EDM 24 Borough of Edmonton. REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1938 JOLLY THE PRINTER (T.U..) EDMONTON. 81946 BOROUGH OF CDMONTON. REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1 938 OLLY THE PRINTER (T U.: EDVEMC\ 8194$ BOROUGH OF CDMONTON 1 938. 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, VV. 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. (L'pool). Deputy Medical Officer of Health, and Deputy School Medical Officer: I. G. McIntyre, 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 M rs. 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 fourth Annual Report for the year 1038, on the Sanitary circumstances, Sanitary administration and Vital Statistics of the Borough of Edmonton. The contents are compiled in accordance with Circular 1728 issued by the Ministry of Health. Edmonton is now a Borough, conscious of the responsibility resting on her, and I am pleased to be able to report that the Staff in my various Departments is responding wholeheartedly to its increased responsibilities. During the year, progress has been made, although naturally in a slowing-down margin, but none the less must it be recognised that the effort necessary to make progress is becoming increasingly great as we approach a certain peak of perfection. Very little change has occurred in the circumstances appertaining to the Borough since my Annual Report for 1937. An increased effort is being made by the Public Health Committee to endeavour to encompass a perpetuation of the good results accruing from the Housing Act, 1936. Although the Borough is almost free from any major condition that would cast a blemish on Public Health, there are yet many minor details, particularly associated with overcrowding, which must receive attention. As you will see from the vital statistics, the Birth Rate (15.8) continues to rise while the Death Rate (9.26), already low in comparison with the rest of the country, has fallen still further. The deaths from Puerperal Causes are down to the very creditable figure of 1.77; this is below the supposed irreducible figure for maternal mortality, namely, 2.00. Nevertheless, we will continue to strive to reduce this figure still further. Infantile mortality is further reduced to 11.7, which compares very favourably with the figure of 53.0 for England and Wales, and 57.0 for London. The incidence of Puerperal Pyrexia continues to rise. In conclusion, I wish to record my thanks for the kindness and courtesy extended to me by the Council, and for the loyal co-operation of the Staff, during the year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, D. REGAN, Medical Officer of Health. 4 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, 1938 103,200 Number of inhabited houses and tenements at the end of 1938 26,056 Number of inhabited houses and tenements at the end of 1937 24,829 Rateable Value, April, 1938 .£734,501 Estimated product of one penny in the £ for the year ending March 31st, 1939 £2,900 Rates in the £ for the year ending March 31st, 1939 13s. 5d. 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 1/4 cost during 1937 11 >> >> Tree ,, 1937 > i ii M ii )i 1938 (2) Number of free dinners during 1937 ,, )} ,t ,, 1938 — — (3) Figures re out-relief :— For the year 1937 :— (a) Ordinary out-relief ... (b) Unemployed out-relief For the year 1938 :— (a) Ordinary out-relief ... (b) Unemployed out-relief Live Births. VITAL STATISTICS. Legitimate Illegitimate Birth-rate per 1,000 of population M. 816 14 F. 774 ' 27 2,583 110,455 152,355 68,052 94,205 Persons. Amount. £ 4,042 44,029 2,340 4,919 6,382 £48,948 £ 4,693 46,136 452 2,658 5,145 £48,794 Grand Total. Total. 1,590 41 1,631 15.5 5 Still-births. Grand M. F. Total. Total. Legitimate 33 26 59 Illegitimate 2 1 3 62 * Total of live and still births 1,693 Rate per 1,000 total births 36.6 Deaths. M. F. Total. Number 490 466 956 Rate per 1,000 population 9.26 Deaths from Puerperal Causes. Rate per 1,000 total Deaths. (live and still) births. Puerperal Sepsis 2 1.18 Other Puerperal causes 1 .59 3 1.77 Death-rate of infants under one year of age. M. F. Total. Number 50 23 73 All infants per 1,000 live births 44.7 Legitimate infants per 1,000 legitimate live births 44.0 Illegitimate infants per 1,000 illegitimate live births 73.0 Deaths from cancer (all ages) 126 ,, ,, measles (all ages) 1 ,, ,, whooping cough (all ages) 1 ,, ,, diarrhoea (under 2 years of age) 14 GENERAL INVALIDITY. The efforts that have been made are bringing forth good fruit and serve to stimulate the staff to make further efforts to improve conditions in the Borough. As I have already remarked, our Maternal Mortality figure and Death Rate are indicative of good work. 6 The following causes of death are supplied by the Registrar-General and refer to deaths which were registered during the calendar year:— Causes of Death. M F Total Typhoid and Para-typhoid Fevers I 1 2 Measles 1 .. 1 Scarlet Fever I 1 2 Whooping Cough .. 1 1 Diphtheria 2 3 5 Influenza .. 2 2 Encephalitis Lethargica .. 1 1 Cerebro-spinal Fever .. .. .. Tuberculosis of the Respiratory System 28 15 43 Other Tuberculous Diseases 4 7 11 Syphilis 2 .. 2 General Paralysis of the Insane, Tabes Dorsalis 3 2 5 Cancer, Malignant Disease 63 63 126 Diabetes 2 7 9 Cerebral Haemorrhage, etc. 16 34 50 Heart Disease 123 140 253 Aneurysm .. 3 3 Other Circulatory Diseases 27 25 52 Bronchitis 17 12 29 Pneumonia (all forms) 34 25 59 Other Respiratory Diseases 3 5 8 Peptic Ulcer 9 2 11 Diarrhoea, etc (under 2 yrs.) 9 5 14 Appendicitis 6 2 8 Cirrhosis of Liver 1 1 2 Other Diseases of Liver, etc. .. 5 5 Other Digestive Diseases 16 13 29 Acute and Chronic Nephritis 15 7 22 Puerperal Sepsis .. 2 2 Other Puerperal Causes .. 1 1 Congenital Debility, Premature Birth, Malformations, etc. 24 10 34 Senility 2 6 8 Suicide 8 6 14 Other Violence 34 20 54 Other Defined Diseases 39 39 78 Causes Ill-defined or Unknown .. .. .. Special Causes (included in " Other Defined Diseases "): — Smallpox .. .. .. Poliomyelitis .. .. .. Polio-Encephalitis .. .. .. Total Deaths 490 466 956 7 The following tables give the deaths of those registered during the 5 weeks ended 31st December, 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 vears 65 & under 75 vears 75 and over Typhoid Fever 1 .. .. .. .. 1 .. .. .. .. .. .. Measles 1 .. .. .. 1 .. .. .. .. .. .. .. Scarlet Fever 1 .. .. .. .. .. 1 .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. .. .. Diphtheria 2 .. 1 1 .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of the respiratory 27 .. .. .. .. 6 4 5 4 5 1 system .. Other T. B. Diseases 4 .. .. 2 2 .. .. .. .. .. .. .. Syphilis 2 .. .. .. .. .. .. .. 1 1 .. .. General Paralysis of the Insane 1 .. .. .. .. .. 1 .. 2 .. .. .. Cancer 62 .. .. .. .. .. 2 4 11 2 16 6 Diabetes 2 .. .. .. .. .. .. .. .. I 1 .. Cerebral Haemorrhage 16 .. .. .. .. .. .. .. 2 2 0 1 Heart Disease ".■) .. .. .. T 1 S 4 7 7 48 44 Aneurysm .. .. .. .. .. .. .. .. .. .. .. Other Circulatory Diseases 27 .. .. .. .. .. .. .... 2 4 I I 10 Bronchitis 17 1 .. 1 .. .. .. .. 1 6 5 .. Pneumonia 11 1 1 .. .. 2 1 4 5 6 3 Other Respiratory Diseases .1 .. .. 1 .. .. .. .. .. .. 2 .. Peptic Ulcer 7 .. .. .. .. .. 1 1 2 .. 2 1 Diarrhoea (under 2 years of age) 9 9 .. .. .. .. .. .. .. .. .. .. Appendicitis 5 .. .. .. .. 1 .. 1 2 1 .. .. Cirrhosis of Liver 1 .. .. .. .. .. .. .. 1 .. .. .. Other Diseases of the Liver .. .. .. .. .. .. .. .. .. .. .. Other Digestive Diseases 16 1 1 1 I .. 1 2 3 1 1 1 Acute and Chronic Nephritis IS .. .. .. 2 2 1 1 3 3 2 1 Congenital Debility, etc. 24 24 .. .. .. .. .. .. .. .. .. .. Senility 2 .. .. .. .. .. .. .. .. .. .. 2 Suicide 8 .. .. .. .. 1 2 1 3 1 .. Other Violence SI 2 .. 1 6 8 2 6 2 1 3 2 Other Defined Diseases 19 2 .. .. 4 4 1 5 3 4 9 7 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. Totals (86 50 3 8 17 23 20 32 51 77 122 83 8 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 1 .. .. .. .. .. 1 .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 1 .. .. .. 1 .. .. .. .. .. .. .. Whooping Cough 1 .. .. 1 .. .. .. .. .. .. .. .. Diphtheria 3 .. .. 1 2 .. .. .. .. .. .. .. Influenza 2 .. .. .. 1 .. .. .. .. 1 .. .. Encephalitis Lethargica 1 .. .. .. .. .. .. 1 .. .. .. .. Cerebro-spinal Fever .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of the respiratory 11 .. .. .. 1 3 5 1 1 .. 2 .. system Other T. B. Diseases 6 1 3 1 1 .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. .. .. General Paralysis of the Insane 2 .. .. .. .. .. .. .. 2 .. .. .. Cancer 63 .. .. .. 1 2 1 4 11 21 12 11 Diabetes 7 .. .. .. .. .. .. 1 1 1 2 2 Cerebral Haemorrhage 35 .. .. .. .. .. .. 1 5 7 9 13 Heart Disease 142 .. .. .. 2 2 3 3 5 25 40 b2 Aneurysm 2 .. .. .. .. .. .. .. .. 1 .. I Other Circulatory Diseases 25 .. .. .. .. .. .. .. .. 8 7 10 Bronchitis 12 .. .. .. .. .. .. 1 1 .. 3 7 Pneumonia 25 6 2 1 .. 1 3 2 .. 2 5 3 Other Respiratory Diseases 6 .. .. .. .. .. 1 1 2 1 .. 1 Peptic Ulcer 2 .. .. .. .. .. .. .. .. 2 .. .. Diarrhoea,etc. (under 2 years of age) .5 5 .. .. .. .. .. .. .. .. .. .. Appendicitis 3 .. .. .. .. .. 1 .. .. 2 .. .. Cirrhosis of Liver I .. .. .. .. .. .. .. 1 .. .. .. Other Diseases of the Liver 5 .. .. .. .. .. .. .. 1 3 .. 1 Other Digestive Diseases 13 .. .. .. 2 .. .. 3 2 1 5 .. Acute and Chronic Nephritis 7 .. .. .. .. .. .. 1 1 2 3 .. Puerperal Sepsis 2 .. .. .. .. .. 2 .. .. .. .. .. Other Puerperal Causes 1 .. .. .. .. .. 1 .. .. .. .. .. Congenital Debility 11 11 .. .. .. .. .. .. .. .. .. .. Senility 5 .. .. .. .. .. .. .. .. .. 1 5 Suicide 6 .. .. .. .. 1 1 .. 1 2 .. 1 Other Violence 21 .. .. .. 1 1 .. 4 .. 1 3 11 Other Defined Diseases 35 .. .. .. 4 2 2 4 5 6 6 6 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. Totals 465 23 5 4 16 12 21 27 39 86 98 134 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. 9 INFANTILE MORTALITY. The deaths of infants under one year of age were as follows:— M F Total Legitimate 48 22 70 Illegitimate 2 1 3 50 23 73 The death-rate of all infants per 1,000 live births was 44 7. A detailed sub-division of the causes, etc., of these infant deaths is as follows: — MALES. 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 1 Total under I year Meningitis .. 1 .. .. 1 I .. .. .. 2 Bronchitis .. .. .. .. .. I .. .. .. I Pneumonia .. .. .. .. .. 2 6 1 2 II Violence .. .. .. .. .. I .. .. .. I Diarrhoea .. .. .. .. .. 2 2 3 2 9 Congenital Malformation 1 .. .. .. 1 3 2 1 .. 7 Inattention at Birth I .. .. .. 1 .. .. .. .. i Premature Birth 9 2 .. .. 11 .. .. .. .. 11 Injury at Birth 2 .. .. .. 2 .. .. .. .. 2 Atelactasis 3 .. .. .. 3 .. .. .. .. 3 Icterus Neonatorum 1 .. .. .. 1 .. .. .. .. I Other Causes .. .. .. .. .. I .. .. I Totals 17 3 .. .. 20 10 11 5 4 50 FEMALES. Causes of 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[/##] Pneumonia .. .. .. .. .. 3 2 I .. 6 T B. Meningitis .. .. .. .. .. .. .. .. I i Diarrhoea .. .. .. .. .. .. 4 .. I 5 Congenital Malformation .. 1 .. .. i .. .. .. .. i Congenital Debility .. .. .. .. .. I .. .. .. i Premature Birth 3 .. .. .. 3 .. .. .. .. 3 Injury at Birth 2 .. .. .. 2 .. .. .. .. 2 Icterus Neonatorum I .. .. .. I .. .. .. .. I Atelactasis 3 .. .. .. 3 .. .. .. .. 3 Totals 9 1 .. •• IO 4 6 I 2 23 10 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 Death-rate per 1,000 births. per 1,000 population From diarrhoea, Total deaths Live Still etc., under 2 years under 1 year England and Wales 0.60 5.5 53 London I3.4 0.48 13.1 57 Edmonton ■5.8 0.60 8.5 44.7 Annual Death Rate per 1,000 of Population. All Causes Enteric Fever Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Violence[/##] England and Wales 11.6 .00 .00 .04 .o1 .03 .02 .11 .00 London 11.4 .00 .00 .06 .01 •03 •05 .06 .00 Edmonton 9.26 .01 .00 00 .01 .00 .04 .01 .65 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 arc 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 252 236 127 149 15 12 Church Street 111 124 95 117 12 2 Angel Road 149 I40 119 82 13 6 Silver Street 178 192 140 5 10 3 Vagrants .. 5 2 .. .. 