Ac 439 (1) ENFELD (Latu Man B.) M. EnF20 Urban Districts Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health and School Medical Officer (D. H. GEFFEN, M.D., D.P.H.) FOR 1936 TOGETHER WITH THE ANNUAL REPORT OF THE Chief Sanitary Inspector (FRED. WILSON, M.R.SAN.I., M.S.I.A.) Crusha & Son, Ltd., Southbury Road, Enfield. - Urban Districts Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health and School Medical Officer (D. H. GEFFEN, M.D., D.P.H.) FOR 1936 TOGETHER WITH THE ANNUAL REPORT OF THE Chief Sanitary Inspector (FRED. WILSON, M.R.SAN.I., M.S.I.A.) 1 Public Offices, Enfield. 30th March, 1937. Annual Report of the Medical Officer of Health, 1936. To the Chairman and Members of the Urban District Council of Enfield. Mr. Chairman and Gentlemen, I beg to place before you my 10th Annual Report on the health of the District. There has been a steady increase of the work in each section of the Department, although the scope has not been much widened. During 1937, however, the coming into force of the Midwives Bill and the new Public Health and Housing Acts will mean alteration in procedure and the undertaking of new schemes. Much time has been devoted to the preparing of a scheme for the protection of Enfield against Air Raid attacks; sites for First Aid Posts and De-contamination Centres have been earmarked throughout the District, and for this purpose use has been made of the Maternity and Child Welfare and School Medical Clinics. Considerable time has been devoted to the preparation of this scheme. The outstanding feature of the year's work was the inspection of the whole District to find out the extent of overcrowding, in accordance with the requirements of the Housing Act, 1935. A report on this will be found within the pages of this Report. The survey enabled me to decide not only what overcrowding there was, but, in addition, the extent to which Council and other houses could contain more persons than they held. I would stress the fact that the standard adopted for legal overcrowding was very low, a standard that included the living room for sleeping accommodation, if necessary. 2 I imagine that this standard was adopted as a first step towards improving housing conditions throughout the country. There is a very large number of houses that are overcrowded on general standards though not statutorily overcrowded according to the Act. The survey showed that there were 341 houses statutorily overcrowded. An attempt is being made to deal with this overcrowding, in the first place, by means of transfers and the offer of alternative accommodation in Council houses. This Report has been compiled with the assistance of my colleagues, and I beg to thank them for the information with which they have supplied me. I would take this opportunity of referring to the loyal help of Mr. Wilson, the Chief Sanitary Inspector, and every member of my Staff, and of recording my thanks to the Members of the Council for the courtesy I have received throughout the year. I beg to remain, Gentlemen, Your obedient Servant, D. H. GEFFEN, Medical Officer of Health. 3 URBAN DISTRICT COUNCIL OF ENFIELD Chairman of the Council . . G. M. Sparrow , Esq., J.P., C.C. Vice-Chairman of the Council .. H. Muspratt, Esq., O.B.E. Members of the Council: H. R. Nkilson, Esq . E. Edwards, Esq. C. Partington, Esq. W. B. Anderson, Esq. J. C. Bland, Esq. F. Greenwood, Esq. W. C. Bennett, Esq. H. A. D. Brown, Esq. W. H. Bishop (Jnr.), Esq. S. G. Rowi.andson, Esq. A. E. Kingwell, Esq., F.R.I.B.A. H. H. Collier, Esq. A. R. Kemp, Esq. H. G. Short, Esq. F. G. Fletcher, Esq. A. M. Eeles, Esq. G. E. Jones, Esq. Members of the Health Committee: Chairman H. Muspratt, Esq., O.B.E. also Messrs. Bishop, Greenwood, Kemp, Rowlandson, Bennett, Brown. Eeles and Fletcher. Members of the Maternity and Child Welfare Committee. Chairman H.A.D. Brown , Esq. Councillors Bennett, Eeles, Fletcher, Greenwood, Jones, Kemp, Rowlandson and Muspratt. Also Co-optative Members—Mrs. H. Hammerton, Mrs. A. E. Heath, Mrs. G. F. Porter and Miss G. M. Ford. Clerk to the Council S.J. Dabbs, Esq. Engineer and Surveyor to the Frank Lee, Esq., A.M.Inst.C.E., Council P.A.S.T., L.R.I.B.A., M.Tnst.M. & Cy.E. Treasurer to the Council . S. Gibson, Esq.. A.S.A.A., F.T.M.T.A. Chief Sanitary Inspector Fred Wilson, Esq., M.R.San.I., M.I.S.A. Solicitor to the Council K. E. Lauder, Esq., LL.B. 4 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 12,400 POPULATION. The population as estimated by the Registrar-General in the middle of the year was 81,920, and this figure is being used in connection with the vital statistics as set out in this Report. It will be recollected that from information obtained during the course of the Housing Survey the population of Enfield was estimated on December 31st, 1935, at 79,000, a figure which has been borne out by other statistics. Working on the excess of births over deaths the population of the District at the end of December, 1936, would be 79,565. This, however, does not take into consideration immigration into the District, which has been considerable, for 1,952 houses have been built in the District during the year; nor the emigration out of the District, which is probably low. Even taking an average of 2.5 persons per house the increase would be 4,880, giving a population at the end of 1936 of 84,445. The following table shows how the population of the District has increased during the last ten years. Year. Population. 1927 64,160 1928 64,910 1929 65,100 1930 65,504 1931 68,220 1932 69,910 1933 71,790 1934 74,664 1935 76,960 1936 81,920 The number of inhabited houses at the end of 1936, according to the Rate Books, was 22,887. The rateable value of the District is £707,617 The net product (after allowing for cost of collection) of a penny rate is £2,625 The following table indicates the growth in the number of inhabited houses, the rateable value and the sum represented by a penny rate during the last ten years. 5 Year. No. of inhabited houses. Rateable value. Sum represented by a penny rate. £ £ s. d. 1927 13,469 369,284 1,304 18 3 1928 13,733 377,644 1,335 0 0 1929 14,123 472,199 2,080 0 0 1930 14,707 479,466 1,920 0 0 1931 15,215 491,451 1,991 0 0 1932 15,962 513,225 2,045 0 0 1933 16,500 548,461 2,145 0 0 1934 17,938 619,042 2,360 0 0 1935 19,298 652,693 2,525 0 0 1936 22,887 707,617 2,625 0 0 SOCIAL CONDITIONS. The number of inhabited houses in the District has increased by 9,418 during the course of ten years. This means that the number of occupied premises which have to be inspected in accordance with the administration of Acts delegated to the Health Department has increased by nearly 70 per cent. The rateable value has nearly doubled itself, whilst the sum represented by a penny rate is more than double that of 1927. During 1935, 1,953 houses were erected, and during 1936, 1,952. This makes a total of 3,905 houses built in the course of two years, all of which, with the exception of 6, were erected by private enterprise. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total. Male. Female. Legitimate 1,330 674 656 Illegitimate 40 19 21 Birth-rate—16.72 per 1,000 population. 6 Still Births:— Total. Male Female. Legitimate 32 15 17 Illegitimate 1 1 — Rate per 1,000 total births—23.52. Total. Male Female. Deaths 805 433 372 Death-rate—9.82 per 1,000 population. Number of women dying in, or in consequence of, childbirth:— Deaths. Rate per 1,000 Total Births. From Puerperal Sepsis — — From other Puerperal causes 3 2.13 3 2.13 Two of these three cases were removed to the North Middlesex Hospital, Edmonton, and the other to 72a, East Dulwich Grove, Camberwell, where they died. Death-rate of Infants under one year of age:— All infants per 1,000 live births 62.77 Legitimate infants per 1,000 legitimate live births 61.65 Illegitimate infants per 1,000 illegitimate live births . 100.00 Deaths from Measles (all ages) 5 Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhoea (under 2 years of age) 6 The following table gives the birth-rate, recorded death-rate and infantile death-rate for Enfield as compared with those for England and Wales, London, 122 County Boroughs and Great Towns (including London) and 143 Smaller Towns:— Birth-rate. Recorded Death-rate. Infantile Death-rate. Live Births. Still Births. England and Wales 14.8 0.61 12.1 59.0 London 13.6 0.53 12.5 66.0 122 County Boroughs and Great Towns (including London 14.9 0.67 12.3 63.0 143 Smaller Towns 15.0 0.64 11.5 55.0 ENFIELD 16.72 0.40 9.82 62.77 7 DEATHS. The deaths registered in the District during the year were 507, of which 269 were males and 238 females, giving a crude death-rate of 6.18. To this must be added 344 deaths of Enfield residents registered outside the District, and from this total must be subtracted 46 deaths of non-residents, occurring in the District, which brings the number of deaths to 805 for the year, giving a net deathrate of 9.82 per 1,000 population. The corresponding figures for Enfield for the five previous years are:— 1931 1932 1933 1934 1935 Net death-rate 10.40 10.64 9.83 9.64 9.81 Eighty-five deaths registered in the District were persons over 80 years of age, 32 being males and 53 females, one man and one woman dying at the age of 95. The more important causes of deaths registered during the year and the previous four years were:— Cause of Death. 1936. 1935. 1934. 1933. 1932. Malignant Disease 133 118 103 85 90 Bronchitis 34 27 36 26 30 Heart Disease 185 164 176 169 180 Old Age 18 20 13 11 25 Tuberculosis of Respiratory System 60 46 52 36 40 Pneumonia 57 64 52 61 54 Other Digestive Diseases 10 21 17 13 15 Other Circulatory Diseases 35 59 44 36 43 Nephritis 15 13 10 19 25 Cerebral Haemorrhage 37 40 29 37 39 Deaths from Violence (excluding Suicides 34 30 27 28 28 Influenza 6 11 5 22 14 Children :— Premature Birth 34 22 14 12 12 Inanition and Marasmus 6 5 7 10 8 Congenital Malformations 4 4 4 3 7 Pneumonia 15 12 8 10 14 Injury at Birth 4 3 4 2 1 Enteritis 5 10 1 6 1 8 It is to be noted that of the 805 deaths that occurred during the year, 344 took place outside the District of Enfield. Of these, 257 were Enfield residents who died in the North Middlesex Hospital, Edmonton, and information as to these deaths and the causes thereof is supplied to me regularly each week by the courtesy of the Medical Officer of Health of the Urban District Council of Edmonton. The figure of 805 deaths assigned to Enfield represents an increase of 50 on last year. There were 15 more deaths from Malignant Disease, 14 more from Tuberculosis of the Respiratory System and 12 more from Prematurity. It is to be hoped that medical science will succeed in overcoming the two first-mentioned diseases, whilst my remarks on Maternity and Child Welfare discuss the increased incidence of Prematurity. 9 TABLE I. Causes of Death during Year 1936. Causes of Death. Males. Females. Total. All Causss—Certified 433 372 805 Uncertified — — — Typhoid and Para-Typhoid Fevers — 1 1 Measles 2 3 5 Scarlet Fever — 1 1 Whooping Cough 2 1 3 Diphtheria — — - Influenza 3 3 6 Encephalitis Lethargica 2 1 3 Cerebro-Spinal Fever — 1 1 Tuberculosis of Respiratory System 31 29 00 Other Tuberculous Diseases 3 1 4 Syphilis — — — General Paralysis of Insane, Tabes Dorsalis 3 1 4 Cancer, Malignant Disease 65 08 133 Diabetes — 4 -1 Cerebral Haemorrhage, etc. 20 17 37 Heart Disease 90 95 185 Aneurysm 1 1 2 Other Circulatory Diseases 13 22 35 Bronchitis 20 14 34 Pneumonia (all forms) 33 24 57 Other Respiratory Diseases 6 3 9 Peptic Ulcer 8 1 9 Diarrhoea, etc. (under 2 years) 4 2 6 Appendicitis 5 3 8 Cirrhosis of Liver — — — Other Diseases of Liver, etc. — 1 1 Other Digestive Diseases 4 6 10 Acute and Chronic Nephritis 8 7 15 Puerperal Sepsis — — — Other Puerperal Causes — 3 3 Congenital Debility, Premature Birth, Malformations, etc. 32 15 47 Senility 10 8 18 Suicide 6 5 11 Other Violence 24 10 34 Other Defined Diseases 38 20 58 Causes ill-defined or unknown — 1 1 Total 433 372 805 10 TABLE II. Infant Mortality. Net Deaths from stated causes at various ages under one year of age. Causes of Death. Under 1 week. • 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months| Total Deaths under One Year. All Causes—Certified 34 7 2 4 47 15 13 3 8 86 Uncertified - - - - - - - - - - Smallpox - - - - - - - - - - Chicken pox - - - - - - - - - - Measles - - - - - - - 1 1 2 Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not Tuberculous - - - - - - - - - - Convulsions 1 — — — 1 — — — — 1 Laryngitis - - - - - - - - - - Bronchitis — 1 — — 1 1 — — — 2 Pneumonia (all forms) 1 — 1 — 2 5 3 2 3 15 Diarrhoea - - - - - - 1 — 1 2 Enteritis - - - - - 2 2 — 1 5 Epidemic Diarrhoea - - — - - - - - - — Gastritis - - - - - - 1 - - 1 Syphilis - - - - - - - - - - Rickets - - - - - - - - - — Suffocation, overlying 1 — — — 1 — — — — 1 Injury at Birth 3 1 — — 4 — — — — 4 Atelectasis Congenital Malformation 3 1 — — — 3 1 1 2 — — 3 4 Premature Birth 23 3 1 4 31 2 1 — — 34 Atrophy, Debility and Marasmus 1 1 - - 2 1 9 - 1 6 Other Causes — 1 — — 1 3 1 — 1 6 Totals 34 7 2 4 47 15 13 3 8 86 Net Births in the year:—Legitimate: Live births, 1,330; Stillbirths, 32. Illegitimate: Live births, 40; Still-births, 1. Net Deaths in the year:—Legitimate Infants, 82; Illegitimate, 4. 11 Cancer carried off 133 individuals, and Tuberculosis of the Respiratory System 60, a combined number of 193. This compares with a total of 164 for last year, and the percentage of deaths from these two causes is 23.9, as against 21.7 for 1935. INQUESTS. Eighteen inquests and twenty-seven P.M.s without inquests were held in Enfield during the year, and the verdicts were as follows:— Natural Causes 27 Accidental Causes 8 Suicides 9 Misadventure 1 The above table shows that 9 persons committed suicide during the year under review. In 1935 there were 4, and in 1934. 7. The ages and sexes of the 9 people who committed suicide during the year were as follows:— Males 30, 53, 57, 63 and 65 years. Females 22, 40, 42 and 68 years. SUICIDES. I once more deplore the publicity that is given not only to suicides, but at attempts to commit suicide. I fail to see any advantage to the public in being informed of the fact that an individual, whose name is always quoted, either committed suicide or attempted to do so. I repeat, moreover, my belief that this publication of cases of suicide tends to unbalance those whose affairs are unhappy, and to suggest to them a way out of their troubles. In many of these cases a cure might have been effected had they not received this incentive to suicide, but adequate treatment instead. It has often been said that those who talk about it are the very persons who never commit suicide; this statement is incorrect and a suggestion of suicide should always be taken seriously, especially so from persons who are unhappy or of neurotic disposition. 12 The causes of death, sex and ages of Enfield residents who committed suicide in or outside the District were as follows:— 4 Coal Gas Poisoning Males: Ages 57 and 65 years. Females: Ages 22 and 40 years. 1 Gunshot Wound of Face.. Male: Age 63 years. 1 Hanging Female : Age 42 years. 1 Poisoned by drinking Prussic Acid Male : Age 30 years. 1 Spirits of Salts Poisoning Male: Age 45 years. 1 Drowned in a River Female: Age 68 years. 1 Drowned in a Bath Female : Age 32 years. 1 Knocked down by a Locomotive Engine Male : Age 53 years. BIRTHS. The actual number of births registered in the District was as follows:— Boys. Girls. Total. 496 471 967 including 27 illegitimate births, i.e., 2.79 per cent, of the total. In addition, 7 male and 8 female still-births were registered. The corrected birth-rates for both sexes, live and still-births, which takes into consideration those born outside the District and those in the District not rightly recorded to the District, and also the corrected birth-rates for the last 5 years, are:— Year. Boys. Girls. Total. Birth-rate per 1,000 Population. Illegitimate Birth-rate per 1,000 Population. 1932 571 527 1,098 15.69 .62 1933 537 520 1,057 14.72 .50 1934 571 555 1,126 15.08 .44 1935 628 639 1,267 16.46 .51 1936 709 694 1,403 17.12 .50 13 INFANTILE DEATHS. The total number of deaths which occurred amongst infants under one year, including 34 registered outside the District, and deducting 2 of non-residents occurring in the District, was 86, giving a death-rate of 62.77 per 1,000 births, as compared with a death-rate of 59.00 for England and Wales, and 63.00 for the 122 County Boroughs and Great Towns (including London). The corresponding figures for Enfield for the last four vears were: 1932, 60.11; 1933, 50.38; 1934, 43.27; and 1935, 50.00. It will be noticed that there were 25 more deaths of children under one year of age this year than last. This is accounted for by the fact that there were 15 deaths from Pneumonia compared with 12 for last year, and 34 deaths from Premature Birth as compared with 22 for last year. The number of deaths of illegitimate children was 4, which gives a death-rate of 100.00 per 1 ,000 illegitimate infants. 14 PUBLIC HEALTH STAFF. Medical Officer of Health: *D. H. GEFFEN, M.D., D.P.H. Assistant Medical Officer of Health and Assistant School Medical Officer: *A. G. T. THOMAS, M.D., D.P.H. Chief Sanitary Inspector: *FRED WILSON, M.R.San. I., M.S. I. A., Cert. Sanitary Inspector's Examination Board (London); Faudell-Phillips Medallist, King's College, London University; Silver and Bronze Medallist, Carpenters' Company; Diploma of R.San.Inst, for Inspection of Meat and other Foods; Cert. Practical Sanitary Science. Sanitary Inspectors: *NOEL SMITH, A.R.San.I., M.S.I.A. *HARRY WIGGETT, Cert. R.San.I., Diploma of R.San. Inst, for Inspection of Meat and other Foods, M.S.I.A. *L. ROWLEY, Cert. R.San.I., M.S.I.A.. Diploma of R.San.I. for Inspection of Meat and other Foods, Cert. of R.San.I. for Smoke Inspectors. (Resigned 31st August, 1936.) ♦A. RAMSDEN, Cert. R.San.I., M.S.I.A., Diploma of R.San.I. for Inspection of Meat and other Foods. ♦G. S. SAFFIN, A.R.San.I., M.S.I.A., Diploma of R.San.I. for Inspection of Meat and other Foods, Cert. of R.San.I. for Smoke Inspectors. (Resigned 12th December, 1936.) ♦R. JOHNSON, A.R.San.I., Diploma of R.San.I. for Inspection of Meat and other Foods, Cert. of R.San.I. for Smoke Inspectors, Certificate and Diploma of Institute of Hygiene. Health Visitors: Miss M. E. NEWBEGIN. General Trained Nurses Certificate, C.M.B., Member of the Royal College of Nursing, State Registered Nurse, Certificate of Queen's Nurses. Miss M. GARLICK, C.M.B., Medical and Surgical Nursing, Invalid Cookery, State Registered Nurse, Member of the Royal College of Nursing. Mrs. C. D. HERBERT, C.M.B.. State and General Trained Nurse, Certificate of R.San.Inst. for Health Visitors, Invalid Cookery, Ranyard District Nursing. Miss C. WILKINSON, C.M.B., New Health Visitor's Certificate of R.San. Inst.. State Registered Nurse, Invalid Cookery. 15 Chief Clerk SYDNEY COULTER, Cert. R.San.I, 2nd Clerk Miss E. W. BOWYER. Clerk J. HULME. Clerk Miss V. M. SIMMONS. Clerk C. W. CHAPMAN. Clerk Miss D. HILLER. Clerk V. F. KERRY. (Resigned 24th October, 1936.) Clerk Miss W. PAYNTER. Shorthand-Typist Miss N. L. BROWN. Shorthand-Typist Miss K. M. HALLAM. Maternity and Child Welfare: Dr. C. J. THOMSON, M.B., M.D. (Part-time Assistant Medical Officer of Health). Mr. C. E. JAMES, L.D.S., Eng., R.C.S. (Part-time Dental Surgeon). Mr. R. BRADBURY, L.D.S. (Manchester) (Part-time Dental Surgeon). (Resigned 28th March, 1936.) Mr. H. MACK AY, L.D.S. (St. Andrews) (Part-time Dental Surgeon). * Contributions received from the County Council. NURSING IN THE HOME. There are two Associations in Enfield which provide nursing for the sick poor of the District, viz.:— The Ponders End, Enfield Highway and District Nurse Fund. The Enfield District Nursing Association. No grant has been made by the Local Authority to either Association. Application, however, has been received for such grant, and negotiations concerning this matter were still being conducted at the end of the year. There are no permanent arrangements in the District for the domiciliary nursing of cases of infectious disease. Although complicated cases of measles and whooping cough may be admitted to Hospital, it is probable that there are occasions when domiciliary nursing would be of help when they are treated at home. 16 AMBULANCE FACILITIES. For Infectious Cases: two Motor Ambulances are stationed at the Isolation Hospital for the removal of cases from the Enfield and Edmonton Districts; 301 patients were removed from Enfield during the year. Three Ambulances are maintained by the Urban District Council of Enfield, and are available for the removal of accident cases and acute or urgent medical and surgical conditions requiring removal to Hospital. Such cases are taken free of charge either to the North Middlesex Hospital, Edmonton, the Prince of Wales' Hospital, Tottenham, or the Enfield War Memorial Hospital. During 1936, the Ambulances removed 1,540 patients. NATIONAL HEALTH INSURANCE. None of the work of the Authority is related to or administered by this service. LABORATORY FACILITIES. The following work was carried out in the Council's laboratory during the year :— Specimen. No. Positive. Negative. Percentage of Positives. Swabs 1,411 117 1,294 8.29 Sputa 239 22 217 9.20 Totals 1,650 139 1,511 8.42 Reference to the laboratory report shows that 1,411 swabs were examined during the year. This number is 169 less than for last year. On the other hand it will be noted that the number of sputa examined increased by 24. In addition to this, regular examinations of the water from the Enfield Swimming Pool and the Enfield Lock Baths were carried out during the time these Baths were open. The laboratory is open every day throughout the year, and by every day is meant Christmas, Easter and every Bank Holiday. 17 An attempt is made to see that every General Practitioner in the District receives a report of specimens he has sent in at about 10 o'clock the next morning after the specimens are received. I consider the laboratory service of the Council to be of the utmost importance and I am satisfied that it is reasonably wellequipped and maintained. LEGISLATION IN FORCE IN THE DISTRICT. Sanitary Administration. Adoptive Acts. The position has not been altered since my Annual Report for 1932, and for information in this respect reference thereto is advised. BYE-LAWS AND REGULATIONS. The alteration in the boundaries of Enfield consequent upon the ceding of Cockfosters to the Borough of Southgate gave the Council an opportunity of revising the Bye-laws and Regulations that have been made for the District of Enfield. In this connection new Bye-laws and Regulations have been framed in accordance with the models of the Ministry of Health in respect of the following:— Nuisances; Common Lodging-houses; Slaughterhouses; Houses Let in Lodgings; Tents, Vans, Sheds and Similar Structures; Offensive Trades; Cleansing of Earth-closets, Privies, Ashpits, etc.; and were confirmed and brought into operation during the year. HOSPITALS. The position with regard to Hospitals has not altered since my Report for 1932, and for information in this respect reference thereto is advised. 18 TUBERCULOSIS (COUNTY OF MIDDLESEX) SCHEME. The following statement shows the total number of beds belonging to, or reserved for the sole use of, the County Council during 1936. Institution. Accommodation. Type of Case. Adults. Children. M. F. County Sanatorium, Harefield 150 150 60 Pulmonary—Sanatorium. 