ENF 25 C 439(3) ENFIELD 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 1941 68586 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 1941 1 Public Offices, Enfield, Middx. 23rd June, 1942. Annual Report of the Medical Officer of Health, 1941. 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 1941. This was a year during which every attempt was made to approach as near to pre-war standards in the health services as might be possible under war-time conditions. The health of the district, as shown in the following pages, will demonstrate that there is little to fear if the achievements of 1941 can be maintained, and I believe that the standard of health portrayed is largely due to the maintenance of the Council's health services. It is after very careful consideration that I make this statement for one has had throughout the year to consider tepeatedly the extent to which health services could be relaxed, in view of the call for man power for direct war service, and now, a release of women for direct Government work. It must then be an encouraging fact to record that the infantile death rate of 38.12 is the second lowest that I have yet been able to trace in the annals of Enfield ; it was only beaten in 1939 when the rate was 35.07. I make a special mention of this figure in the part of my Annual Report devoted to general health, because it is considered to be one of the important indications of the health of the distiict. Enfield's figure of 38.12 compares with a figure of 59.00 for England and Wales ; 68.00 for London ; 71.00 for the 126 County Boroughs and Great Towns (including London), and 56.00 for the 148 smaller towns. The Council, with this figure in mind, may consider that its determination to hold fast to its health services under all possible circumstances has been well justified. Other interesting figures are those for infectious disease. The total number of cases of Diphtheria notified during the year was 27. This again represents one of the lowest incidence of this disease 2 that it has been possible to record. Unfortunately one child died. There were 129 cases of Scarlet Fever. This is an increase over recent years. There were no deaths. Tuberculosis and Pneumonia showed figures comparable with those of last vear. In certain cases I have had to insert blanks instead of giving statistical figures. This is in accordance with a request I have received from the Ministry of Health that no figure or set of figures in this report shall be of such a nature as to give an indication of a group or groups of population. There has been an increase in Scabies comparable with that throughout the country. The quick decision of the Committee to set up a Cleansing Station where Scabies could be treated has enabled this disease to be taken under control, and the position in 1942 is showing decided improvement. This Cleansing Station has been manned from its inception by members of the Civil Defence Casualty Service under the very able management of Sister James— Sister in Charge of the Static Post at St. Michael's. The premises used for the purpose are the Decontamination Wing of the First Aid Post which has been very satisfactorily adapted at small cost. It will be noted that a large number of individuals—adults and particularly children, have been immunised against Diphtheria during the year. This augurs well for the control of this infectious disease in the future. The death rate compares favourably with that of 12.9 for England and M ales, and 16.3 for London. In 1940 it was 10.64 and in 1939, 9.51. The Enfield Ambulance Service has been controlled in conjunction with the Civil Defence Casualty Service since the outbreak of war. As a result no change was necessary when the National Fire Force was formed for Enfield already had achieved the administration of a civilian ambulance service without using the personnel of the Fire Brigade. The service contains 4 ambulances all of which are in excellent condition. Enfield's civilian ambulance service is the pride of the Casualty Service and has received continued appreciation for its efficiency from the Doctors of Enfield from whom the majority of the calls originate, and from the public who have benefitted from its use. To the keenness of the personnel who are responsible for the maintenance of the ambulances I should like to pay a well deserved tribute. It c?n no longer be said that civil defence interferes with the 3 work of the Health Department. It has been integrated as a corporal part of those services, and in acknowledging my thanks to the Health Department I would include the Deputy Ambulance Officer, Mr. Evans ; the Casualty Staff Officer, Mr. Jeffrey ; the Depot Superintendents ; the Nurses and personnel of the civil defence service. 1941 was marked by the retirement of Mr. Fred Wilson, who for no less than 40 years had served the Council as a Sanitary Inspector, during the latter 15 years of which he was Chief Sanitary Inspector. Few officers in charge of a Department can have had more loyal service or closer co-operation than I had over many years from Mr. Wilson. To his dogged persistence and devotion to duty there are many monuments in Enfield ; not made of bricks and mortar but fashioned in the hearts of those with whom and for whom he worked for so many years. There are many who owe the better surroundings in which they live to his work, others to whose comfort he has materially contributed. In his retirement I join with my staff in wishing him continued health in which to enjoy the leisure he has so deservedly won. In his place we welcome Mr. " Noel Smith who has already served Enfield for the past 40 years. A well-tried and trusted servant, we feel that in him we have an enthusiast who will in no small measure contribute to the protection of Enfield against disease. I beg to remain, Your obedient Servant, D. H. GEFFEN, Medical Officer of Health. 