ENF 24 Urban District Council of Enfield ANNUAL REPORT I OF THE Medical Officer of Health and School Medical Officer (D. H. GEFFEN, M.D., D PH.) FOR 1940 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 1940 1 Public Offices, Enfield. 24th July, 1941. Annual Report of the Medical Officer of Health, 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 for the year 1940. It is on lines similar to those of last year and considerably abridged in order to save both time and paper. It is with great pleasure that I can report that the health of the district has been maintained at a level commensurate with that of pre-war years. Reference to the statistics will show that only 28 cases of I3iphtheria were notified, the lowest figure we have been able to record for many years. It is unfortunate that some of the cases were severe and that five individuals lost their lives. Towards the end of the year propaganda was directed towards informing the public of the value of protection against this disease, and the response in Enfield has been most satisfactory. I would also draw attention to the decline in the number of births from 1,756 to 1,607, and in the birth rate from 18.02 to 16.94; this is to be expected in war time. The infantile death rate at 42.53, though higher than that for last year, is the second lowest to be recorded for at least 50 years. Fears that shelter life, the blackout, and general conditions of war would have a deleterious effect upon the health of the community have not been realised either in Enfield or in the country at large; Enfield is as healthy as it was before the war. I would find it hard, if questioned, to account for this state of affairs. I believe it is due in part to the municipal services, the better education of the population in health matters during the years that preceded the outbreak of War, and the determination 2 of Local Authorities to continue their health and welfare services in spite of all the difficulties which the War has brought forth0; I am satisfied that these efforts have been well rewarded. I cannot prophesy for the health of the future, but I am in a position to state that the first six months of 1941 have shown that the present satisfactory state of affairs is continuing. I have been asked many times as to the effect of air raids on the nerves of the population. I have no hesitation in saying that in Enfield War neurosis appears to be conspicuous by its absence. In the minds of the members of Civil Defence, and the public at large, there must have been the question "how will I stand up to air raids ?" It has been my privilege to see how the personnel, both male and female, of Enfield's Civil Defence Services have reacted to the raids which have occurred in our district. I need hardly tell the Council how well they have carried out their duties, or stood by during raids, with a pluck that leaves nothing but admiration. The same applies to the public; many a night have I been down streets, where house after house has been damaged by enemy action, to be greeted by the owners with a joke and an offer of a cup of tea. Such is the spirit of Enfield and a summary of the mental health of its population which, together with its physical well-being, it is my duty to record in this, my Annual Report. I have been proud to be the Medical Officer of Health of such a population and the officer-in-charge of Enfield's Casualty Services. The Council will be aware that the task of its officials to-day is one of extreme difficulty. All the more am I pleased to record the help I have received from the staff of the Department. I beg to remain, Your obedient Servant, D. H. GEFFEN, Medical Officer of Health, 3 URBAN DISTRICT COUNCIL OF ENFIELD. S. G. Rowlandson, Esq., F.C.A., J.P. Chairman *W. H. Bishop, Esq. (Junr.) and on his resigning Vice-Chairman F. Greenwood, Esq. *Mrs. F. M. Bax. Miss G. M. Ford, J.P. II. Muspratt, Esq., O.B.E. C. Partington, Esq., M.R.S.T. W. W. Cakebread, Esq. W. C. Bennett, Esq. H. A. D. Brown, Esq. L. R. Morris, Esq. H. H. Collier, Esq. A. R. Kemp, Esq. *G. S. Thompson, Esq., F.R.C.S.(Edin.). A. M. Eeles, Esq. *G. E. Jones, Esq. W. G. Spice, Esq. E. S. Stock, Esq. C. Evans, Esq. D. Mason, Esq. T. H. M. Clarke, Esq. W. S. Williams, Esq. *D. H. Parker Bowles, Esq. H. Thompson, Esq. W. G. Bowyer, Esq. *F. G. Cobbin, Esq. J. Cottenham, Esq. †C. H. Thomas, Esq. †W. F. Lawrence, Esq. †F. G. Fletcher, Esq. †W. Graham, Esq. †Mrs. E. M. Squire, C.C. †w. G. Jollie, Esq. HEALTH COMMITTEE. G. S. Thompson, Esq., F.R.C.S.