AC 439(1) EDMONTON EDM 30 Borough of Edmonton REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1945 Jolly the Printer Ltd. (T.U.), 238, Fore Street, N.18 6651 Borough of Edmonton REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1945 Borough of Edmonton 1945 His Worship the Mayor Alderman W. Preye, J.P. Deputy Mayor Alderman J. Reid. PUBLIC HEALTH COMMITTEE. Chairman : Councillor Mrs. A. M. Glover. Councillors J. A. G. Beattie, Mrs. E. B. Newsham, Mrs. E. F. Johnson. W. Pullen, J. A. Ward, J.P., L. E. Berridge, Mrs. E. M. Moss. STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health, School Medical Officer, and Supervisor for the Maternity and Child Welfare Services : D. Regan, B.A., B.Sc., M.B., Ch.B., D.P.H. (L'pool). Deputy Medical Officer of Health and Deputy School Medical Officer : Catherine A. Goggin, M.B., B.Ch., B.A.O., D.P.H. Assistant Medical Officers and School Medical Officers : Elizabeth Gray, M.B., Ch.B., D.P.H., L.M. (Dublin). (Commenced April, 1945). Kathleen M. Hart, M.D. (Lond.), M.B., B.S., D.P.H. Margaret Sutcliffe, M.B., B.Ch., B.A.O., D.P.H. Senior Sanitary Inspector : *abcd W. Tillcock, F.S.I.A., M.R.San.I. District Sanitary Inspectors : *abce G. H. Huckle. *abc J. P'. Farrar. *abc F. Beilby. *abcf E. Dodsworth. *abc H. W. Grieves. *a A. Hurley, Miss (Female Sanitary Inspector). Chief Clerk : F. J. Nash, Cert.R.San.I. (In H.M. Forces). (Resumed 6.4.45). J. L. A. Saunders, Infectious Diseases Clerk, a A. E. Clarke, Records Clerk. (Resigned 25.8.45). H. J. Weldon, funior Clerk. (In H.M. Forces). S. Clayton, Shops Acts Inspector. (Resigned 29.7.45) Miss I. M. Bowie, Temporary Cletk. J. H. Cowlard, A.I.M.L.T., Laboratory Technician. R. R. Holland, Temporary Clerk. Miss G. Maryan, Temporary Clerk (Commenced 25.10.45). * 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. f R.S.I. Sanitary Science as applied to Buildings and Public Works. 3 PREFACE. Public Health Department, Town Hall, Edmonton, N.9. His Worship the Mayor, Aldermen and Councillors of the Borough of Edmonton. Your Worship, Ladies and Gentlemen, In presenting my Annual Report for the year 1945, I wish to inform you that it has been compiled in accordance with Ministry of Health Circular 28/46 and contains therefore only a brief outline of the health circumstances relating to the Borough. I am pleased to say that the war terminated during this municipal year to the intense satisfaction of everyone concerned. We must now set ourselves energetically to the task of reconstruction and to make up for the lack of progress which we would otherwise have made but for the outbreak of war. The DEATH RATE continues to be low and shows a reduction on the previous year, notwithstanding the restrictions due to war conditions. The increase in BIRTH RATE for 1944 has not been maintained. During the year we remained free from epidemics, and again it is to be noted quite a number of old people in Edmonton exceed their three score years and ten. Already the citizens are eagerly looking for the repair of their battered accommodation and trying to acquire other, and it would appear that from the requests made at my Department in the Town Hall that it will be not only a matter of prime importance to develop new dwellings but a task difficult to attain; considering the circumstances under which quite a number of the citizens live they still maintain a cheerfulness and good fellowship which was so characteristic of them during the war. The trend of Tuberculosis was upwards for the Country as a whole, but in Edmonton it remained fairly constant with only a very slight increase. I am very happy to be able to report that only eleven cases of Diphtheria occurred in the Borough throughout this year, this in no small measure being due to immunisation; nevertheless I shall feel more happy when larger numbers of children in the Borough have been immunised. The response to our appeal for immunisation was always good, which shows that many of the Edmonton people have a sound realisation of their duties as citizens. Upwards of three-quarters of the child population of the Borough should be immunised in order to secure a fair degree of success for the scheme. Quite a large number of children are immunised for Whooping Cough as well and from reports from the General Practitioners it would appear that not only is there a less incidence of the disease but those immunised children who contract Whooping Cough had much milder symptoms and shorter duration of the illness. I must also mention that the MATERNAL MORTALITY RATE in the Borough is one to be proud of, having reached an exceedingly low rate of 0.61 per 1,000 live and still births. This is in no small measure due to the splendid efforts made by Assistant Medical Officers, Municipal Midwives, Health Visitors, General Practitioners and the willing co-operation which we have received from the Staff of the North Middlesex County Hospital. 4 I regret there is an increase in the INFANTILE MORTALITY RATE but this is more apparent than real as there is a decline in the number of births in 1945 as compared with 1944. The percentage appears higher although the actual number of deaths is lower. The new percentage, however, compares very favourably with the figure for England and Wales and London. I would like to express my deep appreciation to my entire Staff for the willing co-operation which they have given me, often times at great inconvenience, in order to achieve good results. To the Members of the Council I tender my sincere thanks for the help and assistance which they have always given me. I have the honour to be, Your Worship, Ladies and Gentlemen, Your obedient Servant, D. REGAN, Medical Officer of Health. GENERAL STATISTICS. Area (in acres) Population— Census of 1921 Census of 1931 Estimated by the Registrar-General for mid-year 1945 Number of inhabited houses and tenements at the end of 1945 Number of inhabited houses and tenements at the end of 1944 Rateable value, April, 1945 Estimated product of Id. in the £ for the year ending March 31st, 1946 Rates in the £ for the year ending March 31st, 1946 3,896 66,809 77,652 93,530 25,950 25,950 £732,731 £3,000 15s. lOd. 5 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 1944 67,007 „ „ paid „ „ 1944 590,916 „ free „ „ 1945 83,504 „ „ paid „ „ 1945 754,761 The average number of children receiving meals daily was 4,400 (38.3% of the children in school). Under the Milk in Schools Scheme an average of 9,500 children (83.7% of the number in school) had milk daily, of whom 6,600 received 2/3rds pint and 2,900 l/3rd pint. (2) Figures re out relief :— Persons. Amount. For the year 1944— (a) Ordinary out-relief 2,163 £21,295 (b) Unemployed out-relief Nil Nil 2,163 £21,295 For the year 1945— (a) Ordinary out-relief 1,839 £22,107 (b) Unemployed out-relief Nil Nil 1,839 £22,107 VITAL STATISTICS. Live Births. Legitimate Illegitimate Birth-rate per 1,000 of population M. 767 33 F. 740 48 Total. 1,507 81 Grand Total. 1,588 16.98 Stillbirths. Legitimate Illegitimate Total of live and stillbirths Rate per 1,000 total births 22 3 17 2 39 5 44 1,632 26.96 Deaths. Number Rate per 1,000 population 510 455 965 10.31 Deaths from Puerperal Causes. Rate per 1,000 total Deaths, (live and stillbirths). Puerperal and post-abortive sepsis ... — 0.00 Other maternal causes ... ... ... 1 0.61 1 0.61 6 Death rate of infants under one year of age. M. F. Total. Number 29 29 58 All infants per 1,000 live births 36.52 Legitimate infants per 1,000 legitimate live births 37.82 Illegitimate infants per 1,000 illegitimate live births 12.34 Deaths from Cancer (all ages) 171 ,, ,, Measles (all ages) Nil. Whooping Cough (all ages) Nil. „ „ Diarrhoea (under 2 years of age) 4 The following causes of death are supplied by the Registrar General and refer to deaths which were registered during the calendar year :— Cause of Death. M. F. Total Typhoid and para-typhoid fevers ... ... ... Cerebro-spinal fever 1 2 Scarlet fever ... 1 1 Whooping cough ... ... ... Diphtheria ... ... ... ... Tuberculosis of the respiratory system 28 20 48 Other forms of tuberculosis 2 4 6 Syphilitic diseases 2 1 3 Influenza 1 2 3 Measles ... ... ... Acute Poliomyelitis and Polio-encephalitis ... ... ... Acute infective encephalitis 1 ... 1 Cancer of buccal cavity and oesophagus (M.) Uterus (F.) 8 10 18 Cancer of stomach and duodenum 14 8 22 Cancer of breast ... 17 17 Cancer of all other sites 71 43 114 Diabetes 2 4 6 Intra-cranial vascular lesions 39 43 82 Heart disease 109 112 221 Other diseases of the circulatory system 22 14 36 Bronchitis ... 51 36 87 Pneumonia ... 29 31 60 Other respiratory diseases 10 6 16 Ulcer of stomach or duodenum 13 3 16 Diarrhoea (under 2 years) ... 4 4 Appendicitis 1 2 3 Other digestive diseases 14 14 28 Nephritis 13 7 20 Puerperal and post-abortive sepsis ... ... ... Other maternal causes ... 1 1 Premature birth 13 8 21 Congenital malformations, birth injuries, infant diseases 5 11 16 Suicide 4 2 6 Road traffic accidents ... I 1 Other violent causes 17 11 28 All other causes 40 38 78 510 455 965 The two tables overleaf give the deaths of those registered during the 52 weeks ended 29th December, 1945. 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 Registrar General is in possession of additional information on the matter. 7 MALES. 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 and over Acute Encephalitis Lethargica 1 ... ... ... ... ... ... 1 ... ... ... ... Cerebro-spinal Fever ... 1 1 ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of the Respiratory System 27 ... 