4 4 10 Pulmonary—Observation. County Sanatorium, Clare Hall, South Minims 120 66 — Pulmonary—late sanatorium and Hospital. Heatherwood Hospital, Ascot — — 25 Non-pulmonary. Victoria Home, Margate — — 6 Non-pulmonary. Other Institutions at which patients have been maintained by the County Council during 1936 are:— Sanatoria.—Brompton Hospital Sanatorium, Frimley; Cotswold, Gloucester; Daneswood, Woburn Sands; Eversfield, St. Leonards; Fairlight, Hastings; Grosvenor, Ashford, Kent; Hawt.horndene, Bonchurch, I.W.; Holy Cross, Haslemere; Ipswich (County Borough); Kelling, Holt, Norfolk; King Edward VII, Midhurst; King George V, Godalming (L.C.C.); King George's, Liphook; Marillac, Warley, Essex; Merrivale, Sandon, nr. Chelmsford; Milford (Surrey C.C.); Mundesley, Norfolk; National, Benenden; Old Manor House, Broadstairs; Pinewood, Wokingham (L.C.C.); Prior Place, Camberley, Surrey; Royal National, Bournemouth; Royal National, Ventnor; Tehidv (Cornwall C.C.). Hospitals.—St. Barnabas', Torquay; Colindale, Hendon (L.C.C.); Creaton, Northampton; Prince of Wales's, Tottenham; City of London, Victoria Park; National Temperance; Brompton; Royal Chest; St. Bartholomew's; St. Mary's; St. Thomas's; University College: and the London County Council's general hospitals, Archway; Dulwich; Lambeth; St. Luke's. 19 Colonies.—British Legion Village, Preston Hall, Aylesford; Burrow Hill, Frimley; Papworth Village Settlement, Papworth Hall, Cambridge. Homes for very Advanced Cases.—St. Columba's, Swiss Cottage; St. Joseph's Hospice, Hackney. All the above are for Pulmonary cases of various types. The following Hospitals are for Non-pulmonary adult cases:— All Saints', Eastbourne; Atkinson Morley, Wimbledon: Hendon Cottage; Holy Cross, Broadstairs; Royal, Richmond; Royal National Orthopaedic, London, and Country Branch, Stanmore; Royal Sea-Bathing, Margate; St. Anthony's, Cheam; St. Vincent's Orthopaedic, Pinner: St. Luke's, Lowestoft (L.C.C.): Schiff Home, Cobham, Surrey; Tait Home, Broadstairs; Wingfield Orthopaedic, Oxford; and Prince of Wales's, Tottenham; St. Mary's and University College, London. The following Hospitals are for Non-pulmonary child cases:— Alfred Yarrow Home, Broadstairs: Atkinson Morley,. Wimbledon; Heritage Craft Schools, Chailey; Holy Cross, Broadstairs; Holy Cross, Ramsgate; Lord Mayor Treloar Cripples', Alton; Royal, Richmond; Royal National Orthopaedic, London, and Country Branch, Stanmore; Royal Sea-Bathing, Margate: St. Michael's Orthopaedic, Clacton; St. Nicholas and St. Martin's Orthopaedic, Pyrford; St. Vincent's, Pinner; Wingfield Orthopaedic, Oxford; Hendon Cottage; Prince of Wales's, Tottenham; Cheyne, St. Mary's 4and University College, London. Tuberculosis Dispensary (Middlesex County Council).— 279, Fore Street, Edmonton, N. Maternity.—(Maternity Hospital, North Middlesex County Hospital, Edmonton.) Children, Fever, Small-pox, Unmarried Mothers, Illegitimate Infants and Homeless Children. The position with regard to the above has not altered since my Report for 1932, and for information in respect to these reference thereto is advised. 20 INFECTIOUS DISEASE. The following cases of notifiable and other infectious disease were taken to the Edmonton and Enfield Joint Isolation Hospital from the Enfield District during the year:— Scarlet Fever 176 Diphtheria 63 Diphtheria Carriers 2 Erysipelas 19 Typhoid and Paratyphoid 2 Measles and Pneumonia 13 Measles and Bronchitis 2 Measles 11 Whooping Cough 6 Other 7 SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. With the exception of Hadley Wood and Cockfosters Ward, which derive their water from the mains of the Barnet Gas and Water Company, the District is almost entirely supplied by the Metropolitan Water Board. There are, however, about 80 houses in the District which derive their water from wells. During the course of the year samples of water were taken from 2 wells supplying water to 6 houses and premises. The water was found to be unsatisfactory in both cases. Steps are being taken to have the wells closed and the houses provided with a main water supply. Streams and Water-courses. Turkey Street Brook and other streams in the District are under the control of the Middlesex County Council, and observation is also kept on them by your Sanitary Staff. No sources of contamination were detected. Drainage and Sewerage. The populous parts of the District are all provided with sewers with outfall to Cuckoo Hall Farm, where sewage is dealt with by septic tanks, filters, and partly by irrigation. Four men are employed daily, who devote their whole time to the work of examining and flushing the sewers; any defect or obstruction is dealt with immediately. 21 Cesspools. During 1936 the cesspools of the District were emptied by a combined cesspool and gulley emptier. During the course of the year, of the 1,952 houses the construction of which was completed, 3 were drained by means of cesspools. It is hoped that further development in Enfield will be restricted to houses that can be placed on main drainage. Closet Accommodation. All the houses in the Urban portion of the District are supplied with W.C.'s of various types, the majority being those of the "wash-down" pattern. In the Rural parts of the District the accommodation consists of water-closets connected with cesspools, or earth-closets or privies with movable receptacles. I am not aware of any middens in the District. Every week one man in the employ of the Council attends some few earth closets in a Rural part of the District. REMOVAL AND DISPOSAL OF HOUSE AND TRADE REFUSE. At the end of the year the Council possessed the following vehicles for the collection and disposal of refuse:—- 9 "S.D." Freighters. 1 Tuke and Bell Barrier Type Petrol Vehicle. 1 Bedford 2-ton General Purpose 3-way Tipping Lorry. A weekly collection of household refuse was made throughout the District, and market refuse was collected every Saturday evening from the Market in Enfield Town. Enfield's refuse was disposed of at Brown's Brickfields by the method known as controlled tipping until the 18th May. By this time the field had been completely filled in and levelled. An arrangement was entered into with Messrs. Heath & Sons whereby they would receive all refuse and covering material in connection therewith at a fee of one shilling per load. Since 18th May, therefore, refuse has been disposed of by controlled tipping at Heath's Pit, Carterhatch Lane. 22 Some difficulty has been experienced here in view of the fact that there was a large rainfall during the year, causing the water level to rise in the pit. Although pumping operations were carried out, it was, nevertheless, necessary to tip some refuse into water. So far no harmful effects have eventuated and the refuse of Enfield has been disposed of satisfactorily. During the year the Council resolved not to instal a WoodhallDuckham Inclined Rotary Refuse Destructor (Volund Patents) and sell steam to the North Metropolitan Electric Power Supply Company, as had been its previous determination. Instead, the Council resolved to erect a Heenen & Froud Separator and Destructor, and to sell materials obtained by separation. At the end of the year the Council were still awaiting a decision of the Minister of Health on a request for sanction to borrow the money requisite for the erection of this plant. SANITARY INSPECTION OF DISTRICT. A full report on this matter is contained in the Report of the Chief Sanitary Inspector, which will be found at the end of this Report. SMOKE ABATEMENT. During the course of the year observation has been kept on the chimneys of the District for nuisances due to the issue of excess amount of smoke. Many warning letters have been sent, and in all cases these have resulted in the abatement of the nuisance. SWIMMING BATHS AND POOLS. The Enfield Swimming Pool is situated in Southbury Road, Enfield. It is an open-air Bath which measures 200 feet by 80 feet. The water is purified by means of two filtration plants and aerated by an external fountain and an internal aerator. The water is chlorinated and the plant is capable of passing all the water in the Pool through the filter in the course of four hours. The Enfield Lock Baths are situated in Bradley Road, Enfield Lock, and are indoor Baths. 23 There is no filtration plant, but the water is changed at least once a week, and during hot weather twice a week, whilst Chlorine is sprayed into the water in the form of Voxsan. The water at each of the Baths in Enfield is tested twice daily by the Superintendents to ascertain the concentration of Chlorine in the water. In addition, samples are taken each week by my Department and examined in the Laboratory for Chlorine content and Alkalinity. During the season samples of the water are sent to the Home Counties Public Health Laboratories where a full chemical and bacteriological examination is carried out. The number of such tests depends on the number of bathers attending the Pool and Baths. Last year the season was cool and rainy, and the number of bathers was never so great as to cause worry as to the condition of the water. I was satisfied that throughout the season the water was pure, wholesome and free from bacterial pollution. In the following table is set out the attendances for the past 5 years, and against these the number of hours of sunshine from the 1st May to the 30th September. Year. No. of Bathers. Hours of Sunshine. Pool. Baths. 1932 225,553 24,195 738.3 1933 263,284 26,638 1,028.0 1934 162,226 32.215 984.3 1935 149,640 31,129 956.0 1936 97,924 26,007 764.6 The following table shows the extent to which the Slipper Baths both at the Pool and the Enfield Lock Baths have been used during the past 5 years. Financial No. of Attendances. Year. Pool. Baths. 1932-33 14,638 6,786 1933-34 28,967 7,338 1934-35 28,472 6,906 1935-36 27,351 7,037 1936-37 26,007 7,255 24 SUB-LETTING IN COUNCIL HOUSES. The terms of the agreement under which the Council's houses are let does not allow the tenant to sub-let without obtaining permission. During the year I have continued to consider and determine the cases in which sub-letting was to be allowed in Council houses, in accordance with the Resolution passed by the Council on December 13th, 1927. The following work was carried out:— Total number of applications dealt with 65 Number granted permission to sub-let 59 Number refused permission 6 Number of letters sent 224 Number of visits made by Sanitary Inspectors 29 In every case permission to sub-let has been given where such permission can be granted without detriment to the health of the tenants or the property of the Council. SCHOOLS. There are 21 Public Elementary Schools in Enfield, comprising 43 departments. The Secondary Schools include the Boys' Grammar School, the County School for Girls and the Junior Technical School. In addition there are a number of private establishments. There is also a Roman Catholic Institution known as St. Joseph's Home for Destitute Boys. Periodical examinations of the conditions of the public elementary schools are made by the Sanitary Inspectors, and any defects found are brought to the notice of the Education Committee and Managers. INFECTIOUS DISEASES AND SCHOOLS. Following a suggestion of the Ministry of Health, an arrangement is in force between the Council and Education Committee under which the Head Teachers of the various schools notify the Medical Officer of Health of all absentees suspected to be suffering from any infectious disease. These absentees are then visited, and the cause of absence ascertained. 25 This method of discovering cases of infectious disease is important, in that Measles, Whooping Cough, Chicken Pox and Mumps are not notifiable, and the Public Health Department relies upon the list of absentees to discover the extent of an outbreak of such diseases. Number of children notified to be absent from School due to suspected Infectious Disease 1,304 Number of children found to be suffering from Infectious Disease 848 This compares with the following figures for last year:— Number of children notified to be absent from School due to suspected Infectious Disease 670 Number of children found to be suffering from Infectious Disease 378 RAG FLOCK ACTS, 1911 and 1928. There are five premises in the District where Rag Flock is manufactured, used or sold, and these are kept under observation by the Sanitary Inspectors. Five samples were taken during the year, and these were all found to comply with the standard laid down in the Acts. HOUSING. Number of new houses erected during the year:— (a) Total (including numbers given separately under (&)) 1,952 (i) By the Local Authority 6 (ii) By other Local Authorities (iii) By other bodies or persons 1,946 (b) With State Assistance under the Housing Act: (i) By the Local Authority 6 (ii) By other bodies or persons 26 1. Inspection of Dwelling-houses. No. of No. of inspechouses. tions. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) and number of inspections made 2,739 12,693 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925, and the number of inspections made 349 3,730 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 44 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,128 (The number here given is of houses where any insanitary conditions were found.) 2. Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 1 ,038 3. Action under Statutory Powers. A.—Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Notices were served requiring repairs 11 (2) Number of dwelling-houses which were rendered fit after service of formal Notices :— (a) By owners 79 (b) By Local Authority in default of owners None. 27 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 24 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices:— (a) By owners 21 (b) By Local Authority in default of owners 2 C.—Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 8 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders None. D.—Proceedings under Section 20 of the Housing Act, 1930:— (]) Number of separate tenements or underground rooms in respect of which Closing Orders were made None. (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit None. The number of house-to-house inspections made was:— Under Housing Regulations, 1925 349 Apart from the Housing Regulations, 1925 447 Total 796 During the course of 1936 I represented 10 houses as unfit for human habitation. Of these the Council made Demolition Orders in respect of 8 houses; the remaining were still under consideration at the end of the year. During 1935 I entered into arrangements with owners concerning property which was unfit for human habitation, and as a result thereof 9 houses were demolished without official action being taken during 1936. Since the passing of the Housing Act, 1930, 103 houses have been demolished either by official action under Section 19 of the Housing Act, 1930, or by arrangements with owners. 28 GENERAL OBSERVATIONS. The Council now possesses 1 ,746 houses, a figure which has increased by 6 in the last three years. Land has been acquired for the erection of further houses, but so far has not been utilised for this purpose. Housing Survey—Housing Act, 1935. According to the provisions of this Act, it was necessary that a survey be made of the District in order to ascertain which houses situated therein were overcrowded. It was essential that a visit be paid to every house which might be used for housing members of the working-classes. In view of the fact that many houses in the better class areas of the District are occupied by more than one family, or parts of such houses let off to members of the working-classes, it was considered essential that a complete survey of the whole District should be made. As a result thereof, 21,060 dwellings were inspected. These dwellings housed 21,500 families comprising 79,201 persons. This figure included the staff of such Institutions as there are in the District, but not the inmates thereof. The inspection was carried out in two phases. The first or preliminary survey showed the number of houses where overcrowding might be present and where measurement of all rooms in the house would be required in order to discover whether it was overcrowded according to the standard set by the Act. The number of dwellings found to require such special survey was 1,096, or 5.2 per cent. of the dwellings inspected. These 1,096 houses were then re-inspected and the rooms in each of these dwellings measured. From this inspection the following facts emerged:— (1) 341 families were living in overcrowded dwellings; (2) 1.619 per cent. of the dwellings in Enfield were overcrowded : and (3) 1.586 per cent. of the families were living in overcrowded conditions. 29 At the time of the inspection there were 577 vacant dwellings in the District, and these dwellings contained 3,047 rooms. Of these empty houses, 17 were Council houses containing 68 rooms. As already stated, there were 341 dwellings found to be overcrowded. Of these, 110 were Council houses, or 6.47 per cent. of the 1 ,740 houses belonging to the Council; 231 were non-Council houses, or 1.193 per cent. of the remaining 19,360 dwellings in the District. 32.258 per cent. of the overcrowding in the District was in Council houses, and 67.742 per cent. in non-Council houses. The extent of the overcrowding was as follows:— (The expression "½" refers to a child under 10 years of age, and a unit is one adult or two children under the age of 10 years.) Houses. Overcrowded to the extent of ½ 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ Total. t nits Council 36 36 23 9 3 1 2 - - - - 110 Non-Council 83 57 38 28 11 7 3 1 2 — 1 231 Totals 119 93 61 37 14 8 5 1 2 — 1 341 The overcrowding occurred in the following types of dwellings :— Houses. Houses containing *Nil rooms. 1 room. 2 rooms. 3 rooms. 4 rooms. 5 rooms. 6 rooms. Council - - - 25 80 5 - Non-Council 1 16 40 53 74 44 3 Totals 1 16 40 78 154 49 3 * refers to a dwelling where the one room did not measure 50 square feet. 30 THE ABATEMENT OF OVERCROWDING. It must be realised that to abate the overcrowding, the Council must adopt a different standard from that required in Section 2 of the Housing Act, 1935, viz., that in Section 37 of the Housing Act, 1930. This follows from the definition of the words "suitable alternative accommodation" in Section 12 of the 1935 Act. This is as follows :— "Suitable alternative accommodation" means, in relation to the occupier of a dwelling-house, a dwelling-house as to which the following conditions are satisfied, that is to say—- (a) the house must be a house in which the occupier and his family can live without causing it to be overcrowded ; (b) the local authority must certify the house to be suitable to the needs of the occupier and his family as respects security of tenure and proximity to place of work, and otherwise to be suitable in relation to his means; and (c) if the house belongs to the local authority, they must certify it to be suitable to the needs of the occupier and his family as respects extent of accommodation having regard to the standard specified in paragraph (ii) of Section thirty-seven of the Act of 1930. In order that the Members of the Council may realise the position, I quote Section 2 of the Housing Act, 1935, with the Schedules in connection therewith, and Section 37 of the Housing Act, 1930:— Section 2. A dwelling-house shall be deemed for the purpose of this Act to be overcrowded at any time when the number of persons sleeping in the house either— (a) is such that any two of these persons, being persons ten years old or more of opposite sexes and not being persons living together as husband and wife, must sleep in the same room; or (b) is, in relation to the number and floor area of the rooms of which the house consists, in excess of the permitted number of persons as defined in the First Schedule of this Act. 31 TABLE I. Where a house consists of:— (a) one room 2 (b) two rooms 3 (c) three rooms 5 (d) four rooms (e) five rooms or more 10 with an additional 2 in respect of each room in excess of five. Provided that in computing for the purposes of the said Table I the number of rooms in a house, no regard shall be had to and room having a floor area of less than 50 square feet. TABLE II. Where the floor area of a room is:— (a) 110 sq. ft. or more 2 (b) 90 sq. ft. or more, but less than 110 sq. ft. 1½ (c) 70 sq. ft. or more, but less than 90 sq. ft. 1 (d) 50 sq. ft. or more, but less than 70 sq. ft. ½ (e) Under 50 sq. ft. Nil Section 37. For the purposes of the provisions (a) of this Act which relate to the obligations of a local authority with respect to re-housing, or which relate to Government contributions to the expenses of local authorities in providing accommodation available for displaced persons, the Minister, unless he is satisfied that owing to special circumstances some other standard of size or accommodation should be adopted— (ii) shall treat a house containing two bedrooms as providing accommodation for four persons, a house containing three bedrooms as providing accommodation for five persons, and a house containing four bedrooms as providing accommodation for seven persons. In determining for the purposes of this Section the number of persons sleeping in a house, no account shall be taken of a child under one year old, and a child who has attained one year and is under ten years old shall be reckoned as one-half of a unit. 32 The survey therefore showed that there were 341 overcrowded houses in Enfield. This, however, did not show the whole story, for there were a large number of premises that would shortly be overcrowded owing to increase in the ages of the children. The actual state of overcrowding was as follows:— 3 families consisting of 1 person overcrowded. 6 „ „persons „ 7 „ „ 2½ „ „ ,, ,, 18 „ „ 3½ „ 16 „ „ 4 „ „ 4 „ „ 4½ „ „ 21 „ „ 5½ „ „ 20 „ „ 6„ „ 31 „ „ 6½„ „ 32 „ „ 7½„ „ 33 „ „8 „ „ 21 „ „ 8½ „ „ 22„ „ 9„ „ 13„ „ 9½ „ „ 3 ,, ,, 10½ „ „ 2 „ „ 11½„ „ 1 „ „ 12 „ „ 341 Total. Furthermore it was shown that in houses not overcrowded the following state of affairs existed :— Families in Council Dwellings. 57 were fully occupied. 195 could take ½ person. 277 „ 1"„ 234 „ 1½ persons. 223 „ 2"„ 165 „ 2½„ 278„ 3„ 128„ 3½„ 27 „ 4„ 8 „ 4½„ 17 „ 5„ 3 „ 5½ „ 3„ 6„ 33 Families in Non-Council Dwellings. 148 were fully occupied. 888 could take ½ person. 718 „ 1„ 718 „ 1½ persons. 1,390 „ 2„ 518 „ 2½„ 1,624 „ 3„ 868 „ 3½„ 2,622 „ 4„ 885 „ 4½„ 2.573 „ 5„ 1,520 „ 5½„ 2,428 „ 6„ 616 „ 6½„ 430 „ 7„ 534 „ 7½„ 205 „ 8„ 84 „ 8½„ 180 „ 9„ 47 „ 9½„ 112 „ 10„ 62 „ 10½„ 75 „ 11„ 64 „ 11½„ 56 „ 12„ and 179 „ 12½ to 37 persons. Dealing with Council houses alone, it became obvious that whilst some of these houses were overcrowded, a considerable number could house bigger families than those they contained. The Council therefore determined that before building any houses to abate overcrowding, steps should be taken to ascertain the extent to which overcrowding could be abated by means of transferring small families to small houses and large families to large houses. The Council also considered during the year the income of tenants occupying Council houses, and resolved that where the income of families living in such houses was over £5 10s. per week the tenant should be asked to vacate his house unless he could satisfy the Council that his circumstances were such that there would be hardship if his tenancy were terminated. 