(Edin). 1 and on his resigning Chairman H. Muspratt, Esq., O.B.E. also Miss Ford, and Messrs Clarke, Kemp, Cakebread, Bennett, Brown and Morris, and Lawrence (as from the resignation of G. S. Thompson, Esq.) The Members marked *resigned during the course of the year, and the vacancies were filled by those marked †. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 12,400 4 POPULATION. The population as estimated by the Registrar General at the middle of the year was 94,860. The number of inhabited houses at the end of 1940, according to the Rate Books, was 29,416. The rateable value of the District is £895,690 The net product (after allowing for cost of collection) of a penny rate is £3,500 SOCIAL CONDITIONS. The number of houses erected during the course of the year was 166. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total Male. Female. Legitimate 1,558 798 760 Illegitimate 49 20 29 Birth-rate—16.94 per 1,000 population. Still Births:— Total. Male. Female. Legitimate 42 20 22 Illegitimate 2 2 — Rate per 1,000 total births—26.65. Total. Male. Female. Deaths 1,010 574 436 Death-rate—10.64 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 3 1.81 3 1.81 Two of these cases were removed to the North Middlesex County Hospital where they died. The other case died at a Nursing Home in Southgate. Death-rate of Infants under one year of age:— All infants per 1,000 live births 42.53 Legitimate infants per 1,000 legitimate live births 40.62 Illegitimate infantsper 1,000illegitimate live births 102.04 Deaths from Cancer (all ages) 108 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 0 Deaths from Diarrhoea (under 2 years of age) 9 5 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:— Birth-rate. Recorded Death-rate. Infantile Death-rate. Live Still England and Wales 14.6 0.55 14.3 55.00 London 13.7 0.44 17.8 50.00 126 County Boroughs and Great Towns (including London) 16.0 0.64 15.8 61.00 148 Smaller Towns 15.7 0.55 12.8 54.00 ENFIELD 16.94 0.46 10.64 42.53 DEATHS. Of the 1,010 deaths of Enfield residents during the course of the year 108 were due to malignant disease: 263 to heart disease: 70 to pneumonia (all forms), and 54 to tuberculosis of the respiratory system. INFANT MORTALITY. Of the 67 infants who died before attaining the age of one year, 30 died within the first week of life. In 15 cases death was due to pneumonia: in 7 to congenital malformation: in 16 to premature birth, and in 6 to Atrophy, Debility and Marasmus. INQUESTS. Thirty-eight inquests and forty-four P.M's. without inquests were held in Enfield during the year. Out of these, 46 deaths were due to natural causes, 21 to accidental causes, 6 to suicide, 6 to misadventure, and 3 open verdict. AMBULANCE FACILITIES. For infectious Cases: 171 patients were removed from Enfield during the year. 1,731 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 642 10 632 1.55 Sputa 204 12 192 5.88 Totals 846 22 824 2.60 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 1940 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 38 Number granted permission to sub-let 37 Number refused permission 1 Number of visits made by Sanitary Inspectors 8 Numbers of letters sent 53 INFECTIOUS DISEASES AND SCHOOLS. Number of children notified to be absent from School due to suspected Infectious Disease 243 Number of children found to be suffering from Infectious Disease 135 This compares with the following figures for last year:— 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 RAG FLOCK ACTS, 1911 and 1928. One sample of Rag Flock was taken during the course of the year from premises where Rag Flock is manufactured, used or sold. This was 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)) 166 (i) By the Local Authority — (ii) By other Local Authorities 70 (iii) By other bodies or persons 92 (b) With State Assistance under the Housing Act: (i) By the Local Authority — (ii) By other bodies or persons 4 1. 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 1,137 5,369 (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 4 136 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (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 374 (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 250 3. A ction 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 1 (2) Number of dwelling-houses which were rendered fit after service of formal Notices:— (a) By Owners 1 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 21 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices:— (a) By Owners 20 The number of house-to-house inspections made was:— Under Housing Regulations, 1925 and 1932 4 THE MILK (SPECIAL DESIGNATIONS) ORDERS, 1936 and 1938. There are 23 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, none of which are in use at present. During the course of the year 7,602 carcases were examined, and the surrender of 38 carcases and 301 parcels of diseased organs were secured. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The number of cases of Scarlet Fever was 86, compared with 187 in 1939: of Diphtheria 28, as compared with 41; of Pulmonary Tuberculosis 128, as compared with 100; and of Pneumonia 55, as compared with 48. There were five deaths from Diphtheria during the year, as compared with no deaths in 1939. There were no deaths from Scarlet Fever during the year, as was the case in 1939. 9 NOTIFIABLE DISEASES DURING THE YEAR 1940. No. Removed. Deaths Smallpox — — — Cholera—Plague — — — Diphtheria (mc. Membranous Croup) 28 27 5 Diphtheria Carriers — — — Erysipelas 14 5 — Scarlet Fever 86 69 — Typhus Fever — — — Typhoid Fever 1 1 — Paratyphoid Fever 4 4 — Continued Fever Relapsing Fever Puerperal Pyrexia 1 1 — Cerebro-Spinal Meningitis 14 14 1 Poliomyelitis 1 1 — Ophthalmia Neonatorum 3 3 — Pulmonary Tuberculosis 128 — 54 Other forms of Tuberculosis 14 — 9 Encephalitis Lethargica — — — Food Poisoning 3 — — Malaria — — — Pneumonia 55 7 70 Dysentery — — — Polio Encephalitis — — — Measles 279 6 — Whooping Cough 91 8 — Totals 722 146 139 DIPHTHERIA IMMUNISATION. Through the services of the Council 225 individuals were immunised during 1940. ERADICATION OF BED BUGS. Number of Council houses found to be infested 10 Number of Council houses disinfested 10 Number of other houses found to be infested 18 Number of other houses disinfested 18 The following report, in condensed form, gives details of the work of the Sanitary Inspectors during the year 1940, 10 The total number of inspections made during the year for all purposes was 10,178. This figure is considerably less than for the previous year and is accounted for by the fact that the services of the Inspectors were utilised in connection with A.R.P. Casualty Services. NOTICES ISSUED. Statutory 41 Informal 480 Other Notices 478 Total 999 Letters re Air Raid Precautions 5,945 Other Letters sent 8,836 Number of Certificates issued in connection with plans 34 Number of Certificates issued in connection with disinfection 8 Number of Certificates issued in connection witli unsound foods 311 Letters sent re Sub-letting 53 Result of Service of Statutory and Informal Notices:— Statutory Informal Number complied with 39 311 Number outstanding 2 169 41 480 Two hundred and ten 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 10,178. DISINFECTION. Number of houses disinfected after infectious disease, Phthisis and verminous cases 163 Number of articles of clothing, bedding, etc., disinfected 7,301 FACTORY AND WORKSHOP ACT, 1901, AND FACTORIES ACT, 1937. Number of inspections 154 Number of defects found 6 11 HOMEWORK. Seventeen lists containing the names and addresses of 69 outworkers were received during the year. Nineteen addresses of outworkers were forwarded to other districts. PLACES OF PUBLIC ENTERTAINMENT. Number of inspections 3 OFFENSIVE TRADES. Four offensive trade premises are established in the district and in connection with these, 2 inspections were made during the year. 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 7,602 Number, or parts, found to be diseased 339 Weight of do. do. 4 tons 17 cwt. 1 qr. 13 lbs. UNSOUND MEAT AND FOODS. Number of inspections made to Meat Depot, slaughterhouses, shops, stalls in markets and food-preparing shops 1,759 CARAVANS. 9 Number of applications received for consent 4 Number of applications granted 3 12 REMOVAL OF HOUSE REFUSE. Total refuse collected and disposed of 16,062 tons Cost of do. do. £24,385 Cost per head of population 5s. 1.6d. Average cost per house 16s. 6.5d. Income from removal of trade refuse £395 13s. Od. PUBLIC MORTUARY. There is one Public Mortuary in the district which has received close supervision during the year. Number of cases attended to 71 Number of P.M's. carried out 57 MATERNITY and CHILD WELFARE SECTION 14 Public Offices, Enfield. 