6/5 EDM 52 Borough of Edmonton. REPORT OF THE Medical Officer of Health and School Medical Officer FOR THE YEAR 1941 BOROUGH OF EDM O N T O N 19 4 1 His Worship the Mayor Councillor T. H. Joyce, J.P. Deputy Mayor Alderman A. J. Hollywood PUBLIC HEALTH COMMITTEE Chairman Councillor G. D. Euesden Aldermen Mrs.. M.M. Barrass, W.Preye; Councillors L.E.Berridge, W.Bales, Mrs.'A.M.Glover, W.T.Green, Mrs. E.M.Hoarn, J.P., Mrs. F.Long, J.P., Mrs. H.Nicholson, Mrs. E.M.Moss, J.A.Ward. STAFF OP 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 :- Hilda R. Hay, M.B., Ch.B., D.P.H. Assistant Medical Officers and School Medical Officers Margaret F. Coveney, B.Sc., M.B., Ch.B., D.P.H. (Resigned June, 1941) Catherine A. Goggin, M.B., B.Ch., B.A.O., D.P.H. Kathleen M. Hart, M.B., B.S. (Lond), M.D., D.P.H. (Commenced July, 1941) Senior Sanitary Inspector %abcd W. Tillcock, M.R.San.I. District Sanitary Inspectors %abcd G. H. Huckle %abc J. P. Farrar %abc E. Dodsworth %abc H. W. Grieves %abc F. Bielby %a Mrs. H. Fowler (Woman Sanitary Inspector) Chief Clerk F. J. Nash, Cert. R'. San.I. J. L. A. Saunders, Infectious diseases clerk A. E. Clarke, Records clerk (Seconded to Civil Defence duties) D. H. J. Newman, Correspondence clerk (In H.M.Forces until August, 1941) H. J. Weldon, Junior clerk (In H.M. Forcos) S. Clayton, Shops Acts Inspector T. G. Marsden, Assistant Shops Acts Inspector Miss I. M. Bowie, Temporary clerk N. Gilbert, Temporary clerk. % Moiety paid under Public Health Act or by Exchequer Grant 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. PREFACE Public Health Department, Town Hall, Edmonton, N. 9. His Worship the Mayor, Alderman and Councillors of the Borough of Edmonton. Mr. Mayor, Ladies and Gentlemen, I have much pleasure in presenting my seventh Annual Report, for the year 1941. The Report is compiled in accordance with Ministry of Health Circulars 2541 and 2604. The latter Circular requests that on grounds of national security, certain vital statistics, including population figures, shall not bo published. In view of the non-publication of these statistics, I would mention that the BIRTH RATE compares favourably with that of previous years. The DEATH RATE shows a slight increase but is comparable with that of the rest of the country. The functions of the Health Services have been maintained to their full capacity. The health of the residents of the Borough has, on the whole, remained good. The general incidence of infectious disease shows but little increase over 1940 with the exception of Measles and Whooping cough. The response to the propaganda for Diphtheria immunisation is shown by the satisfactory rise in the number of children treated - 3,102 as against 460 in 1940 and my thanks are due to all those who assisted in this work. However, wo have still a long way to go bofore the position can be regarded as satisfactory and every effort will be made to increase the numbers in the forthcoming year. Dr. M. F. Covenoy left us to take an appointment with tho Hendon Borough Council and I would like to record my appreciation of the very valuable services rendered to the Department. Dr. K. M. Hart was appointed in her stead. Mr. D.H.J. Newman returned to duty after twelve months' service with His Majesty's Forces. Dr. R. Groville Samuel, who joined the Department in 1940 as Medical Officer, A.R.P Services, did very good work in the organisation and training of civil defence personnel, and a good deal of his work was concerned with the establishment and accommodation of personnel; this was rendered very difficult on account of lack of premises. Unfortunately, Edmonton is not immune from the incidence of Scabies which is prevalent throughout the country and a great amount of effort has been expended by the Department in an attempt to keep this disease under control. It is well known that the year 1941 was a very trying one on account of the abnormal circumstances created by re-organisation of the country for tho purposes of war. Everyone concerned contributed to this effort to a groat extent, but I would like to place on record tho splendid co-operation shown by the General Practitioners of the Borough; no request was ever refused and no effort was ever too great for the Doctors to undertake and what they have done for tho Borough under very difficult circumstances is very much appreciated by me. I wish to thank the members of the Council for their courtesy which they have extended to mo during the year. In conclusion, my thanks aro due to the members of the staff for their loyal and efficient co-operation. I have the honour to bo, Mr. Mayor, Ladies and Gentlemen, Your obediente Servant, Medical Officer of Health. GENERAL STATISTICS Area (in acres) 3,896 Population Census of 1921 Census of 1931 Estimated by tho Registrar-General for mid-year 1941 Number of inhabited houses and tenements at the end of 1941 25,819 Number of inhabited houses and tenements at the end of 1940 25,807 Rateable value, April 1941 £ 733,137 Estimated product of 1d in the £ for the year ending 31/3/1942 £ 2,830 Rates in the £ for the year ending 31/3/1942 14/11 SOCIAL CONDITIONS The extent of unemployment may be estimated by the following figures relating to: (1) the number of free dinners given to schoolchildren, and (2) the actual figures supplied by the Director of Public Assistance. No. 1 is given purely on economic grounds (1) Number of free dinners during 1940 49,530 „ „ „ „ 1941 22,626 „ paid „ „ 1941 (from 24/2/41) 103,788 (2) Figures ro out relief:- Persons Amount For the year 1940 (a) Ordinary out-relief 2,194 £ 22,475 (b) Unemployed out-relief 207 £789 2,401 £23,264 For the year 1941 (a) Ordinary out-relief 2,054 £ 21,210 (b) Unemployed out-relief 31 £ 18 2,085 £ 21,238 VITAL STATISTICS LIVE BIRTHS M F Total Grand total Legitimate 659 633 1292 Illegitimate 25 28 53 1,345 Birth rate per 1,000 of population - STILL BIRTHS Legitimate 14 16 30 Illegitimate - 1 1 31 Total of live and still births 1,376 Rate per 1,000 total births 22.53 DEATHS Number 552 518 1,070 Rate per 1,000 population - DEATHS FROM PUERPERAL CAUSES Deaths Rate per 1,000 total (live and still births) Puerperal and post-abortive sepsis 1 0.73 Other maternal causes 4 2.90 5 3.63 DEATH RATE OF INFANTS UNDER ONE YEAR OF AGE M F Total Number 31 29 60 All infants per 1,000 live births 48.98 Legitimate infants per 1,000 legitimate live births 49.36 Illegitimate infants per 1,000 illegitimate live births 40.00 Deaths from Cancer (all ages) 150 " " Measles ( -"- ) " " Whooping cough ( all ages) 4 " " Diarrhoea (under 2 years of ago) 3 The following causes of death are supplied by the Registrar General and refer to deaths which were registered during the calender year:- Cause of death M F Total Typhoid and Para-typhoid fevers 1 - 1 Cerebro-spinal fever - 3 3 Scarlet Fever - - - Whooping cough 1 3 4 Diphtheria - - - Tuberculosis of the respiratory system 33 32 65 Other forms of tuberculosis 4 8 12 Syphilitic diseases 12 3 15 Influenza 5 8 13 Measles - - - Acute Poliomyelitis and Polio-encephalitis - - - Acute infective encephalitis 1 2 3 Cancer of buccal cavity and oesophagus (M) Uterus (F) 6 6 12 Cancer of stomach and duodenum 11 6 17 Cancer of breast 1 20 21 Cancer of all other sites 51 49 100 Diabetes 2 5 7 Intra-cranial vascular lesions 45 53 98 Heart disease 139 130 269 Other diseases of the circulatory system 18 6 24 Bronchitis 52 35 87 Pneumonia 41 32 73 Other respiratory diseases 4 7 11 Ulcer of stomach or duodenum 7 5 12 Diarrhoea (under 2 years) 3 - 3 Appendicitis 3 1 4 Other digestive diseases 13 15 28 Nephritis 10 10 20 Puerperal and post-abortive sepsis - 1 1 Other maternal causes - 4 4 Premature birth 7 7 14 Congenital malformations, birth injuries, infant diseases 9 9 18 Suicide 5 4 9 Road traffic accidents 15 3 18 Other violent causes 25 19 44 All other causes 28 32 60 552 518 1,070 The two tables overleaf give the deaths of those registered during the 52 weeks ended 27th December, 1941. The slight difference between the tables overleaf in respect of the causes of death and the one supplied by the Registrar-General is that the RegistrarGeneral is in possession of