1 ... ... 4 8 1 7 4 2 ... Other forms of Tuberculosis ... 2 ... ... ... ... 1 1 ... ... ... ... ... Syphilitic Diseases 2 1 ... ... ... ... ... ... ... ... 1 ... Influenia ... 1 ... ... ... ... ... ... ... ... ... ... i Cancer of Buccal Cavity and Oesophagus 8 ... ... ... ... ... ... ... 1 1 4 2 Cancer of Stomach and Duodenum 13 ... ... ... ... ... ... ... 3 5 3 2 Cancer of all other sites 69 ... ... ... ... 1 1 3 11 21 20 12 Diabetes 2 ... ... ... ... ... ... ... ... ... 1 1 Intra-cranial Vascular Lesions 36 ... ... 1 ... ... 1 2 3 7 10 12 Heart Disease ... 110 ... ... 1 ... ... 1 2 8 14 46 37 Other Circulatory Diseases ... 22 ... ... ... ... ... ... 1 1 3 8 9 Bronchitis 52 1 ... ... ... ... ... 1 5 12 17 16 Pneumonia 29 8 ... i ... ... ... 5 3 6 5 Other Respiratory Diseases ... 12 ... ... ... ... ... ... 1 3 1 5 2 Ulcer of Stomach or Duodenum 12 ... ... ... ... ... ... 1 6 ... 5 ... Diarrhoea (under 2 years) ... ... ... ... ... ... ... ... ... ... ... ... Appendicitis 1 ... ... ... ... 1 ... ... ... ... ... ... Other Digestive Diseases 14 ... ... 1 ... ... 2 3 2 2 3 1 Nephritis 13 ... ... ... ... ... ... 2 3 4 2 2 Premature Birth 13 13 ... ... ... ... ... ... ... ... ... ... Cong, mal., birth injuries, infant dis. 5 5 ... ... ... ... ... ... ... ... ... ... Suicide 4 ... ... ... ... ... ... ... 1 1 2 ... Road Traffic Accidents ... ... ... ... ... ... ... ... ... ... ... ... Other violence 17 ... ... ... 2 ... 2 2 1 3 4 3 All other causes 42 ... ... ... 2 1 1 3 2 4 15 14 Totals 508 29 1 4 5 8 18 23 62 85 154 119 8 FEMALES. 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 and over Scarlet Fever 1 ... ... 1 ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of the Respiratory System 22 ... ... ... ... 6 4 6 3 3 ... ... Other forms of Tuberculosis ... 2 ... ... ... 1 ... ... ... ... 1 ... ... Syphilitic Diseases 1 ... ... ... ... ... ... ... 1 ... ... ... Influenza 2 1 1 ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... Cancer of Uterus 10 ... ... ... ... ... ... ... 3 3 ... 4 Cancer of Stomach and Duodenum 9 ... ... ... ... ... ... ... 1 1 2 5 Cancer of Breast 17 ... ... ... ... ... ... 3 5 4 4 1 Cancer of all other sites 43 ... ... ... ... 1 1 2 5 5 20 9 Diabetes 4 ... ... ... ... ... ... ... ... ... 3 1 Intra-cranial Vascular Lesions 45 ... ... ... ... ... ... 1 6 5 16 17 Heart Disease ... 112 ... ... ... ... 1 1 3 8 10 28 61 Other Circulatory Diseases ... 13 ... ... ... ... ... ... ... ... .. 9 4 Bronchitis 37 1 ... ... ... ... ... 1 ... 2 11 22 Pneumonia 31 4 1 ... 1 1 ... 3 1 2 6 12 Other Respiratory Diseases ... 5 ... ... ... ... ... ... 1 2 1 1 Ulcer of Stomach and Duodenum 3 ... ... ... ... ... ... 1 ... ... 2 ... Diarrhoea (under 2 years) 4 3 I ... ... ... ... ... ... ... ... ... Appendicitis 2 ... ... ... 1 ... ... ... ... 1 ... ... Other Digestive Diseases 13 ... ... ... ... ... 1 1 ... 1 5 5 Nephritis 7 ... ... ... ... ... ... ... 2 1 2 2 Puerperal and Post-abortive Sepsis ... ... ... ... ... ... ... ... ... ... ... ... Other Maternal Causes 1 ... ... ... ... l ... ... ... ... ... ... Premature Birth 8 8 ... ... ... ... ... ... ... ... ... ... Cong, mal., birth injuries, inf. dis. 9 9 ... ... ... ... ... ... ... ... ... ... Suicide 2 ... ... ... ... ... l 1 ... ... ... ... Road traffic accidents 1 ... ... ... ... ... ... ... ... ... 1 ... Other violence 11 1 ... ... ... ... ... 2 1 3 3 1 All other causes 37 l 1 ... 1 1 3 5 1 8 4 12 Totals 452 28 4 1 4 l1 11 30 39 51 116 157 9 INFANTILE MORTALITY. The deaths of infants under one year of age were as follows :— M. F. Total Legitimate 28 29 57 Illegitimate 1 — 1 29 29 58 The death rate of all infants per 1,000 live births was 36.52. The death rate of all infants under one month of age per 1,000 live births was 22.67 A detailed sub-division of the causes, etc., of these DEATHS is as follows: — MALES. Causes of Death Under 1 week Second Week J Third Week Fourth Week Total under 1 month 1—3 months 3—6 months 6—9 months 9—12 months Total under 1 year Cerebrospinal Fever ... ... ... ... ... ... ... 1 ... 1 Syphilitic Diseases ... ... ... ... ... 1 ... ... ... 1 Pneumonia 1 ... 1 1 3 2 3 ... ... 8 Bronchitis ... ... ... ... ... 1 ... ... ... 1 Premature Birth 12 1 ... ... 13 ... ... ... ... 13 Congenital Malformations ... ... ... ... ... 1 ... ... ... 1 Other causes 4 ... ... ... 4 ... ... ... ... 4 Totals 17 1 l 1 20 5 3 1 ... 29 FEMALES. Causes of Death Under 1 week Second week Third week Fourth week Total under 1 month 1—3 months 3—6 months 6—9 months 9—12 months Total under 1 year Influenza ... ... ... ... ... 1 ... ... ... 1 Pneumonia ... ... ... ... ... ... 3 1 ... 4 Congenital Malformations 1 ... ... ... 1 ... ... ... ... 2 Premature Birth 6 1 1 ... 8 ... ... ... ... 8 Atelactasis 1 ... ... ... 1 ... ... ... ... 1 Bronchitis ... ... ... ... ... 1 ... ... ... 1 Injury at Birth 4 ... ... ... 4 ... ... ... ... 4 Gastro-enteritis ... ... ... ... ... 1 1 1 ... 3 Other Causes 1 1 ... ... 2 ... ... 1 ... 3 Violence ... ... ... ... ... 1 ... ... ... 1 Totals 13 2 1 ... 16 4 4 3 1 28 10 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 16.1 0.46 5.6 46 London 15.7 0.40 7.6 53 Edmonton 16.98 0.47 2.5 36.52 Annual Death Rate per 1,000 of Population. All Causes Measles Scarlet Fever Whooping Cough Diphtheria Influenza England and Wales 11.4 0.02 0.00 0.02 0.02 0.08 London 13.8 0.01 0.00 0.02 0.01 0.07 Edmonton 10.66 0.00 0.00 0.00 0.00 0.03 The following table gives the number of births and deaths (registered) sub-divided into the four Wards of the Borough. It should be remembered that births are only those which occurred in Edmonton of residents ; these are registered in Edmonton. Births which take place outside the Borough are not included; this fact accounts for the difference between these figures and those supplied by the Registrar-General. 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 M. F. M. F. M. F. Bury Street 161 180 154 Ill 8 12 Church Street 117 97 95 116 4 4 Angel Road 119 119 112 94 5 8 Silver Street 176 135 146 131 12 4 Vagrants 1 573 531 508 452 29 28 LABORATORY SERVICE. The following examinations were carried out in the Bacteriological Laboratory :— 14 Nature of Examination. Positive. Negative. Total. Blood—Bleeding Time — — 2 Blood—Coagulation Time — — 2 Blood Counts — — 226 Blood—Paul Bunnell Test — — 1 Blood—Sedimentation Rate — — 2 Blood—Sugar Content — — 4 Blood—Urea Content — — 2 Breast Milk—Fat Content — — 36 Eye Smears for presence of Gonococci —■* 2 2 Eye Smears for presence of organisms — — 36 Faeces for presence of Blood — — 1 Faeces for presence of Dysentery Bacilli 71 378 449 Faeces for presence of Tubercle Bacilli — 1 1 Fish Paste for presence of organisms — — 2 Nasal Swabs for presence of Haemolytic Streptococci 12 12 Nasal Swabs for presence of organisms — — 10 Pus for presence of Tubercle Bacilli — 1 1 Pus for presence of organisms — — 3 Sputa for presence of Tubercle Bacilli — 35 35 Sputa for presence of organisms — — 3 Swabs for presence of C. Diphtheriae — (a) From Suspect cases 10 418 428 (b) From Contacts 1 90 91 (c) From Carriers and old cases 8 27 3.5 Throat Swabs for presence of Haemolytic Streptococci 9 9 Throat Swabs for presence of organisms — — 4 Throat Swabs for Vincent's Angina 1 3 4 Urethral Smears for presence of Gonococci 1 1 2 - Urine—Bacteriological Examinations — — 110 Urine—Chemical Examinations — — 288 Urine—Microscopical Examinations — — 239 Urine for presence of Tubercle Bacilli — 2 2 Vaginal Smears for presence of Gonococci — 7 • 7 Vaginal Smears for Trichomonas Vaginalis — 5 5 Vaginal Smears for presence of organisms — — 5 Total Number of Examinations ... 2,059 MILK (SPECIAL DESIGNATIONS) ORDER, 1936. 152 Samples of Designated Milks were examined in the Laboratory. Results were as follows :— Pasteurised Milk. 63 Samples were examined and all satisfied both the prescribed tests. Tuberculin Tested Milk. 62 Samples were examined and 50 satisfied both the prescribed tests. 9 Samples failed to pass both the Methylene Blue and Coliform tests. 1 Sample failed to pass the Methylene Blue Test only. 2 Samples failed to pass the Coliform Test only. 12 Tuberculin Tested (Pasteurised) Milk. 27 Samples were examined and all satisfied both the prescribed tests. School Milk. 28 samples of milk as delivered to the various schools of the Borough were examined, and all samples satisfied' the prescribed tests of the Milk (Special Designations) Order 1936. Ambulance Facilities. The Council possesses four ambulances, and the following figures give some idea of the work carried out during the year :— Private cases 9,138 Accident cases 796 Maternity cases 190 School Medical Dept. (Tonsils) 605 Maternity and Child Welfare (Tonsils) 290 Not required 258 False calls 12 Bedside Apparatus 112 Analgesia 96 Special services 570 12,057 Children's Accidents 207. Factory Accidents 80. Street Accidents 229. First Aid was rendered on 499 occasions. The resusitating apparatus was in use on 9 occasions. The total mileage of the vehicles was 56,248 miles. With regard to Street Accidents, the main danger spots in the Borough noted during the year were as follows :— Hertford Road, from Galliard Road to Lowden Road. Fore Street, from Claremont Street to Silver Street. Great Cambridge Road, from Westerham Avenue to the Roundabout. Great Cambridge Road, from Harrow Drive to Trinity Avenue. Town Road, junction of Hertford Road Traffic Lights. Transport. A 2-ton Bedford Coach conveys 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. Nursing in the Home. This has been described in previous reports. Hospitals. Infectious diseases 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 Royal Waterloo Hospital. Nursing Homes 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 be placed on the register were received during 1945. SANITARY CIRCUMSTANCES OF THE AREA. The water supply of the Borough has at all times been satisfactory both in quality and quantity. The Metropolitan Water Board is responsible for the supply which is piped direct to every dwelling-house throughout the Borough, and serves the entire population. The co-operation of the Board has at all times been of the fullest. 