4 URBAN DISTRICT COUNCIL OF ENFIELD. S. G. Rowlandson, Esg., F.C.A., J.P. Chairman F. Greenwood, Esq Vice-Chairman Miss G. M. Ford, J.P. H. Muspratt, Esq., O.B.E. C. Partington, Esq., J.P., 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. A. M. Eeles, Esq. E. S. Stock, Esq. C. Evans, Esq. D. Mason, Esq. T. H. M. Clarke, Esq. W. S. Williams, Esq. H. Thompson, Esq. W. G. Bowyer, 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. H. G. Short, Esq. HEALTH COMMITTEE. H. Muspratt, Esq., O.B.E. Chairman also Miss Ford, and Messrs. Bennett, Brown, Cakebread, Jollie, Kemp, Lawrence and Morris STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 12,400 5 POPULATION. The population as estimated by the Registrar General at the middle of the year was The number of inhabited houses at the end of 1940, according to the Rate Books, was 29,776. The rateable value of the District is £898,904 The net product (after allowing for cost of collection) of a penny rate is £3,650 4s. 5d. SOCIAL CONDITIONS. The number of houses erected during the course of the year was 2. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births :— Total Male. Female. Legitimate 1.390 692 698 Illegitimate 73 30 43 Birth-rate per 1,000 population. Still Births :— Total. Male. Female. Legitimate 41 16 25 Illegitimate 3 2 1 Rate per 1,000 total births—29.19. Total. Male. Female. Deaths 962 498 464 Death-rate— per 1,000 population. Number of women dying in, or in consequence of, childbirth :— Deaths. Rate per 1,000 Total Births From Puerperal Sepsis 2 1.32 From other Puerperal causes 3 1.99 5 3.31 Four of these cases were removed to the North Middlesex County Hospital where they died. The other case died at Hertford County Hospital. Death-rate of Infants under one year of age : — All infants per 1,000 live births 38.12 Legitimate infants per 1,000 legitimate live births 37.99 Illegitimate infants per 1,000 illegitimate live births 40.54 Deaths from Cancer (all ages) 162 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 4 Deaths from Diarrhoea (under 2 years of age) 1 6 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 14.2 0.51 12 9 59.00 London 8.9 0.33 16 3 68.00 126 County Boroughs and Great Towns (including London) 14.7 0.58 14 9 71.00 148 Smaller Towns 16 4 0.60 13.0 56 00 ENFIELD ........ 0.48 ........ 38.12 DEATHS. Of the 962 deaths of Enfield residents during the course of the year 162 were due to malignant disease : 230 to heart disease : 64 to pneumonia (all forms), and 51 to tuberculosis of the respiratory system. INFANT MORTALITY. Of the 53 infants who died before attaining the age of one year, 20 died within the first week of life. In 9 cases death was due to pneumonia : in 6 to congenital malformation : in 12 to premature birth, and in 3 to Atrophy, Debility and Marasmus. INQUESTS. Seventy-five inquests and fifty-«ix P.M's. without inquests were held in Enf.eld during the year. Out of these, 61 deaths were due to natural causes, 50 to accidental causes, 7 to suicide, 9 to misadventure, 3 open verdict, and 1 acquital of manslaughter. AMBULANCE FACILITIES. For infectious Cases : 247 patients were removed from Enfield during the year. 3,350 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 596 10 586 1.67 Sputa 144 13 131 9.02 Totals 740 23 717 3.10 7 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 1941 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 35 Number granted permission to sub-let 32 Number refused permission 3 Number of visits made by Sanitary Inspectors 3 Numbers of letters sent 112 INFECTIOUS DISEASES AND SCHOOLS. Number of children notified to be absent from School due to suspected Infectious Disease 445 Number of children found to be suffering from Infectious Disease 318 This compares with the following figures for last year :— 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 8 HOUSING. Number of New Houses erected during the year :— (a) Total (including numbers given separately under (b)) 2 (i) By the Local Authority Nil. (ii) By other Local Authorities Nil. (iii) By other bodies or persons 2 (b) With State Assistance under the Housing Act : (i) By the Local Authority Nil. (ii) By other bodies or persons Nil. 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 1,283 5,417 (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 Nil. Nil. (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 (The number here given is of houses where any insanitary conditions were found.) 547 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 413 3. A ction under Statutory Powers. A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— 9 (1) Number of dwelling-houses in respect of which Notices were served requiring repairs Nil. (2) Number of dwelling-houses which were rendered fit after service of formal Notices:— (a) By owners Nil. B.—Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 32 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices:— (a) By Owners 28 The number of house-to-house inspections made was :— Under Housing Regulations, 1925 and 1932 Nil. THE MILK (SPECIAL DESIGNATIONS) ORDERS, 1936 and 1938. There are 22 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 8,439 carcases were examined, and the surrender of 4 carcases and 166 parcels of diseased organs were secured. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The number of cases of Scarlet Fever was 29, compared with 86 in 1940 : of Diphtheria 27, as compared with 28 ; of Pulmonary Tuberculosis 126, ascompared with 128 ; and of Pneumonia 47, as compared with 55. There was one death from Diphtheria during the year, as compared with five deaths in 1940 There were no deaths from Scarlet Fever during the year, as was also the case in 1940. 