690 692 486 465 50 23 11 Section B. GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. Laboratory Facilities. These are as described in previous reports. The following examinations were carried out during 1938:— Swabs for Diphtheria:— Positive. Negative. Total. From suspected cases 97 1,072 1,169 From contacts 19 641 660 From carriers and old cases 2 17 19 118 1,730 1,848 Not Present, found. Total. Sputa for the presence of tubercle bacillus 3 35 38 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. Blood for presence of Typhoid organisms 2 2 4 Faeces for presence of Typhoid organisms — 5 5 Urine for presence of Typhoid organisms — 1 1 Faeces for presence of Dysentery organisms 2 7 9 Swabs for presence of haemolytic streptococci 7 27 34 Milk for presence of hajmolytic streptococci — 1 1 Vaginal swabs for presence of Gonococci — 2 2 Designated milks are sent to the Counties' Public Health Laboratories. The results of these examinations were:— Passed. Failed. Total. Tuberculin Tested Milk 31 10 41 Pasteurised Milk 16 — 16 1 he Middlesex County Council is the Authority under the Sale of Food and Drugs Acts. Ambulance Facilities. The Council possesses three 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 7,296 Accident cases 707 Maternity cases 154 Clinic (tonsil cases) 385 Special services 211 False alarms 12 8,765 12 First aid was rendered on 234 occasions, whilst the resuscitating apparatus was in use 11 times. The bedside apparatus for the supply of oxygen was requested by 29 patients. With the increase in population these three ambulances are in requisition to a greater extent—the corresponding figure for 1937 was 7,052. The total mileage of the vehicles was 44,599 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 a spot to meet the guide; also conveys school children to and from London railway termini in connection with convalescent home treatment. Nursing in the Home. This has been described in previous reports. Hospitals. Infectious fevers are admitted into the Enfield, Edmonton and Potters Bar Joint Isolation Hospital, situated in Enfield. Arrangements for the treatment of ear, nose and throat disorders amongst school children 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 1938. Section C. SANITARY CIRCUMSTANCES OF THE AREA. The information re water supply, rivers and streams and public cleansing has been given in previous reports. The Main Drainage Scheme referred1 to in my previous Report has been submitted to the Ministry of Health. The widening of Montagu Road between Goodwin Road and Salmons Brook has been completed, and application has been made to the Ministry for extending the road to link up with Nightingale Road. The lay-out of Jubilee Park has been completed. The Slipes Housing Scheme of 114 houses was also completed during the year, and a commencement made with the Hoe Lane Housing Scheme, Enfield, where it is proposed to erect 354 houses. Consideration has been given to extending the Refuse Disposal Plant by the addition of a further four cells. The new Branch Library, Maternity and Child Welfare Centre and Public Convenience at Weir Hall were completed and opened to the public during the year. 13 Also a Public Convenience and Works Depot at Tramway Avenue were completed and opened. Plans for a new Fire and Ambulance Station are in course of preparation and Plans are also being prepared for a Branch Library and Maternity and Child Welfare Centre on the Ridge House site, and a Maternity and Child Welfare Centre on the Forest Road site. 1 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 approval of the Ministry of Health was received in June to the appointment of the Housing Inspector as a District Sanitary Inspector. The Woman Sanitary Inspector looks after Outworkers' premises, the sanitary condition of factories where women arc 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. The following tabular statement gives the number and the nature of the inspections made during the year:— Complaints 1740 Infectious disease 504 Tuberculosis 158 House-to-House 100 Factories with mechanical power 200 Factories without ,, ,, 25 Other premises under the Factories Act 12 Outworkers 66 Schools 11 Offensive Trades 73 Shops and Stalls 289 Shops Act (Primary) H5 Shops Act (Re-inspections) 34 Smoke Observations 99 Sanitary Conveniences and Urinals 728 Stables 36 Piggeries 22 Gipsies 32 Petroleum 214 General Inspections 566 Re-inspections 6254 Sundry Visits... 1862 Cinemas and Halls 41 Visits to Canal 42 r4 Inspections of Places where Food is Prepared Butchers 262 Fish Shops 103 Coffee Shops 32 Ice Cream Shops 105 Dairies and Milkshops 104 Slaughterhouses 111 Bakehouses 36 Number of Notices Served Preliminary or Informal Notices 1454 Statutory Notices 33 Defects Remedied. Houses repaired, cleansed, etc. 771 D.W. Cisterns repaired, covered 20 Water Fittings repaired 80 Water taken off main 10 Drains, examined, tested, etc. 269 Drains, cleared, trapped, repaired 274 Drains re-constructed 158 Chambers inserted 119 Chambers sealed down 21 Soil and Vent pipes repaired 96 W.C.'s repaired, cleansed, etc. 388 Flushing cisterns repaired 128 Waste pipes repaired, etc. 149 Sinks repaired or renewed 106 Roofs repaired 427 Gutters and R.W.P.'s repaired 338 Yards paved or repaved 261 Scullery floors repaired 47 Spaces under floors ventilated 98 Dampness remedied 248 Floors repaired r43 Coppers and Stoves repaired, etc. 280 New dustbins supplied 225 Accumulation of refuse removed 31 Nuisances from animals abated 1 Gipsies removed 28 Other nuisances abated 533 Rooms cleansed after infectious disease 1 Overcrowding abated 4 Water supply restored 2 Sanitary Conveniences. There are now seven Public Conveniences in the Borough which are kept under constant supervision by the Public Health Department. The Conveniences at Weir Hall and Tramway Avenue were opened during the year. 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. 15 Offensive Trades. There are38 businesses under this heading in the Borough, comprising one gut scraper, one fat boiler and 36 fish fryers and curers. Permission was refused two applicants to carry on the trade of fish frying, one being a transfer to adjoining premises. One applicant appealed to the Petty Sessions regarding the Council's refusal to allow him to establish the trade of Rag Dealer and his appeal was dismissed. As, however, he carried on such business, proceedings were instituted and he was fined 40/and 3 guineas costs, and ordered to cease within four weeks. Pig Keeping. This business is rapidly disappearing in Edmonton, due to the absence of suitable sites. Rats 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 willing to give advice. The Inspectors of the Public Health Department often examine the drainage of premises where it might be possible that the infestation is due to a defect in the house drainage system. The report from the Acting Chief Officer, Public Control Department, County Council of Middlesex, is as follows:— " During the year, the Council's Inspector of Rat Destruction paid 118 visits to rat-infested premises in Edmonton." Smoke Abatement. Despite the large number of factories in the Borough, it is rarely necessary to employ any legal pressure as to smoke nuisance. Ninety-nine observations were made during the year and four cautions were administered. MIDDLESEX COUNTY COUNCIL (GENERAL POWERS) ACT, 1938. SECTION 71. Hawkers, etc. This Act comes into operation on the 1st of January, 1939, the Council together with other Local Authorities considered the adoptive Sections and put the necessary resolutions and action into being regarding Sections 70 and 71, and as regards the latter Section, up to the end of the year, fortyfive applications had been received for registration. Disinfection and Disinfestation. The following table gives some idea of the work carried out:— Number of journeys to collect bedding 291 Number of journeys to return bedding 280 Rooms disinfected after infectious disease 767 Rooms disinfected after Phthisis 124 Rooms disinfected after Cancer 27 Disinfestation carried out after Vermin 238 16 Redding, clothing, .etc., disinfected after infectious disease: number of articles 3,903 Bedding, clothing, etc., disinfected after Phthisis: number of articles 658 Bedding, clothing, etc., disinfected after other cases: number of articles 1,779 Articles of bedding destroyed 207 The Council distribute a disinfectant powder and fluid to residents who applv for the same at the Town Hall yard. During the year the applicants numbered 35,080. 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 650. Twelve Council houses and 226 other houses were found to be infested, and the total number of rooms disinfected was 387, which includes 37 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. Petroleum (Regulations) Acts, 1928 and 1936. During the year, 15 new licences and 117 renewals were granted by the Council. The following is a list of particulars of quantities, etc., affected by these licences:— Petroleum spirit 395,778 gallons. Petroleum mixtures 5,728 gallons. Carbide of calcium 1 ton 8 cwt. 78 lb. The figures for petroleum spirit and mixtures again show an increase over those of last year. Mortuary. During the year, 97 bodies were deposited in the Mortuary, 79 by order of the Coroner, and 18 for sanitary reasons. Canal Boats Acts. During the year, 42 visits were paid to the canal and 17 boats were seen, but of this number none were fitted or used as dwellings or registered under the Acts. Places of Public Entertainment. Forty-one 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. 17 FACTORY AND WORKSHOP ACTS. The following work has been carried out under the Factory and Workshop Act, 1901, and the Factories Act, 1937:— 1.—Inspections for the purpose of provisions as to health. Premises Number of Inspections Written Notices Occupiers Prosecuted Factories with mechanical power 200 15 .. Factories without mechanical power 25 .. .. Other Premises under the Act (including works of building and engineering and construction but not including outworkers' premises) 12 .. .. Totals 237 15 .. 2.—Defects found. Particulars Number of Defects No. of defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of cleanliness 10 11 .. .. Overcrowding .. .. .. .. Unreasonable temperature • • • • .. .. Inadequate ventilation • • • • .. .. Ineffective drainage of floors 3 3 .. .. Sanitary Conveniences Insufficient 4 4 .. . . Unsuitable or defective 136 136 .. .. Not separate for sexes 1 1 .. .. Other Offences 21 21 .. .. (not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order. 1921, and re-enacted in the Third Schedule to the Factories Act, 1937) Total 175 176 •• .. 3. Outwork in Unwholesome Premises. Notices Nature of work. Instances. Served. Prosecutions. Wearing Appare Making, etc. Cleaning and washing 18 FACTORIES AND WORKSHOPS, ETC. Defects Remedied. W.C. walls cleansed 41 W.C. pans cleansed 52 W.C. cisterns repaired 17 Choked W.C.s unstopped 2 W.C. seats repaired or renewed 25 W.C. flush pipes repaired 8 New W.C. pans fixed 5 Sanitary conveniences provided 3 Ventilated space fixed 1 Separation partitions fixed 1 W.C. doors repaired 2 Drains cleared 5 Roofs repaired 4 Drain removed from bakehouse 1 New sink waste pipes fixed 3 Workroom cleansed 1 Accumulation of refuse removed 3 Chimneys heightened 1 Flooring repaired 1 Outworkers. During 1938 there were added to the Register the names of 45 new outworkers; the total number on the register is 258. House Drainage. A number of Notices were served requiring attention to drainage during the year, and the whole of the properties Nos. I to 67, Barbot Street, Edmonton, were redrained. 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. HOUSING ACT, 1936. Overcrowding. Work in connection with the Survey is still being carried out and applications are still being received for P/N certificates; and in the majority of cases now, it would appear to affect houses sold and owner-occupied houses sub-let or sold and re-let. During the year certificates for permitted numbers were issued in respect of 1,268 dwellings. Sixty-nine Notices were served under Section 62 (1) for failure to insert "Permitted Number" in rent books. 19 Four Notices were served under Section 59 (5) upon landlords as to overcrowding; and nine Notices were served upon Occupiers concerning overcrowding; and at the end of the year all were complied with, with the exception of two, which had not expired. Three cases resulted in persons appearing at the Tottenham Petty Sessions as a result of refusing alternative accommodation offered by the Council having regard to the fact that overcrowding existed at the premises in question. In October the Housing Committee recommended that the Public Health Department be instructed to make a Re-Survey of all those cases which were within one unit of being overcrowded at the date of the Overcrowding Survey, and submit a report thereon; Whereupon a re-scrutiny of all the forms took place disclosing the fact that there were 874 in this category, and a report to this effect was submitted to the Public Health Committee. Clearance Areas. 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 four houses, and nine have been demolished. The Council re-housed eight 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) 1,782 (b) Number of inspections made for the purpose 6,034 (2) (a) Number of dwelling-houses (including under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 100 (b) Number of inspections made for the purpose 946 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 (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 habitation 1,143 2. Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action bv the Local Authority or their Officers 866 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 136 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 102 (b) By Local Authority in default of owners 6 20 Section 9 of the 1936 Act. 136 Notices were served under this Section during the year and the Council were called upon to execute the work in six instances owing to the default of the persons having control of the premises, although such authority was asked for in a number of instances. One can say with pride that a rather large- amount of work has been done in premises as the result of service of Notices under this Section which are accompanied by a Schedule of defects itemised. 21 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 63 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 56 (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 demolition orders were made 4 (2) Number of dwelling-houses demolished in pursuance of demolition orders 9 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 4. Housing Act, 1936—Part IV—Overcrowding:— («) (1) Number of dwellings overcrowded at the end of the year 195 (2) Number of families dwelling therein 200 (3) Number of persons dwelling therein 1,377 (b) Number of new cases of overcrowding reported during the year 39 (c) (1) Number of cases of overcrowding relieved during the year 109 (2) Number of persons concerned in such cases 707 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after- the Local Authority have taken steps for the abatement of overcrowding (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report — (Question of Re-survey before Council of those cases within one unit of overcrowding at time of original Survey.) 