additional information on the matter. MALES Causes of death AIL 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 & over Typhoid and para-typhoid fever 1 - - - - - - - 1 - - - Whooping cough 1 - - 1 - - - - - - - - Tuberculosis of the respiratory system 35 - - - - 5 10 6 6 6 2 - Other forms of tuberculosis 3 - - 1 - 1 1 - - - - - Syphilitis diseases 12 - - . - - - - 3 4 4 1 Influenza 4 - - - - 1 - - - 2 - 1 Acute encephalitis lethargica 1 - - - - - 1 - - - - - Cancer of buccal cavity & oesophagus 6 - - - - - - - 1 1 1 3 Cancer of stomach & duodenun 11 - - - - - - - 4 4 2 1 Cancer of breast 1 - - - - - - - - - - 1 Cancer of all other sites 50 - - - - - 1 3 4 10 23 9 Diabetes 2 - - - - 1 - - 1 - - Intra-cranial vascular lesions 46 - - - - - 2 3 2 13 13 13 Heart disease 133 - - - - - 2 11 5 18 42 55 Other circulatory diseases 17 - - - - - - 1 2 5 4 5 Bronchitis 52 1 - - - 1 2 2 2 17 11 16 Pneumonia 42 9 2 - 1 1 1 3 4 4 10 7 Other respiratory diseases 6 - - - - - - - 1 3 2 - Ulcer of stomach or duodenum 6 - - - - - 1 - 3 2 - - Diarrhoea (under 2 years) 3 3 - - - - - - - - - - Appendicitis 2 - - 1 1 - - - - - - Other digestive diseases 13 - 1 - - 1 - - 3 2 2 4 Nephritis 9 - - - - - - 2 3 2 1 1 Premature birth 7 7 - - - - - - - - - - Cong.mal.,birth injuries, infant dis. 9 9 - - - - - - - - - - Suicide 4 - - - - - 1 1 - 2 - - Road traffic accidents 15 - - 1 - 1 1 3 2 2 3 2 Other violence 30 1 1 - - 3 7 5 2 5 2 4 All other causes 31 1 - 1 3 1 1 5 4 3 4 8 552 31 4 5 5 15 32 45 52 106 126 131 FEMALES Cerebro-spinal fever 3 - - - 1 - - - 1 - 1 - Whooping cough 3 2 1 - - - - - - - - - Tuberculosis of the respiratory system 32 - - - - 15 7 3 5 2 - - Other forms tuberculosis 6 - 2 1 - - 1 - 1 - 1 - Syphilitic diseases 3 - - - - - - 1 - 1 1 - Influenza 9 - - - - - 1 1 - 1 - 6 Acute encephalitis lethargica 2 - - - - - - - 1 - - 1 Cancer of uterus 6 - - - - - - - 2 2 1 1 Cancer of stomach and duodenum 6 - - - - - - 1 - 1 2 2 Cancer of breast 19 - - - - - - 1 6 5 4 3 Cancer of all other sites 53 - - - - - 1 2 11 11 19 9 Diabetes 5 - - - - - - - 1 - 2 2 Intra-cranial vascular lesions 55 - 1 - - - 1 - 4 11 27 11 Heart disease 140 - - - - 1 3 3 5 18 43 67 Other circulatory diseases 6 - - - - - - - 1 2 3 Bronchitis 25 1 - - - - - 1 2 6 2 13 Pneumonia 31 10 1 2 - 1 1 - 2 4 5 5 Other respiratory diseases 7 - - - - 1 - - 2 3 - 1 Ulcer of stomach and duodenum 5 - - - - - - 2 - - 2 1 Appendicitis 1 - - - - - - - - - 1 - Other digestive diseases 15 - - - - - 2 - 1 3 3 6 Nephritis 9 - - - - 1 1 1 1 2 2 1 Puerperal and post-abortive sepsis 1 - - - - 1 - - - - - - Other maternal causes 4 - - - - l 3 - - - - - Premature birth 7 7 - - - - - - - - - - Cong.mal., birth injuries, inf.dis. 6 6 - - - - - - - - - - Suicide 5 - - - - - 2 1 - 1 1 - Road traffic accidents 3 - - - 1 - - - - - - 2 Other violence 26 - - - 1 6 4 1 2 5 1 6 All other causes 31 2 - 1 1 2 1 3 5 5 7 4 524 28 5 4 4 29 28 21 52 82 127 144 INFANTILE MORTALITY The deaths of infants under one year of age were as follows:- M F Total Legitimate 30 28 58 Illegitimate 1 1 2 31 29 60 The death rate of all infants per 1,000 live births -was 48.98. A detailed subdivision of the causes, etc. of these DEAHTS as follows:- MALES Causes of death Under Total Total under 1year 1 week 2nd week 3rd week 4th week under 1 mth 1-3 mths 3-6 mths 6-9 mths 9-12 mths Bronchitis _ _ — 1 1 _ — _ - 1 Diarrhoea - - - - - - - 2 1 3 Pneumonia - 1 1 - 2 2 2 2 1 9 Violence - - - - - 1 - - - 1 Premature birth 5 - 2 - 7 - - - - 7 Injury at birth 1 - - - 1 - - - - 1 Atelactasis 1 - - - 1 - - - - 1 Asphyxia neonatorum 1 - - - 1 - - - 1 Congenital malformations 5 - - - 5 - 1 - - 6 Other causes - - - - - 1 - - - 1 Totals 13 1 3 1 18 4 3 14 2 31 FEMALES Whooping cough - - - - - 2 - - - 2 Bronchitis - - - - - - - 1 - 1 Pneumonia - 1 - - 1 2 6 - 1 10 Congenital malformations - - - - - 1 - 1 -- 2 Congenital debility 2 - - - 2 - - - - 2 Premature birth 5 - 2 - 7 - - - - 7 Injury of birth 1 - - - 1 - - - - 1 Atelactasis 1 - - - 1 - - - - 1 Other causes - - - - - - 1 - 1 2 Totals 9 1 2 - 12 5 7 2 2 28 COMPARATIVE STATISTICS The Registrar-General has forwarded provisional figures relating to the country as a whole and to London, enabling comparisons to be made as follows:- Birth rate per 1,000 population Death rate per 1,000 births From diarrhoea, etc. under 2 years Total deaths under 1 year Live Still England and Wales 14.2 0.51 5.1 59 London 8.9 0.33 6.8 68 EDMONTON - - 2.45 48.98 ANNUAL DEATH RATE PER 1,000 OF POPULATION All causes Measles Scarlet fever Whooping cough Diphtheria Influenza England and Wales 12.9 0.03 0.00 0.06 0.07 0.19 London 16.3 0.02 0.00 0.04 0.03 0.15 EDMONTON - - - - - - The following table gives the number of births and deaths (registered) subdivided into the four Wards of tho Borough. It should bo remenborod that births are only those which occurred in Edmonton of Edmonton residents; these are registered in Edmonton. Births which take place outside the Borough are not included; this fact accounts for the differenco between these figures and those supplied by the Registrar-General. The deaths include those taking place outside the Borough, the information being given quarterly by the Registrar-General. Ward BIRTHS DEATHS INFANT DEATHS Male Female Male Female Male Female Bury Street 155 150 165 138 9 6 Church Street 92 80 116 129 8 9 Angel Road 93 108 127 107 7 6 Silver Street 150 124 144 149 7 7 Vagrants - - - 1 - - 490 462 552 524 31 28 GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH LABORATORY FACILITIES These are as described in previous reports. Consideration is being given to a schcme for enlarging the scope of the laboratory and I hope to report fully on this matter in 1942. The following examinations were carried out during 1941:- Swabs for Diphtheria Positive Negative Total From suspected cases 14 388 402 From contacts 4 108 112 18 496 514 Present Not found Total Sputa for the presence of tubercle bacillus 2 23 25 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 - 5 5 Faeces do do - 7 7 Faeces do dysentery - 12 12 Swabs for virulence of K.L.B. - 1 1 Swabs for presence of haemolytic streptococci 2 9 11 Vaginal swab for presence of gonococci - 2 2 Vaginal swab for presence of trichomonas vaginalis 1 - 1 Urine for presence of bacillus coli - 1 1 Designated Milks are sent to the Counties' Public Health Laboratories. A total of 119 milk samples were sent, made up as follows :- 70 Tuborculin tested, 7 Accredited, 36 Pasteurised and 6 Tuberculin tested (Pasteurised). The following are the results of the examinations:- Nature of test Tuberculin tested Accredited Passed. Failed Passed Failed Methylene Blue & B. Coli 25 40 5 1 Methylene Blue 30 40 6 1 B. Coli 25 45 5 2 Tuberculin tested (Pasteurised) Pasteurised Phosphatase & Bacterial count 5 - 33 1 Phosphatase 6 - 34 2 Bacterial count 5 1 34 2 A number of samples of Tuberculin tested milk taken during the year failed to pass the prescribed tests. The matter was taken up with the producer and the County authority concerned. Of the Tuberculin tested milk samples, 4 were examined for the presence of tubercle bacilli and in no case was it found. 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 5,745 Accident cases 429 Maternity cases 50 Clinic (tonsil cases) Special services 167 False alarms 1 6,392 The resuscitating apparatus was in use 3 times. The bedside apparatus for the supply of oxygen was requested by 13 patients. The total mileage of the vehicles was 34,703 miles. A 2-ton Bedford coach has been purchased to replace the old Morris bus, and alterations were carried out to the Public Health Department Garage in order to accommodate the coach. This vehicle convoys the deaf and dumb and partially blind 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 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 diseases are admitted into the Enfield, Edmonton & Potters Bar Joint Isolation Hospital, situated in Enfield. Arrangements for the treatment of ear, nose and throat disorders amongst school childron are made with the Prince of Wales's Hospital, Tottenham; ringworm is treated at, and altra-violet light treatment given in, the North Middlesex County Hospit al, Edmonton. NURSING HOMES REGISTRATION There is one Nursing Home registered by the Council. This is kopt under supervision by the Medical Officer of Health. No now application to be placed on the Register was received during 1941. SANITARY INSPECTION IN THE AREA Five District Sanitary Inspectors arc 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 arc employed and the investigation of notifiable infectious disease, including tuborculosis. 