34 Although to date I am unaware that any Council house tenant was evicted on account of his income being above the scale, it is probable that the result of this decision was that some tenants of Council houses vacated their premises. Throughout 1936 an attempt was made by means of transfers to abate overcrowding, and at the end of the year the position was as follows:— (a) (i) Number of dwellings overcrowded at the end of the year 299 (ii) Number of families dwelling therein 299 (iii) Number of persons dwelling therein 2,048 (b) (i) Number of new cases of overcrowding reported during the year 67 (ii) Number of persons concerned in such cases 402½ (c) (i) Number of cases of overcrowding relieved during the year 109 (ii) Number of persons concerned in such cases 797 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil (c) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report. With regard to clause (e), transfers which resulted in the abatement of overcrowding have continued during 1937 in co-operation with the Treasurer's Department, and I am of the opinion that further abatement has taken place. The abatement of overcrowding that was found to have taken place occurred as follows:— Council Houses. By removal 10 By marriage of children, or girls going into domestic service 11 By death 1 Total 22 35 On the other hand, 32 Council houses had become overcrowded through increase in family, increase in ages of children, or other causes. Non-Council Houses. By removal 37 By marriage of children, or girls going into domestic service 47 By deaths 3 Total 87 On the other hand, 35 fresh cases of overcrowding have arisen due to increase in size of families, children attaining adult age, or other causes. On January 1st, 1937, overcrowding became a statutory offence, and overcrowding due to people entering new houses should not arise during 1937. The Act required that landlords of working-class houses should state in the rent book or similar document the permitted number of persons allowed to occupy each separate dwelling, and landlords are entitled to obtain such information from the Council. At the end of 1936 some 8,000 houses had been measured in order that landlords might obtain this information. There still remained, however, some 1,500 houses to be measured, and during the early months of 1937 further applications from landlords were still being received. The programme for 1937 consists in supplying this information, abating overcrowding by transfer and the offer of Council houses to overcrowded families in non-Council houses, investigations at the end of June and December to ascertain the state of overcrowding, and a survey of the District to see that all working-class houses have got the required information in the rent book or similar document. It has been deemed advisable to ascertain the extent to which overcrowding can be abated in Enfield by the methods referred to above before Council houses are built. 36 To carry out the initial survey two men were employed at a salary of £3 per week each for approximately 16 weeks, and eight men for about 10 weeks at a similar salary. The cost was £297 in wages and £55 for stationery and other incidentals in connection therewith. One of the men appointed has been employed since in order to measure houses for landlords, to keep the survey up to date, and assist in abating overcrowding. HOUSING CONDITIONS. The standard of housing in Enfield varies within the District, the Eastern portion containing houses for the working classes, and the Western for more wealthy residents. There are very few houses in Enfield which are not built of brick. It will be realised that in the last ten years there have been erected in Enfield about nine-and-a-half thousand houses, and much of the District that was originally fields is now covered with houses. These houses have had to be built in accordance with modern Building Bye-laws, and they therefore all contain damp-proof courses and are built on a site which has been covered with concrete. During 1936, 1,952 houses were erected. These houses became occupied almost as soon as they were built. Most of them were purchased by the tenants; in some cases they were let on lease or otherwise. There is a tendency to build houses for the middle classes in the neighbourhood of Enfield West. FITNESS OF HOUSES. No special measures were taken or suggested for the gradual carrying out of programmes of repair. I should estimate that about 80 houses in Enfield are not supplied with water by the Water Company. There are about 20 houses in the District which are not supplied with a water-closet. All these have earth-closets accommodation. 37 BYE-LAWS RELATING TO HOUSES, TO HOUSES LET IN LODGINGS, AND TO TENTS, VANS, SHEDS, ETC. The existing bye-laws are adequate, but increase in the Staff of the Department would be necessary if the bye-laws with respect to houses let in lodgings were to be enforced. A considerable amount of work was carried out in connection with moveable dwellings in order to put into force the provisions of the Middlesex County Council Act, 1934. A survey was made of every moveable dwelling in the District, and where the provisions of the Act were not complied with the matter was reported to the Health Committee and instructions given that proceedings be taken. INSPECTION AND SUPERVISION OF FOOD. MILK. Dr. Tate, the Medical Officer of Health for the County, has supplied me with the following report on the inspection of cows in the Enfield district during the year under the Milk and Dairies (Consolidation) Act, 1915, and the Tuberculosis Order, 1925. MILK AND DAIRIES (CONSOLIDATION) ACT, 1915. TUBERCULOSIS ORDER, 1925. During the year 1936 thirty-nine samples of milk were taken from retailers in the district. These samples were submitted to the Lister Institute for animal inoculation tests for the presence of tubercle bacilli. Three of these samples, produced in Enfield, were found to contain living tubercle bacilli. In one instance the farmer had disposed of his herd between the taking of the sample and the report from the Institute. The remaining two instances were in connection with the same farm, and one animal was found to be suffering from tuberculosis and was slaughtered. Six cows were reported by owners as suspected to be suffering from tuberculosis. One of these animals died before the result of the tuberculin test, which had been applied, was known. Of the remaining five, on examination three were found to be suffering from tuberculosis and were slaughtered. Routine examination of milch cattle was carried out during the year by Mr. Reginald Wooff, M.R.C.V.S., the County Council's whole-time veterinary inspector; 6,622 inspections of bovine animals were made in Enfield; six cows were found to be suffering from tuberculosis as defined in the Tuberculosis Order, 1925, and were slaughtered. 38 THE MILK (SPECIAL DESIGNATIONS) ORDER, 1923 and 1936. The inspection of premises where Graded Milk is sold has been carried out as heretofore. There are 18 Purveyors of Milk who sell or distribute Pasteurised Milk in the District. During the course of the year 7 samples were taken of this milk, either at the place of pasteurisation or in the course of delivery. These samples all oomplied with the Regulations prescribed in connection with Pasteurised Milk. MEAT. There are no public abattoirs in the District. Quite a large quantity of meat slaughtered at the Caledonian Market is brought into the District. The number of slaughter-houses in the District at the date specified is as follows;— 1914. January, 1936. December. 1936. Registered 10 6 6 Licensed 7 4 4 Total 17 10 10 Mr. Fred Wilson, Chief Sanitary Inspector; Mr. H. Wiggett, Mr. L. Rowley, Mr. A. Ramsden, Mr. G. Saffin and Mr. R. Johnson, Sanitary Inspectors, who hold the Certificate of the Royal Sanitary Institute as Inspectors of Meat and Foods, visit the slaughterhouses at very frequent intervals. They paid 1,192 visits during the year, when they examined 11,635 carcases, securing the surrender of 52 carcases and 211 parcels of diseased organs. SLAUGHTER -HOUSES. The inspection of slaughter-houses and of animals slaughtered therein takes up a large amount of the time of the Sanitary Inspectors and causes considerable difficulty, in view of the fact that much of the slaughtering takes place between the hours of 5 and 9 at nights. 39 SLAUGHTER OF ANIMALS ACT, 1933. The Slaughter of Animals Act, 1933, provides that no animal shall be slaughtered except by means of a mechanically operated instrument. Certain exceptions to this rule, however, are set forth. This Act has been put into force in the District, and the methods recommended are in operation in every slaughter-house in the District. In addition, the Act provides that no person, unless holding a Licence from the Local Authority, shall slaughter animals. One new application for a Licence was received during the year, which was granted. In addition, 22 applications for renewal of Licences were received, and all these were granted. PUBLIC HEALTH (MEAT) REGULATIONS, 1925. Systematic inspection of all butchers' shops and other premises for the sale of meat and offal was carried out during the year. With few exceptions, it was found that the Regulations were obeyed. BAKEHOUSES. There are 31 bakehouses in use in the District, all of which have been regularly inspected. OTHER FOODS. Every shop selling provisions is inspected frequently. ADULTERATION, ETC. The Sale of Food and Drugs Act is administered by the Middlesex County Council. The following report thereon has been supplied by R. Robinson, Esq., Chief Officer of the Public Control Department. URBAN DISTRICT OF ENFIELD. List of samples purchased during the year ended 31st December, 1936. Article. Taken. Adulterated. Milk 142 5 Milk, Sterilized 5 - Cream 1 - Lard 2 - Gin 3 - Hake 2 - Lemon Sole 1 - Sausages 3 - Whisky 9 2 Total 168 7 40 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The number of cases of Scarlet Fever was 213, compared with 229 in 1935; of Diphtheria 68, as compared with 77; of Pulmonary Tuberculosis 80, as compared with 83; and of Pneumonia 58, as compared with 34. The same methods of control were used as in previous years, except that the number of immunisations against Diphtheria was considerably increased, as is shown on pages 42 & 43 of this Report. No children died of Diphtheria during the year, as compared with two deaths in 1935. The following table shows the number of cases of Scarlet Fever, Diphtheria, Pulmonary Tuberculosis and Pneumonia notified during each of the past 5 years;— Disease. 1936. 1935. 1934. 1933. 1932. Scarlet Fever 213 229 252 249 227 Diphtheria 68 77 37 45 96 Pulmonary Tuberculosis 80 83 77 67 75 Pneumonia 58 34 48 80 86 PUBLIC HEALTH (SMALLPOX) PREVENTION REGULATIONS, 1917. No primary vaccinations or re-vaccinations were done by me during the year. NOTIFIABLE DISEASES DURING THE YEAR 1936. The following table shows the cases of infectious diseases notified during the year, and the number of deaths that occurred. 41 TABLE III.—Cases of Infectious Diseases notified during the Year 1936. Notifiable Disease. Number of Cases Notified. Total cases removed to Hospital. Deaths. At Ages—Years. At Ages—Years. At all ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Totals. Smallpox - - - - - - - - - - - - - - - - - - Cholera—Plague - - - - - - - - - - - - - - - - - - Diphtheria (inc. Membranous Croup) 68 - 13 48 4 3 - - 63 - - - - - - - - - Diphtheria Carriers 3 - 2 1 - - - - 2 - - - - - - - - - Erysipelas 32 1 2 3 2 9 10 5 19 - - - - - - - - - Scarlet Fever 213 - 40 133 16 22 2 - 176 - 1 - - - - - - 1 Typhus Fever - - - - - - - - - - - - - - - - - - Typhoid Fever 3 - - 1 2 - - - 2 - - - - - - 1 - 1 Paratyphoid Fever - - - - - - - - - - - - - - - - - - Relapsing Fever Continued Fever - - - - - - - - - - - - - - - - - - Puerperal Fever 2 - - - 1 1 - - - - - - - - - - - - Puerperal Pyrexia 3 - - - - 3 - - - - - - - - - - - - Cerebro-spinal Meningitis 1 - 1 - - - - - - - - 1 - - - - 1 Poliomyelitis 1 - 1 - - - - - - - - - - - - - - - Ophthalmia Neonatorum 5 5 - - - - - - - - - - - - - - - - Pulmonary Tuberculosis 80 - 1 3 21 37 17 1 - - - - - 7 28 21 4 60 Other forms of Tuberculosis 12 - 4 3 1 3 1 - - - 1 1 - - 2 - - 4 Encephalitis Lethargica - - - - - - - - - - - - - - 1 2 - 3 Malaria - - - - - - - - - - - - - - — — — — Pneumonia 58 4 14 14 3 8 11 4 — 15 3 1 1 4 1 13 19 57 Dysentery — — — — — — — — — — — — — — — — — — Totals 481 10 77 207 50 86 41 10 262 15 5 2 2 11 32 37 23 127 42 SCARLET FEVER. Two hundred and thirteen cases of Scarlet Fever occurred during the year in 177 houses, as follows:— Number of houses where 1 case occurred 150 Number of houses where 2 cases occurred 22 Number of houses where 3 cases occurred 3 Number of houses where 4 cases occurred 1 Number of houses (War Memorial Hospital) where 6 cases occurred 1 Total number of houses where cases occurred 177 Total number of cases 213 Deaths 1 DIPHTHERIA. Sixty-eight cases of this disease occurred during the year in 55 houses, as follows:—• Number of houses where 1 case occurred 45 Number of houses where 2 cases occurred 7 Number of houses where 3 cases occurred 3 Total number of houses where cases occurred 55 Total number of cases 68 Deaths DIPHTHERIA CARRIERS. Three cases of this disease occurred during the year in 2 houses. DIPHTHERIA IMMUNISATION. Sanction was received from the Minister of Health on the 31st January, 1935, for the carrying out of the Schick test and immunisation against Diphtheria for the poorer inhabitants of the District. Arrangements were accordingly made whereby the Health Department was authorised either to carry out the work itself or supply the necessary material to the General Practitioners of the District, subject to their giving me information as to the children who had been immunised. 43 There are various reagents that may be used for the immunisation of children against Diphtheria, but I consider it wise to use T.A.F. (Toxoid Antitoxin Floccules), as this reagent gives the least reaction and can be used for adults and children alike. It would appear, moreover, that the best results are obtained by the use of this reagent. In all, 533 individuals received three injections each. This is a decided improvement on the figures of last year when only about 55 individuals received such treatment. At the end of 1936 no case of Diphtheria had occurred in children who had been immunised. There were, however, only 68 cases of Diphtheria in Enfield, and I do not think any definite conclusion should be drawn from such small figures. TYPHOID AND PARATYPHOID FEVER. Three cases of Typhoid Fever were notified during the year. There was one death during the year, which occurred outside the District. POLIOMYELITIS. One case of this disease was notified during the year. CEREBRO-SPINAL FEVER. One case of this disease was notified during the year, which proved fatal. ENCEPHALITIS LETHARGICA. No cases of this disease were notified during the year. MEASLES AND GERMAN MEASLES. As from the beginning of 1932, Measles and German Measles were made non-notifiable in Enfield with the consent of the Minister of Health. Some idea of the extent of these diseases can be obtained, however, by the fact that 369 cases of Measles and 9 cases of German Measles were excluded from the schools during the year. These figures compare with 15 cases of Measles and 2 cases of German Measles for last year. 44 ENTERITIS. Five deaths of children under one year of age occurred from this disease during the year. None of these deaths occurred in children under the age of one month. ZYMOTIC DISEASES. The following table shows the deaths registered in the District from the seven chief zymotic diseases during the past five years:— Disease. 1932. 1933. 1934. 1935. 1936. Small Pox - - - - - *Scarlet Fever 11 3 1 1 2 *Diphtheria 7 6 2 6 2 *Measles 10 - 7 - 8 *Enteric Fever - - - 5 1 *Whooping Cough 6 4 1 1 4 Epidemic Enteritis - - - - - Totals 34 13 11 13 17 * The actual Enfield deaths were: Diphtheria, 0; Scarlet Fever, 1; Whooping Cough, 3: Measles, 5; and Enteric Fever, 1; the latter death occurring outside the District. The figures for Scarlet Fever, Diphtheria, Measles and Enteric Fever include all the deaths that occurred in the Enfield and Edmonton Joint Isolation Hospital, which is situated in the Enfield District. Patients belonging to other districts are also received, so that the figures for Enfield residents only are, therefore, smaller than those given above. ENFIELD ZYMOTIC DEATH-RATE. The zymotic death-rate, after deducting eight deaths of persons residing outside the District who died in Institutions in the District, and adding one death of a person who died outside the District, is 0.12 per 1,000 population. 45 Disease. 1935. 1936. Deaths. Death-rate. Deaths. Death-rate. Scarlet Fever 1 .01 1 .01 Diphtheria 2 .02 - - Enteric Fever 2 .02 1 .01 Small Pox - - - - Measles - - 5 .06 Whooping Cough 1 .01 3 .03 Epidemic Enteritis - - - - Totals 6 .07 10 . 12 PREVENTION OF BLINDNESS. No action was taken during the year under Section 66 of the Public Health Amendment Act, 1925, for the prevention of blindness or for the treatment of persons suffering from any disease or injury to the eyes. OPHTHALMIA NEONATORUM. Cases. Vision Unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 5 4 1 5 — — — It is the duty of the midwife who discovers that a child is suffering from discharge from the eyes, to notify the County Medical Officer immediately. A local practitioner is then called in to see the case, whose duty it is to notify me forthwith. The child is visited by one of the Maternity and Child Welfare Nurses, who reports thereon to me, and the information is passed on to the County Medical Officer of Health. TUBERCULOSIS. The following table shows the number of notifications of Pulmonary and Other Forms of Tuberculosis received during the year:— 46 Ward. Pulmonary. Other. Fresh Cases. Old Cases re-notified. Duplicates. Fresh Cases. Old Cases re-notified. Duplicates. Town 19 - 20 2 - 1 Chase 17 1 40 5 - 2 Ordnance 17 2 26 1 1 1 Green Street and Ponders End 17 - 30 1 - - Bush Hill Park 10 3 34 3 - - Hadley and Cockfosters - - - - - - Totals 80 6 150 12 1 4 First Notifications, including transfer notifications 92 Old cases re-notified, i.e., some by fresh doctors 7 Duplicate Notifications, i.e., those which report the entering and leaving of Sanatoria 154 Total Notifications 253 The following table gives particulars of the ages of the new cases notified, and deaths from this disease during the year:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. Under 1 - - - - - - - - 1 to 5 1 - 4 - - - 2 - 5 to 10 1 — 1 1 — — — — 10 to 15 1 1 1 - - - - - 15 to 20 4 2 1 — 2 — — — 20 to 25 6 9 — — 2 3 — — 25 to 35 6 9 1 2 3 10 1 1 35 to 45 12 10 — — 4 11 — — 45 to 55 7 4 1 — 10 4 — — 55 to 65 5 1 — — 7 — — — 65 and upwards 1 — — — 3 1 — — Totals 44 36 9 3 31 29 3 1 47 SEX (1st NOTIFICATIONS). Form. Males. Females. Pulmonary 44 36 Other 9 3 Totals 53 39 CASES AND DEATHS. The number of cases, also deaths from this disease, in the different Wards during the year is shown in the following table, viz.:— Ward. Pulmonary. Other. Cases. Deaths. Cases. Deaths. Town 19 6 2 - Chase 17 12 5 1 Ordnance 17 18 1 1 Green Street and Ponders End 17 18 1 1 Bush Hill Park 10 6 3 1 Hadley and Cockfosters — — — — Totals 80 60 12 4 Fourteen per cent. of the cases dying of Tuberculosis had not previously been notified. As reported previously, the mortality from Tuberculosis is most severe during what should be the healthiest and most active period of life. Of the 92 first notifications received during the year, 55 were in persons between 20 and 45 years of age, and of the 64 deaths, 35 were in the same age period. Cancer and Consumption are still the present scourges of our generation and account for a large proportion of ill-health and premature death. If these two diseases could be prevented, the expectation of life would be materially lengthened. 48 PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. It was not found necessary to take any action, under the above Regulations, with regard to tuberculous persons employed in the milk trade. PUBLIC HEALTH ACT, 1925, SECTION 62. No action was taken during the year under this Section. SUPPLY OF INSULIN. In November, 1935, permission was received from the Minister of Health to supply Insulin to the poorer inhabitants of the District. During the course of the year the child who was under treatment in 1935 continued to receive Insulin at the expense of the Council. DISINFECTION OF VERMINOUS PERSONS AND THEIR BELONGINGS. No requests were received during the year from the Education Committee for the disinfection and cleansing of verminous dwellings and clothing. ERADICATION OF BED BUGS. (1) Number of Council houses found to be infested 79 Number of Council houses disinfested 79 Number of other houses found to be infested 103 Number of other houses disinfested 103 (2) The methods employed for freeing infested houses from bed bugs. During the course of the year the following substances were used:— Sulphur. Cimex. Ris. Pyagra. Heavy Naphtha. The use of most known methods of disinfestation entails the removal of woodwork from the interior of the house, followed by the use of a blowlamp and/or the spraying with the disinfestant of choice. 49 In view of the large amount of woodwork that there is in Council houses in Enfield. disinfestation by these methods tends to be an expensive item. Consideration was given during the course of the year to the use of Cyanide, but owing to the dangers associated therewith the Council determined against its use. It would certainly be necessary in Enfield to remove the residents from the whole of a block of houses were Cyanide to be used. Towards the end of the year experiments were carried out with the use of Heavy Naphtha; this is used as a spray, and no woodwork need be removed. The experiments which have been carried out are decidedly encouraging, and I hope to include a full report on this matter in next year's Report. (3) No methods were employed for ensuring that the belongings of tenants were free from vermin before removal to Council houses. The experiments referred to above include the use of Heavy Naphtha in a removal van. (4) The work of disinfestation is carried out by the Local Authority. METEOROLOGY. The following instruments are installed at the Public Offices:— Standard Fortin Barometer. Maximum Thermometer Minimum Thermometer Standard Hygrometer In a Stevenson's screen in grounds of the Public Offices. Terrestrial Radiation Thermometer Earth Thermometer In the grounds of the Offices. Campbell-Stokes Sunshine Recorder Rain Gauge On the roof of the Public Offices. Daily records have been taken, and monthly returns sent to the Meteorological Office. The accompanying table gives the result of our operations for the year in a condensed form. METEOROLOGICAL STATISTICS, 1936. Month. Barometer. Temperatures. Rainfall. Millimetres. Sunshine hours. Thunderstorms Fogs on days. Frosts on days. Snowfalls. Prevailing. Winds. Highest. Lowest. Earth. Means. Lowest Grass. Min. Highest Maximum. Lowest Minimum. Means of Latter. January 30.320 on 14th 28.945 on 20th 42.9° 22° on 19th 56° on 9th 22° on 19th 39° 98.8 4.12 inches. 