13 SANITARY INSPECTION IN THE AREA. Five District Sanitary Inspectors and one woman Sanitary Inspector are engaged in the sanitary supervision of the Borough, working under the supervision of the Senior Sanitary Inspector. 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). 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. Infestation Order, 1943. Under this heading your Senior Sanitary Inspector, as Officer-in-Charge, Rodent Control, reports as follows :— The Council have appointed Rodent Operatives and a Junior Clerk, and appointed the District Sanitary Inspectors Rodent Officers. Up to the end of the year, 2,612 visits and re-visits have been made by the Rodent Operatives, in connection with complaints as to alleged rat infestation. Fourteen Intimation Notices have been served—owing to the fact that the Occupiers did not appear to be taking effective measures to eradicate the vermin, and one Statutory Notice was served. Defestation has been carried out on request at 153 premises and at the end of the year 18 premises were in process of " Defestation." The District Sanitary Inspectors in cases where there was a possibility of the infestation being due to defective drainage visited the premises and tested the drainage and any defects discovered were dealt with through the usual channels. Of 103 cases of Rat Infestation referred to the District Inspectors, owing to the possibility of defects in the drainage, in 75% of the cases defects were discovered and as one can quite appreciate entailed quite a large amount of work. Middlesex County Council Act, 1944, Section 279, Hawkers, Etc. This Act came into operation on the 1st October, 1944, and Section 179 replaced Section 71 of the Act of 1938. Five applications were received and the persons registered. Disinfection and Disinfestation. The following table gives some idea of the work carried out:— Number of journeys to collect bedding 243 „ „ „ „ return bedding 239 Rooms disinfected after infectious disease 706 „ „ „ phthisis 118 Rooms disinfected after other cases 189 Disinfestation carried out after vermin 472 Bedding, clothing, etc., disinfected after infectious disease 4,137 articles Bedding, clothing, etc., disinfected after phthisis 1,777 „ „ „ „ „ other cases 1,390 „ The Council distribute a disinfecting powder and fluid to residents who apply for same at the Town Hall Yard. During the year, the applicants numbered 9,042. One hour daily is allowed for such distribution with the exception of Fridays and Saturdays. A Formalin Chamber is used for the 14 disinfection of books, leather goods, etc., articles that would be damaged by steam. The number of books and other articles thus disinfected was 331. Four Council houses and 164 other houses were found to be infested and the total number of rooms disinfested was 472. The whole of the work is carried out by the Department, the materials used being Block Disinfestators combined with the use of Insecticides. At the latter end of the year Insecticides with a D.D.T. base were put into use. Petroleum (Regulations) Acts, 1928 and 1936. During the year five new licences and 101 renewals were granted by the Council. The following is a list of particulars of quantities, etc., affected by these licences :— Petroleum spirit 463,233 gallons. Petroleum mixtures 7,500 ,, Carbide of calcium 1 ton 17 cwts. 78 lbs. Mortuary. During the year 111 bodies were deposited in the Mortuary, 67 by order of the Coroner and 44 for sanitary reasons. Inspections. The following tabular statement gives the number and nature of the inspections made during the year :— Complaints 2,376 Infectious disease 300 Tuberculosis 16 House-to-House 89 Factories with mechanical power 220 Factories without mechanical power 14 Outworkers 127 Schools 3 Offensive trades 5 Shops and Stalls 186 Shops Act (Primary) 13 Shops Act (Re-inspections) 5 Sanitary conveniences and urinals 471 Smoke observations 22 Rat Infestation 54 Stables 27 Piggeries 42 Petroleum 24 General inspections 393 Sundry Visits 2,715 Cinemas and Halls 7 Visits to canal 4 Gipsies 5 Re-inspections 6,023 Inspection of Places where Food is Prepared. Butchers 121 Fish shops 28 Coffee shops 73 Dairies and milkshops 42 Slaughterhouses 47 Bakehouses 21 Ice Cream Shops 19 15 Number of Notices Served. Preliminary or Informal Notices 1,628 Statutory Notices 444 Defects Remedied. Houses repaired, cleansed, etc. 246 D.W. cisterns repaired, covered 17 Water fittings repaired 146 Water taken off mains 5 Drains examined, tested, etc. 490 Drains cleared, trapped, repaired 438 Drains reconstructed 95 Chambers inserted 59 Chambers sealed down 18 Soil and vent pipes repaired 74 W.C.s repaired, cleansed, etc. 287 Flushing cisterns repaired 159 Waste pipes repaired, etc. 83 Sinks repaired or renewed 31 Roofs repaired 291 Gutters and R.W.P.s repaired 237 Yards paved or repaved 75 Scullery floors repaired 48 Spaces under floors ventilated 37 Dampness remedied 83 Floors repaired 114 .Coppers and stoves repaired, etc. 110 New dustbins supplied 204 Accumulation of refuse removed 9 Nuisances from animals abated 1 Other nuisances abated 184 Water supply restored 8 Rat defestation of premises 8 Canal Boats Acts. During the year 4 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. Eight 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 220 12 ... Factories without mechanical power 14 ... Other premises under the Act (including works of building and engineering and construction but not including outworkers' premises) ... ... ... Totals 234 12 ... 16 2.—Defects Found. Particulars Number of defects No. of defects in respect of which prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of cleanliness 19 19 ... ... Overcrowding ... ... ... ... Unreasonable temperature i 1 ... ... Inadequate ventilation ... ... Sanitary Conveniences ... ... Insufficient ... ... ... ... Unsuitable or defective 14 14 ... ... Not separate for sexes ... ... ... ... Other offences (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.) ... ... ... ... Totals 34 34 ... ... 3.—Outwork in Unwholesome Premises. Nature of Work. Instances. Notices Prosecu- Served. tions. Wearing Apparel— Making, etc. — — — Cleaning and washing FACTORIES. Defects Remedied. W.C. walls cleansed 16 W.C. cisterns repaired 1 W.C. Seats repaired or renewed 4 W.C. Flush pipes repaired — W.C. doors repaired — W.C. pans replaced 2 Roofs repaired — Workrooms cleansed 2 Sanitary accommodation improved 2 „ „ for Sexes provided 4 Urinals cleansed 2 Unreasonable Ventilation 1 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) 1,449 (b) Number of inspections made for the purpose 4,583 (2) (a) Number of dwelling houses (including under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 35 (b) Number of inspections made for the purpose 166 17 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 10 (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 1213 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 609 3. Action under Statutory Powers During the Year. A.—Proceedings under Sections 9, 10, and 16 of the Housing Act, 1936 :— (1) Number of dwelling houses in respect of which notices were served requiring repairs 29 (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 6 B.—Proceedings under Public Health Acts :— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 304 (2) Number of houses in which defects were remedied after service of formal notices :— (a) By owners 151 (b) By Local Authority in default of owners 15 C.—Proceedings under Sections 11 and 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. Forty-seven visits were paid and the carcases and organs of 224 pigs were inspected during or shortly after slaughter, permission for slaughter having been obtained from the Area Meat and Livestock Officer, and the following surrendered :— 18 Carcases and Offal. 15 Plucks. 42 Livers. 50 Sets of Lungs. 18 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. Various licences were granted as under :— Primary. Supplementary. Pasteurised 12 7 Tuberculin tested.7 5 19 12 One of the above retailers is 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 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 :— 4651 tins of milk. 22 packets sponge mixture 208 tins of beans. 3 1-cwt. bags of dates. 1128 tins of canned fish. 228 lbs. of dates. 458 tins of canned meat. 10 packets Master Mix. 73 tins of peas. 7 packets chocolate semolina. 67 pots of jam and marmalade. 9 14-lb. boxes of dried egg. 1 cwt. box of dog fish. 1 30-lb. box sultanas 1 cwt. box of hake. 80 lbs. spaghetti 24 stone of skate. 2 lbs. lard. 11J stone of cod. 9 lbs. margarine. 5 stone headless jumbo 13 tins raising powder. 56 tins of rabbit. 7 pots of paste. 94 rabbits. 32 packets cake mixture. 410 lbs. of rabbit. 13 £-gallon tins beef soup. 1 cwt. semolina. 30 1-cwi. sacks of potatoes. 2 cwt. sago. 12 sacks of peas. 104 lbs. of assorted biscuits. 