MED. INTEL Urban District Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health and School Medical Officer (D. H. GEFFEN, M.D., D.P.H.) FOR 1939. TOGETHER WITH THE ANNUAL REPORT of the Chief Sanitary Inspector (FRED WILSON, M.R.San.I., M S.I.A.) Urban District Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health and School Medical Officer (D. H. GEFFEN, M.D., D.P.H.) FOR 1939. TOGETHER WITH THE ANNUAL REPORT OF THE Chief Sanitary Inspector FRED WILSON, M.R.San.I., M S.I.A.) 1 Public Offices, Enfield. 29th November, 1940. Annual Report of the Medical Officer of Health, 1939. To the Chairman and Members of the Urban District Council of Enfield. Ladies and Gentlemen, I beg to place before you my Annual Report for 1939. For reasons of economy, both in time and paper, it has been considerably abridged. Until the outbreak of war the work of the department continued on normal and progressive lines. After September 3rd the whole of the efforts of the department were concentrated on building up an efficient A.R.P. Casualty Service, only such time being applied to the routine work of the department as was absolutely essential. To this effort and the help I have received from the Doctors of Enfield and the St. John Ambulance Brigade is due the credit for such success and praise as the service has had on the occasions when it has been called out for duty. 1939 was a very healthy year; it will be noticed that there was not one death due to Diphtheria or Scarlet Fever, whilst the infant mortality rate was 35.07 per 1,000. I have traced back the records to 1888 and the nearest approach to this figure is 43.27 in 1934 and 44.22 in 1924. It is probable that this is the lowest infantile death rate that Enfield has ever had. War conditions of necessity conduce to the spread of disease. Lack of exercise, overcrowding and the blackout all tend to lower resistance to infection. It is therefore essential that the population should avail itself of every possible means of obtaining immunity from disease. In this connection I would especially mention immunisation against Diphtheria which is now possible, and urge parents in Enfield to see that their children are immunised, and thus to wipe out the 2 possibility of at least this one serious infectious disease; it can be done and it should be done. Apart from this it is essential that every available opportunity to obtain exercise in the open air should be utilised, and that to the fullest extent possible the public should consume fresh fruits and vegetables. This will be greatly facilitated if all those who are able, will cultivate allotments. Although this report is written many months after the end of 1939, I am happy to be able to assure the Council that so far no evidence has been observed by the medical members of your staff of deterioration in the health of the community. I am, Ladies and Gentlemen, Your obedient Servant, D. H. GEFFEN, Medical Officer of Health. 3 URBAN DISTRICT COUNCIL OF ENFIELD. H. Muspratt, Esq., O.B.E Chairman S. G. Rowlandson, Esq., F.C.A. Vice-Chairman also Mrs. F. M. Bax. A. M. Eeles, Esq. Miss G: M. Ford. G. E. Jones, Esq. E. Edwards, Esq. YV. H. Betts, Esq. C. Partington, Esq., J.P. W. G. Spice, Esq. W. W. Cakebread, Esq. E. S. Stock, Esq. F. Greenwood, Esq. C. Evans, Esq. W. C. Bennett, Esq. D. Mason, Esq. H. A. D. Brown, Esq. G. F. Willgress, Esq. W. H. Bishop (Jnr.), Esq. T. H. M. Clarke, Esq. L. R. Morris, Esq. W. S. Williams, Esq. H. H. Collier, Esq. D. H. Parker Bowles, Esq. A. R. Kemp, Esq. H. Thompson, Esq. G. S. Thompson, Esq., F.R.C.S. (Edin.). HEALTH COMMITTEE. G. S. Thompson, Esq., F.R.C.S. (Edin.) Chairman also Miss Ford, and Messrs. Muspratt, Clarke, Kemp, Cakebread, Bennett, Brown and Morris. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 12,400 POPULATION. The population as estimated by the Registrar General at the middle of the year was 97,410. The number of inhabited houses at the end of 1939, according to the Rate Books, was 29,164. The rateable value of the District is £873,412 The net product (after allowing for cost of collection) of a penny rate is £3,487 6s. 1d. 4 SOCIAL CONDITIONS. The number of houses erected during the course of the year was 1,183. