34/6/2 820 AC. 459(1) EDM 32 Borough of Edmonton REPORT of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1947 Printed by Jolly the Printer, 238 Fore Street, Edmonton, N.IS Borough of Edmonton INSTITUTE OF SOCIAL MEDICINE 1O. PARKS ROAD. OXFORD REPORT of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1 947 Borough of Edmonton 1947 Her Worship the Mayor Deputy Mayor - Alderman Mrs. E. A. Young, J.P. Alderman Mr. H. Gatward 3 PUBLIC HEALTH COMMITTEE. Chairman : Councillor Mrs. A. M. Glover. Members: Alderman Mrs. E. A Young, J.P. (Ex-Officio) H. Gatward (Ex-Officio) „ W. Preye Councillor L. E. Berridge „ F. H. Brooks „ Mrs. L. M. George ,, Mrs. S. J. Halliday „ Mrs V. E. Hindell A. J. Tanner PREFACE Public Health Department, Town Hall, Edmonton, N.9. Her Worship the Mayor, Aldermen and Councillors of the Borough of Edmonton. Your Worship, Ladies and Gentlemen, I have much pleasure in presenting my Annual Report for the year 1947. It contains only a brief outline of the health circumstances relating to the Borough, and is compiled in accordance with Ministry of Health Circular 170/47. On the whole this year was fairly successful in Public Health. There was still a great deal to contend with ; arranging for repairs to be done, getting permits for these repairs and contacting the people concerned was very difficult indeed and prolonged each task in turn. We have now replaced the absent members of our Sanitary Inspectors' staff, with the exception of one. This fact in itself brings some relief, but a great deal of difficulty and delay is experienced because of the absence of householders at their daily duties in London or elsewhere. It is a very prolonged task indeed to contact house' holders now, make arrangements for repairs, get permits granted, and obtain the necessary permission to put the work into effect. Notwithstanding the difficulties thus created, a good deal of useful work was accomplished during the year, although it was rather long drawn out. HOUSING. The Department is very embarrassed from time to time on the question of overcrowding. It is becoming frequent in the Borough that when the Housing Committee have rehoused a family from an over' crowded house to have another family occupy the premises. We are at present powerless to prevent such a thing happening. In some instances the overcrowding is very serious. It would be a good thing, therefore, if the powers of the Housing Act could be reintroduced in a modified form to prevent conditions of overcrowding arising out of future circumstances. I am pleased to be able to report that there is no further increase in the incidence of Tuberculosis in the District. We are, however, as far removed from achieving our ideal in the detection and treatment of this disease as we were in other years. Hospital beds and beds in Sanatoria are still difficult to obtain. The public, however, are more alive to the necessity of early diagnosis, and consequently a tendency in this direction is most gratifying. We had the Mass Radiography Unit in the District for about six weeks from the end of May onwards. Quite a large number of people attended voluntarily, which was encouraging, and it is to be hoped that we will obtain this Unit, particularly for the Factory workers, annually in the future. There is, however, the difficulty of accommodation which must be overcome, and I hope the Public Health Committee and the Council will apply themselves to this task very soon. It is also gratifying to note that the large majority of parents now seek immunisation against Diphtheria of their own accord. The numbers immunised, however, amongst the " under 5's' and school children are still far too few to stamp out Diphtheria al together. It is significant, however, that as many cases now occur in the adolescent age as there are amongst school children—showing the beneficial effect that immunisation has amongst the younger population. 4 THE BIRTH RATE shows a very slight increase. The Death Rate shows an increase but continues to be low. The major feature of this is that extremely old make up the greater proportion. INFANTILE MORTALITY RATE is higher this year than last. The figure compares very favourbly with those for England and Wales. PUERPERAL SEPSIS. In District Midwifery this is becoming unknown. In Institutional treatment, however, the instances are relatively high, but the death rate is nil. It is to be regretted that the incidence of Poliomyelitis during this year rose to epidemic standard. Every effort was made at early diagnosis and removal to Hospital for treatment. Treatment, however, was somewhat hampered in the late stages by being unable to admit them to General or Orthopaedic Hospitals for continued Physiotherapy treatment. In a few cases the physical defects are really serious. In the majority, however, good recovery was made, and in a few no serious physical disadvantage could be detected. THE FOOT CLINIC, which was opened in 1946 on a part-time basis, proved to be far more popular than we expected. It is true to say that the patients came along in an avalanche, piling up into a long waiting list, This matter has not yet been attended to, mainly due to the lack of suitable premises. It is hoped that during the year 1948 this will, in part at least, be overcome. Finally, I would say that this was a difficult year in most Departments. There was deficiency of staff and every Department was rendered restless by the return to their duties of those who were absent on war service. On the whole those men who were on National Service recovered their equilibrium rapidly and settled down to the usual routine of duties very effectively. This gave me great pleasure to see, as one would expect a certain amount of mental disturbance due to so great a strain for so long a time. I would like to express my very best thanks to the members of my staff for the manner in which they have helped during this eventful year. It might be said that 1947 was a year of anticipation and change as well as some really very effective work being done. I would like to thank the members of the Council, and my Public Health Committee in particular, for very helpful efforts and good advice during the year. I have the honour to be, Your Worship, Ladies and Gentlemen, Your obedient Servant, D. REGAN, Medical Officer of Health. 5 GENERAL STATISTICS. Area (in acres) 3,896 Population— Census of 1921 66,809 Census of 1931 77,652 Estimated by the Registrar-General for mid-year 1947 10(S,760 Number of inhabited houses and tenements at the end of 1947 28,063 Number of inhabited houses and tenements at the end of 1946 27,976 Rateable value, April, 1947 £753,549 Estimated product of Id. in the £ for the year ending March 31st, 1948 £3,150 Rates in the £ for the year ending March 31st, 1948 19s. 6d. 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 Divisional Finance Officer. No. 1 is given purely on economic grounds. (1) Number of free dinners during 1946 96,659 „ „ paid „ „ 1946 1,067,472 „ „ free „ „ 1947 71,101 „ „ paid „ „ 1947 1,136,253 The average number of children receiving meals daily was 5,556 (48.1% of the children in school). Under the Milk in Schools Scheme an average of 11,526 children (98.3% of the children in Junior and Infants' Departments and 78.4% in Secondary Schools), had milk daily. (2) Figures re out relief :— For the year 1946— Amount. (a) Ordinary out-relief £25,107 (b) Unemployed out-relief £4 £25,111 For the year 1947— (a) Ordinary out-relief £26,801 (b) Unemployed out-relief Nil £26,801 VITAL STATISTICS. Live Births. M. F. Total. Grand Total. Legitimate 1,051 1,048 2,099 Illegitimate 43 56 99 2,198 Birth-rate per 1,000 of population 20.58 Stillbirths. Legitimate 25 24 49 Illegitimate 1 1 50 Total of live and stillbirths 2,248 Rate per 1,000 total births 22.24 6 Deaths. M. F. Total. Grand Total. Number 543 483 1,026 Rate per 1,000 population 9.61 Deaths from Puerperal Causes. Deaths. Rate per 1,000 total (live and stillbirths). Puerperal and post-abortive sepsis 0.00 Other maternal causes 3 1.33 3 1.33 Death rate of infants under one year of age. M. F. Total. Number 44 36 80 All infants per 1,000 live births 36.39 Legitimate infants per 1,000 legitimate live births 36.68 Illegitimate infants per 1,000 illegitimate live births 30.30 Deaths from Cancer (all ages) 185 Measles (all ages) 2 „ „ Whooping Cough (all ages) 2 ,, ,, Diarrhoea (under 2 years of age) 15 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 ... ... ... Scarlet fever ... ... ... Whooping cough ... 2 2 Diphtheria ... 2 2 Tuberculosis of the respiratory system 38 24 62 Other forms of tuberculosis 6 4 10 Syphilitic diseases 3 1 4 Influenza 6 1 7 Measles 2 ... 2 Acute Poliomyelitis and Polio-encephalitis ... ... ... Acute infective encephalitis ... 3 3 Cancer of buccal cavity and oesophagus (M.) Uterus (F.) 3 13 16 Cancer of stomach and duodenum 12 14 26 Cancer of breast 1 13 14 Cancer of all other sites 83 46 129 Diabetes 1 4 5 I ntra-cranial vascular lesions 41 51 92 Heart disease 120 126 246 Other diseases of the circulatory system 28 14 42 Bronchitis 48 35 83 Pneumonia 23 24 47 Other respiratory diseases 6 ... 6 Ulcer of stomach or duodenum 6 ... 8 Diarrhoea (under 2 years) 8 7 15 Appendicitis 1 2 3 Other digestive diseases 14 17 31 Nephritis 11 10 21 Puerperal and post-abortive sepsis ... ... ... Other maternal causes ... 3 3 Premature birth 11 6 17 Congenital malformations, birth injuries, infant diseases 17 10 27 Suicide 6 8 14 Road traffic accidents 6 2 8 Other violent causes 10 6 16 All other causes 32 33 65 543 483 1026 7 The two following tables give the deaths of those registered during the 52 weeks ended 27th December, 1947. The slight difference between the following tables 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. 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 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of the Respiratory 43 ... 1 ... ... 3 7 7 11 9 5 ... System Other forms of Tuberculosis 2 1 ... ... 1 ... ... ... ... ... ... ... Syphilitic Diseases 3 ... ... ... ... ... ... ... ... 2 ... 1 Influenza 6 ... ... ... ... ... ... ... ... 2 2 2 Measles 2 2 ... ... ... ... ... ... ... ... ... ... Cancer of Buccal Cavity and 3 ... ... ... ... ... ... ... ... 1 1 1 Oesophagus ... ... ... ... ... ... ... ... ... ... ... ... Cancer of Stomach and 11 ... ... ... ... ... ... ... 2 3 4 2 Duodenum Cancer of all other sites 86 ... ... ... ... ... 2 5 13 25 28 13 Diabetes 2 ... ... ... ... ... ... ... ... ... 1 1 Intra-cranial Vascular Lesions 42 ... ... ... ... ... 1 4 3 10 13 11 Heart Disease 120 ... ... ... ... ... ••• 2 8 18 44 45 Other Circulatory Diseases 29 ... ... ... ... ... ... ... ... 1 15 13 Bronchitis 47 ... ... ... ... ... ... ... 4 10 10 23 Pneumonia 22 8 ... ... 1 ... ... 2 2 3 3 3 Other Respiratory Diseases 6 ... ... ... ... ... ... ... 1 3 2 ... Ulcer of Stomach or 7 ... ... ... ... ... ... ... 3 1 2 1 Duodenum Diarrhoea (under 2 years) 9 8 l ... ... ... ... ... ... ... ... ... Appendicitis 2 ... ... ... ... ... ... ... 1 1 ... ... Other Digestive Diseases 14 ... ... ... ... ... ... ... 2 4 5 3 Nephritis 11 ... ... ... ... ... ... 1 1 3 3 3 Premature Birth 11 11 ... ... ... ... ... ... ... ... ... ... Cong, mal., birth injuries, 15 15 ... ... ... ... ... ... ... ... ... ... infant dis. Suicide 6 ... ... ... ... ... ... 1 1 3 1 ... Road Traffic Accidents 6 ... ... ... 2 ... 1 ... ... ... 1 ... Other violence 9 1 ... ... ... ... ... 1 4 ... 1 2 All other causes 33 ... ... ... ... 1 1 5 ... 5 3 18 Totals 547 44 4 ... 4 8 12 28 56 104 144 143 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 Whooping Cough 2 2 ... ... ... ... ... ... ... ... ... ... Diptheria 2 ... ... ... 1 1 ... ... ... ... ... ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of the Respiratory 25 ... ... ... 1 9 7 4 1 1 2 ... System Other forms of Tuberculosis 3 ... ... ... ... 2 1 ... ... ... ... ... Syphilitic Diseases 1 ... ... ... ... ... ... 1 ... ... ... ... Influenza 1 ... ... ... ... ... ... ... ... 1 ... ... Measles ... ... ... ... ... ... ... ... ... ... ... Acute Infective Encephalitis 3 ... ... ... ... 1 ... ... 1 1 ... ... Cancer of Uterus 13 ... ... ... ... ... ... ... 2 4 3 4 Cancer of Stomach and Duodenum 14 ... ... ... ... ... ... ... 2 4 4 4 Cancer of Breast 12 ... ... ... ... ... ... 2 3 3 2 2 Cancer of all other sites 47 ... ... ... ... ... 2 3 5 15 16 6 Diabetes 4 ... ... ... ... ... ... ... ... 1 2 1 Intra-cranial Vascular Lesions 52 ... ... ... ... ... 1 1 2 4 18 26 Heart Disease 128 ... ... ... ... ... 1 3 6 14 31 72 Other Circulatory Diseases 14 ... ... ... ... ... ... ... ... 3 ... 11 Bronchitis 35 1 ... ... ... ... ... ... 2 4 9 19 Pneumonia 24 10 ... ... ... ... ... ... 2 1 4 7 Other Respiratory Diseases ... ... ... ... ... ... ... ... ... ... ... ... Ulcer of Stomach and Duodenum 1 ... ... ... ... ... ... ... ... ... 1 ... Diarrhoea (under 2 years) 7 7 ... ... ... ... ... ... ... ... ... ... Appendicitis 1 ... ... ... ... ... ... ... ... ... ... ... Other Digestive Diseases 17 ... ... ... ... ... ... 1 2 1 6 7 Nephritis 9 ... ... ... ... ... ... ... 1 ... 3 5 Puerperal and Post-abortive Sepsis ... ... ... ... ... ... ... ... ... ... ... Other Maternal Causes 3 ... ... ... ... 1 ... 2 ... ... ... ... Premature Birth C 6 ... ... ... ... ... ... ... ... ... ... Cong, mal., birth injuries, inf. dis. 10 10 ... ... ... ... ... ... ... ... ... ... Suicide 8 ... ... ... ... ... 1 2 ... 1 1 1 Road traffic accidents 2 ... ... ... ... ... ... ... ... ... ... 1 Other violence 7 ... ... 1 ... ... ... ... ... 1 ... 5 All other causes 33 ... ... ... 1 2 3 2 1 2 4 17 Totals 484 36 ... l 6 17 16 21 32 61 106 188 9 INFANTILE MORTALITY. The deaths of infants under one year of age were as follows :— M. F. Total Legitimate 44 33 77 Illegitimate 0 3 3 44 36 80 The death rate of all infants per 1,000 live births was 36.39. The death rate of all infants under one month of age per 1,000 live births was 19.56 A detailed sub-division of the causes, etc., of these DEATHS is as follows: — MALES. 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 j 9—12 months Total under 1 year Tuberculosis, other forms ... ... ... ... ... ... ... 1 ... 1 Pneumonia ... 2 ... 1 ... 3 3 2 ... ... 8 Congenital Malformations ... 3 1 ... 4 1 1 ... ... 6 Premature Birth 10 1 ... ... 11 ... ... ... ... 11 Atelectasis ... 3 ... ... ... 3 ... ... ... ... 3 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Gastro-Enteritis ... ... ... 4 2 ... ... 8 Other causes 3 ... ... ... 3 1 ... 1 ... 5 Violence ... ... ... ... 1 ... ... 1 Totals 22 1 2 ... 25 9 6 4 ... 44 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 Whooping Cough ... ... ... ... ... ... 2 ... ... 2 Bronchitis ... ... ... ... ... ... 1 ... ... 1 Gastro-enteritis ... ... ... ... ... 3 2 ... 2 7 Pneumonia 1 2 ... ... 3 1 3 3 ... 10 Premature Birth 4 2 ... ... 6 ... ... ... ... 6 Congenital Malformations 1 1 ... ... 2 ... ... ... ... 2 Other Causes 1 ... ... ... 