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 1940. This was the first complete year of war, and subject to all the interruptions occasioned by the Civil Defence organisation and later by air raids. It was a year when every effort had to be made to maintain the services intact and to secure their continuation. Perusal of the following pages will show the extent to which success was obtained. The total number of individual children who attended at our Clinics was in excess of that for 1939, the Health Visitors paid almost the same number of visits, the clinics for mothers and children were held as usual, and aural, ophthalmic and dental treatment continued on the same scale as in the previous year. The number of cases attended by our Midwives exceeded that for 1939, whilst the attendances at the Ante-Natal Clinics was the highest ever recorded. It is essential that every expectant mother should have medical care and attention during the months before her baby is born. Of the 1,607 Enfield mothers who were confined during the year no less than 1,278 obtained such care at our Clinics, and it may be fairly assumed that the remainder were in the capable hands of their own private doctors. I consider this to be a very satisfactory state of affairs. The majority of our expectant mothers remained in Enfield for their confinement, only a few choosing to accept the Government's evacuation scheme whereby arrangements are made for them to be evacuated to reception areas during the last month of pregnancy. Although I have been amazed at the courage with which our mothers have undergone the stress and strain of pregnancy and child-birth under air raid conditions, I must, nevertheless, strongly advise them to avail themselves of the facilities ol evacuation offered to them by the Government, and to leave the evacuable portion of Enfield for their confinement. 15 The Council will be aware that a few years ago it was decided to invite mothers, who had been attended by our Midwives, to come to special Post-Natal Clinics for examination about six weeks after the birth of their child. This was an innovation ; an idea new to Enfield women and we anticipated that it would take some while for them to appreciate its value. It is well known to medical experts that many diseases in later life and much suffering can be avoided if women will undergo this examination to secure that a full recovery to normality has resulted after confinement. In 1939, 152 mothers attended these Post-Natal Clinics; in 1940 the number was 181. This figure must be considered as most encouraging. The amount of liquid milk which is being distributed free by the Welfare Committee has decreased and is now confined to those cases where one pint of milk a day is considered insufficient. This is due to the Government Scheme whereby one pint of milk per day at 2d. a pint is available to all children under five years of age and to all ante-natal and nursing mothers. In certain circumstances, such milk can be granted free. The Lincoln Road Maternity and Child Welfare Centre still continues to be occupied, not only for Maternity and Child Welfare purposes but for Civil Defence, with consequent inconvenience to both services. Plans have been prepared for the erection of premises that will release the clinic for its welfare purpose. The health statistics for women and children remain satisfactory. The maternal mortality rate was 1.81 as compared with 3.9 in 1939. The infantile death rate was 42.53 compared with 55 for England and Wales and 50 for London. Although this figure is higher than the exceptionally low one we had last year, it is nevertheless the second lowest of which I can find records. A scheme is in operation under the aegis of the London County Council whereby mothers can be taken from the evacuation area of Enfield to reception areas, about one month before their confinement, and an increasing number of mothers are taking advantage of this scheme. The scheme works easily and satisfactorily. The year 1940 was a year in which your Welfare Services continued despite early fears. Health was well maintained and there was no excess of those diseases peculiar to ante-natal and nursing mothers and young children. The babies of Enfield still continue to be a pride to those whose pleasure it is to work for them. The Council may be aware that it was the older children, the toddlers aged between 2 and 5 years concerning whom, not only Enfield, but elsewhere, concern was felt during the past few years. Here again, I have been satisfied that this age group of children in Enfield show increasing health and strength. So many circumstances may be responsible for the satisfactory 16 results that have been achieved throughout the country