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total. Male. Female. Legitimate 1,704 886 818 Illegitimate 52 24 28 Birth-rate—18.02 per 1,000 population. Still Births:— Total. Male. Female. Legitimate 58 34 24 Illegitimate 4 2 2 Rate per 1,000 total births—34.10. Total. Male. Female. Deaths 918 478 440 Death-rate—9.51 per 1,000 population. Number of women dying in, or in consequence of, childbirth:— Deaths. Rate per 1,000 Total Births. From Puerperal Sepsis 0 0.00 From other Puerperal causes 7 3.94 7 3.94 Five of these cases were removed to the North Middlesex County Hospital, where they died. The other two cases died at home. Death-rate of Infants under one year of age:- All infants per 1,000 live births 35.07 Legitimate infants per 1,000 legitimate live births 33.78 Illegitimate infants per 1,000 illegitimate live births 76.92 Deaths from Cancer (all ages) 142 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhoea (under 2 years of age) 0 The following table gives the birth-rate, recorded death-rate and infantile deaths for Enfield as compared with those for England and Wales, London, 126 County Boroughs and Great Towns (including London) and 148 Smaller Towns:— 5  Birth-rate. Recorded Death-rate. Infantile Death-rate. Live Still England and Wales 15.00 0.59 12.1 50.00 London 12.30 0.44 11.9 48.00 126 County Boroughs and Great Towns (including London) 14.80 0.59 12.0 53.00 148 Smaller Towns 15.60 0.57 11.2 40.00 ENFIELD 18.02 0.63 9.51 35.07 DEATHS. Of the 918 deaths of Enfield residents during the course of the year 142 were due to malignant disease: 260 to heart disease: 60 to pneumonia (all forms), and 55 to tuberculosis of the respiratory system. INFANT MORTALITY. Of the 61 infants who died before attaining the age of one year, 32 died within the first week of life. In 10 cases death was due to pneumonia: in 9 to congenital malformation and in 21 to premature birth. INQUESTS. Twenty-five inquests and forty-three P.M's. without inquests were held in Enfield during the year. Out of these, 42 deaths were due to natural causes, 8 to accidental causes and 14 to suicide. AMBULANCE FACILITIES. For infectious Cases: 236 patients were removed from Enfield during the year. 2,726 other patients were conveyed during the year to local hospitals. LABORATORY FACILITIES. The following work was carried out in the Council's laboratory during the year. Specimen. No. Positive. Negative. Percentage of Positives. Swabs 1,130 39 1,091 3.45 Sputa 198 24 174 12.12 Totals 1,328 63 1,265 4.74 6 WATER SUPPLY. There are seven premises in Enfield which receive their water supply other than from a public company; these are under constant supervision. SUB-LETTING IN COUNCIL HOUSES. During the course of 1939 I have continued to deal with applications for sub-letting in Council houses. The following work was carried out:— Total number of applications dealt with 52 Number granted permission to sub-let 48 Number refused permission 4 Number of visits made by Sanitary Inspectors 11 INFECTIOUS DISEASES AND SCHOOLS. Number of children notified to be absent from School due to suspected Infectious Disease 567 Number of children found to be suffering from Infectious Disease 384 This compares with the following figures for last year:— Number of children notified to be absent from School due to suspected Infectious Disease 920 Number of children found to be suffering from Infectious Disease 593 RAG FLOCK ACTS, 1911 and 1928. Three samples of Rag Flock were taken during the course of the year from premises where Rag Flock is manufactured, used or sold. They were all found to comply with the standard laid down in the Acts. 7 HOUSING. Number of New Houses erected during the year:— (a) Total (including numbers given separately under (b)) 1,183 (i) By the Local Authority - (ii) By other Local Authorities 120 (iii) By other bodies or persons 1,045 (b) With State Assistance under the Housing Act:— (i) By the Local Authority - (ii) By other bodies or persons 18 Inspection of Dwelling Houses:- No. of houses No. of inspections (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) and number of inspections made 1,875 8,767 