1 ... ... 1 ... 2 Atelectasis 3 ... ... ... 3 ... ... ... ... 3 Injury at Birth 3 ... ... ... 3 ... ... ... ... 3 Totals 13 6 ... ... 18 4 8 4 2 36 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 20.5 0.50 5.8 41 London 22.7 0.49 4.8 37 Edmonton 20.58 0.46 6.82 36.39 Annual Death Rate per 1,000 of Population. All Causes Measles Scarlet Fever Whooping Cough Diphtheria Influenza England and Wales 12.0 0.01 0.00 0.02 0.01 0.09 London 12.8 0.01 0.00 0.02 0.01 0.08 Edmonton 9.61 0.01 0.00 0.01 0.01 0.06 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. The deaths include those taking place outside the Borough, the information being given quarterly 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 251 234 158 153 10 7 Church Street 137 125 125 97 11 9 Angel Road 180 193 111 96 12 11 Silver Street 211 227 151 138 11 9 Vagrants ... ... 2 ... ... ... 779 779 547 484 44 36 11 LABORATORY SERVICE. The following examinations were carried out in the Bacteriological Laboratory :— Nature of Examination. Positive. Negative. Total. Blood Counts — 44 Blood—Bleeding Time — — 13 Breast Milk for Fat Content — — 20 Eye Smears for presence of organisms — — 23 Faeces for presence of Dysentery — 51 51 Faeces for presence of Tubercle Bacilli — 1 1 Sputa for presence of Tubercle Bacilli 1 8 9 Swabs for presence of C. Diphtheriae — (a) From Suspect cases 3 268 271 (b) From Contacts 1 52 53 (c) From Carriers and old cases, etc. — 4 4 Swabs for presence of Haemolytic Streptococci 38 238 276 Swabs (Post Nasal) for presence of Meningococci — 3 3 Swabs for Vincent's Angina 2 22 24 Swabs for presence of other organisms — — 2 Urine—Bacteriological Examinations — — 29 Urine-—Chemical Examinations — — 285 Urine—Microscopical Examinations — — 83 Vaginal Swabs for presence of Gonococci — 4 4 Vaginal Swabs for Trichomonas Vaginalis 3 12 15 Vaginal Swabs for other organisms — — 10 Total Number of Examinations 1,220 Specimens were sent to the Central Public Health Laboratory, Colindale Avenue, Hendon, as follows Nature of Examination. Positive. Negative. Total. Blood for Wasserman and Kahn reactions — 1 1 Eye Smears for presence of Gonococci — 3 3 Faeces for Pathogenic Organisms 3 24 27 Hair for presence of Ringworm — 1 1 Sputa for presence of Tubercle Bacilli — 5 5 Swabs for presence of C. Diptheriae 4 476 480 Swabs for presence of Haemolytic Streptococci 191 286 477 Swabs for presence of Vincent's Angina 8 36 44 Urine—Bacteriological examinations — — 29 Vaginal Swabs for presence of Tri. Vaginalis — 1 1 Virulence tests — 3 3 Total Number of Examinations 1,071 12 MILK (SPECIAL DESIGNATIONS) REGULATIONS 1936-1946. 76 Samples of Designated Milks were examined in the Laboratory. Results were as follows :— Pasteurised Milk. 25 Samples were examined by both the prescribed tests and found to be sati factory. 6 Samples were examined by the Phosphatase test only and found to be satisfactory. Tuberculin Tested Milk. 21 Samples were examined, 16 satisfied both the prescribed tests. 4 Samples failed to pass both the Methylene Blue and Coliform tests. 1 Sample failed to pass the Coliform Test only. Tuberculin Tested (Pasteurised) Milk. 19 Samples were examined by both the prescribed tests and found to be satisfactory. 4 Samples were examined by the Phosphatase Test only and found to be satisfactory. 1 Sample failed to pass the Methylene Blue Test only. Ambulance Facilities. First Aid was rendered on 6b4 occasions. The resuscitating apparatus was in use on 23 occasions. The total mileage of the vehicles was 66,687 miles. During the year the Ambulance Service dealt with 228 Street Accidents, and in connection with these the main danger spots in the Borough were as follows: Angel Road, between Fore Street and Woolmer Road. Great Cambridge Road, from Roundabout to Westerham Avenue. Hertford Road, from Cuckoo Hall Lane to Forest Road. Motor cars were the chief cause of Street Accidents during the yearChurch Street has a very bad record for cycle accidents. Home Accidents—The number of scalding accidents to children between 6 months and 5 years of age, showed an alarming increase. It would appear necessary that some further attention to safety in the home should be given. i3 The Council possesses four ambulances, and the following figures give some idea of the work carried out during the year :— Private cases 13,736 Accident cases 894 Maternity cases 413 School Medical Dept. (Tonsils) 1 Maternity and Child Welfare (Tonsils) 196 Not required 280 False calls 8 Bedside Apparatus 86 Analgesia 269 Special services 847 16,730 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 Prince of Wales's Hospital and North Middlesex County 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 1947. 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. 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. For at least six months during 1947 we were short of three District Inspectors owing to illness. Mr. G. Huekle, one of the District inspectors, passed away on the 25th November, 1947. One new appointment was made at the end of the year. 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 two Rodent Operatives and the part time services of a Junior Clerk, and appointed the District Sanitary Inspectors Rodent Officers. To comply with the Ministry's Circular, they appointed four Investigators and another three Assistant Rodent Operators, with Mr. Gaffney as Assistant Rodent Officer (which made a total of four Rodent Operators), to carry out the Survey of the District, which commenced in June and was nearing completion at the end of the year, so that for the period under review the staff comprised of one Assistant Rodent Officer, four Assistant Rodent Operators, four Investigators, and the part-time services of a Junior Clerk. 14 Up to the end of the year, 7,405 visits and re-visits have been made by the Rodent Operatives, in connection with complaints as to alleged rat infestation. Eight Intimation Notices and two Statutory Notices have been served—owing to the fact that the Occupiers did not appear to be taking effective measures to eradicate the vermin. Defestation has been carried out on request at 1,882 premises as the result of the Survey, and at the end of the year 30 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 109 cases of Rat Infestation referred to the District Inspectors, owing to the possibility of defects in the drainage, in 55% of the cases defects were discovered and as one can quite appreciate entailed quite a large amount of work. During the year the second maintenance treatment of the sewers took place by the Borough Engineers Department. Middlesex County Council Act, 1944, Section 279, Hawkers, Etc. This Act came into operation on the 1st October, 1944, and Section 279 replaced Section 71 of the Act of 1938. Four persons were registered during the year. Rent and Mortgage Interest (Restrictions) Acts 1920-1933 D iring the year your Senior Sanitary Inspector has issued 12 Certificates under the above Acts upon applications of Occupiers of dwelling-houses in the disirict. Disinfection and Disinfestation. J5 The following table gives some idea of the work carried out :— Number of journeys to collect bedding 230 „ „ „ „ return bedding 219 Rooms disinfected after infectious disease 492 „ „ „ phthisis 104 Rooms disinfected after other cases 106 Disinfestation carried out after vermin 279 Bedding, clothing, etc., disinfected after infectious disease 2,659 articL s Bedding, clothing, etc., disinfected after phthisis 749 „ ,, „ ,, „ ,, other cases 1,540 „ 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 6,214. 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 410. Seven Council properties and 68 other houses were found to be infested the total number of rooms disinfested was 279. The whole of the work is carried out by the Department, the materials used being Insecticides containing D.D.T. as a base. Petroleum {Regulations) Acts, 1928 and 1936. During the year seven new licences and 100 renewals were granted by the Council. The following is a list of particulars of quantities, etc., affected by these licences :— Petroleum spirit 472,279 gallons. Petroleum mixtures 6,923 Carbide of calcium 17 cwts. 78 lbs. Rubber Solution 100 „ Mortuary. During the year 101 bodies were deposited in the Mortuary, 99 by order of the Coroner and 2 for sanitary reasons. Inspections. The following tabular statement gives the number and nature of the inspections made during the year :— Complaints 2,991 Infectious disease 335 Tuberculosis 29 House-to-House — Factories with mechanical power 131 Factories without mechanical power 5 Outworkers 137 Schools 2 Shops and Stalls 111 Shops Act (Primary) 6 Shops Act (Re-inspections) 2 Sanitary conveniences and urinals 210 Smoke observations 7 Rat Infestation 136 Petroleum 26 General inspections 313 Sundry Visits 1,320 Cinemas and Halls 10 Visits to canal 6 Gipsies 2 Re-inspections 6,816 Inspection of Places where Food is Prepared. Butchers 50 Fish shops 10 Coffee shops 12 Dairies and milkshops 27 Slaughterhouses 57 Bakehouses 9 Ice Cream Shops 11 Number of Notices Served. Preliminary or Informal Notices 2,761 Statutory Notices 721 16 Defects Remedied. Houses repaired, cleansed, etc. 756 D.W. cisterns repaired, covered 18 Water fittings repaired 98 Water taken off mains — Drains examined, tested, etc. 402 Drains cleared, trapped, repaired 337 Drains reconstructed 72 Chambers inserted 38 Chambers sealed down 31 Soil and vent pipes repaired 81 W.C.s repaired, cleansed, etc. 452 Flushing cisterns repaired 104 Waste pipes repaired, etc 97 Sinks repaired or renewed 203 Roofs repaired 829 Gutters and R.W.P.s repaired 622 Yards paved or repaved 117 Scullery floors repaired 57 Spaces under floors ventilated 13 Dampness remedied 109 Floors repaired 101 Coppers and stoves repaired, etc. 221 New dustbins supplied 252 Accumulation of refuse removed 3 Nuisances from animals abated 2 Other nuisances abated 1326 Water supply restored 2 Du tbins supplied in default 14 Dustbins supplied on request 45 Canal Boats Acts. During the year 6 visits were paid to the Canal and 2 boats were seen, but of this number none was fitted or used as a dwelling or registered under the Acts. Places of Public Entertainment. Ten 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 131 4 ... Factories without mechanical power 5 1 ... Other premises under the Act (including works of building and engineering and construction but not including outworkers' premises) ... ... ... Totals 136 5 ... 17 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 5 5 ... ... Overcrowding ... ... ... ... Unreasonable temperature ... ... ... ... Inadequate ventilation ... ... ... ... Sanitary Conveniences : ... ... ... ... Insufficient 3 3 ... ... Unsuitable or defective 2 2 ... ... Not separate for sexes ... ... ... ... Other offences 1 1 ... ... (Not including offences relating to Home work or offences under Sections mentioned in the schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) Totals 11 11 ... ... 3.—Outwork in Unwholesome Premises. Nature of Work. Instances. Notices Served. Prosecutions. Wearing Apparel— Making, etc. — — — Cleaning and washing — — — FACTORIES. Defects Remedied. W.C. walls cleansed 5 W.C. cisterns repaired 1 W.C. Seats repaired or renewed 2 W.C. Flush pipes repaired — W.C. doors repaired — W.C. pans replaced — Roofs repaired — Workrooms cleansed — Sanitary accommodation improved 2 „ „ for Sexes provided — Urinals cleansed 1 Unreasonable Ventilation — 18 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) 2,991 (b) Number of inspections made for the purpose 5,643 (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 — (b) Number of inspections made for the purpose — (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 7 (4) Number of dwelling houses (exclusive of those referred to above under the preceding sub-head) found nat to b2 in all respects reasonably fit for human habitation 1,876 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 872 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 374 (2) Number of dwelling houses which were rendered fit after service of formal notices :— (a) By owners 301 (b) By Local Authority in default of owners 12 B.—Proceedings under Public Health Acts :— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 328 (2) Number of houses in which defects were remedied after ' service of formal notices (a) By owners 156 (b) By Local Authority in default of owners 6 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 3 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.— One Clearance Area was dealt with during the year : i.e., eleven cottages, -\os. 2 to it, L.ttle Bury Street, and the propeity subsequently demolished. 19 SLAUGHTERHOUSES. Fifty-two visits were paid and the carcases and organs of 333 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 :— 3 Sets of lungs. 7 Plucks. 4 Hearts. 1 Head. 2 Livers. 1 Pig Carcase (approx. weight 158 lbs.). INSPECTION AND SUPERVISION OF FOOD. Milk Supply. Various licences were granted as under :— Primary. Supplementary. Pasteurised 12 7 Tuberculin tested 8 5 20 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 :— 2393 tins of milk. 1852 „ canned meat. 567 „ beans. 628 „ canned fish. 348 „ peas. 131 „ soup. 45 „ peaches. 10 „ rhubarb. 56 „ pears. 105 „ tomatoes. 28 , beetroot. 300 pots of jam and marmalade. 112 lbs. prunes. 857 lbs. of rabbits. 17 stone of Dabs. 35 stone haddock. 35 lbs. roes. 9 bags of whelks. 25 lbs. cutlets. 10 stone hake. 5 boxes kippers. 5 stone halibut. 27 lbs. Dried Haddock. 11 stone skate wings. 8 boxes fillets. 5 stone mackeral. 5 stone plaice. 10 megrims. 18 chickens. 15 cwts. rolled oats. 9J lbs. sausages 76 lbs. confectionery. 312 lbs. dried peas. 3 cwts butter beans. 10 lbs chocolate caramels. 25 lbs. dried peaches. 30 lbs. sausages. 142 lbs sugar. 143 lettuces. 62 lbs. dates. 138 6-lb. tins piping jelly. 68 tins Gaffe Ibiters 2-gallon tins of apples. 64 1-lb. packets of biscuits. 4 pots pickles 17 56-lbs. onions. 15J lbs. hindquarters ot beef " 2 boneless hindquarters of beef (329 lbs). 1 boneless forequarter of beef (172 lbs.). Together with various small consignments of miscellaneous foods. 20 SHOPS ACTS. Mr. A. Robinson was appointed Shops Acts and Street Trading Inspector in August, 1947. 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. PREVALENCE OF INFECTIOUS DISEASE. Measles and Whooping Cough. These diseases were made compulsorily notifiable in October, 1939. 