10 NOTIFIABLE DISEASES DURING THE YEAR 1941. No. Removed. Deaths Smallpox — — — Cholera—Plague — — — Diphtheria (inc. Membranous Croup) 27 27 1 Diphtheria Carriers — — — Erysipelas 17 8 1 Scarlet Fever 129 111 — Typhus Fever — — — Typhoid Fever 1 — Paratyphoid Fever 5 3 — Continued Fever 1 — — — Relapsing Fever J Puerperal Pyrexia 7 7 — Cerebro-Spinal Meningitis 12 10 2 Poliomyelitis 4 3 — Ophthalmia Neonatorum 4 2 — Pulmonary Tuberculosis 126 — 51 Other forms of Tuberculosis 35 — 8 Encephalitis Lethargica 2 2 — Food Poisoning 35 — — Malaria — — — Pneumonia 47 2 64 Dysentery 9 1 — Polio Encephalitis — — — Measles 1,365 37 1 Whooping Cough 396 25 4 Totals 2,221 239 132 DIPHTHERIA IMMUNISATION. Through the services of the Council 6,771 individuals were immunised during 1941. FOOD POISONING. During the course of the year I had brought to my attention various cases of food poisoning. In most instances only one or two members oi the family were involved and no special measures to prevent the spread of the disease were required. In one case, however, an outbreak of food poisoning affected no less than thirty out of thirty-three individuals who had had a meal at a particular establishment. The outbreak appeared to have been caused by a contaminated custard powder in that it affected thirty out of thirty-three people who had one particular meal, the three unaffected persons not having partaken of a tiifle in which the custard 11 powder was used. Samples of food were taken and submitted for analysis. In investigating the outbreak we had the help of officials of the Ministry of Health, and I would like to pay tribute to their promptness, efficiency and courtesy. It was found that the custard powder was heavily contaminated with bacteria which had probably produced a poison or toxin. ERADICATION OF BED BUGS. Number of Council houses found to be infested 6 Number of Council houses disinfested 6 Number of other houses found to be infested 5 Number of other houses disinfested 5 The following report, in condensed form, gives details of the work of the Sanitary Inspectors during the year 1941. The total number of inspections made during the year for all purposes was 10,426. This figure which is approximately the same as for the previous year is accounted for by the fact that the Department was without the services of one District Sanitary Inspector for several months. NOTICES ISSUED. Statutory 64 Informal 374 Other Notices 910 Total 1,348 Letters re Air Raid Precautions 1,441 Other Letters sent 5,773 Number of Certificates issued in connection with plans 33 Number of Certificates issued in connection with disinfection 51 Number of Certificates issued in connection with unsound foods 228 Letters sent re Sub-letting 112 12 Result of Service of Statutory and Informal Notices :— Statutory Informal Number complied with 56 251 Number outstanding 8 123 64 374 Four hundred and two 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 10,426. DISINFECTION. Number of houses disinfected after infectious disease. Phthisis and verminous cases 315 Number of articles of clothing, bedding, etc., disinfected 13,105 FACTORY AND WORKSHOP ACT, 1901, AND FACTORIES ACT, 1937. Number of inspections 169 Number of defects found 14 HOMEWORK. Twi lve lists containing the names and addresses of 25 outworkers were received during the year. Eleven addresses of outworkers were forwarded to other districts. PLACES OF PUBLIC ENTERTAINMENT. Number of inspections 4 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 35 13 PUBLIC HEALTH (MEAT) REGULATIONS, 1924. Total number of carcases examined 8,439 Number, or parts, found to be diseased 170 Weight of do. do. 1 ton 16 cwt. 3 qr. 12 lbs. UNSOUND MEAT AND FOODS. Number of inspections made to Meat Depot, slaughterhouses, shops, stalls in markets and food-preparing shops 858 CARAVANS. Number of applications received for consent 3 Number of applications granted 3 REMOVAL OF HOUSE REFUSE CESSPOOL EMPTYING. SEWER FLUSHING. The above Services are now under the control of the Engineer and Surveyor's Department. PUBLIC MORTUARY. There is one Public Mortuary in the district which has received close supervision during the year. Number of cases attended to 78 Number of P.M's. carried out 74 Number of Inquest 27 MATERNITY and CHILD WELFARE SECTION 16 Public Offices, Enfield. 23rd June, 1942. 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, Child Welfare, and Midwifery work carried out in Enfield during the year 1941. The care of the expectant and nursing mother, of the young child, and the provision of a suitable and composite Midwifery Service during wartime is no easy task, for shortage of staff, both technical and clerical, and restriction of food supplies make improvisations continually necessary. All the more I am pleased to inform the Council that the infant mortality rate for 1941 was 38.12. This figure was bettered only in 1939 when it was 35.07, the lowest ever recorded in Enfield. It compares more than favourably with the rest of England for which the Infant Mortality rate was 59.00. Whilst, admittedly, statistics can give a false impression, this figure is one on which the Council can rely as an indication of the efficiency of its general health services. The number of confinements in the district was less than in the previous yerr by over 100 but it has surprisingly increased during the early months of 1942 and has created many staff problems at a time when midwives are extremely difficult to obtain. During 1941 it will be seen that no less than 12,536 visits were paid by Health Visitors to homes in Enfield where children under 5 years of age were living. With the growth of clinics, including special sessions for special services, one ter.ds to forget that the