ED 426 Borough of Edmonion. REPORT OF THE Medical Officer of Health and School Medical Officer FOR THE YEAR 1940 BOROUGH OF EDHONTON 1940 Her Worship the Mayor Councillor Mrs E.H.Hearn, J.P. Deupty Mayor Councillor T.H.Joyce PUBLIC HEALTH COMMITTEE Chairman Councillor C.G. Laecy Aldormen Mrs. M.M. Barrass, J.Reid , Mrs. E.A. Young. Councillors W.Cudworth, Mrs. E.M.Moss, A.W. Poarce, J.A.Ward STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health, School Medical Officer, and Supervisor for the Maternity and Child Welfare Services:- D. RAGAN, 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. Mc INTYRE, B.A., M.B. , B.Ch., B.A.O., D.P.H. (Left Council's Service April ,1940) Assistant Medical Officers and School Medical Officers:- Hilda R. Hay., H.3., Ch.B., D.P.H. Margaret F. Coveney, B.Sc., M.B. , Ch.B., D.P.H. Catherine A. Goggin, M.B., B.Ch., B.A.O. , D.P.H. (Cormenced July 1940) Senior Sanitary Inspector:/ic.bcd W.Tilloock, M.R. San. I. District Sanitary Inspectors:- %abce G.H.Huckle, %abc J.P.Ferrar. %abc E. Dodsworth, %abc H.W.Grieves, %abc F.Beilby. %a Mrs H.Fewler, 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, (In H.M.Forces) H.J.Weldon. Junior Clerk, (In H.M..Forces) S.Clayton. Shops Acts Inspector, T.G.Marsden, Assistant Shope Acts Inspector, Miss I.M. Bowic, Temporary Clerk, N.Gilbert, Temporary Clerk. % Moiety paid under Public Health Act or by Exchequer Grants. a Certificated Sanitary Inspector b Certificate of Heat and Food Inspector c Inspector under the Potrolcum. Acts d Inspector of Canal Boats o Certificate of Smoke Inspector. PREFACE Public Health Department, Town Hall, Edmonton, N.9. Her Worship the M.yor, Alclemen and Councillors of tho Borough of E<": onton. Your Worship, Ladies & Gentlemen, I have rjuch pleasure in presenting r.iy sixth Annual Report for the year 194-0. Not it: standing; tho difficulties created by the War, the Medical Services have not only been restored but also improved upon. It is tho wish of the Cor cil that all these Services be rnaintained to their full capacity. In. the year 1940 life in the Borough while not normal, took on a more oven tenor, although much discomfort and abnormailty occured towards the end of the year the health of the people remained steadfastly good. Infectious Disease on the whole remained abnormally low, but the spread of Scabies gave some little difficulty. On account of overcrowding in an already overcrowded department, additional accomodation was obtained adjacent to the Town Hall for the Sanitary Inspectors actors and Shops Acts Inspectors. As anticipated in my Report for 1959, it became necessary to obtain extra assistance to deal with the establishment, training and maintenance of the First Aid Services.Mr.A.E.Clerke, my Records Clerk was seconded to A.R.P. duties in this connection; Mr.A.Bellanitine-.Housing, Survey Clerk at the outbreak of War, was also transferred to A.R.P. duties, and 2 Lady Clerks wore appointed. Later in the year Dr.R.Greville Samuel was appointed as Medical Officer, A.R.P. Services. During the year Dr-.Cathorine A.Goggin joined the Staff as Assistant Medical Officer and School Medical Officer. I would like to mention that Mr. David H.J.Newman, Correspondence Clerk, joined His Mejosty's Forces in August 1940. His services will bo greatly missed in the Department, and I sincerely trust that his return will not be long delayed when Peace is once more restored. I Wish to thank the Members of the Council for their courtesy to me during an exceedingly difficult year. In conclusion, I would like to thank the Members of the Staff for the very excellent manner in which they have carried out their duties in the most trying circumstances, and not only that but also to ful fil many other duties which have fallen to their lot on account of the War. I have the honour to be, Your Worship, Ladies & Gentlemen, Your obedient Servant, D.REGAN, Medical Officer of Health. GENERAL STATISTICS Area (in acres) 3,896 Population - Census of 1921 66.809 Census of 1931 . 77,652 Estimated by the Registrar- General for mid-year, 1940 1940 95,500 Number of Inhabitated Houses and Tenemets mots at the end of 1940 25,807 Number of Inhabitated Houses and Tenements at the end of 1939 25,726 Rateable Value, April, 1940. £739,595 Ecti-'rted product of one penny in the £ for t.hc year ending 31st March, 1241 £ 2,366 Rates in the £ for the year onding 31st March, 1941 15/- SOCIAL CONDITIONS The extent of unemployment my be ostimted by the following figures relating to:- (1) The rumber of free dinners given to schoolchildren, and (2) The actual figures supplied by the Director of Public Assistance. No: 1 is given on purely economic grounds. (1) Number of free dinners during 1939 (to the end of August) 101,681 ,, ,, ,, 1940 49,530 (2) Figures re out-relief:- Persons Amount For the year 1939 (a) Ordinary out-relief 4,244 £44,450 (b) Unemployed out-relief 454 £ 2,556 4,698 £47,006 For tho year 1940 (a) Ordinary out-relief 2,194 £22 ,475 (b) Enemployed out—relief 207 £ 789 2 ,401 £23,264 VITAL STATISTICS Grand Total LIVE BIRTHS M. F Tot; .1 Legitimate 738 696 1,434 Illegitimate 16 21 37 1,471 Birth-rate per 1,000 of population 15.4 STILL-BIRTHS Legitimate 28 24 52 Illegitimate - 1 1 53 Total of live and still-births 1,524 Rate per 1,000 total births 34.77 DEATHS Number 514 530 1044 Rate per 1,000 population 10.93 DEATHS FROM PUERPERAL CAUSES Deaths Rate per 1,000 total (live & still) births Puerperal & Post-abortive Sepsis - Other Maternal Causes 4 2.72 4 2.72 DEATH-RATE OF INFANTS UNDER ONE YEAR OF AGE Number 32 24 56 All Infants per 1,000 live births 39.5 Legitimate infants per 1,000 legitimate live births 39.1 Illegitimate infants per 1,000 illegitimate live births 54.0 • Deaths from cancer (all ages) 145 " " measles( -do- ) 1 " " whooping cough (all ages) " " diarrhoea (under 2 years of age) 3 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 _ _ _ Cerebro-spinal Fever _ _ _ Scarlet Fever _ _ Whooping Cough _ _ _ Diphtheria 1 _ 1 Tuberculosis of the Respiratory System 36 34 70 Other Forms of Tuberculosis 1 6 7 Syphilitic Diseases 3 _ 3 Influenza 4 2 6 Measles 1 _ 1 Acute Poliomyelitis & Polio-Encephalitis _ _ Acute Infective Encephalitis 3 1 4 Cancer of Buccal Cavity & Oesophagus (M) Uterus (F) 13 8 21 Cancer of Stomach & Duodenum 15 16 31 Cancer of Breast _ 21 21 Cancer of all Other Sites 36 36 72 Diabetes 1 4 5 Inter-Cranial Vascular Lesions 29 45 74 Heart Disease 113 125 238 Other Diseases of Circulatory System 16 6 22 Bronchitis 41 35 78 Pneumonia 38 35 73 Other Respiratory Diseases 10 7 17 Ulcer of Stomach or Duodenum 4 5 9 Diarrhoea (under 2 years) 2 1 3 Appedicitis 1 2 3 Other Digestive Diseases 9 20 29 Nephritis 6 8 14 Puerperal & Post-Abortive Sepsis _ _ _ Other Internal Causes _ 4 4 Premature Birth 8 4 12 Congenital Informations, Birth Injuries, Infant Diseases 15 14 29 Suicide 7 7 14 Road Traffic Accidents 12 3 15 Other Violent Causes 52 48 100 All Other Causes ?73 33 70 TOTAL DEATHS 514 530 104-4 The following tables give the deaths of those registered during the 52 weeks ended 28th December, 1940, sub-divided as to ago groups:- MILES Causes of Death ALL AGES to 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 & dip Diphtheria 1 - - - 1 - - - - - - - Tuberculosis of the Respiratory System 34 - - - - 4 8 6 10 5 1 - Other Forms of Tuberculosis 1 - 1 - - - - - - - - - Syphilitic Diseases 3 - - - - - - 2 - 1 - - Influenza 4 - - - 1 - - 1 1 1 - - Measles 1 1 - - - - - - - - - Acute Infective Encephalitis 3 - - - - - - 1 - 1 1 - Cancer of Buccal Cavity & Oesophagus 13 - - - - - - - 1 2 6 4 Cancer of Stomach & Duodenum 14 - - - - - - - 2 5 3 Cancer of all Other Sites 39 - - - - - - - 5 11 17 6 Diabetes 1 - - - - - - - - - 1 - Intra-Cranial Vascular Lesions 29 - - - - - 1 - 2 8 11 7 Heart Disease 112 - - - - 2 2 8 8 27 34 31 Other Dis: of Circulatory System 17 - - - - 1 - - 2 2 6 6 Bronchitis 39 - - - - 1 1 - 5 7 14 11 Pneumonia 30 8 1 - 1 1 - 1 6 8 10 2 Other Respiratory Diseases 10 - - - - - - 1 1 5 1 2 Ulcer of Stomach or Duodenum 4 - - - - - 1 - 2 1 - - Diarrhoea (under 2 years) 2 2 - - - - - - - - - - Appendicitis 1 - - - - - 1 - - - - - Other Digestive Disease 8 - - - - - 1 - 1 1 4 1 Nephritis 6 1 - 2 2 1 Premature Birth 8 8 - - - - - - - - - - Cong:Mal: Birth Injuries, Infant Dis: 13 11 - 2 - - - - - - - - Suicide 6 - - - - - - 2 1 1 2 - Road Traffic Accidents 12 - - - 1 2 2 - 2 2 1 2 Other Violent Causes 47 1 2 - 2 5 8 10 4 8 5 2 All Other Causes 37 1 - - 3 1 1 1 3 3 8 16 503 32 4 2 9 17 26 34 56: 101 128 94 FEMALES Tuberculosis of the Respiratory System 36 - - 1 - 9 10 9 3 2 2 - Othor Forms of Tuberculosis 5 - 1 - 2 1 1 - - - - - Influenza 2 - - - - - - - - - - 2 Acute Infective Encephalitis 1 - - - - - - - - - 1 - Cancer of Uterus 9 - - - - - 1 - 3 1 3 1 Cancer of Stomach & Duodenum 16 - - - - 1 - - 1 5 7 2 Cancer of Breast 21 - - - - - - 4 6 7 - 4 Cancer of all Other Sitos 38 - - - - 3 - 5 6 8 9 7 Diabetes 4 - - - - - - - - - 1 3 Intra-Cranial Vascular Lesions 44 - - - - - - - 3 8 13 20 Heart Disease 121 - 1 - - - 2 5 5 22 31 55 Other Dis: of Circulatory System. 