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 Inspector was appointed Controlling Officer for Emergency Petrol Supplies and also the Authorised Officer for the Decontamination of food (Food Decontamination Officer). The District Sanitary Inspectors are acting as Billeting Officers and, in addition, ono as War Mortuary Superintendent. SANITARY CONVENIENCES There are seven Public Conveniences in the Borough which are 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 the occupier of the premises infested, but the Rat Destruction Officer of the Council 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, 1958: 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. No new applications were received during 1941. DISINFECTION AND DISINFESTATION As reported in 1940, the Council's disinfecting station was completely destroyed and the sanction of the Ministry of Health has now been obtained for a loan for the provision of a new disinfecting station and steam disinfector. During the year, the work has been carried out at the Enfield disinfecting station and I would like to take this opportunity of expressing my thanks for the co-operation received from the Enfield authorities in this matter. The following table gives some idea of the work carried out:- Number of journeys to collect bedding 271 do do return bedding 261 Rooms disinfected after infectious disease 527 Rooms disinfected after phthisis 94 Disinfestation carried out after vermin 181 Bedding, clothing, etc. disinfected after infectious disease 2,261 articles do do do phthisis 992 do do do do other cases 2,852 do The Council distribute a disinfecting powder and fluid to residents who apply for the same at the Town Hall Yard. During the year, the applicants numbered 18,462. 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 389. Seven Council houses and 101 other houses were found to be infested and the total number of rooms disinfected was 131. 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 & 1936 During the year , 2 raw 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 gallons Petroleum mixtures „ Carbide of calcium tons MORTUARY During the year, 87 bodies were deposited in the Mortuary, 75 by order of the Coroner and 12 for sanitary reasons. The following tabular statement gives the number and nature of the inspections made during the year:- Complaints 1,370 Infectious disease 271 Tuberculosis 366 Factories with mechanical power 153 Factories without „ „ 15 Other premises under the Factories Act 2 Outworkers 309 Schools 9 Offensive trades 5 Shops and stalls 193 Shops Act (primary) 4 Shops Act (re-inspections) 1 Sanitary conveniences and urinals 462 Stables 2 Piggeries 8 Petroleum 29 General inspections 207 Sundry visits 1,072 Cinemas and halls 6 Visits to canal 8 A. R. P. shelters 452 Billets 2,419 Re-inspections 2,349 INSPECTIONS OF PLACES WHERE FOOD IS PREPARED Butchers 151 Fish shops 22 Coffee shops 25 Ice cream shops 9 Dairies and. milkshops 105 Slaughterhouses 6 Bakehouses 16 NUMBER OF NOTICES SERVED Preliminary or Informal notices 647 Statutory notices 230 DEFECTS REMEDIED Houses repaired, cleansed, etc. 180 D. W. cisterns repaired, covered 5 Water fittings repaired 61 Drains examined, tested, etc. 322 Drains cleared, trapped, repaired 242 Drains reconstructed 74 Chambers inserted 30 Chambers sealed down 13 Soil and vent pipes repaired 19 W. C's repaired, cleansed, etc. 144 Flushing cisterns repaired 70 Waste pipes repaired, etc. 24 Sinks repaired or renewed 11 Roofs repaired 164 Gutters and R. W. P's repaired 129 Yards paved or repaved 33 Scullery floors repaired 12 Spaces under floors ventilated 21 Dampness remedied 19 Floors repaired 45 Coppers and stoves repaired, etc. 66 New dustbins supplied 72 Accumulation of refuse removed 9 Nuisances from animals abated 2 Other nuisances abated 159 CANAL BOATS ACTS During the year 8 visits were paid to the Canal and 4 boats were seen, but of this number none was fitted or used as a dwelling or registered under the Acts. PLACES OF PUBLIC ENTERTAINMENT Six 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 under the above Act 1. INSPECTIONS FOR THE PURPOSE OF PROVISIONS AS TO HEALTH Premises Inspections Written Notices Occupiers prosecuted Factories with mechanical power 153 18 - Factories without mechanical power 15 - - Other premises under the Act (including works of building and engineering and. construction but not including outworkers' premises) 2 - - Totals 170 18 - 2. DEFECTS FOUND Particulars ' No. of defects No. of defects in respect of which prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of cleanliness 11 10 - - Overcrowding 1 1 - - Unreasonable temperature - - - - Inadequate ventilation 1 1 - - Sanitary conveniences: Insufficient 6 6 - - Unsuitable or defective 19 15 - - Not separate for sexes 2 1 - - Other offences (not including offences relating to Home work or offences under Sections mentioned in the schedule to the Ministry of Health (Factories & Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third schedule to the Factories Act, 1937). 4 3 - - Totals 44 38 - - 3. OUTWORK IN UNWHOLESOME PREMISES Nature of work Instances Notices served Prosecutions Wearing apparel Making, etc:- - - - Cleaning and washing, - - - FACTORIES AND WORKSHOPS, ETC. DEFECTS REMEDIED W. C. Walls cleansed 8 W. C. cisterns repaired 2 W. C. seats repaired or renewed 16 W. C. flush pipes repaired 2 W. C. doors repaired 1 Roofs repaired 4 Workrooms cleansed 2 Sanitary accommodation improved 1 Inadequate ventilation 1 SCHOOLS The exclusion of children suffering from infectious disease and their contacts is dealt with in accordance with the Memorandum issued jointly by the Ministry of Health and the Beard of Education. No schools were 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 669 defects (under Public Health or.Housing Acts) (b) Number of inspections made for the purpose 2,362 (2) (a) Number of dwelling houses (including under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 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 bo in all respects reasonably fit for human habitation 533 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 428 3. ACTION UNDER STATUTORY POWERS DURING THE YEAR A - Proceedings under Sections 9, 10 & 16 of the Housing Act, 1936 (1) Number of dwelling houses in respect of which notices were served requiring repairs 38 (2) Number of dwelling houses which were rendered fit after service of formal notices:- (a) by owners 27 (b) by Local Authority in default of owners 1 B - Proceedings under Public Health Acts:- (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 60 (2) Number of houses in which defects were remedied after service of formal notices:- (a) by owners 43 (b) by Local Authority in default of owners C - Proceedings under Sections 11 & 13 of the 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:- (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 tenements or rooms having been rendered fit SLAUGHTERHOUSES Six visits were paid and the carcases and organs of thirty pigs were inspected during or shortly after slaughter, permission for slaughter having been obtained from the Area Meat and Livestock Officer. INSPECTION MP 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 10 8 Tuberculin tested 9 5 Accredited - 1 19 14 Two of the above retailers are 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 arc granted to retailers who live outside the Borough but who sell milk in the Borough; the primary licence is granted by the Authority in which they reside. UNSOUND FOOD The following is a list of the food surrendered for examination and retained as unfit for human consumption:- 79 tins Peas 15 tins Beans 99 tins Canned meat 183 tins Canned fish 5 boxes Fish 3 chickens 24 Rabbits 15 cases Skinned rabbits 2,6 pots Jam 160 lbs Slab cake 400 Oranges 1 sack Onions 2,169 tins Evaporated Milk (various brands) 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. 