7 lbs. of ham 2 7-lb. boxes of biscuits. 14 lbs. chocolate buttons 15 lbs. Welfare biscuits. 56 lbs. chocolate caramels. 38 3-lb. bags of flour. 10 tins beetroot. 311 lbs. of sugar 5 lbs. porage oats. 17 lbs. tea. 9 lbs. split peas. 17 chickens. 12 lbs. lentils. 26 lbs of fruit cake. 2 lbs. cocoa. 159 lbs. of beef. 2 lbs. coffee. 12 lbs. of sirloin. Together with various small consignments of miscellaneous foods. The above items do not include the food dealt with at shops subjected to damage on account of " Enemy action." Shops Acts. The Shops Acts Inspector submits a monthly report to the Public Health Committee, and the following is a short summary from January to July, 1945 :— Visits to shops, licensed street traders, etc. ... 1,827 Contraventions ... ... ... ... ... 1 Chemical and Bacteriological Examinations of Food. The only examinations carried out by the Council are those for designated milks. The matter has been discussed previously. 19 PREVALENCE OF INFECTIOUS DISEASE. Measles and Whooping Cough. These diseases were made compulsorily notifiable in October, 1939. 948 cases of Measles and 203 cases of Whooping Cough were notified during the year. There were no deaths from Measles or Whooping Cough. Diphtheria. I am happy to report the continued low incidence of this disease. Eleven cases were notified during the year compared with 30 in 1944. There were no deaths. Scarlet Fever. This disease continued to occur throughout the year in a mild form ; there were 194 cases compared with 256 in 1944 ; there was one death. " Return " cases numbered 2 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. Three cases of this disease were notified during the year. There were no deaths from this disease. Dysentery. Fifty-nine cases were notified during the year, 56 of the Sonne type and 3 Flexner type. Investigation failed to reveal the cause of infection. There were no deaths from this disease. Cerebro Spinal Fever. Five cases were notified during the year. These cases were carefully investigated and precautions taken to prevent the spread of infection. Two deaths took place. Puerperal Pyrexia and Ophthalmia Neonatorum. These are referred to later on under the heading of Maternity and Child Welfare. Food Poisoning. No cases were notified during the year. Pneumonia. Thirty-one cases were notified during the year. Diarrhoea and Enteritis under 2 years of age. The death rate per 1,000 live births for London was 7.6 whilst that for Edmonton was 2.5 as compared with 10.1 and 2.6 respectively last year. 20 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 " No. 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 includes puerperal pyrexia and ophthalmia neonatorum. The nuniber of deaths from Pneumonia includes all forms of this disease. Disease Total No. of Cases No. Removed to Hospital 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 and over Scarlet Fever 194 168 1 ... 4 14 10 19 109 26 3 7 2 ... ... Diphtheria 11 11 ... ... ... ... 1 1 2 6 1 ... ... ... ... Puerperal Pyrexia 73 73 ... ... ... ... ... ... ... ... 4 54 15 ... ... Pneumonia 31 4 60 2 2 ... 3 ... 2 ... 1 3 6 9 3 Erysipelas 33 12 ... 1 ... ... ... ... ... 1 3 4 6 11 7 Ophth- Neonatorum 21 19 ... 21 ... ... ... ... ... ... ... ... ... ... ... Dysentery 59 28 ... 2 13 3 5 8 2 5 5 4 5 6 1 Whooping Cough 203 12 ... 29 30 20 23 22 74 1 ... 3 1 ... ... Measles 948 19 ... 44 125 137 115 133 368 15 3 7 1 ... ... C.S.F 5 4 1 1 1 ... ... ... 1 1 1 ... ... ... ... Poliomyelitis ... 3 1 ... ... ... ... 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. Middx. C. Hosp. Other Instnsr Total Scarlet Fever 49 83 19 42 1 ... 194 Diphtheria 6 1 4 ... ... ... 11 Puerperal Pyrexia 3 4 1 65 ... 73 Pneumonia 11 7 6 7 ... ... 31 Erysipelas 11 4 7 11 ... ... 33 Ophth-N eonatorum 3 1 1 1 15 ... 21 Dysentery ... 14 5 7 27 6 ... 59 Whooping Cough 54 53 44 52 ... ... 203 Measles 357 235 189 161 5 1 948 C.S.F ... ... 3 2 ... ... 5 Poliomyelitis 1 ... ... 2 ... ... 3 IMMUNISATION. Diphtheria. During the year, 1,373 appointments were made—1,242 children completed treatment under the Council's arrangements ; of these 1,136 were under 5 years of age. 35 children were Schick tested. In 1944, 1,115 children completed immunisation treatment. Up to 31st December, 1945, 44.89% of children under 5 years of age and 55.84% of children from 5—15 years of age had completed immunisation treatment. Measles. Measles Immune Globulin. None was issued to general practitioners during the year. 21 Whooping Cough. Edmonton children are immunised against Whooping Cough. The material used is " Vaccine A," and during the year, 768 appointments were made for this treatment—510 children completed treatment. CANCER. The incidence of Cancer relative to the various organs of the body is given as under :— Males. Females. Breast — 17 Uterus — 10 Buccal cavity and oesophagus 8 Stomach and duodenum 13 9 All other sites 69 43 90 79 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 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 TREATMENT. Details of this scheme were set out in my Report for 1939. ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT. In 1941 the Council resolved that Part 7 of the Middlesex County Council Act, 1934, be put into operation in the Borough. TUBERCULOSIS. The table below gives details of the ages and sex of new cases of Tuberculosis, also deaths from the disease ; this latter figure includes the deaths of non-notified cases. Age Periods New Cases Deaths Respiratory N on-respiratory Respiratory Non-respiratory M. F. M. F. M. F. M. F. Under 1 year ... ... ... ... ... ... ... ... 1— 5 years 2 ... ... ... 1 ... ... ... 5—15 .. 5 2 2 3 ... ... ... 1 15—25 22 23 3 6 4 6 1 ... 25—35 16 16 1 3 8 4 1 ... 35—45 11 4 ... 4 1 6 ... ... 45—55 10 2 ... 1 7 . 3 ... ... 55—65 „ 9 1 ... ... 4 3 ... 1 65 years upwards 1 ... ... 2 ... ... ... 76 48 6 17 27 22 2 2 22 In addition 9 cases of pulmonary tuberculosis and 1 case of non-pulmonary tuberculosis previously notified in other areas, moved into Edmonton. The total number of names added to the Register for the first time during the year, excluding of course, non-notified deaths was :— Males. Females. New cases (respiratory) 76 48 (non-respiratory) 6 17 Transferred cases (respiratory) 6 3 (non-respiratory) 1 89 68 The cases dying of Tuberculosis and not previously notified were :— Males. Females. Respiratory 2 2 Non-respiratory — There were thus 4 non-notified deaths out of a total of 54 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 :— Genito-urinary tract Other bones and joints Kidney Glands Spine Abdomen Peritoneum Males. 1 3 1 1 Females. 1 2 2 4 4 3 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) Regulations, 1930. The number of cases of tuberculosis on the Register at the end of 1945. was •— Pulmonary forms Non-pulmonary forms . Males. 318 71 389 Females. 255 77 332 Total. 573 148 721 The corresponding figures at the end of 1944 were :— Pulmonary forms Non-pulmonary forms Males. 294 76 370 Females. 250 69 319 Total. 544 145 689 23 Corresponding figures for previous years were:— Males. Females. Totals. 1943 411 355 766 1942 348 304 652 1941 355 293 648 1940 349 313 662 1939 357 301 658 1938 363 297 660 1937 336 260 596 1936 315 252 567 1935 330 265 595 1934 339 281 620 COUNCIL'S EMPLOYEES. During 1945 the Medical Officer of Health paid a total of 296 visits to those employees who had been on the sick list for longer than a fortnight and, when necessary, at fortnightly intervals. Of these 57 were " not at home " and one had already resumed duty. Also, during the year, one person was examined prior to appointment to permanent post. 24 MATERNITY AND CHILD WELFARE COMMITTEE. Chairman : Councillor Mrs. A. M. Glover. Councillors Ald. W. Preye (Mayor), Ald. J. Reid (Deputy Mayor). Councillors J. A. Beattie, L. E. Berridge, Mrs. E. F. Johnson, Mrs. E. M. Moss, Mrs. E. N. Newsham, W. Pullen and J. Ward, J.P. STAFF. D. Regan, B.A. B.Sc. M.B. Ch.B., B.A.O., D.P.H. (L'pool). C. A. Goggin, M.B., B.Ch.. B.A.O., D.P.H., Deputy Medical Officer of Health. K. M. Hart, M.B., B.S. (Lond.), M.D., D.P.H., Assistant Medical Officer. M. Sutcliffe, M.B., B.Ch., B.A.O., T.C.D., D.P.H., Assistant Medical Officer. E. Gray, M.B,, Ch.B., D.P.H.. L.M. (Dublin), Assistant Medical Officer. (Commenced April, 1945). J. A. Cholmeley, 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). bcdi Miss S. Briggs, Lady Superintendent, Health Visitor/School Nurse. dc Miss A. Naylor. bed Miss R. Bullock. bed Miss M. R. Hazelton bed Miss B. F. Lister. acd Miss J. M. Anderson, bed Mrs. I. Jennings (Left Aug., 1945). bed Miss V Garrett bed Miss C. L. Cole (Commenced June, 1945). bed Miss J Paterson bed Miss I. McLean (Commenced Aug., 1945) bd Miss M. Druce. c Miss A Fahy (School work only). Mrs. C. Tonkin (School work only). Physiotherapist. Miss M. F. Rees (Commenced June—Left December, 1945). Municipal Midwives. cdfg Mrs. R. K. M. Neale, Non-Medical Supervisor of Midwives. (Left September, 1945) cdfg Miss H. Bridge, Non-Medical Supervisor of Midwives. (Commenced September, 1945.) cdg Mrs. M. Fitzjohn, Senior Midwife. cdg Mrs. D. S. C. Gazzard. cdg Miss A. G. Walker. cdg Miss K. M. James. cdg Miss D. M. Lewis. cdg Miss V. Ummen. cdg Mrs. A. M. Burton. cdg Miss S. Simpson. cdg Mrs. E. Dennison. (Left August, 1945.) cdg Mrs. E. Lauchlin. dg Miss D. V. Curtis. dg Miss K. A. Blizard. edg Miss A. McAuley. (Commenced September, 1945.) a Maternity and Child Welfare f Teacher's Certificate of Certificate. Midwifery. b New-Health Visitor's Certificate. g Certificate for Gas and Air. c State Registered Nurse. h Nursery Nurses Diploma. d State Certified Midwife. i Diploma of Hygiene. e Sanitary Inspector's Certificate. j Reg. Sick Children's Nurse. 