6 - - - - - - - - 1 3 2 Bronchitis 34 - - - - 1 - 2 4 3 8 16 Pneumonia 34 3 1 - - 4 2 3 6 6 9 Other Respiratory Diseases 7 - - - - 1 - 1 1 - - 4 Ulcer of Stomach or Duodenum 5 - - - - - - 2 1 2 - - Diarrhoea (under 2 years) 1 1 - - - - - - - - - - Appendicitis 2 - - 1 - - - 1 - - - - Other Digestive Diseases 19 - - - - 2 . - 4 1 5 5 2 Nephritis 7 - - - - - - 1 1 - 4 1 Puerperal & Post-Abortive Sepsis - - - - - - - - - - - - Other Maternal Causes 4 - - - - 2 2 - - - - - Premature Birth 4 4 - - - - - - - - - - Cong: Mal: Birth Injuries, Infant Dis: 14 14 - - - - - - - - - - Suicide 6 - - - - 1 1 2 1 1 - - Road Traffic Accidonts 3 - - - - 2 1 - - - - - Other Violent Causes 42 1 - - 4 2 0 6 7 5 8 4 All other Causes 33 1 - 1 1 1 1 2 7 3 7 9 518 24 3 3 7 26 28 46 53 79 108 141 There is a slight difference in rospoct of the causes of death between those last two tables and the one supplied by the Registrar General who is in possession of additional information on the matter. INFANTILE MORTALITY The deaths of infants under 1 year of ago were as follows M F Total Legitimate 31 23 54 Illegitimate 1 1 2 32 24 56 The death-rate of all infants per 1,000 live births was 39.5. A detailed sub-division of the causes etc., of theso infants deaths is as follows:- MALES Causes of Death Under 1 week Total Total under lyear 2nd week 3rd week 4th week under 1 mth 1-3 mths 3-6 mth! 6-9 s mths 9-12 mths Measles - - - - - - 1 - - 1 Diarrhoea - - - - - - - 2 - 2 Pneumonia 2 - - - 2 - 4 2 - 8 Violence 1 - - - 1 - - - - 1 Congenital Debility - - - - - 2 - - - 2 Premature Birth 4 2 - - 6 1 1 - - 8 Injury at Birth 4 - - - 4 - - - - 4 Atelaetasis 2 - - - 2 - - - - 2 Asphyxia Neonatorum 1 - - - 1 - - - - 1 Congenital Malformations 1 - - - 1 1 - - - 2 Other Causes 1 - - - 1 - - - - 1 Totals 16 2 - - 18 4 6 4 - 32 FEMALES Meningitis - - - - - - - 1 - 1 Bronchitis - - - - - 1 - - - 1 Pneumonia - - - - . - 2 - 1 - 3 Violence - - - - - - - 1 - 1 Diarrhoea - - - - - - - 1 - 1 Congenital Malformations 2 - - - 2 2 - 1 - 5 Congenital Debility - - - - - - 1 - - 1 Premature Birth 2 - 1 - 3 1 - - - 4 Injury at Birth 3 - - - 3 - - - - 3 Ateactasis - 1 - - 1 - - - - 1 Asphyxia Neonatorum 3 - - - 3 - - - - 3 Totals 10 1 1 - 12 6 1 5 - 24 COMPARATIVE STATISTICS The Registrar-General has forwarded provisional figures relating to the Country as a whole, and to London, enabling comparisons to be undo as follows:- Birth-rate per 1,000 Death-rate per 1,000 births population From diarrhoea etc., Total deaths Live Still under 2 years under 1 year England and Wales 14.6 0.55 4.6 55 London 13.7 0.44 5.8. 50 EDMONTON 15.4 0.55 2.12 39.5 ANNUAL DEATH RATE PER 1,000 OF POPULATION All Cause's Measles Scarlet Fever Whoop Cough Diphtheria Influenza England and Wales 14.3 .02 .00 .02 .06 .32 London 17.8 .01 .00 .00 .01 .18 EDMONTON 10.93 .01 .00 .00 .01 .06 The following table gives the number of births and deaths (registered) sub-divided into the four wards of tho Borough. It should be remembered that births are only of those which occurred in Edmonton and of course of Edmonton addresses; these are registered in Edmonton. Births which take place outside the Borough arc 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-Goneral.  Births Deaths Infant Deaths Ward Male Female Male Female Male Female Bury Street 206 195 130 149 14 10 Church Street 89 101 84 124 1 4 Angel Road 139 122 135 130 7 5 Silver Street 155 138 150 114 9 5 Vagrants - - - 4 1 1 - 589 556 505 518 32 24 GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH LABORATORY FACILITIES These are as described in previous reports, The following examinations were carried out during 1940:- Swabs for Diphtheria:- Positive Negative Total From suspected cases 13 369 382 From contacts 13 134 147 From carriers and old cases 1 5 6 27 508 535 Present Not found Total Sputa for the presence of Tubercle bacillus 2 18 20 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 - 15 15 Urine -do- -do- -do- - 2 2 Faeces -do- -do- -do- - 8 8 Swabs for virulence of K.L.B. - 1 1 Swabs for presence of haemolytic Streptococci - 1 1 Vaginal swabs for presence of Genococci - 2 2 Blood for Undulant Fever - 1 1 The Middlesex County Council is the Authority under the Food and Drugs Act as regards adulteration. 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 6,278 Accident Cases 512 Maternity Cases 114 Clinic (tonsil cases) 12 Special Services 234 False alarns 29 • 7,179 First aid was rendered on 151 occasions, whilst the resusitating apparatus was in use 36 times. The bedside apparatus for the supply of oxygen was requested by 82 patients. The total mileage of the vehicles was 31,248 miles. The Council's small bus conveys the deaf and dumb and partially blind children to and from school, picks up a few other childron in the morning taking then to a spot to meet the guide; also conveys 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. HURSING H0MES REGISTRATION There is one Nursing Home registered by the Council. This is kept under supervision by the Medical Officer of Health, No new applications to bo placed on the Register wore received during 1940. SANITARY INSPECTION IN THE AREA Five District Sanitary Inspectors are engaged in the sanitary supervision of the Borough, working under the supervision of the Senior Sanitary Inspector. The Woman Sanitary Inspector looks after outworkers' promises, the sanitary condition of factories where women are employed, the investigation of notifiable infectious diseases, including tuberculosis. She also assists in the supervision of the women's public conveniences. The Senior Sanitary Inspector supervises the work of the Borough and is Inspector under the Canal Boats Acts. At the outbreak of hostilities the Senior Sanitary Inspoctor was appointed Controlling Officer for Emergency Petrol Supplies and also Authorised Officer for Decontamination of Food. (Gas Contamination Officer). The District Sanitary Inspectors aro acting as Billeting Officers, and in addition one as War. Mortuary Superintendent. The following tabular statement gives the number and the nature of the inspections made during the year:- Complaints 1191 Infectious Disease 599 Tuberculosis 127 Factories with mechanical power 107 Factories without ," " 12 Other premises under tho Factories Act 2 Outworkers 189 Schools 23 Offensive Trades 25 Shops and stalls 323 Shops Act (Primary) 6 Shops Act (Re-inspections) 1 Sanitary conveniences and urinals 553 Stables 36 Piggeries 12 Petroleum 33 General Inspections 240 Re-inspections 2627 Sundry visits 843 Cinemas and halls 9 Visits to Canal 10 A.R.P.Shelters 39 Billets 2504 INSPECTIONS OF PLACES WHERE FOOD IS PREPARED Butchers 230 Fish shops 69 Coffee shops 63 Ice cream shops 80 Dairies and milkshops 135 Slaughterhouses 10 Bakehouses 24 Food stores (M.C.C.General Powers Act) 12 NUMBER OF NOTICES SERVED Preliminary or Informal Notices 580 Statutory Notices 73 DEFECTS REMEDIED Houses repaired, cleansed, etc. 425 D.W.Cisterns repaired, covered 21 Water fittings repaired 87 Water taken off main 3 Drains examined, tested, etc. 204 Drains