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 1943 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 1943 1 Public Offices, Enfield, Middx. 20th June, 1944. Annual Report of the Medical Officer of Health, 1943. 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 1943. There have been two outstanding features; the first is that there have been 1,908 births to Enfield residents—the highest number that has yet been recorded. The second is that the total number of cases of Diphtheria that occurred in Enfield was five. I am satisfied that this represents the result of the intensive campaign that we have conducted to immunize the children of Enfield against this disease. There is no doubt that its incidence in the District was on the decline even before immunisation was carried out on a large scale, but so low a figure as this could not, in my opinion, have been achieved except for the acceptance by parents of the value of immunisation, a realisation that it could be obtained with but the slightest disturbance to a young child, and their co-operation in securing its achievement. In Enfield immunisation against Diphtheria is being made a Maternity and Child Welfare function for it is offered to every child at the age of one year, and is almost invariably accepted. It was our practice during 1943 to offer a supplementary dose to achieve increased protection as soon as the child entered school. There have been certain disadvantages in this : it has meant that Teachers have had to distribute Leaflets to parents requesting consent to 2 immunisation, and this procedure despite the willing co-operation of the Teachers has not always been entirely successful. We are now offering immunisation to children at the age of 4½ years at our Welfare Clinics where parents are invited to attend with their children for a final routine examination before they are admitted to school. I think this procedure will be more successful and that our children will thus enter school fully protected against Diphtheria. We still continue to receive requests that we should immunize children against whooping cough and we meet this request when we receive it. In the present light of our knowledge and of the results that can be achieved I have not considered it my duty to advise the Council that it should conduct a campaign for protection against this disease by means of inoculation. I have remarked in previous Reports that the work of the Department has continued as in previous years. This has been expected and has not called for comment. In these days however, to be able to make such a remark is, I would assure you, an indication that innumerable difficulties have been overcome to secure continuity of previous work and the carrying out of the essential functions of the Department. Throughout the year I had no Deputy. Excellent as has been the help I have received from the Assistant Medical Officers, the absence of a Deputy has made my work both difficult and onerous. Again it must be remembered that the year commenced with two Assistant Medical Officers, one of whom had been appointed in November, 1942, another in February, 1943, whilst the third was appointed and commenced her duties in May, 1943. There has been therefore an almost complete change in the Medical Staff during the year. On the clerical side only five members of the Staff are either permanent officials of the Council or temporary officials whose status has been altered on account of marriage. Whilst paying tribute to them for their work I think it only fair to recognise the excellent services of the temporary Staff who have given us sound and solid assistance. It will be noted that Scarlet Fever has increased from 257 to 408 cases and Measles from 445 to 1,463. Both diseases were of a reasonably mild character and no death was recorded as arising from Scarlet Fever. 3 It is said that War is always associated with the lowering of social and moral standards with consequent increase in illegitimacy, venereal disease and tuberculosis. Illegitimacy. It will be noted that there were 77 illegitimate births to Enfield residents last year which compared with 70 for 1943, 58 in 1938 and 52 in 1939. In view of the fact that the number of births have geneially increased it would appear that there has been no gross increase in illegitimacy in Enfield as a result of the War. For many years it has been noted that illegitimacy is associated with a high infantile mortality rate, a rate usually twice as high as that for legitimate infants. During the past years there has been a tendency for these two rates to approximate, suggesting that the additional care given to illegitimate children has resulted in their improved welfare and lowered mortality rate. It is interesting therefore to compare the rates for the past ten years in Enfield. TABLE I. Year Live Births Infantile Deaths Death Rates Legitimate Illegitimate Legitimate Illegitimate Legitimate Illegitimate 1934 1,057 29 44 3 41.62 103.44 1935 1,183 37 57 4 48.18 108.10 1936 1,330 40 82 4 61.65 100.00 1937 1,481 42 63 4 42.53 95.21 1938 1,678 58 74 14 44.10 241.37 1939 1,704 52 57 4 33.78 76.92 1940 1,558 49 62 5 40.62 102.04 1941 1,390 73 50 3 37.99 40.54 1942 1,704 70 73 10 42.25 142.85 1943 1,831 77 86 5 46.96 64.93 With the exception of 1941 there has been a closer approximation between the rates for 1943 in Enfield than in any other of the recorded ten years. What inference are we to draw from the above table ?