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932, and the number of inspections made 61 634 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 7 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 678 (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 581 3. Action under Statutory Powers:— A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:- 8 (1) Number of dwelling-houses in respect of which Notices were served requiring repairs 5 (2) Number of dwelling-houses which were rendered fit after service of formal Notices:— (a) By owners 4 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 40 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices:— (a) By owners 40 The number of house-to-house inspections made was:— Under Housing Regulations, 1925 and 1932 61 THE MILK (SPECIAL DESIGNATIONS) ORDERS, 1936 and 1938. There are 25 Purveyors of Milk who sell or distribute Pasteurised Milk in the district. Samples of milk have been taken and tested. SLAUGHTER-HOUSES. There are eight slaughter-houses in Enfield. During the course of the year 14,610 carcases were examined, and the surrender of 26 carcases and 410 parcels of diseased organs were secured. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The number of cases of Scarlet Fever was 187, compared with 190 in 1938: of Diphtheria 41, as compared with 57; of Pulmonary Tuberculosis 100, as compared with 115; and of Pneumonia 48, as compared with 98. There were no deaths from Diphtheria during the year, as compared with one death in 1938. There were no deaths from Scarlet Fever during the year, as compared with one death in 1938. 9 NOTIFIABLE DISEASES DURING THE YEAR 1939. No. Removed. Deaths. Smallpox — — — Cholera—Plague — — — Diphtheria (inc. Membranous Croup) 41 41 — Diphtheria Carriers — — — Erysipelas 32 9 — Scarlet Fever 187 157 — Typhus Fever — — — Typhoid Fever — — — Paratyphoid Fever — — — Continued Fever Relapsing Fever - - — Puerperal Pyrexia 13 5 — Cerebro-Spinal Meningitis 1 1 — Poliomyelitis 3 3 — Ophthalmia Neonatorum 3 1 — Pulmonary Tuberculosis 100 — 55 Other forms of Tuberculosis 20 — 7 Encephalitis Lethargica 1 1 1 Malaria — — — Pneumonia 48 9 60 Dysentery 15 — — Polio Encephalitis 1 1 — Totals 465 228 123 DIPHTHERIA IMMUNISATION. Through the services of the Council 122 individuals were immunised during 1939. ERADICATION OF BED BUGS. Number of Council houses found to be infested 16 Number of Council houses disinfested 16 Number of other houses found to be infested 13 Number of other houses disinfested 13 MATERNITY and CHILD WELFARE SECTION 12 Public Offices, Enfield. 29th November, 1940. To the Chairman and Members of the Urban District Council of Enfield. Ladies and Gentlemen, I beg to place before you my Annual Report on the Maternity and Child Welfare and Midwifery work carried out in Enfield during the year 1939. Owing to the War, and in accordance with the instructions of the Ministry of Health, I am making this report as brief as possible. During the first eight months of the year the normal work of the department continued and satisfactory progress in each sphere of activity was made. During the latter four months the service was disorganised on account of the A.R.P. work which the department was called upon to perform. All four of the Council's Maternity and Child Welfare Centres became First Aid Posts or Casualty Stations, and the Health Visitors spent much of their time in organising the First Aid Posts, static or mobile. Much credit is due to them for the work they carried out, and the present organisation is the result of their efforts in co-operation with the medical officers attached to the posts. In the early days of the war, it was essential to concentrate in the first place on seeing that babies were provided with the foods to which they were accustomed, and although the welfare centres were occupied by A.R.P. personnel, steps were nevertheless taken to assure that the clinics were open an adequate number of times during the week to achieve this object. The sale of foods continued, as did the granting of free foods to those who were in need thereof. At the same time a skeleton dental service was carried out, whilst ante-natal work continued almost unabated. The Committee will realise, however, that this work could not be carried out so easily at the clinics whilst they were in occupation by A.R.P. In order to overcome this difficulty, a scheme was organised whereby ante-natal work was carried out by the midwives visiting the homes of their patients more frequently, and by the regular visitation of the patients by one of the medical officers of your staff. 