AC- 439(3) ENFIELD [???]uddy (hater Man B. ) ENF 26 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 1942 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 1942 1 Public Offices, Enfield, Middx. 11th June, 1943. Annual Report of the Medical Officer of Health, 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 for the year 1942. The Minister of Health has suggested that in this report the opportunity should be taken to deal briefly with subjects in which the public have shewn especial interest, e.g. Diphtheria Immunisation, Scabies, Tuberculosis and Venereal Disease. Diphtheria. During the course of the year 4,309 individuals were immunised against Diphtheria either by officers of the Council ni their capacity as Maternity and Child Welfare Officers or Assistant School Medical Officers, or by General Practitioners, to whom are supplied the necessary materials, free of charge, for the immunisation of their private patients, subject to a return being made to me of the names and addresses of the persons so immunised. A large proportion of the population is now immunised, in particular the child population, and it is interesting to note that the number of cases of Diphtheria which occurred in Enfield in 1942 was 15. This is the lowest number of cases I have been able to record since I was appointed Medical Officer of Health to the district in 1927, and is a figure, moreover, which has not been bettered in the memory of the servants of your Council. Scabies. In order to deal with cases of Scabies, alterations were made at the St. Michael's First Aid Post in 1941 and during the year 1942, 617 cases were dealt with there by the personnel of the Civil Defence Services stationed thereat. 2 Tuberculosis. I set out below the number of new notifications that have been recorded in Enfield for the years 1937 to 1942. This shews a comparison between the three pre-war and three war years. Year Pulmonary Non-Pulmonary 1937 72 16 1938 87 18 1939 71 14 1940 84 14 1941 89 25 1942 100 18 It will be seen that there has been a considerable increase in the number of notifications of Pulmonary Tuberculosis. This is in my opinion a most disturbing factor. Although sanitarians have been satisfied that the health of the community has been well maintained since the outbreak of war, increase in Tuberculosis has been general throughout the country. It is a matter of grave concern to us locally. Tuberculosis is a disease which tends to strike in particular at the adolescent and the young adult. At the best, recovery can be expected after a long period of treatment; at the worst, death occurs after a short illness. I am unable to state the cause of this increase in Tuberculosis ; I would offer the suggestion, however, that there are certain conditions of life today that are conducive towards the acquisition of the disease—the first is the black-out and the second the intensification of daily effort. It has been argued, and possibly rightly so, that many people acquire Tuberculosis at some time or another, but that their normal resistance is such that they cure themselves sometimes without symptoms or with but slight cough and a feeling of debility. Evidence of this is found during post mortem examination of persons dying of another disease at advanced ages. Signs are often found of healed Tubercular lesions in the lungs of individuals, who during their lives, complained of no symptoms of the disease. What is the position today ? The adolescent and the young adult, and even the more elderly person who contracts a small dose of Tuberculosis is subjected to black-out conditions and unsatisfactory ventilation. In addition he is working longer hours than usual and does not obtain the rest and open air recreation he might have had in pre-war years. His resistance is insufficient to overcome a mild tubercular infection and he becomes a case of Tuberculosis. 3 I cannot leave the subject of Tuberculosis, however, without referring to the pasteurisation of milk. There are 25 firms in Enfield selling pasteurised milk and samples have been tested regularly throughout the year. It is argued that pasteurisation, if it be efficient, destroys completely the tubercle bacillus, and it is also suggested that Tuberculosis can be, and is in fact, disseminated by milk. On the other hand for pasteurisation to be efficient, there must be supplied efficient plant, adequately maintained, and this means a highly skilled, well trained permanent staff. In war-time it is extremely difficult to achieve this ; part-time staff and unskilled workers are not conducive to high efficiency in pasteurisation. Venereal Disease. I am unable to give any statistics for the district ; I can only say that amongst that class of the community which passes through our hands from the point of view of medical inspection and treatment, there has been almost no incidence of the disease. The classes concerned are children under 5 years of age, school children and ante-natal and nursing mothers. Adolescents and factory workers would not be known to me were they to contract Venereal Disease. Civil Defence. In my report for the year 1941, I stated that the Civil Defence Ambulance Service had been integrated as a corporal part of the work of the Health Department ; this year I would like to enlarge somewhat on that statement. As the Council will realise I am the responsible officer in charge, both of the Council's Health Service and the Civil Defence Ambulance and First Aid Post Services. My Deputy for Civil Defence purposes is a member of the Council's Public Health staff. The clerks in my department, including Mr. Coulter and Miss Bowyer, are all concerned in various matters appertaining to civil defence ; there is, in fact, a unity between the two services. There is a tendency for the uninitiated to think of a large number of ambulances standing idle and their personnel unoccupied, and during the year various suggestions from well-meaning persons have been placed before me as to how either the one or the other could be more used. As regards the vehicles, it must be remembered that strict economy in petrol and tyres makes it necessary that civil defence vehicles shall only be used insofar as it is necessary to maintain them in efficient running order. 