—in the first place that although there are a sufficient number of illegitimate babies born in a year to warrant concern the figures do not show a gross increase over pre-war years. In the second place that the mortality rate of illegitimate children has 4 shown a striking decrease during the past ten years. It must be remembered that the number of illegitimate births is small and that therefore a small number of deaths effects a high mortality rate and that from such small figures it is dangerous to draw too definite conclusions, but I am satisfied that there is an improvement in the care of the illegitimate children in our area. Venereal Disease. As regards venereal disease there are no figures available upon which to constitute a comparison between War and pre-War years. It is not the practice in Enfield to make a routine blood or bacteriological test of all expectant mothers for these diseases. It is only when there are grounds for suspecting their presence that such tests are advised. A few cases have been diagnosed at our Ante Natal Clinics but the number is not such as to warrant the suggestion that in Enfield venereal disease is present to any extent in our expectant mothers. The same inference can be drawn from the result of routine medical inspection of our school children and of the children under 5 years of age who attend at the Welfare Clinics. Realising the extent of these inspections in Enfield it is possible to draw an optimistic picture. On the other hand they do not include adults and adolescents and the factory workers of the District concerning whom I am unable at this stage to give you any definite information. Tuberculosis. I set out below the number of new notifications that have been received since 1934. TABLE II-TUBERCULOSIS. Year. Pulmonary. Non-Pulmonary. Male. Female. Total. Male. Female. Total. 1934 32 30 62 4 4 8 1935 33 22 55 7 7 14 1936 35 26 61 7 2 9 1937 37 35 72 9 7 16 1938 51 36 87 11 7 18 1939 43 28 71 9 5 14 1940 48 36 84 10 4 14 1941 48 41 89 14 11 25 1942 54 46 100 10 8 18 1943 72 46 118 13 11 24 5 % These figures show that there is an almost yearly increase in the number of cases of Tuberculosis notified. Two factors must be taken into consideration. In the first place our population has increased, and in the second place it is probable that diagnosis of Tuberculosis is more accurate than it was in pre-War years and that therefore a larger number of cases are diagnosed. Bearing these two points in mind it would appear that such increase in Pulmonary Tuberculosis as has occurred is not unduly out of proportion to the increase in population and methods of diagnosis. The work of Sanitary Inspectors has been carried out under great difficulty throughout the year. Limitation of labour and scarcity of materials have rendered it difficult even for a good Landlord to meet all the requirements of his Tenants. On the whole there has been satisfactory co-operation between Landlords and Inspectors, but it has been necessary to curtail our demands to the essentials of health. It is for this reason that we have carried out our work under the provisions of the Public Health Act 1936 rather than the Housing Acts. I would take this opportunity of thanking the Council for the help and courtesy I have received during the year, my colleagues for their co-operation, and the Staff of the Departments for which I am the Executive Officer for their help and hard work. I am, Ladies and Gentlemen, Your obedient Servant, DENNIS H. GEFFEN, Medical Officer of Health. 6 URBAN DISTRICT COUNCIL OF ENFIELD. L. R. Morris, Esq., J.P. Chairman W. S. Williams, Esq. Vice-Chairman Mrs. G. M. Jay, J.P. H. Muspratt, Esq., O.B.E. C. Partington, Esq., J.P., M.R.S.T S. G. Rowlandson, Esq., M.B.E. F.C.A. H. A. D. Brown, Esq. F. G. Greenwood, Esq. H. H. Collier, Esq. A. R. Kemp, Esq. A. M. Eeles, Esq. E. S. Stock, Esq. †C. Evans, Esq. F. C. Watts, Esq. † Resigned. D. Mason, Esq. T. H. M. Clarke, Esq. W. C. Bennett, Esq. . H. Thompson, Esq. W. G. Bowyer, Esq. J. Cottenham, esq. C. H. Thomas, Esq. W. F. Lawrence, Esq. W. Graham, Esq. Mrs. E. M. Squire, c.c. W. G. Jollie, Esq. H. G. Short, Esq. Derek Parker-Bowles, Esq. *H. D. Hyde, Esq. *Vacancy filled on resignation of † HEALTH COMMITTEE. H. Muspratt, Esq., O.B.E. Chairman also Mrs. Jay, and Messrs. Brown, Jollie, Kemp, Lawrence, Morris, Watts and Parker-Bowles. STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 12,400 7 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 1943, according to the Rate Books, was 29,901. The rateable value of the District is £903,540 The net product (after allowing for cost of collection) of a penny rate is £3,677 8s. 8d SOCIAL CONDITIONS. The number of houses erected during the course of the year was 6. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total Male. Female. Legitimate 1,831 945 886 Illegitimate 77 37 40 Birth-rate— per 1,000 population. Still Births:— Total. Male. Female. Legitimate 54 33 21 Illegitimate 3 2 1 Rate per 1,000 total births—29.00. Total. Male. Female. Deaths 1,038 515 523 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 3 1.52 From other Puerperal causes 4 2.03 7 3.56 Six of these cases were removed to the North Middlesex County Hospital and one to an Enfield Nursing Home, where they died. Death-rate of Infants under one year of age:— All infants per 1,000 live births 47.69 Legitimate infants per 1,000 legitimate live births 46.96 Illegitimate infants per 1,000 illegitimate live births 64.93 Deaths from Cancer (all ages) 156 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 19 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 16.5 0.51 12.1 49.00 London 15.8 0.45 15.0 58.00 126 County Boroughs and Great Towns (including London) 18.6 0.63 14.2 58.00 148 Smaller Towns 19.4 0.61 12.7 46.00 ENFIELD ............ 0.59 ............ 