primary duty cf a Health Visitor is to visit homes, to see babies in the surroundings in which they spend the major ptrt of their lives, and to advise mothers how best to look after them in these surroundings and improve them where possible. It is difficult to exaggerate the value of a good home life, and no factor is more deplorable than the disruption which the war has caused in our homes, and the separations it has entailed. In this lies one of the curses of war, the evil consequences of which it is very difficult to overstate. The large number of visits paid by Health Visitors in the homes is a realisation of the benefits they can secure, and I believe 17 that the Council will join with me in the belief that this work has materially contributed to the satisfactory statistics which this report shows. Like every other Medical Officer of Health in the country, I have been giving continual observation to the possible onset of deficiency diseases, signs of lack of resistance to infection, debility or anaemia, in our women and children. At the end of 1941 I was reasonably satisfied that the health of our women and children was being safeguarded, but I believe that continued supervision is very necessary to maintain this level of health. In many ways the Council has acted as agents for the Ministry of Food and the Board of Trade. The Ministry of Food provide milk, both dried and liquid, free of charge or at reduced cost to ante-natal and nursing mothers and every child under the age of five years. The distribution of these products is organised by the local Food Control Office and the bulk of the certificates required are signed by the Council's Health Visitors. There has been little demand in Enfield for the Government's National Dried Milk. This is due to the confidence which the mothers in Enfield have in the infant foods they have obtained via your maternity and child welfare centres. They have preferred to continue with these foods. The Ministry of Food has also made available various most valuable vitamin products for young children which have included blackcurrant syrup, blackcurrant puree, orange juice and cod liver oil compound. These products have been largely distributed through your maternity ard child welfare clinics and in part tl rough the local Food Control Office. 1 he co-operation between the two departments has been extremely successful and to the great benefit of the children of the district. As the Council will know, clothing coupons to the value of 50 have been made available by the Board of Trade to expectant mothers as soon as pregnancy is certain. 'Ihese coupons are issued through the Council's Health Department. In that there are very few, if any women, who do not desire to obtain these coupons, the result has been that the Department has had a more or less complete notification of pregnancy throughout the year and this has enabled us to extend our ante-natal services. The number of coupons issuable was increased to 60 on the 1st June, 1942. During the course of the year the Ministry of Health called our attention to the possible increase in conditions of uncleanliness 18 not onlv of school children, but of the "under fives" as well, and an investigation was carried out to see to what extent this applied in Enfield. Your Health Visitors investigated some 1,800 children choscn at random amongst the children they visit, and it was only found that eight had nits in their hair. The scheme for the evacuation of expectant mothers, in order that they can have their confinements in the quiet and peace of rural surroundings, continued through the year. In this we coordinated with the Lcndon County Council who have undertaken the administration of this work for the London Region. Some 60 mothers were evacuated. Curing the course of the year the Ministry of Health asked if the Council would be prepared to release one of its Health Visitors, Miss Brown, in order to undertake work for the Ministrv for the duration of war and, in accordrrce with this request, Miss Brown was released. On the 10th December, 1941, Enfield's first wartime Nursery was opened by Miss Florence Horsbrugh, C.B.E., M.P., Parliamentary Secretary to the Ministry of Health. This Nursery occupies a portion of the Suffolks School released for this purpose by the Education Committee, and alterations have been carried out in order to make the accommodation suitable for the care of children under 5 years of age. The Nursery is open from 7 a.m. to 7 p.m. and is designed to care for 60 children. At the time of writing this report, the average daily attendance was between 50 and 55. All the children in the Nursery have been immunised against diphtheria and, in so far as it may be practicable, against whooping cough, and they are all receiving vitamin and iron preparations. The conversion of a school wing into a Nursery has taught us that there are many difficulties which may easily be forgotten. In the first place, heating is a question of great importance and we found that the heating of the Suffolks School was inadequate for our purpose. Furthermore, heating was required at times when the school was normally closed and to heat the wing in question we had to heat a large proportion of the rest of the school. To overcome this, it has been nccessary to install a special plant at considerable cost, and at the time of writing this report, this new scheme was not yet in operation. The hot water system again was found insufficient and the new heating plant will deal with this as well. Inadequate lavatory accommodation, or rather accommodation of unsuitable type, was a difficulty that had still to be overcome at the end of the year. 19 The children in the Nursery are, nevertheless, shewing great improvement in habits and health. Students