4 What about the personnel ? The personnel have been responsible for the control and running of the Council's Scabies Clinic where no less than 617 persons have received skilled and sympathetic treatment during the year. The Council's civil ambulance service is maintained and serviced by the personnel of the civil defence ambulance service. In an emergency the civil defence ambulance service has provided a substitute cook at one of the Council's wartime day nurseries in the absence, on account of sickness, of the cook. At the time of writing this report civil defence has found a substitute for a war-time nursery school teacher who is away on account of sickness. The staff of the Council's war-time day nurseries is assisted by personnel from the civil defence ambulance service, who come in turn every day to undertake the most unpleasant of the tasks that have to be carried out in a nursery, i.e., peeling potatoes and washing up for hours on end. At one time the civil defence casualty personnel were responsible for the conveyance of food to British Restaurants, and lastly our drivers are now available to take the Council's midwives to urgent cases during black-out hours, if necessary in the midst of barrage conditions. There are some, too, who perhaps forget that the civil defence ambulance service is also the ambulance service to the Home Guard with whom there is need for close co-operation. In the event of serious emergency, we would also be the ambulance service to the army. The full-time paid personnel of the service is now very small ; it covers not 8, but 24 hours a day. I think that the above summary of extraneous duties carried out in conjunction with the routine work of civil defence, must dispel all the fears of some of those who are apt to think that civil defence is just a question of " standing-by." While recording my thanks to the personnel of the civil defence ambulance service for their loyal co-operation, I would assure the Council that despite repeated call-ups and curtailment of wholetime personnel, the efficiency of the service has been excellent throughout the year, and if the service has added considerably to my responsibilities and duties, I should also feel bound to say that its efficiency, and the happy co-operation I have received at the posts and stations, has given me great satisfaction and pleasure. These few remarks about the service would be incomplete were I not to acknowledge the services of the hundred or so part-time members. Being a part-time member of civil defence does not mean giving a few hours service at the convenience of the volunteer. 5 Our volunteers attend regularly for a whole night at least once a week and in many cases two or three times a week. It has meant hours of study in order to attain efficiency, and I know that our part-time volunteers have the same pride in the service as have the full-time members. There have been changes in the medical staff of your Health Department since the beginning of the year and I would refer with sorrow to the resignation and subsequent death of Doctor Giles who, appointed in November 1941, resigned in November 1942 to accept an important Government position abroad. Doctor Giles was a very efficient member of the staff and a very popular officer. He was a deputy upon whom I could rely at all times to exercise sound judgment and to carry out whatever task was placed upon him, with energy and enthusiasm. His loss at sea a short time after he had said good bye to us, was a blow which we all feel very deeply. I would wish to record my thanks to the staff of the Health Department for its loyal help during the year. Few of us realise that Mr. Smith, the Senior Sanitary Inspector, Mr. Coulter, the Chief Clerk and Mr. W'iggett, Deputy Senior Sanitary Inspector, have given between them no less than 110 years service to the Council. I would also thank the members of the Council and its Committees for the courtesy I have received throughout the year. I beg to remain, Your obedient Servant, D. H. GEFFEN, Medical Officer of Health. 6 URBAN DISTRICT COUNCIL OF ENFIELD. W. C. Bennett, Esq., J.P.Chairman L. R. Morris, Esq Vice-Chairman Miss G. M. Ford, J.P. D. Mason, Esq. H. Muspratt, Esq., O.B.E. T. H. M. Clarke, Esq. C. Partington, Esq., J.P., W. S. Williams, Esq. M.R.S.T. H. Thompson, Esq. S. G. Rowlandson, Esq., F.C.A. W. G. Bowyer, Esq. H. A. D. Brown, Esq. J. Cottenham, Esq. F. G. Greenwood, Esq. C. H. Thomas, Esq. H. H. Collier, Esq. W. F. Lawrence, Esq. A. R. Kemp, Esq. fF. G. Fletcher, Esq. A. M. Eeles, Esq. W. Graham, Esq. E. S. Stock, Esq. Mrs. E. M. Squire, C.C. C. Evans, Esq. W. G. Jollie, Esq. F. C. Watts, Esq. H. G. Short, Esq. *Derek Parker-Bowles, Esq. † Resigned. * Vacancy filled on resignation of † HEALTH COMMITTEE. H. Muspratt, Esq., O.B.E Chairman also Miss Ford, and Messrs, Brown, Jollie, Kemp, Lawrence, Morris, Watts and Parker-Bowles. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 12,400 7 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 £903,540 The net product (after allowing for cost of collection) of a penny rate is .. £3,706 0s. Od. SOCIAL CONDITIONS. The number of houses erected during the course of the year was 9. EXTRACTS FROM VITAL STATISTIC IS FOR THE YEAR. Live Births:— Total Male. Female. Legitimate 1,704 875 829 Illegitimate 70 38 32 Birth-rate—per 1,000 population. Still Births:— Total. Male. Female. Legitimate 47 21 26 Illegitimate 3 3 — Rate per 1,000 total births—27.41. Total. Male. Female. Deaths 950 459 491 Death-rate— per 1,000 population. Number of women dying in, or in consequence of, childbirth :— Rate per 1,000 Total Births. Deaths. From Puerperal Sepsis .. 1 0.54 From other Puerperal causes 5 2.74 6 3.28 Two of these cases were removed to the North Middlesex County Hospital and two to Chase Farm 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 46.78 Legitimate infants per 1,000 legitimate live births .. 