47.69 DEATHS. Of the 1,038 deaths of Enfield residents during the course of the year 156 were due to malignant disease: 237 to heart disease: 72 to pneumonia (all forms), 65 to bronchitis; 91 to Intra-cranial vascular lesions ; and 51 to tuberculosis of the respiratory system. INFANT MORTALITY. Of the 91 infants who died before attaining the age of one year, 37 died within the first week of life. In 16 cases death was due to Pneumonia: in 10 to Congenital Malformation: in 21 to Premature Birth : in 3 to Atrophy, Debility and Marasmus and 17 to Enteritis. INQUESTS. Fifty-seven inquests and sixty-three P.M.'s without inquests were held in Enfield during the year. Out of these, 69 deaths were due to natural causes, 33 to accidental causes, 7 to suicide, 10 to misadventure, and 1 to wounds sustained in 1914 War. AMBULANCE FACILITIES. For infectious Cases: 419 patients were removed from Enfield during the year. 2,637 other patients were conveyed during the year to local hospitals. 9 LABORATORY FACILITIES. The following work was carried out in the Council's laboratory during the year. Specimen. No. Positive. Negative. Percentage of Positives. Swabs 342 1 341 0.29 Sputa 155 12 143 7.74 Totals 497 13 484 2.61 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 1943 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 26 Number granted permission to sub-let 24 Number refused permission 2 Number of visits made by Sanitary Inspectors 3 INFECTIOUS DISEASES AND SCHOOLS. Number of children notified to be absent from School due to suspected Infectious Disease 122 Number of children found to be suffering from Infectious Disease 94 This compares with the following figures for last year:— 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 10 HOUSING. Number of New Houses erected during the year:— (a) Total (including numbers given separately under (b)) 6 (i) By the Local Authority Nil. (ii) By other Local Authorities Nil. (iii) By other bodies or persons 6 (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 Hottses:— No. of No. of inhouses. spections. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts), and number of inspections made 2,420 7,812 (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 897 (The number here given is of houses where any insanitary conditions were found.) 2 Remedy of Defects without service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 767 3. Action under Statutory Powers. A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Notices were served requiring repairs Nil. 11 (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 101 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices:— (a) By Owners 106 (b) By Local Authority in default of owners 56 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 21 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 435 carcases were examined, and the surrender of 6 carcases and 1,331 parcels of diseased organs were secured. The weight of these carcases and parcels was 4 tons 7 cwts. lqtr. 251bs. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The number of cases of Scarlet Fever was 408, compared with 257 in 1942: of Diphtheria 5, as compared with 15; of Pulmonary Tuberculosis 126, ascompared with 123; and of Pneumonia 59, as compared with 59. There were no deaths from Diphtheria during the year, as compared with two death in 1942. There were no deaths from Scarlet Fever during the year, as was also the case in 1942. 12 NOTIFIABLE DISEASES DURING THE YEAR 1943. No. Removed. Deaths Smallpox — — — Cholera—Plague — — — Diphtheria (inc. Membranous Croup) 5 5 — Diphtheria Carriers — — — Erysipelas 26 9 — Scarlet Fever 408 336 — Typhus Fever — — — Typhoid Fever — — 1 Paratyphoid Fever — — — Continued Fever Relapsing Fever - - - Puerperal Pyrexia 8 5 - Cerebro-Spinal Meningitis 7 7 2 Poliomyelitis 2 2 — Ophthalmia Neonatorum 1 1 — Pulmonary Tuberculosis 126 — 51 Other forms of Tuberculosis 33 — 7 Encephalitis Lethargica — — — Food Poisoning 1 — — Malaria — — — Pneumonia 59 — 72 Dysentery 1 — — Polio Encephalitis — — — Measles 1,463 34 — Whooping Cough 215 8 1 Totals 2 355 407 134 The above figures are in respect of Civilians and Non-Civilians. DIPHTHERIA IMMUNISATION. Through the services of the Council 2,434 individuals were immunised during 1943. ERADICATION OF BED BUGS. Number of Council houses found to be infested 3 Number of Council houses disinfested 3 Number of other houses found to be infested 4 Number of other houses disinfested 4 13 The following report, in condensed form, gives details of the work of the Sanitary Inspectors during the year 1943. The total number of inspections made during the year for all purposes was 12,781. NOTICES ISSUED. Statutory 163 Informal 591 Other Notices 3,880 Total 4,634 Letters re Air Raid Precautions 569 Other Letters sent 7,683 Number of Certificates issued in connection with plans 13 Number of Certificates issued in connection with disinfection 45 Number of Certificates issued in connection with unsound foods 685 Result of Service of Statutory and Informal Notices:— Statutory Informal Number complied with 157 424 Number outstanding 6 167 163 591 One hundred and thirty thiee 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 12,781. DISINFECTION. Number of houses disinfected after infectious disease, Phthisis and verminous cases 796 Number of articles of clothing, bedding, etc., disinfected 19,209 14 FACTORY AND WORKSHOP ACT, 1901, AND FACTORIES ACT, 1937. Number of inspections 253 Number of defects found 15 HOMEWORK. Nine lists containing the names and adresses of 323 outworkers were received during the year. Forty-two addresses of outworkers were forwarded to other districts. PLACES OF PUBLIC ENTERTAINMENT. Number of inspections 11 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, unde the Milk (Special Designations) Orders, 1936 and 1938 34 PUBLIC HEALTH (MEAT) REGULATIONS, 1924. Total number of carcases examined 435 Number, or parts, found to be diseased 1,337 Weight of do. do. 4 tons 7 cwt. 1 qr. 25 lbs. UNSOUND MEAT AND FOODS. Number of inspections made to Meat Depot, slaughterhouses, shops, stalls in markets and food-preparing shops 816 No. of articles etc. condemned 9,340 No. of Certificates issued 906 Weight of foodstuffs condemned as unfit for food 9 tons 12 cwt. 0 qr. 0¾ 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 38 Number of P.M's. carried out 36 Number of Inquests (Held elsewhere) 8 MATERNITY and CHILD WELFARE SECTION 18 MATERNITY AND CHILD WELFARE COMMITTEE. 