during the past year that it would be foolish to moralise on the strength of them or to be in any way complacent. There never was a time when it was so difficult to prophesy for the future and I feel that every effort and every step that has been taken in the past to maintain and secure the health of our women and children should be continued in unrelenting fervour during the war. I am not of the opinion that we can afford to risk the cessation of any of those efforts which have been found successful in the past. This report would be incomplete were I not to pay high tribute to the Council's Midwives for their work during the latter months of 1940. During the nights when, as the black out descended, the air raid siren sounded and the barrage commenced, alone, unaccompanied and unprotected by special mask or helmet, your Midwives attended their cases without query or complaint. Sometimes, they had to walk, or cycle, quite considerable distances to reach their patients, but they unfailingly succeeded in doing so. I know that they have had not only my admiration but also that of the Members of the Council. I would also like to pay tribute to the Enfield mothers who during these terrible times waited for the midwife in patience, without complaint, without hysteria and, may I say, unwarranted anxiety. Your Midwifery Service has been proud to serve them. To the Chairman and Members of the Maternity and Child Welfare Committee I would record my thanks for their courtesy and confidence at all times. I am, Ladies and Gentlemen, Your obedient Servant, D. H. GEFFEN, Medical Officer of Health. 17 INFANT MORTALITY. The infant mortality rate was 42.53, the second lowest recorded for at least 50 years. BIRTHS. 1940 1939 Live births 1,607 1,756 Still births 44 62 PUERPERAL PYREXIA. During the year 1 case of puerperal pyrexia was notified which was removed to hospital. MATERNAL MORTALITY. There were two maternal deaths resulting from Pregnancy. Both died in institutions. SUPERVISION OF NURSING HOMES. There are in Enfield the following Nursing Homes: Proprietor. Address. Total No. of Beds. No. of Maternity Beds. Barker, Mrs. 238 & 240, Baker Street, Enfield. 11 — Tughan, Dr. & Mrs. 29, Derby Road, Ponders End. 4 4 These homes were inspected regularly by your Medical Officers during the course of the year. ADMINISTRATION OF MIDWIVES ACT, 1902-36. During the year 1940 there were 14 Midwives practising in Enfield, all of whom lived in the district. The Midwives were visited regularly by the Medical Officers, and their records and equipment inspected. Of these 14 Midwives, 11 were employed by the Council as whole-time Municipal Midwives, and one in a temporary capacity. 18 The following table shows the cases attended during 1940. 1940. 1939. MUNICIPAL MIDWIVES. Cases attended as Midwives 661 658 Cases attended as Maternity Nurses 230 210 PRIVATE MIDWIVES. Cases attended as Midwives 32 38 Cases attended as Maternity Nurses 51 58 NOTIFICATIONS. In accordance with the rules of the Central Midwives Board, the following notifications were received from Midwives:— 1940 1939 Sending for Medical Aid 173 219 Still Births 5 7 Laying out of the Dead 3 6 Artificial Feeding 2 9 Liability to be a source of infection 5 4 HELP WITH COST OF MIDWIVES' FEE. During the year 75 cases were helped with the cost of their Midwife's fee, compared with 73 in 1939. OBSTETRIC SPECIALIST. In no case was the Obstetric Specialist at the North Middlesex County Hospital called in by the Enfield Practitioners, for assistance in difficult midwifery cases. HOME HELPS. During the year Home Helps were supplied in 99 cases. The notifications in connection with Medical Aid can be classified as follows:— During Pregnancy 6 During Labour 114 During Lying-in Period 12 Infant 38 19 BIRTH CONTROL. Throughout the year such advice was given on Birth Control as is authorised by Memorandum 153 M. and 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 as heretofore. In so far as it is possible, and the Department has the necessary knowledge, arrangements are made for the booklet to reach the expectant mother. Where this is not possible, then it is sent as soon as the notification of birth is received. With the strictest view of economy I am satisfied that the continuation of the circulation of this booklet is well justified; it is extremely popular and thankfully received. ANTE-NATAL CLINICS. During the year, 1,278 individual mothers attended Ante-Natal Clinics, that is 80 per cent. of Enfield mothers who were