3,808 Contraventions 1 CHEMICAL AND BACTERIOLOGICAL EXAMINATIONS 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 has been discussed previously. PREVALENCE OF INFECTIOUS DISEASE MEASLES AND WHOOPING COUGH These diseases were made compulsorily notifiable in October, 1939. 1,556 cases of Measles and 682 cases of Whooping cough were notified during the year. There were 4 deaths from Whooping cough and no deaths from Measles DIPHTHERIA I am happy to report the continued low incidence of this disease. 18 cases were notified during the year compared with 14 in 1940. There were no deaths. SCARLET FEVER This disease continued to occur throughout the year in a mild form; there were 143 cases compared with 111 in 1940; there were no deaths. 'Return' cases numbered 4, allowing for an interval of 28 days between a patient returning home from the Isolation Hospital and the onset of the disease in another inmate of the house SMALLPOX No cases of smallpox were notified during the year POLIOMYELITIS 5 cases wore notified during the year, but there were no deaths. ENTERIC FEVER - PUBLIC HEALTH (INFECTIOUS DISEASES) REGULATIONS, 1927 Pathological speciriens wore obtained from the typhoid carrier referred to in my Report for 1940, over a period of time but in no case were organisms of the typhoid/para-typhoid group found. The man was therefore allowed to resume his normal occupation as a moat porter at the expiration of the period of twelve months for which ho was excluded from carrying out his normal occupation. DYSENTERY 1 case of this disease was notified during the year; the patient died. Investigation failed to reveal the source of infection. There was one other death of an Edmonton resident which took place outside the Borough. CEREBRO -SPINAL FEVER 18 cases were notified during the year. The,cases were carefully investigated and precautions taken to prevent the spread of infection. 3 deaths took place. PUERPERAL PYREXIA AND OPHTHAIMIA NEONATORUM These are referred to later on under the heading of Maternity & Child Welfare FOOD POISONING 9 cases were reported but there were no deaths. PNEUMONIA The number of cases of primary and influenzal pneumonia notified showed an increase. The number of deaths from all forms of pneumonia remains about the same. DIARRHOEA AND ENTERITIS UNDER 2 YEARS_OF AGE the death m.te per 1,000 live births for London was 6.8 whilst that for Edmonton was 2.45 as compared with 5.8 and 2.12 respectively last year. I M M U N I S A T I 0N The Council authorised the exhibition of posters drawing the attention of the public to the fact that various typos of immunisation were available to those who wished voluntarily to avail themselves of those services. Sanction was subsequently received from the Ministry of Health for facilities being provided for immunisation against Whooping cough, Scarlct fever and Measles under Section 177 (1) of the Public Health Act, 1936. DIPTHERIA As anticipated last year, the result of more extensive propaganda, including poster displays, press notices, etc. throughout the Borough, has been a far greater demand for this treatment, necessitating extra clinics being held. During the year, 3,102 children completed treatment under the Council's arrangements; of these, 1,404 were under 5 years of age. 46 children were Schick tested. In 1940, 460 children completed immunisation treatment. A number of requests were received from local medical practitioners for immunising material and the Council agreed to supply the same 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. MEASLES Measles Immune G lobulin was issued to general practitioners in accordance with the Council's resolution quoted in my report for 1940. 17 x 2 c.cs. were issued during the year. WHOOPING COUGH In accordance with the resolution quoted above, Edmonton children are immunised against Whooping cough. The material used is 'Vaccine A', and during the year 215 children under 5 and 48 children 5-15 years completed treatment. the treatment is carried out at the Council's clinics. The following table gives the ago, incidcnce, 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 ('No. removed to hospital') includes those already under treatment at a hospital, for instanco, tho North Middlesex County Hospital. This remark applies more particularly to the infections associated with parturition and includes puerperal pyrexia and. ophthalmia neonatorum. Disease Total No. of cases NUmber removed 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 & over Scarlet fever 143 140 - 1 4 7 13 11 86 6 4 8 2 1 - Diphtheria 18 18 - - 1 - - 1 6 2. 3 5 - - - Enteric fever 3 3 1 - - - - - - - - 2 - 1 - Puorperal pyrexia 117 116 5 - - - - - - - 11 86 20 - - Pneumonia 99 43 73 6 7 7 1 4 11 3 6 17 14 15 8 Erysipelas 24 6 - - - - - - - 1 1 5 6 8 3 Ophthalmia neonatorum 8 8 - 8 - - - - - - - - - - - Food poisoning 9 - - - - - - - - - - 6 1 1 1 Whooping cough 682 39 4 41 71 85 84 106 279 6 4 5 1 - - Measles 1,556 40 - 54 131 179 161 288 792 26 8 12 1 1 - Cerebro-spinal fever 18 12 3 1 - - 1 3 1 5 2 3 1 1 Poliomyelitis 5 5 - - - - 1 - - 2 2 - - - - Dysentery 1 1 2 - - - - - - - - 1 - - - The following table indicates the wards from which the cases were notified:- Disease. Bury Street ward Church Street ward Angel Road ward Silver Street ward North Mddsx C.Hosp Othor Inst'ns Total Scarlet fever 63 82 18 35 5 - 143 Diphtheria 4 2 3 9 - - 18 Enteric fever - - - 3 - - 3 Puerperal pyrexia 12 1 7 8 89 - 117 Pneumonia 41 . 16 15 27 - - 99 Erysipelas 7 3 3 11 - - 24 Ophthalmia neonatorum - - 1 - 7 - 8 Food poisoning 1 - 6 2 - - 9 Whooping cough 195 136 141 210 - - 682 Measles 593 181 283 490 8 1 1,556 Cerebrospinal fever 6 2 4 5 1 - 18 Poliomyelitis 1 1 2 1 - - 5 Dysentery - - - 1 - - 1 CANCER The incidence of Cancer relative to the various organs of the body is given as under:- Males Females Breast 1 19 Uterus - 6 Buccal cavity and oesophagus 6 - Stomach, and duodenum 11 6 All other sites 50 53 68 84 PREVENTION. OF BLINDNESS Cases of ophthalmia neonatorum are promptly visited and, if thought necessary, are removed to 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 exist withe the Middlosex County Council for the treatment at the school clinics of adolescents who are ascertained at school to bo suffering from defective vision. ORTHOPAEDIC TREATMENT Details of this scheme were set out in my Report for 1939. Financial assistance was rendered for the supply of surgical appliances in 1 case during the year. ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT Consideration was given to the question of licences for establishments for massage and special treatment with particular reference to the technical qualifications necessary for the granting of such licences. As a result, the Council resolved that Part 7 of the Middlesex County Council Act, 1934, be put into operation in the Borough. 