1943-44. Chairman H. A. Deshborough Brown, Esq. Mrs. M. M. Howard Mrs. E. Squire Mrs. S. M. Lowe Mrs. A. Perkins Mrs. L. Turvey Miss G. M. Ford W. G. Jollie, Esq. A. R. Kemp, Esq. W. F. Lawrence, Esq. L. R. Morris, Esq. H. Muspratt, Esq. D. ParkeR-Bowles, Esq. WAR-TIME NURSERIES COMMITTEE. 1943-44. Chairman H. A. Deshborough Brown, Esq Mrs. E. Squire Mrs. M. M. Howard Mrs. A. Perkins Miss G. M. Ford Miss N. Hill L. R. Morris, Esq. H. Muspratt, Esq. C. Partington, Esq. 19 Public Offices, Enfield, Middx. June, 1944. 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 Health of the women and children in Enfield during the year 1943. The number of children born to Enfield residents during the year constitutes a record, being 1965 as compared with 1824 in 1942. Our infantile mortality rate at 47.69 per 1000 births is 1.31 less than that for England and Wales as a whole. Satisfactory as these figures may be they nevertheless require some careful consideration. Although the health of the babies in Enfield generally has reached, and is being maintained, at a high standard, it is nevertheless a fact that during the year, 92 children died before they attained the age of one year. In so far as it is possible all such deaths are investigated and I asked Doctor Rivlin to correlate the information obtained and report thereon to me. I am indebted to Doctoi Rivlin for her report on this subject and for her valuable assistance throughout the year. We were able to obtain information concerning 58 of the above deaths. Thirty-six of them occurred in the first month of life, of which 28 occurred in the first week. Of the 28, 20 were males and 8 were females. The following conditions were notified as the cause of death, in the 58 cases investigated In first week. In first month. In first year. Prematurity 14 2 — Gastro-enteritis 1 2 10 Bronchitis and broncho-pneumonia - 2 9 Conditions incompatible with life 7 2 1 Birth injuries 5 - - Oedema of lungs 1 — - Misadventure — — 1 Intussusception — - 1 20 It will be seen that the main causes of death in the first week were prematurity, conditions incompatible with life and birth injuries. All of the five birth injuries investigated were apparently due to difficult labour. Of the deaths that occurred between the first month and the end of the first year of life there were two principle causes, gastro enteritis and broncho pneumonia. Of the 10 children who died of gastro enteritis only three were breast fed at the time of their death. Sex sub-division shows little of interest except for deaths in the first week where there was a preponderance of males. Prematurity, gastro enteritis and bronchitis account for no less than 40 of the 58 infantile deaths. It is somewhat difficult to generalise as to the cause of prematurity. It is probably associated with a way of life and possibly with toxaemia or abnormalities of pregnancy, and I believe that there is evidence to show that it diminishes as social amenities improve. Gastro-enteritis and broncho-pneumonia are diseases that should be preventable in babies. It is to the prevention of the above three conditions that we must look for a reduction in our infantile mortality to a level comparable with that obtained in parts of American and the Scandinavian countries before the War. A low infantile mortality rate does not mean the survival of the unfit. It means that the health of the children in a community has been so improved in all directions as to enable its youngest members, i.e., those most susceptible to disease to resist infection or overcome it. During July, Circular 2831 was received from the Ministry of Health. It deals with the cleanliness and habits of children under the age of five years, makes recommendations as to the steps that might be taken to improve them where they are bad, and asks that a reference to the subject be made in the Annual Report of the Medical Officer of Health. It will be remembered that a prior Circular on this matter was issued in 1941 when an investigation was carried out by the Health Visitors as to the condition of cleanliness in children under five years in Enfield. This investigation had shown that there were very few children in the district under five years of age whose heads were infested with nits or vermin. Upon receipt of Circular 2831, I called a meeting of the Assistant Medical Officers and the Health Visitors to discuss the position in Enfield and to take such steps as might appear desirable. At this conference it was determined to see if we could 21 ascertain the position from another angle and to investigate the condition of school entrants who had been examined at routine inspection quite shortly after their admission to school. This investigation was carried out by Doctor Butler who examined 453 such entrants. It is interesting to note that only four of them were found to be suffering with nits and that none had vermin. A further step that was taken was the examination of children who had been admitted to our war-time nurseries during 1943. The total admissions amounted to 422. The Matrons of the lespective nurseries informed me that of the children admitted six had nits and six were refused admission because they were