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 90. of which 13 were added during the year. A total of 104 visits were paid to these during the year. No contraventions have come to the knowledge of the staff. With respect to the Milk (Special Designations) Order, 1936, samples of designated milks arc sent to the Counties' Public Health Laboratories for bacteriological examinations; the results are tabulated previously under "Laboratory Facilities." There are two slaughterhouses in the Borough (both licensed) and visits are made when slaughtering is carried on ; the figures shown above arc not very large, consequent upon the fact that the majority of the meat sold in this Borough is bought from the London markets. 22 Various licences w ere granted as under:— Primary. Supplementary. Pasteurised 13 G Tuberculin Tested 14 4 Accredited — 1 27 11 Two of the above retailers are licensed to bottle Tuberculin 1 ested milk, and one firm is licensed to pasteurise and bottle the milk on the premises. Supplementary licences arc 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 262 Fish shops 103 Coffee shops 32 Ice cream shops 105 Shops and stalls 289 Slaughterhouses 111 Bakehouses 36 Dairies and milkshops 104 The following carcases were examined during or shortly after slaughter : Oxen 48 Sheep and lambs 245 Pigs 188 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 a list of the food surrendered for examination and retained as unfit for human consumption:— 26 boxes of pears. 35 lb. of skate wings. 1 tin of lunch tongue. 1 steak and kidney pie. 178 boxes of prunes (44½ cwt.). 50 boxes of canned and bottled fruits (29 cwt.). 5 boxes of Chilean grapes. 4 cwt. of potatoes. 3 tins of corned beef. 1 box of crayfish tails. 2'.) trays of tomatoes. 93 bags of walnuts Consignment of tins of salmon, pilchards, corned beef, peaches, pears and fruit salad (approx. 1 ton). 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. Bakehouses. There are 19 bakehouses in the district, which are under periodical visits. Food and Drugs (Adulteration) Act. The Middlesex County Council is the Authority for the administration of this Act, and I am indebted to the Acting Chief Officer of the Public Control Department for the following information, which relates to foodstuffs purchased in Edmonton. 23 List of samples taken during 1938:— Taken. Adulterated. Milk 201 4 Milk, sterilised 11 — Butter 6 — Camphorated Oil 2 — Cream 1 — Eucalyptus Oil 2 — Gin 3 1 Hydrarg. Potassium Iodid 1 — Iodine 1 — Jam 4 — Lard 2 — Liq. Ferris Perchlor Fort 1 — Quinidine Sulphate 1 — Sardines 1 — Tinct. Stramon 1 — Ung. Iodi Denigrescens 1 — Whisky 18 7 260 12 Number of Prosecutions, 2 ; Number of Convictions,. 1. (One summons for watered whisky was dismissed under the Probation of Offenders Act.) Shops Act, 1934. The three items (1) ventilation, (2) temperature, and (•'!) sanitary conveniences, in connection with the shops which come within the sphere of the Sanitary Inspector's duties, have been dealt with. 179 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 bv 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. 2,922 Number of contraventions 18 Proceedings were taken against 3 traders, and fines of two of 10/- each and one of 5/-, respectively, were imposed. 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 was discussed previously. Nutrition. As can be seen by reference to the figures in the School Medical Section, the nutrition of our children has been high, though there are still a number in the " C " class. With the augmentation of the School Medical Staff, we are now overcoming many difficulties which formerly presented themselves. 24 Section F. PREVALENCE OF INFECTIOUS DISEASE. Measles and Whooping Cough. Measles and Whooping Cough still prevail amongst young children. Diphtheria. The incidence of Diphtheria was slightly higher than last year, but is still comparatively low. It is pleasing to note that all the cases were removed to the Isolation Hospital. A minor outbreak occurred at one of the Schools, but as the result of the prompt swabbing of several classes and the isolation of the "carriers" found therein, the outbreak was soon got under control, and it was not necessary to close the school. I wish to express my thanks for the kind cooperation 1 received from the teaching staff at the school. Scarlet Fever. Scarlet Fever is fairly prevalent, although low in comparison with the rest of the country, and mild in type. "Return" cases numbered five, 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. Six cases of this disease were notified during the year, as compared with nine last year. Despite exhaustive investigation, we were unable to trace the source of infection. Dysentery. Fourteen cases of this disease were notified, mostly during the early part of the year, a continuation of the rather disturbing outbreak which occurred during the latter part of 1937. No deaths were reported. Immunisation Against Diphtheria. The demand for immunisation against Diphtheria continues. The preparation used is T. A. F. and three injections are given at weekly intervals. Puerperal Pyrexia and Ophthalmia Neonatorum. These are referred to later on, under the heading of Maternity and Child Welfare. 25 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 293 262 2 .. 8 16 21 21 161 10 15 3 5 .. Diphtheria 1 113 5 .. 3 2 .5 4 78 1 2 4 .. Enteric Fever 6 5 2 . .. .. .. .. 1 1 3 1 .. Puerperal Pyrexia 84 83 3 . .. .. .. .. .. S 63 12 1 .. Pneumonia 79 39 59 7 7 3 .. 3 11 6 4 9 9 ■) Erysipelas 46 25 .. .. 1 .. .. .. 1 1 12 12 r4 5 Ophthalmia .. .. Neonatorum 12 10 .. 12 .. .. .. .. .. .. .. .. .. .. .. Acute Polio-myelitis 7 7 .. .. 1 .. .. .. 5 1 .. .. .. .. .. Dysentery 14 5 .. .. .. .. 2 3 1 1 .. 1 2 1 1 Food Poisoning .. 1 .. .. .. .. .. .. .. .. .. I .. Food Poisoning. One case was reported during the year. A pork pie, purchased in a neighbouring borough, was suspected to be the cause of the illness, but was not confirmed. The patient made a full recovery. Rheumatism. The incidence of Rheumatism is still rather high, but it is early yet to make any observations on the effects of the Rheumatic Clinic established for our school children. It will be necessary to extend this service to the pre-school group at the earliest possible moment. The outlook, however, up to the present is good. Pneumonia. The number of cases of primary and influenzal pneumonia notified remains about the same. Infantile Diarrhoea. The death-rate per 1,000 live births for London as a whole was 13T, whilst that for Edmonton was 8 5 as compared with 12 0 and 75 respectively last year. 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 includc puerperal pyrexia and ophthalmia neonatorum. 26 The following table indicates the wards from which the various cases wefe notified:— Disease Bury Street Ward Church Street Ward Angel Road Ward Silver Street Ward North Middlesex County Hospital Other Institutions Total Scarlet Fever 123 38 65 6l 5 I 293 Diphtheria 21 12 39 37 3 I 113 Enteric Fever 2 2 2 — 6 Puerperal Pyrexia 8 3 9 3 61 84 Pneumonia 29 9 21 19 — I 79 Erysipelas 14 11 6 12 3 46 Ophthalmia Neonatorum 3 1 — — 8 12 Acute Polio-myelitis 5 — 1 — 1 7 Dysentery 3 5 2 — 4 14 Food Poisoning 1 1 CANCER. The incidence of Cancer relative to the various organs of the body is given as under:— Males. Females. Respiratory 16 2 Genital organs (female) — 4 Genito-urinary (male) 7 — Breast — 10 Digestive organs and peritoneum 32 35 Uterus — 5 Buccal cavity and pharynx 6 4 Other organs 1 3 62 63 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. As provided by Section 176 (1) of the Public Health Act, 1936, arrangements have now been entered into with the Middlesex County Council for the treatment at the school clinics of adolescents who are ascertained at schools to be suffering from defective vision. 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:— 27 Age Periods. New Cases Deaths Respiratory Non-respiratory Respiratory Non-respiratory M F M F M F M F Under 1 year .. .. .. 2 .. .. .. 1 1— 5 years .. 2 2 4 • • .. 2 4 5—15 3 .. 6 5 .. 1 2 1 15—25 19 27 2 .. 6 3 .. .. 25—35 11 14 .. .. 4 5 .. .. 35—45 11 2 .. . 5 1 .. .. 45—55 8 4 1 1 4 1 .. .. 55—65 4 2 .. .. 5 .. .. .. 65 years upwards 3 I 1 1 3 2 .. .. Totals 59 52 12 13 27 13 4 6 In addition, 27 cases of pulmonary tuberculosis and seven cases of nonpulmonary tuberculosis previously notified in other areas, moved into Edmonton. 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 59 52 Non-respiratory 12 13 Transferred cases—Respiratory 15 12 Non-respiratory 5 2 91 79 The cases dying of tuberculosis and not previously notified were:— Males. Females. Respiratory 5 1 Non-respiratory — — I here were thus six non-notitiecl deaths out of a total ol 54 persons registered as dying of tuberculosis (Registrar's figures). Regarding the non-notification of the above cases, there was no suggestion of wilful neclect or of refusal to notify. he non-respiratory forms of tuberculosis notified were :— Males. Females Miliary 1 — Other bones and joints 1 5 Meningeal 3 5 Glands 4 Abdomen 1 2 Kidney 2 Skin — 1 28 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 which 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 1938 was Males. Females. Total Pulmonary forms 285 225 510 Non-pulmonary forms 78 72 150 363 297 660 The corresponding figures at the end of 1937 were:— Males. Females. Total Pulmonary forms 266 192 458 Non-pulmonary forms 70 68 138 336 260 596 Corresponding figures for previous years were :— Males. Females. Total 1936 315 252 567 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 1938 the Medical Officer of Health paid a total number of 17G visits to those employees who had been on the sick list longer than a fortnight and, when necessary, at fortnightly intervals. Of these 48 were " not at home " and four had already resumed duty. Also, during the year, 58 persons were examined prior to their appointment to permanent posts. 29 MATERNITY AND CHILD WELFARE COMMITTEE. Chairman : Councillor C. G. Lace, . T. J. Harington, J.P. (Mayor); G. I. W. Tott (Deputy Mayor); Aldermen Mrs. M. M. Bakrass, Mrs. E. A. Young; Councillors L. E. Berridge, W. H. Coleman, Mrs. E. M. Moss, A. W. Pearce, 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., Deputy 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.), Orthopaedic 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. de Miss A. Naylor. bed Miss V. Garrett. d Mrs. C. Boothby. bed Miss J. Paterson. bed Miss M. R. Hazelton. bd Miss M. Druce. acd Miss J. Anderson. bed Miss R. Bullock. bed Miss M. E. Bishop. Masseuse. Miss M. F. Cozens-Walker, Chartered Masseuse, Orthopa;dic Clinic. (Part-time.) Municipal Midwives. d Miss F. G. Browne (Retired Sept.). 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 Certificate. 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. Churchi.ey, 2nd Assistant. Miss V. Slatf.r, 3rd Assistant. Miss I. Wilkins, 4th Assistant. Clinic Workers. Miss E. Boyle. Miss A. Watson. Mrs. F. Chandler. Mrs. A. Bowers (commenced 11th August, 1938). 3° DAY NURSERY (on 31.12.38). cd Miss W. J. Vigar, Matron. / Miss E. A. WeLLer, Staff Nurse. / Miss J. M. Coryn, Assistant Nurse. / Miss M. E. Noel, Assistant Nurse. Probationers, Miss C. Knight, Miss M. Moore, Miss B. Howell, c State Registered Nurse. d State Registered Midwife. / Certificate of Day Nursery Training. I have pleasure in submitting my fourth Annual Report on matters appertaining to Maternity and Child Welfare in Edmonton. I am pleased to be able to report that further progress has been made during the vear 1938, and not only have we encompassed a greater number of mothers and children but the quality and standard of the work done has become more effective. The mothers are now more eager to come to the Clinics regularlv, in the first instance because the Clinics are more convenient, and, secondly, they do not have to wait so long for their requirements. During the year 1938 the Weir Hall Clinic was opened by the Chairman, Coun. C. Lacev, and he stated then that it was a much needed institution in that area, and evidence has since proved that his words were correct, and I would venture to say that in the future the building will be even more utilised by the mothers of this area. The Midwifery Service, which was commenced towards the end of 1937, has progressed favourably in the year 1938—the work has practically doubled itself, and further midwives are to be employed in order to cope with the increased work. I am happy to be able to say that from the onset the midwives strove to make the Service a success, and I have every confidence that the Officers appointed will ensure an excellent standard of work for the mothers of Edmonton. The Report of the Joint Council of Midwifery suggests that each wholetime midwife might reasonably be expected to attend 80 cases per annum, while the Departmental Committee on Midwives suggested a figure of 100 per year, but 1 am of the opinion that these figures are too high, especiallywhen one takes into account the wider scope of the Service, the more frequent ante-natal care necessary, off duty time and official holidays, the figure of 80 cases per annum must be a maximum. This calculation, however, makes no allowance for suspension of midwives to prevent the spread of infection, nor does it allow for a very desirable feature in midwifery work, namely, having a midwife to attend one case only at a time. On the whole, however, 1 am pleased with the uniformity of the Service, and having regard to the fact that it is an entirely new feature of the Maternity Service, it has proved itself of great value, and has given quite a considerable amount of satisfaction to the General Public. 