13 Towards the end of the year, two of the Maternity and Child Welfare Centres, namely, St. Stephen's Road and Southbury Road, were vacated by the A.R.P. and became once more fully available for their normal purposes. It was not until the middle of 1940, however, that Rosemary Avenue Clinic was vacated: in the meanwhile the clinic was held at the hall of the Church of the Latter Day Saints, 49, Lancaster Road. Lincoln Road Maternity and Child Welfare Clinic is still occupied by the A.R.P. Casualty Services, but Maternity and Child Welfare work still continues there, the two services working side by side with no more than the expected amount of discomfort to both services. During this time trained nurses were being appointed to take charge of the First Aid Posts, and as a result it became possible to free the Health Visitors for their normal duties. They are, however, all attached to First Aid Posts and render excellent services there as additional trained nurses. In one case, one of your staff remains in charge of a mobile unit and is carrying out her duties there in conj unction with her welfare work and is giving satisfaction in both directions. She also has the help of another Health Visitor. The figures will show that midwifery work has been continuing throughout the year on a scale no less than in 1938, and I consider that great appreciation is due to the midwives for the way in which they have carried out their work under black-out conditions. 'The question that is now foremost in our minds is, naturally, what has been the effect of the war on ante-natal and nursing mothers and children under the age of five years. This report deals only with the year ending the 31st December, 1939, but I am satisfied and I think you will agree that the statistics in this report will show that during the whole of 1939 the health of the district was well maintained and was, in fact, as satisfactory as in any previous year. The partial closure of the centres at the outbreak of war caused a considerable curtailment of their activities. It was immediately followed by many demands from the public that they should be opened at once for the purpose for which they were designed, namely, Maternity and Child Welfare. Every step was made to meet this demand, which was felt to be a public appreciation of the valuable work of the clinics. After the clinics were re-opened every attempt was made to keep the numbers attending low to avoid a large congregation of persons on the premises at any one time. This again was found to be difficult, and even to-day, when this report is being written, the number of 14 mothers and children attending the centres still remains very high, a further demonstration of the desire and the need for Maternity and Child Welfare work throughout the district. I am satisfied that the demand and the need for Maternity and Child Welfare to-day is as great, if not greater, than heretofore, and I am glad to realise that I have the full sympathy of my Committee in strengthening every possible scheme for the health of the children and the ante-natal and nursing mothers in the district. It is most interesting to note that after a year of war the demand for the Council's midwives is almost the same as it was a year ago. I would at this stage wish to express my thanks to the Committee for the help I received throughout the year and to record my appreciation of the Doctors, Nurses and Clerical Staff who, despite the demands of A.R.P., combined to secure the continuity of Maternity and Child Welfare work in the district. I am, Ladies and Gentlemen, Your obedient Servant, D. H. GEFFEN, Medical Officer of Health. 15 INFANT MORTALITY. The infant mortality rate was 35.07, the lowest ever recorded in Enfield. BIRTHS. 