confined. POST-NATAL CLINICS. During the course of the year 181 mothers attended for examination after their confinement. This compares with 152 n 1939. This figure is significant. It is a new idea to many women that it is essential that they should be examined after their confinement in order to be sure that no complication has arisen needing treatment. The increase in the number of mothers who have accepted this offer of examination is encouraging, and a complete success of this scheme would do much to prevent chronic illness in many women in later life. INFANT WELFARE CENTRES. The total number of children who attended at the Infant Welfare Clinic was 1,654, compared with 1,523 in 1939. VISITS. The Council's Health Visitors paid 407 visits to Expectant Mothers, 2,301 to children under one year of age, and 3,787 to children between the ages of one and five years. 20 ASSISTED MILK SUPPLY. The quantity of fresh and dried milk supplied free to necessitous cases under the Milk Supply Scheme during the year was as follows:— Fresh Milk 10,288 galls.; cost £1,148 6s. 11d. Dried Milk 2,972 lbs.; cost £243 14s. 10d. ROUTINE MEDICAL INSPECTION OF CHILDREN UNDER FIVE YEARS OF AGE. Routine Medical Inspection of children under five years of age ceased at the outbreak of war, and has not been recommenced. AURAL TREATMENT. During the year 47 children and 3 mothers were referred to the School Aural Clinic. OPHTHALMIC TREATMENT. 23 Mothers and 56 children were referred during the year to the School Ophthalmic Surgeon. CHILD LIFE PROTECTION. PUBLIC HEALTH ACT, 1936. At the end of 1940, 22 persons in Enfield were receiving children for reward ; the total number of children being 25. BABY WEEK. Baby week celebrations were not held during 1940. DENTAL TREATMENT. During the course of the year, 679 attendances were made by ante-natal and nursing mothers, and 248 by children at the Dental Clinics. Dentures were provided for 48 mothers. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER DENNIS H. GEFFEN, M.D., D.P.H. For the year ending 31st December, 1940 22 MEMBERS OF THE ENFIELD EDUCATION COMMITTEE. 1940-41. Chairman Mr. H. A. Deshborough Brown Vice-Chairman Mr. H. G. Short. Representative Members. Mr. W. C. Bennett Mr. H. A. Deshborough Brown- Mr. T. H. M. Clarke Mr. F. G. Cobbin 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 Miss Z. Smee Mr. H. Campbell Mr. L. Daines Mr. A. J. Neaves Mr. H. G. Short Mr. J. E. Sheppard Director of Education. E. Pascal, Esq., M.A. 23 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, 1940. 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 for the year ending 31st December, 1940. The work of the department was carried on steadily despite the war, though in some respects it had to be suspended, and in others curtailed. It will be seen that the number of children examined in Routine Medical Inspection is lower by 85u than in the previous year. Air raids and Air Raid Precaution distractions account, to a certain extent, for this. It must be remembered, however, that the department carried out a large amount of work in examing children to see if they were fit for evacuation both at home and overseas, and this took up a considerable time. During the course of the year the Committee accepted with regret Dr. Forrester's resignation on the grounds of ill-health. Dr. Forrester had served the Committee for nineteen years, and had helped to build the School Medical Service. The good wishes of all her colleagues follow her in her retirement. Dr. Forrester was replaced on 9th May, 1940 by Dr. M. E. Nevin. Throughout the year the Albany Clinic continued to be used as a First Aid Post, and the work of dealing with minor ailments was transferred therefrom to the old Eastfielcl Road School Clinic. I am satisfied that the health of the children attending Enfield schools has been maintained at a satisfactory level. It will be noted that, with the exception of Scabies, skin disease was less frequent. Scabies, itself, deserves mention. It is a disease of the skin known as "Itch" and is being seen increasingly, not only in Enfield, but throughout the country. It became obvious to 24 the Committee in the latter part of the year that steps would have to be taken to deal with this disease, and plans are now under consideration by the Council for the setting up of a scabies clinic. Space does not allow me to place before you, in full, the report I have received from Mr. James on the dental condition of our school children. As usual, it is full of information. The work carried out during the year showed an increase on that of 1939. 