended five times only and was discharged as an absentee. The average gain in weight was 1 lb. 7⅓ ozs. INFECTIOUS ILLNESSES. Ophthalmia Neonatorum. Twenty cases were notified during the year and of this number 16 cases were in the North Middlesex County Hospital, 4 of which were Edmonton cases. Two other women were sent to St. Margaret's Hospital, and the mother and baby in each case was an inmate for 22 days. Puerperal Fever and Pyrexia. Sixty-one cases were notified during the year and of this number 52 were notified from the North Middlesex County Hospital, 22 of which were Edmonton cases. Six cases were sent to the Queen Charlotte's Hospital, one mother was admitted on the 31st December, 1936, and was away during 1937, and one mother was admitted to the North Western Isolation Hospital. Seven of the mothers made a complete recovery, but it is with very great regret that the death of one mother must be reported. The Council have very good reason to be proud of this service, as such prompt and skilled treatment has in nearly all instances saved the lives of our mothers. 37 The 8 patients sent by the Council were inmates for the following periods:— 1st Mother.—6 days. 2nd Mother.—19 days (died in hospital). 3rd Mother.—21 days. 4th Mother.—9 days. 5th Mother.—19 days. 6th Mother.—15 days. 7th Mother.—9 days. 8th Mother.—21 days. MIDWIFERY AND MATERNITY SERVICES. The Borough Council are the Local Supervising Authority under the Midwives Acts for their area. Dr. Outram carries out the duties of inspection of Midwives and Nursing Homes. The 13 midwives resident in Edmonton area were inspected quarterly and at each visit it was found that everything was in order. The Nursing Homes in the district were similarly found to be conducted in a satisfactory manner. The number of claims made by doctors for medical aid during 1937 was 131, and of these 55 came under the scale for financial help from the Council. On October 1st, 1937, the Council commenced their Municipal Midwifery Scheme, when 5 Midwives were appointed. A total of 72 cases were taken over by the Council from the 3 Midwives resident in the district, but ot' these 3 cases had their babies prior to the 1st October. In addition to the above, 93 cases were booked in the Office between the inauguration of the Scheme and December 31st, 1937, Of the total cases 8 finally went into the North Middlesex County Hospital and 3 removed from the district, so that the fees were refunded in each case. The actual number of confinements attended by the Municipal Midwives between October 1st and December 31st was 67 as Midwives and 7 as Maternity Nurses. DAY NURSERY. The Day Nursery was open for the whole year with the exception of Bank Holidays and one week during August. During the latter period the necessary repairs and alterations to the Nursery were carried out. Dr. Outram pays weekly visits to the Day Nursery to advise the dietary of the children. The attendances of children for three years were as follows:— 1935. 1936. 1937. Whole-day 5,769 6,490 5,453 Half-day (Saturdays) 348 484 369 Resident children admitted during year 22 13 27 38 INFANT LIFE PROTECTION. Each of the Health Visitors employed by the Council is an Officer for Infant Life Protection, and great care is taken by them in surpervising this part of the work. A considerable amount of time and trouble is frequently taken in order to be satisfied about some of the more difficult cases, especially those who migrate from district to district. The number of persons on the register at the end of 1937 was 53 and the number of children 56. BIRTH CONTROL. There is no Birth Control Clinic in Edmonton, but an arrangement has been made to send Edmonton women to the Royal Free Hospital at a cost to the Council of 7/6 for two consultations. Only women coming within the meaning of the Ministry of Health's Circular 1108 may be referred by the Medical Officer to the Hospital. During the year 19 such patients were sent and of these 9 had free advice and the remainder were in a position to pay for their own expenses. 39 Education Committee. 1937. Chairman Councillor T. H. Joyce. Vice-Chairman Councillor T. J. Harington, J.P.* Councillor Mrs. M. M. Barrass.* „ Mrs. E. M. Hearn. „ Mrs. F. Long, J.P. „ Mrs. E. M. Moss. „ Mrs. H. Nicholson. „ Mrs. A. E. Young.* „ G. E. Albon. „ W. Bales. „ W. A. Edmunds. „ A. J. G. Hollywood.* „ C. E. Lacey. „ W. F. Middleton.* „ W. Preye.* „ J. Reid.* „G. T. W. Tott. * Appointed Alderman 9th November, 1937 Whole-Time Medical Staff. D. Regan, B.A., B.Sc., M.B., Ch.B., D.P.H. (L'pool), School Mcdical Officer, Medical Officer of Health and Supervisor of Maternity Services. Mrs. M. E. Dalby, M.B., B.S. (Lond.), D.P.H., Assistant School Medical Officer. I. G. McIntyre, B.A., M.B., B.Ch., B.A.O., D.P.H., Assistant School Medical Officer and Medical Officer of Health. Whole-Time Dentists. J. F. Ardouin, L.D.S., R.C.S., Senior Dentist. E. Underhill, L.D.S., R.C.S., Assistant Dentist. C. E. Godfrey, L.D.S., Assistant Dentist. Consultants. H. J. Seddon, F.R.C.S. (Eng.), Orthopædic Surgeon. Miss L. Smith-Clark, M.B., Ch.B., Ophthalmic Surgeon. J. Browning Alexander, M.R.C.P , Rheumatic Specialist. (Commenced November, 1937.) W. Ibbotson, F.R.C.S., Aural Specialist. (Commenced December, 1937.) 