cleared, trapped, repaired 254 Drains re-constructed 54 Chambers inserted 23 Chambers sealed down 24 Soil and vent pipes repaired 47 W.C's repaired, cleansed, etc. 238 Flushing cisterns repaired 81 Paste pipes repaired, etc. 70 Sinks ropaired or renewod 35 Roofs repaired 340 Gutters end R.W.P's repaired 193 Yards paved or repaved 75 Scullery floors repaired 29 Spaces unddr floors ventilated 79 Dampness remedied 162 Floors ropaired 100 Coppers and stoves repaired, etc. 117 New dustbins supplied 66 Accumulation of refuse removed 9 Nuisances from animals abated 1 Other nuisances abated 292 SANITARY CONVENIENCES There arc seven Public Conveniences in the Borough which arc kept under constant supervision by the Public Health Department. RATS AND MICE (DESTRUCTION) ACT, 1919 The Middlesex County Council is the Authority for this Borough under the Act, which places the responsibility upon tho occupier of the promises 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. MIDDLESEX COUNTY COUNCIL (GENERAL POWERS) ACT, 1938. SECTION 71 HAWKERS, ETC. This Act came into operation on the 1st 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, 87 applications for registration were received during 1939. No new applications wore received during 1940. DISINFECTION AND DISINFESTATION The Council's Disinfocting Station was completely destroyed during October of this year, and from that time onwards the work has been carried out at Disinfecting Station of the Enfield Urban District Council. I would like to take this opportunity of expressing my thanks for the co-operation received from the Enfield Council in this matter. The following table gives some idea of the work carried out:- Number of journeys to collect bedding 278 " " " M return bedding 245 Rooms disinfected after infectious disease 475 Rooms disinfected after phth isis 99 Rooms disinfected after cancer — Disinfestation carried out after vermin 269 Bedding,clothing,etc. disinfected after Infectious Disease Number of articles 2,518 Bedding,clothing,etc. disinfected after Phthisis Nur.bor of articles 583 Bedding,clothing,etc, disinfected after other cases Number of articles 1,785 The Council distribute a disinfectant powder and flcid to residents who apply for the same at the Town Hall Yard. During the year the applicants numbered 22,460. 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 541. Twenty-two Council houses and 103 other houses were found to be infested and the total number of rooms disinfected was 269. 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 4 new licences and 114 renewals were granted by the Council. The following is a list of particulars of quantities, etc., affected by these licences:- Petroleum Spirit 475,315 gallons Petroleum Mixtures 5,609 gallons Carbide of Calcium 1 ton 102 lbs. MORTUARY During the year 81 bodies were deposited in the Mortuary, 69 by order of the Coroner, and 12 for sanitary reasons, CANAL BOATS ACTS During the year 10 visits were paid to the Canal and 6 boats were seen, but of this number none were fitted or used as dwellings or registered under the Acts. PLACES OF PUBLIC ENTERTAINMENT Nino 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. FACTORIES ACT. 1937 The following work has been carried out u.nder the above Act:1 - INSPECTIONS FOR HIE PURPOSE OF PROVISIONS AS TO HEALTH Premises Inspections Written Notices Occupiers Prosecuted Factories with mechanical power 104 14 - Factories without mechanical power 10 - - Other promises under the Act (including works of building and engineering and construction but not including outworkers' premises) 2 - - Totals 116 14 - 2 - DEFECTS FOUND No: of defects No of defects in Particulars Found Remedied Referred to H.M. Inspector respect of which prosecutions were instituted Want of cleanliness 18 18 - Overcrowding - - - - Unreasonable temperature - - - - Inadequate ventilation - - - - Ineffective drainage of floors - - - Sanitary (Insufficient 3 3 - - Conveniences(Unsuitable or defective 16 16 - - (Not separate for sexes - - - - Other offences 1 1 - - ("not including offences relating to Home Work or offences under 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 30 38 - - 3 - OUTWORK IN UNWHOLESOME . PREMISES Nature of work Inatances Notices Served Prosecutions, Wearing apparel Making, etc. Cleaning and washing - , FACTORIES AND WORKSHOPS, ETC. DEFECTS REMEDIED W.C.Walls cleansed 13 W.C. Cisterns repaired 1 W.C.Seats repaired or renewed 11 W.C.Flush pipes repaired 3 W.C.Doors repaired 1 Roofs repaired 1 Workrooms cleansed 5 Sanitary accommodation improved 3 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 wore closed during the year on account of infectious diseases. HOUSING - HOUSING- ACT, 1936 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) 960 (b) Number of inspections made for the purpose 3455 (2) (a) Number of' dwelling-houses (including under sub -head (1) above which were inspected an d recorded under the Housing Consolidated Regulations, 1925 and 1932 - (b) Number of inspections made for the purpose - (3) Number of dwelling-houses found to bo in a state so dangerous or injurious to health as to be unfit for human habitation - (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 591 2. REMEDY OF DEFECTS DURING THE YEAR WITHOUT SERVICE OF FORMAL NOTICES:- Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 571 3. ACTION UNDER STATUTORY POWERS HIRING 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 92 (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) By owners 78 (b) by Local Authority in default of owners 1 B - Proceedings under Public Health Acts:- (1) Number of dwelling-houses in respect of which notices wore served requiring defects to bo remedied 5 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices:- (a) By owners 7 (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 - (2) Number of dwelling-houses demolished in pursuance of demolition orders .- D - Proceedings under Section 12 of the Housing Act, 1936:- (l) 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 tenements or rooms having boon rendered fit. - INSPECTION AND SUPERVISION OF FOOD MILK SUPPLY With respect to the Milk (Special Designations) Orders samples of designated milks are sent to the Counties Public Health Laboratories for bacteriological examinations. Various licences were granted as under:- Primary Supplementary Pasteurised 17 8 Tuberculin Tested 13 5 Accredited - 1 30 ~14 Two of the above retailors arc licensed to bottle Tuberculin Tested Milk, and one firm is licensed to pasteurise and bottle milk on the premises; one firm is licensed to bottle pasteurised milk on the premises. Supplementary licences are granted to milk retailers who live outside the Borough, but who sell milk in the Borough; the primary licence is granted them by the Authority of the area in which they reside UNSOUND FOOD The following is a list of the food surrendered for examination and retained as unfit for human consumption:- 28 lbs Dabs 15 lbs Tripe and ½ set of Feet 1 box Plaice 1 cwt Fish 26 lbs Bacon (various) 1 Pig carcase 25½1bs Bacon (various)(Lithuania) 5 boxes Megrims 12¾lbs Bacon 1 boneless Ham 1 Shoops Liver 3 tins Corned Beef (18 lbs) 1 Lamb 5 boxes Kippers 30 lbs Pork 15,800 tins Pineapple . 49 boxes Tomatoes 34 lbs Dried Apricots 32 lbs Rump Trimmings 36 lbs Bacon 1 tin Boneless Ham 20 boxes Tasmanian Apples 10 lbs Bacon 80 tins Fruit (miscellaneous) 9 lbs Chine of Mutton 14 tins Plums 29 lbs Bacon 25 bottles Mixed Pickles 23 lbs Bacon 10 jars Paste 2 Sides of B acon 10 tins Ham & Beef Roll 77,000 tins Skippers in Oil 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, 2,801 Contraventions 33 Proceedings were taken against 4 traders and fines were inflicted as follows:- 1 of £4 2 of 10/- and 1 of 5/-. (CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD The only examinations carried out by the Council arc those for designated milks; these are sent to the Counties* Public Health Laboratories, The matter was discussed previously. PREVALENCE OF INFECTIOUS DISEASE MEASLES AND WHOOPING COUGH Those diseases were made compulsorily notifiable in October, 1939. 