25 CLERICAL. Miss R. S. Saunders (Senior Clerk). Miss N. A. Eyres. Miss H. P. Turton. (Left March, 1945). Miss J. Blatter. Mrs. V. Carter. Miss K. Arnold (Commenced March, 1945). Miss O. Cunningham (Commenced April, 1945). In submitting the report of the Maternity and Child Welfare Department for 1945, I am pleased to be able to report that notwithstanding the many difficulties and problems which have been encountered, we have surmounted them successfully and finished the year with a record of good service to the community. The last three months of 1945 indicated the trend of the birth rate and proved that 1946 would be a very busy period for the Midwifery Service and create many serious problems. Mrs. Neale, the Non-Medical Supervisor, left in September, 1945, and her place was taken by Miss H. M. Bridge. The Ante-Natal Clinics were well patronised and an increase in the number of sessions is urgently required as soon as an adequate Medical Staff is appointed. The Ante-Natal Clinics are under the supervision of the Non-Medical Supervisor of Midwives with her Staff, and this gives an opportunity to the midwives of obtaining first hand knowledge of the cases they will be attending for confinements. The arrangements with the Hospital for the transfusion service to be available to the women on the district has proved a very great boon and the results have been excellent. The Gas and Air Analgesia is gradually gaining more popularity and the publicity given is showing its results. On 31st August the Evacuation Scheme for expectant mothers which operated during the war, officially ended, and Local Authorities were asked to accept financial responsibility for their own cases. The arrangements with regard to the admissions and discharges to and from Maternity Homes remained as usual. The Council inaugurated the financial scheme, but when it was in operation the Middlesex County Council took over the responsibility. The general arrangements, however, are still carried out by the Department, as in the past. The Home Help Scheme has not been easy to operate, owing to the shortage of suitable labour, but it is an achievement to report that during the whole of the war period the women of Edmonton have had the advantage of a service which, by the end of 1945, showed every sign of gradually recruiting more women, although it is slow progress. I am very happy to state that the Maternal Mortality Rate is again very low, viz.: 0.61 per 1,000 births, and there has been an absence of deaths from puerperal infection. I have to report that the four War-time Nurseries have given excellent service and been very well patronised. The staffing of these establishments has MATRONS—NURSERIES. Fore Street h Miss M. W. Betteridge. Hertford Road cj Mrs. I. Drummond. Florence Road c Mrs. M. Vincent. Silver Street c Mrs. Mundy (Left September, 1945). h Mrs. Smith (Commenced September, 1945). FOREWORD. 26 presented many difficulties, but the children have had every care and attention and the infection and illness has been low. Extra attention is now being given to the care of premature babies, and a scheme of co-operation arranged with the North Middlesex County Hospital. The Post-Natal Clinic shows encouraging increases and as soon as the staff permits, another session will be started. In 1944 the average attendance was 24.72, and in 1945, 31.87. The Infant Welfare Clinic at Bush Hill Park became so overcrowded that it was necessary to start a second session in May, 1945. From April, 1945, certain services were introduced as free to children under 5 years of age, to bring them into line with concessions granted under the Education Act, 1944, to children under 5 years of age who attend school, viz.: dental treatment, orthopaedic appliances, operations for tonsillectomy and adenoidectomy, and the supply of spectacles. I have appreciated the excellent work carried out by every Member of the Staff of the Maternity and Child Welfare Department and wish to place on record how much I have appreciated their loyal co-operation. In conclusion, I should also like to express my thanks to the Chairman and all the Members of the Maternity and Child Welfare Committee for their help and understanding. D. REGAN, Medical Officer of Health. The following information gives details of the Maternity and Child Welfare Clinics at the end of 1945:— (1) Ante-Natal Clinic at Brookfield House, Fore Street (adjoining the Town Hall). Six sessions weekly. (2) Child Welfare Centres :— (a) Brookfield House. Three sessions weekly. (b) Methodist Church Hall, Bush Hill Park. Two sessions weekly. (c) St. Edmund's Church Hall. Two sessions weekly. (d) Weir Hall. Two sessions weekly. (e) St. John's. One session weekly. (3) Post-Natal and Advisory 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. The following information will give some indication as to the work carried out by the Department during the year 1945:— Births. The total number of births notified during 1945 was as follows:— Live births notified by midwives 2,429 „ „ „ „ doctors and parents 76 Still-births „ „ midwives 95 „ „ „ doctors 4 2,604 27 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 1,043 „ „ „ doctors and parents 73 Still-births „ „ midwives 22 „ „ ,, doctors 4 1,142 Number of live Edmonton babies born in outlying institutions 214 Number of still-born Edmonton babies born in outlying institutions 4 218 The following table includes births of Edmonton residents and those born and registered in other districts :— Male. Female. Total. Live Births 683 635 1,318 Still-births 20 11 31 703 646 1,349 Premature Babies. Arrangements have been made for additional care and supervision to be given and special records are kept. Premature children in need of hospital care are admitted to the North Middlesex County Hospital, as in the past. No. of babies notified during 1945 who weighed 5A lbs. or less:— (a) Born at home 27 (b) Born in hospital 46 73 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 115 Total visits 115 To children under 1 year of age :— First visits 1,407 Total visits 9,406 To children between 1 and 5 years of age 13,322 Infant Protection visits to children 5-9 years 141 Visits re adoption 128 23,112 Ante-Natal Clinic. This clinic was held six times weekly (one session being for new patients only) and the following are the figures for the year:— Number of general sessions in the year 256 Number of prospective mothers 1,802* Number of consultations 8,223 Total number of attendances 10 023 Average number of attendances:— la) Per session 39.15 V / (b) For consultation 32.12 28 Clinic for New Patients (commenced March, 1945):— (a) No. of sessions 41 (b) New cases 547 (c) Total number of attendances 729 * Included in this total are 508 referred from the North Middlesex County Hospital under the scheme of co-operation with that hospital. The Ante-Natal Clinics are under the supervision of the Non-Medical Supervisor of Midwives, with the help of the Midwifery Staff. Post-Natal Clinic. Number of sessions 46 Actual number of mothers who attended 482 Number of consultations 1,362 Total attendances at clinic 1,366 Average attendance per session 31.87 Advisory Clinic. New Cases 8 Total attendances 16 Number of mothers seen by Doctor 16 Specialist's Clinic. The Consulting Specialist made 25 visits during the year and saw 188 cases, making an average of 7.52 per session. Child Welfare Clinics. The figures relating to attendances are:— Brookfield House. Methodist Hall. St. Edmunds. Weir Hall. St. Johns. Number of sessions 152 84 100 102 50 New cases—(a) Under 1 year 494 192 254 277 127 (b) 1—5 years 113 25 41 49 32 Attendances— (a) Under 1 year 8,089 3,659 5,191 6,085 2,724 (6) 1—5 years 3,476 2,329 2,355 3,859 1,041 11,565 5,988 7,546 9,944 3,765 Average attendances 76.08 71.28 75.46 97.49 75.3 Doctor's consultations 4,134 1,794 2,539 2,941 1,174 From April. 1945 it was decided that certain services should be free of charge to children under five years of age to bring them into line with concessions granted under the the Education Act. 1944, to children under five years of age who attend school. The services involved include:— (a) Orthopaedic appliances. (b) Dental treatment for children. (c) Spectacles and repairs. (d) Tonsils and adenoids-oDerations. The Clinic is held twice weekly and the following are the figures for the year:— Number of sessions 74 New cases referred during the year 117 Attendances. Surgeon's days 238 Treatments given 318 No. of children attending for treatment 270 No. of wedges fitted 83 No. of surgical instruments 11 In-patient Treatment. Five children were admitted to Stanmore during 1945. Three children left in hospital from 1944 were discharged in 1945. 29 Dental Clinic. Details of the work carried out are:— Mothers. Children. Number of sessions 94 79 Number of attendances 868 386 Number of new cases 310 205 Total number treated 598 360 Fillings 100 — Dressings 23 621 Scalings 56 — Extractions (Number of teeth)— (a) Under Gas 1,400 210 (b) Local Anaesthetic 22 — Number of gas cases 393 131 Dentures. Number supplied—61 of whom 53 paid the full cost, 6 were half cost, and 2 were free of charge. Sunlight Clinic. 