42.25 Illegitimate infants per 1,000 illegitimate live births 142.85 Deaths from Cancer (all ages) 155 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 5 8 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 15.8 0.54 11.6 49.00 London 14.0 0.48 13.9 60.00 126 County Boroughs and Great Towns (including London) 17.3 0.66 13.3 59.00 148 Smaller Towns 18.4 0.62 12.1 46.00 ENFIELD 18.66 0.52 9.99 46.78 DEATHS. Of the 950 deaths of Enfield residents during the course of the year 155 were due to malignant disease : 209 to heart disease : 50 to pneumonia (all forms), and 47 to tuberculosis of the respiratory system. INFANT MORTALITY. Of the 83 infants who died before attaining the age of one year, 39 died within the first week of life. In 11 cases death was due to pneumonia : in 14 to congenital malformation : in 22 to premature birth, and in 6 to Atrophy, Debility and Marasmus. INQUESTS. Fifty-four inquests and sixty-eight P.M's. without inquests were held in Enfield during the year. Out of these, 72 deaths were due to natural causes, 33 to accidental causes, 5 to suicide, 6 to misadventure, 4 open verdict, 1 manslaughter, and 1 murder. AMBULANCE FACILITIES. For infectious Cases : 309 patients were removed from Enfield during the year. 2,547 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 508 1 507 0.19 Sputa 112 6 106 5.35 Totals 620 7 613 1.12 9 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 1942 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 22 Number granted permission to sub-let 22 Number refused permission — Number of visits made by Sanitary Inspectors 4 INFECTIOUS DISEASES AND SCHOOLS. Number of children notified to be absent from School due to suspected Infectious Disease 216 Number of children found to be suffering from Infectious Disease 149 This compares with the following figures for last year:— 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 10 HOUSING. Number of New Houses erected during the year:— (a) Total (including numbers given separately under (b)) 9 (i) By the Local Authority Nil. (ii) By other Local Authorities Nil. (iii) By other bodies or persons 9 (fc) 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 1,958 6,604 (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.) 797 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 617 3. Action under Statutory Powers. A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936 :— 11 (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 36 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices :— (a) By Owners 31 (b) By Local Authority in default of owners 2 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 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, none of which are in use at present. During the course of the year 1,527 carcases were examined, and the surrender of 179 parcels of diseased organs were secured. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The number of cases of Scarlet Fever was 257, compared with 129 in 1941: of Diphtheria 15, as compared with 27,; of Pulmonary Tuberculosis 123, ascompared with 126 ; and of Pneumonia 59, as compared with 47. There were two deaths from Diphtheria during the year, as compared with one death in 1941. There were no deaths from Scarlet Fever during the year, as was also the case in 1941. 12 NOTIFIABLE DISEASES DURING THE YEAR 1942. No. Removed. Deaths Smallpox — — — Cholera—Plague — — — Diphtheria (inc. Membranous Croup) 15 15 2 Diphtheria Carriers — — — Erysipelas 17 3 1 Scarlet Fever 257 230 — Typhus Fever — — — Typhoid Fever — — — Paratyphoid Fever — — — Continued Fever — — — Relapsing Fever Puerperal Pyrexia 5 3 — Cerebro-Spinal Meningitis 14 12 3 Poliomyelitis — — — Ophthalmia Neonatorum 6 5 — Pulmonary Tuberculosis 123 — 47 Other forms of Tuberculosis 20 — 9 Encephalitis Lethargica — — — Food Poisoning 0 — — Malaria — — — Pneumonia 59 5 50 Dysentery 49 3 — Polio Encephalitis 1 1 — Measles 445 23 2 Whooping Cough 302 9 1 Totals 1,323 309 118 DIPHTHERIA IMMUNISATION. Through the services of the Council 4,309 individuals were immunised during 1942. ERADICATION OF BED BUGS. Number of Council houses found to be infested 5 Number of Council houses disinfested 5 Number of other houses found to be infested 3 Number of other houses disinfested 3 13 The following report, in condensed form, gives details of the work of the Sanitary Inspectors during the year 1942. The total number of inspections made during the year for all purposes was 13,905. NOTICES ISSUED. Statutory 73 Informal 529 Other Notices 2,520 Total 3,122 Letters re Air Raid Precautions 892 Other Letters sent 7,527 Number of Certificates issued in connection with plans 21 Number of Certificates issued in connection with disinfection 77 Number of Certificates issued in connection with unsound foods 598 Result of Service of Statutory and Informal Notices :— Statutory Informal Number complied with 67 338 Number outstanding 6 191 73 529 Four hundred and one 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 13,905. DISINFECTION. Number of houses disinfected after infectious disease, Phthisis and verminous cases 481 Number of articles of clothing, bedding, etc., disinfected 23,990 14 FACTORY AND WORKSHOP ACT, 1901, AND FACTORIES ACT, 1937. Number of inspections 341 Number of defects found 21 HOMEWORK. Sixteen lists containing the names and addresses of 40 outworkers were received during the year. Three 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 39 PUBLIC HEALTH (MEAT) REGULATIONS, 1924. Total number of carcases examined 1,527 Number, or parts, found to be diseased 179 Weight of do. do. 10 cwt. 1 qr. 27¼ lbs. UNSOUND MEAT AND FOODS. Number of inspections made to Meat Depot, slaughterhouses, shops, stalls in markets and food-preparing shops 862 Weight of foodstuffs condi mned as unfit for food 2 tons 6 cwt. 3 qr. 3¾ lbs. 15 CARAVANS. Number of applications received for consent Nil Number of applications granted Nil 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 73 Number of P.M's. carried out 71 Number of Inquests 14 MATERNITY and CHILD WELFARE SECTION 18 MATERNITY AND CHILD WELFARE COMMITTEE. 1942-43. Chairman H. A. Deshborough Brown, Esq. Mrs. E. Adams (deceased) Mrs. M. M. Howard Mrs. F. M. Macklow Mrs. M. Martin Mrs. E. Squire Miss G. M. Ford F. G. Fletcher, Esq. W. G. Jollie, Esq. A. R. Kemp, Esq. W. F. Lawrence, Esq. L. R. Morris, Esq. H. Muspratt, Esq. WAR-TIME NURSERIES COMMITTEE. 