308 cases of Measles and 47 cases of Whooping Cough wore notified during the year. There were no deaths from Whooping Cough and only one death from Measles. In October of this year the Council agreed to supply Measles Immune Globulin to General Practitioners for the treatment of Edmonton children, subject to the Doctors signing a statement that the material would be supplied to the patient free of charge. DIPHTHERIA Once again I am happy to report a still lower incidence of this disease. Only 14 cases were notified during the year. There was one death. SCARLET FETOR. This disease continued to occur throughout the year in a mild form, but here again I an pleased to report a still lower incidence than last year, 111 cases against 182. There were no deaths. SMALLPOX. No. cases of smallpox were notified during the year. ENTERIC FEVER. During June and July there was a miner outbreak of this disease, but despite extensive investigation we were unable to trace the source of infection. There were no deaths In November we were informed that an Edmonton patient, who was a typhoid carrier, had discharged himself from Hospital, and further that he was employed as a neat porter. In the circumstances a Notice was served on him under the Public Health (Infectious Diseases) Regulations, 1927 excluding him from employment in such trade or business concerned with the preparation or handling of food or drink for human consumption for a period of 12 months, in the first instance. A Notice to this effect was also served on his employer. DYSENTERY. No cases of this disease were notified during the year. CEREBRO-SPINAL FE7ER, A slight rise in the incidence of this disease occurred during 1940. The cases were carefully investigated, and precautions taken to prevent the spread of infection. No deaths took place. POLIOMYELITIS. Three cases were notified during the year, but there were no deaths. IMMUNISATION AGAINST DIPHTHERIA. As reported last year the outbreak of war caused a temporary suspension of this scheme. The Clinic was re-opened in March of this year. During the year some 460 children wore immunised, this was a fairly satisfactory response considering the circumstances prevailing during the latter half of the year. However I feel confident that with mere extensive propaganda and more settled times, the response will be much greater. PUERPERAL PYREXIA AND OPHTHALMIA NEONATORUM These are referred to later on under the heading of Maternity and Child Welfare. FOOD POISONING Only 1 case was reported - a non-resident inpatient at the N.Mddx.C.Hosp. PNEUMONIA The number of cases of primary and influenzal pneumonia notified remains about the same . There was a slight increase in the number of deaths from all forms of pneumonia. BIARRHOEA AND ENTERITIS UNDER 8 YEARS OF AGE The death-rate per 1,000 live births for London as a whole was 5.8 whilst that for Edmonton was 2.12 as compared with 8.2 and 1.23 respectively last year. The following table gives the age incidence etc., of those suffering from notifiable diseases, excluding tuberculosis, which is dealt with separately. It must be noted that the figures in the second column as being removed to hospital includes those already under treatment at a hospital - for instance the North Middlesex County Hospital. This remark applies more particularly to the infections associated with parturition and include puerperal pyrexia and ophthalmia neonatorum. Disease Total No: of Cases No: remvd to Hosp: Deaths to 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 & s Scarlet Fever 111 101 - 1 4 5 11 10 52 11 7 7 1 2 - Diphtheria 14 14 1 - - 1 2 3 7 1 - - - - - Enteric Fever 26 26 - - 1 - - - 4 2 5 10 2 2 - Puerporal Pyrexia 85 79 4 - - - - - - - 2 72 11 . - - Pneumonia 65 29 73 3 2 3 1 2 3 - 5 16 9 18 3 Erysipelas 25 6 - 1 - - 1 - - - - 5 3 14 1 Ophthalmia Neonatorum 6 5 - 6 - - - - - - - - - - Food Poisoning 1 1 - - - - - - - - - - - 1 - Whooping Cough 47 1 - 9 6 6 2 11 12 1 - - - - - Measles 308 11 1 7 16 23 19 26 183 8 10 16 - - - Cerebrospinal Fever 13 13 - 3 1 - - - 4 2 2 1 - - - Poliomyelitis 3 3 - - - -- - - - 1 1 - 1 - - The following table indicates the Wards from which the Various cases were notified:- Disease Bury Street Ward Church Street Ward Angel Road Ward Silver Street Ward N.Mddx. C.Hosp: Other Instins Total Scarlet Fever 52 14 22 23 - - 111 Diphthoria 5 1 4 4 - - 14 Enteric Fever 6 1 12 5 2 - 26 Puerperal Pyrexia 10 5 7 12 51 - 85 Pneumonia 21 12 23 8 - 1 65 Erysipelas 7 6 5 6 - 1 25 Ophthalmia Neonatorum 2 1 - - 3 - 6 Food Poisoning - - - - 1 - 1 Whooping Cough 22 14 2 9 - - 47 Measles 57 193 22 33 3 - 308 Cerebrospinal Fever 2 3 1 7 - - 13 Poliomyelitis 1 - 2 - - - 3 CANCER The incidence of Cancer relative to the various organs of the body is given as under Males Females Breast - 21 Uterus - 9 Buccal Cavity and Oesophagus 13 - Stomach and Duodenum 14 16 All Other Sites 39 38 66 84 PREVENTION OF BLINDNESS Cases of ophthalnia necenatorum are promptly visited and, if thought necessary, are removed to Hospital for treatment, In one case blindness resulted, but the baby died later from measles. As provided by Section 176 (1) of the Public Health Act, 1936, arrangements exist with the Middlesex County Council for the treatment at the school clinics of adolescents who are ascertained at school to be suffering from defective vision. ORTHOPAEDIC SCHEME In my Report for 1939 I gave details of a scheme for orthopaedic treatment for children after leaving school in cases where they are found whilst at school to be needing such treatment. Financial assistance was rendered for the supply of surgical appliances in one case during the year. TUBERCULOSIS The following table gives details as to ages and sex of new cases of tuberculosis, also deaths from the disease; this latter figure including tho deaths of non-notified cases:- n New Cases Deaths Respiratory N on-respiratory Respiratory Non-respiratory Age periods Male Female Male Female Male Female Male Female Under 1 year - - - - - - - - 1-5 years 1 - 1 2 - 1 1 - 5 -15 '' - 2 3 2 - - - 2 15-25 '' 10 16 - 8 4 9 - 1 25-35 '' 11 18 2 2 8 10 - 1 35-45 '' 3 7 - 1 6 9 - - 45-55 '' 12 2 - - 10 3 - - 55-65 '' 10 4 - - 5 2 - - 65 years upwards - - - - 1 2 - - Totals 47 49 6 15 34 36 1 5 In addition, 22 cases of pulmonary tuberculosis and 3 eases 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 47 49 Non-Respiratory 6 15 Transferred cases - Respiratory 11 11 Non-respiratory 1 2 65 77 The cases dying of tuberculosis and not previously notified were:- Males es Respiratory 2 . 1 Non-respiratory - - There were thus 3 non-notified deaths out of a total of 77 persons registered as dying of tuberculosis (Registrar's figure). Regarding the non-notification of the above cases, there was no suggestion of wilful neglect or of refusal to motify. The non-respiratory forms of tuberculosis notified were:- Males Femles Spine 2 1 Other bones and joints - 3 Meningeal - 2 Glands 3 2 Abdomen - 5 Kidney - 1 Testis 1 - Salpingitis - 1 The Public Health (Prevention of Tuberculosis) Regulations, 1925, relate to tuberculous employees in the milk trade; whilst Section 172 of the Public Health Act, 1936, gives power to the Local Authority to remove to hospital certain cases of tuberculosis which are dangerous to other people. No occasion during the year had occurred in which it has been necessary to invoke these powers. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930 The number of eases of tuberculosis on the Register at the end of 1940 was:- Males Females Total Pulmonary forms 267 232 499 Non-Pulmonary forms 82 81 163 349 313 662 The corresponding figures at the end of 1939 were:- Males Femles Total Pulmonary forms 273 225 498 Non-Pulmonary forms 84 76 160 357 301 658 Corresponding figures for previous years were:- Males Females Total 1938 363 297 660 1937 336 260 596 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 COUNCIL'S EMPLOYEES During 1940 the Medical Officer of Health paid a total lumber of 304 visits to those employees who had boon on the sick list longer than a fortnight and, when necessary, at fortnightly intervals. Of those 81 were "not at home" and 27 had already resured duty. Also, during the year 12 persons wore examined prior to their appointment to peramanont posts. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Cr, J. WARD. Mrs. E.M.Hearn (Mayor); T.C.Joyce (Deputy Mayor); Aldermen W.Preye and Mrs. M.M. Barrass. Councillors - G.W.Ballams; L.E.Berridge; W.Cudworth; C.G.Lacey; Mrs.M.M.Moss. 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 Deputy School Medical Officer (Left April, 1940), H.R.Hay, M.B., Ch.B.(Edin)., D.P.H., Assistant Medical Officer. M.F.Coveney, B.Sc., N.U.I,, M.B., Ch.B(Sheff)., D.P.H.(Eng)., Assistant Medical Officer. C.A Goggin, M.B., E.Ch., B.A.O., D.P.H. (Commenced July, 1940}. J.A.Cholmcley, F.R.C.S.(Eng)., Orthopaedic Surgeon. R.Leslie Dodds, F.R.C.S., Consulting Accoucheur. E. Underhill, L.D.S., R.C.S., Dentist. HEALTH VISITOR SCHOOL NURSES (Combined Service). abde Miss .A. Binteliffe - Lady Superintendent, Health Visitor School Nurses. do Miss A. Naylor bed Miss J. Pater son. d Mrs.C. Boothby bd Miss M. Druco. bed Miss M. R. Hazelton bed Miss R. Bullock. acd Miss J. M. Anderson bod Miss M.E.Bishop (resigned Nov.1940) bed Miss V. Garrett bed Miss B. F. Lister. c Miss A. Fahy (School Work only). Mrs. C. Tonkin (School Work only). MASSEUSE. Miss M. F. Cozens-Walker, Ch artered Masseuse, Orthopaedic Clinic 'Part-time). MUNICIPAL MIDWIVES cdf Mrs. R.K.M. Wingrove - Non-Medical Supervisor of Midwives. cd Mrs. D.S.C. Gazzard. cd Miss HAM, James. d Mrs. A.J. Griffiths cd Miss D.M. Lewis, cd Miss D.L.N.Noakes (res. July l940)cd Miss V. Ummen. cd Miss A.G.Walker cd Mrs. A.M.Burton (temporary), cd Miss A.L. Gow d Miss D.Chaplin (temporary from July 1940). a Maternity and Child Welfare Certificate. b New Health Visitors' Certificate. c State Registered Nurse. d State Certified Midwife. e Sanitary Inspector's Certificate. f Teacher's Certificate of Midwifery. CLERICAL. Miss R. Saunders Miss N. A. Eyres Miss C. L. Churchley Miss E. Slater Miss I. Wilkins Hiss H. P. Turton Miss W. A. Boattie Senior Clerk. 1st Assistant. 2nd Assistant (resigned Oct.1940). 3rd Assistant (resigned Oct. 1940). 4th assistant Commenced Nov. 1940. Commenced Nov. 1940. DAY NURSERY. cd Miss W. J. Vigar g Miss W. Betteridgo g Miss E. A . Weller Matron (resigned Nov. 1940). Temporary Matron. Staff Nurse. c State Registered Nurse. d State Registered Midwife. g Certificate of Day Nursery Training. The following information gives details of the Maternity and Child Welfare Clinics at the end of 1940:- (1) Ante-Natal Clinic at Brookfield House, Fore Street (adjoining The Town Five sessions weekly Hall). (2) Child Welfare Centre:- (a) Brookfield House. (b) St. Stephen's Church Hall. (c) St. Alphege Church Hall. (d) St. Aldhelm's Church Hall, One session weekly. Two sessions weekly. Two sessions weekly. (3) Post-Natal Clinic at Brookfield House. One session weekly. (4) Dental Clinic at C-royland Road School Clinic. Two sessions weekly. (5) Orthopaedic Clinic at Methodist Central Hall, Foro Streot. Two sessions weekly. (6) Obstetric Surgeon attends once a fortnight at Brookfield House. FOTMOKD. In spite of the War the Maternity and Child Welfare Department has every reason to be proud of its progress, and although there were many problems, especially during the period of intensive air-raids, most satisfactory results have been obtained. The Clinic services have been carried on as usual, and the attendances have amply justified 'this step. The progress of the AnteNatal Clinic has been more than encouraging, and whilst in 1939 there wore 215 sessions in 1940 there wore 254. The total attendances increased from 5,271 in 1939 to 5,645 in 1940. 1,184 prospective mothers attended the Clinic during the year, which speaks for itself as to the value of the work and the manner in which it is appreciated. The Ante-Natal Service is carried on by the midwives under the supervision of the Non-Medical Supervisor of Midwives, and in that way the nurses are in a position to know the whole medical and social history of the women they will be attending for their confinements. The St, Alphege and St. Aldhelms Clinics wore re-opened in 1940 as there was a great need for Infant Welfare sessions in these areas. The attendances at all Infant Welfare Clinics has been most satisfactory. The National Milk Scheme was introduced in July 1940 as a war measure by the Ministry of Food, and expectant and nursing mothers and children under 5 years of age can obtain 1 pint of milk daily either at a reduced rate (2d per pint) or free in necessitous cases. Application certificates are completed for the mothers by members of the Medical, Health Visiting and Midwifery Staffs under the schema of co-operation with the Ministry of Food. An arrangement was also made thereby National Dried Milk could be distributed in the Infant Welfare Centres. Mothers can obtain this food at their nearest Clinic instead of journeying each week to the local Food Office, and in this way the infant is kept under constant supervision. The normal brands of dried milk foods are still available at the Clinics for sale or free under the same arrangements as in operation prior to the War. The Governments Evacuation Scheme for expectant mothers was in operation throughout the year, and when the air raids commenced in August many women took advantage of the scheme and left Edmonton for their confinements. The women were sent away at the eighth month of pregnancy, but mohers can claim billeting allowance at any period of pregnancy if they can find private accommodation in a reception area. A certificate is issued by the Department confirming the date of the confinement, and the Education Department then make the other arrangements under the L.C.C. Schcme. On January 6th, with the approval of the Ministry of Health, the Nursery children (evacuated at the outbreak of war), were transferred from billets to the ' Foxes", Ramsden Heath, Essex. The accommodation and general arrangements proved most satisfactory, but unfortunately as the year advanced the area was not considered suitable on account of its proximity to the coast. After great difficulty a suitable house was found, namely Children's House, Sun Lane, Harpenden, Herts, and the 16 children were transferred on 3rd October, 1940, The party have settled down very happily and when the premises are filly equipped there will be accommodation for 28 children. Many changes have taken place in the Nursery Staff, and in November 1940, Miss Vigar, who had been in tho Council's employment for many years, loft to get married, and a temporary Matron had to bo engaged. I would like to extend ray very best thanks to the Members of the Maternity and Child Welfare Committee for their co-operation during the year and to the members of the Staff, who through many vicissitudes, have unfailingly carried out their duties. The under-mentioned information will give some indication of the work carried out by the Department during the year 1940:- BIRTHS. The total number of births notified during 1940 was as follows Live births notified by midwives 1,741 " " " " doctors and parents 125 Stillbirths notified by midwives 98 " " " doctors 12 1,976 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:- Live births notified by midwives 889 " " " doctors and parents 119 Stillbirths notified by midwives 36 " " " doctors 10 1,054 Ntimber of live Edmonton babies born in outlying Institutions 204. The following table includes births of Edmonton residents and those born and registered in other districts:- Male. Female. Total. Live Births 698 651 1,349 Stillbirths 24 23 47 722 674 1,396 VISITS PAID BY THE HEALTH VISITORS. The following table gives details as to the visits paid by the Health Visitors- To expectant Mothers:- First visits 119 Total visits 124 To children under 1 year of age:- First Visits 1,438 Total visits 9,270 To children between 1 and 5 years 11,994 Infant Protection visits to children 5-9 years 49 21,437 ANTE-NATAL CLINIC. This Clinic was held five