73.7 per cent. of the children examined were found to need treatment, and, of these, 65.3 per cent. received treatment by the school dentists. Sixteen children had special apparatus fixed in order to effect regulation of the growth of their teeth. Mr. James states that the conservative treatment of teeth has always been a marked feature of the Enfield School Dental Service, a feature that is being well maintained under war conditions, as shown by the large number of fillings inserted during the year under review, viz., 6,421. I have no hesitation in assuring the Committee, not only of the fine work our dentists are doing for the school children, but also of their enthusiasm. The number of children who accept treatment varies from school to school. It may be as low as 63 per cent. or as high as 97 per cent. The higher figure shows what was achieved at St. George's C. of E. School, and it reflects credit not only on the dentists, but in particular on the Head Teacher concerned, and on the parents of the children. 1 can do no more than repeat that the success of the School Medical and Dental Service rests largely in the hands of the Head Teachers, to whom once again I wish to pay a tribute. At one school in Enfield it was found that no less than 34.6 per cent. of the entrants were naturally fit, that is to say, no teeth had been extracted or filled and no teeth were carious. In view of the fact that in other schools this figure varies between five and ten per cent., it is worthy of note. The school in question is Merryhills, and this excellent percentage is the result of the wise care which the parents of the children have devoted to the up-bringing of their children, their preparedness to study child hygiene and child nurture, and to avail themselves of the services provided by the Local Authority. What has been achieved at Merrhyills can, and should, be achieved elsewhere. Enfield children have learned to take air raids in their stride. They are not unduly frightened of them, and we are not having children brought to us suffering from the war complaint of "nerves as a result of air raids." This is particularly interesting in view of the fact that this happy position did not pertain during the last war when air raids were in no way so severe as they were in 1940. In those days it was quite a routine for children to be dubbed as 25 suffering from nerves as a result thereof, and for years after the war, mothers brought their children to me saying that they were " nervy " because they were born during air raids. During 1940 our children were sturdy, healthy and clean. Despite uneven and irregular school hours their health was maintained, though I am told that they tended to be a little less controlled. One must remember, however, that parents had a difficult task to perform. I wish to extend my thanks for the help and co-operation which I have received from Mr. Pascal, the Director of Education, and my staff, during a very trying year ; and to the Education Committee, my gratitude for the help, consideration, and courtesy which I have always met at their hands. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, Dennis H. Geffen, School Medical Ofjicer. 26 REPORT OF THE SCHOOL MEDICAL OFFICER Average number on books of Elementary Schools (1.9.40— 31.12.40) 9,656 Average weekly attendance (1.9.40—31.12.40) 7,016 Number of Schools 22 ROUTINE MEDICAL INSPECTION. The total number of children examined during the year was 1,986 as compared with 2,843 examined during 1939. 80 per cent. of the children examined were accompanied by their parents, and 34 per cent. were vaccinated. DEFECTS FOUND AT ROUTINE MEDICAL INSPECTION. Uncleanliness. Of 1,986 children examined six were found 1o have vermin in their heads, and 58 had nits, i.e., 0.3 per cent. had verminous heads, and 2.9 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 1,986 Number of children classified "A" 104 Percentage of children classified "A" 5.2 Number of children classified "B" 1,474 Percentage of children classified "B" 74.2 Number of children classified "C" 367 Percentage of children classified "C" 18.5 Number of children classified "D" 41 Percentage of children classified "D" 2.0 A Excellent B Normal C Slightly sub-normal D Bad 27 INFECTIOUS DISEASE, Measles 11 German Measles 83 Mumps 28 Whooping Cough 25 Chicken pox 18 Scarlet Fever 48 Diphtheria 14 Paratyphoid 1 Cerebro-spinal Meningitis 2 THE WORK OF THE SCHOOL NURSES. Number of home visits 1,874 Number of school visits 272 Number of school visits for routine examination of heads 156 Total number of heads examined 32,400 Number of individual children found unclean 1,107 Number of cases in which legal proceedings were taken — TREATMENT CLINICS. Tonsils and Adenoids:— Number of cases seen at clinics 211 Number of cases operated under the Authority's Scheme 114 Number of cases operated by private arrangement17 Ringworm.