are being taught to becom? Nursery Nurses so that they are learning a profession which should be valuable to them as a career, or alternatively, if they marry and have children, they are gaining knowledge which will help them in rearing their children. During the year Enfield received a gift from America of 200 layettes ior babies. Beautifully prepared, they have been most gratefully accepted by many mothers. In times of war one thinks of success or failure in terms of military victories or military defeats. But wars are won not only in the battle field. The morale of the soldier depends largely on his satisfaction that his wife and children are being well looked after, and so far it has been possible to reassure him on this point. If Councillors and Officials, by their continued labours can maintain the health of the women and children through the remaining period of the war, I think that they will have made their contribution to the defeat of the aggressor nations. I am, Ladies and Gentlemen, Your obedient Servant, D. H. GEFFEN, Medical Officer of Health. 20 INFANT MORTALITY. The infant mortality rate was 38.12, the second lowest recorded for at least 50 years. BIRTHS. 1941 1940 Live births 1,463 1,607 Still births 44 44 PUERPERAL PYREXIA. During the year 7 cases of puerperal pyrexia were notified all of which were removed to hospital. MATERNAL MORTALITY. There were five maternal deaths resulting from Pregnancy. All 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. 2 2 These homes were inspected by youi Medical Officers during the course of the year. ADMINISTRATION OF MIDWIVES ACT, 1902-36. During the year 1941 there were 15 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 15 Midwives, 13 were employed by the Council as whole-time Municipal Midwives, two in a temporary capacity. 21 The following table shows the cases attended during 1941 and 1940. 1941. 1940. MUNICIPAL MIDWIVES. Cases attended as Midwives 610 661 Cases attended as Maternity Nurses 177 230 PRIVATE MIDWIVES Cases attended as Midwives 23 32 C.ises attended as Maternity Nurses 1 51 NOTIFICATIONS. In accordance with the rules of the Central Midwives Board, the following notifications were received from Midwives :— 1941 1940 Sending for Medical Aid 169 173 Still Births 1 5 Laying out of the Dead 1 Artificial Feeding 5 2 Liability to be a source of infection 6 5 The notifications in connection with Medical Aid can be classified as follows :— During Pregnancy 11 During Labour 112 During Lying-in Period 14 Infant 32 HELP WITH COST OF MIDWIVES FEE. During the year 83 cases were helped with the cost of their Midwife's fee, compared with 75 in 1940. OBSTETRIC SPECIALIST. In two cases the Obstetric Specialist at the North Middlesex County Hospital was called in by Enfield Practitioners, for assistance in difficult midwifery cases. HOME HELPS. During the year Home Helps were supplied in 46 cases. 22 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. As the Council may recall, it has always been our aim to circulate this booklet during pregnancy rather than after the birth of the child in that much of the information in this book is of value to the Expectant Mother. ANTE-NATAL CLINICS. During the year 1,453 individual mothers attended the Enfield Ante-Natal Clinics. This indicates that nearly all Enfield mothers attend our Clinics, with the exception of those who are under the direct supervision of their own General Medical Practitioner. It may be recalled that attendance at an ante-natal clinic assures the provision not only of medical care, but of advice as to social amenities and help that are of importance to the expectant mother. POST-NATAL CLINICS. During the course of the year 218 mothers attended for examination after their confinement. This compares with 181 in 1940. This figure is still small but it shows a steady and very healthy increase over previous years. INFANT WELFARE CENTRES. The total number of children who first attended at the Infant Welfare Clinics was 1,552, compared with 1,654 in 1940. VISITS. The Council's Health Visitors paid 510 visits to Expectant Mothers, 3,598 to children under one year of age, and 8,938 to children between the ages of one and five years. 23 ASSISTED MILK SUPPLY. The quantity of fresh and dried milk supplied free to necessitous cases under the Council's Milk Supply Scheme during the year was as follows :— Fresh Milk 73¾ galls. ; cost £10 7s. 8d Dried Milk 2,703 lbs. ; cost £234 17s. 6d. ROUTINE MEDICAL INSPECTION OF CHILDREN UNDER FIVE YEARS OF AGE. Following upon a resolution of the Council, the routine medical inspection of children under five years of age was recommenced in November. AURAL TREATMENT. 66 mothers and children were referred to the School Aural Clinic. OPHTHALMIC TREATMENT. 25 Mothers and 77 children were referred 11 the School Ophthalmic Surgeon. CHILD LIFE PROTECTION. PUBLIC HEALTH ACT, 1936. At the end of 1941, 15 persons in Enfield were receiving children for reward ; the total number of children being 17. Routine inspection of homes where these children are cared for is carried out throughout the year. DENTAL TREATMENT. 667 attendances were made at the Dental Clinics by ante-natal and nuising mothers, and 254 by children. Dentures were provided for 72 mothers. CONVALESCENT TREATMENT. One child was sent away to a Convalescent Home. 24 ORTHOPAEDIC TREATMENT. Treatment was provided for 3 children needing orthopaedic care. DIPHTHERIA IMMUNISATION. During the year 1,760 children under the age of five years were immunised against diphtheria. This represents approximately 30 per cent, of the under 5 population and does not take into consideration children who were immunised in previous years. There is a tendency nowadays for mothers to desire to have their children immunised at the age of one year or slightly before and I trust that in future years there will be a sufficient proportion of the Community immunised to ensure against the possibility of an epidemic of this disease. ANNUAL REPORT of the SCHOOL MEDICAL OFFICER DENNIS H. GEFFEN, M.D., D.P.H. For the year ending 31st December, 1941 26 MEMBERS OF THE ENFIELD EDUCATION COMMITTEE. 