times weekly, and the following are the figures for the year:- Total number of sessions in the year 254 Number of prospective mothers 1,184 X Total number of attendances 5,645 Number of consultations 4,849 Average number of attendances (l) Per session 22.22 (2) For consultations 19.09 (X) Included in this total are 311 referred from the North Middlesex CountyHospital under the scheme of co-operation with that hospital. POST-NATAL CLINIC. This Clinic is held once weekly and the following are the figures for the year:- Number of sessions 50 Actual number of mothers who attended 343 Number of consultations 457 Average attendance per session 12.68 Total attendances at Clinic 634 SPECIALIST' CLINIC The consulting Specialist made 25 visits during the year and saw 131 cases, making an average of 5.24 per session. CHILD WELFARE CLINICS. The figures relating to attendances are:- Brookfield House. St. Stephens. St. A1phege's. St. Aldhelms. Number of sessions 206 51 80 40 New Cases:(a) Under 1 year 717 147 182 80 (b) 1-5 years 264 55 71 26 Attendances. (a) Under 1 year 10,210 2,047 3,251 1,109 (b) 1-5 years 10,341 998 2,490 828 Total attendances 20,551 3,045 5,741 1,937 Doctor's consultations 4,507 727 1,477 747 Average attendances 99.76 59.70 71.76 48.42 ORTHOPAEDIC CLINIC. The Clinic is held twice weekly and the following are the figures for the year:- Number of sessions 104 New Cases referred during the year 63 Attendances Surgeon's days 227 Treatment Days 788 Total attendances 1,015. In-patient Treatment. Six children wore admitted to Stanmoro during 1940, the average length of stay being 9 weeks. One child sent to Stanmore in 1939 was still away during 1940. DENTAL CLINIC. Details of the work carried out are:- Mothers. Children. Number of attendances. 799 358 No. of new cases 244 191 Total number treated 532 345 Fillings. 101 12 Dressings 10 436 Scalings 41 Extractions (no. of teeth) (a) Under Gas 1,193 532 (b) Local Anaesthetic 21 - Number of Gas Cases 365 224 Dentures. Number supplied - 54 of whom 23 were assisted by Committee. MUNICI PAL MILK SUPPLY. Number of applications 1,328 Number of renewals 1,279 Number of recipients 2,258 Number of pints granted free 95,466 MUNICIPAL MILK SUPPLY Contd. In July 1940 the Ministry of Food introduced the National Milk Scheme, whereby members of the Public could obtain milk at 2d per pint or free in necessitous cases. This has meant that the Maternity and Child Welfare Scheme of distribution was no longer required, but it is still possible for children under 5 years of age and nursing or expectant mothers to receive an additional pint of milk per day through the Maternity Department, if such a course is desirable on medical grounds and they come within the scale of income. DETAILS KEC&HDING FREE SUPPLIES OF DRIED FOODS. COD LIV7.R OIL, ETC. (Distributed by M & C. W. Department). Trufood 905 tins. Cod Liver Oil and Malt 4,192 cartons. BomaX 204 cartons. Pure Cod Liver Oil 294 bottles. Halycalcyne 186 bottles. Ferrofax 62 bottles. Cow and Gate 1,535 packets. Glucose 143 packets Ostermilk 377 tins. NATIONAL DRIED MILK. 150 tins of National Dried Milk were distributed in tlio Clinics, 95 boin sold and 55 given free. This distribution is carried out under a Scheme of co-operation with the Ministry of Food. CONVALESCENT OASES. 8 children were sent away under contract with the Invalid Children's Aid Association. TONSILS AND ADENOIDS. 24 children were admitted to hospital for Tonsils and Adenoids operation during 194 0, of this number 22 paid the full cost of 5/- and the other were granted free treatment. HOME HELPS. 114 women had the services of Home Helps during the year - 33 Paid the full cost. 17 Paid half cost. 64 were free. INFECTIOUS ILLNESSES. Ophthalmia Neonatorum. Six cases wore notified during the year, and of this number 4 cases occurred in the North Middlesex County Hospital, none of which were Edmonton cases. Puerperal Pyrexia. 85 casos wore notified during the year, and of this nunbor 71 casos occurred in the North Middlesox County Hospital, of which 20 were Edmonton cases. Two were admitted to Enfield and Edmonton Isolation Hospital. i-IEDWIFERY AND MATERNITY SERVICES. The number of claims made by doctors for Medical Aid during the year 1940 was 211, of this number 57 casos were granted free of charge. MUNICIPAL MIDWIFERY SERVICE. The following gives information as to the actual bookings for 1940:- Number of women who booked during 1940 763. Of this number 173 were granted the service of a midwife free and 56 reapplications were reviewed during the year, these mothers thus being relieved from further payments. Analysis of work. Actual confinements attended by midwives ... 606 (Of this number 576 as midwives and 30 as Maternity Nurses). Attended by midwives, but women admitted to Hospital for actual confinement 72 Left district before confinement or mothers evacuated through L.C.C. scheme etc. 101 (Attention and Supervision given by Municipal Midwives during Ante-Natal period). EVACUATION OF EXPECTANT MOTHERS UNDER THE GOVERNMENT SCHEME AT THE 8th MONTH OF PREGNANCY. The Department has been responsible for the arrangements in connection with the evacuation of Expectant Mothers under the Government Scheme, and in 1940, 3.22 mothers applied to be sent away and by the 31st December 68 women had been sent to reception areas for their confinements, and 9 had cancelled arrangement s. ANTE-NATAL SCHEME OF CO-PERATION BETWEEN THE COUNCIL AND THE MIDDLESEX COUNTY COUNCIL. Under an arrangement with the Middlesex County Council the Health Visitors visited 135 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. 311 women were referredto the Council's Ante-Natal Clinic for attendance for routine supervision purposes prior to their confinements. CHILDREN UNDER 5 YEARS OF AGS DISCHARGED FROM TEE NORTH MIDDLESEX COUNTY HOSPITAL. 52 visits wore paid to children under 5 years of ago who had been discharged from the North Middlesex County Hospital, and it was necessary for then to remain under supervision. STERILISED MATERNITY OUTFITS. 245 Sterilised Maternity Outfits were issued during the year, 146 being paid for, and 99 being given free of charge. DAY NURSERY. On the 6th January the Nursery was transferred to the Foxes, Ramsden Heath, hut during the year the area became unsuitable on account of its nearness to the coast, and on the 3rd October 1940 the children were transferred to the Children's House, Sun Lane, Harpenden. Sixteen children are accommodated but when the final arrangements are complete it will bo possible to take 28 children. 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 suporvising this part of the work. A considerable amount of time and trouble is taken in order to K satisfied in all cases. The number of persons on the register at the end of 1940 was 25 and the number of children 24. BIRTH CONTROL CLINIC. The arrangements for Edmonton women to attend the Royal Free Hospital has had to bo discontinued since the ourbreak of War, as the Hospital Clinic has boon closed, but it has now re-opened. One mother only was referred during the period the Clinic was available for patients. OPHTHALMIC. During 1940 an arrangement was made with the Edmonton Education Committee for children to attend their Ophthalmic Clinic at a fee of 7/6 per child per refraction. Glasses are supplied under a similar, arrangement asthat which operates for the Education Authority. A scale of income is in force, and glasses can be supplied free of charge when necessary. 