783 cases of Measles and 183 cases of Whooping Cough were notified during the year. There were two deaths from Measles and two from Whooping Cough. Diphtheria. I am again happy to report the continued low incidence of this disease. There is a decrease compared with last year ; 8 cases were notified during the year compared with 24 in 1946. There were 2 deaths—immunisation had not been carried out in either case. Scarlet Fever. This disease continued to occur throughout the year in a mild form ; there were 261 cases compared with 299 in 1946 ; there were no deaths. " 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. Dysentery. One case was notified during the year (Sonne type). Investigation failed to reveal the cause of infection. Cerebro Spinal Fever. Four cases were notified during the year. These cases were carefully investigated and precautions taken to prevent the spread of infection. No 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. Forty-nine cases were notified during the year. 21 Diarrhoea and Enteritis under 2 years of age. The death rate per 1,000 live births for London was 4.8 whilst that for Edmonton was 6.82 as compared with 4.2 and 5.21 respectively last year Poliomyelitis. During the year 18 confirmed cases of Poliomyelitis occurred in the Borough. Notifications were received from April to December (inclusive), but the peak period was August and September, when 6 and 4 cases respectively were notified. The age distribution was as follows .— 0— 5 years 7 cases. 5—15 „ 4 „ 15—20 1 „ 20—35 5 „ 35—45 „ 1 „ The disease was not confined to any particular area of the Borough Each case was thoroughly investigated, but in no instance was the source of infection discovered. All cases were admitted to the Hospital and where necessary patients were later transferred to the Royal National Orthopaedic Hospital, Stanmore, for further remedial treatment. There were no deaths. Three cases were notified in 1946 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 number 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 261 240 ... 5 13 18 26 105 61 16 12 3 2 ... Diphtheria 8 8 2 ... ... ... 1 1 2 1 1 1 1 ... ... Puerperal Pyrexia 77 77 ... ... ... ... ... ... ... ... 5 59 12 1 ... Pneumonia 49 6 47 ... 1 ... 3 1 3 ... 3 6 7 18 7 Erysipelas 34 15 ... 1 ... 1 ... ... 1 ... 1 7 7 12 4 Ophth- Neonatorum 24 22 ... 24 ... ... ... ... ... ... ... ... ... ... ... Dysentery 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 183 15 2 18 22 20 33 25 68 3 ... 1 3 ... ... Measles 783 33 2 41 79 98 105 130 305 15 4 5 1 ... ... C.S.F 4 4 ... ... ... 1 ... 1 ... 1 ... ... ... ... 1 Poliomyelitis 18 18 ... ... 1 3 3 ... 2 2 1 5 1 ... ... 22 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 Instns. Total Scarlet Fever 58 76 39 85 3 ... 261 Diphtheria 2 2 ... 4 ... ... 8 Puerperal Pyrexia ... ... 2 1 70 4 77 Pneumonia 15 6 16 12 ... ... 49 Erysipelas 9 5 6 12 2 ... 34 Ophth-Neonatorum 1 ... 2 ... 20 1 24 Dysentery ... ... ... ... 1 ... 1 Whooping Cough 36 14 44 84 5 ... 183 Measles 167 118 221 259 18 ... 783 C.S.F ... 1 2 1 ... ... 4 Poliomyelitis 5 5 2 5 1 ... 18 IMMUNISATION. Diphtheria. During the year, 1,760 appointments were made—1,498 children completed treatment under the Council's arrangements ; of these 1,366 were under 5 years of age. 24 children were Schick tested. In 1946, 2,088 children completed immunisation treatment. In addition 186 children received a re-inforcing injection. Up to 31st December, 1947, 47.92% of children under 5 years of age and 65.66% of children from 5—15 years of age had completed immunisation treatment. Whooping Cough. Edmonton children are immunised against Whooping Cough. The material used is " Glaxo Vaccine A.P.," and during the year, 886 appointments were made for this treatment—522 children completed treatment and 3 children were given re-inforcing injection. PREVENTION OF WHOOPING COUGH Authority was given for the Medical Research Council to carry out Anti-Whooping Cough Inoculation Trials in the Borough, the object being to ascertain the preventive value of Whooping Cough Vaccine. Inoculations are given by a Medical Research Council team at specially arranged sessions, and for the next two years each child will be visited monthly in its home by a special Health Visitor, who will keep a careful record of all coughs and colds and will be prepared to take post-nasal swabs as an aid diagnosis. A Medical Officer from the Medical Research Council will also visit doubtful cases to establish the diagnosis. As a check on the value of the treatment some of the children will get an anti-catarrhal vaccine instead of pertussis antigen ; no-one engaged in the day-to-day work of inoculation and subsequent " follow-up " will know which vaccine any particular child has received. Three injections are given at intervals of one month ; children between 6 and 18 months of age only will be included in the scheme, provided they have not already had whooping cough or have not already been inoculated against it. In addition if a child received any further inoculation against pertussis in the next two years, it will have to be excluded from the final statistic analysis. 23 During the latter part of the year the Medical Research Council intimated that a further supply of the vaccine was available, and as the response of Edmonton parents had been excellent, it was decided to continue the investigations in order to give more parents an opportunity of taking part in the scheme. The scheme is entirely voluntary. Full details of the investigations carried out in the Borough are not yet to hand. CANCER. The incidence of Cancer relative to the various organs of the body is given as under :— Males. Females. Breast — 12 Uterus — 13 Buccal cavity and oesophagus 3 — Stomach and duodenum 11 14 All other sites 86 47 100 86 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. 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 Non-respiratory Respiratory Non-respiratory M. F. M. F. M. F. M. F. Under 1 year ... ... 1 1 ... ... 1 ... 1— 5 years 4 4 1 ... 1 ... ... ... 5—15 „ 6 7 3 2 ... 1 1 ... 15—25 ,, 17 33 3 1 3 9 ... 2 25—35 ,, 15 20 ... 1 7 7 ... 1 35—45 ,, 10 8 1 1 7 4 ... ... 45—55 ,, 13 3 1 1 11 1 ... ... 55—65 ,, 9 1 ... ... 9 1 ... ... 65 years upwards 5 ... ... ... 5 2 ... ... 79 76 10 7 43 25 2 3 24 In addition 16 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) 79 76 (non-respiratory) 10 7 Transferred cases (respiratory) 6 10 (non-respiratory) ... 1 95 94 The cases dying of Tuberculosis and not previously notified were :— Males. Females. Respiratory 5 1 Non-respiratory — 2 There were thus 8 non-notified deaths out of a total of 72 persons registered as dying of tuberculosis (Registrar's figures). Regarding the nonnotification 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. Skin — — Genito-urinary tract — 1 Other bones and joints 3 — Kidney — 1 Glands 4 3 Spine — — Abdomen 1 1 Liver — — Brain 2 1 Miliary — — 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 1947 was :— Males. Females. Total. Pulmonary forms 369 321 690 Non-pulmonary forms 73 84 157 442 405 847 The corresponding figures at the end of 1946 were :— Males. Females. Total. Pulmonary forms 344 288 632 Non-pulmonary forms 73 87 160 417 375 792 25 Corresponding figures for previous years were :— Males. Females. Totals. 1945 389 332 721 1944 370 319 689 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 MASS RADIOGRAPHY The Middlesex County Council Mass X-Ray Unit visited Edmonton during May and June, 1947, and set out below is the report of Dr. W. Pointon Dick, Physician-in-Charge :— "Since November, 1946, discussions have taken place regarding a visit of the Mass X-Ray Unit to Edmonton. Dr. Regan, Medical Officer of Health, was very keen that both the factories in the Borough (employing about 13,000 people) and the general public should be included in the scheme. Some Edmonton firms have already shown great interest and were on the County Council's waiting list, notably, The Klinger Manufacturing Company who offered accommodation to the Unit for an indefinite period. The space provided was, unfortunately, too small to examine more than a limited number of people, so after the Klinger Staff themselves had been X-Rayed, the machine was moved to the British Oxygen Company, which was very conveniently situated in the middle of the Angel Road Colony. The resident Director kindly agreed that other groups should attend at B.O.C. and altogether 2,721 were examined there, including 438 of the Borough Council staff. For the general public it was felt that the best centre would be in the town itself, if accommodation could be found. This proved to be a great difficulty, and the project was almost abandoned for lack of a suitable place to instal the apparatus. The situation was saved by Major Gibbons of 4/6 Battalion, Middlesex Regiment who agreed that application should be made to Lt.-Col. Pettman for the use of the Army huts in Church Street. The Edmonton Council agreed to pay for the use of the huts and also for some adjustments, such as a covered way from one hut to another. The accommodation thus adapted proved to be very suitable, although it would have been still better in the centre of the Borough. An extensive publicity campaign was undertaken. Posters, notices in the local paper, a short film shown at the Regal, handbills to all Doctors in the Borough and Local Organisations and to 3,000 schoolchildren who took them home to their parents ; talks at Union Branches and other Meetings. Finally a loud-speaker van. County Councillor Mrs. Long, accompanied by several Councillors and Dr. Goggin, opened the first women's session—she addressed about fifty housewives who were waiting to be X-Rayed, and congratulated them on coming out on what turned out to be one of the very hottest afternoons of a sudden heat wave. The Member of Parliament for Edmonton, Mr. Evan Durbin, opened the evening session for men, and made some very helpful remarks on the need for supporting this public health measure—he showed his practical interest by being the first man to be X-Rayed. The 26 response from the public was very gratifying—a total of 2,990 were X-Rayed— this number was made up of 2,047 general public (804 men, 1,243 women), 754 schoolchildren (231 boys and 523 girls), 189 Factory workers (by appointment not included at B.O.C.). It is interesting to note that of the 1,243 women, 680 were housewives, a group whom it would not be possible to include other than at a public session. The County Council are anxious that housewives should have the same facilities in this way as are offered to factory workers, when possible. The rest of the women were individuals working on their own or in small groups, such as shops, etc., who came on their own initiative and not by appointment with the Council through their place of work ; the same description would apply to the men. On this occasion, the schoolchildren were X-Rayed with the adults, and some criticism was encountered on this score. In future, when organised groups of school children attend, they will be given separate sessions of their own. A special arrangement was made with the Latymer School for 50 boys and 21 girls to have an X-Ray and a skin test. Unfortunately, a number of these did not return for the reading of the test, but of the 59 who did, the test showed that only 9 had been in contact with the tubercle bacillus. This is a very satisfactory proportion if it is also applicable to those who did not return. Special thanks for their co-operation are due to Mr. Nash (Chief Clerk Public Health Department) Mr. Gilbert (Manager Director of Klinger Manufacturing Company), Mr. Livesey (Director of the Britain Oxygen Company), Mr. Harold Doherty (Chairman, Edmonton Manufacturers Association). Major Gibbons (4/6 Battalion Middlesex Regiment), and the Edmonton Red Cross. The question of accommodation for this service, which it is hoped will be repeated in the Borough at some future date, is a point for the consideration of the Borough Council. TOTALS X-RAYED Factory Workers :— Klingers 1,195 B.O.C 2,721 Huts 189 4,105 Public 2,047 Schoolchildren 754 Total 6,906 The findings are shown in the table below. It will be seen that, as would be expected, the proportion of schoolchildren requiring further investigation is less than one-half of that found in the adult population. It should be pointed out that persons requiring further action are not necessarily suffering from Pulmonary Tuberculosis. The group includes heart cases, etc., and the ultimate diagnosis is not yet available." Factories School Children General Public Total X-Rayed 4,105 754 2,047 Recalled for large film 222 28 115 (5.4%) (3.7%) (5.6%) Further Medical Action 83 7 57 (2.1%) (0.9%) (2.8%) Failed to return for large film 3 — 1 27 Particular attention is drawn for the need for suitable accommodation to be provided for any future visits of the Unit, especially is this necessary for dealing with members of the general public and schoolchildren. It will be noted "the project was almost abandoned for lack of a suitable place to instal the apparatus" —therefore every effort must be made to ensure such a situation does not arise in the future. COUNCIL'S EMPLOYEES. During 1947 the Medical Officer of Health paid a total of 289 visits to those employees who had been on the sick list for longer than a fortnight and, when necessary, at fortnightly intervals. Of these 80 were " not at home " and 4 had already resumed duty. Also, during the year, 87 persons were examined prior to appointment to permanent posts. MUNICIPAL FOOT CLINIC This Clinic was opened to the Public on 5th November, 1946, with two sessions per week for men and two for women. The demand for treatment was immediate, and the number of sessions was doubled in an endeavour to cope with the waiting list ; despite this, there were more than 250 persons awaiting treatment at the end of the year. It is hoped that the present clinic will be extended or an additional clinic established in order to cope with the demand for treatment. A part-time temporary clerk was appointed to deal with the clerical side of this service. The charges were increased during the year. Charges 2/- per foot per visit for ordinary patients for ordinary treatment. 6d. „ „ old age pensioners „ ,, 2- „ „ ordinary patients for infra red treatment. 6d. „ „ old age pensioners „ „ Sessions:— Men : Tuesdays and Fridays 2—5 p.m. and 7—9 p.m. Women : Mondays and Thursdays 2—5 p.m. and 7—9 p.m. Summary of Attendances and Treatment, 1947 During the year 1947, 482 patients made 1883 attendances, an average of 3.9 attendances per patient. New Cases Subsequent Attendances Total At tendances Old Age Pensioners Attendances Primary Secondary Men 173 708 881 71 394 Women 309 693 1002 102 289 Total 482 1401 1883 173 683 28 Defects Treated— Anidrosis 6 Hyperidrosis 22 Bursitis 88 Metetarsalgia 307 Callosities 1191 Nails, club 281 Corns, hard 1354 „ ingrowing 48 „ soft 199 Neuro vascular 12 „ minute 38 Osteoma 6 „ seed 19 Pes Cavus 26 „ under nail 70 ,, Planus 33 „ in nail groove 138 Synovitis 11 ,, vascular 8 Splayed Met. Bones 2 Exostosis 3 Verruca Pedis 26 Hallux Valgus 283 Infra Red 21 „ Rigidus 39 29 Maternity and Child Welfare Committee 1947 COMMITTEE Chairman : Alderman W. Preye, J.P. Members : Alderman Mrs. E. A. Young (Mayor) Ex-Officio. Alderman Gatward (Deputy Mayor) Ex-Officio. Councillor L. E. Berridge. „ F. G. Durham. ,, Mrs. L. M. George. Mrs. A. M. Glover. ., Mrs. S. J. Halliday. Mrs. F. Jong, J.P. ,, Miss. E. J. Mattocks. 