1,052 children were referred during the year for sunlight treatment and 4,508 treatments were given. Ophthalmic Clinic. Ill children under 5 years of age attended this clinic during the year. 78 attendances were made for Refraction, 46 for re-examination and 67 for Examination. Number of spectacles supplied were 64 and repairs numbered 28. Speech Clinic. Arrangements are made with the Education Committee for children under five years of age to attend the Speech Clinic and 6 children were referred during the year. No charge is made to the parents. Details of Distribution of Dried Milk, Cod Liver Oil, etc. Distributed by the Maternity and Child Welfare Department apart from any scheme of the Ministry of Food. Trufood 71 tins. Ostermilk 137 „ Cow and Gate 708 packets. Cod Liver Oil and Malt 49 cartons. Haly-calcyne 15 packets. Glucose 43 „ Fersolate 46 „ Bemax 33 „ Convalescent Cases. One child was sent away under the contract with the Invalid Children's Aid Association and one child was still away at the beginning of the year who had been sent during 1944. Tonsils and Adenoids. One hundred and forty-five children were admitted to hospital for the removal of tonsils and adenoids. INFECTIOUS DISEASES. Ophthalmia Neonatorum. Twenty-one cases were notified during the year and of these 18 occurred in the North Middlesex County Hospital, 3 of which were Edmonton cases. Of 3 cases which occurred in the district, one was removed to hospital. Puerperal Pyrexia. Seventy-three cases were notified during the year and of this number 71 occurred in the North Middlesex County Hospital of which 22 were Edmonton cases. Two cases occurred in the district and were removed to the Isolation Hospital, 30 MIDWIFERY SERVICE. Analysis of work. Actual confinements attended by midwives 595 (Of this number 537 as midwives and 58 as Maternity Nurses). Attended by midwives, but women admitted to hospital before or during confinement 104 Left district before confinement or mothers evacuated through L.C.C. scheme, etc. 94 (Attention and supervision given by Municipal midwives during AnteNatal period). In addition to the actual 595 confinements attended, a total of 12,875 visits were paid by midwives as under:— Ante-Natal visits to homes 1,206 Post-Natal Visits 9,931 Additional evening visits 159 Visits after fourteenth day 111 False alarms 397 Special Visits 704 Second Nurse for Gas and Air Analgesia 53 Miscellaneous 314 Medical Aid. The number of claims made by doctors for Medical Aid during the year 1945 was 95, of this number 12 cases were granted free of charge, 10 at half cost and the remainder paid the full fee. Gas and Air Analgesia. One hundred and twenty-nine cases were booked during the year, of these 86 had gas and air administered. Blood Transfusion Service. Under an arrangement with the North Middlesex County Hospital, Medical Practitioners can now call upon the Blood Transfusion Service, and two cases were attended during the year. Evacuation of Expectant Mothers under the Government Scheme at the eighth month of pregnancy. The department is responsible for the arrangements in connection with the evacuation of expectant mothers under the Government Scheme and in 1945, 203 mothers applied to be sent away. By December 31st, 121 women had been sent to reception areas for their confinement. Fifty-five cancelled the arrangements for various reasons. Home Helps. One hundred and thirteen women had the services of a Home Help during 1945, 96 paid full cost, 8 paid half cost, and 9 had the services free of charge. Ante-Natal Scheme of Co-operation between the Council and the North Middlesex County Hospital. Under an arrangement with the Middlesex County Council 120 homes were visited during the year where women applied to the North Middlesex County Hospital for admission and the Authorities desired to have a report on the home circumstances. Sterilised Maternity Outfits. Four hundred and twenty-eight sterilised maternity outfits were issued during the year, 404 were paid for, 7 paid half cost, and 17 were granted free of charge. 31 X-Rays. Thirteen mothers were referred to the hospital for X-Ray Examination during the year, 12 of whom paid the full cost and one was free of charge. PRIORITY DOCKETS FOR SHEETS. Priority dockets for sheets are issued to mothers having their confinement at home, and during the year 1,307 were issued. CHILDREN UNDER 5 YEARS OF AGE DISCHARGED FROM THE NORTH MIDDLESEX COUNTY HOSPITAL. Twelve visits were paid to children under 5 years of age who had been discharged from the hospital and it was necessary for them to remain under supervision. ILLEGITIMATE CHILDREN. Every effort is made to assist the women, and a contract has been made with the Middlesex County Council for the admission of women and babies to suitable Hostels. 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. The number of persons on the register at the end of 1945 was 15 and the number of children 17. Adoption of Children (Regulation) Act, 1939. The Health Visitors are now responsible for the carrying out of this work, viz.:— Number of persons who gave notice under Section 7 (3) during the year 24 Number of children in respect of whom notice was given 24 Number of children under supervision at the end of the year 8 War-time Nurseries. Attendances for the whole year were:— Fore Street 15,985 Hertford Road 11,01)6 Florence Road 9,709 Silver Street 12,302 Medical Inspections in Nursery Schools and Classes. From February, 1945, the clerical arrangements for medical inspection and following up work have been carried out by the Maternity Department. As these children are all under five years of age it was important that a new scheme be introduced to enable a link up between the medical records at the Infant Welfare Centres and those at the Nursery Schools and Classes. Forty-eight medical inspections were arranged during the year, and in addition the Health Visitor/School Nurses carried out routine visits of inspection to the children. BOROUGH OF EDMONTON Education Committee 1945 Chairman - Councillor Mrs. E. M. Hearn. Vice-Chairman Councillor S. W. Creasey. Aldermen: A. J. Hollywood, J. Reid, H. Gatward, W. A. Edmunds, Mrs. E. A. Young and W. Preye. Councillors: Mrs. E. Long, J.P., W. Bales, T. H. Joyce, W.Green, J. A. Ward, J.P., W. H. Coleman, Mrs. E. B. Newsham and G. T. W. Tott. Whole-Time Medical Staff. D. Regan, B.A., B.Sc., M.B., Ch.B., B.A.O., D.P.H. (L'pool), School Medical Officer, Medical Officer of Health and Supervisor of Maternity and Child Welfare Services. C. A. Goggin, M.B., Ch.B., D.P.H., Deputy School Medical Officer and Deputy Medical Officer of Health. K. Hart, M.B., B.S. (London), M.D., D.P.H., Assistant School Medical Officer and Assistant Medical Officer of.Health. M. Sutcliffe, M.B., B.Ch., B.A.O., T.C.D., D.P.H., Assistant School Medical Officer and Assistant Medical Officer of Health. E. Gray, M B., Ch.B,, D.P.H., L.M. (Dublin). (Commenced April, 1945.) Temporary Assistant School Medical Officer and Assistant Medical Officer of Health. Whole-Time Dental Surgeons. J. F. Ardouin, L.D.S., R.C.S., Senior Surgeon Dentist. E. Underhill, 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 His Majesty's 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. Ibbotson, F.R.C.S., Aural Specialist. V. A. F. Greenish, L.D.S., R.C.S., Orthodontic Specialist. Michael S. M. Fordham, M.R.C.P., Psychiatrist. Part-Time Staff. Miss B. N. Oldrey, M.S.S.T., Speech Therapist. Miss G. Kerr, Chartered Physiotherapist. (Left January, 1945.) Physiotherapist: Miss M. Rees (Commenced duty June, 1945, left December, 1945). School Nurses and Health Visitors. Miss S. Briggs (Superintendent). Miss V. Garrett. Miss A. Naylor. Miss J. Patterson. Mrs. C. Tonkin. Miss M. Druce. Miss A. Fahy. Miss R. Bullock. Miss M. R. Hazelton. Miss M. Butterfield. Miss J. Anderson. Miss Cole. Mrs. I. Jennings (nee Jones). (Commenced June, 1945.) (Left August, 1943.) Miss MacClean. Miss B. Lister. (Commenced August, 1945.) Educational Psychologist. Miss I. Best. 33 Psychiatric Social Worker. Miss S. A. Toynbee. Dental Attendants. Miss O. Brooks. Mrs. J. Dyble (nee Collyer). (Left September, 1945.) Clerical Staff. B. R. Allen, F.I.P.S., F.C.T.S., A.F.T.Com., Senior Clerk. (Now serving with H.M. Forces.) H. A. Carless, Clerk. S. E. Woodroffe, Clerk. (Now serving with H.M. Forces.) Miss A. Savill, Clerk. (Two years' leave of absence granted since June, 1945.) Mrs. E. R. Taylor, Clerk. Mrs. P. R. Thorley (Temporary). Miss V. D. Bruton (Temporary). Miss J. Wittcke (Temporary, Commenced October, 1945). Clinic Workers (Cleansing Station) : Mrs. V. R. Dennison. Mrs. F. Chandler (Half-time). To the Chairman and Members of the Education Committee: Ladies and Gentlemen, 1 beg to submit my Annual Report on the circumstances of the School Medical work for the year 1945. The report is compiled concerning the health and wellbeing of the school children of Edmonton in accordance with the wishes of the Ministry of Education conveyed to me through the medium of the County Council. The satisfactory treatment of tonsils and adenoid cases has again caused great difficulty throughout the year, mainly due to the lack of suitable hospital accommodation. In pursuance of my policy of completely treating every child who needs such treatment, I am glad to be able to report that the results have justified the efforts that have been made on behalf of the children. We have, however, a waiting list and it appears to be impossible to have all these children treated. The treatment is carried out in strict rotation except in cases of extreme urgency. The year 1945 saw the foundations of Child