2 licences were granted during the year. INCIDENCE OF LICE Ministry of Health Circular 2306 and Board of Education Circular 1544 were received, and in accordance with the provision contained therein, a full report so far as Edmonton is concerned was submitted. I was able to report that although the recurrence percentage of those who suffer is high, I was glad to say that the percentage incidence is very low, although I am not in a position to mike any statement other than that concerning the School Medical Service. • I submitted the following suggestions for. improvement 1. That the provisions of the Education Act, 1921, be extended to all pro-school children, 2. That health visitors and school nurses have the right of entry similar to that of the Sanitary Inspectors as at present, for the purpose of this work. Copies of the report were submitted to the Ministry of Health and the Board, of Education. LANDLORD AND TENANT - WAR DAMAGE AMENDMENT ACT, .1941 The Senior Sanitary Inspector (Mr. W. Tillcock) has been empowered to carry out the provisions of the above Act as to inspections and issuing of certificates of repairs executed at-premises suffering from war damage. LOUSE-BORNE TYPHUS FEVER Ministry -of Health Circular 2513 Was received too late in the year for a report to be made there on, but a letter was addressed to the medical practitioners in the Borough outlining the contents of the Circular and inviting their close co-operation with the Public Health Department, the services of which would at all times be at their disposal. TREATMENT OF SCABIES Having regard to the lack of accommodation at the Council's Cleansing station, arrangements were made with the Hornsey Borough Council for the treatment of Edmoton adult males at their station, for which a charge of 5/-d. per treatment is charged. Details of the Scabies Order, 1941, were reported to the Council and each of the Sanitary Inspectors, health visitors and school nurses were given authority to enter premises for the purpose of making inspections under the Order. TUBERCULOSIS The table overleaf gives details of the., ages and sex of new cases ox Tuberculosis, also deaths from the disease; this latter figure includes the deaths of non-notified cases Age periods New cases Deaths Respiratory Non-respiratory Respiratory Non-respiratory Male Female Male Female Male Female Male Female Under 1 year - - - - - - - - 1 - 5 years - 2 4 5 - - 1 3 5-15 " 4 2 2 2 - - - - 15 - 25 „ 33 18 2 4 5 15 1 - | 25-35 " 28 12 4 4 10 7 1 1 35-45 " 8 4 1 - 6 3 - - 45-55 " 6 4 - 2 6 5 - 1 55 - 65 " 5 1 1 - 6 2 - - 65 years upwards 1 1 - 1 2 - - 1 85 44 15 18 35 32 3 6 In addition, 22 cases of pulmonary tuberculosis and 3 cases of non-pulmonary tuberculosis previously notified in other areas, moved into Edmonton. The total number of names added to the Register during the year excluding, of course, non-notified deaths, was:- Males Females Now cases Respiratory 85 44 Non-respiratory 14 18 Transferred cases Respiratory 15 7 Non-respiratory 2 1 116 70 The eases dying of Tuberculosis and not previously notified wore:- Males Females Respiratory 5 2 Non-respiratory 1 1 non There were thus 9/notifiod deaths out of a total of 77 persons registered as dying of tuberculosis (Registrar's figures). Regarding the non-notification of the above cases, there was no suggestion of wilful neglect or of refusal to notify. The non-respiratory forms of tuberculosis notified were:- Males Females Spine 1 2 Other bones and joints 2 3 Meningeal - 2 Glands 6 9 Abdomen 1 1 Kidney 3 - Ovary - 1 Miliary 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 those powers. PUBLIC HEALTH_(TUBERCULOSIS) REGUIATIONS, 1930 The number of cases of tuberculosis on the Register at the end of 1941 Was:- Males Famles Total Pulmonary forms 276 214 490 Non-pulmonary forms 79 79 158 355 293 648 The corresponding figures at the end of 1940 were:- Males Females Total Pulmonary forms 267 232 499 Non-pulmonary forms 82 81 163 349 313 662 Corresponding figures for previous years were:- Males Females Total 1939 357 301 658 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 COUNCIL'S EMPLOYEES During 1941, the Medical Officer of: Health paid a total number of 298 visits to those employees who had boon on the Sick list longer than a fortnight and, when necessary, at fortnightly intervals. Of those, 80 wore 'not at hone' and 11 had already resumed duty. Also, during the year, 6 persons were examined prior ro their appointment to permanent posts. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Cr. J. WARD. Councillors T. C. Joyce (Mayor); A. J. Hollywood (Deputy Mayor); Aldermen W. Preys and Mrs. M. M, Barress. Councillors - W. Bales; L. E. Beridge; Mrs, A.M. Glover; R. J. Grant; W. T . Green; Mrs, E.M. Heara; Mrs. F. Lone; Mrs. E. M. Moss; Mrs. H. Nicholson. STAFF. D.Regan, B.A., B.Sc., M.B., Ch.B., B.A.O., D.P.H.(L'pool) H. R. Hay, M.B., Ch.B.(Edin)., D.P.H., Deputy Medical Officer. M.F.Coveney, B.Sc., N.U.I., M.B., Ch.B(Sheff)., D.P.H.(Eng.)., Assistant Medical Officer (Left June, 1941), C. A. Goggin, M.B., B.Ch., B.A.O. D.P.H., A sistant Medical Officer. K. M. Hart, M.B.. B.S(Lond)., M.D., D.P,H. Assistant Medical Officer-comnenced July. 1941. J. A. Cholmeley, F.R.C .S. (Eng)., Orthopaedic Surgeon. R. Leslie Dodds, F.R.C.S., Consulting Accoucheur. E. Underlain, L.D.S., R.C.S., Dentist. HEALTH VISITOR SCHOOL NURSES (Combined Service). abde Hiss A. Bintcliffe - Lady Superintendent, Health Visitor School Nurses. de Miss A.Naylor. bed Miss J. Paterson. d Mrs. C.Boothby (retired June 1941) bd Miss M. Druce. bed Miss M.R. Hazelton. bed Miss R. Bullock. acd Miss J.M. Anderson. bed Miss B. F. Lister. bed Miss V. Garrett bed Miss V.H. Hughes (com. July, 1941) c Miss A. Fahy (School work only). Mrs. C. Tonkin (School work only). MASSEUSE. Miss M. F. Cozens-Walker, Chartered Masseuse, Orthopaedic Clinic (Part-time). MUNICIPAL MIDLIVES. cdfg Mrs. R.K.M. Wingrove - Non-Medical Supervisor of Midwives. edg Mrs. D.S.C. Gazzard. edg Miss K.M. James. dg Mrs. A.J. Griffiths. edg Miss D.M. Lewis. edg Miss A.G.Walker. edg Miss V. Ummen. edg Miss A.L. Gow (res. Dec. 1941). edg Mrs. A.M. Burton (temporary). dg Miss D.Chaplin (temporary). 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. g Certificate for Gas and Air. CLERICAL. Miss R. Saunders. Senior Clerk. Miss N.A. Eyres. 1st Assistant. Miss I. Wilkins 2nd Assistant (res. Oct. 1941). Miss H.P. Turton 3rd Assistant. Miss W.A. Beattie 4th Assistant. Mrs. K. Corden Commenced October, 1941. NURSERIES. Harpenden. - h Miss M.W. Betteridge - Matron until June, 1941. h Miss IS Stephenson - Matron from June, 1941. h. Miss E.A. Wollor-Staff Nurse. Edmonton - h Miss M.F. Better idge - Matron from July, 1941. h Certificate of Day Nursery Training. The following information gives details of the Maternity and Child Welfare Clinics at the end of 1941:- (1) Ante-Natal Clinic at Brookfield House, Fore Street (adjoining the Town Hall) Five sessions weekly. (2) Child Welfare Centres (a) Brookfield House. Four sessions weekly. (b) St. Stephen's Church Hall. One session weekly. (c) St. Alphego Church Hall. Two sessions weekly. (d) St. Aldhelm's Church Hall Two sessions weekly. (3) Post-Natal Clinic at Brookfield House. One session weekly. (4) Dental Clinic at Croyland Road School Clinic. Two sessions weekly. (5) Orthopaedic Clinic at Methodist Central Hall, 'Fore Street. Two sessions weekly. (6) Obstetric Surgeon attends once a fortnight at Brookfield House. FOREWORD. The year 1941 was very satisfactory In every way, and showed marked progress in many directions. The Intent Welfare Clinics were well attended during the year, and the Ante-Natal Clinics had record attendances (namely 7,583), showing a total increase in the actual attendances of 1,938 above those for 1940. The Post-Natal Clinic also shows a healthy increase in the number of women availing themselves of this service. The Council's Evacuated Nursery at Harpenden, Hertfordshire, is now well established in that arsa where it accommodates 28 children under 5 years of age. Many problems were experienced during the year on account of the shortage of staff, but fortunately the health of the children was good. The evacuation, of expectant mothers under the Government Scheme at the eighth month of pregnancy was still popular as the figures in this report will indicate. The following extensions to the service have been introduced during the year. I feel that this progress is very noteworthy bearing in mind the difficulties of expansion in such an abnormal period:- (a) The Nursery at Fore Street, Edmonton, was officially re-opened as a War-time Nursery on August 5th, 1941, with accommodation for 40 children. By the end of the year plans were being considered for the extension of the premises, together with the question of a scheme of War-time Nurseries for the district. (b) An Advisory Clinic was introduced in November, 1941 to run in conjunction with the Post-Natal Clinic. (c) Free meals for expectant and nursing mothers can now be obtained at British Restaurants in the district where the women come within the Council's scale for assistance. (d) By the end of the year a