1939. 1938. Live births 1,756 1,736 Still births 62 51 PUERPERAL PYREXIA. During the year 13 cases of Puerperal Pyrexia were notified, five of whom were removed to Hospital. MATERNAL MORTALITY. There were seven maternal deaths resulting from Pregnancy. SUPERVISION OF NURSING HOMES There are in Enfield the following Nursing Homes:— Address. Proprietor. Total No. of Beds. No. of Maternity Beds. 238 & 240, Baker Street, Enfield. Barker, Mrs. 11 — 29, Derby Road, Ponders End. Tughan, Dr. & Mrs. 4 4 These homes have been regularly inspected by your Medical Officers. ADMINISTRATION OF MIDWIVES ACT, 1902-36. During the year 1939 there were 21 Midwives practising in Enfield of whom five lived outside the district, but practised therein. The Midwives resident in the district were visited regularly by the Medical Officers and their records and equipment inspected. Of the 21 Midwives practising in the district, 12 were employed by the Council as whole-time Municipal Midwives, and one in a temporary capacity. 16 The following table shows the cases attended during 1939. 1939 1938. MUNICIPAL MIDWIVES. Cases attended as Midwives 658 482 Cases attended as Maternity Nurses 210 197 PRIVATE MIDWIVES. Cases attended as Midwives 38 97 Cases attended as Maternity Nurses 58 60 NOTIFICATIONS. In accordance with the rules of the Central Midwives Board, the following notifications were received from Midwives:— 1939. 1938. Sending for Medical Aid 219 150 Still Births 7 3 Laying-out of the Dead 6 6 Artificial Feeding 9 5 Liability to be a source of Infection 4 10 The notifications in connection with Medical Aid can be classified as follows:— During Pregnancy 9 During Labour 144 During Lying-in Period 26 Infant 40 HELP WITH COST OF MIDWIVES' FEE. During the year 73 cases were helped with the cost of their Midwife's fee, compared with 21 in 1938. OBSTETRIC SPECIALIST. The Obstetric Specialist at the North Middlesex County Hospital was called in by the Enfield Practitioners in two cases of difficult labour. HOME HELPS. During the year Home Helps were supplied in 160 cases. 17 BIRTH CONTROL. Throughout the year advice was given on Birth Control in accordance with Memorandum 153 M. & C.W. and Circulars 1208 and 1408 of the Ministry of Health. CIRCULATION OF BOOKLET ON REARING OF CHILDREN. The booklet "To Mothers and Fathers" was circulated throughout the year to mothers of all children born in the district. This booklet is very much welcomed by all classes of persons in Enfield, and I am satisfied that its circulation is of increased importance in war time. ANTE-NATAL CLINICS. During the year 1,165 individual mothers attended the AnteNatal Clinics, that is, 64 per cent. of Enfield mothers who were confined. INFANT WELFARE CENTRES. The total number of children who attended at the Infant Welfare Clinic was 1,523. VISITS. The Council's Health Visitors paid 586 visits to Expectant Mothers, 2,436 to children under one year of age, and 3,955 to children between the ages of one and five years. ASSISTED MILK SUPPLY. The quantity of fresh and dried milk supplied to necessitous cases under the Milk Supply Scheme during the year was as follows:— Fresh Milk 14,574 galls; cost, £1,596 6s. 4d. Dried Milk 2,919 lbs.; cost, £225 1s. 9d. ROUTINE MEDICAL INSPECTION OF CHILDREN UNDER FIVE YEARS OF AGE. Routine medical inspection of children under five years of age continued until the outbreak of war. 18 AURAL TREATMENT. During the year 37 children were referred to the School Aural Clinic. OPHTHALMIC TREATMENT. Twenty-five mothers and 59 children were referred during the year to the School Ophthalmic Surgeon. CHILD LIFE PROTECTION. PUBLIC HEALTH ACT, 1936. At the end of 1939 37 persons in Enfield were receiving children for reward; the total number of foster children being 45. DENTAL TREATMENT. During the course of the year 628 attendances were made by ante-natal and nursing mothers, and 373 by children at the Dental Clinics. Dentures were provided for 85 mothers. BABY WEEK. Baby Week was carried out as in previous years. Competitions were held and prizes were given. CONVALESCENT TREATMENT. Two mothers and seven children were sent to Convalescent Homes during the year. 