1942-43. Chairman H. A. Deshborough Brown, Esq. Mrs. E. Adam (deceased) Mrs. M. M. Howard Miss G. M. Ford Miss N. Hill L. R. Morris, Esq. H. Muspratt, Esq. C. Partington, Esq. 19 Public Offices, Enfield, Middx. June, 1943. To the Chairman and Members of the Urban District Council of Enfield. Ladies and Gentlemen, I have much pleasure in placing before you my Annual Report on the maternity and child welfare work carried out in Enfield during the year 1942. Perhaps the most interesting point is that during the year more babies were born to the mothers of Enfield than in any previous year, the total number being 1824. This figure compares with 1507 for 1941. It is a most striking proof of the confidence of the mothers of Enfield in Victory, that, undaunted and unafraid of the present or the future, they are having babies in greater numbers than in peace time. It is a tribute also to the Council's midwifery service, for I believe it fair to say that the mothers know that they will be well looked after. There is one aspect, however, which has given cause for great concern, namely, the question of housing accommodation. Throughout the year 1942 I received repeated calls and many letters from expectant mothers complaining of their living conditions and their inability to secure anything better. In most cases they had approached every person, every officer that they might have expected would give them help. Mothers consider pregnancy to be a perfectly adequate reason for a successful application for satisfactory housing accommodation, and I cannot but agree with this point of view. There was very little I could answer the mothers who complained to me that although the Government desired an increased birth rate in order to secure the preservation of Britain it offered little encouragement to women to have children if it did not provide them with suitable accommodation in which to rear their children. It has been very difficult for me to explain to them that there was nothing I could do to help them for they look to me as their Medical Officer of Health to ameliorate their unhappy and unhygienic housing conditions. Most difficult of all have been the interviews I have had with service men home on leave who have appealed to me to do something for their wives. I am of the opinion that much discontent is being caused by the inability of Health Authorities to deal with the position of bad housing. 20 The attendance at our Clinics was excellent; foods especially essential to mothers and young babies and vitamin containing products had a larger sale than ever before; foster children were visited regularly; our midwives attended more confinements, and more dental treatment was asked for and provided than in previous years. It will be seen that our midwives attended at no less than 987 cases during the year. Each midwife attended on an average 82 cases. This figure is much too high and one I hope to be able to reduce during the year 1943. I would add, however, that this is but a hope. It is extremely difficult to-day to obtain the wholetime services of competent midwives. The Enfield infantile mortality rate at 46.78 per 1,000 live births is higher than last year though it is nevertheless 2.22 below the infantile death rate for England and Wales, which at 49 per 1,000 live births, was the lowest ever recorded. Some analysis of the Enfield figure is helpful. The number of children under the age of one year who died was : 1939. 61 out of 1756 live births. Infant mortality rate 35.07 1940. 67 „ „ 1607 „ „ „ „ „ 42.53 1941.53 „ ,,1463 „ „ „ „ „ 38.12 1942. a3 „ „ 1774 „ „ „ „ „ 46.78 The point to note is that we were unfortunate in 1942 in that we lost 14 children with congenital malformations. This can only be looked upon as bad luck ; there is no known method of preventing such conditions. This figure compares with 9 in 1939, 7 in 1940 and 6 in 1941. Apart from this, prematurity accounted for no less than 22 deaths, a figure which compared with 21 for 1939, 16 for 1940 and 12 for 1941. It will be seen that the increase in our infantile mortality rate is due to two main factors, foetal abnormality over which we have no control: the other, prematurity, the cause of which is little known. I have not found it possible to attribute it with any certainty either to work during pregnancy, to diet or to standard of living. Another factor of importance is that of the 83 children who died before they reached the age of one year, 39 died in the first week of life and 58 before they were a month old. The death of 36 of these is accounted for, however, by the two factors previously quoted. I have often been asked why women are having children in larger numbers than in previous years. I have already suggested that confidence in victory is one reason. This, however, is somewhat negative for possibly the position would be more correctly stated were I to say that the number of births might have decreased had there been any doubt as to the outcome of the War. Another way of seeking the answer must be found, and I think this is the 21 position. Women will have children when they see other women's children bright, healthy, happy, bonny and thriving, and when they know that everything that can be done will be done for themselves in child-birth and for their children when they are born. To allow women to work in factories a second day nursery was opened in Enfield in July, 1942. This is a hutted nursery made of Maycrete and designed to accommodate 60 children. I have every praise for the layout of the nursery though I think it unfortunate that it was not built of better material. It was one of the first of the prefabricated nurseries to be built in England and I have no doubt that the experience gained in its construction will prove of value in future nurseries to be built throughout the country. The children in our day nurseries have thrived satisfactorily. A third nursery is under construction but at the time of writing this report it was not completed. During the latter part of the year a campaign to immunise children under five years of age against diphtheria was carried out and in accordance with the recommendations of the Ministry of Health the duty of securing as great a success as possible was placed upon the Health Visitors, each being responsible for her own district. During the year 2644 children under 5 years of age were immunised, and at the conclusion of the campaign in early 1943 I was able to report that the percentage of children between the ages of 1 and 5 years of age immunised was 76.7. Much praise is due to the Health Visitors for the fine response they made to this call upon them. Two additions have been made to the service we can supply to our young children. By arrangements with the Education Committee children suffering from speech defects attend the Speech Therapy Clinic. It is a service which I hope to see developed ; good speech is most essential and permanent errors can sometimes be cured if dealt with in early life. Secondly, I have arranged to see all cases of orthopaedic defects myself and to obtain Specialist advice for such children as may need it. This has worked satisfactorily and although only a wartime measure, it has contributed greatly to improvement in the health of certain of our children. If I have written at some length in these opening remarks, my only apology can be that I believe every member of the Council is desirous that there shall be no diminution in the care and attention we can give to the mothers and children of our district on account of the War. I would take this opportunity of expressing to the Members 22 of the Maternity and Child Welfare Committee my appreciation of the courtesy I have received from them throughout the year. Nor would this report be complete without an expression of thanks to the Voluntary Workers at our Maternity and Child Welfare Centres who have so regularly and conscientiously attended through the year, and to Miss E. W. Bowyer in particular, and the other Members of the Staff concerned with the care of mothers and children for their loyalty and devotion to their work. I am, Ladies and Gentlemen, Your obedient Servant, D. H. GEFFEN, Medical Officer of Health. 