40 Part-Time Staff. E. H. S. Bebb, M.R.C.S., L.R.C.P., Anæsthetist. Miss M. F. Cozens-Walker, Chartered Masseuse. A. D. Bradfield, Speech Correction Instructor. (Deceased May, 1937.) Miss B. N. Oldrey, M.S.S.T., Speech Therapist. (Commenced August, 1937.) School Nurses and Health Visitors. Miss A. Bintcliffe (Lady Superintendent). Miss A. Fahy. Miss M. Hazelton. Miss M. Bishop. (Commenced March 1st, 1937.) Miss V. Garrett. Miss A. Naylor. Mrs. C. Boothby. Miss J. Paterson. Miss M. Druce. Miss R. Bullock. Miss J. Anderson. Dental Assistants. Mrs. C. Tonkin. Miss O. Brooks. Miss C. E. Stanbridge. Clerical Staff. B. R. Allen, School Medical Clerk. Miss E. Service, Clerk. (Resigned July 31st, 1937.) Miss N. Humphries, Clerk. (Resigned December 11th, 1937.) H. A. Carless, Junior Clerk. Miss C. Logsdon, Clerk. (Commenced August 16th, 1937.) To the Chairman and Members of the Edmonton Education Committee. Ladies and Gentlemen, I beg to submit my Third Annual Report on the work of the School Medical Service during the year 1937. It is drawn up in accordance with the wishes of the Board of Education and the sections of this report are numbered to correspond with the Board's Schedule to Form 6M, in which it is suggested that where the arrangements under any of the various headings which have been described in previous reports remain unaltered, it would be unnecessary, as far as the Board are concerned, to repeat such information, but to state that no alterations have been made. A comparison with previous years has been entered, where considered necessary, for information. 1. STAFF. The staff has now been amalgamated and arrangements are being slowly proceeded with in order to accomplish this with the least possible inconvenience to the execution of duties. It will be necessary to add yet another officer to the School Medical Staff as the County Medical Inspections will be taken over by the department from the 1st January, 1938, and this will also make possible a more thorough inspection of 4he elementary schoolchildren. There are approximately 13,500 children in the elementary schools and some 1,500 pupils in the secondary schools, with quite a large percentage need "following-up." In order that the School Medical Service should be in no 41 way lacking it will be necessary for a more thorough and complete medical inspection to be given and this will necessarily mean more "follow-up" cases. The parents and children seem to appreciate this service very much as is indicated by the now fairly high percentage of parents who attend the medical inspections. Owing to the special services that have been introduced it may be necessary before long to increase the nursing staff. It is rather a pity that a central clinic has not been developed for Edmonton. 1 would like to point out here that the more clinics that are established the more officers are required, and I think it is a grave mistake in the case of the School Medical Service to be establishing a large number of clinics. The special services suggested in 1936 have been put into operation this year and Mr. Ibbotson, Senior Consultant Specialist in the Ear, Nose and Throat Department of the Prince of Wales's General Hospital, began a monthly Aural Clinic in December, 1937. Dr. J. Browning Alexander, also of the Prince of Wales's General Hospital, began a monthly Rheumatic Clinic in November, 1937. Unfortunately the need for these services was so great that it was necessary to form a waiting list and gradually bring the cases for treatment. As the work is necessarily slow during these sessions, it will take quite a long time to exhaust the numbers already on the list for consultation. It is a great advantage that the officers appointed are consultants at the same hospital and that it is within easy reach of Edmonton. In this way difficulties which are common to both specialists can easily be treated in the hospital. It will be necessary for contact to be made with a hospital school as it has been found necessary to exclude children for long periods from school. I have no doubt that these services, both rheumatic and aural, will, in time, give very good results to Edmonton, and that the number of severe heart cases now in existence will, in the near future, diminish. I regret that Mr. Bradfield, our Speech Correction Instructor, died during the year. Miss B. N. Oldrey, who is also attached to the staff of the Prince of Wales's General Hospital, was appointed in his stead. A thorough search of the schools was made for children requiring speech correction and the large number of 135 are now on the list—most of them are now under instruction. I am hoping, in the ensuing year, to have this service extended to the Maternity and Child Welfare Department so that correction will begin much earlier, because it is in the early days of speech that most of the defects develop into habits. We are at present forming a very successful combination between the aural specialist, the speech therapist and the London Child Guidance Clinic. The results that have been made at this early stage are most encouraging and it is to be hoped that greater benefits will be derived later on. Miss M. Bishop was appointed to the permanent staff at the beginning of the year. During the year the Misses E. Service and N. Humphries left the service to get married and I wish them every happiness in their future life. Miss C. D. Logsdon was appointed in the place of Miss Service and commenced duties on the 16th August, 1937. 