31 FOREWORD It is with a sense of melancholy that I place on record the report of the activities for 1947—this year sees the end of an important phase in the life of the Maternity and Child Welfare Service which embraces its birth and sub' sequent expansion in Edmonton under the control of the local Borough Council. During 1948 we shall pass on to another era, when the Middlesex County Council will take over the responsibility under the National Health Service Act, and we shall see many changes ; expansions of the present and the commencement of new schemes, old methods replaced by new. Let us hope that the new will achieve as much as the old. At the moment the future appears obscure, but with bold and constructive planning, valuable steps forward can be taken in the work which is so essential and important to the welfare of mothers and children. During 1947 the Midwifery Service continued to maintain its usual high standard with encouraging results and the record was again highly satisfactory. The attendances at the Ante-Natal Clinics were splendid and the table below will give some indication as to the growth of the work. An additional Clinic was opened in June, 1947 in the Weir Hall area, and it is proving very popular and relieving the congestion in the Brookfield House Clinic. Attendances at the Ante-Natal Clinic 1935 1,176 1938 3,801 1946 12,499 1947 13,185 These figures are practical evidence that the public realise the value of attention before the birth of a child, not merely to safeguard the actual confinement itself, but an appreciation on their part that an Ante-Natal Clinic means so much to the future of the unborn child. The work has, however, put a severe strain on the staff who have been required to deal with such high numbers per session without incurring any risk to the patient. They have, however, borne the extra burden cheerfully and the confinements during the year 1947 were in nearly all instances without complications. It is good to be able to report that no maternal death occurred in the Domiciliary Midwifery Service this year, which is good testimony to the close observation and special interest that is given to these mothers by the staff. The Flying Squad Service maintained by the North Middlesex County Hospital has proved itself of immense value and it is puzzling to imagine why such a simple method of assistance was not put into operation many years ago. The gas and air service is also proving very popular with the mothers and is yet another proof of the assistance rendered by the Council which is being appreciated more and more by the women. The following figures will speak for themselves. 1942 18 had gas and air 1946 181 had gas and air 1947 236 had gas and air Up to the present the Ambulance Service has been employed to convey the apparatus both night and day to the women who need this service. It is to be hoped with the change over of the ambulances from the Council to the Fire Brigade it will not in any way interfere with the carrying out of this good work. 32 Below is a table of the comparison of attendances at the Infant Welfare Centres which will give further proof of the work which has been carried out : Attendances 1935 27,188 1938 42,166 1946 40,944 1947 50,311 With increased knowledge regarding preventive measures to be adopted in Infant Welfare Centres this service is bcoming quite a complicated one, and the amount of benefit which can be rendered to the developing child in his tender years is very great. The work done in the Maternity and Child Welfare Department is the surest foundation for a sound "School Medical Health Record" of the child. The more attention rendered to the Infant at this period of his life, the less necessary it is to supervise him from a health standpoint during the school years, a fact which has been forgotten in the past. The fact that this service concentrates on this particular aspect and period of child life can be seen from the School Health Reports of the last few years. The decline in serious Orthopædic and Dental defects is mainly due to the increased attention to Dietetics and correction made during the early years of the child's life. The value of the Post Natal Clinic is becoming increasingly evident to the women and it is anticipated that another session will be opened in the Weir Hall area early in 1948 to enable more mothers to be seen, and the necessary treatment carried out. The following figures need no comment :— Attendances 1938 348 1946 1,576 1947 1,485 In the past the Post-Natal Clinics under Local Authorities were mainly of a supervisory nature—a check-up was given at certain times in the PostNatal period of a mother and then according to the findings she was referred on for treatment. The desirablity of attending to minor conditions and pursuing them to their ultimate goal is now being recognised as a very important factor. The major conditions are readily recognised and dealt with accordingly, but the minor infections and abrasions are inclined to be overlooked. This is particularly so because the immediate consequences to the individual are not serious, but the remote consequences may be very serious indeed. It is for this reason that every attention must be focused on the minor form of complaint to a far greater extent than in the past. The Consultant Service is a very important one and women from the Ante-Natal and Post-Natal Clinics are referred to this Clinic for expert advice from any source in the Borough though they are usually referred from the Council's own Ante-Natal and Post-Natal Clinics. The Orthopaedic Clinic plays a very important part in the life of the child under five years of age, and has a most encouraging record of services rendered. It is the oldest Specialist Clinic in Edmonton and during the long term of years it has served the child population of Edmonton well. Difficulties have been experienced, mainly associated with accommodation, and these difficulties must continue on until new and properly equipped premises are obtained. There are extensions needed from the point of view of equipment 33 which cannot be adopted in property utilised for other purposes. The understanding and assistance which has been given by the Authorities at the Methodist Central Hall should be placed on record—it has been very much appreciated. Every effort has always been made to meet our requests, often to the detriment of their own work. For the last ten years major forms of defects seem to be completely disappearing from the child population. Poliomyelitis is one outstanding condition which seems to remain outside our reach, and leaves major defects. If such cases are brought to the Clinic early, and treatment in Hospital has been afforded, the amount of defect from this ugly disease can be greatly reduced. The time factor is very important, as indeed it is in most other diseases. There is a decline in the major type of orthopaedic defect. Marked defects which formerly needed the attention of the Orthopædic Surgeon are more rarely seen and the less serious cases can now be treated by class exercises in the Clinic. Even some of the minor defects due to developmental conditions are disappearing altogether. The position with regard to children under five years of age awaiting operation for tonsillectomy and adenoidectomy is not satisfactory. All operations were suspended during the epidemic of Poliomyelitis, but as the year came to its close the shortage of hospital beds, and the long waiting list which accumulated owing to the ban, has presented a problem. There had been a weekly allocation of beds from the Royal Waterloo Hospital, but the Authorities there were compelled to cancel the arrangements, and at the present time the position is far from satisfactory. There is little prospect in the near future of the waiting list being reduced, and the children receiving the treatment which they require. It is high time that an extension of service in this direction was established. It is also apparent that a children's Unit is very necessary either alone or in conjunction with a General Hospital and should be developed in the North Middlesex area. The Day Nurseries have been well attended and the very long waiting list of children proves that more establishments of this nature are required. It is still a very difficult problem to obtain suitable probationers for Day Nurseries. There is a tendency in this Service from the applicants standpoint that if a girl cannot get suitable work elsewhere, then she will try a Day Nursery—such girls very quickly realise that the duties in a Day Nursery are more exacting than they imagine. Great credit is due to the young people who adopt this work as a career and carry on and see it through. The care rendered to children in a Day Nursery is one of constant attention and concentration on detail, in diet, training and character development. Compliments have been received from the teaching staffs of Edmonton Schools as to how well the Day Nursery children fit in to school life. The Services rendered at the Technical College are very good and appreciated by the probationers, but de-centralisation of training away from the Nurseries has not had a good effect. It tends to minimise the importance of the practical training, and raises in the minds of a pupil the desire of obtaining a certificate in a theoretical manner. The future, however, may see greater attention given to the practical work in a Day Nursery, and being brought into closer co-operation with the teaching side. A shortage of nursing staff, especially Heath Visitor/School Nurses has made it necessary to employ part-time State Registered Nurses to assist, and it will be some time before this difficulty can be overcome. 34 There are certain factors in this service which should be stated : (1) the retiring age of Health Visitors is earlier now than it used to be. (2) There is a great difficulty in obtaining new staff, as the demand is very much greater than the supply. Within the next five or six years a number of your staff will retire, and if the supply position does not improve it will be very serious for the district. It is desirable that facilities for training should be made available in the district for Health Visitor Pupils in order to widen the scope through which candidates can obtain instructions. It is now apparent from the National Health Service Act that district nursing will have to become a part of the Health service of the future. In passing, I would like to pay tribute to the good service and excellent attention that has been given to the sick in the neighbourhood by the local branch of the Queen's Nursing Association. This Organisation has experienced the same difficulties as ourselves in obtaining the necessary staff to carry out the nursing duties in the district. Great credit is therefore due to the efforts that have been made by those who have remained, in maintaining their usual high standard. It is to be hoped that a place will be found for this Organisation in the Health Service of the future. It is easy to control, it is effective in application, and efficient in its work, and altogether a condition of complete satisfaction is established amongst the General Practitioners, local Hospitals and our own Department. When necessary the Speech Clinic is available for children under five years of age by arrangement with the Education Committee. This service has proved of great value in teaching children of tender years to speak correctly, and it is extraordinary how quickly children of about three years of age and upwards, can accept the correction given to them. Through this medium, habit formation is curbed and the difficulties which would occur in the later life of the child are avoided. The dental sessions are held weekly by the School Dentists who devote this period to the attention of mothers and children under five years of age. This is not enough, but the restriction is due to the lack of premises to extend, and until building facilities become available again, it will have to remain a limited service. I should like to place on record once again, and for the last time under the old regime, my appreciation of the work carried out by the staff of the Maternity and Child Welfare Department whose co-operation has made it possible to plan and carry out the schemes for the mothers and children of which the district may be justly proud. The service rendered by this Department is performed so quietly, so efficiently and effectively that little attention is ever attracted towards it. The self-sacrifice and devotion to duty of the medical, nursing and clerical staff is a fact about which I am very proud. My thanks must also be recorded to the Chairman and all Members of the Maternity and Child Welfare Committee for their sympathy and understanding during the year. 35 The following information gives details of the Maternity and Child Welfare Clinics at the end of 1947 :— (1) Ante-Natal Clinic at Brookfield House, Fore Street (adjoining the Town Hall). Six sessions weekly. Ante-Natal Clinic at Weir Hall, Silver Street. One session weekly. (2) Child Welfare Centres :— (a) Brookfield Hou se. 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 wee kly. (e) St. John's. One session weekly. (3) Post-Natal and Advisory Clinic at Brookfield House. One session weekly. (4) Dental Clinic at Pymmes Park. Two sessions weekly. (5) Orthopaedic Clinic at Methodist Central Hall, Fore Street. Orthorpaedic Surgeon attends once a month. (6) Obstetric Surgeon attends once a fortnight at Brookfield House. Births. The total number of births notified during 1947 was as follows :— Live births notified by midwives 3,027 ,, ,, ,, „ doctors and parents 71 Still-births „ „ midwives 114 ,, „ „ doctors 3 3,215 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 1,506 „ „ ,, ,, doctors and parents 67 Still-births „ ,, midwives 38 „ doctors ... 