23 INFANT MORTALITY. The infant mortality rate was 46.78. BIRTHS. 1942 1941 Live births 1,774 1,463 Still births 50 44 PUERPERAL PYREXIA. During the year 5 cases of puerperal pyrexia were notified, 3 of which were removed to hospital. MATERNAL MORTALITY. There were nine maternal deaths resulting from Pregnancy. Three died at home and six 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. 5 5 These homes were inspected by your Medical Officers during the course of the year. ADMINISTRATION OF MIDWIVES ACT, 1902-36. During the year 1942 there were 13 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 13 Midwives, 12 were employed by the Council as whole-time Municipal Midwives. 24 The following table shows the cases attended during 1942 and 1941. 1940. 1941. MUNICIPAL MIDWIVES. Cases attended as Midwives 747 610 Cases attended as Maternity Nurses 240 177 PRIVATE MIDWIVES. 59 23 Cases attended as Midwives Cases attended as Maternity Nurses 12 11 NOTIFICATIONS. In accordance with the rules of the Central Midwives Board, the following notifications were received from Midwives :— 1942 1941 Sending for Medical Aid 222 169 Still Births 7 1 Laying out of the Dead 5 1 Artificial Feeding 1 5 Liability to be a source of infection 6 6 The notifications in connection with Medical Aid can be classified as follows:— During Pregnancy 14 During Labour 141 During Lying-in Period 13 Infant 54 HELP WITH COST OF MIDWIVES' FEE. During the year 120 cases were helped with the cost of their Midwife's fee, compared with 83 in 1941. OBSTETRIC SPECIALIST. In one case the Obstetric Specialist at the North Middlesex County Hospital was called in by an Enfield Practitioner, for assistance in a difficult midwifery case. HOME HELPS. During the year Home Helps were supplied in 26 cases, 25 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 1648 individual mothers attended the Enfield Ante-Natal Clinics. As the number of births was 1824, it will be seen that the ante-natal care of mothers extended not only to those who were attended by our midwives as such, but also to those where they attended as maternity nurses. Furthermore, ante-natal work for mothers confined i i nstitutions was carried out at our clinics. This is as it should be for the ante-natal clinics provide not only medical care and attention, but general advice and social help to the expectant mother. POST-NATAL CLINICS. During the course of the year 376 mothers attended for examination after their confinement. This compares with 218 in 1941 and 181 in 1940. This figure shows a steady and very healthy increase over previous years. INFANT WELFARE CENTRES. The total number of children who made their first attendance at the Infant Welfare Clinics was 1,769 compared with 1,552 in 1941. VISITS. The Council's Health Visitors paid 585 visits to Expectant Mothers, 2,209 to children under one year of age, and 6,359 to children between the ages of one and five years. 26 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 Nil. Dried Milk 1,459 lbs.; cost £135 16s. 8d. Milk is supplied free or at reduced cost to all expectant and nursing mothers and children under 5 years of age by the Ministry of Food. The only cases where help from the Council is required is where milk in addition to that supplied by the Ministry of Food is necessary. It will be seen that in 1942 there were no such cases, but a need for a supply of dried milk was found to exist. It is the practice in these cases to notify the Office of the Ministry of Food to secure that no child receives a double ration. ROUTINE 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 1941. The number of children who kept appointments during the year 1942 was 2,034. AURAL TREATMENT. 64 mothers and children were referred to the School Aural Clinic. OPHTHALMIC TREATMENT. 109 Mothers and children were referred to the School Ophthalmic Surgeon. CHILD LIFE PROTECTION. PUBLIC HEALTH ACT, 1936. At the end of 1942, 11 persons in Enfield were receiving children for reward ; the total number of children being 11. Routine inspection of homes where these children are cared for is carried out throughout the year. DENTAL TREATMENT. 764 attendances were made at the Dental Clinics by ante-natal and nuising mothers, and 280 by children. Dentures were provided for 124 mothers. 27 CONVALESCENT TREATMENT. Three children were sent away to a Convalescent Home; also three mothers. ORTHOPAEDIC TREATMENT. Advice and/or treatment was provided for 20 children needing orthopaedic care. DIPHTHERIA IMMUNISATION. During the year 2,644 children under the age of five years were immunised against diphtheria. In order to estimate the percentage of the under five population immunised I made certain enquiries during the year and from these I obtained the following information. No. of children under 5 years of age in Enfield 7151 No. of children on the books of the Health Visitor 6930 No. of children under the age of one year 1399 No. of children between the ages of 1 and 5 years 5531 No. of children immunised by the end of 1942 4245 Percentage of children between the ages of 1 and 5 immunised. 76.7 ANNUAL REPORT of the SCHOOL MEDICAL OFFICER DENNIS H. GEFFEN, M.D., D.P.H. For the year ending 31st December, 1942 30 MEMBERS OF THE ENFIELD EDUCATION COMMITTEE. 1942-43. Chairman Mr. H. A. Deshborough Brown Vice Chairman Mr. H. G. Short. Representative Members. Mrs. E. M. Squires, C.C. Mr. W. C. Bennett, J.P. 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., C.C. 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. A. J. Crofts. Mr. A. J. Neaves Director of Education. E. Pascal, Esq., M.A. 31 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 Giles, M.D., D.P.H. (Resigned 26.11.42.) Assistant School Medical Officer: Frances A. Roberts, M.B., Ch.B. (Resigned 9.7.42.) Erenda J. Mayfs, M B., B.S. (Appointed 1.10.42.) School Dentists: C. E. James, L.D.S., R.C.S.