1941-42. Chairman Mr. H. A. Df.shborough Brown Vice Chairman Mr. H. G. Short. Representative Members. Mrs. E. M. Squires, C.C. Mr. W. C. Bennett Mr. H. A. Deshborough Brown- Mr. T. H. M. Clarke Mr. D. Mason Mr. H. Muspratt, O.B.E Mr. C. Partington, J.P., M.R.S.T. Mr. S. G. Rowlandson, F.C.A., J.P. Mr. H. G. Short Mr. E. S. Stock Co-optative Members. Mrs. L. Daines. Mrs. I. G. Dufton Mrs. E. Pascoe. Mrs. H. Rothwell Miss Z. Smee Mr. G. J. Guidon. Mr. A. J. Neaves Director of Education. E. Pascal, Esq., M.A. 27 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. Deputy School Medical Officer: William D. Hyde, M.B., Ch.B., D.P.H. (Resigned 23.8.41.). William Giles, M.D., D.P.H. (Appointed 10.11.41.) Assistant School Medical Officer: Mary E. Nevin, M.D., D.P.H. (Resigned 28.2.41.) Frances A. Roberts, M B., Ch.B. (Appointed 3.3.41.) School Dentists: C. E. James, L.D.S., R.C.S.(Eng.). H. Mackay, L.D.S. J. R. H. Williams, L.D.S. School Ophthalmic Surgeon : S. Macky, M.B., B.S., D.O.M.S. School A ural Surgeon : J. C. Hogg, F.R.C.S. School Nurses : E. Sanders, M.R.C.N., S.R.N. (Resigned 30.4.41.) I. Fowler, S.R.N. V. Murphy, S.R.N., C.M.B. E. Davies, S.R.N., C.M.B.New H.V.'s Cert. (Resigned 31.8.41.) M. Hilton, S.R.N., C.M.B. New H.V.'s Cert. (Appointed 1.9.41.) Dental Nurse: F. Anderson, R.S.C.N. Dental A ttendants: M. Freston. I. Groves. Clerks: H. Ogilvie. E. Williams. 28 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, 1941. To the Chairman and Members of the Enfield Education Committee. Mr. Chairman, Ladies and Gentlemen, I beg to submit my Annual Report on the work of the School Medical Department for the year ending 31st December, 1941. The freedom from aerial bombardment during the course of the year enabled the work of the department to revert to normality. This was achieved as speedily as possible with the result that the statistics for work carried out are comparable with those of pre-war days. The average attendance at school rose from a figure of 7,016 in 1940 to 8,745 in 1941, and this figure was steadily increasing towards the end ol the year. The time has come in the course of the war when one does well to weigh up each activity of the School Medical Department and assure oneself of its value, and to consider whether the curtailment of any service is justifiable in order to effect economy in time and man-power. One has to consider what are the particular changes in the life of the school child, what are his reactions thereto, and what special measures are required to meet them. The chief change in 1941 has been in the diet of the school child. As the Committee may know, the growing child is considered to need a large proportion of proteins, the substances which are found, in particular, in meat, fish, eggs and milk. With the exception of milk, wartime diet has increasingly diminished the 29 school child's supply of these products. He has had to substitute for these substances an increased consumption of potatoes, bread, and milk. This change of diet has been accomplished without obvious detriment to the child. It is probable that school children are drinking milk in larger quantities than ever before, and this is largely due to the facilities granted to them by the Ministry of Food in conjurction with the Milk Marketing Board. I have no hesitation in saying that the present reasonably satisfactory state of nutrition of our children is in a measure due to foresight in this direction. Milk still remains the finest food for children, and, whilst there is a sufficiency of it, the greater part of our difficulties in nutrition of children can be overcome. Limitation in eggs and cheese are unfortunate in that both these are good foods. The other factor one has to consider is the supply of vitamins to children. It would appear that the one vitamin likely to be deficient is that which prevents rickets, and much has been done in this respect by adding it in definite quantities to margarine. The change in diet has, in my opinion, rendered routine inspection of school children all the more necessary, both for full examination and as a nutrition survey, and both have been effected throughout the course of the year in Enfield. The results show that the nutrition of the children has been maintained at a reasonably high level, and no evidence has been forthcoming so far to show that the children are suffering from any gross dietetic deficiency. On the whole they are vigorous and healthy. The extent of their resistance to disease is somewhat difficult to gauge for there has been a comparative absence of disease in the district throughout the course of the year. The severe winter of 1942 will be a test as to the power of children to throw off such infections as usually accompany a hard winter, and it is already possible to say that so far they have shown a resiliency and a return to health after coughs and colds, which is more than encouraging when one remembers the rigour of the winter, and the bodily and mental unhealthiness of the black-out. A further matter which has given cause for consideration has been the increased incidence of diseases of the skin, including Scabies or the "Itch." Continued inspection of children has enabled me to keep these conditions under control. Lastly, I would refer to the fact that at Routine Inspection, amongst other diseases which were discovered, it was found that 198 children were suffering from diseases of the