verminous. It must be presumed that in the case of the six admitted the infestation was so mild that it could be treated immediately without risk of transmission to other children. This position is not quite so good as that reported in the case of school entrants. I also enquired of the Matrons of the Nurseries as to the habits and clothing of the children whom they admitted. The reports generally seem to show that there was no need to iefuse any child on account of unsatisfactory or dirty clothing. Some children were unsuitably clothed and the parents responded to advice given them in this respect. The Matrons agree that generally 75 per cent. of the children admitted were trained in good habits. On the other hand there were very few children who had been instructed in the regular washing of the hands after evacuation of the bowels or bladder, and few were accustomed to the routine use of a tooth brush. This is somewhat unfortunate and bears out the suggestions in the Circulai that if good habits and cleanliness are to be inculcated into young children the morning and evening toilet with their routine of undressing, cleaning the teeth, washing, saying prayers and getting into a clean bed in a well ventilated bedroom ; waking in the morning, washing, dressing, cleansing of the teeth, breakfasting, opening of the bowels and rewashing-are the most important hygienic habits a young child has to learn. Parents must be taught to realise the importance of these bedtime and early morning hours in the training of their children. The experience of some of my colleagues in the reception areas has shown that there are far too many children whose idea of going to bed is to take off their shoes and some of their outer clothing and get into bed ; whilst getting up in the morning consists of replacing these clothes, possibly douching with cold water and having a piece of bread with peihaps some jam as they hurry off on their way to school. I do not think these conditions apply in Enfield but in order 22 to fuither the recommendations of the Circular the card index system which the Health Visitors have for the children on their district has been divided into three groups. Group A consists of healthy children in satisfactory homes who need only to be visited on the request of the mother ; Group B consists of healthy children in reasonably satisfactory homes who will need to be visited regularly every six months at least ; Group C are children in unsatisfactory homes who need constant visiting and supervision. Arrangements have also been made whereby Health Visitors are informed of homes where school children have been excluded from school on account of verminous conditions. On the whole our investigations would show that the district of Enfield is reasonably satisfactory, for which credit must be given not only to our Health Visitors and School Nurses but also to the whole of the Enfield teaching staff, and, of course, the parents. This does not mean, however, that there is no room for improvement. In Enfield individual attention to particular homes is now required rather than mass propaganda to the district as a whole. The real value of a maternity and child welfare service in a district is easily assessed by reference to the condition of children when they enter school at the age of five years. During the course of the year I have attempted to see what the position is in Enfield. Of the 453 children examined shortly after admission to school 77 per cent. had already been immunised against diphtheria. In a further 6.6 per cent. there was some uncertainty because the parents were not present at the routine inspection. This is a figure which is reasonably satisfactory and may account for the fact that only five cases of diphtheria were notified in the whole district during 1943, not one of whom had been immunised against this disease. As regards the nutrition of our entrants 90 per cent. were either of normal nutrition or of excellent nutrition; 8.7 per cent. were found to be slightly below par and this percentage included children who had recently had an illness temporarily reducing their vitality. Six children, i.e., 1.3 per cent. showed malnutrition. The children below par and those suffering from malnutrition were followed up at our clinics. As regards the throat condition of the entrants 71.3 per cent. had normal throats, 10.1 per cent. had already had their tonsils removed making a total of 81.4 per cent. Of the remainder, 6.6 per cent., i.e., 30 children needed to have an operation for removal of tonsils and adenoids, leaving 12 per cent. who were placed on a list for further observation. 23 Very few orthopaedic defects were found, none of them serious. There were in fact only 8 cases of knock-knee which needed observation. A reference to the condition of teeth in school entrants and the improvement that has taken place will be found in another part of this report dealing with the school medical service. This survey of our entrants shews that generally children are entering our schools in sound nutrition with but a few defects which should have been remedied before entering school. In most cases treatment has been offered to the parents but had been refused. I know that the Committee will not be satisfied until all our children attend school completely sound in wind and limb, and that the present situation should not cause us to adopt an attitude of complacency but should be an encouragement to an intensification of our present efforts. Once again I would ask the Committee to accept my thanks for their courtesy throughout the year. It has been very pleasant to realise not only during 1943, but in all other years, that any suggestion I might make for the betterment of the Health of the women and children of the district would always be received not only w'th encouragement and help but also with enthusiasm I am, Ladies and Gentlemen, Your obedient Servant, D. H. GEFFEN, Medical Officer of Health. 