Scheme had been introduced for the administration of gas and air analgesia to women during their confinements, and it is hoped that this will, be a popular service,, Prior to its introduction the midwives were sent to the North Middlesex County Hospital for a course of training. (e) In November 1941 arrangements were made with the Education Committee for children under 5 years of age to attend their Sunlight Clinic, This means that the children can now remain under the supervision of the Council's Medical Staff. (f) The Departments arc now responsible for the distribution of clothing coupons to all expectant mothers in the district. (g) Under a scheme of co-operation with the local branch of the Women's Voluntary Services, medical examinations are carried out in respect of children under five years of age for whom that Organisation make arrangements for evacuation. I should like to express my appreciation to the Members of the Maternity and Child Welfare' Committee and to the Members of the Staff for their co-operation during the year. The following information will give some indication of the work carried out by the Department during the year 1941:- BIRTHS. The total number of births notified during 1941 was as follows:- Live births notified by midwives 1,675. „ „ „ „doctors and parents 101. Stillbirths „ „ midwives 85 „ „ „ doctors 7 1,868. 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 856 „ „ „ „ doctors and parents 97 Stillbirths notified by midwives 19 „ „ „ doctors 4 976 The following table includes births of Edmonton residents and those born and registered in other districts:- Male. Female. Total. Live births 44 41 85 Stillbirths 2 — 2 46 41 87 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 99 Total visits 102. To children under 1 Year of age:- First visits 1,097 Total visits 7,956 To children between 1 and 5 years:- 11,956 Infant Protection visits to children 5-9 years 63 20,077 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 258 Number of prospective mothers 1,574 (X) Total number of attendances 7,583 Number of consultations 6,327 Average number of attendances:- (a) Per session 29.39 (b) For consultations 24.52 (X) Included in this total are 328 referred from the North Middlesex County Hospital under the scheme of co-operation with that hospital. POST-NATAL CLINIC. This Clinic is hold once weekly and the following are the figures for the year:- Number of sessions 50 Actual number of mothers who attended 356 Number of consultations 847 Average attendance per session 17.36 Total attendances at Clinic 868 SPECIALIST CLINIC. The consulting Specialist made 27 visits during the year and saw 230 cases, making an average of 8.51 per session. CHILD WELFARE CLINICS. The figures relating to attendances are:- Brookfield House. St. Stephens. St. Alphege. St. Aldhelm. No. of sessions. 207 50 106 92 New Cases:- (a) Under 1 year 530 112 215 205 (b) 1-5 years 180 49 97 97 Attendances. (a) Under 1 year 8,259 1,782 4,061 3,728 (b) 1-5 years 6,527 1,373 3,256 3,561 14,586 3,155 7,317 7,289 Doctor's consultations 4,536 904 2,321 2,134 Average attendances 70.46 63.1 69.02 79.22 ORTHOPAEDIC CLINIC. The Clinic is held twice weekly and the following are the figures for the year:- Number of sessions 95 New cases referred during the year 118 Attendances:- Surgeon's days 271 Treatment days 756 Total attendances 1,007 In-patient Treatment. Two children were admitted to Stanmore during 1941, the average length of stay being 8 weeks. One child was still in hospital from 1940 and the other was still there after December, 1941. DENTAL CLINIC. Details of the work carried out are:- Mothers. Children. Number of sessions 99. Number of attendances 1,135 270 Number of new cases 418 190 Total number treated 838 (X) 265 Fillings 253 9 Dressings 44 243 Scalings 112 - Extractions (No. of teeth). (a) Under Gas 1,995 579 (b) Local Anaesthetic 77 - Number of gas cases 519 171 (X) This figures does not include mothers attending for dentures. DENTAL CLINIC Contd. Dentures. Number supplied-60, of whom 18 were assisted by Committee. ADVISORY CLINIC. In November an Advisory Clinic was introduced to run in conjunction with the Post-Natal Clinic, where women from 40 - 50 years of ago could seek advice, and the following attendances have been made:- Number of sessions 6 Number of attendances 10 Number of new cases 8 SUNLIGHT CLINIC. In November 1941 arrangements were made with the Education Committee for children under five years of age to attend the Sunlight Clinic inaugurated by them. 22 children were referred during the period from the 15th November to the 31st December, 1941, and they received 91 treatments. OPHTHALMIC CLINIC During 1940 an arrangement was made with the Edmonton Education Committee for children to' attend their Ophthalmic Clinic. Glasses arc supplied under a similar arrangement as that which operates for the Education Authority. A scale of income is in force, and glasses can be supplied free of charge when necessary. 58 children under 5 years of age attended the Ophthalmic Clinic in 1941. 52 attended for Refraction and 53 for. re-examination. BIRTH CONTROL CLINIC. 4 women wore referred to this Clinic during 1941. SPEECH CLINIC. An arrangement was made with the Edmonton Education Committee for children under five years of age to attend the Speech Clinic held under that Committee. Five children were referred during the year. DETAILS Off DISTRIBUTION OF MILK, COD LIVER OIL etc, distributed' by the Maternity and Child Welfare Department apart from any scheme of the Ministry of Food. Liquid Milk 427 pints. Trufood 296 tins. Cow and Gate 967 packets. Ostermilk 520 tins. Cod Liver Oil and Malt 1,098 cartons. Bemax 48 cartons. Pure Cod Liver Oil 146 bottles. Halycalcyne 223 bottles. Ferrofax 57 bottles. Glucose 44 packets. N.R. Vitamin 19 tubes. NATIONAL DRIED MILK. 5,121 tins of National Dried Milk were distributed "in the Clinics, 2,160 being sold, 956 issued free of charge, and 5 paid for by the Council. This distribution is carried out under a scheme of co-operation with the Ministry of Food. FREE MEALS. From September 1941 the following free meals were granted' at British Restaurants to Expectant and Nursing Mothers who came within the necessary scale of income:- No. of applications received 34 No. of applications granted free of charge 29 No. of applications Above Scale 5 No.of renewals 9 Total number of meals supplied. 595 CONVALESCENT CASES. 20 children were sent away under contract with the Invalid Children s Aid Association, plus one still away who was sent in 1940. TONSIL AND ADENOIDS. 48 children were admitted to hospital for Tonsils end Adenoids operation during 1941, of this number 32 paid the full cost fixed by the Committee, 11 were free and 5 were through the H.S.A. INFECTIOUS DISEASES. Ophthalmia Neonatorum. Eight cases were notified during the year, and of this number 7 cases occurred in the North Middlesex County Hospital, none of which were Edmonton cases. Puerperal Pyrexia. 112 cases were notified during the year, and of this number 107 occurred in the North Middlesex County Hospital of which 23 were Edmonton cases. Three others were admitted to the Enfield and Edmonton Isolation Hospital, and one occurred in the Mothers Hospital, Clapton. Pemphigus Neonatorum. One notification only was received during the year which was an Edmonton case. MIDWIFERY SERVICE. Medical Aid The number of claims made by doctors for Medical Aid during the year 1941 was 177, of this number 45 cases were granted free of charge and 10 at half cost. Midwifery. The following gives information as to the actual bookings for 1941:- Number of women who booked during 1941 397 Of this number 165 were granted the service of a midwife free, 26 were assessed at half-fee, and 49 re-applications were reviewed during the year, these latter mothers thus being; relieved from further payment. Analysis of work. Actual confinements attended by midwives 625 (Of this number 566 as midwives & 59 as Attended by midwives, but women admitted to maternity nurses). hospital for actual confinement 64 Loft district before confinement or mothers evacuated through L.C.C. scheme etc. 114 (Attention and Supervision given by Municipal Midwives during AnteNatal period). Gas and Air Analgesia. In December 1941 a scheme was introduced for the administration of Gas and Air Analgesia to women during their confinement. This was made possible by the generosity of the National Birthday Trust, who supplied one apparatus free and another at a reduced price. A nodical certificate must be obtained within one month before the confinement, as to the physical condition of the mother, and under the C.M.B. rules two nurses must be present during the administration. A charge of 5/- is made but it can be given free of charge if the mother comes within a scale of income adopted by the Committee. One woman applied for the service during December and was attended. Evacuation of_Expectant Mothers under the Government Scheme at the eighth 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 1941, 265 mothers applied to be sent away and by December 31st, 151 women had been sent to reception areas for their confinement, and 41 cancelled the arrangements. Home Helps. 