throat needing treatment, that 127 needed observation for such conditions, and that 40 children needed treatment for infective conditions of the 30 eye. Furthermore, twelve children were found to be suffering from spinal curvature needing treatment, 24 from defective hearing, and that 17 children suffering from organic disease of the heart needed to be kept under observation. These facts, I would humbly submit, are a justification for the continued surveillance of the School Medical Service, as a safeguard of the health of the children. It should be maintained even at great sacrifice. There are one or two figures which are well worth noting. In the first place 53 per cent, of our elementary school population were immunised against Diphtheria during the course of 1941. This is a source of great encouragement. I think that the willingness of parents and, in fact, their anxiety to have their children immunised is largely due to broadcasts by the Chief Medical Officer of the Ministry of Health, for it was noticeable that these broadcasts were always followed by a local demand for protection against Diphtheria. They achieved more than local or newspaper propaganda had done in the past. I am of the opinion, in addition, that the showing of a film locally advocating immunisation against Diphtheria was of great value. I would call the attention of the Committee to the fact that only four school children died during the course of the year, and in two cases the cause of death was accident, and not illness. In previous years I have had to record a figure of about thirteen deaths. In one respect the amenities of the School Medical Service have been improved, and I refer to arrangements with the War Memorial Hospital and the North Middlesex County Hospital whereby X-rays may be obtained by our School Dentists where this is required. Mr. James's report, which space does not permit me to print, shows a very satisfactory increase in the work that has been carried out both in our elementary and secondary schools. No less than 5,149 children received treatment. Of the children found to need treatment, parents asked for this treatment to be carried out through the aegis of the School Dental Service in 76 per cent, of the cases. Orthodontic treatment was carried out for 33 children. On an average each dentist treated 1716 children. This number,according to Mr. James, can only be increased if treatment becomes curative rather than conservative, i.e., if extractions replace fillings, and this I should be very sorry to see. In one school the entrants were found in 35.5 per cent, of the cases to be dentally fit ; in other schools this figure dropped to about 10 per cent. In general there was an improvement in the condition of the teeth of the children, 31 and Mr. James reminds me that such an improvement occurred in 1914-1918, due, according to some observers, to increased consumption of wholemeal bread, and a reduction in sweet eating. It will be interesting to note what the effect of these factors will be during 1942. Mr. Macky reports that no less than sixteen children were referred to the Western Ophthalmic Hospital for operation for squint, and two for other eye operations. His work increased during the year. Mr. Hogg's report again shows the need for careful supervision of pathological conditions affecting the ear, nose, and throat in young children. Four cases were referred to hospital for operations which have materially improved their health, and this is apart from cases of enlarged tonsils and adenoids. There is still a need for a better orthopaedic service than we have been able to organise, and this is a matter receiving the attention of the Committee. During the course of the year there were a number of children found to be suffering from speech defects for whom I hope to suggest some appropriate treatment in the coming year. Lastly, I have the very pleasant task of once more expressing my appreciation to the Education Committee for the courtesy I have received throughout the year, and for the ready sympathy with which the members have always received any suggestions from me that might improve the health of the children of the district, either generally or individually. For this sympathy an official is always grateful, though opportunity to express his gratitude is not often available. To my own staff I would once again express my appreciation of their loyalty, and devotion to duty ; and to the Director of Education, Mr. Pascal, for his ever present eagerness to help me in solving the many problems of health and education that are brought to our notice throughout the course of the year, and that have to be faced when one has to consider how best to help a school child. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, DENNIS H. GEFFEN, School Medical Officer. 32 REPORT OF THE SCHOOL MEDICAL OFFICER Average number on books of Elementary Schools 10,402 Average weekly attendance 8,745 Number of Schools 22 ROUTINE MEDICAL INSPECTION. The total number of children examined during the year was 3,305 as compared with 1,986 examined during 1940. 