1 should like to tender my very best thanks to the midwives employed for the individual efforts they have made to bring success to the scheme. I have no doubt that in the future a greater perfection will be brought to bear 31 on this subject as it is survery important and is the focus of so much attention at the present time. Arrangements have already been made for the midwives to attend Post Graduate Courses, and it is my intention to have one midwife sent away per month throughout the coming year. This experience should prove of great value to them. The absence of suitable Clinics is still an outstanding defect in the ultimate success of our Maternitv Service as a whole, and I hope the Council will not stop until they have established in each Ward a major Clinic to which the mothers of that area can go for advice and attention. In the coming year it will be necessary to extend the special services, as the numbers now attending the Clinics are so large that the present arrangements are proving to be inadequate; I refer in particular to the Dental Service, which has considerably increased during the last three years, and there is no definite Ophthalmic Scheme in existence for children under five years of age, and the present methods of referring them to the School Medical Surgeon or Local Hospital must either be substituted or increased; it will also be necessary to extend the Orthopaedic work. This speaks well for the increased attention and higher quality of the work done in the Maternity and Child Welfare Department. A Specialist Clinic for Rheumatic and Aural Treatment has been established in relation to the School Medical work, and it will be necessary in time to extend this Service to the Maternity and Child Welfare Department as well. The success in the treatment of Rheumatic and Aural defects is entirely dependent upon detecting cases in their early stages. Aural defects are very prevalent whilst the children are cutting their teeth and a Specialist's advice during this critical period is invaluable. During the course of the year it was necessary to increase the clerical staff by the addition of a junior clerk, on account of the demand made on their services, in the main due to the Midwifery Service, and the Municipal Milk Scheme; the latter figures have nearly doubled themselves for 1938 over those of 1936, and a great deal of clerical work is involved in the execution of these duties. It is most important that this work is carried out promptly as otherwise mothers would be kept waiting for their supply. On account of the long neglect of the toddler question in this area, it is proving to be a very difficult part of the Service to induce the mothers to bring their older children under five years of age to the Clinics, but persistent efforts should gradually overcome this neglect. The following information gives details of the Maternitv and Child Welfare Clinics at the end of 1938 :•— (1) Ante-Natal Clinic at Brookfield House, Fore Street (adjoining the Town Hall). Four sessions weekly. (2) Child Welfare (a) At Brookfield House. Four 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. (e) Weir Hall, Silver Street. Two sessions weekly. 32 (3) Post-Natal Clinic at Brookfield House. One session weekly. (4) Dental Clinic at Pymmes Park School Clinic. One session weekly. (5) Orthopaedic Clinic at Methodist Central Hall, Fore Street. Two sessions weekly. Births. The number of births notified during 1936, 1937 and 1938 were as follows:— 1936. 1937. 1938. Live births notified by midwives 2,300 2,462 2,558 ,, ,, ,, doctors and parents 359 288 230 Stillbirths notified by midwives ,, ,, ,, doctors Totals 107 9 2,775 109 6 2,865 117 9 2,914 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:— 1936. 1937. 1938,[/##] Live births notified bv midwives 1,114 1,142 1,172 ,, ,, ,, doctors and parents 345 286 230 Stillbirths notified by midwivs 39 37 39 ,, ,, ,, doctors 8 6 8 Totals 1,506 1,471 1,449 Number of live Edmonton babies born in outlviner Institutions :— 193 6. 1937. 1938 17 2 160 253 The following table includes births of Edmonton residents and registered in other districts:— 1936. 1937. 1938. Male Female Total Male Female Total Male Female Total Live births 809 808 1,617 838 734 1,572 823 812 1,635 Stillbirths 31 24 55 26 20 46 33 26 59 Totals 840 832 1,672 864 754 1,618 856 838 1,694 VISITS PAID BY THE HEALTH VISITORS. I he following tables will give details as to the visits paid by the Health Visitors during the years 1936, 1937 and 1938:— 33 1936. 1937. 1938. To expectant mothers :— (1) First visits. 5 461 673 (2) Total visits 14 586 886 Visits to children under 1 year :— (1) First visits 1,673 1,620 1,698 (2) Total visits 10,426 7,938 8,131 Visits to children 1 to 5 years 5,224 7,700 7,943 Infant Protection visits to children 5 to 9 years 169 135 106 15,833 16,359 17,066 Ante-Natal Clinic. This Clinic was held four times weekly, and the following are the figures for the last three years, showing the details of the work:— 1936. 1937. 1938. Total number of sessions in the year 99 128 199 Number of prospective mothers 346 588 967* Total number of attendances 1,382 2,630 3,801 Number of consultations 1,088 2,479 3,595 Average number of attendances:— (1) Per session 13.9 20.54 19.10 (2) For consultations 11.0 19.36 18.06 * Included in this total are 387 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 is proving a very valuable service. 1937. 1938. Number of sessions 11 49 Actual number of mothers who attended . 26 348 Number of consultations 39 631 Average attendance per session 3.54 13.44 Specialist's Clinic. The Consulting Specialist made 26 visits during the year and saw 147 cases, making an average per session of 5.65. Child Welfare Clinics. There are four sessions at Brookfield House, one at St. Stephen's Church Hall, two at St. Alphege Church Hall, one at St. John's Church Hall and two at Weir Hall Clinic. The Weir Hall Clinic was opened on September 6th, 1938, and the attendances have been most encouraging. 34 The figures relating to attendances are Brookfield House. St. Stephen's. St. Alphege. St. John's. Weir Hall. Number of sessions 218 50 98 50 33 New cases :— (a) Under 1 year 568 133 271 128 106 (b) 1 to 5 years 276 48 118 53 92 Attendances:— (a) Under 1 year 11,230 2,261 4,750 2,473 1,626 (b) 1 to 5 years 10,515 1,410 4,510 2.071 1,320 Total attendances 21,745 3,671 9,260 4,544 2,946 Doctor's consultations... 4,611 836 2,021 1,007 589 Average attendances ... 99.74 73.42 94.48 90.88 89.27 The following comparisons of attendances with the years 193G, 1937 and 1938 will show the rapid increase in the attendances at the Infant WelfareCentres:— Total attendances at all Clinics:— 1936. 1937. 19308. (a) Under 1 year 16,459 18,569 22,340 (b) 1 to 5 years 15,863 16,483 19,826 32,322 35,052 42,166 Orthopaedic 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:— 1937. 1938 Number of sessions 87 90 New cases seen 149 142 Attendances :— Surgeon's days 390 372 Treatment days 659 671 Total attendances 1,049 1,043 In-Patient Treatment. Nine children were admitted to the Royal National Orthopaedic Hospital at Brockley Hill, Stanmore, during 1938, and of this number three were still away on December 31st, 1938. Two children who were sent to Stanmore in 1937 were away in part of 1938. The average length of time spent in Stanmore during 1938 was eight weeks. 35 Dental Clinic. This is held once weekly at the school dental clinic at Pymmes Park. Details of the work carried out there are:— 1936. 1937. 1938. Mothers. Children. Mothers. Children. Mothers. Children. Number of attendances 443 288 462 267 716 318 Total number treated 420 272 448 257 686 309 Fillings 41 38 42 5 98 15 Dressings 1G 143 24 207 35 423 Scalings 10 — 7 — 28 — Extractions (number of teeth) Under gas 780 588 1,052 548 1,360 534 Local anaesthetic 22 — 8 — 6 — Number of gas cases 197 195 256 185 359 199 Dentures:— Number supplied 37 27 43 (13 assisted by (14 assisted by (19 assisted bv Committee). Committee). Committee). Details regarding the Supply oe Milk. 1936. 19:57. 1938. Number of applications 2,214 2,779 3,881 ,, recipients 2,101 2,667 3,619 ,, pints granted at 1/4 cost 6,454 2,583 Discontinued ,, pints granted free 82,929 110,455 152,355 Actual number of people who applied for milk 452 579 789 Number of expectant mothers who applied 75 117 224 Details regarding Free Supplies of Dried Foods, Cod Liver Oil and Malt, etc. 1936. 1937. 1938. Trufood 48 1,554 2,513 Lactogen 6 18 281 Cow and Gate — 56 453 Ostermilk — 5 176 Cod Liver Oil and Malt 2,504 2,826 3,766 Pure Cod Liver Oil ... 119 383 679 Numol ... 800 1,168 1,455 Halycalcyne 17 46 134 Ferrofax 4 32 143 Glucose — 728 415 Farex ... — 70 207 Liquid Malt and Iodide — 214 72 Grimsby Emulsion — — 624 36 Municipal Milk Supply. The increase in the supply of milk and free commodities has been very rapid during the past few years and the following figures will give an indication as to the actual comparisons between the years 1936, 1937 and 1938 Convalescent Cases. This is a very valuable service to the mothers and children who are able to take advantage of it. 1936. 1937. 1938. Number of mothers sent 7 10 7 Number of mothers who took babies with them Children. 5 6 12 Number sent away through I.C.A.A. 9 7 17 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:— 1936. 1937. 1938. 3 10 16 Home Helps. This service is gradually becoming more popular with the mothers, as will be seen from comparative figures given below :— Number of cases where Home Helps were sent 1936. 1937. 1938. 18 27 48 INFECTIOUS ILLNESSES. Ophthalmia Neonatorum. Twelve cases were notified during the year and of this number nine cases were in Ihe North Middlesex County Hospital, one of which was an Edmonton case. Puerperal Pyrexia. Eighty-four cases were notified during the year and of this number 72 were notified from the North Middlesex County Hospital, 24 of which were Edmonton cases. Nine cases were sent to the Queen Charlotte's Hospital, all of whom made a complete recovery. The average length of stay for each mother in Queen Charlotte's was two weeks five days. MIDWIFERY AND MATERNITY SERVICES. The Borough Council are the Local Supervising Authority under the Midwives Acts for their area. Midwives resident in Edmonton area were inspected quarterly and at each visit is 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 1938 was 191. 37 MUNICIPAL MIDWIFERY SERVICE. The following details give information as to the actual bookings during 1938:— Number of women who booked during 1938 385 Less bookings cancellcd for various reasons, e.g., admitted to Hospital, left district, etc. 22 363 Of this number 67 were granted the services of a midwife free of charge, the women having made application for assistance from the Council. A total of 356 confinements were carried out by the Municipal Midwives, namely, 303 as midwives and 53 as maternity nurses. ANTE-NATAL SCHEME OF CO-OPERATION BETWEEN THE COUNCIL AND THE MIDDLESEX COUNTY COUNCIL. Under an arrangement with the Middlesex County Council the Health Visitors visited 248 homes during the year where women had applied to the North Middlesex County Hospital for admission and the Authorities desired to have a report on the home circumstances. 403 women were referred to the Council's Ante-Natal Clinics for attendance for routine supervision purposes prior to their confinements, and of this number 387 actually attended. CHILDREN UNDER 5 YEARS OF AGE DISCHARGED FROM THE NORTH MIDDLESEX COUNTY HOSPITAL. 30 visits were paid to children under five years of are who had been discharged from the North Middlesex County Hospital, and it was necessary for them to remain under supervision. DAY NURSERY. The Day Nursery was open for the whole year with the exception of Bank Holidays. One of the Medical Officers pays a weekly visit to the Day Nursery to advise the dietary of the children. The attendances of children for the three years were as follows:— 1936. 1937. 1938. Whole-day 6,490 5,453 6,196 Half-day (Saturdays) 484 369 337 Resident children admitted during the year 13 27 17 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 supervising 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. 38 The number of persons on the register at the end of 1938 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 1408 may be referred by the Medical Officer to the Hospital. During the year 33 such patients were sent and of these 17 had free advice and the remainder were in a position to pay for their own expenses. STERILISED MATERNITY OUTFITS. Fifty-three mothers applied for Sterilised Maternity Outfits during the year, and of this number 17 came within the Committee's scale and the outfits were granted free of charge, and the other 36 mothers were able to pay the full cost of 4/6. 39 EDUCATION COMMITTEE 1 938. Chairman Councillor T. H. Joyce. Vice-Chairman Alderman T. J. Harinqton, J.P. Aldermen: Mrs. M. M. Barrass. Mrs. E. A. Young. A. J. Hollywood. W. F. Middleton. W. Preye. J. Reid. Councillors: Mrs. E. M. Hearn. Mrs. E. Long, J.P. Mrs. E. M. Moss. Mrs. H. Nicholson. G. E. Albon. W. Bales. W. A. Edmunds. C. E. Lacey. G. T. W. Tott. Whole-Time Medical Staff. D. Regan, B.A., B.Sc., M.B., Ch.B., B.A.O., D.P.H. (L'pool), School Medical Officer, Medical Officer of Health and Supervisor of Maternity Services. I. G. McIntyre, B.A., M.B., B.Ch., B.A.O., D.P.H., Deputy School Medical Officer and Medical Officer of Health. Mrs. M. E. Dalby, M.B., B.S. (Lond.), D.P.H., Assistant School Medical Officer. Whole-Time Dentists. J. F. Ardouin, L.D.S., R.C.S., Senior Dentist. E. Underhill, L.D.S., R.C.S., Assistant Dentist. F. H. S. Weiss, L.D.S., R.C.S., Assistant Dentist. (Commenced lune 13th, 1938.) Consultants. H. J. Seijdon, F.R.C.S. (Eng.), Orthopaedic Surgeon. Miss I,. M. Smith-Clark, M.B., Ch.B., Ophthalmic Surgeon. J. Browning Alexander, M.R.C.P., Rheumatic Specialist. W. Ibbotson, F.R.C.S., Aural Specialist. 