(Eng.). H. Mackay, L.D.S. C. A. Martinez, L.D.S. (Appointed 13.4.42.) School Ophthalmic Surgeon: S. Macky, M.B., B.S., D.O.M.S. School Aural Surgeon: J. C. Hogg, M.A., F.R.C.S. (Resigned 3.6.42.) F. Popper, M.D. (Prague) (Appointed 10.6.42.) Speech Therapist: Miss E. Richnell, L.R.A.M. School Nurses: I. Fowler, S.R.N. V. Murphy, S.R.N., C.M.B. M. Hilton, S.R.N., C.M.B. New H.V.'s Cert. N. Pluck, S.R.N., C.M.B. New H.V.'s Cert. (Resigned 9.12.42.) Dental Nurse: F. Anderson, R.S.C.N. Dental A ttendants: M. Freston. I. Mackay. Clerks: H. Pearson. E. Williams. 32 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, 1942. 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, 1942. I am happy to inform the Committee that throughout the year the care of the children attending the elementary and secondary schools i"n Enfield continued on a sure and steady basis. It was interrupted by changes in staff due to retirement of assistant school medical officers. Such changes are unfortunate for they prevent that continuity in the care of the children, that gaining of experience both of the service generally, and of the children individually which is so valuable. In the hope that 1943 may be more fortunate in this respect, the Council and Education Committee have appointed three female assistant medical officers, two of whom are married. Exemption from military service has been obtained for the third for a period of one year. It will be noted that the school population has increased by over 1,000, and this fact and war time conditions have increased both our work and its responsibilities. I know that there is one matter on which the Committee will want my immediate assurance, i.e. as to whether this third year of war has passed without serious detriment to the health of the children for whom the Education Committee is responsible. I feel that I can answer this question in the affirmative with every confidence. There is no increase of material importance in the number of children suffering from malnutrition, and, in so far as secondary 33 school children are concerned, I have not had one instance reported to me. Assessments of nutrition are difficult to make on statistical or scientific bases. Attempts have been made to determine the state of nutrition of individual children or groups of children by assessment of heights and weights, by a comparison of a heightweight ratio, and by blood tests, but I am not satisfied that any of these tests have received general acceptance. Children vary in height and weight as do adults, and the thin child is not always the unhealthy child. Personally, I know of only one way of assessing nutrition, and that is to rely upon the eye of the experienced observer. There are many members of the Education Committee who, from this point of view, are as fit to judge of the health of our school children as I am, and I think they will agree with me that our children are as fine looking, as upright, and as healthy as in pre-war years. Only eight children suffered from Diphtheria, and I believe this to be about the lowest figure ever recorded in the district. There must be many residents who can remember when Diphtheria was endemic in Enfield ; when our cases were numbered in hundreds, and when there was a definite mortality from this disease every year. It is not my duty, nor would it be wise for me to prophesy for the future, but I think I may say with confidence that if the children of Enfield continue to obtain immunisation from this disease as they have in the past two or three years, there should be little reason for us to fear a return of Diphtheria in epidemic form. There are two new services which have been given much consideration by the Education Committee, namely, the Orthopaedic service and the Speech Therapy service. The Committee authorised me to make arrangements for the organisation of an Orthopaedic Clinic, and to appoint the appropriate staff. Unfortunately, I was unable to obtain the services of an orthopaedic specialist. I have, therefore, in the first place, dealt with the orthopaedic cases myself in conjunction with the assistant school medical officers, but I have had considerable hospital assistance and arrangements are now reasonably well in hand for the care of children suffering from orthopaedic defects. In the latter months of the year a school Speech Therapy Clinic was commenced under the supervision of Miss E. Richnell, who holds the appropriate certificates. At this stage it is too early for me to speak of results. Let it suffice that, in Enfield, we have recognised the necessity for dealing with children suffering from defects of speech, and that we have commenced an organisation to deal with them. The clinic is held twice weekly and has an average attendance of about ten. Miss Richnell receives assistance from one of the school nurses, and there is already a long waiting list of 34 children recommended for attendance by the assistant school medical officers and teachers. I have received reports from the Ophthalmic and Aural Specialists which show a steady continuity of work throughout the year. Mr. James, the Senior School Dental Surgeon, has also submitted to me a full report on the dental condition of the children in our elementary and secondary schools. In this report he stresses that dental health depends largely on correct diet, and points to the fact that about 30 per cent of children in institutions are dentally fit as compared with about 10J per cent of children living at home. I asked Mr. James whether in his opinion the alteration in diet resulting from the war had had any effect on school entrants, and received from him some very interesting information which I set out below: School. Year Inspected. No. Inspected. % inspected who were "naturally fit." No. (per child inspected) of temporary teeth carious and lost. A. 1938 91 2.19% 4.8 1942 89 20.22% 3.3 B. 1938 83 2.40% 5.45 1942 72 12.50% 4.84 C. 1938 126 4.76% 5.62 1942 79 11.39% 4.12 D. 1938 104 19.23% 4.53 1942 111 7.20% 4.29 The figures are a comparison between 1938 and 1942, and by the words "naturally fit" Mr. James means children with perfect dentition, i.e. no teeth previously extracted, no teeth requiring extraction, no teeth previously filled, and no teeth requiring filling. The table shows that the inspection of 1942 revealed a marked increase in the number of children naturally fit in the case of three schools, and a