31.4 — 5 9 5 S.W. February 30.570 on 7th 29.076 on 18th 40.8° 19° on 13th 52° on 18th 22° on 13th 37° 38.3 1.65 inches. 69.2 — 6 16 — E. March 30.293 on 16th 29.198 on 1st 42.8° 27° on 4th 63° on 21st 30° on 4th 46° 26.8 1.09 inches. 77.3 — — 8 1 E. April 30.365 on 28th 29.506 on 21st 45.8° 27° on 21st & 23rd 66° on 28th 29° on 21st 45° 30.2 1.25 inches. 127.2 — 1 4 3 N.E. May 30.383 on 3rd 29.593 on 30th 50.8° 32° on 29th 76° on 6th & 18th 35° on 29th 55° 2.6 0.09 inches. 182.0 3 — — — N.E. June 30.226 on 18th 29.716 on 3rd 54.8° 38° on 4th 87° on 20th 40° on 4th 55° 99.7 3.86 inches. 177.7 5 — — — N. & S.E. July 30.272 on 30th 29.289 on 15th 59.9° 44° on 30th 76° on 5th 47° on 30th 62° 69.4 2.93 inches. 133.1 3 — — — S.W. August 30.418 on 26th 29.638 on 2nd 59.8° 44° on 23rd & 29th 84° on 29th 47° on 23rd & 29th 63° 10.1 0.39 inches. 175.7 — — — — S.W. September 30.408 on 22nd 29.508 on 7th 59.6° 38° on 29th 75° on 2nd 41° on 29th 59° 71.0 2.83 inches. 96.1 3 2 — — S.W. & S.E. October 30.394 on 29th 29.412 on 26th 53.8° 29° on 29th 66° on 15th 32° on 4th & 29th 49° 41.0 1.73 inches. 97.1 — — 2 — S.W. November 30.579 on 20th 28.934 on 7th 49.0° 28° on 11th 56° on 17th 30° on 22nd&29th 42° 79.7 3.15 inches. 44.0 — 3 8 — S.W. December 30.709 on 23rd 29.102 on 14th 45.2° Broken 55° on 17th 25° on 8th 41° 42.7 1.64 inches. 43.6 — 7 Broken — S.W. Totals 610.3 24.73 inches. 1254.4 hrs. 14 24 47 9 / MATERNITY and CHILD WELFARE SECTION 52 MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE, 1936-1937. Chairman H. A. Deshborough Brown, Esq. Councillors Bennett, Eeles, Fletcher, Greenwood, Jones, Kemp, Muspratt and Rowlandson; also Co-optative Members:—Miss G. M. Ford, Mrs. H. Hammerton, Mrs. A. E. Heath and Mrs. R. G. Porter. MATERNITY AND CHILD WELFARE STAFF. Medical Officer of Health and Maternity and Child Welfare Officer: Dennis H. Geffen, M.D., D.P.H. Assistant Part-time Medical Officers and Specialists: Dr. C. J. Thomson, M.B., M.D. *Dr. T. Thomas, M.D., D.P.H. †Mr. C. E. James, L.D.S. (Eng.), R.C.S. (Dental Surgeon). †Mr. R. Bradbury, L.D.S. (Manchester). (Dental Surgeon.) (Resigned 28th March, 1936.) †Mr. H. Mackay, L.D.S. (St. Andrews). (Commenced April, 1936.) ††Mr. S. Macky, M.B., B.S., D.O.M.S. (Ophthalmic Surgeon.) ‡fMr. J. C. Hogg, F.R.C.S. (Aural Surgeon.) Health Visitors: Miss M. E. Newbegin, S.R.N., C.M.B., M.R.C.N. Miss M. Garlick, S.R.N., C.M.B., M.R.C.N. Mrs. C. D. Herbert, S.R.N., C.M.B., Cert. R.San .Inst, for Health Visitors. Miss C. Wilkinson, S.R.N., C.M.B., New H.Vs. Cert. *Half-time M. & C. W. and half-time School. †School Dental Surgeons. ††Part-time Ophthalmic Officer to the Education Committee. ‡Part-time Aural Surgeon to the Education Committee. 53 Public Offices, Enfield , 30th March, 1937. To the Chairman and Members of the Urban District Council of Enfield. Mr. Chairman and Gentlemen, I beg to place before you my report on the Maternity and Child Welfare services of Enfield for the year 1936. Whilst the scope of the work has not been increased by the commencement of any new service, there has been a steady growth in the number of individuals who have been helped and of the work that has been carried out. This is fully indicated by the figures quoted in this Report. Despite this increase in work, children are still entering our schools suffering from dental, aural and ophthalmic defects. These defects should have been remedied prior to their admission, and it should be unnecessary for children to lose school time for the treatment of defects that could have been prevented or cured at the Maternity and Child Welfare Clinic. An increase in the number of three-year old and four-year old children attending our Clinics should prevent this. I would like to take this opportunity of stressing the value of the ante-natal and allied dental, aural and ophthalmic clinics. Here the expectant mother can obtain such treatment as will assure her that she faces pregnancy and child-birth in as fit a condition as possible. Contentment during pregnancy is an important factor in the protection of mothers against some of the disabilities associated with child-birth. One cannot expect an ante-natal mother to be happy if she is deaf or suffering from headaches or dental pain. The minor maladies of pregnancy can cause serious distress, and the efforts which the Council are making towards the comfort of pregnancy are of the greatest importance. It has been suggested that a fear of pregnancy has been engendered in the public as a result of the widespread propaganda which has been made in order to effect a lowering of maternal 54 mortality. The general attitude of the profession to-day is to assure mothers that this fear may be dangerous. Pregnancy is, and should be, a normal physiological function, but inasmuch as no one should undertake a- task involving bodily strain without assuring himself that he is fit, no woman should undertake pregnancy without similar precautions. In this lies one of the greatest values of the ante-natal clinic. It is not concerned alone with the lie of the baby, nor the actual details of labour. The ante-natal clinic encourages women to approach pregnancy, and labour, as normal individuals free from disabilities or diseases which can be prevented. It also attempts to allay anxiety and fear by securing that the mother is well nourished; by seeing that proper arrangements are made for the confinement; and by engendering that spirit of happiness in the home which should be associated with the birth of a child. I wish to take this opportunity of mentioning the excellent work which has been carried out by the Voluntary Workers who have attended so regularly at each of our Clinics. I am indebted to my Staff for their loyal co-operation throughout the year and to the Members of the Maternity and Child Welfare Committee for their courtesy and help. I am, Mr. Chairman and Gentlemen, Your obedient Servant, DENNIS H. GEFFEN, Medical Officer of Health. 55 MATERNITY AND CHILD WELFARE CLINICS UNDER THE CONTROL OF THE LOCAL AUTHORITY. District. Situation of Centre. Day and times open. Infant Welfare Centres:— Ponders End School Clinic, Southbury Road, Ponders End Tuesday and Thursday afternoons, 2 to 5 p.m. Bush Hill Park Lincoln Road, Bush Hill Park Tuesday and Thursday afternoons, 2 to 5 p.m. Town and Chase Rosemary Avenue, Enfield Monday and Wednesday afternoons, 2 to 5 p.m. Ordnance St. Stephen's Road, Enfield Wash Monday and Wednesdays afternoons, 2 to 5 p.m. Ante-Natal Clinics :— Ponders End School Clinic, Southbury Road, Ponders End 1st and 3rd Thursdays and 2nd Tuesday in each month, 9.30 to 11.30 a. m. Bush Hill Park Lincoln Road, Bush Hill Park 1st and 3rd Wednesdays in each month, 9.30 a.m. to 12 noon. Town and Chase Rosemary Avenue, Enfield 2nd and 4th Wednesdays in each month, 9.30 to 11.30 a. m. Ordnance St. Stephen's Road, Enfield Wash 2nd and 4th Thursdays in each month, 9.30 to 11.30 a.m. Dental Clinic:— Whole District School Dental Clinic, Southbury Road, Ponders End Saturday mornings, 9.30 to 11.30 a.m.; Wednesday afternoons, 2 to 4 p. m. Each of the above Centres is provided and maintained by the Council. 56 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total. Male. Female.86 Legitimate 1,330 674 656 Illegitimate 40 19 21 Birth-rate—16.72 per 1,000 population. Still Births:— Total. Male. Female. Legitimate 32 15 17 Illegitimate 1 1 — Rate per 1,000 total births—23.52. Total. Male. Female. Deaths 805 433 372 Death-rate—9.82 per 1,000 population. Number of women dying in, or in consequence of, childbirth:— Deaths Rate per 1,000 Total Births. From Puerperal Sepsis — — From other Puerperal causes 3 2.13 3 2.13 Two of these three cases were removed to the North Middlesex County Hospital, Edmonton, and the other to 72a, East Dulwich Grove, Camberwell, where they died. Death-rate of Infants under one year of age:— All infants per 1,000 live births 62.77 Legitimate infants per 1,000 legitimate live births 61.65 Illegitimate infants per 1,000 illegitimate live births 100.00 Deaths from Measles (all ages) 5 Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhoea (under 2 years of age) 6 57 The following table gives the birth-rate, recorded death-rate and infantile deaths for Enfield as compared with those for England and Wales, London, 122 County Boroughs and great towns (including London) and 143 smaller towns:— Birth-rate. Recorded Death-rate. Infantile Death-rate. Live Still England and Wales 14.8 0.61 12.1 59.00 London 13.6 0.53 12.5 66.00 122 County Boroughs and Great Towns (including London) 14.9 0.67 12.3 63.00 143 Smaller Towns 15.0 0.64 11.5 55.00 ENFIELD 16.72 0.40 9.82 62.77 INFANT MORTALITY. On page 10 of this report full details of deaths of infants under the age of one year will be found, and a further reference on the subject will be found under the heading "Zymotic Death-rate" on page 44. BIRTHS. The actual number of births registered in the district was as follows:— Boys. Girls. Total. 496 471 967 including 27 illegitimate births, i.e., 2.79 per cent. of the total. In addition, 7 male and 8 female still-births were registered. The corrected birth-rates for both sexes, live and still-births, which takes into consideration those born outside the district and those in the district not rightly recorded to the district, and also the corrected birth-rates for the last 5 years, are:— Year. Boys. Girls. Total. Birth-rate per 1,000 Population. Illegitimate Birth-rate per 1,000 Population. 1932 571 527 1,098 15.69 .62 1933 537 520 1,057 14.72 .50 1934 571 555 1,126 15.08 .44 1935 628 639 1,267 16.46 .51 1936 709 694 1,403 17.12 .50 58 INFANTILE DEATHS. Reference to Table 2 on page 10 of this report shows that of the 86 deaths of children under one year of age, 34 occurred during the first week of life, 7 during the second week, 2 during the third week and 4 during the fourth week. In other words, 47 of the 86 deaths occurred before the children attained the age of one month. In 31 of the 47 cases the cause was prematurity, in 4 injury at birth, in 3 atelectasis (failure of the lungs to expand), in 1 congenital malformation and in 2 marasmus. During the course of the year I investigated 40 cases where death occurred during the first two weeks of life, and 22 still-births. In these 62 cases special attention was directed towards the attendance of mothers at ante-natal clinics, for any attempt to avoid still-births and early infantile deaths must be made, in most cases, during the ante-natal period. Of the 62 cases, only 16, or 26 per cent. of the mothers of these children attended at one of the Council's ante-natal clinics. Now the percentage of expectant mothers in Enfield who attend at our clinics is 46.1 per cent., and at this rate one would have expected that 28, or 46.1 per cent. of the 62 Enfield mothers who lost their children before they were two weeks old would have attended our clinics, whereas in actual fact the number was 16, or 26 per cent. These figures are small and there are other factors that should be taken into consideration. They tend, however, to indicate that the chance of survival of children whose mothers attend our antenatal clinics is nearly double that of those whose mothers do not. Ante-natal work should not consist, and in Enfield does not consist, of a medical examination to see that the lie of the child is correct, that the pelvic measurements are normal and the health of the mother satisfactory, although this is the major problem that must be considered. The work of the ante-natal clinic ensures that expectant mothers are well fed and obtain additional nutritive foods if malnutrition is present. It consists in seeing that the home is properly prepared for a confinement, that a Home Help is provided if necessary, and that the clothing of the mother and her general hygiene are satisfactory. The ante-natal clinic is not only a medical clinic instituted to discover medical defects, but is directed towards the placing of the ante-natal mother in the best medical and hygienic state to achieve healthy motherhood. It includes, moreover, adequate 59 provision for the care of the teeth, the eyes and the ear, nose and throat if necessary. The ante-natal clinic should not stand as an isolated unit, but be part of the general scheme for the welfare of the mother and the unborn child. The figures quoted in this report would appear to show that the Enfield clinics are achieving this object. MATERNAL MORTALITY. During the year 2 cases of Puerperal Fever and 3 cases of Puerperal Pyrexia were notified. The two cases of Puerperal Fever and one case of Puerperal Pyrexia were removed to Hospital. The other two cases of Puerperal Pyrexia were treated at home. There were three maternal deaths during the year, and the cause of death was as follows:— Puerperal Eclampsia In North Middlesex County Hospital. Eclampsia. Ante-Partum In North Middlesex County Hospital. Ruptured Tubal Gestation .. At 72, East Dulwich Grove, Camberwell. The average age of these three women was 37 years. Both of the cases that died in the North Middlesex County Hospital were investigated by me and a report thereon transmitted to the Minister of Health . These reports are private and confidential. MIDWIVES. The Middlesex County Council is the Supervising Authority under the Midwives Act. There are 26 Midwives practising in the district. ATTENDANCES AT INFANT WELFARE AND ANTE-NATAL CLINICS. The following tables show the attendances at the Infant Welfare and Ante-Natal Clinics during the year. 60 INFANT WELFARE CENTRES. Centre. Total Attendances. Individual Attendances. New Attendances. Number seen by Doctor. Average Attendance per Meeting. Ponders End 7,851 3,798 363 1,531 77.7 Bush Hill Park 7,898 3,698 344 2,212 77.4 Town and Chase 7,070 3,462 335 1,989 70.0 Ordnance 8,173 4,069 410 1,646 81.7 Totals 30,992 15,027 1,452 7,378 76.9 ANTE-NATAL CLINICS. Centre. New Attendances. ReAttendances. Total Attendances. Average Attendance per Meeting. Ponders End 204 434 638 17.7 Bush Hill Park 124 269 393 16.4 Town and Chase 115 254 369 15.4 Ordnance 168 346 514 22.3 Totals 611 1,303 1,914 18.0 The following table gives particulars of the work done by the Health Visitors during the year. VISITS. Town, Chase and Hadley. Bush Hill Park. Ordnance. Ponders End. Totals. Birth Notification Visits 275 281 346 287 1,189 ,, ,, Re-visits 370 718 485 669 2,242 Children, 1-5 years, Visits 1,301 1,570 1,468 1,255 5,594 Visits re Insanitary Conditions 12 8 - - 20 General Visits 436 77 75 139 727 Ante-Natal Visits 163 155 142 185 645 Post-Natal Visits 10 148 32 32 222 Blank Visits 286 134 103 83 606 Infectious Disease Visits 207 266 129 52 654 Ophthalmia Neonatorium Visits 5 4 9 Puerperal Fever Visits — — — — — Puerperal Pyrexia Visits 1 — 2 — 3 Visits re Foster Children 37 71 57 36 201 Totals 3,098 3,433 2,843 2,738 12,112 61 FEEDING, ETC. Feeding. Town, Chase and Hadley % Bush Hill Park % Ordnance. % Ponders End % j Totals % Natural 249 90 256 91 322 93 255 88.8 1,082 91 Artificial 26 9 25 9 24 7 32 11.1 107 9 Mixed — — — — — — — — — — Separate Cot 268 97 266 95 299 86 278 97 1,111 94 BIRTHS NOTIFIED. The number of children born to Enfield mothers during 1936 was 1,323. This includes 381 which were born outside the district. The Health Visitors visited 89.8 per cent. of the Enfield babies born during the year. ASSISTED MILK SUPPLY. The quantity of fresh and dried milk supplied to necessitous cases under the Assisted Milk Supply Scheme during the year was as follows Fresh Milk 11,414 galls. Cost £1,269 12s. 6d. Dried Milk 2,803 lbs. Cost 204 0s. l0d. The corresponding figures for 1933, 1934 and 1935 are as follows:— 1933. Fresh Milk 19,860 galls. Cost £1,825 l1s. 2½d. Dried Milk 3,683 lbs. Cost 273 19s. 0¾d. 1934. Fresh Milk 16,414 galls. Cost £1,481 4s. 3d. Dried Milk 4,201 lbs. Cost 311 3s. 4d. 1935. Fresh Milk 13,377 galls. Cost £1,395 15s. 6 1/5d. Dried Milk 3,389 lbs. Cost 243 13s. 11¾d. The amount of fresh and dried milk supplied free continued to drop in amount and cost, despite the fact that the tendency of the Maternity and Child Welfare Committee for the last few years has been to deal with applications on more generous lines. Consideration is given to the needs of the unborn child by the provision of extra nourishment to the expectant mother. For the purpose of applying the financial scale for the determination as to whether or not an applicant is entitled to help, the unborn child is considered as a member of the family. Consideration is also given to the fact that the cost of living is higher in the winter season than in the summer. 62 It will be seen that the cost of milk is £555 18s. 8½d. less than that supplied in 1933. This saving to the Council has not been at the expense of the mothers and children who have needed its help, but is due to increased prosperity and lessening of unemployment. Wherever help has been necessary, the Health Visitors have not hesitated to advise mothers to apply for it. I am satisfied that the maternity and child welfare benefits are well known in the district. ROUTINE MEDICAL INSPECTION OF CHILDREN UNDER FIVE YEARS OF AGE. The following table shows the result of the work carried out under the above scheme during the year:— Total number of appointments made 7,340 Total number kept 2,309 Total number of additional examinations 1,280 This table compares with the following for the years 1934 and 1935:— 1934. Total number of appointments made 6,780 Total number kept 2,231 Total number of additional examinations 960 1935. Total number of appointments made 7,570 Total number kept 2,714 Total number of additional examinations 1,222 The following table is an analysis of the children sent for routine examination, showing the number of appointments made at each birthday. Appointments. 1st Birthday. 2nd Birthday. 3rd Birthday. 4th Birthday. Total. Number sent for 1,007 861 727 712 3,307 Number kept 384 250 194 141 969 The total number of appointments made, not including birthdays, was 4,033. The total number kept was 1,340. 63 The procedure whereby invitation cards are sent to children on their birthdays inviting them to attend the Maternity and Child Welfare Clinic to be medically examined, has been continued throughout the year and has proved reasonably satisfactory. I would like, however, to see a larger percentage of these invitations accepted. It will be noticed that the smallest percentage of the appointments kept is for children aged four years. This particular examination is of great importance. It is the one opportunity the Maternity and Child Welfare Committee has of remedying defects before children enter school, and of saving a large amount of the time that is lost in rendering children fit to be taught on entering school. At four years of age dental defects are apparent in the majority of children and can be treated, whilst minor maladies of nutrition can be investigated and remedied. An increase in the number of children attending on their fourth birthday would do much to improve the health of the younger members of the district. AURAL TREATMENT. The scheme whereby children under five years of age and antenatal and nursing mothers could be referred to the School Aural Clinic was continued, and during the course of the year 45 children and 3 mothers were so referred. This compares with 33 children during the previous year. Of the 45 children and 3 mothers, 22 were found to have enlarged tonsils and adenoids needing removal. OPHTHALMIC TREATMENT. The scheme whereby mothers and children attending the Centres who are in need of ophthalmic treatment could be referred to the School Ophthalmic Surgeon, was continued throughout the year. From the following figures it will be seen to what extent such services have been utilised. Mothers. Children. Total. Number of individual cases seen 39 45 84 Number of attendances made 44 86 130 Number of glasses prescribed 28 9 37 Number not requiring glasses 5 17 22 Number of cases referred for conditions other than refractions 5 7 12 Number referred to Hospital 1 2 3 Number referred to Hospital for meibomian cyst - 1 1 64 BIRTH CONTROL. Arrangements exist whereby advice on Birth Control is given to those mothers attending the Council's Maternity and Child Welfare Centres for whom further pregnancy would be detrimental to health. This is in accordance with Memorandum 153/M. and C.W. and Circulars 1208 and 1408 of the Ministry of Health. The Committee determined that, where possible, advice should be given to the husband rather than, or as well as, to the wife. CHILDREN ACT, 1908-1932. Two hundred and one visits were paid by the Infant Life Protection Visitors during the year in connection with their duties under this Act. ADMINISTRATION OF PART I OF THE ACT DURING THE YEAR 1936. (a) Number of persons receiving children for reward on the Register at the end of the year 23 (b) Number of children on the Register:— (i) at the end of the year 26 (ii) who died during the year Nil (iii) on whom inquests were held during the year Nil (c) Number of Infant Protection Visitors holding appointment under Section 2 (2) at the end of the year who were:— (i) Health Visitors 4 (ii) Female, other than Health Visitors Nil (iii) Male Nil (d) Number of persons (in addition to or in lieu of Visitors under (c) above) or societies authorised to visit under the proviso to Section 2 (2) Nil (e) Proceedings taken during the year:— Number of cases. Section of Act under which taken. Nil. — (/) Number of cases in which the Local Authority has given sanction during the year:— (i) Under (a) of Section 3 of the Act of 1908 Nil (ii) Under (6) ,, ,, ,, Nil (iii) Under (c) ,, ,, ,, Nil (g) Number of Orders obtained during the year under Section 67 of the Act of 1932:— (i) From a Court of Summary Jurisdiction Nil (ii) From a single Justice Nil 65 DENTAL TREATMENT. The following particulars show the work which has been carried out during 1936 and the previous four years. Mothers. Children. Total. Totals. 1935. 1934. 1933. 1932. Attendances 703 324 1027 991 1071 1257 1111 Treated 177 213 390 468 319 340 340 Administrations: Local Anaesthetics 36 62 98 96 84 115 100 Extractions with Local Anaesthetics 107 123 230 207 166 211 181 Administrations: N20 201 125 326 302 272 252 308 Extractions under N20 1049 376 1425 1350 1187 1071 1501 Total Extractions 1156 499 1655 1557 1353 1310 1682 N20 Sessions 41 — 41 39 39 36 40 Ordinary Sessions 45 - 45 43 41 44 41 Total Sessions 86 — 86 82 80 80 81 Dentures fitted 121 — 121 82 129 131 120 Patients receiving Dentures 64 64 44 70 78 63 Number of Patients having repairs 9 9 13 11 20 3 Number of Repairs fitted 9 — 9 14 11 20 3 Number of Fillings 29 106 135 187 192 218 217 Other Operations 408 83 491 394 661 803 593 Number of Patients having extractions under N20 90 120 210 203 157 127 159 Number of Patients having extractions under Local Anaesthetics 28 58 86 69 60 134 81 BABY WEEK. This was held on the 29th and 30th June and the 1st and 2nd of July, Garden Parties being held at St. George's Hall, Freezywater, and the Red Triangle Club, Church Street, Enfield. We were fortunate in having fine weather on all occasions, and the mothers and children spent a very enjoyable time, the total number attending being 1,537. For those mothers attending the Infant Welfare Centres, competitions were held and prizes were presented at the Garden Parties. 