1,611 Number of live Edmonton babies born in outlying institutions 582 Number of still-born Edmonton babies born in outlying institutions 9 The following table includes births of Edmonton residents and those born and registered in other districts :— Male. Female. Total. Live Births 290 292 582 Still-births 8 1 9 298 293 591 36 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 1947 who weighed 5½ lbs. or less :— (a) Born at home 53 (b) Born in hospital 61 114 VISITS PAID BY THE HEALTH VISITORS. The following table gives details as to the visits paid by the Health Visitors To children under 1 year of age First visits 2,236 Total visits 9,993 To children between 1 and 5 years of age 9,062 Infant Protection visits to children 5-9 years 73 Visits re adoption 237 Futile visits 2,507 Total visits paid 21,872 CLINICS Ante-Natal Clinic. The clinic at Brookfield House was held six times weekly (one session being for new patients only), and a new clinic session was commenced at Weir Hall in June, 1947. The following are the figures for the year :— Number of general sessions in the year 286 Number of prospective mothers 2,233 Number of consultations *10,621 Total number of attendances 13,185 Average number of attendances :— (a) Per session 39.01 (b) For consultation 37.13 Clinic for New Patients :— (a) No. of sessions 52 (b) New cases 1,534 (c) Total number of attendances 1, 661 * Included in this total are 651 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 AND ADVISORY CLINIC The Deputy Medical Officer of Health is responsible for the Post-Natal Clinic and the following will give some indication of the work carried out :— "The Post-Natal Clinic plays an important part in the work of the Borough. Its aim is the prevention of the many ills that woman is prone to, particularly those following child-birth. 37 Associated with it is the Advisory Clinic which caters mainly for the older woman, but also for the younger woman who is childless and seeks advice. In the past six years I have seen a steady growth in the popularity of the clinic, so much so that to cope with the numbers a second clinic will be opened in Weir Hall. The ideal times for a Post-Natal examination is the sixth week or the third month following the birth of the baby. Unfortunately owing to the large number of confinements this standard cannot be maintained. It is further complicated by the many women who do not seek advice until a year or two has elapsed after their confinements. These people of necessity will require prolonged treatment, and therefore impede the passage of other patients through the Clinic. The waiting list is very long at present, but it is hoped that 1948 will see the work extended. It has been noticeable, that in the case of mothers who ask for the examination at the proper time, and are found to need treatment, they respond far more readily and make a quick recovery. Regarding the types of cases seen, they may be classified thus :— (1) Displacements of the uterus and to appendages. (2) Cervical erosions and lacerations. (3) Deficient Perinii. (4) Cystocles and rectoceles. (5) Lax abdominal muscles. The latter may not seem in itself to be of great importance, but the resultant visceroptosis may lead to chronic ill health. (6) Psychological conditions. Cases which require operative treatment and those making poor progress are referred to Mr. Dodds, F.R.C.S., who attends fortnightly, and where necessary he makes the arrangements for operations at the Samaritan Hospital. We are fortunate in having the laboratory at hand as immediate examination of troublesome discharges can be undertaken, in many cases giving the lead to the correct treatment. Miss Jeans, Organiser of Physical Education, who was approached with the suggestion of special classes for remedial exercises for slack abdoninal muscles and uterine displacements has been most helpful in arranging these classes weekly in different parts of the Borough, namely Oakthorpe School, Raglan School, and Raynham School, and they are much appreciated and well attended. Her co-operation has been very valuable." The Glinic is held twice weekly and the following are the figures for the year :— Post-Natal Clinic. Number of sessions 46 Actual number of mothers who attended 423 Number of consultations 1,475 New cases 362 Total attendances at clinic 1,485 Average attendance per session 30.32 Advisory Clinic. New Cases 57 Total attendances 96 Number of mothers seen by Doctor 96 Specialist's Clinic. The consulting Specialist made 26 visits during the year and saw 159 cases, making an average of 6.11 per session. 38 Child Welfare Clinics. The figures relating to attendances are :— Brookfield House. Methodist Hall. St. Edmunds. Weir Hall. St. Johns. Number of sessions 151 100 103 101 51 New cases—(a) Under 1 year 665 253 364 418 221 (b) 1—5 years 93 45 67 70 29 Attendances— (a) Under 1 year 11,066 5,638 7,866 8,378 4,740 (b) 1—5 years 2,859 2,039 3,067 3,499 1,159 Total Attendances 13,925 7,677 10,933 11,877 5,899 Average attendances 92.21 76.77 106.14 117.58 115.66 Average doctor's consultations 33.44 20.30 23.23 25 48 26.49 Doctor's consultations 3,950 2,030 2,393 2,574 1,351 ORTHOPÆDIC CLINIC The following report from the Surgeon will provide a testimony which needs no further comment :— "This is one of the most satisfying of all clinics. Cases are seen in their early stages, when simpler forms of treatment are successful in curing them, and preventing permanent damage occurring. Long stays in hospital and operations are thus avoided in later years, and schooling and careers are not interfered with. The type of case we are particularly anxious to see in the first few weeks of the child's life is the 'club foot,' wry neck, and dislocated hip. These cases are serious if left untreated, and the sooner treatment is commenced, the better the ultimate result will be. Early treatment will minimise surgical operations at a later stage of the child's life. After the child had commenced walking, the postural deformities, such as flat feet and knock knee are common. On the whole these are easy to treat provided the Co-operation of the parents is obtained in bringing the children to the clinic regularly. It is particularly pleasing to see cases on their second or third examination showing marked improvement. Facilities are available for giving the majority of the treatments at the clinic. The clinic is associated with the Royal National Orthopaedic Hospital who supply any instruments or special footwear and also cases requiring operation are admitted to the Royal National Orthopaedic Hospital. Cases requiring operations are, however, very few. Vitamin deficiencies are now practically unknown and as a consequence rickets is no longer an orthopaedic problem. We hope that in the future with more and more attention being directed towards prophylactic medicine, that all infants will be seen and treated at the earliest possible stage, and thus reduce to a minimum deformities which remain with them through adult life." 39 The Clinic is held twice weekly and the following are the figures for the year :— Attendances. Surgeon's days 354 Treatments given 962 No. of children attending for treatment 748 No. of wedges fitted 130 No. of surgical instruments 3 In-patient Treatment. Three children were admitted to Stanmore during 1947. Dental Clinic. Details of the work carried out are :— Mothers. Children. Number of sessions 105 102 Number of attendances 1,220 618 Number of new cases 395 317 ' Actual number treated 609 372 Total number treated—General Treatment 714 585 Dentures 410 — (Average of 4.55 visits each denture). Fillings 131 — Dressings 37 1046 Scalings 43 — Extractions (Number of teeth)— (a) Under Gas 1,594 323 (b) Local Anaesthetic 22 — Number of gas cases 504 215 Dentures. Number supplied—90 of whom 89 paid the full cost, and 1 free of charge. Sunlight Clinic. 427 children were referred during the year for sunlight treatment and 1,851 treatments were given. The work of this Clinic had to be curtailed in order to devote more time to the orthopaedic side. Ophthalmic Clinic. 123 children under 5 years of age attended this clinic during the year. 79 attendances were made for Refraction, 27 for examination and 104 for re-examination. The examinations consist of cases other than refractions who on their first visit to the Clinic were suffering from persistent discharge of the eyes styes, Tarsal cysts, blinking, ptosis, etc, The re-examinations refer to the follow-up visits of children who have already attended once for refractions or examinations. Speech Clinic. Arrangements are made with the Education Committee for children under five years of age to attend the Speech Clinic and 12 children were referred during the year. No charge is made to the parents. 40 Details of Distribution of Free Dried Milk, Cod Liver Oil, etc. Distributed by the Maternity and Child Welfare Department apart from any scheme of the Ministry of Food. Trufood 18 tins. Ostermilk 105 „ Cow and Gate 286 packets. Cod Liver Oil and Malt 20 cartons. Halycalcyne 6 packets. Glucose 50 „ Convalescent Cases. One child was sent away under the contract with the Invalid Children's Aid Association. Tonsils and Adenoids. One hundred and ninety-five children were referred for operation during 1947, and 49 children had operative treatment. INFECTIOUS DISEASES. Ophthalmia Neonatorum. Twenty-four cases were notified during the year and of these 20 occurred in the North Middlesex County Hospital, 9 of which were Edmonton cases. Of 4 cases which occurred in the district one was removed to hospital. Puerperal Pyrexia. Seventy-seven cases were notified during the year and of this number 74 occurred in the North Middlesex County Hospital of which 19 were Edmonton cases. Two cases occurred in the district and 1 was removed to the Isolation Hospital. It must be understood that the more serious cases of midwifery are referred to the Hospital, and therefore complications are more likely to occur. MIDWIFERY SERVICE. Analysis of work. Actual confinements attended by mid- wives 981 Attended by midwives, but women admitted to hospital before or during confinement 218 Left district before confinement or mothers evacuated through L.C.C. scheme, etc. 40 (Of this number 887 as midwives and 94 as Maternity Nurses.) (Sixty of these women were discharged from Hospital after the fourth day and attended by the Council's Midwives for the nursing period.) (Attention and supervision given by Municipal midwives during AnteNatal period.) In addition to the actual 981 confinements attended, a total of 19,691 visits were paid by midwives as under :— Ante-Natal visits to homes 2,283 Post-Natal Visits 14,871 Additional evening visits 96 Visits after fourteenth day 58 False alarms 630 Special Visits 989 Second Nurse for Gas and Air Analgesia 4 Miscellaneous 758 41 Medical Aid. The number of claims made by doctors for Medical Aid during the year 1947 was 184, of this number 7 cases were granted free of charge, 3 at half cost and the remainder paid the full fee. Gas and Air Analgesia. Two hundred and thirty-six women had gas and air analgesia during the year. Blood Transfusion Service. Under an arrangement with the North Middlesex County Hospital, Medical Practitioners can now call upon the Blood Transfusion Service, and one case was attended during the year. Home Helps. One hundred and thirty-four women had the services of a Home Help during, 1947, all of whom paid full cost. Ante-Natal Scheme of Co-operation between the Council and the North Middlesex County Hospital. Under an arrangement with the Middlesex County Council 399 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. A further 27 were visited for the Mothers' Hospital, Clapton. Sterilised Maternity Outfits. Five hundred and ninety-nine sterilised maternity outfits were issued during the year, 590 were paid for, 3 paid half cost, and 6 were given free of charge. X-Rays. Two mothers were referred to the hospital for X-Ray Examination during the year, both of whom paid the full cost. PRIORITY DOCKETS FOR SHEETS. Priority dockets for sheets are issued to mothers having their confinement at home, and during the year 1,109 were issued. 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. Two were admitted during 1947. 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 1947 was 8 and the number of children 11. The Deputy Medical Officer of Health also makes periodic visits of inspection to the homes. 42 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 31 Number of children in respect of whom notice was given 31 Number of children under supervision at the end of the year 12 Day Nurseries. Attendances for the whole year were:— Fore Street 16,733 Hertford Road 12,466 Florence Road 13,758 Silver Street 12,972 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. Fifty-seven medical inspections were arranged during the year, and in addition the Health Visitor/School Nurses carried out routine visits of inspection to the children. Fees Collected. £3,830 5s. 8d. was taken for the sale of food in Clinics and £2,749 2s. 3d. collected for fees for the various services connected with the Department. 43 COUNTY COUNCIL OF MIDDLESEX BOROUGH OF EDMONTON Education Committee 1947 Chairman Alderman A. J. G. Hollywood Vice-Chairman Councillor Mrs. F. Long, J.P. Aldermen: W. T. Green, W. Preye, J. Reid, J.P., R. W. Ricketts and Mrs. E. A. Young, J.P. Councillors: J. A. G. Beattie, S. W. Creasey, Mrs. L. M. George, R. J. Grant Mrs. S. J. Halliday, W. C. Humphries, E. Jones, C. G. Lacey, M. Simpson, C. F. Watkinson and A. Wright. County Councillor: T. H. Joyce. County Alderman: Mrs. L. R. Ithell, J.P. Co-opted Members: E. G. Cole, Mrs. M. A. Langford, A. J. Smith and E. S. Taylor. 45 To the Chairman and Members of the Education Committee: Ladies and Gentlemen, I beg to submit my Annual Report on the School Health Service for the year 1947. The report is compiled in respect of the health and well-being of the school children of Edmonton in accordance with the wishes of the Ministry of Education conveyed to me through the medium of the Middlesex County Council. We have now grown accustomed to the operation of the 1944 Education Act in the School Health Service, and accordingly have developed our Services more efficiently and in some ways more effectively. Coupled with the benefits that will undoubtedly accrue from the National Health Service Act, a further more detailed improvement will be brought about. It is to be hoped that more speedy and effective treatment of the children under the new circumstances will add considerably to their health and happiness in the course of their School life. The conditions with regard to tonsils and adenoids have improved a good deal since last year, but we are still experiencing some difficulty in getting patients into Hospital for operations. In some instances the waiting list becomes so tedious that the patients proceed to have the operations carried out privately. I am glad to be able to report that those children who have been treated have in the mam shown a great improvement in their health, and parents are satisfied that the best thing had been done for the children. I am happy to report that serious deformities are now the exception rather than the rule in the Orthopædic Clinic. There are, however, quite a number of minor deformities which still need the attention of the Surgeon, and this type of deformity seems to be on the increase. We have also had the services of two Remedial Gymnasts. These Officers are to work under the direction of the Orthopædic Surgeon or the School Medical Officer, but we had not been able to arrange this mainly because the problem involves administrative difficulties as well as technical ones. Unless there are sufficient number of Gymnasts appointed it is impossible to make a definite return concerning the whole Borough. We have, however, used the Officers in question as far as possible in a number of schools, and we are satisfied that benefits have been given to the children. We have had a setback this year in Child Guidance Our Medical Psychiatrist, Dr. Fordham, left the Staff, and it has been very difficult to replace him. The result is that some of the benefits that one would expect from Child Guidance had to be set aside and both parents and teachers showed some annoyance at the delay in having their children examined and treated. The Dental service has continued to give good results, but the number of Dentists employed by the Borough is not yet sufficient to deal with the problems of dentistry throughout all the schools. We are hampered here, and indeed in other departments too, by the lack of suitable premises in order to expand our services and give immediate treatment to all who need it. Parents are showing an added interest in the Asthma Clinic. In some instances we have acquired a great degree of success while in others the results are somewhat disappointing. We combine the services of the Inoculation Department of St. Mary's Hospital with suitable exercises and, in many instances, admission to the Open Air School. 