decrease in one. For this latter decrease neither Mr. James nor I can account. It may be argued that it is wrong to rely on impressions but, as I have indicated in the case of nutrition, the impressions of 35 experienced observers are sometimes as well worthy of note as statistics prepared on a scientific basis. The impression I get from our dentists is that they are of the opinion that the dental condition of the children of Enfield is considerably better than in pre-war years, and especially so in the case of entrants who have lived the major part of their lives on the diet imposed upon them by the war. They attribute this to the absence of sweets, to a more regular diet, and the ingestion of fresh vegetables. There is one school in Enfield where the children come from superior homes in a healthy part of the district. They are well looked after, beautifully clothed, well-behaved, and, in my opinion, wisely fed. It is interesting to note that at this school the percentage of children who were dentally fit on entering school in 1942 was 32 per cent. I quote this as an example of what can be achieved in a community of children who are well-housed, whose parents are educated in the care of children, and who have the facilities to provide their children with the elementary requisites of life in their own good homes. During the course of the year I have given specialised attention to children suffering from defects likely to be of a lasting nature, and have held clinics regularly in my office where I have examined such children and consulted with their parents. A satisfactory School Medical Service must first of all have a routine that will deal with the care of normal children, supervise their welfare, and secure the treatment of defects which occur in large numbers. I think that Enfield is reasonably provided for in this respect. There are other cases which do not fall into this category ; individual cases requiring very careful consideration and special methods if the children concerned are not to suffer permanently. Obviously, under this heading comes that number of children which is dealt with by the Director of Education and his special department ; children whose parents are not capable of giving them the care and protection that they need ; and children who have appeared before the Court for various offences. In addition to these there are children suffering from medical defects, and these are the ones to whom I would refer. There are children whose mental capacity is such that they cannot learn with other children. During the year no less than fifty-four such cases were dealt with ; ten were educable in an ordinary school, eighteen needed education in a special school, two were incapable of further instruction in a special school, eleven were incapable of educational instruction in any form, and thirteen were not scheduled. This does not mean that these thirteen children will 36 be forgotten ; they will be re-examined again in six months or possibly a year when the progress they have made will be taken into consideration with the general educational knowledge they possess. The point I would stress is that in each one of these cases the parents have been interviewed, and the steps taken in the care of their children have been taken in co-operation with them. Few realise the sad plight of the mother of an only child, whose only child is an imbecile. I have repeated the words "only child" twice because all too frequently parents are apt to consider that all cases of imbecility are hereditary, and for this reason refrain from having further children. The hereditary factor only applies in a small proportion of cases, and I have found it possible to dispel the fears of many parents in this respect. I have reason to believe that as a result, some of them have had other children, perfectly normal healthy children who will bring them that affection and pride which they have a right to expect as a return for the lavish care they have bestowed upon them. I have seen many good parents literally devoting their lives to the care of imbecile children with little hope of anything in return—parents who might have other healthy children without any fear of a repetition of their previous misfortune. In addition I have seen one hundred and sixteen children suffering from other defects. I would inform the Committee of one of these special cases—a small undersized child of about ten years, suffering from a severe form of congenital heart disease. This child had never been to school and neither I nor the Director of Education would have been prepared to enforce such attendance, and take the responsibility of the consequences on our own shoulders, without the willing co-operation of the parents. On interviewing the parents I gained the impression that they were loathe to " worry the child with learning " when the prospects for the future were so doubtful and limited. It had not occurred to them that, in that the child was debarred from the natural physical pleasures and recreations of the normal child, its life would be made doubly hard if it were unable to occupy and amuse itself either by reading or writing. After some weeks of consideration the parents asked me to arrange for the child to attend school in the mornings only, and this was effected. A year later I received a request that the child should attend all day, and it is now doing so. There has been no detriment to health ; on the other hand, the child has improved in physique, is looking better, and is now considerably happier. There are other cases I could quote to the Committee where the School Medical Service has' achieved similar happy results; it is my desire to stress that the School Medical Service exists, not to secure healthy robots and robust amazons, but to look after the weak and faulting, and to provide them with as happy an outlook on 37 life as can be afforded them despite any disability they might possess. I would assure the Committee that its staff is sincerely grateful for the opportunity it is given to do the best for these children, and for their very sympathetic attitude. Your officers are very well aware of the Committee's desire to give every consideration and help to the special child. May I express my personal appreciation of the courtesy and help I have received from the members of the Committee and the Director, and the loyal help and co-operation I have received from all the members of the School Medical Staff. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, DENNIS H. GEFFEN, School Medical Officer. 