- Your cases were seen and treated at the clinics. Impetigo.—Twenty-six cases were treated at the clinics. Scabies.—Thirty-four cases were treated. Other Skin Diseases.—Sixty-four cases were seen and treated at the clinics. Eye Diseases.— Seventy-five cases were treated. Ear Diseases.—Thirty-nine cases were treated at the minor ailment clinics. The total number of children examined during the year, excluding those attending the Dental Department, was 4,848. 28 This number was made up as follows:— Examined at Routine Medical Inspection 1,986 Examined at Minor Ailment Clinics 1,450 Examined at Ophthalmic Clinic only 671 Examined at Aural Clinic only 67 Examined at School Leaving Age for Juvenile Employment Committee 611 Examined under Juvenile Employment Bye-laws 48 Examined under Mental Deficiency Act. 15 The following help was afforded to children who were found to require it:— Twenty children were sent to residential schools for physically defective children. Two children were supplied with surgical instruments. The Enfield Children's Care Committee assisted in the following ways:— Six children were given cod liver oil and malt. One hundred and forty six children were supplied with boots. DEATHS AMONGST SCHOOL CHILDREN. There were 15 deaths among school children during the year. The causes were as follows:— 2 Heart Disease. 1 Tuberculous Meningitis. 1 Meningitis. 1 Glioma. 1 Bronchiectasis. 1 Septicaemia. 1 Abscess of Lung. 1 Suicide. 1 Accident. (Fractured Skull). 1 Accident. (Multiple injuries). 1 Accident. (Nitrous Oxide Poisoning). 1 Epilepsy. 1 Diphtheria. 1 Due to War Operations. PROVISION OF MEALS. Meals are provided for necessitous children at the following centres:— 29 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 1940, 25,089 dinners were provided. 1,134,850 ⅓-pint bottles of milk were provided and paid for, and 53,507 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. Eight children are in attendance at Philip Lane School for the Deaf, Tottenham; these may be classified as follows:— 5 suffering from acquired deafness. 3 suffering from motor aphasia. Fifteen children were examined under the Mental Deficiency Act (1913) during 1940. These were scheduled as follows:— Dull and backward but capable of instruction in an elementary school 2 Mentally defective but capable of instruction in a special school 9 Imbecile 4 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 54 Grammar School 212 County School 148 30 The classification of the nutrition of these children was as follows:- School. Classification. "A" "B" "C" "D" Junior Technical 3 43 7 1 Grammar 7 166 38 1 County 10 121 16 1 The following defects were found:— Defects. School. Jnr. Technical Grammar County Dental Caries 7 12 1 Defective Vision 4 15 46 Enlarged Tonsils 1 - 1 Defective Hearing 1 - — Other diseases and defects - 1 — Three hundred and thirty-two children were treated at the School Dental Clinic and one hundred and eight at the School Ophthalmic Clinic during 1940. SCHOOL DENTAL CLINICS. Elementary Schools. Secondary Schools. Number Inspected 6574 360 Number Treated 3732 332 Number of Fillings 5299 1122 Number of Extractions 7559 250 31 SCHOOL OPHTHALMIC CLINIC. Elementary Schools. Secondary Schools. Total attendance 1527 192 New Cases 869 103 Prescriptions for glasses 308 49 Number not requiring glasses 72 8 Five children were referred to the Western Ophthalmic Hospital for squint operations, three were operated upon and two are awaiting operation. Four children had Meibomian Cysts removed at the Western Ophthalmic Hospital, and eleven children attended the hospital for investigation of other eye conditions. SCHOOL AURAL CLINIC. Number of cases dealt with 180 Number of new cases 113 Total number of attendances 243 Number of cases discharged cured 49 Number of cases of a recurrent nature requiring occasional treatment 41 Number of cases still under treatment 24 Number of cases who have refused treatment, or sought treatment elsewhere 5 Enfield: Stanley Woodfield Printer 8-12 Windmill Hill