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' Departments in order to demonstrate to the older girls the bathing of a baby. 19 Report of the Chief Sanitary Inspector For the year 1939. Public Offices, Enfield. 29th November, 1940. To the Chairman and Members of the Urban District Council of Enfield. Ladies and Gentlemen, I beg to submit my Annual Report for the year ended 31st December, 1939. For reasons of economy my Report this year will be in a condensed form. The total number of inspections made during the year for all purposes was 16,901. This figure is considerably less than for the previous year and is accounted for by the fact that from the outbreak of war to the end of the year, the services of the Inspectors were utilised in the building up of an efficient A.R.P. Casualty Service. 20 NOTICES ISSUED. Statutory 91 Informal 549 Other Notices 1,633 Total 2,273 Letters re Air Raid Precautions 5,946 Other Letters sent 12,598 Number of Certificates issued in connection with plans 89 Number of Certificates issued in connection with disinfection 29 Number of Certificates issued in connection with unsound foods 110 Result of Service of Statutory and Informal Notices:— Statutory. Informal Number complied with 86 357 Number outstanding 5 192 91 549 The inspection of premises revealed defects varied and general in character, and it is pleasing to record that a considerable amount of work was carried out by owners during the year. Six hundred and seventy-three 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 16,901. DISINFECTION. Number of houses disinfected after infectious disease, Phthisis and verminous cases 207 Number of articles of clothing, bedding, etc., disinfected 2,683 FACTORY AND WORKSHOP ACT, 1901, AND FACTORIES ACT, 1937. Number of inspections 236 Number of defects found 14 21 HOMEWORK. Sixty-three lists containing the names and addresses of 102 outworkers were received during the year. Fourteen addresses of outworkers were forwarded to other districts. PLACES OF PUBLIC ENTERTAINMENT. Number of inspections 31 OFFENSIVE TRADES. Thirty-five offensive trade premises are established in the district and in connection with these, 55 inspections were made during the year. One new fish-frying shop was opened during the year with the consent of the Council. MILK. Number of Licences in force on 31st December, under the Milk (Special Designations) Orders, 1936 and 1938 37 PUBLIC HEALTH (MEAT) REGULATIONS, 1924. Total number of carcases examined 14,610 Number, or parts, found to be diseased 436 Weight of do. do. 2 tons 9 cwt. 2 qrs. 12½ lbs. It was found necessary, however, to take action against one butcher for not giving notice of intention to slaughter and for exposing a portion of a carcase affected with disease. The Magistrates imposed fines totalling £3 5s. Od. UNSOUND MEAT AND FOODS. Number of inspections made to slaughter-houses, shops, stalls in markets and food-preparing shops 2,215 CARAVANS. Number of applications received for consent 7 Number of applications granted 3 22 REMOVAL OF HOUSE REFUSE. Total refuse collected and disposed of 20,497 tons Cost of do. do. £24,035 Cost per head of population 21s. 5.8d. Average cost per house 16s. 5.7d. Income from removal of trade refuse £354 17s. 9d. PUBLIC MORTUARY. There is one Public Mortuary in the district which has received close supervision during the year. Number of cases attended to 70 This Report would not be complete unless I again state how much I appreciate the kindly manner in which Dr. Geffen, 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 Ladies and Gentlemen, Your obedient Servant, FRED. WILSON, M.R.San.I., M.S.I.A., Chief Sanitary Inspector. ANNUAL REPORT of the SCHOOL MEDICAL OFFICER for the year ending 31st December, 1939. 24 MEMBERS OF THE ENFIELD EDUCATION COMMITTEE 1939-40. Chairman Mr. H. A. deshborough Brown Vice-Chairman Mr. H. G. Short. Representative Members. Mrs. F. M. Bax Mr. W, C. Bennett Mr. H. A. Deshborough Brown Mr. T. H. M. Clarke Mr. H. H. Collier Mr. D. Mason Mr. H. Muspratt, O.B.E. Mr. C. Partington, J.P., M.R.s.T. Mr, S. G. Rowlandson Mr. E. S. Stock Co-optative Members. Mrs. I. G. Dufton Mrs. H. Rothwell Mr. H. Campbell Mr. F. G. Cobbin Mr. A. J. Neaves Mr. H. G. Short Mr. J. E. Sheppard Director of Education E. Pascal, Esq., M.A. 25 Annual Report of 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, 1939. 