42 2. CO-ORDINATION. Co-ordination of the School Medical and Maternity and Child Welfare Departments is somewhat in the same position as last year. Use is still being made of the Sanitary Inspectors who put right the items that are found wanting by the Nurses in the discharge of their duties. The work is bearing good fruit. The minor ailments clinics, both at Pymmes Park and Croyland Road, leave much to be desired. The arrangements at Pymmes Park could not be arranged in a better way to take up the time of the officers. The facilities at the disposal of the officers, which we are trying to remedy, could not be worse than they are and it is to be hoped that some new arrangement will be made by the Education Committee for the treatment of the children. There is no doubt that the lack of space devoted to both clinics to the numbers of children who attend is fraught with great evil to the children and also to the officers. Crowded together in such a small space it is impossible, first of all, for the officers to avoid infection. As a result they become ill and are absent from duty. In the second, place the children who attend are bound likewise to infect one another, particularly in the case of impetigo. Attempts have been made to give each school a set time but, with 150 to 180 children crowded into each session with a waiting-room of not more than 12 by 14 feet, it can readily be understood the difficulties that confront our service. It is to be hoped, therefore, that drastic changes will be made in the accommodation, not only for clinics but officers, within the very near future. The Hazelbury Dental Clinic (originally intended for a period of six months) has now reached its second year and so far little effort is being made to replace it with a large modern dental clinic. This room was intended in the first place for a store-room for the Hazelbury School. Let us hope that when the Committee are aroused to the necessity of building, they will, in future, build clinics worthy of the name. The Croyland Road Clinic, which is relatively new (being built in 1928), has a waiting-room space that could not have been considered seriously as such. In the past the consulting-room and treatment-room were in one, and the mother who attends with her child has, of necessity, to consult the doctor in the presence of nurses, patients and other parents. It is to be hoped that in the case of this clinic, the conscience of the Education Committee will be roused to give to the parent of the humble schoolchild the same facilities that they themselves would expect from their private practitioners. 3. SCHOOL HYGIENE. The greater proportion of the schools in Edmonton are well-built, but it is to be regretted that even in the most modern the establishment of a medical room has been reglected and the staff are forced, in the discharge of their duties, to carrry out medical, dental and head inspections, in a school that is not yet two years old, in a store-room. In some instances head inspections are carried out in open corridors; in other schools in the class-room behind blackboards, and in nearly all cases without heating. I would like to draw attention to the sites of these schools and their relationship. At the present time I come across children attendng one school and they actually pass another school. Evidently no attention was given to the choice of site. Great hardship is given to many children and some parents because of this arrangement. We have yet in our midst older schools that sadly need alteration and extension, but we are satisfied to put up with the difficulties in the older school but it should not be necessary in the case of modern schools. 43 Improvements in the schools- or in the school environment have been noted year by year in previous reports and I am indebted to the Director of Education Committee for the appended report regarding the improvements which have taken place during the year 1937. Improvements carried out at the Schools during the Year 1937. Redecoration of Schools.—Silver Street, Croyland Road Girls', Raynham Road Domestic Subjects Centre. Installation of two Central Heating Boilers at Eldon Road. Resurfacing Playgrounds, Eldon Road Girls' and Infants'. Hot Water Heating Installation, Raynham Road School. Installation of Electric Lighting, Eldon Road School. Erection of Open Air School in hand. 4. MEDICAL INSPECTIONS. Unfortunately, the whole-time Assistant School Medical Officer and Medical Officer of Health, suggested last year, has not yet been appointed and we cannot, therefore, embark upon a more effective scheme of medical inspection until this is accomplished. Because of the lack of staff in the past omissions have become almost the rule, and it is not easy to tear ourselves away from slovenly and careless methods. I would like here to thank the teaching staff for the co-operation which they give us at the inspections. Medical inspections have been carried out as in former years, but I am far from satisfied with the thoroughness of the scheme in relation to the "following-up" of cases. It is to be regretted that the facilities at the schools are not adequate and they should be dealt with during the ensuing year. 5. FINDINGS OF MEDICAL INSPECTION. (a) Malnutrition. We are still suffering in our feeding centres from the lack of expert attention to the cooking of food, and this is leading to some complaints on the part of parents for their children to take the food. It is, however, the intention of the Committee to appoint a Cook-Manageress, with expert knowledge in the cooking, at a central kitchen, from which meals will be supplied to the new oper-air school and the feeding centres. (b) Uncleanliness. During the year a determined effort was made to cleanse children, and I regret that thorough investigation has proved that the "unclean" child is still among us. This has necessitated the re-opening of the cleansing station, but I am happy to now be able to say that the mothers affected are taking more interest in the cleanly state of their children. There are, however, some who still think that the School Medical Service exists solely for carrying out the work which they themselves neglect, and it is the intention of the Committee to have such parents summoned. I hope that this course will not be necessary, but if it should, I consider it should be rigorously applied. 