66 The following were the competitions:— (1) Write a letter to a friend telling her how Diphtheria can be prevented. (2) The best made new knitted garment. (3) The best garment made from new material. (4) The best garment made from an old knitted garment. (5) The best garment made from old material. The garments were judged by Doctor Helen Garrow, and the letters were referred to me. We found that the entries had improved a great deal on those submitted in previous years. This indicates that the mothers have been interested and followed the advice given them at the Clinics. Besides the Garden Parties, two very successful Fathers' Meetings were held, one at St. George's Hall, when Doctor Olunie Harvey, Medical Officer of Health for Southgate, gave a very interesting lecture on "Happy Motherhood." The other meeting was held at the Red Triangle Club, when a very helpful and inspiring address on "Maternal Happiness" was given by Doctor Dick Read. Those who attended showed a great interest in the subject. The lectures were followed by an interesting discussion. CIRCULATION OF BOOKLET ON REARING OF CHILDREN. During the course of the year approximately 1 ,383 booklets called "To Mothers and Fathers" were sent to mothers giving birth to a child . HOME HELPS. The number of Home Helps supplied during 1936 was 88, as compared with 52 in 1935 and 30 in 1934. This service of the Council is appreciated by the mothers of Enfield, who are being freed during the lying-in period from domestic responsibility and given an opportunity of recovering normal health. MIDWIVES. During the year a free midwife was supplied in 41 cases. This figure compares with 36 during 1935 and 5 in 1934. 67 OBSTETRIC SPECIALIST. The scheme whereby the General Practitioners of Enfield are enabled to call in the help of the Obstetrician at the North Middlesex County Hospital in cases of doubt or difficulty during the antenatal period or at the confinement, has continued throughout the year. The Obstetrician was called to four cases during the year. On each occasion when the Specialist is called in a fee of £2 2s. is paid to the Middlesex County Council and is recovered from the patient or her husband to the extent to which the family circumstances make this possible. During 1936, £6 16s. was recovered out of a cost to the Council of £8 8s. CONVALESCENT TREATMENT. The Maternity and Child Welfare Committee has no Convalescent Homes nor Homes for Mothers and Babies under its control, nor have any beds been reserved. Should it be found by the Medical Officers at the Centres that a mother or baby needs convalescent treatment they submit a report thereon to me. The family circumstances are investigated and the matter reported to the Maternity and Child Welfare Committee. During the year four children under the age of five years, and five mothers and their babies, were sent to Convalescent Homes. CO-OPERATION WITH THE EDUCATION COMMITTEE. The co-operation with the Head Teachers has been continued as in previous years, and the Health Visitors have attended at Senior Girls' Department in order to demonstrate to the older girls the bathing of a baby. The following work was carried out:— Miss Newbegin 5 demonstrations at Bush Hill Park School. 3 demonstrations at Central Girls' School. 2 demonstrations at Suffolk Girls' School. Miss Garlick 3 demonstrations at Chesterfield Road Girls' School. Mrs. Herbert 1 demonstration at Lavender Road Girls' School. 1 demonstration at Chase Side Girls' School. Miss Wilkinson 2 demonstrations at Alma Road Girls' School. 68 It will be seen that 17 demonstrations were given. In 1935 the number was 8. I welcome these requests for help from the School Teachers and their co-operation in organising these demonstrations. The school child that has scientific knowledge as to the care of young babies helps to disseminate that knowledge throughout the district. In certain homes the older girls perform domestic duties of the kind taught them in school, and it is as well that they should carry out these functions in a scientific manner. SUMMARY. Enfield's Maternity and Child Welfare Scheme includes the provision of:— 1. Health visiting. 2. Eight clinics weekly for children under 5 years of age. 3. Nine clinics monthly for expectant mothers. 4. Milk and other foods to children under 5 years of age, and to expectant and nursing mothers. 5. Dental treatment. Dentures. 6. Home Helps. 7. Payment of Midwives' fees. 8. Ophthalmic treatment. 9 . Aural treatment. 10. Convalescent treatment. 11. Obstetric Specialist in difficult confinements. 12. Routine examination of children under 5 years of age. 13. Diphtheria immunisation. CONCLUSION. The scope of maternity and child welfare work has not been increased during the year by the addition of any new service. In nearly every branch of the work there has been an increase in the number of persons to whom valuable help has been afforded. There has been a decrease in the demand for free milk and free foods. 69 Public Offices, Enfield. 30th March, 1937. Report of the Chief Sanitary Inspector For the Year 1936. To the Chairman and Members of the Urban District Council of Enfield. Gentlemen, I beg to submit my Report for the year ending 31st December, 1936. STATEMENT PREPARED BY SANITARY INSPECTOR UNDER ARTICLE XIX (12), MINISTRY OF HEALTH ORDER, No. 276, 1922. NUMBER OF HOUSES INSPECTED. Inspections. Under the Housing Consolidated Regulations, 1925 349 From House-to-House, apart from this Act 447 On account of Infectious Disease 252 On account of Phthisis 65 On account of Complaint by Occupant or otherwise 1,261 On account of Vermin 365 194 Factories 208 106 Workshops and Workplaces 79 Outworkers' premises inspected 162 41 Bakehouses, of which 30 are in use 71 10 Slaughterhouses, of which 7 are in use 1,192 Carried forward 4,451 70 Brought forward 4,451 21 Cowkeepers' premises 412 84 Dairies and Milkshops inspected frequently 268 21 Schools 81 Public Conveniences inspected 475 Conveniences at Railway Stations inspected 9 Fish Shops: Total number of visits 100 Coffee and Eating Houses: Total number of visits 7 Coffee Stalls: Total number of visits 27 Shops where Ice-cream is made: Total number of visits 33 Meat Shops: Total number of inspections 285 Food Stalls in Markets: Total number of inspections 969 2,666 Visits to absentees excluded from Elementary Schools 1,386 Visits in connection with cases of Infectious Disease 1,455 Visits in connection with Phthisis 223 Visits re Verminous Premises, etc. 1,172 Offensive Trades (excluding Fish Shops) 12 Smoke observations 67 Other inspections, including works in progress 8,782 Visits re Shops Acts 240 Cinemas, etc., inspected 23 Visits and inspections re rats 246 Visits re Sub-letting in Council houses 29 Visits re Gipsy Vans, etc. 98 Visits re Overcrowding 376 Visits re Rag Flock Act 8 Visits and Inspections at Mortuary 26 Inspections of Stables 11 Visits re Noises, etc. 84 Visits re Pig-styes 3 Visits re Fair Grounds 1 Other visits 1,513 15,755 22,872 71 NOTICES ISSUED. Statutory:— Public Health Acts. Provision of dustbins 2 For repairs to houses, drains and abatement of nuisances 52 Providing sufficient water-closets 12 Paving of yards — Provision of sinks or drains 10 Housing Act, 1930 33 109 Informal:— Notices—Public Health Acts 557 Housing Act 411 968 1,077 Other Notices issued under Infectious Diseases Acts:— To occupiers 435 To Education Committee and Head Teachers at Schools 1,862 To Librarian 12 2,309 3,386 Other letters sent 8,437 Number of Certificates issued in connection with Plans 122 Number of Certificates issued in connection with disinfection 23 Result of Service of Statutory and Informal Notices:— Statutory. Informal. Number complied with 106 703 Number outstanding 3 265 109 968 72 It will be noticed that the number of outstanding Statutory Notices is very small compared with the number issued, and I think this may be taken as a very satisfactory position for the end of the year. The defects found during the inspection of dwelling-houses are of a somewhat general character, and include the following:— Defective drains and ventilating pipes, etc.; W.C. flushing cisterns and pipes out of order; cracked and broken W.C. pans; broken, cracked and porous scullery sinks and waste pipes; leaking roofs; defective gutters; absence of, or broken, paving around houses: defective plaster of ceilings and walls; damp walls; want of ventilation under ground floors and general uncleanly conditions. The following are the works carried out as the result of the notices or letters:— Houses or parts of houses cleansed, repaired, etc. 579 Roofs repaired 270 Gutters and downpipes repaired 203 Downpipes disconnected from drains 19 Houses underpinned and settlement remedied 0 Dampness remedied 255 Concrete site provided under floors 0 Cesspools emptied 238 Cesspools abolished 1 New Cesspools provided 0 Closet pails emptied 1,679 House drains cleared, repaired, etc. 143 House drains tested, examined, etc. 184 House drains reconstructed 33 Soil-pipes and drains ventilated, including repairs to ventilators. 150 New vents provided 6 Sink-wastes disconnected or repaired 43 New sinks provided 60 Closets provided with proper flushing cisterns or water supply 4 New closets provided 27 Closets repaired, covered, cleansed, etc. 229 Water-closets substituted for earth-closets 4 Elsan or Chemical Closets provided 0 Urinals repaired 0 Privy substituted for earth-closet 0 Storage cisterns repaired, covered, cleansed, etc. 28 Storage cisterns provided 0 Water laid on or restored 1 73 Taps provided over sinks 0 New wells provided 0 Wells closed 0 Wells cleansed and repaired, etc. 0 Samples of water taken from Wells 6 ,, ,, ,, Main 0 ,, ,, ,, Swimming Pool and Baths 39 Samples of Rag-Flock taken under Rag Flock Act 5 Samples of Milk taken 7 Yards paved, or existing paving made good 151 Yards drained 0 Ventilation provided under ground floors 30 Floors repaired 124 Handrails provided to Stairs 34 Dustbins repaired, or new ones provided 303 Forecourts paved 4 Food Stores provided 43 Ventilation provided to food stores 15 Chimney stacks rebuilt or repaired 3 Doors repaired or replaced with new 4 Manure heaps removed 14 Fowls and other animals removed 0 Coppers repaired, etc. 42 Stoves repaired, etc. 96 Windows repaired, etc. 257 Other nuisances abated 389 Cases of overcrowding abated 1 Ditches cleaned out 3 Gipsy vans removed 23 Pig-styes removed 1 Heating provided to Shops 1 Coffee Stalls abolished 1 Every possible endeavour is made to ensure the carrying out of work with as little delay as possible, and in order to secure this I have interviewed many owners and agents and thus expedited the work. By interviewing owners and others having control of property in the District the work has been speeded up, and in cases where there seemed to be no just cause or reason for delay, a suitable warning from the Council has helped to have the work carried out, and so avoided further proceedings being taken to secure the finish of the repairs necessary. 74 Some inconvenience was experienced during the year owing to the fact that we were short of one Sanitary Inspector on the Staff for some months. 1,386 visits were paid in respect of children excluded from elementary schools during the year, and the total number of inspections and visits for all purposes made by the Staff of the Public Health Department was 22,872. DISINFECTION. Houses Disinfected:— After infectious disease 332 After Phthisis 60 392 After verminous cases 103 Vacated Council houses 176 279 671 Rooms stripped and re-papered, etc., after occupation by cases of infectious disease 5 Ditto ditto by cases of Phthisis 3 Articles of clothing, bedding, etc., disinfected 1,243 Ditto ditto destroyed 147 Library books disinfected 32 Number of Certificates issued re disinfection of clothing and premises 23 Number of Schools disinfected 4 Private patients removed to Hospitals 1,540 Gipsy Vans removed from the District 23 Articles or parcels of unsound food destroyed or otherwise disposed of 27 176 vacated Council houses were disinfested during the year. Of these, 79 showed signs of vermin—44 per cent. of the total. It is a decision of the Council that before an occupier may transfer from one Council house to another, the person wishing to be transferred must, on inspection, be found to be occupying a house free from vermin. DISINFESTATION OF VERMINOUS HOUSES. It is the practice of the Health Department to inspect every Council house as soon as it becomes vacant, in order to ascertain if the house be verminous; where vermin are found the house is disinfested before being re-let. 75 During the early part of the year disinfestation was carried out by means of various preparations. During the last four months, experiments have been carried out with Heavy Naphtha, and at the end of the year the results were promising. The problem is increased by the fact that the furniture of new tenants is not disinfested before being brought into a clean Council house, and it is to be hoped that some scheme will be devised whereby this may be accomplished. The disinfection of verminous clothing and bedding is carried out by means of a Washington-Lyon's Steam Disinfector situated at the Council's Sewage Farm. FACTORY AND WORKSHOPS ACTS, 1901 and 1907. A register is kept of all the workshops in the District, and at the end of 1936 there were 77 workshops, 29 workplaces' and 41 bakehouses registered. The following tables give details of the work done in connection with these places:— INSPECTIONS. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 208 2 - Workshops (including Workshop Laundries) and Workplaces 241 1 - Bakehouses 71 - - Total 520 3 - 76 DEFECTS FOUND. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— Want of cleanliness 2 2 — — Want of ventilation — — — — Overcrowding 1 1 — — Want of drainage of floors — — — — Other Nuisances — — — — Sanitary Accommodation:— Insufficient 10 9 1 — Unsuitable or defective 12 12 — — Not separate for sexes — — — — Offences under the Factory and Workshops Acts:— Illegal occupation of underground bakehouses - - - - Breach of special sanitary requirements for bakehouses - - - - Other offences — — — — Total 25 24 1 — HOMEWORK. Nature of Work. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Sending once in the year. Sending twice in the year. Lists. Workmen. Lists. Workmen. Fancy Paper Goods 1 61 - - - Badges 1 1 — — — Making Wearing Apparel 15 24 18 28 8 Boot-making 2 5 2 2 — Toys 2 2 — — — Cardboard Boxes — — 2 2 — Artificial Flowers 1 1 — — — Totals 22 94 22 32 8 Five addresses of outworkers have been forwarded to other Districts. 77 PLACES OF PUBLIC ENTERTAINMENT. Twenty-three inspections of cinemas and other places of entertainment were made in accordance with the recommendation contained in the Circular of the Ministry of Health, dated August 25th, 1920. The sanitary accommodation at each place was found to be satisfactory and sufficient. There are prospects now of places of entertainment of a more imposing and luxurious character being erected in Enfield. Whether this can be considered a matter calling for consideration from the sanatarian I do not know, but it is evident that this latest craze of the public is going to receive consideration. OFFENSIVE TRADES. The following offensive trades are established in the District:— Fish Fryers 30 Rag and Bone Dealers 3 Glue Maker Soap Boiler 1 and in connection with these, 112 inspections were made during the year. With regard to the Fish-fryers, 17 have been established with the consent in writing of the Council, and the majority of the oldestablished businesses are now fitted with up-to-date frying stoves. No doubt the Council will have noted that we are now endeavouring to obtain a higher standard of Fish Fryers by asking for the most up-to-date apparatus to be installed in Fish Saloons rather than the old type of open Fish Fryers' shops. MILK. Routine inspection of cowsheds, dairies and milkshops has been carried out during the year under the Milk and Dairies (Consolidation) Order, 1926. The standard of cleanliness has been fairly well maintained. I am pleased to say that practically the whole of the farms retailing milk are now fitted with sterilisation plants. 78 I am also pleased to say that the farmers have realised their responsibility with regard to lime washing and have complied with the requirements of the Act. Licences as follows were in force on the 31st December under the Milk (Special Designations) Orders, 1923 and 1936:— Dealer's Licence to use the Designation "Grade A" 1 Dealer's Licence to use the Designation "Pasteurised'' 16 Dealer's Licence to use the Designation "Grade A (Tuberculin Tested)" or "Tuberculin Tested" 6 Dealer's Licence to use the Designation "Certified" 1 Dealer's Licence to use the Designation "Grade A (Pasteurised)" 1 Pasteuriser's Licence to sell milk as "Pasteurised" 1 Supplementary Licence to use the Designation "Grade A (Pasteurised)" 1 Supplementary Licence to use the Designation "Certified" 1 Supplementary Licence to use the Designation "Grade A (Tuberculin Tested)" 1 Supplementary Licence to use the Designation "Grade A" 1 Supplementary Licence to use the Designation "Pasteurised" 2 PUBLIC HEALTH (MEAT) REGULATIONS, 1924. Inspection of meat under the above Regulations has, as a routine matter, been carried out as in previous years. Every endeavour is made to ensure that all foodstuffs are dealt with by the best possible hygienic methods. The tradesmen themselves are paying attention to this matter, and various machines and methods are being tested by the shopkeepers to improve the present system. As in previous years, animals have been conveyed in lorries, to the various slaughterhouses in Enfield, by road, thus avoiding driving the animals by road through the District from a station in the outlying part of the District. It will be seen that the number of pigs slaughtered is an increase on the previous year. 79 Slaughtering is carried out at almost all hours of all days, holidays or otherwise, and the Sanitary Inspectors have to spend a considerable amount of their time in examining the carcases and organs of slaughtered animals, and although there is an increase of one certified Meat Inspector on the Staff, they are all still fully employed. The old back-and-forward movement of meat from the slaughterhouses in Enfield to the Central Meat Market, London, and meat from the latter being sent to and sold in Enfield, still continues. The number of carcases examined during the year under these Regulations is as follows:— Oxen 373 Organs or parts of carcases found diseased 15 Cows 56 ,, ,, ,, ,, 13 Calves 123 ,, ,, ,, ,, — Sheep 4,119 ,, ,, ,, ,,, 76 Pigs 6,964 ,, ,, ,, ,, 159 Totals 11,635 ,, ,, ,, ,, 263 The organs or parts of carcases found to be diseased were surrendered and destroyed. The weight of the meat destroyed was 2 tons 17 cwt. 3 qrs. The carcases generally were in good condition, and there was no case which necessitated the obtaining of a Magistrate's Order. I am satisfied that matters are still on the improvement with regard to meat inspection in Enfield. UNSOUND MEAT AND FOODS. In this connection frequent visits were paid to the slaughterhouses, shops and markets, the number of inspections for this purpose being:— Slaughterhouses 1,192 Shops 264 Stalls in Markets 969 Food Preparing Shops 21 2,446 80 As in previous years, foodstuffs purchased in the various London Markets were submitted for inspection, and 12 parcels were found to be unfit for human consumption; these consisted of fish, meat, vegetables, etc. Certificates were given in all cases, as it was found that the articles were unfit for the food of man, so that the owner might obtain replacement of the goods or return of the money from the wholesale dealer. Four certificates in all were granted. COFFEE STALLS. As stated in previous reports, renewal of old Licences and the plans for new Coffee Stalls are passed through this Department, and up-to-date provisions are required with regard to the removal of refuse, water supply and drainage. We were quite justified in our statement in last year's Report that this work would increase under the provisions of the Shops Acts. MOTOR AMBULANCES. There are three Motor Ambulances for use in the District and are under the charge of Mr. A. H. Johnstone, the Fire Brigade Superintendent. SHOPS ACTS. The duties of the Inspectors under the Shops Acts are carried out by this Department. It was found necessary to take action during the year against three shopkeepers for contravention of the Act, and fines were imposed in each case. In one case it was the fourth occasion, and in one other the second instance, on which proceedings had had to be instituted. Unfortunately in taking cases to Court we have not been able to obtain the inflicting of such penalties as, in some cases, would be sufficiently heavy to act as a deterrent to the contravention of the Act. 81 The arrangements made with regard to the inspection of plans for all new shops by this Department is now being carried out, and this naturally has meant an increase in the work, both in respect of the inspection of the plans and the inspection of the premises by the Inspectors under the Shops Acts. Whilst the provisions of the Shops Act, 1934, relating to ventilation and temperature of shops and to sanitary conveniences are being dealt with as speedily as possible, it was not found necessary to take legal action under this Act during the year. REMOVAL OF HOUSE REFUSE. There is a weekly collection of refuse throughout the District, but we are being asked in some quarters for a bi-weekly collection. Forty-four Dustmen and the following vehicles are in use for the removal of house refuse:— 1—6 cubic yards "S.D." Freighter (petrol) dust-van. 2—10 cubic yards dustless-loading "S.D." Freighters. 6—15 cubic yards "S.D." Moveable Floor Rear-loading Freighters. 1—Tuke and Bell 10 cubic yards "Barrier" Type endloading vehicle. 1—Bedford 2 ton General Purpose 3-Way Tipping Lorry. I am of the opinion that, on the whole, the roller-floored type of refuse collection vehicle gives very satisfactory service and is undoubtedly the best type at present available for use on a dump. Arrangements exist whereby trade refuse is removed from shopkeepers' premises on payment of a pre-arranged charge. The income from this source was £84 9s. during the year. During the year, 18,388 tons of refuse were collected and disposed of at a cost of £16,717. This equals 18s. 2.1d. per ton for collection and disposal, as against 16s. 4.5d. in 1935. The cost per head of the population is 4s. 0.9d. per annum, or 0.9d. per week. The average for each house is 14s. 7.2d. per year, or 3.3d. per week. 82 DISPOSAL OF REFUSE. The depositing of refuse on the old Gravel Pit in Carterhatch Lane has been far from a pleasant experience, as, owing to springs being present in the land, a considerable amount of refuse had to be deposited in water. At the end of the year we were faced with a continuance of the same trouble. This was a very serious problem. We were fortunate in that we were able to secure a fair amount of covering material which helped to prevent much of the nuisance. SEWER FLUSHING. This work is carried out by the Department, and all sewers are regularly examined and flushed by men whose special duty it is. A further duty is the clearing and repair of sewers, and the regular examination of all main drains has been maintained. CESSPOOLS. A dual-purpose cesspool-gulley emptying machine with two men is employed in the emptying of cesspools, on request. This machine is available for the emptying of street gulleys when not required for cesspool emptying. A proportion of the cost of the work entailed in cesspool emptying is charged to the owner or occupier of the property. SCHOOLS AND HOSPITALS. The arrangement with the Education Committee is still carried out as regards the conveniences at all non-provided Schools, and these receive daily attention as regards cleansing by one of the employees of this Department. The drainage systems of all elementary and secondary schools in the District are examined by the Sanitary Inspectors. At both the Isolation Hospital and the Enfield War Memorial Hospital the sanitary arrangements are under the supervision of this Department, and those at the Isolation Hospital are attended to regularly in accordance with arrangements made by the Joint Hospital Board, while those at the War Memorial Hospital are attended to weekly as a voluntary service on the part of the Council. In addition, a large amount of disinfection has been carried out at the latter Hospital free of charge. PUBLIC CONVENIENCES. The public conveniences at the Parks and Pleasure Grounds, and also five attached to public-houses, making eighteen in all, are under the supervision of this Department . 