46 The Ophthalmic service for the last two years has shown a great expansion and in order to meet this we have had to establish two extra sessions every fortnight. It would, however, be desirable for an orthoptic department to be established in association with this in order to relieve many of the minor conditions associated with errors of refraction. The Aural Clinic continues to give great satisfaction especially in those conditions that are allied to diseased tonsils and adenoids. A greater degree of examination and consequently a greater degree of treatment helps to restore the child to normal health more rapidly. The Open Air School continues its good work. One wonders why authorities have been so long without Open Air Schools, and why more of them are not established in order to afford a wider and more thorough restoration to health of even the slightly abnormal. The Headmaster and his Staff are enthusiastic in the work they are doing, and consequently the work left for the Medical Department becomes easier and more easily accomplished. The popularity of this school is now well-known in the district. Formerly, when it was first opened, we had great difficulty in getting parents to allow their children to go to the School. Now we have an equal difficulty in getting them to leave. The mentally sub-normal children in the district are presenting quite a problem. A number of borderline cases of educationally sub-normal children are causing difficulties mainly because of the overcrowded nature of the classes in school. Sufficient attention cannot be given to these cases, as the particular types of teacher is not available, and it would appear that it will be some time before they are. Special attention to the education of such children (I.Q. 70-85) in special classes in the ordinary schools can bring tremendous benefit to the children in this category. It is our duty in the Medical Department to discover and classify these children. Having done so it oftentimes is a year or more before they are admitted to the Special School. This is due to the lack of accommodation in the School itself. The benefits to such children are very well established, and to anyone in doubt about the conditions, both of health and education to the pupils of this school, should visit the premises particularly when the school is in session. The improvement in most of the children's outlook is very marked indeed. Some, however, are perturbed when their friends outside can leave school at the age of 15 and they cannot. A good deal of the burden of the Special School can be eased by the establishment of special classes in the ordinary schools for the education of some of these children. The borderline cases present a great difficulty which I hope will soon receive attention to a greater degree than at present. The Rheumatic Clinic seems to be steadily finding its own sphere. The help and assistance to parents is undoubtedly beneficial, and in many instances the pupil is saved unnecessary worry at school by a timely diagnosis. There should, however, be some form of treatment associated with the clinic, particularly of a hospital nature. This would be exercised if "Rheumatism" were made a notifiable disease and reports went to the private practitioner concerning the child. We are very pleased indeed to see the good progress, and better still the good results, obtained in our Orthodontic Clinic. We are doubly proud of this fact because the clinic was started during the early years of the War, when it was difficult to obtain appliances and to achieve continuous treatment on account of evacuation. Nevertheless the parents perceive the good results, 47 and there are now some 800 cases under treatment. The aesthetic effect on the children concerned is a matter of great satisfaction. The Speech Clinic as usual presents very satisfactory results. This Clinic has always given very good results in a very high percentage of cases. The parents, children and Clinic workers seem to co-operate beautifully, and the children who otherwise are mostly hesitant and nervous seem to fall into line with other treatment and sometimes to accomplish what appears to be the impossible. It is to be regretted that throughout most of the services quite an effective part of treatment in all departments is lost on account of failure to keep appointments. This also means that the School Nurses and Welfare Officers have to spend quite a considerable time in rounding up the defaulters. It is true that the numbers involved are not as great as they used to be, but they are still large enough to weaken the services. I would like to express my thanks to the members of the Education Committee for their help and assistance during the year. I would like also in a special way to thank the Head Teachers and Staffs for their kindly co-operation and friendly assistance at all times. To my Staff I owe a great deal for the effective way in which they set about their duties, their timely attendance and personal interest in the work of the various Departments in which they operate. I have the honour to remain, Ladies and Gentlemen, Your obedient Servant, D. REGAN, School Medical Officer. 1. CO-ORDINATION. I am pleased to report that every assistance is given by head teachers, private practitioners, the Chest Clinic, local and Metropolitan Hospitals, social services and various departments of the County Council, thus enabling the co-ordination to run smoothly as in previous years. 2. MEDICAL INSPECTION. During the year 1947, 5,881 children attending Primary and Secondary Schools were given a full routine medical inspection and the analysis of the age groups was as follows:— Entrants 2,124 Second Age Group 2,490 Third Age Group 1,213 Other Periodic Inspections 54 Special inspections and re-inspections totalled 17,779 during the year. 48 3. FINDINGS OF MEDICAL INSPECTIONS. (a) Classification of the Nutrition of Children inspected during the year:— Number A B C Inspected (Good) (Fair) (Poor) 5,881 2,097 3,386 398 (b) Cleanliness. The total number of examinations carried out in the schools by the school nurses was 43,620 and the total number of individual pupils found to be infested 918, in respect of whom cleansing notices under Section 54 (2) of the Education Act, 1944, were issued. The number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3)) was 144. (c) Minor Ailments and Diseases of the Skin. The total attendances at the two Minor Ailments Clinics during the year were 26,910, as follows:— Pymmes Park Clinic 13,013 Croyland Road Clinic 13,897 (d) Visual Defects and External Eye Diseases. The Ophthalmic Surgeon has submitted the following report:— "The progressive increase in the number of school children and children under school age, which has been going on since the Ophthalmic Clinic commenced, is even more marked than in previous years, and the total attendances have reached the very large figure of 3,697, which is a record. There can be little doubt that in comparison with other clinics of this kind the parents attending this clinic show much more interest and enthusiasm in the matter of the children's eyesight than is found elsewhere. The merit in this matter is due to the doctors in the Edmonton Clinics and in some cases to the general practitioners in the neighbourhood. The number of children referred for Refraction during the year has amounted to 1,358. It will be appreciated that glasses are frequently ordered for children whose vision is in fact not defective but as a result of such children suffering from headaches or from styes or from eyestrain and sometimes from the child's inability to keep its writing on a straight line, and that it is not showing progress in school. This, of course, in many instances has to be explained to the parents who otherwise would not understand why glasses are ordered when there is no defect in vision, though it is usually due to their own descriptions of their child's symptoms. It would be safe to state that of all these cases practically 100% are rapidly cured by the wearing of the glasses prescribed, and, the difficulties caused by the headaches, styes and eyestrain disappear almost immediately. One of the outstanding benefits of this clinic is that congenital defects are dealt with in the earliest stage. This has always been earnestly desired by Ophthalmic Surgeons so that treatment can be commenced before school age, thereby preventing the conditions becoming more difficult or even impossible to remedy. In cases of squint and congenital cataract this early treatment at the youngest age is of paramount importance. 49 It will be readily understood that Ophthalmic treatment, where required, has considerable effect in improving the child's intelligence and outlook. This is noticeably observed when the children come for re-examination. / In conclusion, the work of the Ophthalmic Clinic has been rendered more comprehensive and efficient by the assistance and co-operation by the doctors of the Edmonton Clinics and also the nurses attached thereto and by the careful attendance of the nurses in the Ophthalmic Clinic and in all the other clinics concerned. Credit in this respect is further due to the teachers for their careful observation of the children. It is only proper that credit should be given to the optician as the prescriptions are made up with great care and accuracy and more speedily than in other clinics." (e) Ear, Nose and Throat Defects. The Aural Clinic is held at Croyland Road twice each month. The yearly attendances were:— New Cases: 153. Old Cases : 382. Total 535. The Specialist reports as follows:— THE CASES. " Nasal Catarrh—10 Cases, 5 cured. Argyrol or Sulfex used. (Per Se) 3 much improved. 1 sent to Speech Clinic. 1 with Diseased Teeth, not yet treated. Pathological Nasal Septal Deflection—16 Cases. 5 cured or greatly improved. 7 not yet operated on. In some of these 16 cases, Diseased Teeth were treated, but the other causes present as well have not yet received operative help, and are still waiting for such. Nasal Sinusitis with Diseased Teeth—1 Case, operated on with great improvement. Aphonia—2 Cases, one associated with Pathological Nasal Septal Deflection. Diseased Tonsils and (generally) Nasopharyngeal Adenoid Excess—59 Cases, majority awaiting operation. Sixteen of these cases also had a Pathological Nasal Septal Deflection, and showed a good result after treatment. Another had, besides the above, active Nasal Sinusitis. He was cured by operative treatment. A further 36 Cases suffered with Diseased Tonsils and Adenoid Excess, associated with Chronic Tympanico Mastoid Suppuration, several of which cleared up well with treatment. Another Series of Cases—numbering 27—showed Diseased Tonsils and Adenoid Excess with Diseased Teeth, several of which have undergone Dental Treatment with very satisfactory results, but most of these children are awaiting operation. 50 A further Series—12 in number—were cases of Nasal Sinusitis, with Diseased Tonsils and Adenoid Excess, many of which were operated on. Four cases of Diseased Tonsils and Adenoid Excess complicated by Acute Tympanic Suppuration were treated. There were 5 Cases with Chronic Tympanico-Mastoid Suppuration and Diseased Teeth. There were 9 Cases of Chronic Tympanic Catarrh, mostly associated with Diseased Tonsils and Adenoid Excess. One Case of Tympanic Deafness was sent to the Speech Clinic, but is not yet cured. There was 1 Case with Nerve-deafness, Diseased Tonsils and Adenoid Excess, and Diseased Teeth, who underwent operation, and then Eustachian Catheterisation, and was definitely improved. Another Case showed Acute Tympanico-Mastoid Suppuration with Diseased Tonsils and Adenoid Excess. One Case suffered with Nasal Sinusitis, and complicated by Acute Tympanic Suppuration. Six Cases showed Nasopharyngeal Adenoid Excess without Diseased Tonsils. Sixteen other Cases including the following:— 1 Asthma—greatly relieved by surgical Diathermy to the Inferior Turbinals that were very swollen. 1 Foreign Body in the Left Ear, with Diseased Tonsils and Adenoid Excess. 1 Congenitally deaf child, almost a mute. GENERAL REMARKS It is a very common experience to find that great relief in nasal breathing is obtained after small puncture and lavage of one or both infected Maxillary Sinuses . . . and, as regards the Sinusitis itself, this method of treatment once, or twice in some cases, using very temporary general anaesthesia, has given very encouraging results. I have noticed that, in several instances, the Notes of Hospital Out-patient Treatment, such as the above, have not been entered on the Aural Clinic documents. Of the various methods of relieving nasal obstruction in children, due to mechanical faults, I have found none so efficacious as that of ' Straightening of the nasal septum. This, carried out with a pair of special forceps, consists in simple intra-nasal septal fracture, rarely needing the subsequent help of splints. The manoeuvre occupies about one minute, causes no, or very slight haemorrhage, and does not alter the external configuration of the nasal organ. 