Guidance being established in the Borough. This service was at first received with some trepidation on the part of the parent. Having realised, however, the benefits that can be gained by partaking of this serving, we are now having the experience of being requested by the parents themselves to help them and their children in their difficulties. The service is not yet complete, due mainly to the lack of officers and also suitable premises in which to carry out this very important work. The standard of efficiency in the Medical Services is being pursued and the assistance given is very much appreciated by the parent. This is borne out by the high attendances at the Minor Ailments Clinics and the eagerness with which parents seek the advice of Doctors and Health Visitors in School Medical inspection. A few years ago I personally started assisting some children who were suffering from asthma in order to increase their attendance at school and to relieve them of some of the distressful conditions from which they suffered. As time went on this Clinic grew in importance and we must now set aside a special session weekly for the purpose. The children are sent to St. Mary's Hospital, Paddington, where they are "typed" by Dr. John Freeman, and his recommendations are carried out. Some of these children are sent to the Open-Air School where we give them special exercises. I am pleased to be able to report that the results achieved are very satisfactory, although we have not attained 100 per cent. results. 34 I would like to express my thanks to the members of the Middlesex County Council Borough of Edmonton Education Committee for their unfailing courtesy at all times. We are now growing accustomed to our association with the Middlesex County Council authorities and I am sure, in future years, this association will be crowned with even better results. I would like to express to my staff my deep appreciation of the help and assistance which they have at all times given to me and who are as eager to establish more and more higher principles for the prosecution of their work. I have the honour to remain, Ladies and Gentlemen, Your obedient Servant, D. Regan, School Medical Officer. 1. STAFF. Dr. E. Gray was appointed Temporary Assistant School Medical Officer and commenced duties in April, 1945. We were sorry to lose the services of Miss Kerr, masseuse, who left the service in January, 1945, to take up duties with the British Red Cross in India. Owing to staff difficulties, the Royal National Orthopaedic Hospital authorities were unable to supply another masseuse and I ultimately obtained permission to appoint a full-time physiotherapist. Miss Marjorie Rees commenced duties in June, 1945, but, unfortunately, left the service in December. 2. CO-ORDINATION. The co-ordination between the various Departments, general practitioners, Education Offices, and teaching staff ran smoothly as in previous years. 3. SCHOOL HYGIENE. It has been impossible during the war years to improve the hygiene in some of the older schools. The sanitary accommodation in these buildings leaves much to be desired and I hope that the Committee will make every effort to bring about a change. 4. MEDICAL INSPECTION. The number of children who received full routine medical inspections for all groups during the year 1945 was 3206. The analysis of the age groups was as follows:—- Entrants 1,154 Second Age Group 1,093 Third Age Group 959 5. FINDINGS OF MEDICAL INSPECTIONS. (a) Malnutrition. The Education Committee are to be congratulated on the condition of the children in their schools. As can be seen from the report the nutrition standard is high, only a few cases come under the heading of "D." The following table shows the classification of nutrition for children inspected in the routine age groups during the year 1945:— Number Inspected A. B C. D. 3,206 434 2,426 340 6 (b) Cleanliness. The cleansing of heads and the treatment of scabies continued to be carried out at the Town Hall Inspection Clinic. I regret to say, however, that the condition of school children gives me cause for anxiety. This matter will in future be prosecuted with greater vigour than was possible during the war years. (c) Minor Ailments and Diseases of the Skin. Up to October the only Minor Ailment Clinic in the district was Croyland Road, and the attendances were 17,194. In October the Pymmes Park Clinic was opened and the total attendances for the two clinics were 19,177. 35 (d) Visual Defects and External Eye Diseases. The clinic for the treatment of visual defects was held, as usual, at the Central Hall, Fore Street, N.9, but was transferred to the Pymmes Park Clinic in November of this year. Statistics are given at the back of this report. (e) Nose and Throat Defects and (f) Ear Diseases and Defective Hearing. Mr. William Ibbotson attended the Aural Clinic at the Croyland Road Clinic twice each month. The yearly attendances were:— New Cases: 235. Old Cases: 217. Total: 452. Children recommended for the removal of their tonsils and/or adenoids were admitted to the E.M.S. Hospital at Barley Lane, Goodmayes, and later to the Royal Waterloo Hospital, S.E.I. Children were conveyed to both hospitals by ambulance and brought home again. Children referred for other throat operations other than Tonsillectomy were referred to the Prince of Wales' General Hospital. The number of children who received operative treatment during 1945 was 337. Arrangements were also made for children to see the Ear, Nose and Throat Specialist at the North Middlesex County Hospital, when parents preferred this, and the number of operations carried out there during 1945 was 200. Cases of speech defects were dealt with by the Speech Therapist, and the following is an account of the year's work: — "During the year the work of the speech clinic has continued steadily. During the latter part strenuous efforts have been made to readmit all children who have returned from evacuation and are still in need of Speech Therapy. For this reason the discharges are lower, but the number of children on the waiting list is halved. "On January 1st, 1945, there were 148 cases on the books, there have been 52 new cases during the year, making a total of 200. These are accounted for as follows: — Discharged cured 38 Deleted 48 (this includes numerous evacuees, left the district, left school, etc.) Returned from evacuation but not yet seen 4 Awaiting previous treatment 9 Waiting list 9 Receiving treatment 92 200 Number at the beginning of 1946 is therefore 114. The somewhat large number listed as 'receiving treatment' is due to the fact that in some cases instead of recalling defaulters we readmitted returning evarnees: all defaulters will be recalled early in the New Year. The figures for the last five years are as follows: — 1941 1942 1943 1944 1945 New Cases 52 96 74 92 32 Received Treatment 93 122 125 143 144 Discharged 33 46 61 51 38 Waiting 45 58 49 44 22 (The number waiting includes those requiring previous treatment.) 36 We were asked to treat a child attending Bowes Road School, N.14, and she has had regular treatment throughout the year. Welfare: The Maternity and Child Welfare Department have referred four cases during the year. In all there have been 57 attendances. Two have been transferred to the School register, two have defaulted, one has refused treatment and two will be called for regular treatment early in January. (g) Dental Defects. DENTAL REPORT. 1945. A summary of the work of the Dental Clinics will be found set out in the table of statistics. With only two Dental Officers at work in the Borough it was only to be expected that the Dental Scheme would suffer in consequence. Comparison with the corresponding tables for the last normal year prior to the war shows a big drop in the numbers of children inspected and treated, viz.: — 1938 Inspected 13,937 Treated 5,760. 1945 Inspected 10,582 Treated 3,701. In addition, the provision of Orthodontic treatment has a considerable effect upon these figures. In spite of this and of six years of war-time conditions, there does not appear to have been any deterioration in the dental health of the school children in general judging by the relative percentages referred for treatment: — 1938 approximately 75 per cent. of those inspected. 1945 approximately 60 per cent. of those inspected. The high number of "Specials" is partly attributed to the return of children from evacuation areas where they had received little or no treatment throughout the war years. The conservation of the permanent teeth by removal of caries and insertion of fillings occupies by far the larger part of the Dental Officers' time, and in this we endeavour to maintain as high a standard as possible. This involves not only the removal of caries but also extension to eradicate all danger areas as far as possible, and all fillings are lined with an insulating cement. From an analysis of some 2,300 children in an effort to find the relative incidence of caries to various age groups, I found the following ratios: — Age. % referred for treatment. 5 50% 6-7 63%-66% 8-10 58%-60% 11-12 50%-51% 13-14 65%-76% 15 41% 16 61% 17 51% 18 83% The table shows a sharp rise from 5 to 7 years, followed by a progressive drop in incidence rate between the ages 8 to 12 years. There is a very sharp rise again at 13 to 14 years, followed by the lowest incidence at 15 years which is succeeded by varying rates at 16 and 17 years. The 18 year group is a much smaller group and the very high percentage may be out of proportion in consequence. 