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 school children of Enfield for the year ending 31st December, 1939. The work of the School Medical Department was continued on the same lines as in previous years until the outbreak of the war in September. The schools, which were closed for the Summer holidays did not re-open, and the staff of the School Medical Department was employed in the Air Raid Precaution Casualty Service. Eastern Enfield is an evacuation area and western Enfield a neutral area. The schools in the neutral area were opened for part-time education at the beginning of October, and some of the School Medical Services were recommenced as soon as the schools opened. The scope of the work then gradually increased until by the end of the year it was possible to return almost to pre-war conditions. I beg to take this opportunity of thanking the Committee for the courtesy it has always extended to me, and to pay tribute to my colleague, Mr. Pascal, and to every member of the School Medical Department who has helped me during the year. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, Dennis H. Geffen, School Medical Officer. 26 REPORT OF THE SCHOOL MEDICAL OFFICER. July, 1939. Average number on books of Elementary Schools 11,888 Average weekly attendance 10,547 Number of Schools 20 ROUTINE MEDICAL INSPECTION. The total number of children examined during the year was 2,843 as compared with 4,112 examined during 1938. 78 per cent. of the children examined were accompanied by their parents, and 36 per cent. were vaccinated. DEFECTS FOUND AT ROUTINE MEDICAL INSPECTION. Undeanliness.-Of 2,843 children examined six were found to have vermin in their heads, and 77 had nits, i.e., 0.2 per cent. had verminous heads, and 2.7 per cent. had nits. No cases of body vermin were found. Nutrition. The following table shows the state of nutrition among the children examined:— Number of children examined 2,843 Number of children classified "A" 149 Percentage of children classified "A" 5.8 Number of children classified "B " 1,641 Percentage of children classified "B" 64.6 Number of children classified "C" 673 Percentage of children classified "C" 26.4 Number of children classified " D" 81 Percentage of children classified D" 3.2 A Excellent. B Normal. C Slightly sub-normal. D Bad. 27 Skin Diseases.—Nineteen cases were seen: all required treatment. Ear Diseases.—Three cases of middle ear disease were found and 18 cases of defective hearing. All were referred to the Aural Clinic for treatment. Tonsils and Adenoids.—Nine hundred and seventy-three children had already had operation for removal of tonsils and/or adenoids. One hundred and eighty-eight were found to have enlarged tonsils, adenoids, or both. Eye Diseases and Defects.—Seventeen children were found to be suffering from external eye disease. One hundred and eighty-one cases of defective vision were found, including 12 cases of squint. INFECTIOUS DISEASE. Measles 1 German Measles 4 Mumps 14 Whooping Cough 198 Chickenpox 190 Scarlet Fever 99 Diphtheria 28 Poliomyelitis 1 Encephalitis Lethargica 1 THE WORK OF THE SCHOOL NURSES. Number of home visits 2,892 Number of school visits 368 Number of school visits for routine examination of heads 149 Total number of heads examined 33,773 Number of individual children found unclean 1,090 Number of cases in which legal proceedings were taken 1 TREATMENT CLINICS. Tonsils and Adenoids.— Number of cases referred for treatment 334 Number of cases operated under the Authority's scheme 271 Number of cases operated by private arrangement 15 28 Ringworm.—Four cases were seen and treated at the clinics. Impetigo.—Fifty-two cases were treated at the clinics. Scabies.—Sixteen cases were treated. Other Skin Diseases.—One hundred and twenty cases were seen and treated at the clinics. Eye Diseases.—One hundred and forty-five cases were treated. Ear Diseases.