24 BIRTHS. 1943 1942 Live births 1,908 1,774 Still births 57 50 INFANT MORTALITY. Number of deaths of children under 1 year 91 The infant mortality rate was 47.69 PUERPERAL PYREXIA. During the year eight cases of puerperal pyrexia were notified, five of which were removed to hospital. MATERNAL MORTALITY. There were six maternal deaths resulting from Pregnancy, all of whom 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. 10 — Tughan, Dr. & Mrs. 29, Derby Road, Ponders End. 6 6 These homes were inspected by your Medical Officers during the course of the year. ADMINISTRATION OF MIDWIVES ACT, 1902-36. At the end of the year 1943 there were sixteen Midwives practising in Enfield. Fifteen were employed by the Council as whole-time Municipal Midwives and one was employed in a private Nursing Home. The Midwives were visited regularly by the Medical Officers and their records and equipment inspected. 25 The following table shows the cases attended during 1943 and 1942. MUNICIPAL MIDWIVES. 1943. 1942. Cases attended as Midwives 678 747 Cases attended as Maternity Nurses 316 210 PRIVATE MIDWIVES. Cases attended as Midwives 108 59 Cases attended as Maternity Nurses 4 12 NOTIFICATIONS. In accordance with the rules of the Central Midwives Board, the following notifications were received from Midwives:— 1943 1942 Sending for Medical Aid 198 222 Still Births 9 7 Laying out of the Dead 4 5 Artificial Feeding 18 1 Liability to be a source of infection 9 6 Notification of death 4 — The notifications in connection with Medical Aid can be classified as follows:— During Pregnancy 8 During Labour 125 During Lying-in Period 25 Infant 40 HELP WITH COST OF MIDWIVES' FEE. During the year 164 cases were helped with the cost of their Midwife's fee, compared with 120 in 1942. OBSTETRIC SPECIALIST. In two cases 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 18 cases. The 26 Home Help Scheme was abandoned on the 28th August, 1943 owing to inability to obtain suitable persons to do the work, despite increase in the remuneration offered. BIRTH CONTROL During the year your Medical Officers have been prepared to give advice on this subject in accordance with the authority given by the Minister of Health in memorandum 153 M. and C.W. and Circulars 128 and 1408. CIRCULATION OF BOOKLET ON REARING OF CHILDREN. The booklet "To Mothers and Fathers" was circulated as heretofore. ANTE-NATAL CLINICS. During the year 2,202 mothers attended the Enfield AnteNatal Clinics. This number included some mothers whose confinement had not taken place by the end of the year. POST-NATAL CLINICS. During the course of the year 447 mothers attended for examination after their confinement. This compares with 376 in 1942 and 218 in 1941. This examination takes place by appointment six weeks after the confinement and is an attempt to secure that a complete recovery to normal health has been made. Appointments are given to all those mothers whose confinement has been conducted under the responsibility of one of the Council's Midwives and also to those whose confinement took place in the North Middlesex County Hospital. Appointments are not made where the confinement has been conducted by a private practitioner. The attendance of 447 mothers represents about a 40 per cent, acceptance. This is an encouraging figure although it is not as high as it should be. INFANT WELFARE CENTRES. The total number of children who made their first attendance at the Infant Welfare Clinics was 1,822. 27 VISITS. The Council's Health Visitors paid 495 visits to Expectant Mothers, 2,223 to children under one year of age, and 6,900 to children between the ages of one and five years. MILK AND ACCESSORY FOODS SUPPLIED. 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 960 lbs. cost £84 7s. 8½d. In addition 40 lbs. of other food adjuncts were supplied in cases where the products supplied by the Ministry of Food were not satisfactory for the individual cases. 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 1943 was 2,210 as compared with 2,034 in 1942. AURAL TREATMENT. Mothers and children under 5 years of age suffering from aural defects were referred to the School Ear, Nose and Throat Specialist. The following is a summary of the work carried out during 1943. No. of cases dealt with 61 No. of new cases 44 Total number of attendances 103 No. of cases discharged cured 58 No. of cases still under treatment 3 No. of cases referred for removal of adenoids 7 No. of cases referred for removal of tonsils and adenoids 7 No. of cases nil abnormal discovered 5 OPHTHALMIC TREATMENT. The scheme whereby ante-natal and nursing mothers and 28 children under 5 years with eye defects are referred to the School Ophthalmic Surgeon continues. The following are particulars of the cases so referred during the year 1943. Total attendances 192 New cases 107 Prescriptions for glasses 45 No glasses required 12 Attendances other than for refraction 62 Referred to hospital 14 SPEECH CLINIC. Six children were referred to the Speech Clinic for defects and treatment, if necessary. CHILD LIFE PROTECTION—PUBLIC HEALTH ACT, 1936. At the end of 1943, fourteen persons in Enfield were receiving children for reward. The total number of children concerned was fourteen. Each of these was visited at least monthly by the Infant Life Protection Visitors (Health Visitors). DENTAL TREATMENT. 