83 The conveniences provided for men are now cleansed by wholetime attendants, and there has been a considerable improvement in cleanliness of these places since the Attendants commenced work. The Council have under consideration at the present time the alteration of the conveniences in the Town. This will be a great improvement to the District, as the present conveniences in the Market Place are now practically obsolete. HORSE TROUGHS AND DRINKING FOUNTAINS. Drinking fountains, and also four horse troughs in the District, receive daily attention as regards cleansing. PUBLIC MORTUARY. One Public Mortuary in the District, established at the Enfield Highway Cemetery, is constantly under supervision. There is now a whole-time Attendant at the Mortuary. RATS. It is the responsibility of the householder to carry out such measures as will prevent rat infestation. The Council have been, and are, at all times willing to supplement efforts made by the occupier to effect an improvement. There still remains the serious question as to whether the Health Department contains sufficient Staff to carry out the work that now falls upon it. Housing and other Acts are increasing the work of the Sanitary • Inspectors, whilst at the same time the population and number of houses in the District show rapid increase year by year. I am of the opinion that increase in Staff is now required. This Report would not be complete unless I again state how much I appreciate the kindly manner in which Dr. GefEen, your Medical Officer of Health, has always treated me and the Staff, and the happy conditions under which we work. I also wish to thank the Council for their continued courtesy and support, and all the members of the Public Health Staff for the very competent manner in which they have carried out their duties, and for their help during the past year. I am, Gentlemen, Your obedient Servant, FRED WILSON, M.R.San.I., M.S.I.A., Chief Sanitary Inspector. THE ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE YEAR ENDING 31st DECEMBER, 1936. 86 MEMBERS OF THE ENFIELD EDUCATION COMMITTEE, 1936-37. Chairman Mr. H. A. Deshborough Brown. Vice-Chairman Mr. H. G. Short. Representative Members: Mr. J. C. Bland. Mr. H. A. Deshborough Brown. Mr. H. H. Collier. Mr. A. M. Eeles. Mr. F.G. Fletcher. Mr. A. R. Kemp. Mr. H. Muspratt, O.B.E. Mr. C. Partington. Mr. H. G. Short. Mr. G. M. Sparrow, J.P. Co-optative Members: Mrs. N. Davies. Mrs. J. G. Dufton. Mrs. A. E. Heath . Mrs. H. Rothwell. Mr. T. H. M. Clarke. Mr. F. G. Cobbin. Mr. C. F. Watts. Director of Education: E. Pascal, Esq., M.A. STAFF OF THE SCHOOL MEDICAL DEPARTMENT. School Medical Officer: Dennis H. Geffen, M.D., B.S., D.P.H., M.R.C.S., L.R.C.P. Assistant School Medical Officers: Gertrude Forrester, M.B., B.S. (Lond.). A. G. T. Thomas, M.D., B.S., D.P.H. School Dentists: C. E. James, L.D.S., R.C.S. (Eng.). H. Mackay, L.D.S. School Ophthalmic Surgeon: S. Macky, M.B., B.S., D.O.M.S. School Aural Surgeon: J. C. Hogg, F.R.C.S. School Nurses: E. Sanders, M.R.C.N., S.R.N. I. Fowler, S.R.N. V. Murphy, S.R.N., C.M.B. Dental Nurse: F. Anderson, R.S.C.N. Clerks: H. Ogilvie. I. Groves. M. Stiff. 88 Annual Report of the School Medical Officer DENNIS H. GEFFEN. M.D., B.S., D.P.H., M.R.C.S., L.R.C.P. For the Year ending 31st December, 1936. To the Chairman and Members of the Enfield Education Committee. Mr. Chairman, Ladies and Gentlemen, I beg to submit my annual report on the health of the school children of Enfield during the year ending 31st December, 1936. The figures in the report show that there has been an increase of over 400 in the school population, and, in consequence thereof, a corresponding increase in the work that has been carried out. It must be remembered that for the past five years the years the school population has steadily increased, and that together with this, the Committee has undertaken the inspection and treatment of over 1,000 secondary school children. During the past ten years the staff has been increased by the addition of one parttime medical officer; the increase of work, however, is now falling somewhat heavily on the school nurses, and I think the time has come when an additional nurse will be required. In these opening remarks I would like to refer to an investigation which Dr. Forrester and I carried out in conjunction with the teachers of each of our schools. I had received complaints from various sources that children returned to school on Monday listless and tired after their week-end, rather than rested and keen for work. In order to investigate this matter I asked the teachers to give me certain information concerning the habits of school childre n, and although this entailed a large amount of work, the forms sent in were most satisfactorily completed. The result of this investigation will be found in a special report. 89 I would call the attention of the Committee to the increase of work shown in the report of Mr. Hogg, and, moreover, to the large number of children that have been cured as a result of attendance at the special Ear, Nose and Throat Clinic. Mr. Macky's report shows a steady continuation of the work of the Eye Clinic, with special reference to the number of children who are receiving themost modern treatment available for squint. Two points of outstanding importance emerge from the report of the Senior School Dentist. In the first place he has demonstrated very definitely the good effects of continuous dental treatment, by his comparison between the dental condition of children at the Central School, who have received regular treatment, and those of a similar age at the Junior Technical School, who until recently have not had adequate dental treatment. It will be remembered that it is only during the last two years that a dental scheme for children attending the Junior Technical School has been in operation. Not only is there a bigger percentage of children at the Junior Technical School in need of treatment, but, moreover, the state of dental decay in the children there is more advanced. The second point is that the ideal to be aimed at is regular dental examination every six months. The least that would be adequate would be an inspection once a year. To achieve this Enfield would require two more dentists. I am hopeful that in the near future the Committee will increase the staff in order to overcome this deficiency in the school dental service. I would take this opportunity of thanking the Committee for its continued courtesy throughout the year, and all the members of the staff for their help and co-operation. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, D. H. GEFFEN, School Medical Officer. 90 REPORT OF THE SCHOOL MEDICAL OFFICER. Area (in acres) 12,400 Population 81,920 Number of Schools 20 School. Number on roll 31.12.36. Alma Road Boys' 259 Alma Road Girls' 235 Alma Road Infants' 238 Bush Hill Park Boys' 210 Bush Hill Park Girls' 180 Bush Hill Park Junior Boys' 190 Bush Hill Park Junior Girls' 182 Bush Hill Park Infants' 267 Botany Bay 18 Chase Side Boys' 253 Chase Side Girls' 252 Chase Side Infants' 265 Chesterfield Road Boys' 376 Chesterfield Road Girls' 393' Chesterfield Road Junior Mixed 455 Chesterfield Road Infants' 415 Eastfield Road Mixed 574 Eastfield Road Infants' 320 Forty Hill Mixed Ill George Spicer Central Boys' 261 George Spicer Central Girls' 252 George Spicer Junior 324 Lavender Road Boys' 341 Lavender Road Girls' 328 Lavender Road Infants' 267 Southbury Road Boys' 292 Southbury Road Girls' 283 Southbury Road Infants' 297 Suffolks Senior 495 Suffolks Junior and Infants' 665 St. Andrew's Boys' 88 St. Andrew's Girls' 126 St. Andrew's Infants' 80 St. George's C.E. Infants' 82 St. George's R.C. Mixed 79 St. James' Boys' 242 91 St. James' Girls' and Infants' 311 St. John's Mixed 61 St. Mark's Infants' 33 St. Mary's Mixed 189 St. Matthew's Girls' and Infants' 216 St. Michael's Boys' 53 St. Michael's Girls' and Infants' 152 Secondary Schools. County School for Girls 470 Grammar School for Boys 505 Junior Technical School for Boys 179 1932. 1933. 1934. 1935. 1936. Average number on books of Elementary Schools 9,453 9,725 9,970 10,155 10,570 Average weekly attend- ance 8,495 8,685 8,857 9,200 9,342 ROUTINE MEDICAL INSPECTION. Three age-groups are examined as required by the Board of Education Grant Regulations No. 19 (1925). These groups are:— 1. Entrants. 2. Intermediates (children having attained their eighth birthday). 3. Leavers (children having attained their twelfth day) . The total number of children examined during the year was 3,819. In 1935, 3,436 were examined. Routine Medical Inspection is carried out on the school premises except in those cases where there is a school or maternity and child welfare clinic conveniently placed. During the year the arrangements were continued whereby notices were handed to children stating in lay terms the defect from which they were suffering, with the request that they should hand these notices to their parents. In addition to this, a visit is made subsequently by the school nurse, who urges upon the parent the necessity of getting the defect remedied. 92 79 per cent, of the children examined during the year in the course of routine examination were accompanied by their parents. The comparative figures for the last five years are as follows:— 1932. 1933. 1934. 1935. 1936. Percentage of children accompanied by parents 78 77 76 76 79 39 per cent, of the children examined were vaccinated. The comparative figures for the last five years are as follows:— 1932. 1933. 1934. 1935. 1936. Percentage of children vaccinated 42 37 37 37 39 DEFECTS FOUND AT ROUTINE MEDICAL INSPECTION. Uncleanliness.—Of 3,819 children examined, 11 were found to have vermin in their heads and 220 had nits. The following is a comparative table for the last five years:— 1932. 1933. 1934. 1935. 1936. Number of children examined 3,087 2,869 3,378 3,436 3,819 Number of children with verminous heads 54 21 15 7 11 Percentage of children with verminous heads 1.7 0.7 0.4 0.2 0.3 Number of children found to have nits 281 224 279 182 220 Percentage of children found to have nits 9.1 7.8 8.2 5.0 5.8 The conditions found consisted of nits and vermin in the head; in no case during the year was a child found to have body vermin. Nutrition.—At the end of 1934 the Chief Medical Officer of the Board of Education requested that nutrition in children should be classified under the four headings:— A Excellent. B Normal. C Slightly sub-normal. D Bad. 93 The. number of children examined in routine inspection in 1936 was 3,819, and these were classified as follows:— A 7.7 per cent. B 51.1 C 29.3 D 11.9 The comparative figures for the last two years are as follows 1935. 1936. No. of children examined 3,436 3,819 No. of children classified "A" 38 295 No. of children classified "B" 2,286 1,953 No. of children classified "C" 1,056 1,116 No. of children classified "D" 56 455 From this table it would appear that the number of children in excellent health has increased: also that the number of children in bad health has increased. It must be remembered, however, that the standard varies to such an extent with each doctor as to render conclusions from small numbers of children unreliable. Skin Diseases.-Twenty-two cases were seen; all required treatment. Ear Disease.—Twenty-seven cases of middle ear disease were found; also twenty-six cases of defective hearing. All these cases were referred to the Aural Clinic for treatment. 1932. 1933. 1934. 1935. 1936. Number of children examined 3,087 2,869 3,378 3,436 3,819 Number of cases of Middle Ear Disease found 18 23 18 19 22 Percentage of cases of Middle Ear Disease found 0.6 0.8 0.5 0.6 0.6 Number of cases of Defective Hearing found 56 53 53 33 26 Percentage of cases of Defective Hearing found 1.8 1.8 1.6 0.98 0.7 Tonsils and Adenoids.—One thousand one hundred and fortythree children had already had operation for removal of tonsils and/or adenoids; 597 were found to have enlarged tonsils, adenoids, or both. 94 The following is a comparative table for the last five years:— 1932. 1933. 1934. 1935. 1936. Number of children examined 3,087 2,869 3,378 3,436 3,819 Number of children already operated upon 1,049 1,121 1,202 1,205 1,143 Percentage of children already operated upon 33.9 39.1 35.6 35.0 29.9 Number of children with enlarged tonsils, adenoids, or both 787 388 512 663 597 Percentage of children with enlarged tonsils, adenoids, or both 25.5 13.5 15.3 19.3 15.6 Eye Diseases and Defects.— Thirty-three children were found to be suffering from external eye disease. Thirty-one were referred for treatment to the minor ailment clinic and two were kept under observation. Two hundred and sixty-six cases of defective vision were referred for treatment to the Ophthalmic Clinic or hospital; forty-six of these had squint. The following is a comparative table for the last five years:— 1932. 1933. 1934. 1935. 1936. Number of children examined 3,087 2,869 3,378 3,436 3,819 Number of children with defective vision 237 296 234 200 220 Percentage of children with defective vision 7.7 10.3 6.9 5.9 5.8 Number of children with squint 48 21 40 43 46 Percentage of children with squint 1.6 0.7 1.1 1.2 1.2 In 1934 arrangements were made with the Western Ophthalmic Hospital that for a fee of ten guineas per annum the hospital should accept for in-patient or out-patient treatment all children referred there by the School Ophthalmic Surgeon. During the course of the year the following cases were referred to the Western Ophthalmic Hospital:— 1 for removal of meibomian cyst. 5 for operation for squint. 7 for other conditions. 1 for operation for detached retina. 95 In addition to these, 30 children attended the hospital during the year for treatment for squint, making a total of 297 attendances during the year. Tuberculosis.—No cases of pulmonary tuberculosis were found. Crippling Defects.—The following defects were found during Routine Medical Inspection :— 1 case of birth palsy. 1 case of hemiplegia. 1 case of spinal curvature. 1 case of cleft palate. 1 case of spastic diplegia. 1 case of talipes equinus. 1 case of wry neck. 1 case of severe flat foot. 2 cases of old tuberculous hip. 1 case of cleft palate and hare lip. INFECTIOUS DISEASE. 1932. 1933. 1934. 1935. 1936. Measles 460 4 430 15 404 German Measles 5 6 160 1 9 Mumps 43 667 277 53 197 Whooping Cough 180 78 72 79 154 Chicken-pox 131 235 100 243 149 Scarlet Fever 124 134 135 136 128 Diphtheria 77 28 11 32 53 Diphtheria Carriers 1 — 3 — 1 Small-pox 1 — — — — Poliomyelitis 1 — — — — During the course of the year whooping cough and mumps remained prevalent. This is a somewhat unusual feature, both these diseases being most common during the first three months of the year and tending to disappear as spring approaches summer. In 1936, cases continued to occur throughout the year. Diphtheria immunisation has been continued, and in the early part of my report as Medical Officer of Health the number of immunisations carried out has been stated. Although a fair number of school children are being immunised, I do not consider that a satisfactory number are as yet taking advantage of this service 96 which is provided by the Council. Facilities exist for immunisation to be carried out either by the Medical Practitioner or by a member of the Council's staff. I have received the willing help and co-operation of the Medical Practitioners of the district. Further propaganda, however, will be required to persuade parents to take their children to their own doctors or to our clinics for immunisation purposes. DETECTION AND PREVENTION OF SPREAD OF INFECTIOUS DISEASE. Close co-operation exists between the School Medical Department and the Public Health Department, whereby when either becomes aware of infectious disease in any school, house or district, the other department is informed. Joint action is therefore possible in preventing the spread of infectious disease. VERMIN. Of 3,819 children examined at Routine Inspection, 11 were found to have vermin in their hair, and 220 had nits—i.e., 6.0 per cent, had unclean heads. No child was found to have body vermin. THE WORK OF THE SCHOOL NURSES. There are four school nurses. One is attached to each of the three Treatment Clinics, which she attends daily for the treatment of minor ailments; one of them is also in charge of the Aural Clinic. Each nurse is responsible for the following up of children attending her clinic, for the cleanliness of the scholars attending the schools which feed her clinic, and for any visits to those schools besides those for head inspections. In addition to these duties, two of the school nurses attend in turn at the Routine Medical Inspection to assist the Medical Officers. The fourth nurse is employed mainly on dental work assisted bv a clerk. The following is a summary of the work of the school nurses during 1936 and for the past five years:— 1932. 1933. 1934. 1935. 1936. Number of home visits 2,298 2,943 2,697 2,830 2,710 Number of school visits 377 621 559 573 535 Number of school visits for routine examination of heads 220 220 195 184 166 Total number of heads examined 37,469 39,154 37,303 36,616 33,806 97 TREATMENT CLINICS. There are three Minor Ailment Clinics in Enfield at which a nurse attends every day. These clinics are held from 2 p.m. to 3.30 p.m. at Eastfield Road School and Lavender Road School, and from 9 a.m. to 10.30 a.m. at Southbury Road School. Every new case attending the Nurse's Clinic during the week is seen by one of the Assistant School Medical Officers at the next Doctor's Clinic. One attendance a week is made by the Assistant School Medical Officer at Eastfield Road, Lavender Road and Southbury Road Clinics, and an additional clinic is held on Wednesday mornings at the Southbury Road Clinic by the Deputy Medical Officer of Health and Assistant School Medical Officer. The number of children that attended the minor ailment clinics during 1936 was 3,958 and the total number of attendances was 25,486. The average attendance at the nurses' clinics was 34 (i.e., 102 per day for the three clinics). At the School Medical Officers' Clinics the average attendance was 41. Although the average attendance at the Doctors' Clinics is practically the same as last year, four clinics per week are now being held, whereas until the beginning of the year only three were held. There has really been a considerable increase in the number of children attending the clinics. All children leaving school are given a medical examination early during their last term, so that defects may be remedied before they leave. The result of this examination is entered upon a special card which is sent to the Juvenile Employment Committee. Table IV gives in detail the diseases dealt with at the Minor Ailment Clinics. Tonsils and Adenoids.—During the year 400 cases were seen at the clinics and referred for treatment, and 219 cases were kept under observation. Of these, 290 were operated on under the Authority's scheme and 76 were operated on by private arrangement. The following is a comparative table for the last five years:— 1932. 1933. 1934. 1935. 1936. Number of cases referred for treatment 709 467 320 501 400 Number of cases operated under the Authority's scheme 295 224 224 331 290 Number of cases operated by private arrangement 62 53 29 76 76 98 Tuberculosis.— Eight cases of suspected or definite pulmonary tuberculosis were seen at the clinic during the year. Five children were offered sanatorium treatment and four accepted. Three children who were recommended in 1935 were still away in sanatoria in 1936. All cases notified in previous years were kept under observation, and some were given convalescent treatment. Ringworm.—Six children were found to be suffering from ringworm. One was a scalp lesion and was treated by X-ray. The following is a comparative table for the last five years:— 1932. 1933. 1934. 1935. 1936. Number of children found to be suffering from ringworm 3 9 11 1 6 Impetigo.—During the year thirty-three cases were seen; all were treated at the clinic. The following is a comparative table for the last five years:— 1932. 1933. 1934. 1935. 1936. Number of children found to be suffering from impetigo 13 14 12 14 33 Scabies.—Fifteen cases were seen. The following is a comparative table for the last five years:— 1932. 1933. 1934. 1935. 1936. Number of children found to be suffering from scabies.. 13 11 16 — 15 Other Skin Diseases.-—One hundred and sixty-eight cases were seen. These consisted chiefly of seborrhoea, eczema and psoriasis. Eye Diseases.—Two hundred and sixty cases were treated at the clinics. These were chiefly conjunctivitis, blepharitis and styes. All cases of defective vision were referred to the Ophthalmic Clinic for treatment. Ear Diseases.—Seventy-eight cases of otitis media were found. Seventy-seven were referred for treatment to the Aural Clinic. 99 Heart Disease.— Seventy-two children were found to be suffering from organic heart disease; nine of these were referred for treatment and the rest were kept under observation. In addition to these, four cases were seen at Routine Inspection only, making a total of seventy-six cases seen during the year. Of these cases, ten were congenital and five followed acute infectious diseases. The remaining sixty-one cases may be classified as follows:— Definite rheumatic history 24 Vague pains 9 No history of illness 28 Chorea.—Fourteen children were found to be suffering from chorea; five of these were recovering and were kept under observation. All the rest were referred for treatment to a doctor or hospital. Crippling Defects.—The following defects were seen at the clinic:— 3 cases of hemiplegia. 1 case of congenital multiple exostosis. 6 cases of spinal curvature. 5 cases of hammer toe. 3 cases of club foot. 3 cases of old tubercular hip. 8 cases of infantile paralysis. 3 cases of cleft palate and hare lip. 3 cases of cleft palate. 1case of dwarfism. 1 case of congenital shortening of leg. 1 case of spastic paraplegia. 1 case of crippling following osteomyelitis. 