37 The ratio of fillings in permanent teeth per child shows a big difference between the elementary and the secondary school children, from .5 per child in the elementary to .2 per secondary pupil. Approximately 60 per cent. of permanent extractions were made for orthodontic purposes. Other operations consist mainly of silver nitrate dressings of temporary teeth at three-monthly intervals. The Orthodontic Scheme was introduced in 1941 with the appointment of a visiting consultant who attended each clinic once a month. Up to the end of 1945 about 850 cases had been seen under the scheme, of which a little over 300 had been completed. During the year there were 232 new cases dealt with; 1,353 impressions taken; 388 appliances fitted; 2,668 attendances for adjustments and 228 radiographs taken. The value of this scheme is immense, both from the point of view of treatment and propaganda. It also brings variety and added interest into the work of the Dental Officer. It has a decided effect in encouraging the acceptance of conservative treatment. On the other hand it has greatly increased the work of the Dental Clinics. With the welcome return of Mr. Weiss from the Services, more can be accomplished, but we shall still be very much below strength to make the Dental Scheme complete. The school population of Edmonton is calculated to require the services of six Dental Officers. It would certainly seem that an addition of at least two more Officers is very necessary. In conclusion I would like to suggest that it would help us a great deal if the Education Department could notify us through the School Medical Department of all admissions and transfers to the various schools. (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.9. Mr. J. A. Cholmeley, the Orthopaedic Specialist, attended the Clinic monthly Miss Kerr, the Masseuse left the Service in February and the Royal National Orthopaedic Hospital were unable to supply us with the services of another masseuse. Permission was obtained to appoint a full time masseuse and consequently treatment recommenced in June, 1946, when Miss Rees took up duties. The attendances for the year were 1,469. The Surgeon saw 100 New Cases and 253 Old Cases—making a total of 353. For the time being the Ultra-Violet Light Clinic is under the aegis of the Orthopaedic Clinic, four afternoon sessions being held weekly. The total attendances for the year were 2,258. (i) Heart Diseases and Rheumatism. Dr. J. B. Alexander, F.R.C.P., attended the Clinic, held once monthly, for the purpose of examining children suffering from rheumatism and diseases of the heart. Where necessary, arrangements were made for children to be admitted to Heart Homes. The attendances for 1945 were 82 New Cases and 158 Old CasesTotal 240. 38 (j) Tuberculosis. I must again extend my most grateful thanks to the Tuberculosis Officer for the co-operation he has given to this Department when dealing with cases referred to him. The number of notified cases and the mortality of children of school age during 1945, taken from the records of the Public Health Department, was:— Notified. Deaths. M. F. M. F. Pulmonary 5 1 — — N on-pulmonary 2 2 — — (k) Other Defects and Diseases. These cases continued to be dealt with as in previous years. 6. FOLLOWING-UP. The arrangements for following-up cases were the same as in previous years. ARRANGEMENTS FOR TREATMENT. The arrangements for treatment at the various Clinics were as follows:— (1) Minor Ailments: Pymmes Park Clinic and Croyland Road Clinic—Doctor and Nurse in attendance every morning. (2) Rheumatism: Clinic held once monthly—the third Thursday. By appointment only. (3) Aural: Clinic held twice monthly—the second and fourth Friday. By appointment only. (4) Ophthalmic: Held at Pymmes Park Clinic every Monday, with occasional extra sessions. New cases by appointment only. (5) Orthopaedic: Surgeon attends on the first Friday in each month. Treatment carried out every morning at Central Hall, Fore Street, N.9. (6) Dental: Clinics are held at Hazelbury Road, Pymmes Park and Croyland Road. By appointment only. (7) Orthodontic: The Specialist attends once at each clinic every month By appointment only. (8) Speech: Speech Therapy Clinic is carried out by Miss Oldrey at the Hazelbury Road Girls' School and is held on four sessions a week. By appointment only. (9) UltraViolet Light: This Clinic is held at the Orthopaedic Clinic, Central Hall, on four afternoons per week. Cases seen by appointment only. (10) Asthma: The Clinic is held at the Pymmes Park Clinic once weekly. Cases are first referred to Dr Freeman at St. Mary's Hospital, Paddington, who examines them and recommends the necessary vaccine. INFECTIOUS DISEASES. Children suffering from infectious diseases were dealt with in the same manner as in previous years. 39 MINISTRY OF EDUCATION. Medical Inspection and Treatment Returns. YEAR ENDED 31ST DECEMBER, 1945. Table I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. A.—Routine Medical Inspections. (1) Number of Inspections in the Prescribed Age Groups :— Entrants 1.154 Second Age Group 1,093 Third Age Group 959 Total 3,206 (2) Number of other Routine Inspections Nil GRAND TOTAL 3,206 B.—Other Inspections. Number of Special Inspections and Re-Inspections 1,504 Table II. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Number of Children Inspected. A. B. C. D. No. % No. % No. % No. % 3,206 434 13.53 2,426 75.67 340 10.62 6 .18 Table III. GROUP I. Treatment of Minor Ailments (excluding uncleanliness). Total Number of Defects treated or under treatment during the year under the Authority's Scheme 6,833 GROUP II. Treatment of Defective Vision and Squint. Under the Authority's Scheme Errors of Refraction (including squint) 1,053 Other defect or disease of the eyes (excluding those recorded in Group I.) Total 1,053 Number of children for whom spectacles were:— (a) Prescribed 1,018 (6) Obtained 996 GROUP III. Treatment of Defects of Nose and Throat. Received Operative Treatment 537 Received Other Forms of Treatment 681 Total Number Treated 1,218 40 Table IV. DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist:— (a) Routine Age Groups 9,075 (6) Specials 1,507 Total (Routine and Specials) 10,582 (2) Number found to require treatment 6,278 (3) Number actually treated 3,701 (4) Attendance made by children for treatment 8,929 (5) Half-days devoted to:— Inspection 52 Treatment 795 Total 847 (6) Fillings:— Permanent Teeth 2,231 Temporary Teeth 149 Total 2,380 (7) Extractions:— Permanent Teeth 1,276 Temporary Teeth 3,212 Total 4,488 (8) Administrations of general anaesthetics for extractions 2,484 (9) Other Operations:— Permanent Teeth 522 Temporary Teeth 3,330 Total 3,852 Table V. VERMINOUS CONDITIONS. (1) Average number of visits per school made during the year by the School Nurses or other authorised persons 23 (2) Total number of examinations of children on the schools by School Nurses or other authorised persons 45,295 (3) Number of individual children found unclean 1,123 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 — — — Deaf Children — — 1 41 SECONDARY SCHOOLS. RETURNS IN RESPECT OF CHILDREN ATTENDING SECONDARY AND JUNIOR TECHNICAL SCHOOLS FOR THE YEAR ENDED 31st MARCH, 1945. A.—Cases In which a full examination has been made. Nil. B.—Classification of the Nutrition of Pupils Inspected During the Year, in Ages. Nil. 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) 87 (Sec.) — 87 14 (Tech.) — 14 Other defect or disease of the eyes (excluding those recorded as minor ailments) — (Sec.) — — (Tech.) — — Totals 87 (Sec.) — 87 14 (Tech.) — 14 Total Number of Children for whom Spectacles were Prescribed:— (a) Under the Authority's Scheme 84 (Sec.) 12 (Tech.) (b) Otherwise — (Sec.) — (Tech.) Total Number of Children who Obtained or Received Spectacles:— (a) Under the Authority's Scheme 68 (Sec.) 9 (Tech.) (b) Otherwise— (Sec.) 1 (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 — — — — — — — — — Technical — — — — — — — — — Total Secondary— — Technical— — Specials Secondary— — Technical — 4 Grand Totals Secondary— — Technical — 4 (6) Found to require treatment Secondary— — Technical — 4 (c) Actually treated Secondary— — Technical — 4 42 (2) Half days devoted to:— Inspection (Sec.) — (Tech.) — Treatment (Sec.) 12 Secondary 12 ,, (Tech.) — Technical — — (3) Attendances by pupils for treatment Secondary 72 Technical 4 (4) Fillings:— Permanent Teeth Secondary 62 Permanent Teeth Technical — 4 Temporary Teeth Sec. & Tech. — Total Secondary 62 Technical — 4 (5) Extractions:— Permanent Teeth Secondary 25 Permanent Teeth Technical — 1 Temporary Teeth Secondary 4 ,, ,, Technical — — Totals Secondary 29 Technical — 1 (6) Administrations of general anaesthetics for extractions:— Secondary 12 Technical 1 (7) Other Operations:— Permanent Teeth Secondary — 18 Permanent Teeth Technical — — Temporary Teeth Sec. & Tech. — Total Secondary — 18 Technical — — Group 1. Minor Ailments (excluding uncleanliness). Disease or defect. Number of Defects treated, or under treatment during the year. At Minor Ailment Clinic. Otherwise. Total. Sec. Tech. Sec. Tech. Sec. Tech. Skin— Ringworm—Scalp X-Ray — — — — — — Other — — — — — — Body — — — — — — Scabies — — — — — — Impetigo — — — — — — Other skin disease 6 — — — 6 — Minor Eye Defects— External and other, but excluding cases treated at Ophthalmic Clinic 3 1 — — 3 1 Minor Ear Defects 1 — — — 1 — Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 23 3 — — 23 3 Total 33 4 33 4 43