44 (c) Minor Ailments and Diseases of the Skin. Impetigo has caused a great deal of trouble in some schools. It is now the rule that any child suffering from active impetigo is to be excluded from school during the period whilst the child is so affected. Attention to this complaint, as in other medical matters, has borne good fruit, but the numbers who attend our clinics are so large that it may be necessary to adopt some other procedure in treating the children. A very significant fact is the drop in attendances during the school holidays. It would give the casual observer the idea that a good deal of the attendances at the clincs could be avoided. (d) Visual Defects and External Eye Disease. Dr. Smith-Clark (Ophthalmic Surgeon to the Committee) has kindly supplied me with the following report:— "The Ophthalmic Clinic has continued progress which has characterised it during the past ten years. The parents appear to be taking an everincreasing interest in their children being treated by it, and are attending in increasing numbers. They are now beginning to recognise that headaches and "nervy" children are amenable to treatment of the eyes. There is an increase in the number of accident cases, as the parents seem to be inclined more and more to bring their children to the Clinic instead of taking them to the Hospital. From the point of view of ophthalmic treatment the Convalescent Homes are of great importance. "Otherwise, I have very little material to add to my report of last year." (e) Nose and Throat Defects. The Aural Clinic, with Mr. Ibbotson in attendance, was started in December, and it was found necessary at the outset to have a waiting-list. The parents appreciate the work done, and are very apt to partake of the services offered. It is to be hoped that these services will reduce the number of otorrhœa and slight defects of hearing, so prevalent amongst our school population. The Speech Clinic has been re-organised, and was re-opened on September 6th, 1937. Classes are being held twice weekly, and up to the beginning of the Christmas holidays 30 sessions were held, with a total 572 attendances. One hundred and thirty-three cases were recommended for treatment by the various head teachers; of these the Speech Therapist has seen 103 children and, with only two exceptions, either or both parents. A full history has been taken, a report obtained from the school and a diagnosis made. Where necessary recommendations have been made for medical or psychological treatment to be carried out before the child attends for regular speech therapy. It is hoped to see the remaining cases before Easter. Thirty cases were accepted for immediate treatment, and were grouped as follows: Senior stammerers (boys, average age, 12), 8; junior stammerers (severe type), 7; junior stammerers (less severe type), 6; retarded speech, 3; defective breathing and palatal weakness, 2; special cases for individual treatment, 4. Owing to pressure of time due to the inevitable number of new cases it has not been possible to give the children as much individual 45 attention as the speech therapist deems advisable, and the work has been carried out mainly in groups with, in the case of stammering, an average of seven children in each group, the treatment lasting about 40 minutes and being given twice weekly in severe cases and once weekly in slighter cases, but, in addition to the first interview, each child has had at least one individual treatment during the term. It is hoped later to arrange that each case is seen individually at least once a month and more often if necessary. The mothers of the younger children have frequently accompanied them to the clinic, and the therapist has found them very anxious to co-operate by helping the children as much as possible between clinics with, in many cases, most encouraging results. Two stammering and one retarded speech cases have been temporarily discharged as cured, in all three cases a second report being first obtained from the school. It is proposed to follow up these cases by asking them to attend the clinic at intervals of four months during the current year. The speech therapist is most anxious that there should be close cooperation between the clinic, the school medical services, the parents and the teachers, and with that end in view she hopes that later it may be possible for her to see the parents and teachers of all defective speech cases at regular intervals. (f) Ear Diseases and External Eye Disease. There are still a large number of children suffering from otorrhoea. It is to be hoped that, with the specialist's attention at the aural clinic, these cases will decline. A goodly number is due to lack of attention to the tonsils in the "toddler" stage. (g) Dental Defects. A better effort was made during the year to cope with the large number of dental cases and in time a better standard of dental hygiene will be established, but this can only be achieved by persistent hard work, as the number of defects amongst Edmonton school children are relatively high. A great deal of the difficulty occurs amongst the entrant group, which indicates that the Maternity and Child Welfare Department will have to become more thorough in their investigation and treatment of dental caries. (h) Orthopædic and Postural Defects. The orthopaedic clinic is held at the Methodist Central Hall, Fore Street, Edmonton, N.9; the surgeon attends on the first Friday of each month, and the nurse-masseuse on Tuesday, Wednesday and Friday each week. Operative treatment is carried out at Stanmore, the Country Branch of the Royal National Orthopædic Hospital. The number of individual children treated during the year again shows a heavy increase. The totals for the last four years are given for comparison:— 1934 175 1935 220 1936 275 1937 303 46 The total attendance during the year was 