1 case of wry neck. 2 cases of severe knock knee. 1 case of congenital dislocation of hip. 1 case of birth palsy. 1 case of old tubercular knee. 4 cases of severe flat foot. 3 cases of cerebral diplegia. 1 case of rheumatoid arthritis. All of these children who required treatment were either attending hospital or obtaining treatment locally. 100 Other Conditions:— 1 case of enchondroma of rib was referred to hospital and operated upon. 10 girls and 1 boy were found to be suffering from ment of the thyroid gland: all are being kept under observation. 4 cases of chronic nephritis were seen, of which three were attending hospital or doctor for treatment. 51 cases of obesity; thirteen were referred for treatment and thirty-eight were kept under observation. 1 case of hydrocephalus was kept under observation. 1 case of diabetes is being treated at hospital. 1 boy suffering from dwarfism is attending hospital. 1 girl was found to be suffering from thyroglossal cyst and was referred to hospital. 11 children were found to be suffering from hernia; all were referred to doctors or hospitals; four were operated upon. 2 cretins were referred to hospital. 1 child was found to be suffering from erythema nodosum. The total number of children examined during the year, excluding those attending the Dental Department, was 10,015. This number was made up as follows:— Examined at Routine Inspection 3,819 Examined at Minor Ailment Clinics 3,958 Examined at Ophthalmic Clinic only 550 Examined at Aural Clinic only 105 Examined at school leaving age for Juvenile Employment Committee 832 Examined under Juvenile Employment Bye-laws 85 Examined under Mental Deficiency Act 20 Examined as contacts with infectious disease 646 Payments at the clinics were continued on the same lines as in former years—i.e., a charge of twopence per week was made for treatment at the Minor Ailment Clinic, and threepence per attendance at the Dental Clinic (sixpence if gas is given). For spectacles and for nose and throat operations parents are asked to sign a form of 101 consent and willingness to pay at least part of the cost before the child is referred for treatment. In really necessitous cases the Local Authority bears the whole cost. During the year the sura of £336 3s. 7d. was collected as follows:— £ s. d. . Minor Ailment Clinics 2 14 For cost of spectacles 48 5 3 For convalescent treatment 75 19 3 For operations for tonsils and adenoids 147 12 6 For dental treatment 62 5 3 The Local Authority still reserves four beds (two for boys and two for girls) at the Russell-Cotes School of Recovery, Parkstone, Dorset. The children are sent for a period of six weeks or longer; 16 girls and 16 boys were sent during 1936. During 1936 two beds were also reserved for a period of six months at Collington Manor, Bexhill, and three girls and two boys were sent during this period. Wherever possible, the Local Authority recovers part of the cost of maintenance from the parent, but as most of the children are drawn from really necessitous homes, the amount recovered is comparatively small. During the course of the year, in addition to the help set out above, four children were supplied with surgical instruments, one child suffering from diabetes was provided with insulin, and eight children were sent to residential schools other than the RussellCotes School or Collington Manor. There was a total of five deaths among school children during the year. In 1935 there were ten. The causes of death during 1936 were as follows:— 3 Pneumonia. 2 Heart Disease. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC HEALTH. The hygienic conditions of the schools in Enfield are the same as in my report for the year 1935. 102 THE TEACHING OF HYGIENE. The teaching of hygiene is part of the routine of the school syllabus, which includes a special course in such training for junior and senior children. In connection with Housecraft and Mothercraft teaching, arrangements have been made for the Health Visitors to visit Senior Girls' Departments to give a demonstration of the bathing of a baby, with the Housecraft teacher assisting. This is part of the educational course laid down for all girls from ages 12 to 14. The following demonstrations have taken place:— By Miss Newbegin at Bush Hill Park School 5 demonstrations. By Miss Newbegin at the Central School 3 demonstrations. By Miss Newbegin at Suffolks School 2 demonstrations. By Miss Garlick at Chesterfield Road School 3 demonstrations. By Mrs. Herbert at Lavender Road School 1 demonstration. By Mrs. Herbert at Chase Side School 1 demonstration. By Miss Wilkinson at Alma Road School 2 demonstrations. Thus 17 demonstrations were given during the year, as compared with ten last year. OPEN-AIR EDUCATION. There are no open-air schools or classes in Enfield. PHYSICAL TRAINING. In September, 1935, the Education Committee appointed Mr. Dixon as organiser of physical training, to supervise the physical training of the children throughout the elementary schools and instruct the teachers in the latest methods of physical training. I have come into contact with Mr. Dixon on many occasions and I hope that by means of close co-operation with him much may be achieved to improve the physical condition of Enfield's school population. I am hopeful that later I shall be able to co-operate with him in arranging for special classes for children suffering from minor physical defects. 103 PROVISION OF MEALS. Meals are provided for necessitous children. Until July, 1935, the arrangements were made by the Care Committee, but subsequent to that date the arrangements were taken over by the Education Committee itself and are now in the hands of the "Provision of Meals Sub-Committee." 42,657 dinners were provided in 1936. During 1935 arrangements were made for the provision of milk to children at ½d. for one-third pint. The children took advantage of the arrangement to such an extent that 892,743 bottles of milk were provided and paid for; in addition to which 96,974 bottles of milk were provided free to those children whose circumstances were such that their parents could not afford to pay. The milk supplied was in every case pasteurised, regularly tested by the Public Health Department to see that it conformed to the prescribed standard for pasteurised milk, and was delivered in one-third pint bottles and drunk through a straw. Those children who are receiving milk free of charge are examined by one of the Medical Officers of the Staff in order that the necessity may be ascertained and the condition of the children observed. It is very difficult to assess in figures the value of this scheme. Children do not gain weight and height entirely according to the milk with which they are provided, and each child has its own personal rate of gain. Under the circumstances a comparison on the above lines between children who receive milk and children who do not receive milk would denote very little. In the first place it is natural for all children to gain weight, and in the second place it would be fair to assume that the children who do not receive milk in school may have come from wealthier families and receive it at home. Without, therefore, being able to give an opinion based on fact, I can only say that I consider the scheme to be worth while. Medical opinion is almost unanimous in its appreciation of the value of good milk as a food. There has been some difficulty about the time at which milk should be given. If it is given in the middle of the morning it upsets the children's lunch, whilst if given earlier it upsets the school routine. On the whole I am inclined to advise that the milk should be given as soon as possible after arrival in school. Whilst many children in Enfield have a good breakfast, there are many, and especially those coming from poor homes, for whom a breakfast consists of a slice of bread, sometimes with margarine or jam, and a cup of weak tea. For these children, and they are the ones with whom I am most concerned, a cup of milk early in the morning is of great value. 104 A record was kept of the gain in weight of children receiving milk in school free of charge, and the average gain worked out at about six pounds during the year. CO-OPERATION OF PARENTS. Seventy-nine per cent, of the children examined in our elementary schools were accompanied by their parents; this is an improvement of 3 per cent, on last year, but is no higher than it was in 1931. I do not think I would be asking too much were T to expect that 100 per cent, of the parents came with their children to routine examination. Their presence is of two-fold advantage; in the first place they can explain to the doctor the child's medical historv and the peculiarities of health to which the child is subject; in the second place they can receive personal advice from the doctor, not only as to physical defects, but as to the general hygienic upbrirging of children both mentally and physically. CO-OPERATION OF TEACHERS. It has been my pleasant duty year by year to inform the Committee of the excellent co-operation which exists between the School Medical Department and the teachers. I hesitate now to report what is so well known. Were it not for the active co-operation which I have received for the last ten years it would have been impossible for the Education Committee to do as much for the children as has been accomplished. Co-operation is now no longer an official matter in Enfield, but the mutual desire of a number of friends to help each other in a common object. Through the help of the teachers I have become aware of many cases that subsequently derived great benefit from medical attention. CO-OPERATION OF SCHOOL ENQUIRY OFFICERS. Arrangements are in force by which the School Enquiry Officers, on becoming aware of absence from school due to infectious disease or contact therewith, notify the School Medical Officer. On the other hand, the School Medical Department notifies the Director of Education of similar cases in order that he may pass on the information to the Enquiry Officers. CO-OPERATION OF VOLUNTARY BODIES. The children's Care Committee provides help for necessitous children in those cases that cannot be helped within the scope of 105 the Education Acts. Through its agency the following help was given during the course of the year:— Twelve children were given cod-liver oil and malt, Parrish's Food, etc., and thirteen convalescent treatment; 341 pairs of ordinary boots were also provided. Two children were provided with fares to hospital. Through the medium of the children's Care Committee, massage is provided for the children requiring it. A fee of two shillings per visit is charged, and this is paid by the parent whenever possible. In really necessitous cases the Care Committee bears the cost. The National Society for Prevention of Cruelty to Children assists in dealing with parents who are guilty of continued neglect. CO-OPERATION OF LOCAL PRACTITIONERS. The co-operation of the general practitioners of Enfield has been sought and maintained throughout the year. In 333 instances parents were advised to obtain advice from their own doctors; only those cases which are too trivial to need the advice of the general practitioner are treated at the minor ailment clinic. The thanks of the school medical service are due to the doctors of Enfield for their whole-hearted co-operation throughout the year. BLIND, DEAF, EPILEPTIC AND MENTALLY DEFECTIVE CHILDREN. There is no special school for the blind in this area, and children suffering from vision so defective that they are unable to be taught in an ordinary elementary school are educated either at a special school in Wood Green or at a residential school for the blind. There are seven such children in Enfield, and they are educated as follows:— 3 girls attending residential schools for the Blind. 4 girls attending Wood Green School for the Partially Blind. Deaf and Deaf-mutes.—These children attend the Tottenham (Philip Lane) School for the Deaf. At the end of 1936, 13 children were attending: 4 deaf-mutes, 5 suffering from acquired deafness, and 4 suffering from motor aphasia. Mentally Defective Children.—Twenty children were examined under the Mental Deficiency Act (1913) during 1936. 106 The following is a comparative table for the last five years:— 1932. 1933. 1934. 1935. 1936. A. Dull and backward, but capable of instruction in an elementary school 2 1 4 5 4 B. Mentally Defective but capable of instruction in a special school 6 7 8 9 8 C. Incapable, of further instruction in a special school 1 - 2 1 1 D. Imbecile 4 4 1 4 6 Moral Imbecile — — — 2 - E. Not scheduled — 5 2 — 1 EXAMINATION OF SECONDARY SCHOOL CHILDREN. The Enfield Education Committee undertakes the examination of children attending the secondary schools in the district, on behalf of the Middlesex Education Committee. There are three such schools in Enfield, namely, the Grammar, County, and Junior Technical Schools. The following tables set out the number of children examined at each school during the course of the year and the defects found to be present:— Junior Technical. Grammar. County. Number of children examined 106 222 180 DEFECTS, Junior Technical. Grammar. County. Requiring Treatment. Requiring Observation. Requiring Treatment. Requiring Observation. Requiring Treatment. Requiring Observation. Dental Caries 2 - 4 - 1 - Defective Vision 2 - 19 - 27 20 Enlarged Tonsils, etc. 3 1 4 1 1 2 Other Nose and Throat Conditions - - - - - - Other Deformities 1 - - - 2 1 Other Diseases and Defects - - 8 - 10 — Anaemia - - 1 1 1 — Stammer - - 2 — — — Other Skin Diseases - - — — 5 — Organic Heart Disease - 1 — — — 1 107 Report on Tiredness in School Children By Dr. D. H. Geffen and Dr. G. Forrester. The investigations on which this report is based were originally made to ascertain the correctness of the following statement:— "Children attend school on Monday morning more tired than on other days." This is a statement which we have heard on frequent occasions. The conclusions reached are based on the statements of the teachers who have helped us, but are not necessarily our own opinions. In all we received 266 reports embracing:— Senior Children 2,877 Junior Children 3,249 Infants 2,590 Whilst many teachers were satisfied that a child's week-end instead of being a time of rest was a time of increased activity, resulting in tiredness on Monday, other teachers did not agree that there was anything to choose between Monday or any other day in the week. In this respect, therefore, we were unable to substantiate the statement which initiated this report. Other facts, however, emerged which we consider to be of great importance. 1. It would appear that habitual late bed-time of children in all departments is a far greater factor in producing tiredness in school children than an occasional late night during the week or over the week-end. This especially applies to younger children and infants. From the figures we received bed-time was generally too late, and actually 3.6 per cent, of infants and 6 per cent, of junior children (i.e., under 11 years of age) were stated to go to bed between 10 p.m. and 12 p.m. Teachers generally complained that there were a large number of social activities in the district which kept children up late. We would suggest that these activities, many of which are of a beneficial nature, should be carried out at a time that would allow elementary school children to go to bed at a reasonable hour. 108 2. No less than 52 per cent, of infants and 35 per cent, of junior children listen to the wireless whilst in bed, and a considerable proportion of these have a wireless set in their bedroom. In the case of senior children, the percentage is lower, namely, 26 per cent., but this is probably due to the fact that the children sit up late in order to listen-in. The teachers especially mention the lure of variety programmes, which often take place at a time when children should be asleep. The position is complicated by the fact that even where children do not have a set in their own room, they are disturbed by a wireless set in the house, or even by the sets of next-door neighbours. Parents consult us almost daily concerning sleeplessness of their children, and we, therefore, consider the matter to be of importance. 3. 28 per cent, of infants, 35 per cent, of junior and 20 per cent, of senior children read in bed. This often takes place with inadequate lighting and in an unsatisfactory posture; it excites the mind when it should be quiescent, and is a frequent cause of sleeplessness. Apart from this, it may have a deleterious effect on the eye-sight. 4. We are informed that a large percentage of children attend the cinema at least once a week. One boy at the Central School was reported to be paying five visits regularly each week. One wonders how this child can be benefiting from a Central School education. Many children attend on Saturday morning or afternoon; times when they should be playing in the open air. 5. Many of the teachers who complained of listlessness on Monday morning reported that the children spent most of Saturday going long journeys in closed cars to the seaside, and that some of them were either late at school on Monday or were unable to attend at all owing to fatigue. 6. Some teachers of infants and girls' schools complained of the craze for dancing. Dancing classes are held after school hours and are concerned in teaching tap dancing, which is very tiring. Some of the children perform in public subsequent to tiring nights of rehearsals. The words of one teacher vividly explain this point. She writes: "The children go to bed with muscles twitching to the rhythm of the latest jazz tune, and their sleep and rest is thereby disturbed." Another teacher states that 40 per cent, of her children attend these classes. 109 Generally, one comes to the conclusion that the average elementary school child of to-day does not get sufficient rest to secure a healthy mind in a healthy body. One teacher considers that the mental and physical inertia only too apparent among his pupils is a condition due to the disturbing factors in the social and industrial conditions of modern life, and genera] freedom from restraint which has unfortunately accompanied it. It would appear that the activities of children outside school hours should be limited to healthy exercise and play. The strain on the town child of to-day is greater than it was even twenty years ago. The adult population sets the pace and the children have to keep up with it. We believe that children should have at least as much rest to-day as their parent's had in their own childhood. The report of a Head Teacher of a small country school in Enfield, as opposed to those in the urban parts of the district, is interesting. She states that only one child is tired at any time, and he is the only child of well-to-do parents and motors a great deal. No children attend the cinema regularly, and only two go occasionally. As the teacher herself says: "The percentage of attendance for the last two quarters, 91.8 and 94, speaks for itself." We beg to acknowledge with thanks the help we have received from the school teachers in connection with this report. 110 Annual Report of the Senior School Dental Surgeon Mr. C. E. James, L.D.S., R.C.S. (Eng.), for the year ending 31st December, 1936. To the Chairman and Members of the Enfield Education Committee. Mr. Chairman, Ladies and Gentlemen, I beg to submit the Annual Dental Report for the year ending 31st December, 1936. An examination of the figures given under Table V shows that a total of 5,597 elementary school children were inspected and 3,554 treated during the year under review— an increase, as compared with 1935, of 1,458 children inspected and 977 treated. There was also a considerable increase in the number of fillings and extractions carried out for elementary school children. The following table is submitted for the purpose of comparison:— INSPECTION AND TREATMENT OF ELEMENTARY SCHOOL CHILDREN. Year. Number Inspected. Number Treated. Number of Fillings. Number of Extractions. 1935 4,139 2,577 3,268 4,339 1936 5,597 3,554 4,871 6,498 These increased figures for elementary school children were only made possible by the fact that the inspection of secondary school children was held in October instead of June as in 1935, in order that new admissions might be included. Consequently, the amount of work done for secondary school children during the year 111 under review was much less than in 1935, and the treatment of these children will not be completed until 1937. Nevertheless, the combined amount of work for both elementary and secondary school children was considerably increased, as is shown by the following figures:— INSPECTION AND TREATMENT OF ELEMENTARY AND SECONDARY SCHOOL CHILDREN COMBINED Year. Number Inspected. Number Treated. Number of Fillings. Number of Extractions. 