40 Part-Time Staff. E. H. S. Bebb, M.R.C.S., L.R.C.P., Anaesthetist. Miss M. F. Cozens-Walker, Chartered Masseuse. Miss B. N. Oldrey, M.S.S.T., Speech Therapist. Mrs. S. Sills, Guide. Mrs. V. R. Dennison, Clinic Worker. (Commenced duties September 13th, 1938.) School Nurses and Health Visitors. Miss A. Bintcliffe, Lady Superintendent. Miss J. Anderson. Mrs. C. Boothby. Miss M. E. Bishop. Miss R. Bullock. Miss M. Druce. Miss A. Fahy. Miss V. Garrett. Miss M. R. Hazelton. Miss A. Naylor. Miss J. Paterson. Mrs. C. Tonkin. Dental Attendants. Miss O. Brooks. Miss C. E. Stanbridge. Miss A. B. Chaplin. (Commenced December 5th, 1938.) Clerical Staff. B. R. Allen, School Medical Clerk. Miss C. D. R. Logsdon, Clerk. Miss B. E. T. Cross, Clerk. (Commenced January 3rd, 1938.) H. A. Carless, Clerk. S. E. Woodroffe, Junior Clerk. (Commenced August 8th, 1938.) To the Chairman and Members of the Edmonton Education Committee. Ladies and Gentlemen, I beg to submit my fourth Annual Report on the work of the School Medical Service during the year 1938. 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 bo 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. I am pleased to be able to report that the School Medical Service has taken shape and is doing good work. The very intensive efforts which have been made are now bearing good fruit, although the numbers of children having recourse to the School Clinics have increased. It will be noted that the percentage found with defects, many of them slight, has increased. The 41 special services for children suffering from rheumatic and aural defects are, I regret to state, over-taxed, but it is what I anticipated in the course of the first two or three years of these services, and I do not expect to arrive at a normal incidence of these defects until the schemes have been in operation for some three years, and extra sessions must, of necessity, be brought into existence during the forthcoming year. 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. 1. STAFF. Mr. F. H. S. Weiss was appointed as Assistant Dentist and commenced duties on the 13th June, 1938, at the Croyland Road Dental Clinic. Mrs. Tonkin was transferred from the post of Dental Attendant at the Pymmes Park Dental Clinic to that of School Nurse—for which she was originally appointed. In these circumstances it was necessary to appoint a new Dental Attendant and Miss A. B. Chaplin was appointed to act as Dental Attendant from the 5th December, 1938. In my last Report I mentioned that Miss N. Humphries left the Department to get married at the end of 1937. Miss B. E. T. Cross took up office at the Croyland Road Clinic on the 3rd January, 1938. Another clerk was needed to meet the increased duties in the School Medical Service and Mr. S. E. Woodroffe was appointed. He commenced his work here on the 8th August, 1938. 2. CO-ORDINATION. The work of the School Medical Department continues to be closely co-ordinated with that of the Public Health and Maternity and Child Welfare Departments. Any matter pertaining to school children likely to affect the community in general is brought to the notice of the department concerned. The Specialist Officers appointed by the Committee treat school children only. During the year under review arrangements have been made for continuation of treatment after a child leaves school (provided the name was already upon the register) for children suffering from orthopaedic defects, if considered necessary by the Surgeon, under the Public Health Act of 1936. The services of the consultants in eye, ear and rheumatic defects employed by the Education Committee should be made available for children below school age and also extended to adolescents if considered necessary by the specialist concerned. The Dental Scheme was recently extended to cover the pre-school child, and now that parents realise the benefit of this serv ice, the number of sessions 42 devoted to the work has correspondingly been increased, and I intend to submit next year a Report for the inclusion of children between the ages of 14 and 16 years in respect of conservative dental treatment. The Sanitary Inspectors are utilised to the fullest extent and willingly co-operate with the School Medical Staff in the execution of their duties. It is a matter of great pleasure to me to realise that an initial step has been taken to increase the size of the Croyland Road Clinic. On account of the delay in developing the proposed Health Centre occasioned by A.R.I', work, it will be necessary to re-arrange Pyrnmes Park House in order to meet the requirements of the modern mother in Edmonton. It is becoming increasingly apparent that "any old premises" will not satisfy the majority of mothers in this District if we wish them to take the fullest advantage of the services offered. I am personally glad to note this, because it proves that the standard of hygiene, both personal and environmental, has reached a higher level and is entering into the everyday thoughts of the mothers. 3. SCHOOL HYGIENE. We are happily situated with regard to hygiene in the majority of the schools in Edmonton, and I am pleased to note that some of the teachers are now inculcating a very high standard of personal hygiene into the minds of their pupils. If these conditions prevail the hygienic outlook of the Edmonton School child will be vastly improved and ultimately assured. It will be necessary for the School Medical Staff to press forward in this direction by educating, not only the children, but the parents, and I am hopeful that films and lectures will be included in the school curriculums in order to further educate school children and their parents. This matter is very apparent in the case of the Dental Scheme, as is evidenced by the large number of children who do not participate in the Committee's Scheme or just simply neglect to keep their appointments. Improvements in the schools have been noted year by year in previous reports, and I set out below a list of the improvements which have taken place during the current year, for which I am indebted to the Director of Education:— 1. Internal and external redecoration of Eldon Road and Croyland Road Schools. 2. The provision of a new entrance and pathway at Amberley Road to Raglan Infants' School. 3. The installation of electric light at Raynham Road School. 4. The erection of boundary iron fencing to Houndsfield School and Wilbury Way Playing Fields. 5. The levelling and turfing of Hazelbury School Playing Field. 6. The furnishing of the Central Kitchen at the Open-Air School with cooking equipment and appliances for preparation and distribution of of meals to the various Dining Centres. 7. Providing a new Dining Centre at Pymmes Park Refreshment Room, including structural alterations and new dining furniture. 43 4. MEDICAL INSPECTIONS. Although our Staff has been increased during- the; year (Dr. Mclntyre devoting more time to the School Medical Service) it will be noted that the number of routine medical inspections has decreased. Most of the Officers' time is taken up in filling in gaps at the Minor Ailments Clinics. I am satisfied, however, that the quality of the work is improving and that more attention is being paid to the minor defects usually associated with school children. It is my intention to have nutritional surveys of all the children in elementary schools with the object of discovering marked cases of malnutrition. At present the procedure is for children found, during the course of routine medical inspections and at minor ailments clinics, to be suffering from malnutrition to be referred to the Director of Education with a recommendation for milk and/or meals for a period of six months, at the end of which period the child is re-examined and any improvement noted. If necessary the child is recommended for continuance in the scheme. 44 The number of children fully examined in the routine of each group during 1938 was 4,054, and these were analysed as follows:— Entrants 1,061 Second Age Group 1,495 Third Age Group 1,083 Total 3,639 Number of other Routine Inspections 415 Grand Total 4,054 The number of "Other Inspections" carried out during the year was practically the same as during 1 937:— Number of Special Inspections 9,123 Number of Re-Inspections 17,707 Total 26,830 5. FINDINGS OF MEDICAL INSPECTION. (a) Malnutrition. Assessment in respect of nutrition of all children examined in the course of routine medical inspection was continued as in previous years and the following table shows the results:— Number examined 4,054 Percentage A (excellent) 41.64 ,, B (normal) 51.63 ,, C (slightly sub-normal) 6.46 D (bad) .27 ( b) Uncleanliness. I am satisfied that the condition of the majority of Edmonton school children leaves nothing to be desired in cleanliness but a small percentage are persistently found to be "dirty" and are cleansed by the Nursing Staff at the Town Hall Clinic. The Nurses have made great efforts to bring to the minds of the defaulting mothers their duties towards their children, and in many instances good results have been achieved, but I regret to state that there are still a large number who apparently take no interest in the welfare of their children. It is interesting to record that I have repeatedly found that a child excluded from school on account of a "dirty" head belongs to a mother who goes out to work during the day and consequently cannot pay the required attention to her home and children. (c) Minor Ailments and Diseases of the Skin. This year I am pleased to record that the intensive efforts made by the Staff have brought about a marked decrease in the incidence of that unsightly complaint Impetigo. (d.) Visual Defects and External Eye Disease. In general, the scheme provides for the refraction of all cases of visual defects twice yearly, all cases of myopia or squint and astigmatism. There still exists in the minds of many parents a definite antipathy to their children wearing spectacles, reflected in the space of time which elapses between the glasses being supplied and collected by the parents or children. Glasses are supplied if prescribed by the Surgeon at the contract rate to the Committee and where the income is below the Committee's Scale (which is very generous) glasses are provided free. The School Medical Officer requests parents to attend at the Town Hall when it is considered that parents have no intention of collecting the glasses or refuse to allow a refraction. I intend during the course of the coming year to organise a scheme whereby Head Teachers are informed whenever glasses are prescribed, so that any child who does not wear them will be reported to me immediately. I am convinced that the time spent on an explanation (and sometimes a demonstration) is amply repaid. Dr. Smith-Clark, the Committee's Ophthalmic Surgeon, continues her good work, but I am afraid that provision will shortly have to be made for an increase in the number of her weekly sessions. Dr. Smith-Clark has kindly supplied me with the following report:— During the year 1938 an even more progressive advance has been made than that detailed in my last Report, as is shown by the fact that there was an increase in the number of Refractions from 851 to 967 in the Elementary children and from 145 to 198 in the children of the Secondary Schools. The parents, likewise, show an increasing interest in the subject, as is exemplified by the increase in the number attending with their children and by the interest they show at the Clinic. "The Clinic is very well situated, both as to its site and its pleasant surroundings." 45 At last I am pleased to report that provision will he made for the installation of electric light at the Pymmes Park Clinic. At present the Ophthalmic Surgeon brings the desired instruments, but I am hoping that shortly the Committee will prowide a fully.equipped and modern Consulting Ophthalmic Clinic—a necessity much over-due in a district of a school population of 15,000 school children. (e) Nose and Throat Defects. The treatment of ear, nose and throat defects is under the supervision of the Committee's Consultant, Mr. William Ibbotson, F.R.C.S., and during the year he examined 234 children, composed of 112 New cases and 122 Re-examinations. Children found to require tonsillectomy and/or adenoidectomy are admitted to the Prince of Wales's General Hospital through the Committee's Scheme after the necessary dental treatment has been carried out wherever possible. Close contact is maintained between this service and the Speech Clinic, where children attend after the operation for speech correction exercises. Mr. Ibbotson has submitted the following report on the Edmonton Aural Clinic covering the year 1938:— "The vast majority of the children were suffering from the serious effects of chronic pharyngeal infection, as evidenced by such symptoms as Chronic Nasal Obstruction (resulting in chronic mouth-breathing, with all its pernicious sequelae), Deafness, Aprosexia, etc. The chief clinical signs were found to be Infected Tonsils, with Nasopharyngeal Adenoid Excess, Aural Suppuration, Cervical Adenitis, Nasal Suppuration and General Toxicity. "Treatment viz.: Removal, by operation in the Prince of Wales's General Hospital, of the infective lesions, and of mechanical nasal impediments, followed by courses of instruction in nasal breathing in Miss Oldrey's Speech Clinic, and non-operative measures in the Aural Clinic itself, is resulting in very marked improvement, so that not only is the General Health restored to a much higher standard, with disappearance, in a large number of the children, of Nervous Instability (so frequently associated with the above lesions), but Aural Suppuration, and its accompanying Deafness, Headache, etc., have often entirely disappeared, thus rendering the serious operation of Mastoid Drainage unnecessary. "In my opinion the value of this Clinic is being proved, in so much as it is helping to reform these children into healthy, happy and, therefore, valuable citizens." The following is a copy of the report submitted by the Speech Therapist, Miss I?. N. Oldrey, M.S.S.T. " Work