793 attendances were ma de at the Dental Clinics by Ante-natal and Nuising Mothers, and 206 by children. Dentures were provided for 71 mothers. CONVALESCENT TREATMENT. Four children and one mother were sent away to Convalescent Homes. EVACUATION OF EXPECTANT MOTHERS. The London County Council scheme whereby expectant mothers in the evacuable part of Enfield are evacuated into the country for their confinements continued throughout the year, 118 mothers being so registered for this purpose. The scheme has worked extremely well and the mothers have appreciated the facilities afforded them. 29 ORTHOPAEDIC TREATMENT. During the course of the year 28 children suffering from Orthopaedic defects received treatment either from the Officers of the Council or as a result of reference to hospital. The following are the conditions from which they suffered:— Knock knees (genu valgum) 17 Bow legs (genu varus) 4 Flat feet (pes planus) 3 Metatarsal varus 1 Little's disease 1 Deformity of toes 1 Deformity of limbs (neurological cause) 1 DIPHTHERIA IMMUNISATION. The campaign for the immunisation of children against diphtheria continued throughout the year. No less than 1,322 children under the age of five years were so immunised during 1943. On a child's first birthday it is the practice to send him a birthday card and to invite him to attend at one of the Maternity and Child Welfare Clinics to be medically examined and immunised against diphtheria. It is pleasing to note that these invitations are well accepted. All children when reaching the age of 4½ yeais are now invited to attend the Maternity and Child Welfare Clinic, not only for their routine examination, but also to be immunised or to receive a supplementary reinforcing dose. WHOOPING COUGH IMMUNISATION. During the course of the year we have received requests from 66 parents that we should immunise their children against Whooping Cough and these requests have been met. In another section of my report I have referred to the fact that immunisation against Whooping Cough by means of inoculation is not wholeheartedly accepted by the medical profession as entirely or partially successful. I have thought it advisable to immunise all the children entering our War-time Nurseries and this has largely been done. Despite this some of the children have suffered from Whooping Cough, admittedly mild in character but it has not been necessary to close any of our Nurseries. I am not, however, prepared to state that 30 the mildness of the attack from which our children have suffered is a direct cause of the immunisation that has been carried out. DISTRIBUTION OF VITAMINS. The distribution of orange juice, cod liver oil and Vitamin A capsules to ante-natal and nursing mothers and children under 5 years of age is carried out in Enfield at each of the Council's six Maternity and Child Welfare Centres and at the Central Food Office and each of its two sub-offices. In this way it has been possible to secure adequate facilities for all the residents of the district. During the course of the year the following has been distributed through these centres:— Orange Juice 131,343 bottles Cod Liver Oil 16,835 bottles Vitamin A capsules 2,633 packets ILLEGITIMACY. Circular No. 2866 from the Ministry of Health was received during the year. In this Circular it was suggested that a scheme be devisea possibly in conjunction with other Authorities, for the better care and protection of the illegitimate child. Contact has been made with the Middlesex County Council and it is hoped that a combined scheme may be in operation during 1944. ADOPTION ACT. During the course of the year we have received requests from Adoption Societies that we should investigate homes at which persons are living who are desirous of adopting children. In all cases these homes have been visited by our Health Visitors and confidential reports submitted to the appropriate Association. On the whole these reports have shown that the homes have been satisfactory and that a real and genuine desire has existed for the adoption of a child. This desire has in most cases been due to the fact that the marriage of the persons concerned has been childless. It has been suggested that the increase in the number of requests for adoption since the outbreak of war, which is, I understand, very striking, is due to a far less satisfactory cause. The cases investigated in Enfield do not bear out this supposition. 31 WAR-TIME NURSERIES. At the end of 1943 there were three War-time Nurseries in Enfield. Name of Nursery. No. of Places. Average Attendance. Suffolks, opened December, 1941 60 45 Green Street, opened July, 1942. 60 46 High Street, opened July, 1943. 60 40 A further Nursery was nearing completion towards the end of the year and was in fact actually opened in February, 1944. The children in the Nurseries have been immunised against Diphtheria and Whooping Cough. No case of Diphtheria occurred in any of the children but some contracted Whooping Cough. Coughs and colds were frequent but I doubt if more so than amongst the under 5 population generally. Some children also contracted Measles which was epidemic during the year. War-time Nurseries are not ideal in the hours they are open, nor in their construction, and it would be unfair to judge the "Nursery for children under 5" on such standards. It must be remembered that the War-time Nursery was erected in order to enable mothers with young children to go to work. This is its primary object. Despite all this it is a fact that children in our Nurseries have maintained a satisfactory standard of nutrition which I think would be bettered if the Nurseries opened later, closed earlier, and were erected on a standard appropriate to peace-time needs. The future of the Nursery for children under 5 is uncertain. It is generally accepted that the best place for such children is in a good home with parents who have been educated in, and understand