2,416—1,395 boys and 1,021 girls. During the year 111 new cases were examined, and these have been analysed by Mr. Seddon. The tabulation is set out below, together with a report on the work of the clinic during the year. "The work of the schools section of the Orthopaedic Clinic during the past year has been remarkable in two respects: the small number of new patients seen, and the large number, 22, admitted to Hospital. "The second group illustrates well one of the features of orthopaedic treatment that is not generally appreciated. Most people imagine that a condition requiring operative treatment is dealt with in hospital as soon as the diagnosis has been made. This is true in the majority of general surgical conditions, but it is far from being the case in orthopaedics. Infantile paralysis affords the best example of the need for delay before operative treatment is undertaken. Let us suppose that a child suffers from this disease at the age of four, and one leg is affected. The appropriate treatment is given, but it is found that recovery is incomplete. The deficiency can, however, be remedied by operation; but it is necessary to wait until the bones of the foot are sufficiently developed to permit of an operation being performed without interfering with the growth of the foot. Meanwhile an instrument has to be supplied—until the child is eleven or twelve years of age. Thus there may be an interval of six years or more between the onset of the condition requiring treatment and the final operative correction. "This means that the number of admissions to hospital may bear little relation to the number of new patients seen during the same year. Many of the children requiring operative treatment are legacies from earlier years. This was the case last year. "Continuity of observation and treatment is of the first importance in the successful handling of crippling defects, and this is where the clinic system is invaluable. Thanks to the Child Welfare and School Medical Officers, there is every prospect of a defect being recognised at an early stage. The health visitors and clerical staff enable us to keep in continual touch with our patients, and the principle of working with one hospital ensures continuity of supervision and treatment. The great fault, however, is that this almost ideal state of affairs comes to an end abruptly when a child leaves school. The restriction is a legal one, but it is not recognised by a number of the more important conditions, particularly scoliosis and infantile paralysis, that we are called upon to treat. It is important that we should not lose sight of a certain small proportion of our patients after they have left school, and I am glad to report that the Medical Officer of Health has given me permission to keep in touch with such cases through the clinic for as long as may be necessary. "It is to be hoped that more inclusive legislation, similar to that covering the treatment of tuberculosis and the acute specific fevers, may one day be available for cripples, actual and potential, irrespective of their age, or if school children, the type of school they attend." 47 Girls. Boys. Congenital Defects 11 12 Birth Injuries 2 — Rickety Deformities 1 — Knock-knees (non-rickety) 1 5 Postural Defects of the Spine 11 13 Structural Curvature of the Spine — 1 Flat Feet 19 9 Infantile Paralysis 1 1 Sequelae of Acute Fevers — — Fractures 1 2 Tuberculous Joints — 1 Other Bone Diseases — 3 Osteomyelitis — — Other Conditions 1 7 Non-Orthopaedic 6 3 54 57 Total 111 (i) Heart Disease and Rheumatism. A special rheumatic clinic, mentioned in my last report has been established. It is too early to say what the effect of this clinic will be on a disease, the progress of which depends so largely on early diagnosis. So far we are only dealing with "late" cases, and it is to be regretted that in this department again we have a long waiting-list. The success of this clinic will depend largely not so much on diagnosis at the clinic as treatment and the co-operation of the parents. We find it very difficult to bring home to the parents the necessity of continuous vigilance as well as treatment. Our usual experience is that when the child is capable of getting up and attending school there is no necessity for any further treatment. In rheumatic heart disease of children this is far from being the case and a great deal of "following-up" and propaganda is necessary in this department. (j) Tuberculosis. An excellent system of co-operation exists between the Tuberculosis Office and School Medical Department, inasmuch as any cases, definite or suspected, which need investigation are immediately referred for investigation. I am grateful to Dr. Evans for the courtesy that is extended to the department at all times. The following information, taken from the records of the Public Health Department, gives the number of notified cases and the mortality of children of school age during 1937:— Notified. Deaths. M. F. M. F. Pulmonary 1 — 0 0 Non-Pulmonary Forms 4 3 1 1 (k) Other Defects and Diseases. In my previous report 1 drew the attention of the Committee to a rather peculiar spinal deformity which I found amongst Edmonton school- 48 children. I have mentioned this matter to the physical training instructors who are responsible for the area, and I am glad to be able to say that a good deal of the more marked cases are showing definite improvement. 6. FOLLOWING-UP. A good deal of following-up has been carried out during the year, but it is yet far from thorough and we are not making the progress with regard to the treatment of these cases which should occur in a thorough school medical service. Physically defective cases are being slowly weeded out and an effort is being made to have some of the more suitable cases taught trades. It is to be hoped that before the end of the ensuing year a complete schedule of these cases will be receiving treatment from one source or another. 