129 women had the services of Home Helps during the year, - 79 paid the full cost; 9 paid half the cost end 41 had the services free of charge. Ante-Natal scheme of co-operation between the Council and North Middlesex County Hospital. Under an arrangement with the Middlesex County Council the Health Visitors visited 146 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. Children under 5 years of age discharged from the North Middlesex County Hospital. 75 visits were paid to children under 5 years of age who had been discharged from North Middlesex County Hospital, and it was necessary for them to remain under supervision. STERILISED MATERNITY OUTFITS. 392 Sterilised Maternity Outfits were issued during the year; 273 were being paid for and 119 were issued free of charge. INFANT LIFE PROTECTION. Each Health Visitor 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 taken in order to bo satisfied in all cases. The number of persons on the register at the end of 1941 was 25, and the number of children 24. BOROUGH OF EDMONTON EDUCATION C0MMITTEE 1941 Chairman: Cr. Mrs. H. Nicholson Vice-Chairman; Ald. Mrs. E. A. Young. His Worship the Mayor; Cr. Mr. J. H. Joyce. ALDERMEN: W. F. Middleton, 7, Preye, J. Reid, A. J. Hollywood, W. A. Edmunds, T. H. Harington. COUNCILLORS: Mrs. P. Long, Mrs. E. M. Moss, G. E. Albon, 77, Bales, C. E. Lacey, T. 7. 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 and Medical Officer of Health and Supervisor of Maternity Services. H. R. Hay, M.B., .Ch.B., D.P.H., Deputy School Medical Officer and Deputy Medical Officer of Health. M. P. Coveney, M.B. Ch.B., B.Sc., D.P.H., Assistant School Medical Officer and Assistant Medical Officer of Health (Left the service in June 1941) C. A. Goggin, M.B., Ch.B., D.P.H., Assistant School Medical Officer and Assistant Medical Officer of Health. K. Hart, M.B., B.S., (Lond), M.D., D.P.H. Whole-Time Dental Surgeons J. P. Ardouin, L.D.S., R.C.S., Senior Surgeon Dentist. E. Underbill, L.D.S., R.C.S., Assistant Surgeon Dentist. F. H.S. Weiss, L.D.S., R.C.S. Assistant Surgeon Dentist (now serving with H.M. Forces) Consultants J. A. Cholriieley, F.R.C.S., (Eng), Orthopaedic Surgeon. Miss L. M. Smith-Clark, M.B., Ch.B., Ophthalmic Surgeon. J. Browning Alexander, P.R.C.P., Rheumatic Specialist. W. Ibbotson,F.R.C.S., Aural Specialist. V. A. P. Greenish, L.D.S., R.C.S. (Eng), Orthodontic Specialist. Part-Time Staff. Miss M.P. Cozens-Walker, Chartered Masseuse. Miss B. N. Oldrey, M.S.S.T., Speech Therapist. Sohool Nurses and Health Visitors Miss A. Bintcliffe (Lady Superintendent)Miss V. Garrett Miss A. Naylor Miss J. Paterson Mrs. C. Tonkin Miss M. Druce Miss M. R. Hazelton Miss R. Bullock Miss A, Fahy Miss B. Lister Miss J. Anderson Miss V. Hughes (commenced July, 1941) Dental Attendants Miss O. Brooks. Miss C. E, Stanbridge (left owing to marriage: 1st June, 1941. Miss J. Collyer (Commenced Dec. 1941. Clerical Staff B. R. Allen, School Medical Clerk, (Now serving with H.M. Forces) H. A. Carless, Clerk. S. E. Woodroffe, Clerk (now serving with the Royal Navy) Miss A. Savill, Clerk. Mrs. E. R. Taylor (nee Cross) Clerk, Mrs. P. R. Thorley. (Commenced May, 1941) 1 To the Chairman and Members of the Education Committee, Ladies and Gentlemen, I beg to submit my seventh Annual report, for the year 1941, on the work of the School Medical Department. To comply with the wishes of the Board of Education, the report is very much less detailed and deals mainly with the changes in the School Medical 'Department during the year under review. During the year, the services of the School Medical Department were working practically normal. Clinic attendances were good, although, with the Minor ailments Clinic, lost of the patients were from the Lower Edmonton District. This was mainly due to the fact that there was only one Minor Ailments Clinic in that part of the district. 1941 saw the introduction of the Orthodontic Scheme. Mr. Greenish, the Specialist comme need duties in May. He came twice a month at the Croyland Road Clinic. Later, it was arranged that Mr. Greenish attended the Hazelbury Dental Clinic on the; second Monday- and the Croyland Road Clinic on the fourth Monday of the month. The attendances were very good, although, the numbers were small for the Croyland Road Clinic. Towards the end of the year the number of cases we had on record wore 156. May I take this opportunity of tendering my sincere thanks to my staff for their loyal co-operation; also my thanks and appreciation to the Head Teachers and teachers for their help and co-operation with the School Medical Department. May I also extend my grateful thanks to the Chairman and Members of the Education Committee for their courtesy and interest shorn in the work of the Department. I have the honour to remain, Ladies and Gentlemen, Your obedient Servant, D. Regan. School Medica1 Officer. 1. STAFF The changes in Staff this year were few: Miss C. E. Stanbridge resigned on the 1st June, 1941 owing to her marriage and Miss J. Collyer was appointed in her stead. Miss Collyercommenced duties at the Hazelbury Dental Clinic on the 1st December, 1941. Dr. M. Coveney left the service- to take up another appointment and Dr. K. Hart, who was appointed in her stead, took up duties in June, 1941. 2. CO-ORDINATION The co-ordination between the various Departments, general practitioners, the Education Offices and teaching staff, continued to run smoothly as in previous years. 3. SCHOOL HYGIENE. It is to be regreted that the shelter arrangements as established at the schools have interfered very much with the proper ventilation of the class rooms and corridors and, in some instances, artificial light has to be constantly used. 4. MEDICAL INSPECTION. The number of children fully examined in the routine inspection of each group during the year 1941 was 2111 and the analysis of the age groups were as follows:- Entrants; 959; Second Age group: 756; Third Age group; Total: 2091 Mo, of other routine inspections: 20 2111 2 5. FINDINGS OF MEDICAL INSPECTION (a) Malnutrition. The following table gives the classification of the nutrition of the children inspected during the year 1941 in the routine ago groups:- Total A B C D Entrants 959 83 650 208 18 Second Age Group 756 89 483 175 9 Third Age Group 376 46 257 70 3 Other Routine Insps. 