51 A few cases require a more extensive operation, involving removal of some of the obstructing tissue, together with Straightening, but these latter are few and far between. In spite of the adverse criticism levelled at these procedures, I have been unable to find any evidence that they seriously interfere with the subsequent growth of the nasal tissues, whilst the advantages gained are very obvious. No Tonsillectomy and Adenoidectomy will cure nasal obstruction due to bony or cartilaginous deviation . . . and, if this be left untouched, the Tonsillectomy and Adenoidectomy will have lost a great part of its value, with serious consequences to the physical and mental development of the child. I would point out that many cases of nasal catarrh are cured by Tonsillectomy and Adenoidectomy. I still find that nasal guttae Sulfex provides the best type of treatment for nasal catarrh, especially when acute—suppurative or otherwise, and where there is no Tonsillar disease or excessive Adenoid growths—but it must be Vised with caution, as it contains Sulphathiazole—and where this latter drug is inadvisable, Argyrol or Argotone are helpful. In all Cases requiring operation, where the Teeth are diseased, I have always urged prior Dental treatment, except in urgent conditions. Some patients shew marked Tonsillar improvement after Dental treatment has been carried out. In one Case where Tonsillar operation had been performed (elsewhere), Tonsillar remains were found on one side, which looked very unhealthy, but recovered their healthy state after removal of Dental sepsis. The epidemic of Acute Poliomyelitis, during the late summer and autumn, prevented a large number of operations being performed within a reasonable period, and so has protracted the pathological state of these little patients—thus rendering the task of cure more difficult. I am still of the opinion that a second Adenoidectomy should not be performed unless nonoperative treatment has failed; so very often does nasopharyngeal adenoid excess diminish to a great extent when the active infection has disappeared— this Adenoid excess being one of Nature's methods of resistance to bacterial invasion. A large majority of children with recurrent Adenoid excess shew great improvement with the use of Nasal guttae Argyrol—5 per cent.—or some other similar drug. I feel sure that this excess is often encouraged by nasal obstruction, especially when this has been chronic. During this last year I have had further confirmatory proof of the great value of our Speech Clinic in Cases where there is no mechanical obstruction (often previously removed), thereby promoting the habit of nasal breathing—and thus indirectly aiding hearing. It is not an easy matter to distinguish between some Cases of Deafness due to an aural lesion per se, and those due to cerebral lack of appreciation —often in combination, for deaf patients gradually lose that "qui vive" so vital to acute hearing. Some of these children shew great lack of attention and power of concentration—often with no obvious aural lesion, and these latter are more successfully treated by Mental rather than Physical means. The treatment of early Cases of Acute Tympanic suppuration with Systemic, and sometimes, local Penicillin, is proving successful, and is often aided by Myringotomy, when there is definite membranic bulging, with lack of necessary drainage. The value of Penicillin in these Cases must not be 52 over-estimated, however, as often it seems to confer but temporary amelioration, thus producing an unjustifiable sense of security. I have found that in Cases of Acute Mastoiditis, where before the days of M. & B. products and Penicillin (combined or separate), I should have operated, the results seem to have been quite as satisfactory as with their use—whilst in recent Cases of this disease, even though these drugs have been administered, operation has had to be resorted to after all. However, there is no question that these drugs have proved of very great value in some very severe Cases, and seem to have aborted the onset of serious complications in mild acute conditions. The sensitivity, or its opposite to these chemical products—and the type of bacteria that are chiefly attacked by them, are two problems that necessitate much careful investigation. In Cases of Eustachian infection that is maintaining Tympanic suppuration, as evidenced by the persistence of a thin, muco-purulent discharge, can often be successfully treated by Eustachian Catheterisation, with, the injection into the tube of the following oil, viz.:— Iodum Resublimat gr. 2 Ol. Eucalypti m. 3 Menthol gr. 5 Ol. Sassafras m. 3 Camphor gr. 3 Liq. Paraffin ad. 1 It can be truthfully said that Chronic Tympanico-Mastoid suppuration is much easier to cure where no diseased Tonsils or Adenoid excess are present. Among the list of cases was one of Enuresis, which was definitely improved after Tonsillectomy and Adenoidectomy. I have found it very difficult to estimate many results of treatment in these children, as so large a number have failed to keep their appointments." (/) Speech Defects. Cases of speech defects were dealt with by the Speech Therapist and the following is an account of the year's work:— "The work of the Clinic has continued steadily with five sessions per week throughout the year. Our new premises have proved most useful and we feel really happy and at home there. We should, however, like some more equipment—toys, books, etc., and one or two gay pictures would make our quarters more attractive to the children. The clinic was first opened in 1937 and looking back over ten years' work through the stress and strain of war and post-war conditions we feel reasonably satisfied. In all 833 school children have been seen, this year we have a record high number of discharges (70) and a record low number of children awaiting treatment (14). A pleasant aspect of our work at Pymmes Park has been the friendly calls we have received from parents of old cases who were visiting other departments in the building. We have always held the view that happy co-operation with the parents is one of the essentials of successful speech therapeutic work among children and we have been gratified that busy mothers should find a few minutes to come and thank us for work done in the past. 53 We are pleased to report that only 17 out of 90 new cases were aged ten or over but we would again emphasise that children should be referred as early as possible in their school life. A little advice to the mother, watching and guidance at 5 or 6 may save prolonged treatment for a true stammer later on. Of the 90 new cases only 14 were diagnosed as stammerers, by far the greater number being dyslalics. 182 children have received treatment during the year. We still feel that the number of defaulters (22) is too high ; having almost eliminated a waiting list we hope to make the reduction in the number of defaulters one of our main tasks for 1948. Of the 14 children on the waiting list 3 are awaiting surgical treatment, 2 are awaiting the eruption of second teeth, and the remaining 9 will be called in January. he figures for 1947 are as follows:— 1/1/47 144 children on the books. 90 new cases. 7 re-admissions. Total 241 Discharged 70 Deleted 46 (includes defaulters, left school, etc.) Waiting 14 Treatment 111 Total 2411 The number of children on the books 1/1/48 is 125. Five years comparison 1943 1944 1945 1946 1947 New cases 74 92 52 90 90 Treated 125 143 144 153 182 Discharged 61 51 38 40 70 Waiting 49 44 22 42 14 WELFARE.—During the year 8 old and 8 new cases have been seen making a total of 16. Discharged 1, transferred to school 6, treatment 4, being kept under observation (3 monthly) 5. (g) Dental Defects. The Senior Dental Officer reports as follows:— "There were three full time Dental Clinics in operation throughout the year for the first time since 1938. It may therefore be of some interest to compare the work carried out in these 2 years. The following table sets out the most important details of Inspection and treatment during 1938 and 1947. 1938 1947 Routine Inspection 11,886 4,731 Specials' 2,051 1,481 Total 13,937 6,394 54 Number Referred for Treatment 10,894 4,422 Actually Treated 5,760 4,456 Permanent Fillings Inserted 7,255 3,875 Permanent Teeth Extracted 1,922 972 Temporary Teeth Extracted 9,107 4,946 Other Operations 6,450 8,838 The percentage of children referred for treatment in 1938 was 78%. The same figures for 1947 show a drop to 71%. I should point out here that these figures include the specials for whom a much higher percentage are referred. Although considerably under half the number were inspected and referred during 1947 than in 1938, the corresponding ratio of actually treated is more than three quarters. This would appear to indicate a much higher rate of acceptance although not necessarily a true one which can only be assessed over the whole school population. Comparison of numbers of fillings and extractions of permanent teeth shows approximately as follows:— Per 100 children:— 1938 1947 126 fillings 87 fillings 33 extractions 22 extractions These figures are consistent with the generally noticeable decrease in caries recorded during the War years. Of the 972 permanent extractions during the present year, 377 were for orthodontic purposes. Temporary extractions also show a similar decrease. Two other factors have to be borne in mind with regard to the pre-war years and the present. In 1938 one session per week was devoted to M. C.W. whereas now two sessions are the rule. Orthodontic work before the War was confined to the extraction of misplaced teeth. The fuel cut early in the year put a stop to filling work while it 'lasted. Mr. McCallin gave 929 consultations during the year, of which 258 were new cases. About 150 cases were closed. There are in the region of 800 cases under treatment. The following table gives a rough idea of the work involved:— Appliances fitted 841 X-rays taken 450 Impressions taken 1,724 Attendances about 7,500 Adjustments, etc. 4,194 I am to some extent adopting the principle of making and fitting space retaining appliances where temporary teeth are lost too early, in order to avoid more complicated treatment at a later age in those cases which may be reasonably attributed to this cause. In presenting this report, I hope that I have been able to give a clear picture of the efforts of myself and my colleagues in the School Dental Service. There is a great deal more that we, with more help, desire to achieve. We want all our children to have the opportunity of being cared for at least once a vear. 55 I am well aware of the efforts you are making for us in that direction, and I would like to take this opportunity of officially expressing my appreciation of your sympathetic understanding of our problems, and readiness to help us in whatever way possible." Orthodontic Clinic. Herewith report on the activities of the Orthodontic treatment for Edmonton school children. ' Since reporting at the end of 1946, Orthodontic treatment for the school children of the Borough has been carried out by the three dental officers with the assistance of the specialist. During this year the specialist has attended each of the three clinics once each month, which has meant that not only has it been possible for more children to come under treatment, but it has been possible to devote ) more time to the consideration of each problem. This has meant an increase in the number of children under treatment and must have thrown a heavier burden on the dental officers, as more appliances have required to be watched. As in the past these officers have shown great interest in the work and credit for any results obtained is due to them. The mechanical work has been carried out with patience and skill by Mr. Gittus, who also has been invaluable on clinic mornings, shepherding the children around, so that the minimum of time is lost between each patient. It is difficult to assess the results obtained as there is no reliable yard' stick, but it is true to say, that in many cases considerable improvement has been effected and that in some cases pleasing aesthetic results can be shown. The only difficulty that has been encountered through the year is the problem of the broken appointment. Patients have a way of slipping through the net of the system of recall as it stands at present. It is realized that the problem of keeping track of each of these children is a great burden to the assistants, and that in any event the parents should feel a responsibility to see that the children attend, but experience shows that quite a large number of them do not. That the breaking of appointments is unavoidable on occasions is realized, but it is possible that the system of recall when this happens might be studied to see if anything could be done to tighten it up and avoid having to start cases a second time with the inevitable expense and waste of time that this involves. On the whole it has been a good year, and I hope these details will give you some idea of how we have fared.'' (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. The following report has been submitted by the Orthopaedic Specialist:— " Examining the returns of the orthopaedic clinics, it is noted that flat feet, knock knee, and postural spinal deformities composed the major part 56 of the work. The large majority of these were in the early stages, and have on the whole, responded well to treatment. Success to a large extent, depends on the co-operation and enthusiasm of the parents, in encouraging the children in regular remedial exercises at home as well as regular attendances at the clinic for supervised treatment. With a few exceptions, this has been easily obtained. Postural deformities of the spine occur mostly in the older children between eight and fourteen years of age and treatment is helped considerably as the patient is old enough to take an interest in curing their disability. The past year has been notable for the very severe epidemic of infantile paralysis, and several in this district have been affected. In spite of the difficulties in obtaining good children's footwear, I have been impressed with the good relative standard of boots and shoes seen at the clinics and this has helped considerably in the treatment of foot conditions. The almost total absence of rickets amongst the children reflects credit on the health welfare of the borough, as does the absence of new cases of tuberculous joints. The Specialist saw 289 New Cases and 460 Old Cases—making a total of 749. The following is an analysis of the new cases seen during the year :— Boys Girls 1. Congenital Defects 13 8 2. Birth Injuries 2 — 3. Rickety Deformities 1 — 4. Knock-knees (non-rickety) 8 18 5. Postural Defects of the Spine 12 13 6. Structural Curvature of the Spine — 2 7. Flat Feet 33 32 8. Infantile Paralysis 2 1 9. Sequelae of Acute Fevers — — 10. Fractures 2 1 11. Tuberculous Joints — — 12. Other Bone Diseases 2 6 13. Other Conditions 35 39 14. Non-Orthopaedic 4 4 15. Normal 23 28 - 137 152 The attendances for treatment by the physiotherapist during the year were 1,896. The Ultra-Violet Light Clinic was held on four afternoon sessions weekly. The total attendances for the year were 2,100. 