7. ARRANGEMENTS FOR TREATMENT. The large number of children attending the clinics and the increase in the number of the clinics have taxed the nursing staff to its utmost capacity. There are two minor ailments clinics in Edmonton, but a doctor is not always in attendance, and I am of opinion that this is fraught with danger in leaving so much responsibility on the shoulders of the nurses. Although arrangements have been made for artificial sunlight treatment, it is to be regretted that we have not yet had the necessary apparatus provided. This is partly due to lack of suitable premises. 8. INFECTIOUS DISEASES. The arrangements made to deal with children suffering from infectious diseases is the same as in previous years. 9. OPEN-AIR EDUCATION. The Open-Air School is on its way to completion and will be open early in the new year. The service of this school is long overdue, and I am sure it will prove of much value to the mal-nourished child, not only from the point of view of returning him to normal health, but, what is more important, establishing a " way of life " for the child which will tend to better circumstances in his health. As often as possible classes are held in the playgrounds, and it is remarkable to see how the children pay strict attention to their classes, even in the midst of distraction. Some 80 children were sent to residential convalescent homes during the year and the remarkable improvement in weight and height in a short period is surprising. I have visited some of these homes, and am pleased to be able to say that the conditions and treatment are excellent. The interest the children take in the subjects taught to them is an indication of their return once again to sound health. The Director to the Education Committee has kindly supplied details regarding camp journeys which our children have gone during the year, including the cost to the Committee, etc. 49 SCHOOL CAMPS, 1937. School. Place and Date. Number of Children and Teachers. Estimated cost per Child. Estimated cost per Teacher. Hoys. £ s. d. £ s. d. Eldon Road Ryde, Isle of Wight. 13-23 July 40 (2) 2 0 0 3 13 6 Croyland Road 40 (2) Silver Street 20 (1) Latymer Elem 20(1) Raynham Road Weymouth. 16—20 July 40 (2) 2 5 0 4 2 0 Montague Road Llanfairfechan, N. Wales. 9-16 July 40 (2) 2 10 0 4 0 0 Girls. All Saints Weymouth 40 (2) 2 5 0 3 13 6 Eldon Road Sandown, Isle of Wight. 8-18 June 40 (2) 2 0 1 2 6 7 Hazelbury Senior Isle of Wight, or Littlehampton. 9-19 July 40 (2) 2 0 0 3 13 6 Raynham Road Sandown, 40 (2) 2 3 6 3 13 0 St. james's Isle of Wight. 21 June-1 July 40(2) Higher Grade Penzance. 29 April-8 May 40 (2) 2 15 0 3 0 0 Total Cost of above:—Children, £954 3s. 4d. ; Teachers, £78 4s. 2d.—Total, £1,042 7s. 6d. As last year, the Committee made a uniform grant of 15s. per pupil towards the cost and accepted full liability for the travelling and maintenance expenses of the Teachers-incharge. On this calculation the total cost of the above journeys to the Committee was £408 4s. 2d. 10. PHYSICAL TRAINING. Nothing further can be added to the 1936 report on this subject. ARRANGEMENTS FOR TREATMENT. Treatment is carried out directly at the following school clinics:— Minor Ailments. Pymmes Park Clinic: Situated in Upper Edmonton, daily from 9a.m. to 1p.m. (Sat., 9—12), with a doctor in attendance. Croyland Road Clinic: Situated in Lower Edmonton, daily from 9a.m. to 1p.m. (Sat.,9—12), with a doctor in attendance on Tuesday, Thursday and Saturday. Denial Clinics. Dental Clinics arc situated at Croyland Road, Pymmes Park and Hazelbury School, and are held daily between the hours of 9a.m. to 1p.m. and 2 to 5p.m. (Sat., 9—12). 50 Ophthalmic Clinic. At Pymmes Park House every Monday (two sessions), with additional sessions for secondary school children as required. Orthopaedic Clinic. The Orthopædic Clinic is held at the Methodist Central Hall, Fore Street, Edmonton, N.9. The Orthopædic Surgeon attends on the first Friday of each month, and the Nurse-Masseuse on Tuesday, Wednesday and Friday of each week. Aural Clinic. The Aural Clinic is held at the Croyland Road Clinic in the afternoon session on the second Thursday of each month, with Mr. Ibbotson in attendance. Rheumatic Clinic. Dr. Browning Alexander attends the Rheumatic Clinic, which is held on the third Thursday of each month at the Croyland Road Clinic. Speech Clinic. Miss Oldrey (Speech Therapist) is in attendance at this clinic, which is held at the Education Offices, Brettenham Road, Edmonton, N.18, every Monday (2—4 p.m.), Wednesday (9.30—11.30 a.m.), and Thursday (2—4 p.m.). MINOR AILMENTS CLINICS—ATTENDANCES. Total attendances for 1937 were:— Pymmes Park Clinic 22,820 Croyland Road Clinic 19,990 CO-OPERATION OF TEACHERS, PARENTS, ETC. This was fully described in the Report for the year 1932, and no alterations or additions are necessary. The co-operation of the head teachers is always willingly given, and is a necessity if the School Medical Service is to realise its fullest value to the child. PROVISION OF MEALS. The arrangements for the provision of meals are the same as those described in previous years. The number of free dinners provided during 1937 was:— At Houndsfield Road Centre 37,238 At Pymmes Park Centre 30,814 Total 68,052 The total number of individual children fed was 367. 