in the Speech Clinic has progressed steadily during 1938. " At the beginning of the year there were 100 cases on record, since then 01 new cases have been seen and diagnosed. Of a total of 1G1 : 52 have received regular treatment, once or twice weekly ; four have been removed from the books, either to attend special schools or because they have left the district; two are receiving adequate treatment elsewhere; and three have voluntarily ceased attendance. Of the 52 who have received treatment, 20 have been discharged; 32 children are therefore receiving treatment already, 46 and as soon as term begins this number will be increased to 40. There are, at present, 100 children on the waiting list. Of these, 40 require medical, surgical, dental or psychological treatment before they can take full advantage of Speech Therapy, while 60 are ready for immediate treatment, should there be time and vacancies for them. Of these, it is proposed to take eight into the Clinic at once. "The Monday and Thursday clinics have been continued throughout the year on the original plan of treating the children in groups. There are now three groups of stammering held twice weekly (a few of the children only come in once weekly), one group of sigmatismus cases attending once weekly, and one group of dyslalia cases attending twice weekly. At Easter it was decided that, owing to the number of cases referred for treatment, the number of sessions should be increased to three. Accordingly, another clinic was arranged for Wednesday mornings, when, for the most part, children requiring more individual attention have been seen. "All cases have been sent for at regular intervals during the 12 months following their discharge, in order that any relapse may be noted and dealt with. So far, no case once discharged has had to be recalled for treatment, but several have not responded to the request to attend for inspection." (/) Ear Disease and Defective Hearing. I have nothing to add to my former reports. (g) Dental Defects. The increased efforts made by the Dentists in dealing with the larger number of dental cases is bearing fruit, but there is yet much to be done before Edmonton school children can be regarded as dentally fit. (h) Orthopaedic and Postural Defects. In view of the increased numbers attending the Orthopaedic Clinic, arrangements are being made for a House Surgeon to attend monthly in order to assist the Orthopaedic Surgeon at the Clinic. It was also found necessary to recommend the Committee an additional session for massage and exercises for the Masseuse. Operative treatment is carried out at Stanmore, the country branch of the Royal National Orthopaedic Hospital, and during the year 13 children received in-patient treatment. The total attendances were as follows:— 1,391 boys and 1,073 girls—a total of 2,464. Mr. Seddon has kindly submitted the following report:— " The most noteworthy advance in the work of the Orthopaedic Clinic during the past year is the decision of the Council to allow observation and treatment to be continued in the small number of cases in which it is found that something more will be required after a child has left school. Hitherto the arrangements have been satisfactory only up till school-leaving age, but there are certain diseases and deformities that pay no attention to legal age limits and in which the 14 to 17 age period is of vital importance. In the past, special arrangements have had to be made for such cases, and it is most gratifying to know that, after April, 1939, they may continue to be dealt with at the Clinic. Only a very small number will be involved, but this in no way diminishes their importance. 47 "The volume of work at the School Clinic is steadily increasing; the number of individual children treated during each of the last five years is shown in the following table:— 1934 175 1935 220 1936 275 1937 303 1938 313 "The need for more satisfactory quarters is more urgent than ever, and I hope that it will not be long before a fully-equipped department will be available at a proper Health Centre. The work done at the Clinic is of prime importance, for it is of great preventive value and is undoubtedly responsible for the disappearance of certain deformities, such as knock-knee, which were formerlv common. Such work deserves to be carried out in good surroundings. Girls. Boys. Congenital Defects 8 10 Birth Injuries — — Rickety Deformities 2 2 Knock-Knees (non-ricketv) 4 4 Postural Defects of the Spine 9 10 Structural Curvature of the Spine 3 — Flat Feet 24 15 Infantile Paralysis 1 3 Sequelae of Acute Fevers — — Fractures 4 2 Tuberculous Joints — 1 Other Bone Diseases 2 3 Other Conditions — 3 Non-Orthopaedic 9 7 66 60 Total 126 The list of diagnoses shows nothing outstanding, though two negative features are worth noting. Edmonton has been fortunate in escaping the outbreak of poliomyelitis that has been severe in many parts of the country and particularly Essex. Three of the four cases observed during the past year have been admitted to hospital; two of them have done well, but in the third case the paralysis is severe. Deformities due to rickets are conspicuously absent. At first sight this would appear to be satisfactory, but I regret to say that minor degrees of rickets continue to be seen at the Child Welfare Clinic; no fewer than six cases of bow legs were so severe that the children had to be admitted to hospital for operative correction. Nowadays this ought not to happen, for there are few diseases about which we know so much or that are so easy to prevent. Although most of our cases of rickets are dealt with effectively before they reach school age, it would be far better if there were no such cases at all." 48 (i) Heart Disease and Rheumatism. At the special Rheumatic Clinic (which is held monthly—on the third Thursday of each month at the Croyland Road Clinic), 165 examinations were carried out during the year. It is more difficult to arrange for continuity in this service, on account of frequency of illness amongst the patients. Most of the mothers are very keen to attend, but on account of the insidious nature of the complaint there are many instances where they become impatient but they again resume treatment at a later date. It is rather difficult for a mother with a number of children to be expected to keep one of her offsprings at rest in her own time. I find, however, that the general body of the parents are anxious to do their best. Further, it is not so easy in the case of rheumatism to decide whether good results are being achieved, as in the case of dentistry and orthopaedics, for instance. (i) Tuberculosis. Again I wish to extend my very sincere thanks to Dr. Evans, the Tuberculosis Officer, for the courtesy and accommodation which I have always received from him in respect of any cases, definite or suspected, which require immediate investigation. The number of notified cases and the mortality of children of school age during 19.'?8, taken from the records of the Public Health Department, is as follows:— Notified. Deaths. M. F. M. F. Pulmonary 3 — 1 Non-Pulmonary Forms G 5 2 1 (k) Other Defects and Diseases. Nothing further can be added to the previous reports on this subject. 6. FOLLOWING-UP. Following-up has been carried out as in previous years, but I hope, in future, that it will be possible to devote more time to this very necessary procedure. During the school terms, Nurses have most of their time occupied with the various clinics, and most of the following-up is done during the school holidays. 7. ARRANGEMENTS FOR TREATMENT. Treatment is carried out at the following school clinics:— Minor Ailments. Pymmes Park Clinic : Situated in Upper Edmonton, daily from 9 a.m. to 1 p.m. (Saturday, 9 to 12 noon), with a doctor in attendance. Croyland Road Clinic : Situated in Lower Edmonton, daily from 9 a.m. to 1 p.m. (Saturday, 9 to 12 noon), with a doctor in attendance. 49 Denial Clinics. Dental Clinics are situated at Croyland Road, Pymmes Park and Hazelbury School, and are open between the hours of 9 a.m. to 1 p.m. and 2 to 5 p.m. (Saturdays, 9 to 12 noon). Ophthalmic Clinic. At Pymmes Park House every Monday (two sessions), with additional sessions for secondary school children as required. Orthopcrdic Clinic. The Orthopaedic Clinic is held at the Methodist Central Hall, Fore Street, Edmonton, N.9. The Orthopaedic Surgeon attends on the first Friday of each month, and the Nurse-Masseuse on Monday, Wednesday, Thursday and Friday of each week—morning sessions only. 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. Continuation of treatment is carried out by an Assistant School Medical Officer at the Croyland Road Clinic on Wednesday afternoons. Rheumatic Clinic. Dr. Browning Alexander attends the Rheumatic Clinic, which is held on the third Thursday of each month at the Croyland Road Clinic. Continuation of treatment is carried out by an Assistant School Medical Officer at the Croyland Road Clinic on Wednesday afternoons. Speech Clinic. The Speech Clinic is held at the Education Offices, Brettenham Road, Edmonton, N.18, Monday (2 till 4), Tuesday (2 till 4), Wednesday (9.30 till 11.30) and Thursday (2 till 4). Treatment is carried out at the following hospitals, etc.:— Tonsillectomy and/or Adenoidectomy, Mastoid Drainage, Eustachian Catheterisation, straightening of the Nasal Septum, etc., at the Prince of Wales's General Hospital, Tottenham, N.15. Ultra-Violet Light Treatment at the North Middlesex County Hospital, Silver Street, Edmonton, N.18. Orthodontic Treatment at Eastman's Dental Clinic, Gray's Inn Road, W.C.I, and Royal Dental Hospital of London, Leicester Square, London, W.C.2. Ophthalmic cases requiring in-patient or special treatment are sent to the Royal London Ophthalmic Hospital, City Road, London, E.C.I. Functional Nervous Diseases, Attacks of Rage, Emotional Stupidity, Somnambulism, Obsessional Neurosis, etc., requiring psychological treatment, are sent to the London Child Guidance Clinic, Tudor Lodge, 1, Canonbury Place, Islington, N.l. 8. INFECTIOUS DISEASES. The arrangements made to deal with children suffering from infectious diseases, is the same as in previous years. 50 9. OPEN-AIR EDUCATION. I append herewith a report submitted by Mr. E. E. Rapley (Headmaster) of the Open-Air School:— " The Open-Air School opened on April 25th, 1938, and, to the week ending 27th January, 1939, 185 children had entered the School and 45 children had, in the period under review, been discharged:— Fit for Elementary School 30 Over Age 3 Non-co-operation by the Parent 6 Death 1 Removal from Borough 3 At Parents' Request 2 45 7 he School Day commences at 9 o'clock, when the children, many of whom arrive by coach, have breakfast. From 9.30 to mid-day, lessons are taken. Personal Hygiene is a regular feature of the school routine; each child having his own towel and toothbrush, and regular times are fixed for the children's ablutions. In this way, and by informal discussion, the necessity for personal cleanliness, internal and external, is impressed upon the children. The boys and girls have one or more shower-baths a week. This shower is taken under the supervision of the School Nurse, and its tonic effect has a marked influence on the health of the children. A Resting Period, is arranged for an hour or more immediately after the mid-day meal. Many of the children sleep during this time, and, as most children suffer from lack of sufficient sleep, the value of the rest is obvious. Lessons, mainly of a practical nature, are continued in the afternoon, and after tea the children return to their homes. The last child leaves the school premises at about 5 p.m. in winter and at about 5.45 p.m. in summer. The Diet consists of three full meals a day, varied according to season. It is drawn up by the Cook Superintendent of the Central Kitchen in consultation with the School Medical Officer and Headmaster. Each day's menu provides for a pint of milk and fruit in some form or other. Medical Supervision. A general medical inspection of the children is made once a quarter and in the interim the School Medical Officer visits the school and examines any child with a particular defect requiring constant medical supervision. For minor ailments the Nurse attends to most of these, but it is sometimes necessary to send children to the ordinary School Clinic for diagnosis and treatment. I am glad to be able to say that the progress made by all these children is very satisfactory, and, what is more pleasing to note, the psychological outlook towards school improves. In the beginning I feared it would be very difficult to get the majority of these children to attend school, especially in cold weather, but I found the reverse to be the case, and I have noted the disappointment of some of the children when it has been decided to send them back to an ordinary elementary school. 