18 Children under 5 years of age attended the Ophthalmic Clinic in 1940, and 7 attended for re-examination, This is a Service which is filling a very great need, and the figures for 1941 will show a substantial increase. BOROUGH OF EDMONTON EDUCATION committee 1940 Chairman: V i c e-Chai rinan: Cr. Mrs. F. Long, J.Po Cr. Mrs. H. Nicholson. Her Worship the Mayor: Cr. Mrs. E. M. Hears. ALDERkiEN Mrs. M. M. Barrass. Mrs, E. A. Young. U. F. Miudleton. W. Preye. J. Read. A. J. Hollywood. T. H. Haringcon, J.P. COUNCILLORS Mrs. E. M. Moss G. E. Albon W. Bales W. A. Edmunds. T. H. Joyce C. E. Lacey T. W. Tott Whole-Time Medical Staff. D. REGAN, B.A., B.Sc., k.B., Ch.B., B.A.O., D.P.R. (L1 pool) , School Medical Officer and 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 Deputy Medical Officer of Health (Left the Service, April, 1940) . Mrs. M. E. DALBY, M.B., B.S., (Lond.), D.P.H. Assistant School Medical Officer. (Retired February, 1940). H. R. HAY, M.B., Ch.B., D.P.H., Assistant School Medical Officer and Assistant Medical Officer of Health. M. F. COVENEY, M.B., Ch.B., B.Sc., D.P.H., Assistant School MedicalOfficer ana Assistant Medical Officer of Health. Whole-Time Dentists. J. F. ARDOUIN, L.D.S., R.C.S., Senior Dentist. E. UNDERHILL, L.D.S., R.C.S., Assistant Dentist. F. H. S. WEISS, L.D.S., R.C.S., Assistant Dentist (now serving with H.M. Forces). Consultants. J. A. CHOLMELEY, F.R.C.S. (Eng.), Orthopaedic Surgeon. Miss L. M. SMITH-CLARK, M.B., Ch.B., Ophthalmic Surgeon J. BROWNING ALEXANDER, F.R.C.P., Rheumatic Specialist. W. IBB0IS0N, F.R.C.S., Aural Specialist. -1- Part-Time Staff. Miss M. F. COZENS-WALKER, Chartereu Masseuse. Miss B. ft. OLDREY, M.S.S.T., Speech Therapist. School Nurses and Health Visitors, Miss A. BINTCLIFFE, Lady Superintendent. Miss A. NAYLOR. Mrs. C. BOOTHBY Mrs. C. TONKIN Miss M. R. HAZELTON Miss A. FAHY Miss J. ANDERSON kiss V. GARRETT Miss J. PATERSON Miss M. DRUCE Miss R. BULLOCK Miss M. E. BISHOP (Resigned owing to Marriage November, 1940). Miss B. LISTER. Dental Attendants. Miss 0. BROOKS Miss C. E. STANBRIDGE. Clerical Staff. B. R. ALLEN, School Medical Clerk (Nov. serving with H.M.Forces) Miss C. D. R. LOGSDOH, Clerk (Resigned owing to Marriage 20th April, 1940). Miss B. E. T. CROSS, Clerk (Resigned owing to Marriage 1st January, 1940). H. A. CARLESS, Clerk. S. E. W00DR0FFE, Clerk. Miss A. SAVILL, Clerk (Commenced 24th June, 1940). Miss E. R. CROSS, Clerk (Commenced 24th June, 1940). To the Chairman and Members of the Education Committee. Ladies ana Gentlemen, I beg to submit ray sixth Annual Report on the work of the School Medical Service for the year 1940. In accordance with the Board of Education's Form 6M, the report is being confined to a short statement of salient facts, especially any changes in nutrition, cleanliness, etc. As the Members are aware, the schools re-opened officially in January after a great number of the evacuated children had returned to Edmonton. Immediately alterwards, the School Medical Services were brought practically up to peace-time standard. The only exception being that Croyland Road Clinic was utilised as an A.R.P. Depot, but this was restored to the School Medical Department during the early part of November of this year when it was redecorated and arrangements were made for the Minor Ailments Clinic to be re-opened as in peace-time. Unfortunately, Pymmes Park Clinic was destroyed by fire on the 13th December, and consequently only one Minor Ailments Clinic is functioning that is, Croyland Road Clinic, which is totally inadequate for the number of children in Edmonton. During the later part of the year attendances at the various clinics were quite good, in spice of the incidents occurring in the district. I wish to acknowledge the loyal co-operation of my entire staff who have given the best of their services throughout the year, and also my thanks and appreciation to the Head Teachers -2- and Teachers for their help and co-operation with my Department. I am very grateful to the Chairman ana Members of the Education Committee for their courtesy shown in the work of the School Medical Service. I have the honour to remain, Ladies and Gentlemen, Your Obedient Servant, D. REGAIN. School Medical Officer 1. STAFF. During the year there were a few changes in staff. Miss B. E. T. Cross and Miss C.D. R. Logsdon left during the early part of the year owing to marriage, and their places were filled by temporary clerks. On the 24th June, Miss A. Savill and Miss E. R. Cross commenced uuties with the Department as clerks. Mr. Bernard R. Allen was enlisted in H.M. Forces on the 2nd August. I regret to say that Mr. Eric Underhill, School Dentist, contracted poliomyelitis during August and in consequence the services of Mr. VJ. Howitt were engaged, in a temporary capacity, until the 6th December, when Mr. Howitt enlisted in the Royal Air Force. 2. CO-ORDINATION. Co-ordination between the School Medical, Public Health and Maternity and Child Welfare Departments was greater than it has-ever been in previous years and smooth working between the general practitioners, the Education Office and teaching staff continued to exist. . SCHOOL HYGIENE. Arrangements for School Hygiene were the same as in previous years. 4. MEDICAL INSPECTION. The number of children fully examined in the routine inspection of each group during the year 1940 was 7537, and the analysis of the age groups were as follows:- Entrants. 1109 Second Age Group. 2090 Third Age Group. Total 1197 4396 Number of Other Routine Inspections 3141 Grand Total 7537 5. FINDINGS OF MEDICAL INSPECTION. (a) Malnutrition. The following table givos the classification of the nutrition of the children inspected during the year 1940 in the routine age groups:- Total A B c D Entrants 1109 182 814 112 1 Second Age Group 2090 397 1494 195 4 Third Age Group 1197 363 735 92 7 Other Routine Inspections 3141 730 2111 281 19 7537 1672 5154 680 31 -3- (b) Cleanliness. The question of cleanliness was dealt with as in previous years. (c)Minor Ailments and Diseases of the Skin. The attendances at the Pymmes Park Minor Ailment Clinic for the year were as follows 11,145 attendances The above figure represents only eleven months of the year as the Pymmes Park Clinic was destroyed by fire on the 13th December. Many recorus were lost and full details as to the nature of complaints, etc., cannot be given. (Croyland Road iiinor Ailments Clinic re-opened in January, 1941.) . (d) Visual Defects and External Eye Diseases. The Ophthalmic Clinic was conducted on the same lines as in previous years at the Pymmes Park Clinic, until December when arrangements were made for the Clinic to be held in the Croyland Road School (adjoining Croyland Road Clinic). Statistics are given at the foot of this report. (e) Nose and Throat Defects, and (f) Ear Diseases and Defective Hearing. During the year the Aural Clinic was hela on the fourth Friday of each month with Mr. William Ibbotson, F.R.C.S., in attendance. One of my assistants held the Clinic weekly in oraer to keep close observation on the cases. Owing to the outbreak of hostilities operations for the removal of tonsils and/or adenoids at the Prince of Wales's General Hospital ceased, and it was during the end of August that arrangements were made with the Emergency Base Hospital at Goodmayes for the admission of six cises per week for tonsillectomy and/or adenoidoctomy. During the year Mr. Ibbotson saw 107 New Cases ana 103 Old Cases. The Speech Clinic was held as usual during the year, and the following figures show comparisons over a period of three years.- 1958 1939 1940 New Cases 61 66 57 Received Treatment 52 85 93 Discharged , 20 32 23 Waiting List 100 83 50 (g) Dental Defects. The arrangements for the treatment of dental defects were carried out at the Pymmes Park ana Haselbury Clinics. When the Pymmes Park Clinic was destroyed by fire on 13th December, the Dental Clinic at Croyland re-opened in the early part of January, 1941. (h) Orthopaedic and Postural Defects. This Special Clinic continued to run in a very satisfactory manner at the Methodist Centra], Hall. The Consulting Surgeon attended on the first Friday of each month, and the Masseuse on Monday, Wednesday, Thursday and Friday mornings. During the year 95 new cases were seen and the total attendances were as follows: 1047 BOYS and 1527 GIRLS - a total of 2574. (i) Heart Diseases and Rheumatism. This clinic continued to take place at Pymmes Park House. Dr. Browning Alexander attended on the third Thursday of each month and one of my Assistant Medical Officers held weekly sessions in the interval to keep cases under observation. The total attendances for tne year were 640 and Dr. Browning Alexander saw 85 NEW CaSES and 107 OLD CASES - a totel of ly2. Arrangements were jiade for 7 cases to be admitted to Heart Homes for a period of treatment] 2 at Cuckfield and 5 at West Wickham. -4- (j) Tuberculoses. I am grateful to Dr. E. Evans, Tuberculosis Officer, lor the courtesy he has extended to this Department at all times and for his promptitude in attending to all cases referred. The number of notified cases ana the mortality of children of school age, taken from the records of the Public health Department, during 1940 was as follows Notified„ Deaths . M. Fo Mo F. Pulmonary 1 2 __ r! on- puluiona ry 3 1 — 2 (k) Other Defects and Diseases. These cases are freely referred to the Minor Ailment Clinic anc either treated there or referred elsewhere. 