51 In April, 1937, the Committee took over new premises at Houndsfield Road. This consists of the ground floor of a building erected by the Council for use as a Feeding Centre and Branch Library. The Branch Library is on the first floor. The amount of Grade "A" T.T. milk provided free was 12,034 pints, whilst 1,909 pints were paid for by parents. EMPLOYMENT OF CHILDREN. Dr. Dalby examines children who apply for permits under the Bye-laws. The Secretary has kindly furnished me with details of the work carried out by the Committee under the Children and Young Persons Act, 1933. Children and Young Persons Act, 1933. Children in Entertainments— Number of Licences applied for and granted 9 Employment of Children— Number of Employment Permits applied for 51 Number of Children examined by Assistant S.M.O., and Permits granted 48 Number of Applications for Permits refused 3 (Under age, working in other areas, etc.) Warning Notices to Employers 24 Warning Notices to Parents 24 NATIONAL SOCIETY FOR PREVENTION OF CRUELTY TO CHILDREN. The Local Inspector of this Society has been very willing to give whatever co-operation he could in dealing with some of our more difficult cases. I am very grateful to him for kindly assistance at all times, and I would like to express my appreciation to the Society on behalf of the Education Committee for the work carried out in this direction. To the members of the Education Committee my most grateful thanks for their support during the past year. I wish to gratefully acknowledge the loyal co-operation of the staff of the School Medical Service. I have the honour to remain, Your obedient servant, D. REGAN, School Medical Officer. 52 Table I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. C.—Children found to require Treatment. Number of individual children found at Routine Medical Inspection to require Treatment (excluding Defects of Nutrition, Uncleanliness and Dental Diseases.) Group. For defective vision (excluding squint). For all other conditions recorded in Table 11a. Total. (1) (2) (3) (4) Entrants 37 841 878 Second Age Group 185 880 1,065 Third Age Group 138 415 553 Total (Prescribed Groups) 360 2,136 2,496 Other Routine Inspections — — — Grand Total 360 2,136 2,496 53 A.-Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 1,949 Second Age Group 2,194 Third Age Group 1,324 Total 5,467 Number of other Routine Inspections — Grand Total 5,467 B.-Other Inspections. Number of Special Inspections 8,714 Number of Re-Inspections 18,045 Total 26,759 Table II. A.-RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1937. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Skin (1) Ringworm—Scalp - - - - (2) Body 2 1 43 - (3) Scabies 3 — 90 - (4) Impetigo 19 — 633 2 (5) Other Diseases (Non-Tuberculous) 235 3 3,278 2 Total (Heads 1 to 5) 259 4 4,044 4 Eye (6) Blepharitis 26 - 113 - (7) Conjunctivitis 15 1 164 — (8) Keratitis — — — — (9) Corneal Opacities - - 1 — (10) Other Conditions (excluding Defective Vision and Squint) 39 6 224 2 Total (Heads 6 to 10) 80 7 502 2 (11) Defective Vision (excluding Squint) 360 56 14 14 (12) Squint 54 6 9 2 Ear (13) Defective Hearing 45 2 112 1 (14) Otitis Media 46 6 292 4 (15) Other Ear Diseases 13 4 178 — Nose and Throat (16) Chronic Tonsillitis only 396 137 144 4 (17) Adenoids only 9 10 12 — (18) Chronic Tonsillitis and Adenoids 202 5 103 4 19) Other Conditions 77 5 129 — (20) Enlarged Cervical Glands (Non-Tuberculous) 36 110 141 5 (21) Defective Speech 7 6 4 3 Heart and Circulation Heart Disease— (22) Organic 6 4 5 1 (23) Functional 18 59 18 3 (24) Anaemia 5 — 25 — Lungs (25) Bronchitis 138 14 161 — (26) Other Non-Tuberculous Diseases 17 8 316 - Tuberculosis Pulmonary— (27) Definite 1 — 1 — (28) Suspected 2 2 9 — Non-Pulmonary— (29) Glands 1 1 — — (30) Bones and Joints 1 — 2 — (31) Skin — — — — (32) Other Forms — — 3 — Total (Heads 29 to 32) 2 1 5 — Nervous System (33) Epilepsy 8 1 3 — (34) Chorea 3 1 63 — (35) Other Conditions 101 28 92 3 Deformities (36) Rickets 10 2 15 — (37) Spinal Curvature 48 6 5 — (38) Other Forms 119 16 87 5 (39) Other Defects and Diseases (excluding Defects of Nutrition, Uncleanliness and Dental Diseases) 434 36 1,301 43 Total Number of Defects 2.496 536 7,790 930 B.CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. AgeGroups. Number of Children Inspected. A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Entrants 1,949 983 50.44 886 45.46 79 4.05 1 .05 Second Age-group 2,194 1,139 51.91 909 41.43 136 6.20 10 .46 Third Agegroup 1,324 841 63.52 439 33.16 42 3.17 2 .15 Other Routine Inspections — — — — — — — — — Total 5,467 2,963 5420 2,234 4086 257 470 13 .24 Table III. BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 4 — — — 4 PARTIALLY SIGHTED CHILDREN. At Certified Schools for the Blind. At Certified Schools for the Partially Sighted. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. - 5 5 — — 10 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 5 — — — 5 55 PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 4 — — — — 4 MENTALLY DEFECTIVE CHILDREN. Feeble-Minded Children. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 47 - 3 6 56 EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — — PHYSICALLY DEFECTIVE CHILDREN. A.—Tuberculous Children. I.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — - — 1 1 II.—Children Suffering from Non-Pulmonary Tuberculosis. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 - 2 — 3 56 B.-Delicate Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 15 96 — 13 124 C.—Crippled Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 9 45 - - 54 D.-Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 2 - - - 2 Children Suffering from Multiple Defects, Combination of Defect. At Cerfified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — — — TREATMENT TABLES. Group I.—Minor Ailments( excluding Uncleanliness, for which see Table VI). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm-Scalp (i) X-Ray Treatment — — — (ii) Other Treatment — — — Ringworm—Body 47 — 47 Scabies 62 — 62 Impetigo 646 3 649 Other skin disease 2,000 23 2,023 Minor Eye Defects 506 4 510 Minor Ear Defects 596 37 633 Miscellaneous 1,865 225 2,090 (e.g., minor injuries, bruises, sores, chilblains, etc.) Total 5,722 292 6,014 57 Table IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1937. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Number of Defects dealt with. Under the Authority's Scheme. Otherwise. Total. Errors of Refraction (including squint) 851 - 851 Other defect or disease of the eyes (excluding those recorded in Group I) 93 — 93 Total 944 — 944 Under the Authority's Scheme. Otherwise. Total. Number of Children for whom spectacles were— (a) Prescribed 725 — 725 (b) Obtained 608 — 608 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. 1 Received Other Forms of Treatment. Total Number Treated. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 1,089 1,259 32 6 129 1 1 — 1 — 33 6 130 1 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. Group IV.—Orthopaedic and Postural Defects.[] Under the Authority's Scheme. Otherwise. Total number treated. (1) (2) Residential treatment with education. Residential treatment without education. Nonresidential treatment at an orthopaedic clinic. Residential treatment with education. Residential treatment without education. Nonresidential treatment at an orthopaedic clinic. (i) (ii) (iii) (i) (ii) (iii) No. of children treated 21 — 303 — — — 303 58 Table V. DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist— (a) Routine age-groups— Age. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Total. No 2 261 1,313 1,557 1,301 1,306 1,366 1,287 1,130 999 893 181 38 2 11,636 (b) Specials 2,273 (c) Total (Routine and Specials) 13,909 (2) Number found to require treatment 10,583 (3) Number actually treated 5,443 (4) Attendances made by children for treatment 10,647 (5) Half-days devoted to:— Inspection 96 Treatment 1,337 Total 1,433 (6) Fillings:— Permanent Teeth 5,562 Temporary Teeth 725 Total 6,287 (7) Extractions:— Permanent Teeth 1,639 Temporary Teeth 9,88 Total 11,027 (8) Administrations of general anaesthetics for extractions 3,200 (9) Other Operations:— Permanent Teeth 871 Temporary Teeth 3,508 Total 4,379 Table VI. UNCLEANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 20 (ii) Total number of examinations of children in the Schools by School Nurses 57,491 (iii) Number of individual children found unclean 1,237 (iv) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 378 (v) Number of cases in which legal proceedings were taken:— (а) Under the Education Act, 1921 — (б) Under School Attendance Byelaws — 59 STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1937, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. Analysis of the above Total. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School:— (a) Idiots — — (b) Imbeciles 5 6 (c) Others — — (ii) Children unable to be instructed in a Special School without detriment to the interests of other children:— (a) Moral defectives (b) Others 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 3. Feeble-minded children notified under Article 3, i.e., “special circumstances ” cases 4. Children who, in addition to being mentally defective were blind or deaf. Grand Total Table IV—(continued). SECONDARY SCHOOL CHILDREN. Dental Defects. (1) Number of pupils who were:— (a) Inspected by the Dentist:— Ages:— 9 - 10 — 11 149 12 285 13 354 14 226 15 135 16 146 17 38 18 4 19 — Total 1337 Specials 25 Grand Total 1,362 (b) Found to require treatment 990 (c) Actually treated 359 (2) Half-days devoted to:— Inspection 12 Treatment (Mixed) Total 60 (3) Attendances made by pupils for treatment 763 (4) Fillings:— Permanent teeth 967 Total 1002 Temporary teeth 35 (5) Extractions:— Permanent teeth 283 Total 323 Temporary teeth 40 (6) Administrations of general anaesthetics for extractions 158 (7) Other operations:— Permanent teeth 193 Total 199 Temporary teeth 6 JUNIOR TECHNICAL, etc., SCHOOLS. Dental Defects. (1) Number of pupils who were:— (a) Inspected by the Dentist:— Ages:— 9 — 10 — 11 — 12 — 13 40 14 49 15 28 16 — 17 — 18 — 19 — Total 117 Specials 6 Grand Total 123 (6) Found to require treatment 97 (c) Actually treated 37 (2) Half-days devoted to:— Inspection 1 Total Treatment (Mixed) - (3) Attendances made by pupils for treatment 85 (4) Fillings:— Permanent teeth 96 Total 97 Temporary teeth 1 (5) Extractions:— Permanent teeth 36 Total 37 Temporary teeth 1 (6) Administrations of general anaesthetics for extractions 19 (7) Other operations:— Permanent teeth 27 Total 29 Temporary teeth 2 61 Group II.—Defective Vision and Squint (excluding minor eye defects treated as minor ailments—Group I.) Defect or Disease. Number of Defects dealt with. Under the Authority's Scheme. Otherwise. Total. Errors of Refraction (including squint) Other Defect or Disease of the Eyes (excluding 114 — 114 those recorded as minor ailments) — — — Total 114 - 114 Total Number of Children for whom Spectacles were prescribed:— (a) Under the Authority's Scheme 110 (b) Otherwise — Total Number of Children who obtained or received Spectacles:— (а) Under the Authority's Scheme 100 (b) Otherwise — Group II.—Defective Vision and Squint (excluding minor eye defects treated as minor ailments—Group I). Defect or Disease Number of Defects dealt with. Under the Authority s Scheme. Otherwise. Total. Errors of Refraction (including squint) 31 - 31 Other Defect or Disease of the eyes (excluding those recorded as minor ailments) — — — Totals 31 — 31 Total Number of Children for whom Spectacles were prescribed:— (а) Under the Authority's Scheme 27 (b) Otherwise — Total Number of Children who obtained or received Spectacles:— (a) Under the Authority's Scheme 23 (b) Otherwise — 62 B I \