51 A Nurse is in constant attendance at the school who, in addition to the duties enumerated below, looks after the general welfare of the children. It must be understood that all the children are in subnormal health, and the individual attention at her hands enables them to combat their various disabilities and so benefit from the education provided. It must be emphasised, however, that the children are not treated as invalids. The school is run on normal lines and the children are encouraged to live the lives of fit children, who are very fortunate in that they enjoy constant fresh air in the midst of natural surroundings. They are taught to keep well by ' the observation and practice of a hygienic way of life.' Duties performed by the School Nurse include:— Minor Ailments, number treated daily averages 14 Ear, Nose and Throat do. 8 Minor Eye Defects do. 10 Shower Baths do. 34 Emulsion, Parrish's Food and Cod Liver Oil 14 In addition to the above, the School Nurse collects and sends to the clinics all Aural, Refraction, Orthopaedic, Rheumatic and 'Sunlight' cases. The School Nurse assists the Headmaster at meal times, when she supervises the special diets of some and takes notes of the varying types of appetites of others. The children have been remarkably free from skin troubles, and only one case of infectious illness (a mild attack of Chicken Pox) was reported during the period ending 27th January. On the whole, parents have co-opcrated well, and where contact between home and school has been maintained, much good has resulted to the children. At an ' Open Day ' in September, over 100 parents were addressed by the School Medical Officer. ' Open Days ' are to be a regular feature and it is hoped that mothers and fathers will avail themselves of the opportunity of making themselves familiar with the objects and work done in the Open-Air School. When the school first opened, many children were over-clothed; this has now been largely overcome, but the question of suitable footwear is a constant source of concern to the staff. It is necessary that the child's feet should be dry, yet many children arrive at school on wet days with footwear in a bad state. Help through the Boot Fund is given to necessitous cases, but no excuse can be offered for those parents who will not allow their children to wear the 'Sunday' pair. Parents are urged to keep their children well shod." The Director to the Education Committee has kindly supplied details regarding camp journeys in which Edmonton school children have participated during the year, including the cost to the Committee, etc. 52 SCHOOL CAMPS, 1938. School Place Visited Date No. of Chil dren Cost per Head No. of Teachers Cost per Head Senior Boys— £ s. d. s. d. Silver Street 1 20 1 Croyland Road I Hopton-on-Sea 8th to 17th June J 4° 2 Latymer Elementary 1 40 2 0 0 2 3 '3 6 St. James's \ 20 1 EldonRoad.. Margate 20th to 30th June 40 2 0 0 2 3 13 6 Montague Road Sandown, 15th to 26th July 40 2 7 2 2 3 9 4 Raynham Road I. of W. Llanfairfechan, N. Wales 5th to 15th July 40 2 17 0 2 4 7 6 Senior Girls— Raynham Road Llanfairfechan, N Wales 24th June to 4th July 40 2 17 0 2 4 7 6 Hazelbury Sandown, I. of W. 4th to 14th July 40 1 18 6 2 2 15 0 St. James's Sandown, I. of W. 16th to 26th May 27 2 2 6 2 3 9 5 EldonRoad Hopton-on-Sea 23rd May to 2nd June 40 2 5 0 2 3 10 6 Brettenham Road Tankerton, Kent 10th to 20th May 3° 2 3 0 2 3 6 3 Higher Grade— Mixed Wye Valley & S. Wales 20th to 27th May 40 2 15 0 2 2 6 0 N.B.— 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. O11 the same calculation the total cost of the above journeys would be 1 is., Teachers, and £342 15s. Total ^427 6s. Junior Depts.— Houndsfield Road Boys Shanklin, I. of W. 13th to 27th May or 17th June to 1st July 3° 2 11 3 2 3 9 11 Brettenham Road Boys Weymouth 10 days 40 252 2 420 Cost to Committee on above calculation—£15 3s. 10d., Teachers and £52 10s. Total £67 13s. 10d. 10. PHYSICAL TRAINING. Report of Physical Organisers:— "Owing to the reorganisation of Physical Training in Middlesex in January, 1938, the Organisers became officially responsible for Physical Education, not only on the elementary side, but also in the Secondary and Technical Schools, livening Institutes, Juvenile Organisations Committee and all post-school organisations. Recreative Physical Training. Prior to January, 1938, visits had been made to many factories, clubs, shops, etc., and after the position had been surveyed it was found that, with 53 the exception of the Juvenile Organisations Committee and football and cricket clubs, there were few activities or facilities for those of post-school age. As a result of this survey the first meeting of the newly formed Edmonton Physical Training Area Committee was held to approve the formation of " Keep Fit " classes on lines suggested by the Organisers. Leaders with some experience of recreative physical training were appointed by the Area Committee to take these classes, and two courses for men and women were taken during the year. Classes for the general public started on 10th January and were held in various school halls in Edmonton. The classes began with very small numbers, and response from the factories was poor. The organisers then tackled various Ratepayers' and Tenants' Associations, etc., and also addressed the Rotary Club at their weekly luncheon. From this last source came the idea of a dance for members of the " Keep Fit " classes and their friends. This was held at the Regal Cinema on the 7th and 8th April, and 1,500 people attended. The numbers in the classes gradually increased until there were over 900 on roll by Easter. It was considered wise to continue the classes during the summer, and this decision was justified. Some groups played games, but on the whole these were not satisfactory, as they had to use the playgrounds. After the long break from July to September the classes were resumed on 26th September—crisis week—since then they have never recovered, and although most of the centres are still open, the decrease in numbers is due in no small measure to the calls of National Service and extra working hours. Juvenile Organisations Committee. Suggestions and help have been given to the Juvenile Organisations Committee when and where required, and very happy relations exist between the organisers and the various groups of the organisation. Facilities for Post-School Work, and Adult Recreation. Under the Physical Training and Recreation Act of 1937, Local Authorities have been given very wide powers for the provision of buildings and the granting of facilities for adults. The organisers are responsible for discovering what facilities are necessary for games, swimming, and recreation of all types in the district, and for putting forward suggestions to the Local Authority so that all sections of the community, whether tenants, ratepayers, Juvenile Organisations Committee, or educational bodies, should benefit from any scheme which may be put into operation. Thus the organisers feel that co-operation between the Borough Authorities who could provide the facilities and organisers who would provide the recreation for the people would result in a growth of that section of the community who are public spirited enough to wish to help any scheme which provides healthy recreation for the leisure time of all grades of society. 54 The present facilities for adult classes leave much to be desired in the way of unsuitably lighted halls and lack of changing accommodation, to say nothing of the bleak atmosphere necessarily associated with these conditions. Until some arrangement is made whereby the social side of these classes can be developed to a far greater extent by the introduction of a central building, large enough not only to house the various classes for all types of physical activities, but also to provide club rooms, etc., for quieter activities and social amenities, all the spade-work done by the organisers during the last year—and only they know how much that was—will be useless, for the classes will dwindle in favour of counter attractions which supply these social contacts. The necessity for such a building has from time to time been pointed out by the organisers, without result, but it has now been recognised by Middlesex and is considered of such paramount importance that they have made a generous offer to all local authorities, many of whom have already submitted applications (see Circular, 14th April, 1938). It is therefore very disappointing that, although Edmonton was the first area to start " Keep Fit " classes on a large scale, it is likely to be the last to benefit from the County Scheme. Outdoor Activities. Beyond two Netball Courts at Pymmes Park, which are, in the opinion of the organisers, too dangerous for play, and where there are no changing facilities whatever, and the playground granted to the Juvenile Organisations Committee when their ground is unfit for play—factories, clubs, etc., who wish to play netball and have been encouraged to form teams, find that on application for playing pitches the only ones available to them are those mentioned above. Whereas the fact is appreciated that school fields cannot be used by outside organisations owing to general wear and tear, the organisers feel that school playgrounds already in use as Netball pitches should be available for post-school activities. Finally, the above report shows that some progress has been made during the year in all directions, and that the organisers have created an interest in, and a demand for, better conditions. They now feel concerted action is necessary to acquire these facilities before further ideas and suggestions can be put forward. In conclusion, the organisers wish to thank all those who have given help and advice during a very difficult year and they hope that 1139 will show that these efforts have not been made in vain." 11. PROVISION OF MEALS. The new Central Kitchen, attached to the Open Air School, opened on 16th May, 1938. All dinners are prepared and cooked at the Kitchen and conveyed to the various Centres in insulated containers. The number of free dinners provided at the various Centres during the year 1938 was 94,205, and the total number of individual children fed was 542. The amount of T.T. milk provided to under-nourished children during the year was 21,694 pints. 55 12. CO-OPERATION OF TEACHERS, PARENTS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. If the School Medical Service is to realise its fullest value for the children, co-operation between the Departments and teachers, parents and outside bodies is essential, and I am very pleased to state that close contact is preserved always. National Society for Prevention of Cruelty to Children. Most of the " difficult " cases are referred to the Local Inspector of this Society, and I am grateful to him for his assistance at all times. Edmonton Voluntary Boot Fund. During the course of medical examinations many children are found to be badly shod and they are immediately referred to the organisers of this fund who see that the footwear is repaired or, if beyond repair, that new boots are supplied. Edmonton Social Service Council. During the last two years several children who have been recommended for convalescence through the School Medical Service have, upon the parents being questioned, been found not to have a spare outfit of clothing, and these cases have been referred to the Edmonton Social Service Council, who always willingly assist them. The Shaftesbury Society. Occasionally parents apply to this department on behalf of their children who require crutches, chairs, etc., for a short time only, and it is customary to make arrangements through the Shaftesbury Society for these to be loaned free of charge. Employment of Children. An Assistant School Medical Officer examines children who apply for permits under the By-laws. The Director has kindly furnished me with details of the work carried out by the Committee during the year 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 04 Number of Children examined by Assistant S.M.O. and mits granted 64 Warning Notices to Employers 48 Warning Notices to Parents 48 13. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. There are in Edmonton no totally blind school children who require special tuition at a residential school. Arrangements are made by this Authority whereby all partially sighted 56 children who cannot read ordinary school books or cannot read them without injury to their eyesight, are admitted to the Special School for Partially Sighted Children, Lordship Lane, Wood Green, N.22, and five children were on the roll at the end of the year. There are in Edmonton four totally and three partially deaf children, and these attend the Special School for the Deaf, Philip Lane, Tottenham, N.15. At the end of the year there were 47 mentally defective (feeble-minded) children attending the Nassau House Special School, Enfield Highway, Middlesex. Head Teachers are regularly circularised and requested to submit Form 41 D. in respect of any mentally retarded child attending their Department. If, after examination, I consider them suitable for admission to Nassau House Special School, immediate arrangements are made for their transfer. Ineducables are referred to the County Medical Officer (under the Mental Deficiency Act, 1913) who makes arrangements, subject to the parent's consent, for their admission to the Occupation Centre, which is held daily at Bassishaw Hall, Bury Street, Edmonton, N.9. Special cases requiring in-patient treatment are dealt with accordingly. In this way there are no mentally defective children, to my knowledge, attending ordinary elementary schools. At the end of the year there were two epileptic children both in the Lingfield Epileptic Colony. MINOR AILMENTS CLINICS—ATTENDANCES. Total attendances for 1938 were Pymines Park Clinic 25,597 Croyland Road Clinic 21,463 57 GENERAL INFORMATION. Number of Elementary Schools 17 Provided Schools 13 Non-Provided Schools 4 Number of Departments 40 Infants 13 Junior Boys 3 Junior Girls 3 Senior Boys 3 Senior Girls 3 Boys 5 Girls 5 Mixed 1 Junior Mixed 2 Higher Grade 1 Open Air 1 Total Accommodation, January, 1939 15,712 Number on Books, January, 1938 13,910 Number on Books, January, 1939. ' 14,082 Increase during the year 172 During the course of the year children have been supplied with Emulsion, Cod Liver Oil and Parrish's Food, and the following statistics are given :— Pymmes Park Clinic. Croyland Road Clinic. Boys on Emulsion 187 219 Cod Liver Oil 113 256 Parrish's Food 248 466 Girls on Emulsion 107 195 Cod Liver Oil 94 213 Parrish's Food 545 453 Bottles of Emulsion distributed 967 1019 Cold Liver Oil distributed 431 1067 Parrish's Food distributed ... 