20 3 12 5 - 2111 221 1402 458 30 (b) Cleanliness . The cleansing of heads and the treatment of scabies was carried out at the Town Hall Clinic, as in previous years. The number of individual children cleansed were 953. There was an increase in the number of children suffering from scabies. (c) Minor Ailments and Diseases of the Skin. There was only one clinic in the district for the treatment of Minor Ailments during 1941 and that was the Croyland Road Clinic. The attendances for the year were 14382. (d) Visual Defects and External Eye Diseases. The Ophthalmic Clinic continued to be run on similar lines, as in previous years. The Clinic being held at the Central Hall, Fore Street, Edmonton, N.9. Statistics are given at the end of this report. (e) Nose and Throat Defects and (f) ear disease and Defective Hearing. The Aural Clinic was hold at the Croyland Road Clinic on the fourth Friday of each month. Towards the end of the year, Mr. Ibbotson, the Aural Specialist, attended the Clinic on the second and fourth Friday of the month. One of my Assistants held the. Clinic weekly 5-n order to keep the cases under obserration. Children recommended for the removal of their tonsils and/or adenoids were admitted to the Australasian Hospital, Barkingside for this operatior The number of children operated on during the year were 172. During the year Mr. Ibbotson saw 188 New Cases and 133 Old cases. Cases of speech defect were referred to the Speech Clinic under the care of Miss B. N. Oldrey, Speech Therapist. (g) Dental Defects. The treatment of dental defects were carried out at the Croyland Road and Hazelbury Dental Clinics. Particulars of attendances, etc. are given at the end of the report. (h) Orthopaedic and Postural Defects. Orthopaedic defects were, as in previous years, treated at the Special Clinic held at the Central Hall, Fore Street, N.O. The Orthopaedic Specialist, Mr. J. A. Cholmeley, F.R.C.S. attended the Clinic once monthly, and Miss Walker, the Masseuse attended on Monday, Wednesday, Thursday and Friday mornings. During the year under review 82 New cases were seen by the Specialist and the total attendances wore as follows:- 1067 BOYS and 1384 GIRLS-a total of 2451 3 (i) Heart Diseases and Rheumatism. Cases found to be suffering from rheumatism and diseases of the heart were referred for examination to the Rheumatic Specialist, Dr. Browning Alexander, who attended the Croyland Road Clinic once a month. The patients arc kept under close observation by one of my Assistants who attends the Clinic weekly. The attendances for the year were: 83 New cases and 148 Old cases. (j) Tuberculosis. Once again, I must extend my grateful thanks to Dr. H. Evans, the Tuberculosis Officer, for the co-operation he has given to this Department in dealing with cases referred to him. The number of notified cases and the mortality of children of school age, taken from the records of the Public Health Department during 1941 were as follows:- Notified Deaths M. F. M. F. Pulmonary 4 2 - - Non-pulmonary 2 2 - - (k) Other defects and Diseases These cases were dealt with as in previous years. 6. FOLLOWING-UP The same arrangements were in effect as in 1940. 7 . ARRAGEMENTS FOR TREATMENT Arrangements for treatment were the same as in 1940 with the exception that the Minor Ailments Clinic is now held at the Croyland Road Clinic, N.9. 8. INFECTIOUS DISEASES Children suffering with infectious diseases were dealt with in the same manner as in previous years. 4 BOARD OF EDUCATION Medical Inspection and Treatment Returns Year Ended 31st December, 1941 TABLE I. Medical Inspections of children attending Public Elementary Schools. A - ROUTINE MEDICAL INSPECTIONS. (1) No. of Inspections in the Prescribed Age Groups: Entrants: 959. Second Age Group: 756. Third Age Croup: 376 Total: 2091 (2) No. of other Routine Inspections: 20 Grand Total: 2111 B-OTHER INSPECTIONS. No. of Special Inspections and Re-Inspections: 832 TABLE II. Classification of the Nutrition of Children Inspected During the Year in the Routine Age Groups. No. of Children Insp. A B C D No. % No. % No. % No. % 2111 221 10.47 1402 66.41 458 21.7 30 1.42 TABLE III. Treatment of Minor Ailments (Excluding uncleanliness). (1) Total No. of Defects treated or under treatment during the Year under the Authority's Scheme: 4612 Under the Authority's Scheme (2) Treatment of Defective Vision and Squint. Errors of Refraction (including Squint: 784 Other defect or disease of the eyes (excluding those recorded in (1)). 20 Total: 804 No. of children for whom spectacles were (a) Prescribed: 721 (b) Obtained: 690 (3) Treatment of Defects of Nose and Throat. Received Operative treatment: 172 Received other forms of treatment: 62 Total Number treated: 234 TABLE IV (1) Number of children inspected by the Dentist (a) Routine Age Groups: Age No. Age No. Age No. 4 191 5 759 6 935 7 905 8 908 9 997 10 1143 11 941 12 852 13 1002 14 217 15 11 Total: 8859 (b) Specials 1215 (c) Total (Routine & Specials) 10074 5 (TABLE IV continued) (2) Number found to require treatment: 6593 (8) Administrations of general anaesthetics for extractions:- 2361 (3) Number actually treated 3980 (4) Attendances made by children for treatment 6839 (5) Half-days devoted to:- Inspection 56 (9) Other Operations: Treatment 713 Total 769 Permanent Teeth:- (6) Fillings: 364 Permanent Teeth 3259 Temporary Teeth:- Temporary Teeth 89 2748 Total 3348 ( 7) Extractions: Total 3112 Permanent Teeth 894 Temporary Teeth 8053 Total 8947 TABLE V Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses or other authorised persons: 18 (ii) Total number of examinations of children in the Schools by School Nurses or other authorised persons: 23001 (iii) Number of individual children found unclean: 1066 (iv) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921: 953 (v) 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. Number of totally or almost totally blind and deaf children who are not at the present time receiving education suitable for their special needs. At a Public Elementary School At an institution other than a Special School At no School or Institution Blind Children — - - (7 children on rolls of the Partially sighted School, N.22.) 1 Deaf Children - - - (11 children on rolls of the School for Deaf, 11.15) Mentally Defective Children Total number of children notified during the year ended 31st December, 1941, by the Local Education Authority to the Local Mental Deficiency Authority, under the Mental Deficiency (Notification of Children) Regulations, 1928. 6 SECONDARY SCHOOLS Returns in respect of children attending Secondary and Junior Technical Schools for the year ended 31st December, 1941. A. (i) Cases in which a full examination has been made. Age 9 10 11 12 13 14 15 16 17 18 19 Boys - - 21 62 28 22 53 33 5 3 - Girls (Sec) - 14 30 19 16 14 15 1 - - (Tech) - - - 6 34 14 1 - - - Total (Sec) - - 35 92 47 58 67 46 6 3 - B. Classification of the Nutrition of Pupils inspected during the year, in ages. Ages Number of Pupils Inspected A (Excellent ) B (Normal) C (Slightly subnormal) D (Bad) 11 35 7 21 7 - 12 82 6 65 10 1 13 (Sec) 47 3 36 7 1 (Tech) 6 - 3 3 - 14 (S) 38 3 31 4 - (T) 34 1 23 10 - 15 (S) 67 4 62 1 - (T) 14 1 10 3 — 16 (s) 46 6 39 1 - (T) 1 - 1 - - 17 (S) 6 — 6 - - (T) — - - — - 18 (S) 3 - 2 - - (T) - - - - - Total (S) 524 30 262 30 2 (T) 55 2 37 16 - C. Defective Vision and Squint (Excluding minor eye defects treated as minor ailments) -• Number of Defects Dealt With Under the Authority's Scheme Otherwise Total Errors of Refraction (including squint) 114 (Sec) - 114 41 (Tech) - 41 Other defect or disease of the eyes(excluding those recorded as minor ailments). -(Sec) - - -(Tech) - - Totals 114 (Sec) - 114 41(Tech) - 41 Total Number of children for whom Spectacles were prescribed: (a) under the Authority's Scheme: 114(Sec) 41 (Tech) (b) Otherwise: -(Sec) -(Sec) 7 C. (Continued) Total Number of children who obtained or received Spectacles: (a) Under the Authority's Scheme: 113 (Sec) 41 (Tech) (b) Otherwise: 1 (Sec) - (Tech) D. Dental Defects. (1) Number of pupils who were:- (a) Inspected by the Dentist:- Ages 11 12 13 14 15 16 17 18 19 Secondary 185 343 221 164 105 31 15 5 - Technical - 3 67 35 4 1 - - - Total: Secondary 1069 Technical 110 Specials: Secondary 26 Technical 14 Grand Totals: Secondary 1095 Technical 124 Sec. Tech. (b) Found to require treatment 691 94 (c) Actually treated 490 59 (2) Half days devoted to Inspection 6(Sec) 1 (Tech) 126 60 Total: (Treatment 120(Sec) 59(Tech) (3) Attendances made by pupils for treatment 918 137 (4) Fillings. Permanent Teeth 988 (Sec) 148 (Tech) 988 148 Total: Temporary Teeth-(Sec)-(Tech (5) Extractions Permanent Teeth 183 (Sec) 38 (Tech) 223 39 Total: Temporary Teeth 40 (Sec) 1 (Tech) (6) Administrations of general anaesthetics for extractions: 98 21 (7) Other operations (Permanent Teeth 234 (S) 22 (T) 234 22 Total: Temporary Teeth-(S)-(T) 8