6, FOLLOWING-UP. The same arrangements were in elfect as in 1939° 7. ARRANGEMENTS FOR TREATMENT. During 1940 the arrangements for treatment ivere as follows:- Minor Ailment Clinic - held at Pymmes Park House with a doctor and nurse in attendance each morning. Ophthalmic Clinic - By appointment only each Monday at Pymmes Park House. Rheumatic Clinic - By appointment only each Thursday afternoon at Pymmes Park House. The Specialist attended every third Thursday each month. Aural Clinic - By appointment only every Friday afternoon at Pymmes Park House. The Specialist attended the fourth Friday each month. Orthopaedic Clinic - By appointment only at the Central Hail, Fore Street, N.9» The Masseuse held four sessions weekly and the Specialist attended on the first Friday of each month. (Pk.Clinics Dental Clinics - These Clinics were held at Haselbury and Pymmes Speech Clinic - The Speech Therapist held a Clinic at the Education Offices on Monday and Thursday mornings. 3. INFECTIOUS DIS^ADES. Arrangements were carried out as in previous years with regard to children suffering from infectious diseases. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY_SCH00LS. TABLE 1 A. Routine Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 1109 Second Age Group 2090 Third Age Group 1197 Total 4396 Number of other Routine Inspec tions 3141 7537 B. Other Inspections. No. of Special Inspections and Re-Inspections: 7834 5 TABLE II. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR ENDED 31st DECEMBER, 1940. Age-Groups Number Inspected A B c D No. %+ No. % No. % No. % Entrants 1109 182 16.4l 814 75.59 112 10.10 1 •10 Second Age Group 2090 397 19.00 1494 71.48 195 9.55 4 .12 Third Age-Group 1197 363 30.32 755 61.40 92 7.79 7 •58 Other Routine Insps. 3141 75 0 23.24 2111 . 67.21 281 8.95 19 •6 TABLE III. GROUP 1 - TREATMENT OF MINOR AILMENTS (excluding Uncleanliness, for which see Table V.). Unfortunately, the records for this table were destroyed by fire at Pymmes Park House. GROUP II- TREATMENT OF DEFECTIVE VISION AND SQUINT (excluding - Minor Eye Delects treated as iiinor Ailments - Group l). No. of Defects dealt with Under the Authority's Scheme Otherwise Total Errors of Refraction (including squint) . 846 2 848 Other defect or disease of the eyes (excluding those recorded in Group 1). 25 - 25 TOTAL 871 2 875 Under the Authority's Scheme Otherwise Total Wo- of Children for whom Spectacles were (a) Prescribed 811 1 812 (b) Obtained 805 - 805 GROUP III - TREATMENT OF DEFECTS OF NOSE AND THROAT. Unfortunately, records for this table we re destroyed by fire at Pymmes Park House. TABLE IV.- DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist. (a) Routine age-groups Age 4 6 7 8 9 10 11 12 15 14 15 16 TOTAL No. 6 636 787 683 792 795 320 726 701 686 169 11 5 6813 (b) Specials (c) TOTAL (Routine and Specials) 8419 (2) Number found to require treatment 5807 (3) Number actually treated 3098 (4) Attendances made by children for treatment 5324 -6- DENTAL INSPECTION AND TREATMENT (Cont.) (5) Half-days devoted to:- (7) Extractions:- Inspection 61 Permanent Teeth 447 Treatment 623 Temporary Teeth 5304 TOTAL 684 TOTAL 5751 (6) Fillings:- (8) Administrations of general anaesthetics for extractions 1889 Permanent Teeth 2395 Temporary Teeth 162 (9) Other Operations:- 2557 Permanent Teeth 488 Temporary Teeth 3050 3558 TABLE V._ VERMINOUS CONDITIONS. (l) Average number of visits per school made during the year by the School Nurse 17 (2) Total number of examinations of children in the Schools by School Nurses 31315 (3) Number of individual children found unclean 1161 (4) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 1157 (5) Number of cases in which legal proceedings were taken: — (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws - TABLE VI._ BLIND AND DEAF CHILDREN. AT A PUBLIC ELEMENTARY SCHOOL AT AN INSTITUTION OTHER THAN A SPECIAL SCHOOL AT NO SCHOOL OR INSTITUTION TOTAL NOT RECEIVING SUITABLE EDUCATION BLIND CHILDREN - - - - NOTE:- 7 children are on the rolls of the School for Partially-Sighted Children, Lordship Lane, N.22.). DEAF CHILDREN 4 NOTE:- 10 children were on the rolls of the Special School for Deaf and Dumb Children, Philip Lane, Tottenham, N.15. MENTALLY DEFECTIVE, CHILDREN. Total number of children notified during the year by the Local Education Authority to the Local Mental Deficiency Authority., under the Mental Deficiency (Notification of Children) Regulations, 1928 4 SECONDARY SCHOOLS TABLE I Number of Pupils inspected - 1st January, 1940 to 31st Dec.,1940 A. ROUTINE MEDICAL INSPECTION. (l) Cases in which a full examination has been made. Age. 9 10 11 12 15 14 !5 16 17 18 TOTAL Boys - - 24 40 6 - - - - - 70 Girls - - 41 49 27 2 10 9 — — 138 TOTAL - - 65 89 33 2 10 9 - - 208 -7- TABLE II. 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 subnormal). No. D. (Bad). No. 11 64 12 47 5 - 12 90 32 51 6 - 13 33 8 24 1 - 14 2 - 2 - - 15 10 3 6 1 - 16 9 2 7 - - Total 208 58 137 13 - table iii DEFECTIVE VISION AND SQUINT (Excluding minor eye defects) Defect or Disease. Number of Defects Dealt with. Under the Authority's Scheme. Otherwise. Total. Errors of Refraction (including squint) 134 - 134 Other defect of disease of the eyes (excluding those recorded as minor ailments). - - - TOTALS. 134 - 134 TOTAL NUMBER OF CHILDREN FOR WHOM SPECTACLES WERE PRESCRIBED. (a) Under the Authority' s Scheme 125 (b) Otherwise TOTAL NUMBER OF CHILDREN WHO OBTAINED OR RECEIVED SPECTACLES (a) Under the authority's scheme 121 (b) Otherwise TABLE IV DENTAL DEFECTS. (1) Number of pupils who Were:- (a) Inspected by the Dentist Ages Ages 9 15 10 16 18 11 36 17 3 12 56 13 - 13 54 14 54 TOTAL 272 Special 29 GRAND TOTAL 301 (b) Found to require treatment 194 (c) Actually treated 129 (2) Half days devoted to (Inspection 2) Total 32 (Treatmemnt 30) -8- Dental Defects (Cont.) (3) Attendances made by pupils for treatment 236 (4) Fillings Permanent teeth 274) Temporary teeth -) =Total 274 (5) Extractions Permanent teeth 74) Temporary teeth 10) Total 84 (6) Administrations of general anaesthetics for extractions 30 (7) Other Operations (Permanent teeth 58) ( Temporary teeth 1) Total 59 JUNIOR TECH N I C A L SCHOOL. TABLE I. DEFECTIVE VISION AND SQUINT (Excluding minor eye defects). Defect or Disease. NUMBER OF DEFECTS DEALT WITH Under the Authority's Scheme Otherwise. Total Errors of Refraction. (including squint) 22 - 22 Other defect or disease of the eyes (excluding those recorded as minor ailments). - - TOTALS 22 - — TOTAL NUMBER OF CHILDREN FOR WHOM SPECTACLES WERE PRESCRIBED. (a) Under the Authority's Scheme 21 (b) Otherwise TOTAL NUMBER OF CHILDREN WHO OBTAINED OR RECEIVED SPECTACLES. (a) Under the Authority's Scheme 21 (b) Otherwise TABLE II. DENTAL DEFECTS. (l) Number of pupils who were:- (a) Inspected by the Dentist:- Age 12 - 13 12 TOTAL 27. 14 15 Specials 5 GRAND TOTAL 32 (b) Number found to require treatment 14 (c) Number actually treated. 17 (2) Half days devoted to ) Inspection) Total 4 (Treatment 3 ) (3) Attendances made by pupils for treatment 38 (4) Fillings (Permanent teeth 30) Total 3D (Temporary teeth-) (5) Extractions ( Permanent teeth 20 ) Total 20 ( Temporary teeth-) (6) Administrations of general anaesthetics for extractions 7 (7) Other Operations (Temporary teeth-) Total 10 9