1935 5,102 3,005 4,353 4,667 1936 6,679 3,640 5,049 6,558 The large number of fillings will be noted, all but 282 being in permanent teeth. In the Enfield School Dental Service the conservation of the teeth has always been a prominent feature, and annual reports have invariably shown a high average of fillings inserted. The average during the past five years has been 4,974— an unusually high figure. Of the total of 6,558 extractions (6,498 for elementary and 60 for secondary school children), 5,540 were temporary and 1,018 permanent teeth. This total represents an increase of 1,891 extractions as compared with the previous year and may be ascribed to two causes: (1) the larger number of children receiving treatment who had previously refused, and (2) the influx into Enfield from other towns and districts of many children who had previously not received conservative dental treatment. Of the permanent teeth extracted, 85 were not carious but were extracted for regulation purposes. The number of elementary school children who were referred for dental treatment as a result of routine dental inspection was 70 per cent, of those inspected. Parents gave their written consent to treatment in the case of 72.9 per cent, of children referred. Some children, however, failed to keep their appointments on account of ill-health or other reasons, so that the percentage of those referred actually treated was reduced to 67.2 per cent. The total number treated was 3,640, 3,554 being elementary and 86 secondary school children. This figure includes 1,054- specials—an increase of 338 over the corresponding figure for 1935. It would be an advantage if the number of specials could be reduced so that more 112 time might be available for the treatment of routines. It has been laid down that cases sent to clinics as specials should be restricted to: "(a) children with serious septic conditions, (b) children requiring dental treatment as a preliminary to other treatment, and (c) children who are in pain." The number of children it is possible to treat each year depends very largely on the nature and completeness of the treatment. When emphasis is laid on the conservative side of the work, as in Enfield, it is found that each dentist is very fully occupied if he gives treatment to 1,800 children annually. Previous to the appointment of a second school dentist in 1931 , the average number of children treated each year in Enfield was 2,500. At that time, however, the treatment was less conservative in character. The number of children treated annually is dependent on the number of those referred who accept treatment, and the time available to carry out the treatment required. At the present time the large amount of conservative work done necessitates an interval of approximately two years between the inspections of elementary school children in Enfield. It is generally accepted that the time between inspections should not be more than one year, and that the inspection of each child every six months should be the ultimate aim of an efficient dental scheme. In the case of children attending the Public Schools and the better private schools it is a routine custom for each child to undergo a dental examination and to receive treatment when found to be necessary every six months. To ensure an annual inspection of Enfield's elementary school population, and annual treatment on conservative lines for those requiring it, an increase of the present dental staff by the appointment of two more dentists would be necessary. The number of administrations of general anaesthetics for the extraction of teeth was 202—184 administrations being for elementary and 18 for secondary school children. The total number of administrations of local anaesthetics for the extraction of teeth amounted to 2,431 . The total number of other operations was 1,019, the number performed for elementary school children being 964 and the number for secondary school children 55. Included under this heading are 158 applications of silver nitrate to temporary teeth, 212 polishings of permanent teeth, temporary fillings, root dressings and root fillings in permanent teeth, adjustments to regulation plates, etc. The total number of attendances for treatment was 5,730— 5,548 by elementary and 182 by secondary school children. The average amount of work done by each dentist per treatment session was:— Fillings 6.75 Extractions 8.85 Other Operations 1.35 113 During the year under review 20 children were fitted with regulation appliances. In the case of 13 children the treatment was completed, while 7 children were still under treatment at the end of the year. The results of the Dental Inspection of Secondary School children are given in the following table:— 114 School. Number Inspected. Found to require Treatment. Percentage of those Inspected requiring Treatment. Halfdays devoted to Inspection. Number of Permanent Teeth. Total number of decayed Permanent Teeth. Number per Child Inspected. Decayed. Saveable. Number per Child Inspected. Decayed. Unsaveable. Number per Child Inspected. Girls— County School 436 283 64.9 5 462 1.05 71 .16 533 1.2 Boys— Grammar School 473 385 81.3 5 1,140 2.41 148 .31 1,288 2.7 Technical School 173 158 91.3 2 554 3.2 89 .51 643 3.7 Totals 1,082 826 76.3 12 2,156 1.9 308 .28 2,464 2.2 115 It will be noted that the teeth of the girls are considerably better than those of the boys. The fact that most of the girls brush their teeth regularly, while the number of boys who do so are in a distinct minority, no doubt contributes towards the lower incidence of dental caries in the girls' teeth. Further, more girls than boys receive treatment from private dentists, and more accept treatment offered them at the Dental Clinic. The number of consents for County School girls was 63.5 per cent, of those referred, for Grammar School boys 48 per cent., and for Technical School boys 38.1 per cent. In endeavouring to persuade boys to take an interest in their teeth, one feels that the only appeal likely to be effective is to their desire for physical fitness. If the fitness campaign now being launched throughout the country should be successful, increased interest in dental health should eventually result among the older schoolboys, who at present constitute the most apathetic section of the school population. The greater incidence of dental caries found in the Technical School boys, as compared with the boys attending the Grammar School, is no doubt partly due to the fact that many boys at the Technical School come from outside districts where dental schemes are possibly less complete than in Enfield. In order, to convey some idea of the results of dental neglect, a comparison was made during the year under review of the teeth of Central School boys aged 15 years with the teeth of boys of the same age attending the Technical School. In this age group it was found in the case of the Central boys that 37.9 per cent, of those inspected required no treatment, while the corresponding figure for the Technical School boys was only 4.7 per cent. The contrast in the incidence of dental caries was further revealed by the fact that the Central boys had an average of 1.03 carious permanent teeth per boy inspected, while the average for each Technical School boy was 3.9. Professor Schiotz of Oslo, after a thorough investigation which he recently carried out, found that the teeth of young children of the well-to-do classes have a marked superiority over the teeth of children whose parents are in poorer circumstances. This finding is supported by figures obtained in the year under review during the inspection of children aged 5-6 years in two Enfield elementary schools. In a school situated in a poor district the number of children who were naturally fit (no teeth carious, filled or extracted) was 3.4 per 100 children inspected. In the school situated in a better district, where the parents of the children were financially better circumstanced, the number of 116 children with naturally perfect teeth was 10.5 per 100 children inspected. There was a corresponding difference in the degree of Caries found to be present in the children attending the two schools. Of all the temporary teeth, the molar teeth are the most important, and the number of these teeth unsaveable and already extracted on account of advanced caries was, in the case of the poorer school, 3.1 per child inspected. The corresponding figure for the other school was only 1.7 . The Medical Research Council has recently issued its final report on "The influence of diet on caries in children's teeth." It emerges from this report that a diet rich in Vitamin D reduces in a marked degree the incidence of dental caries when given during the development of the teeth, and that there is a beneficial effect even when it is given after the teeth have erupted. The finding of this report may be held to supply a partial explanation of the lower incidence of dental caries found in the teeth of those young children in Enfield who come from homes where the weekly budget permits a better balanced diet with, one may presume, a higher Vitamin D content than is found possible in the case of the poorer children. The sum received in fees from elementary school children during 1936 amounted to £62 5s. 3d.—an increase of £11 17s. over the sum received in 1935. In conclusion, Mr. Mackay and I wish to express our thanks to all Head Teachers for their unfailing co-operation, and to acknowledge the great assistance rendered by Nurse Anderson and Miss Groves—assistance which contributes so largely to the success of the Dental Clinic. 1 am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, C. E. JAMES, Senior School Dental Surgeon. 117 Annual Report of the School Ophthalmic Surgeon Mr. S. Macky, M.B., B.S., D.O.M.S., for the year ending 31st December, 1936. To the Chairman and Members of the Enfield Education Committee. Mr. Chairman, Ladies and Gentlemen, I beg to submit my report on the Ophthalmic Department for the year ending 31st December, 1936. Elementary Schools. Secondary Schools. Total attendances 2,072 96 New cases 1 ,028 49 Prescription for glasses 336 25 Number not requiring glasses 112 5 The cases requiring glasses consisted of:— Hypermetropia 84 2 Hypermetropia with astigmatism 314 10 Hypermetropic astigmatism 154 1 Myopia 96 12 Myopia with astigmatism 99 14 Myopic astigmatism 11 — Mixed astigmatism 64 1 Anisometropia 15 3 Five children were referred to the Western Ophthalmic Hospital for operation for squint. Three were operated upon and two are awaiting operation. Two children who were referred for operation in 1935 were operated upon in 1936. One child was referred to the Western Ophthalmic Hospital for removal of meibomian cyst, and one child found to have a detached retina was operated upon early in 1937. 118 Thirty children have been treated in the Orthoptic Department of the Western Opthalmic Hospital. Nineteen of these have finished treatment. This arrangement has worked very well and solved the problem of giving these squinting children a reasonable amount of muscle training. Again the percentage of myopia in secondary school children is remarkably high, but the numbers are still too small to be reliable, and, of course, the age factor may account for most of the increase. Once again I have great pleasure in recording my gratitude for the eager help given me by the staff of the clinic. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, STEWART MACKY, School Ophthalmic Sure/eon. 119 Annual Report of the School Aural Surgeon Mr. J. C. Hogg, F.R.C.8., for the year ending 31st December, 1936. To the Chairman and Members of the Enfield Education Committee. Mr. Chairman, Ladies and Gentlemen, I beg to submit my report on the work done in the Aural Department for the year ending 31st December, 1936. Number of cases dealt with 303 Number of new cases 198 Total number of attendances 683 Number of cases discharged cured 182 Number of cases of recurrent nature requiring occasional treatment 17 Number of cases still under treatment 35 Number of cases which have refused treatment 21 Number of cases which have sought treatment elsewhere 9 Seventy-eight children have been recommended for the removal of tonsils and adenoids, of which forty-nine, have had the operation, eleven have refused treatment and eighteen are awaiting operation. Two cases have been admitted, under my care, at the Throat Hospital, Golden Square. The first case was operated on for chronic sinusitis and is attending the clinic again for occasional inspection. The other was a case of chronic aural suppuration, for which a Radical Mastoid operation has been performed. 120 During the year under review, forty-five infants and three mothers have been seen in connection with the Infant Welfare Centre. Of this total, twenty-two were referred for removal of their tonsils and adenoids. The number of attendances was seventythree . Once again I would express my gratitude to the Nursing Staff in Soutbbury Road and other Clinics for their whole-hearted support and co-operation in the work of this Department during the past year. A detailed list of cases is appended. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, J. C. HOGG, School Aural Surgeon. 121 LIST OF CASES. Classification. Still under Treatment. I.S.Q. Improved. Discharged Cured. Recurrent, but again Discharged. Refused Treatment. Left School, District or treated elsewhere. Total. 1. Acute or subacute suppurative otitis media - 1 51 3 55 2. Chronic suppurative otitis media 15 13 22 15 3 4 72 3. Chronic catarrhal deafness, Eustachian obstruction and otosclerosis 7 9 6 - 2 - 24 4. Wax, otitis externa, eczema, boils, etc. — 2 24 2 2 1 31 6. Chronic Rhinitis, nasal obstruction, T.s and A.s, etc. 9 6 77 2 11 3 108 6. Non-aural — — — — - — 13 Total 303 122 STATISTICAL TABLES for the ANNUAL REPORT of the SCHOOL MEDICAL OFFICER for the Year 1936 TABLE I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.— ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups:— Entrants 1,295 Second Age Group 958 Third Age Group 885 Total 3,138 Number of other Routine Inspections 681 Grand Total 3,819 B.—OTHER INSPECTIONS. Number of Special Inspections 6,111 Number of Re-Inspections 5,157 Total 11,268 C.— CHILDREN FOUND TO REQUIRE TREATMENT. Number of Individual Children found at Routine Medical Inspection to require treatment (excluding defects of nutrition, uncleanliness and Dental Diseases). Prescribed Groups:— Entrants 278 Second Age Groups 216 Third Age Group 159 Total (Prescribed Groups) 653 Other Routine Inspections 157 Grand Total 810 123 TABLE II. A.-RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION in the year ended 31st December, 1936. Disease or Defect. (1) Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. (2) Requiring to be kept under observation, but not requiring Treatment. (3) Requiring Treatment. (4) Requiring to be kept under observation, but not requiring Treatment. (5) Skin. Ringworm:— Scalp — - 1 — Body - - 5 — Scabies 1 - 15 — Impetigo 2 - 32 — Other Diseases (NonTuberculous) 19 - 148 20 Total 22 - 201 20 Eye. Blepharitis 18 - 66 — Conjunctivitis 6 - 100 — Keratitis — - — — Corneal Opacities — - 1 2 Other Conditions 7 1 96 4 (Excluding Defective Vision and Squint) - - - - Total 31 2 263 6 Defective Vision (excluding Squint) 220 151 178 7 Squint 46 26 34 4 Ear. Defective Hearing 26 3 22 4 Otitis Media 27 - 77 1 Other Ear Diseases 30 — 67 3 Nose and Throat. Chronic Tonsillitis only 29 63 72 67 Adenoids only 4 6 4 5 Chronic Tonsillitis and Adenoids 293 202 342 147 Other Conditions 20 4 109 268 124 TABLE II.—continued. Enlarged Cervical Glands (Non-Tuberculous) 2 2 11 22 Defective Speech — 7 — 12 Heart and Circulation. Heart Disease:— Organic 3 23 9 63 Functional — — — — Anaemia 1 4 4 7 Lungs. Bronchitis 3 — 12 12 Other Non-Tuberculous Diseases 1 2 7 5 Tuberculosis. Pulmonary:— Definite — — 3 — Suspected 2 — 5 — Non-Pulmonary:— Glands 1 2 2 1 Bones and Joints 1 2 1 1 Skin — — — — Other Forms — — — — Total 2 4 3 2 Nervous System. Epilepsy — 1 7 6 Chorea 2 1 9 5 Other Conditions 2 1 6 9 Deformities. Rickets — — 2 — Spinal Curvature - - 5 1 Other Forms 10 12 40 22 Other Diseases and Defects (excluding Defects of Nutrition, Uncleanliness and Dental Diseases) 76 43 1,761 313 Total 851 557 3,253 1,011 125 TABLE II—continued. B.—CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Age-Groups. Number of Children Inspected. A (Excellent). B (Normal). C (Slightly subnormal). D (Bad). No. % No. % No. % No. % Entrants 1,295 54 4.2 647 49.9 407 31.4 187 14.5 Second Age-Group 958 68 7.1 455 47.5 304 31.7 131 13.7 Third Age-Group 885 123 13.9 509 57.6 214 24.2 39 4.4 Other Routine Inspections 681 50 7.3 342 50.3 191 28.0 98 14.4 Total 3,819 295 7.7 1,953 51.1 1,116 29.3 455 11.9 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 3 — — — 3 PARTIALLY SIGHTED CHILDREN. At Certified Schools for the Blind. At Certified Schools for the Partially Sighted. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 4 — — — 4 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 4 - - — 4 126 TABLE III—continued. PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the PartiallyDeaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 5 — - - 5 MENTALLY DEFECTIVE CHILDREN. FEEBLE-MINDED CHILDREN. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 30 — — — 30 EPILEPTIC CHILDREN. CHILDREN SUFFERING FROM SEVERE EPILEPSY. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — - — — PHYSICALLY DEFECTIVE CHILDREN. A.— TUBERCULOUS CHILDREN. I.— Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 3 — 1 5 127 TABLE III—continued. II.—Children Suffering from Non-Pulmonary Tuberculosis. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 3 1 — 5 B.—DELICATE CHILDREN. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 9 25 — — 34 C.— CRIPPLED CHILDREN. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 2 22 1 3 28 D.—CHILDREN WITH HEART DISEASE. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 1 — 1 3 Children suffering from Multiple Defects Nil. 128 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1936. TREATMENT TABLES. Group I.— Minor Ailments (excluding Uncleanliness, for which see Table VI). Disease or Defect. (1) Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin. Ringworm—Scalp:— (i) X-Ray Treatment 1 — 1 (ii) Other — — — Ringworm—Body 5 - 5 Scabies 14 1 15 Impetigo 33 - 33 Other skin diseases 143 13 156 Minor Eye Defects. (External and other, but excluding cases falling in Group II) 260 4 264 Minor Ear Defects 339 4 343 Miscellaneous. (E.g., minor injuries, bruises, sores, chilblains, etc.) 1,528 97 1,625 Total 2,323 119 2,442 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Number of defects dealt with. Under the Authority's Scheme. Otherwise. Total. Errors of Refraction (including Squint) 837 8 845 Other defect or disease of the eyes (excluding those recorded in Group I) 16 - 16 Total 853 8 861 Under the Authority's Scheme. Otherwise. Total. Number of children for whom spectacles were:— (a) Prescribed 336 8 344 (b) Obtained 332 8 340 129 TABLE IV— continued. Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other Forms of Treatment. Total Number Treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 41 2 247 — 9 1 66 — 50 3 313 — 92 458 (i) Tonsils only. (iii) Tonsils and adenoids. (ii) Adenoids only. (iv) Other defects of the nose and throat. Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme. Otherwise. Total Number Treated. Residential treatment with education. Residential treatment without education. Nonresiden tial treatment at an Orthopaedic Clinic. Residential treatment with education. Residential treatment without education. Nonresiden tial treatment at an Orthopaedic Clinic. Number of Children treated 2 — — — 1 8 11 130 TABLE V. DENTAL INSPECTION AND TREATMENT. 1. Number of children inspected by the Dentist :— (a) Routine Age-Groups Aged 179 Total 4,543 5 6 412 7 422 8 410 9 399 10 508 11 615 12 608 13 521 14 409 15 56 16 4 (b) Specials 1,054 (c) Total (Routine and Specials) 5,597 2. Number found to require treatment 4,502 3. Number actually treated 3,554 4. Attendances made by children for treatment 5,548 5. Half-days devoted to:— Inspection 40 Treatment 739 Total 779 6. Fillings:— Permanent Teeth 4,589 Temporary Teeth 282 Total 4,871 7. Extractions:— Permanent Teeth 967 Temporary Teeth 5,531 Total 6,498 8. Administrations of general anaesthetics for extractions 184 9. Other Operations:— Permanent Teeth 752 Temporary Teeth 212 Total 964 TABLE VI. UNCLEANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 9 (ii) Total number of examinations of children in the Schools by School Nurses 33,806 (iii) Number of individual children found unclean 622 (iv) Number of individual children cleansed under arrangements made by the Local Education Authority - (v) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws 13 INDEX A. page Adulteration 39 Ambulance facilities 16 Area of District 4 Aural Surgeon's Report 119 Aural Treatment 63 B. Baby Week 65 Bakehouses 39 Births 12 Birth Control 64 Blind, Deaf, Epileptic and Mentally Defective Children 105 Blind and Partially Blind Children 125 Bye-laws and Regulations 17 C. Causes of death at all ages 9 Causes of death under 1 year of age 10 Cerebro-spinal Fever 43 Cesspools 21, 82 Chief Sanitary Inspector's Report 69 Children Act 64 Children suffering from Multiple Defects 127 Children suffering from Pulmonary and Non-Pulmonary Tuberculosis 126 Children with Heart Disease 127 Circulation of Booklet on Rearing of Children 66 Clinics and Treatment Centres 55, 97 Closet Accommodation 21 Coffee Stalls 80 Convalescent Treatment 67 Co-operation of Local Practitioners 105 Co-operation of Parents 104 Co-operation of Teachers 104 Co-operation of School Enquiry Officers 104 Co-operation of Voluntary Bodies 104 Co-operation with Education Committee 67 Councillors 3 Crippled Children 127 D. Deaf and Partially Deaf Children 125 Deaths . . 7 Defective Vision and Squint 128 Defects found at Routine Medical Inspection 92 Delicate Children 127 Dental Inspection and Treatment 130 Dental Surgeon's Report 110 Dental Treatment 65 Detection and Spread of Infectious Disease 96 Diphtheria 42 Diphtheria Carriers 42 Diphtheria Immunisation 42 Disinfection 74 Disinfection of verminous persons and their belongings 48 Disinfestation of Verminous Houses 48, 74 D. PAGE Disposal of house refuse 21, 82 Drainage and sewerage 20 Drinking fountains 83 E. Encephalitis Lethargica 43 Enteric and Paratyphoid Fever 43 Enteritis 44 Epileptic Children 126 Eradication of Bed Bugs 48 Examination of Secondary School Children 106 F. Factory and Workshops Act 75 Fitness of houses 36 G. General Observations 28 H. Home Helps 66 Horse troughs 83 Hospitals 17, 82 Housing 25 Housing conditions 36 Housing Survey 28 I Infantile Mortality 13 Infectious Diseases and Schools 24, 95 Infectious Diseases table 41 Inquests 11 Inspection and supervision of food 37 Insulin, Supply of 48 Isolation Hospital 20 L. Laboratory facilities 16 Legislation 17 M. Maternal Mortality 59 Maternity and Child Welfare Statistics 59 Maternity and Child Welfare Staff 52 Maternity Centres 55 Maternity Hospital 19 Measles and German Measles 43 Meat 38 Members of Education Committee 86 Members of Health Committee 3 Members of Maternity and Child Welfare Committee 3, 52 Mentally Defective Children 126 Meteorology 49 Midwives 59, 66 Milk 37, 77 Milk (Special Designations) Order 38 Minor Ailments 128 Mortuary 83 Motor Ambulances 80 N. PAGE National Health Insurance 16 Notices issued 71 Notifiable diseases 40 Number of School Children 90 Number of Individual school children found at Medical Inspection to require treatment 122 Nursing in the Home 15 O. 0bstetric Specialist 67 Offensive Trades 77 Officials of Council 3 Open-Air Education 102 Ophthalmia Neonatorum 45 Ophthalmic Surgeon's Report 117 Ophthamlic Treatment 63 Orthopaedic and Postural Defects 129 Other foods 39 P. Paratyphoid and Enteric Fevers 43 Physical Training 102 Physically Defective Children 126 Places of Public Entertainment 77 Poliomyelitis 43 Population 4 Prevalence of, and control over, Infectious and other Diseases 40 Prevention of Blindness 45 Provision of Meals 103 Public Conveniences 82 Public Health (Meat) Regulations 39, 78 Public Health (Prevention of Tuberculosis) Regulations 48 Public Health (Smallpox Prevention) Regulations 40 Public Health Staff 14 R. Rag Flock Acts 25 Rats 83 Regulations and Byelaws 17 Removal and disposal of house refuse 21,81 Report on Tiredness in School Children 107 Return of Defects found by Medical Inspection 123 Return of Defects Treated 128 Return of Medical Inspections (Aural) 121 Routine Medical Inspection 91 Routine Medical Inspection of Children under 5 years 62 S. Sale of Foods and Drugs Act 39 Sanitary Administration 17 Sanitary circumstances of District 20 Sanitary Inspection of District 22 Scarlet Fever 42 School Medical Officer's Report 88 School Medical Service in Relation to Public Health 101 Schools 24, 82 s. PAGE Sewerage and drainage 20 Sewer flushing 82 Shops Act 80 Slaughter of Animals Act 39 Slaughterhouses 38 Smoke abatement 22 Social conditions 5 Staff of Public Health Department 14 Staff of School Medical Department 87 Statistical Tables of School Medical Officer 122 Statistics . . 6 Streams and Water-courses 20 Sub-letting in Council houses 24 Suicides 11 Supply of Insulin 48 Swimming Baths and Pools 22 T. Teaching of Hygiene 102 Tuberculosis 45 Tuberculosis (County of Middlesex) Scheme 18 Treatment Clinics (Schools) 97 Treatment of Defects of Nose and Throat 129 U. Uncleanliness and Verminous Conditions 130 Unsound Meat and foods 79 V. Vermin 96 Verminous houses 48 Veterinary inspection of cows 37 Vital Statistics 5 W. Water-courses and streams 20 Water supply 20 Work of School Nurses 96 Z. Zymotic death-rate 44 Zymotic diseases 44 :