81 per cent, of the children examined were accompanied by their parents, and 33 per cent, were vaccinated. DEFECTS FOUND AT ROUTINE MEDICAL INSPECTION. Requiring Treatment. Requiring to be kept under observation. Enlarged tonsils and adenoids 162 88 Enlarged tonsils only 3 22 Adenoids 16 7 Other nose and throat conditions 17 10 Conjunctivitis 2 — Blephartis 38 — Other Eye Conditions 6 1 Enlarged Cervical Glands _ 4 Scabies 12 — Impetigo 9 — Other Skin Conditions 50 1 Defective Hearing 24 — Otitis Media 9 — Other Ear Conditions 7 — Defective Speech 1 8 Defective Vision 216 140 Bronchitis 3 1 Other Lung Conditions : Non-tuberculous 2 37 Organic Heart Disease — 17 Functional Heart Disease —- 25 Anaemia 4 7 Chorea — — Epilepsy —- — Other Nerve Conditions — 10 Spinal Curvature 12 19 Other Deformities 4 24 Other Diseases and Defects 41 85 33 Uncleanliness. Of 3,305 children examined none were found to have vermin in their heads, and 60 had nits, i.e., 1.8 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 3,305 Number of children classified "A " 558 Percentage of children classified "A" 16.9 Number of children classified " B " 2,044 Percentage of children classified " B " 61.9 Number of children classified " C " 671 Percentage of children classified " C " 20.3 Number of children classified " D " 32 Percentage of children classified " D " 0.9 A Excellent B Normal C Slightly sub-normal D Bad INFECTIOUS DISEASE Measles 430 German Measles 2 Mumps 33 Whooping Cough 69 Chickenpox 55 Scarlet Fever 70 Diphtheria 10 Poliomyelitis 2 Cerebro-spinal Meningitis 1 THE WORK OF THE SCHOOL NURSES. Number of home visits 2,170 Number of school visits 240 Number of school visits for routine examination of heads 163 Total number of heads examined 32,539 Number of individual children found unclean 1,017 Number of cases in which legal proceedings were taken — 34 SPECIAL NUTRITION SURVEYS. Number of children examined 3455 Number of children classified " A " 593 Percentage of children classified " A "17.1 Number of children classified " B " 1937 Percentage of children classified " B " 56.0 Number of children classified " C " 708 Percentage of children classified " C " 20.5 Number of children classified "D" 217 Percentage of children classified " D " 63 TREATMENT CLINICS. Tonsils and Adenoids :— Number of cases seen at clinics 288 Number of cases operated under the Authority's Scheme 197 Number of cases operated by private arrangement 9 Ringworm.—Five cases were seen and treated at the clinics. Impetigo.—One hundred and nineteen cases were treated at the clinics. Scabies.—One hundred and eleven cases were treated. Other Skin Diseases.—One hundred and sixty-three cases were seen and treated at the clinics. Eye Diseases.—One hundred and ninety-six cases were treated. Ear Diseases.—Sixty-one cases were treated at the minor ailment clinics. The total number of children examined during the vear, excluding those attending the Dental Department, was 7,227. This number was made up as follows :— Examined at Routine Medical Inspection 3,305 Examined at Minor Ailment Clinics 2,506 Examined at Ophthalmic Clinic only 656 Examined at Aural Clinic only 51 Examined at School Leaving Age for Juvenile Employment Committee 606 Examined under Juvenile Employment Bye-laws 60 Examined under Mental Deficiency Act 43 35 The following help was afforded to children who were found to require it :— Fifteen children were sent to residential schools for physically defective children. Six children were supplied with surgical instruments. The Enfield Children's Care Committee assisted by supplying boots to school children. DEATHS AMONGST SCHOOL CHILDREN. There were 4 deaths among school children during the year. The causes were as follows :— 1 Heart Disease. 1 Peritonitis. 2 Accidents. PROVISION OF MEALS. Meals are provided for necessitous children at the following centres :— St. Luke's Institute, Enfield. Merryhills School. Durants Special School. The Dining Room, St. Mark's Road, Bush Hill Park. During 1941, 20,698 dinners were provided. 1,925,715 J-pint bottles of milk were provided and paid for, and 43,664 were provided free. BLIND, DEAF, EPILEPTIC AND MENTALLY DEFECTIVE CHILDREN. There are two blind children in Enfield and they are attending Residential Schools for the Blind. Nine children are in attendance at Philip Lane School for the Deaf, Tottenham ; these may be classified as follows :— 6 suffering from acquired deafness. 3 suffering from motor aphasia. 38 Forty-three children were examined under the Mental Deficiency Act (1913) during 1941. 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 20 Imbecile 12 Not scheduled (to be seen again) 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 148 Grammar School 249 County School 326 The classification of the nutrition of these children was as follows School. Classification. "A" " B " '* C " " D " Junior Technical 5 116 27 - Grammar 16 262 47 1 County 44 172 33 - 37 The following defects were found :— ]Defects. School. Jnr. Technical Grammar County Scabies — — 1 Other Skin Conditions — — 1 Enlarged Tonsils — 14 — Enlarged Tonsils and Adenoids — — 3 Defective Hearing 1 1 1 Adenoids — — 3 Blepharitis — — 1 Defective Vision 16 17 52 Dental Caries 7 35 2 Organic Heart Disease — 2 — Anaemia — — 1 Other Nerve Conditions — — 1 Other diseases and defects — 10 9 Two hundred and seventy-seven children were treated at the School Dental Clinic and one hundred and forty-eight at th" School Ophthalmic Clinic during 1941. SCHOOL DENTAL CLINICS. Elementary Schools. Secondary Schools. Number Inspected 7206 1057 Number Treated 4872 277 Number of Fillings 7560 658 Number of Extractions 8609 212 38 SCHOOL OPHTHALMIC CLINIC. Elementary Schools. Secondary Schools. Total attendance 1461 248 New Cases 870 148 Prescriptions for glasses 314 49 Number not requiring glasses 111 8 Sixteen children were referred to the Western Ophthalmic Hospital for operation for squint. Two children had Meibomian Cysts removed at the Western Ophthalmic Hospital, and two children attended the hospital for investigation of other eye conditions. SCHOOL AURAL CLINIC. Number of cases dealt with 281 Number of new cases 230 Total number of attendances 495 Number of cases discharged cured 166 Number of cases of a recurrent nature requiring occasional treatment 14 Number of cases still under treatment 70 Number of cases who have refused treatment, or sought treatment elsewhere 21 Gnfield : Stanley Woodfield Printer S-12 Windmill Hill