38 REPORT OF THE SCHOOL MEDICAL OFFICER Average number on books of Elementary Schools 11,660 Average weekly attendance 9,777 Number of Schools 22 ROUTINE MEDICAL INSPECTION. The total number of children examined during the year was 5,063. 79 per cent, of the children examined were accompanied by their parents, and 30.8 per cent, were vaccinated. DEFECTS FOUND AT ROUTINE MEDICAL INSPECTION. Requiring Treatment. Requiring to be kept under observation. Enlarged tonsils and adenoids 253 104 Enlarged tonsils only 67 112 Adenoids 17 16 Other nose and throat conditions 16 4 Conjunctivitis 5 3 Blepharitis 43 3 Other Eye Conditions 9 2 Enlarged Cervical Glands 4 24 Scabies 40 — Impetigo 8 — Other Skin Conditions 6 15 Defective Hearing 51 5 Otitis Media 7 4 Other Ear Conditions 12 — Defective Speech 5 7 Defective Vision 279 255 Bronchitis — 6 Other Lung Conditions : Non-tuberculous 5 37 Organic Heart Disease 1 16 Functional Heart Disease — 33 Anaemia 5 13 Chorea 1 2 Other Nerve Conditions — 2 Spinal Curvature 11 17 Other Deformities 18 13 Other Diseases and Defects 37 87 39 Uncleanliness. Of 5,063 children examined three were found to have vermin in their heads, and 97 had nits, i.e., 1.9 per cent, were unclean No cases of body vermin were found. Nutrition. The following table shows the state of nutrition among the children examined:— Number of children examined 5,063 Number of children classified " A " 673 Percentage of children classified " A " 13.2 Number of children classified " B " 3,431 Percentage of children classified " B " 67.8 Number of children classified " C " 870 Percentage of children classified " C " 17.2 Number of children classified " D " 89 Percentage of children classified " D " 1.8 A Excellent B Normal C Slightly sub-normal D Bad INFECTIOUS DISEASE. Measles 99 German Measles 2 Mumps 28 Whooping Cough 45 Chickenpox 97 Scarlet Fever 168 Diphtheria 8 Poliomyelitis 1 Cerebro-spinal Meningitis 3 THE WORK OF THE SCHOOL NURSES. Number of home visits 2,859 Number of school visits 301 Number of school visits for routine examination of heads 211 Total number of heads examined 48,174 Number of individual children found unclean 1,167 Number of cases in which legal proceedings were taken — 40 TREATMENT CLINICS. Tonsils and Adenoids:— Number of cases seen at clinics 727 Number of cases operated under the Authority's Scheme 513 Number of cases operated by private arrangement 1 Ringworm.—Seven cases were seen and treated at the clinics. Impetigo.—One hundred and nineteen cases were treated at the clinics. Scabies.—One hundred and three cases were seen. Other Skin Diseases.—One hundred and twenty-six cases were seen and treated at the clinics. Eye Diseases.—One hundred and eighty-nine cases were treated. Ear Diseases.—One hundred and five cases were seen at the Minor Ailment Clinics. The total number of children examined during the year, excluding those attending the Dental Department, was 9,136. This number was made up as follows :— Examined at Routine Medical Inspection 5,063 Examined at Minor Ailment Clinics 3,473 Examined at Ophthalmic Clinic only 396 Examined at Aural Clinic only 99 Examined under Juvenile Employment Bye-laws 51 Examined under Mental Deficiency Act 54 The following help was afforded to children who were found to require it:— Twenty-three children were sent to residential schools for physically defective children. Three children were supplied with surgical instruments. The Enfield Children's Care Committee assisted by supplying boots to school children. 41 DEATHS AMONGST SCHOOL CHILDREN. There were fifteen deaths among school children during the year. The causes were as follows:— 1 Haemophilia. 2 Nephritis. 1 Epilepsy. 1 Toxaemia. 1 Heart Disease. 1 Diphtheria. 1 Tuberculosis. 1 Cerebral Haemorrhage. 1 Sarcoma. 1 Cerebral Tumour. 4 Accident. (2 Burns. 1 poisoning. 1 drowned.) PROVISION OF MEALS. Meals were provided for children at the following centres:— Albany School. Botany Bay School. Eastfield Road School. St. John's School. Suffolks School. St. James' School. Bush Hill Park School. George Spicer School. Central School. Chesterfield Road School. Chase Side School. During 1942 13,649 dinners were provided free, and 118,377 were provided and paid for. 2,690,059 j pint bottles of milk were provided and paid for, and 48,250 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. 42 Fifty-four children were examined under the Mental Deficiency Act (1913) during 1942. These were scheduled as follows:— Dull and backward but capable of instruction in an elementary school 10 Mentally defective but capable of instruction in a special school 8 Incapable of further instruction in a special school 2 Imbecile 11 Not scheduled (to be seen again) 13 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 135 Grammar School 79 County School 244 The classification of the nutrition of these children was as follows:— School. Classification. "A" " B " "C" " D " Junior Technical 13 114 8 - Grammar 1 66 12 - County 28 204 12 - 43 The following defects were found:— Defects. School. Jnr. Technical. Grammar. County. Defective Vision 8 5 53 Defective Hearing 2 — 1 Functional Heart Disease — — 3 Kyphosis — — 9 Other Deformities 1 — 6 Blepharitis — — 1 Impetigo — — 1 Enlarged Tonsils 4 — 1 Enlarged Glands 1 — — Anaemia — — 2 Other Diseases and Defects — — 2 Dental Caries 2 1 — Three hundred and fifty-eight children were treated at the School Dental Clinic and one hundred and forty-five at the School Ophthalmic Clinic during 1942. SCHOOL DENTAL CLINICS. Elementary Schools. Secondary Schools. Number Inspected 9613 1211 Number Treated 4634 358 Number of Fillings 6232 1046 Number of Extractions 6760 297 SCHOOL OPHTHALMIC CLINIC. Elementary Schools. Secondary Schools. Total attendance 1883 281 New Cases 1079 161 Prescriptions for glasses 343 63 Number not requiring glasses 190 17 44 Nine children were referred to the Western Ophthalmic Hospital for operation for squint. One child had a Meibomian Cyst removed at the Western Ophthalmic Hospital, and five children attended the hospital for investigation of other eye conditions. SCHOOL AURAL CLINIC. Number of cases dealt with 324 Number of new cases 225 Total number of attendances 614 Number of cases discharged cured 187 Number of cases of a recurrent nature requiring occasional treatment 6 Number of cases still under treatment 79 Number of cases who have refused treatment, or sought treatment elsewhere 12 Enfield: Stanley Woodfield Printer 8-12 Windmill Hill