57 (i) Heart Diseases and Reumatism. The Rheumatic Clinic is held once monthly at Croyland Road for the purpose of examining children suffering from rheumatism and diseases of the heart. The specialist reports as follows :— "During the year 1947 altogether 251 children attended the Rheumatic Clinic, of which 187 were old cases and 64 new. It is interesting to note that only 3 of the number of children seen were of the arthritic type, thus emphasizing the important truth, that childish rheumatism differs essentially from the adult form. It is not surprising that in past years the absence of joint involvement in children led to the failure to detect the presence of juvenile rheumatism, with the result that many young people did not receive proper treatment and guidance until they presented cardiac symptoms and signs—the too often dramatic results occurring in missed childish rheumatism. The picture of the rheumatic child, is as already stated, different from the arthritic form seen in adults. In children rheumatism may assume many guises—as for example—listlessness, irritability, pallor with or without real anaemia, nervous twitchings and vague aches and pains in different parts of the body, more particularly in the lower limbs. Such types of rheumatism are common, and are best designated as "subacute cases," ninety-five of these being diagnosed at the Clinic during the year. A considerably large group of cases, namely, 36 in our series came under the heading of "Fascial type." The word, fascia, denotes a sheet or band of tissue which invests and connects the muscles. Inflammation of this band of tissue is prone to occur in rheumatic infection, and gives rise to an ache or even severe pain in such places where fascia exists, e.g., the thighs or the abdomen. In the latter situation, if the pain be located chiefly to the right lower region of the abdomen, the diagnosis of appendicitis may wrongly be made. Apart from the irritability and muscle twitchings already referred to in connexion with the subacute cases, a more severe and haphazard type of jerky movements are often met with in rheumatic children, and denote either a choreic tendency or a definite chorea. Forty-five chorea examples were noted in our cases. The importance of recognising chorea at an early stage of the disease, lies in the fact that this form of juvenile rheumatic trouble leads more often to heart complication than any other variety of rheumatism. I am convinced that the early recognition of those somewhat indefinite nervous symptoms as manifestations of childish rheumatism, and the appropriate advice given to the parents, and the limiting of the patient's activities, must have resulted in the lesser incidence of rheumatic heart disease in later life 58 Children exhibiting nervous symptoms, unless some definite cause otherwise, is apparent, should be suspected as sufferers of rheumatism. Of the 38 cases in the series showing heart involvement, a history of vague nervous symptoms, or chorea, was obtained oftener than that of rheumatic fever. When a child suffers from definite rheumatic fever, it is obvious that all care and precautions will be taken to avoid, if possible, cardiac complications in the future, but unless chorea, or indeed, nervous manifestations are recognised as being of rheumatic origin, the same care and precautions will too often be neglected. Of the children seen by me at the Clinic during the period under consideration, 7 were recommended for the " open air school." I have been greatly impressed with the great improvement in the condition of those who were fortunate enough to be admitted to such schools. I hope, and wish, that it may be possible in the future to be able to extend such privileges to a greater number of children suffering from early, and * even mild rheumatic tendencies. During the year only 20 were discharged, and this may seem a very small percentage, but in my opinion, one of the great advantages of the rheumatic clinic, is that one can observe the cases over a protracted period, and guarantee for them, as far as is reasonably possible, an assurance that in later 'life they will have no recurrences, or complications of the disease." (j) Open Air School. The headmaster has submitted the following report :— "The number on roll has remained constant at 140. 91 children were discharged in the course of the year and this number is considerably above the average. 91 children were admitted. The weather during the early part of the year was very severe and for days on end the temperature was below 32 degrees. The children stood up to this remarkably well and, in fact, appear to have thrived in the cold but dry conditions. There are 125 children admitted under category 'E' and 15 under category ' J" (^) Educationally Subnormal Children. The following is the headmaster's report :— "There are at present 58 Edmonton children attending the School. Enfield children number 66. 59 On the waiting list there are eight Edmonton children and nineteen Enfield children. The above figures indicate that the number of children from Edmonton attending the school is increasing. During 1947 25 Edmonton children were admitted and 6 Enfield. The proportion of Edmonton and Enfield children in the school is approximately equal. In 1943 the ratio was 3 Enfield to 1 Edmonton. This does not necessarily indicate that in recent years there has been an increase in Educational Subnormality, but rather that more children are being detected in the normal schools. It is most important that we should receive these children at about the age of eight years so that we have them over a period of eight years before they reach the age of 16. Children who are sent to us at the ages of 12, 13, 14 are at a grave disadvantage. They have lost the groundwork and take a very long while to settle down in their new surroundings and also they create a problem in the school from the administrative standpoint. Since September, 1947, most of the children have been brought to school by private coach from various picking-up points in the Edmonton district. This arrangement is certainly a great improvement upon the old method of public service transport. As the children grow and become more responsible they are allowed to travel on their own after consultation with Dr. Regan." (l) School Meals and Milk. During the year 1,207,354 dinners were supplied to school children in Edmonton. Of these 71,101 were provided free of charge to necessitous cases. The average number of children receiving meals daily at the end of the year was 5,556 (48.1% of the children in school). The increased demand for school meals during the year placed a heavy strain on the kitchens and as it had not been possible to make a start on the scheme to increase and improve the canteen facilities in schools, it became necessary to restrict the output of dinners to 5,300 daily and to limit the number of children commencing dinners to those coming within certain priority categories, e.g., neither parent at home during the day, living a long distance from school, etc. Later in the year the supply of dinners was supplemented when the neighbouring authority of Southgate agreed to supply up to 250 meals daily. The number of children receiving milk daily under the Milk in Schools scheme was 11,526 (98.3% of the children in Junior and Infants Departments and 78.4% in Secondary Schools). General Information. Average Number on rolls—1.1.47 to 31.12.47 13,924 Number of permits issued for Employment of Children 5 60 Number of Licences issued for Children in Entertainments 5 Number of Children supplied with Clothing 134 Number of Children supplied with Footwear 293 Number of Children who had Footwear Repaired 139 Number of cases undertaken under Adoption of Children Act, 1926, during 1946 55 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) Rheumatic : 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 and alternate Tuesdays. New cases by appointment only. (5) Orthopaedic: Surgeon attends on the second and fourth Friday in each month. Treatment carried out every morning at Central Hall, Fore Street, N.9. (6) Dental: Clinics held at Hazelbury Road, Pymmes Park and Croyland Road. (7) Orthodontic : The Specialist attends on the first, second and third Monday each month, one session at each clinic. By appointment only. (8) Speech : Held at Pymmes Park Clinic on five sessions a week. By appointment only. (9) Ultra Violet Light: This Clinic is held at the Orthopaedic Clinic, Central Hall, on four afternoons per week. By appointment only. (10) Asthma : Held at Pymmes Park Clinic every Thursday after- noon. Cases are first referred to Dr. Freeman at St. Mary's Hospital, Paddington, who examines them and recommends the necessary vaccine. 61 MINISTRY OF EDUCATION Medical Inspection Returns YEAR ENDED 31st DECEMBER, 1947 Table I. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. A.—Periodic Medical Inspections Number of Inspections in the Prescribed Groups :— Entrants 2,124 Second Age Group 2,490 Third Age Group 1213 Total 5,827 Number of other Periodic Inspections 54 GRAND TOTAL 5,881 B.—Other Inspections. Number of Special Inspections 6,711 Number of Re-Inspections 11,068 TOTAL 17,779 C. -Pupils Found to Require Treatment. NUMBER OF INDIVIDUAL PUPILS FOUND AT PERIODIC MEDICAL INSPECTION TO REQUIRE TREATMENT (excluding Dental Diseases and Infestation with Vermin). Group For defective vision (excluding squint) For any of the other conditions recorded in Table II A Total of individual pupils (1) (2) (3) (4) Entrants 6 942 942 Second Age Group 202 961 1,065 Third Age Group 94 553 603 Total (prescribed groups) 302 2,456 2,610 Other Periodic Inspections — 19 19 Grand Total 302 2,475 2,629 62 Table II. A RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1947. Detect Code No. Defect or Disease PERIODIC INSPECTIONS SPECIAL INSPECTIONS No. of Defects No. of Defects Requiring Treatment Requiring to be kept under observation but not requiring treatment Requiring Treatment Requiring to be kept under observation but not requiring treatment (1) (2) (3) (4) (5) 4 Skin 192 9 285 23 5 Eyes—a. Vision 298 46 56 8 b. Squint 32 5 7 t c. Other 105 12 97 5 6 Ears—a. Hearing 31 7 42 3 b. Otitis Media 2 — 7 — c. Other 58 9 132 15 7 Nose or Throat 529 515 641 327 8 Speech 32 13 19 3 9 Cervical Glands 24 173 15 45 10 Heart and Circulation 40 70 29 33 11 Lungs 176 79 87 43 12 Developmental— a. Hernia — — — — b. Other — 1 — — 13 Orthopaedic— a. Posture 235 19 187 10 b. Flat foot 320 25 276 13 c. Other 371 63 423 41 14 Nervous system— a. Epilepsy 3 1 5 1 b. Other 43 29 56 27 15 Psychological— a. Development 12 8 43 15 b. Stability 7 1 15 4 16 Other 967 293 1854 725 B. CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS Age Groups Number of Pupils Inspected A (Good) B (Fair) C (Poor) No. % of col. 2 No. , % of col. 2 No. % of col. 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants 2124 805 37.90 1190 56.03 129 6.07 Second Age Gronp 2490 818 32.85 1485 59.64 187 7.51 Third Age Group 1213 459 37.84 675 55.65 79 6.51 Other Periodic Inspections 54 15 27.78 36 66.67 3 5.55 Total 5881 2097 35.66 3386 57.57 398 6.77 63 Table III—Treatment Tables GROUP 1.—MINOR AILMENTS (EXCLUDING UNCLEANLINESS, FOR WHICH SEE TABLE V). Number of Defects treated, or under treatment during the year (a) Skin— Ringworm—Scalp— (i) X-Ray treatment. If none, indicate by dash — (ii) Other treatment 3 Ringworm—Body 18 Scabies 33 Impetigo 144 Other Skin Diseases 1058 Eye Disease 693 (External and other, but excluding errors of refraction, squint and cases admitted to hospital) Ear Defects (Treatment for serious diseases of the ear (e.g., operative treatment in hospital should not be recorded here but in the body of the School Medical Officer's Annual Report) 621 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 7560 Total 10130 b) Total number of attendances at Authority's minor ailments clinics 26910 GROUP II.—DEFECTIVE VISION AND SQUINT (EXCLUDING EYE DISEASE TREATED AS MINOR AILMENTS—GROUP I) No. of defects dealt with Errors of Refraction (including squint) 1,358 Other defect or disease of the eyes (excluding those recorded in Group I.) 1 Total 1,359 Number of pupils for whom spectacles were :— (a) Prescribed 1,300 (6) Obtained 1,300 GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT Received operative treatment— Total number treated (a) for adenoids and chronic tonsillitis 224 (b) for other nose and throat conditions 4 Received other forms of treatment 4 Total 232 64 GROUP IV.—ORTHOPAEDIC AND POSTURAL DEFECTS (a) Number treated as in-patients in hospitals or hospital schools 18 (b) Number treated otherwise, e.g.. in clinics or out-patient departments 487 GROUP V.—CHILD GUIDANCE TREATMENT AND SPEECH THERAPY Number of pupils (a) under Child Guidance arrangements 142 (b) under Speech Therapy arrangements 182 Table IV. DENTAL INSPECTION AND TREATMENT.* (1) Number of pupils inspected by the Authority's Dental Officers — (a) Periodic Age Groups 4,713 (b) Specials 1,481 (c) Total (Periodic and Specials) 6,194 (2) Number found to require treatment 4,118 (3) Number actually treated 4,436 (4) Attendance made by pupils for treatment 11,110 (5) Half-days devoted to :— (a) Inspection 31 (b) Treatment 1,288 Total (a) and (b) 1,319 (6) Fillings :— Permanent Teeth 3,875 Temporary Teeth 112 Total 3,987 (7) Extractions :— Permanent Teeth 941 Temporary Teeth 4,937 Total 5,878 (8) Administrations of general anaesthetics for extractions 2,977 (9) Other Operations :— (a) Permanent Teeth 1,298 (b) Temporary Teeth 7,540 Total (a) and (b) 8,838 * For the present the Ministry are not asking for information regarding treatment carried out apart from the Authority's Scheme Table V. INFESTATION WITH VERMIN Notes — A statement as to the arrangements made by the Local Education Authority for the examination and cleansing of infested pupils should appear in the body of the School Medical Officer's Report. All cases of infestation, however slight, should be recorded. The return should relate to individual pupils and not to instances of infestation. 1. Total number of examinations in the schools by the school nurses or other auihorised persons 43,620 2. Total number of individual pupils found to be infested 9j8 3 Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 918 4. Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) 144 65 Details Required for the Ministry of Education Return and School Medical Officer's Report for 1947 Employment of Children and Young Persons. (1) Number of children medically examined, in order to ascertain whether they were physically fit to undertake employment of a light nature outside school hours 5 (2) Number of instances in which the state of health was found to be such that certificates were withheld Nil (3) Number of children examined as to fitness to take part in entertainments 5 (4) Number of cases in which certificates to take part in entertainments were withheld Nil Medical Examination of Teachers and First Appointments. (a) Number of Teachers examined as to fitness for appointment 21 (b) Number of Students examined as to fitness for first appointment 6 66