2150 2155 58 Table I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 1,061 Second Age Group 1,495 Third Age Group 1,083 Total 3,639 Number of other Routine Inspections 415 Grand Total 4,054 B.— Other Inspections. Number of Special Inspections 9,123 Number of Re-Inspections 17,707 Total 26,830 C.—Children found to require Treatment. Number of individual children found at Routine Medical Inspection to require Treatment (excluding Defects of Nutrition, Uncleanliness and Dental Diseases.) Group. (1) For defective vision (excluding squint). (2) For all other conditions recorded in Table IIa. (3) Total. (4) Entrants 46 384 430 Second Age Group 149 437 586 Third Age Group 148 293 441 Total (Prescribed Groups) 343 1,114 1,457 Other Routine Inspections 25 161 186 Grand Total 368 1,275 1,643 59 Table II. A.—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1938. Defect or Disease (1) Routine Inspections Special Inspections No. of Defects No. of Defects Requiring Treatment Requiring to be kept under observation, but not requiring Treatment (3) Requiring Treatment (4) Requiring to be kept under observation, but not requiring Treatment (5) Skin 1. Ringworm—Scalp — — 13 - 2. ,, Body 2 — 41 1 3. Scabies 8 — 193 — 4. Impetigo 12 — 718 1 5. Other Diseases (Non-Tuberculous) l6l 1 1016 2 Total (Heads 1 to 5) 183 1 1981 4 Eye 6. Blepharitis 28 — 78 7. Conjunctivitis 8 — 340 — 8. Keratitis — — - — 9. Corneal Opacities — — — — 10. Other Conditions (excluding Defective Vision and Squint) 34 4 242 3 Total (Heads 6 to 10) 70 4 660 3 11. Defective Vision (excluding Squint) 368 25 82 2 12. Squint 21 — 9 — Ear 13. Defective Hearing 12 — 25 — 14. Otitis Media 31 — 385 2 15. Other Ear Diseases 35 5 149 Nose and Throat 16. Chronic Tonsillitis only 493 23 201 7 17. Adenoids only 11 2 8 / 18. Chronic Tonsillitis and Adenoids 117 2 368 23 19. Other Conditions 71 1 565 2 20 Enlarged Cervical Glands (Non-Tuberculous) 97 57 81 - 21. Defective Speech 34 3 6 - Heart and Circulation Heart Disease 22. Organic 4 3 21 2 23. Functional 64 38 36 1 24. Anaemia 12 1 23 — Lungs 25. Bronchitis 127 — 554 3 26. Other Non-Tuberculous Diseases 54 3 145 3 Tuberculosis Pulmonary— 27. Definite 1 — 2 — 28. Suspected — — 19 — Non-Pulmonary— 29. Glands — — 4 — 30. Bones and Joints 2 — — — 31. Skin 1 — — — 32. Other Forms 2 - 7 — Total (Heads 29 to 32) 5 — 11 — Nervous System 33. Epilepsy 1 — 1 1 34. Chorea 13 — 105 1 35 Other Conditions 204 5 56 - Deformities 36. Rickets 6 - 14 — 37. Spinal Curvature 11 — 10 — 38 Other Forms 136 6 76 — 39. Other Defects and Diseases (excluding Defects of Nutrition, Uncleanliness and Dental Diseases) 439 10 3291 66 Total number of defects 2620 189 8884 120 B.—CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Age-Groups. Number of Children Inspected. A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Entrants 1,061 386 36.38 635 59.85 38 3.58 2 .19 Second Age-group 1,495 721 48.23 662 44.28 104 6.96 8 .53 Third Age-group 1,083 543 50.14 478 44.14 61 5.63 1 .09 Other Routine Inspections 415 38 9.16 318 76.63 59 14.21 - — Total 4,054 1,688 41.64 2,093 51.63 262 6.46 11 .27 Table III. BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — — 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 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 4 — — 4 61 PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf and Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total 3 — — — 3 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 - — — 47 EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 2 1 - — 3 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 2 — 3 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 3 3 4 11 62 B.-Delicate Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 137 48 — — 185 C.—Crippled Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 16 47 — — 63 D.—Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 23 53 — — 76 Children Suffering from Multiple Defects. Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — — — Table IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1938. TREATMENT TABLES. Group I.—Minor Ailments( excluding Uncleanliness, for which see Table VI). Disease or Defect. (1) Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin— Ringworm—Scalp— (i) X-Ray Treatment — - - (ii) Other Treatment 13 - 13 Ringworm—Body 39 — 39 Scabies 190 - 190 Impetigo 714 3 717 Other skin disease 959 22 981 Minor Eye Defects 649 9 658 Minor Ear Defects 547 18 565 Miscellaneous 2,200 114 2,314 (e.g., minor injuries, bruises, sores, chilblains, etc.) Total 5,311 166 5,477 63 Croup II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group 1). Number of Defects dealt with Under the Authority's Scheme. Otherwise. Total. Errors of Refraction (including squint) 884 - 884 Other defect or disease of the eyes (excluding those recorded in Group I) 83 — 83 Total 967 — 967 Under the Authority's Scheme. Otherwise. Total. Number of Children for whom spectacles were— (a) Prescribed 828 — 828 (b) Obtained 816 — 816 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. 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) 43 4 122 9 1 - 5 3 44 4 127 12 654 841 (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. (1) Otherwise. (2) Total number treated. Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopaedic clinic. (iii) Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopaedic clinic. (iii) No. of children treated 13 — 313 — — — 313 64 Table V. DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist— (a) Routine age-groups— Age. 4 5 6 7 8 9 10 11 12 13 14 15 16 Total. No. 153 826 916 1,122 1,363 1,334 1,268 1,128 1092 997 336 35 11 10,581 (6) Specials 2,013 (c) Total (Routine and Specials) 12,594 (2) Number found to require treatment 9,854 (3) Number actually treated 5,288 (4) Attendances made by children for treatment 10,566 (5) Half-days devoted to:— Inspection 83 Treatment 1,356 Total 1,439 (6) Fillings:— Permanent Teeth 6,170 Temporary Teeth 564 Total 6,734 (7) Extractions :— Permanent Teeth 1,574 Temporary Teeth 9,074 Total 10,648 (8) Administrations of general anaesthetics for extractions 3,372 (9) Other Operations:— Permanent Teeth 858 Temporary Teeth 5,277 Total 6,135 Table VI. UNCLEANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 16 (ii) Total number of examinations of children in the Schools by School Nurses 46,391 (iii) Number of individual children found unclean 2,294 (iv) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 564 (v) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 2 (b) Under School Attendance Byelaws — 65 STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1938, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. TOATL NUMBER OF CHILDREN NOTIFIED—3. 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 2 1 (c) Others — — (ii) Children unable to be instructed in a Special School without detriment to the interests of other children:— (a) Moral defectives — — lb) 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 2 1 66 Table I. SECONDARY SCHOOLS. Number of Pupils Inspected—1st January to 31st December 1938. A. Routine Medical Inspections. (i.) Cases in which a full examination has been made (see para. 4, Circular 1153. Board of Education). Age 9 10 11 12 13 14 15 16 17 18 19 Total Boys - - 1 9 7 16 38 2 - - - 73 Girls — — 32 71 7 2 - - - - - 112 Total - — 33 80 14 18 38 2 — — 185 (ii.) Cases in which only partial examination has been made (see para. 4, Circular 1153, Board of Education). Age 9 10 II 12 13 14 15 16 17 18 19 Total Boys - - - - - - - - - - - - Girls - - - - - - - - - - - - Total - - - - - - - - - - - Special Cases Re-Examinations (i.e. No. of pupils re-examined) Boys Girls — 21 Total — 21 CLASSIFICATION OF THE NUTRITION OF PUPILS INSPECTED DURING THE YEAR, IN AGES. Ages Number of Pupils Inspected A Excellent No. B Normal No. C Slightly Sub-normal No. D Bad No. 9 - - - - - 10 — - — — - 11 33 19 13 1 12 80 53 24 3 - 13 14 11 3 — — 14 18 15 3 — — 15 38 36 2 — — 16 2 2 — — — 17 — — — — — 18 -- — — — — 19 — — — — — Total 185 136 45 4 — 67 RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1938. Defect or Disease Routine Inspections Special Inspections No. of Defects No. of Defects A B A B Skin Ringworm—Scalp - - - - Body - — — — Scabies — — — — Impetigo — — — — Other diseases—non T.B. 6 — — — Eye Blepharitis - - - - Conjunctivitis — — — — Keratitis — — — — Corneal Opacities — — — — Defective Vision (excluding Squint) 14 — — — Squint - — — — Other conditions 1 — — — Ear Defective Hearing - - - - Otitis Media — — — — Other Ear diseases 1 — — — Nose and Throat Chronic Tonsillitis 1 - - - Adenoids only 1 — — — Chronic Tonsillitis and Adenoids — — — — Other conditions 2 — — — Enlarged Cervical Glands (non T.B.) — — — — Defective Speech — — — — Heart & Circulation Heart disease—Organic - - - - Functional — 3 — — Anaemia — — — — Lungs Bronchitis — — — — Other non T.B. disease 1 — — — Pulmonary—Definite - - - - Suspected — — — — Tuberculosis Non-Pulmonary—Glands — — — — Bones and Joints — — — — Skin — — — — Other forms — — — — Nervous System Epilepsy — — — - Chorea — — — — Other Conditions 1 — — — Deformities Rickets - - - - Spinal Curvature 2 1 — — Other forms —- — — — Other diseases and defects 17 4 — — Teeth Dental diseases 1 — — — A—Requiring treatment. B-Not requiring treatment, but requiring to be kept under observation. 68 Table IV—(continued). 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) 148 - 148 Other Defect or Disease of the Eyes (excluding those recorded as minor ailments) — — — Total 148 — 148 Total Number of Children for whom Spectacles were prescribed :— (a) Under the Authority's Scheme 146 (6) Otherwise - Total Number of Children who obtained or received Spectacles:— (a) Under the Authority's Scheme 146 (6) Otherwise — SECONDARY SCHOOL CHILDREN. Dental Defects. (1) Number of pupils who were:— (a) Inspected by the Dentist:— Ages:— 9 — 10 — 11 155 12 261 13 215 14 244 15 192 16 73 17 24 18 9 19 — Total 1 173 Specials 34 Grand Total 1,207 (6) Found to require treatment 925 (c) Actually treated 394 (2) Half-days devoted to:— Inspection 10 Treatment (Mixed with Elementary) Total 10 (3) Attendances made by pupils for treatment 811 (4) Fillings:— Permanent teeth 949 Temporary teeth 31 Total 980 (5) Extractions:— Permanent teeth 267 Temporary teeth 38 Total 305 (ti) Administrations of general anaesthetics for extractions 150 (7) Other operations:— Permanent teeth 264 Temporary teeth — Total 264 69 Table I. JUNIOR TECHNICAL SCHOOLS. Number of Pupils Inspected—Ist January to 31st December, 1938. A. Routine Medical Inspection. (i.) Cases in which a full examination has been made (see para. 4, Circular, 1153, Board of Education). Age 9 10 11 12 13 14 15 16 17 18 19 Total Boys Girls — — — 3 67 40 84 2 — — — 196 Total — — 3 67 40 84 2 — — — 196 (ii.) Cases in which only partial examination has been made (see para. 4, Circular 1153, Board of Education). Age 9 10 11 12 13 14 15 16 17 18 19 Total Boys - - - - - - - - - - - - Girls - - - - - - - - - - - - Total - - - - - - - - - - - - Special Cases Re-Examinations (i e. No. of pupils re-examined) Boys — — Girls — 13 Total — 13 CLASSIFICATION OF THE NUTRITION OF PUPILS INSPECTED DURING THE YEAR, IN AGES. Ages Number of Pupils Inspected A Excellent No. B Normal No. C Slightly Sub-normal No. D Bad No. 9 - — — - - 10 — — — — — 11 — — — — — 12 3 3 — — — 13 67 48 16 3 — 14 40 32 8 — — 15 84 77 7 — — 16 2 2 — — — 17 — — — — — 18 — — — — — 19 — — — — — Total 196 162 31 3 — 70 RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1938. Defect or Disease Routine Inspections Special Inspections No. of Defects No. of Defects A B A B Skin Ringworm—Scalp — - — - Body — — — — Scabies — — — — Impetigo — — — — Other diseases—non T.B. 10 — — — Eye Blepharitis - — — - Conjunctivitis — — — — Keratitis — — — — Corneal Opacities — — — — Defective Vision (excluding Squint).. 35 — — — Squint - — — — Other conditions 4 — — — Ear Defective Hearing 1 - - - Otitis Media — — — — Other Ear diseases 2 — — — Nose and Throat Chronic Tonsillitis 4 - - - Adenoids only - — — — Chronic Tonsillitis and Adenoids — — — — Other conditions 6 — — — Enlarged Cervical Glands (non T.B.) 1 — — — Defective Speech — — — - Heart & Circulation Heart disease—Organic - - - - Functional - 2 — — Anaemia 1 — — — Lungs Bronchitis - - - - Other non T.B. disease i1 — — — Tuberculosis Pulmonary—Definite - - - - Suspected - — — — Non-Pulmonary—Glands - — — — Bones and Joints - — — — Skin Other forms - — — — Nervous System Epilepsy - — — — Chorea - — — — Other conditions — — — — Deformities Rickets - — — — Spinal Curvature 6 — — — Other forms 11 — — — Other diseases and defects 35 — — — Teeth Dental diseases 15 — — — A—Requiring treatment. B-Not requiring treatment, but requiring to be kept under observation. 71 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) 50 - 50 Other Defect or Disease of the eyes (excluding those recorded as minor ailments) — _ — Totals 50 - 50 Total Number of Children for whom Spectacles were prescribed :— (a) Under the Authority's Scheme 50 (b) Otherwise — Total Number of Children who obtained or received Spectacles :— (a) Under the Authority's Scheme 50 (6) Otherwise — JUNIOR TECHNICAL, etc., SCHOOLS Dental Defects. (1) Number of pupils who were:— (a) Inspected by the Dentist:— Ages:— 9 — 10 — 11 — 12 — 13 46 14 70 15 16 16 — 17 — 18 19 — Total 132 Specials 4 Grand Total 136 (6) Found to require treatment 115 (e) Actually treated 78 (2) Half-days devoted to:— Inspection 1 Treatment (Mixed with Elementary) Total 1 (3) Attendances made by pupils for treatment 174 (4) Fillings :— Permanent teeth 136 Temporary teeth 3 Total 139 (5) Extractions :— Permanent teeth 81 Temporary teeth 2 Total 83 (6) Administrations of general anaesthetics for extractions 45 (7) Other operations:— Permanent teeth 51 Temporary teeth — Total 51 72