—Forty-eight cases were treated. The total number of children examined during the year, excluding those attending the Dental Department, was 7,029. This number was made up as follows:— Examined at Routine Inspection 2,843 Examined at Minor Ailment Clinics 2,446 Examined at Ophthalmic Clinic only 562 Examined at Aural Clinic only 27 Examined at School Leaving Age for Juvenile Employment Committee 673 Examined under Juvenile Employment Bye-laws 64 Examined under Mental Defficiency Act 23 Examined as contacts with infectious disease 391 The amounts collected during the year in respect of medical treatment were as follows:— £ s. d. Minor Ailment Treatment 415 8 Ophthalmic Treatment (cost of Spectacles) 37 12 4 Convalescent Treatment 65 2 9 Operative treatment for removal of tonsils and adenoids 147 8 1 Dental treatment 49 7 3 Provision of Instruments 10 0 The following help was afforded to children who were found to require it:— Forty-one children were sent to residential special schools for physically defective children. Two children were supplied with surgical instruments. 29 The Enfield Children's Care Committee also assisted in the following ways:— Five children were sent to convalescent homes. One child was given cod liver oil and malt. Two hundred and fifteen children were supplied with boots. There were 13 deaths among school children during the year. The causes were as follows:— 1 Mitral Stenosis. 3 Tuberculous Meningitis. 1 Uraemia. 1 Acute Nephritis. 1 Cerebral Tumour. 1 Tumour of Spinal Cord. 2 Murdered (Coal Gas Poisoning). 1 Drowned. 1 Accident (Fractured Skull). 1 Accident (Multiple Injuries). PROVISION OF MEALS. Meals are provided for necessitous children at the following centres:— St. Luke's Institute, Enfield. Feeding Centre, Alma Road, Ponders End. Bellside Dining Rooms, Enfield Wash. Dining Rooms, St. Mark's Road, Bush Hill Park. During 1939 50,436 dinners were provided free. 906,477⅓-pint bottles of milk were provided and paid for, and 84,546 were provided free. BLIND, DEAF, EPILEPTIC, AND MENTALLY DEFECTIVE CHILDREN. There is one blind child in Enfield and she is attending Swiss Cottage School for the Blind. Eleven children are in attendance at Philip Lane School for the Deaf, Tottenham; these may be classified as follows:— 2 Deaf-mutes. 4 suffering from acquired deafness. 5 suffering from motor aphasia, 30 Twenty-three children were examined under the Mental Deficiency Act (1913) during 1939. These were scheduled as follows:Dull and backward but capable of instruction in an elementary school 3 Mentally defective but capable of instruction in a special school 9 Imbecile 2 Not scheduled 9 EXAMINATION AND TREATMENT OF SECONDARY SCHOOL CHILDREN. The number of children examined in the course of Routine Medical Inspection at the secondary schools was as follows:— Junior Technical School 51 Grammar School 71 County School 204 The classification of the nutrition of these children was as follows:— School. Classification. "A” " B ” "C” "D” Junior Technical 4 40 7 — Grammar 4 56 11 — County 15 150 37 2 The following defects were found:— Jnr. Technical. Grammar. County. Dental Caries 2 5 4 Defective Vision 3 3 23 Enlarged Tonsils — — 1 Other Nose & Throat Conditions - 1 Skin Diseases — — 1 Conjunctivitis — — 1 Other diseases and defects — 1 7 Three hundred and twenty-one children were treated at the Dental Clinic and 81 at the Ophthalmic Clinic during 1939. 31 SCHOOL DENTAL CLINICS. Elementary Schools. Secondary Schools. Number Inspected 4838 859 Number Treated 3059 321 Number of Fillings 3778 1210 Number of Extractions 6372 286 SCHOOL OPHTHALMIC CLINIC. Elementary Schools. Secondary Schools. Total attendance 1565 129 New Cases 866 81 Prescriptions for glasses 290 30 Number not requiring glasses 117 7 Twelve children attended the Western Ophthalmic Hospital for Orthoptic treatment, and four children had operation for squint. SCHOOL AURAL CLINIC. Number of cases dealt with 289 Number of new cases 159 Total number of attendances 495 Number of cases discharged cured 162 Number of cases of a recurrent nature requiring occasional treatment 13 Number of cases still under treatment 41 Number of cases who have refused treatment, or sought treatment elsewhere 19 Enfield: Bennett & Starling Printers, Windmill Hill.