their needs. This does not mean of necessity that the future will hold no place for the Nursery as such. There are certain mothers, who, apart from the needs of the country in war-time will need or desire to work in peace-time. It is argued that if England is to obtain the increase in population that is required to secure that the English shall survive as a race it is essential that mothers must receive at least some relief from the continuous responsibility of the care of their children. The first thing that parents achieve when they can afford it is the employment of a nurse. This is not due to lack of fondness for their children but a realisation of the fact that for one person to bring up several children satisfactorily constitutes more than a whole time task. ANNUAL REPORT of the SCHOOL MEDICAL OFFICER DENNIS H. GEFFEN, M.D., D.P.H. For the year ending 31st December, 1943 34 MEMBERS OF THE ENFIELD EDUCATION COMMITTEE. 1943-44. 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, M.B.E., F.C.A., C.C. Mr. H. G. Short Mr. E. S. Stock Co-optative Members. Mrs. L. Daines. Mrs. I. G. Dufton Miss Z. Smee Mrs. A. L. Henry Mrs. E. M. Toomer Mr. A. J. Crofts. Mr. A. J. Neaves Mr. B. D. Bowyer Director of Education. E. Pascal, Esq., M.A. 35 STAFF OF THE SCHOOL MEDICAL DEPARTMENT. School Medical Officers: Dennis H. Geffen, M.D., B.S., D.P.H., M.R.C.S., L.R.C.P. Assistant School Medical Officers: Brenda M. Mayes, M.B., B.S., D.P.H., M.R.C.S., L.R.C.P. Lilian Rivlin, M.R.C.S., L.R.C.P. Dora M. Butler, M.B., B.S., D.P.H., M.R.C.S., L.R.C.P. School Dentists: C. E. James, L.D.S., R.C.S.(Eng.). H. Mackay, L.D.S. C.' A. Martinez, L.D.S. (Resigned 29.11.43.) 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. (Released) F. Popper, M.D. (Prague) Specch Therapist : Miss E. Richnell, L.R.A.M., A.S.S.T., M.A.S.T. School Nurses: I. Fowler, S.R.N. V. Murphy, S.R.N., S.C.M., M.S.S.Ch. M. Hilton, S.R.N., C.M.B. New H.V.'s Cert. (Resigned 28.11.43.) E. Horgan, S.R.N., C.M.B. Dental Nurse: F. Anderson, R.S.C.N. Dental Attendants: M. Freeman. M. A. Morter (Appointed 22.3.43.) Clerks : H. Pearson (Resigned 30.11.43.) E. Williams (Resigned 2.12.43.) A. Cooper (Appointed 8.11.43.) 36 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, 1943. To the Chairman and Members of the Enfield Education Committee. Mr. Chairman, Ladies and Gentlemen, I beg to submit my report for the year ending 31st December, 1943. The picture I am able to draw of the health of the school children in Enfield is on the whole a bright one. The percentage of those found at routine inspection to be suffering from malnutrition in slight form, dropped from 19 per cent, to 13.7 per cent, during the year. In one respect, however, I am not so satisfied. There has undoubtedly been an increase in skin infections, such as impetigo, scabies and other such lesions, and this is well marked. Whilst I am not inclined to be definite as to the cause, I feel that it may be associated with housing difficulties and with increased employment of parents, especially mothers who are doing overtime and are thus kept away from their homes and the care of the children. It may be associated with soap rationing, though this I very much doubt. It has, however, been marked during the year and has involved considerable work at our minor ailment clinics. The School Medical Department is being consulted concerning the care of difficult and defective children in increasing numbers and in one or two cases we have had the help and assistance of Child Guidance Clinics. There is no doubt that a large number of children are not deriving all the happiness they should from their home life on account of housing difficulties and in particular 37 through parents who lack understanding of a child's mind. There have been some parents expecting more from their children than they could achieve, others trying to provide an education for them of a type from which they could never benefit, with consequent disappointment to the parents and unhappiness to the children. I have seen children persistently nagged by parents who, whilst expecting them to behave as angels, would be worried if they succeeded in their expectations. I have, unfortunately, had to console many a parent whose child was either an imbecile or an idiot. I still notice the repeated fear of parents of mentally defective children that the Local Authority is going to take their children away from them and put them in an institution. It is surprising how deep rooted this fear is and over and over again I have found it necessary to assure parents that no Local Authority desires to take a child from its parents provided that the child is being well looked after and progressing satisfactorily in its own home. It has been pathetic to have mentally defective children brought to me, unable to talk, yet well clothed, neat and tidy and well cared for by parents with a sense not only of duty, but a feeling of deep affection, whose initial remark has been " you are not going to take him away from me, are you Doctor ?" No too wide publicity can be given to this subject in order that parents may realise that the object of the Local Education Authority is primarily to help and but very rarely to admonish. Mr. James, the Senior Dental Surgeon, in his report to me remarks on the number of children requiring orthodontic treatment, i.e., dental regulation treatment. Cases so treated, he states, could be greatly increased if more time were available, for no treatment is more appreciated by parents than that concerned with the regulation of the teeth. Success in this work can be measured not only in the great improvement in appearance that results, but also in the preservation of the teeth. Mr. James has previously referred to the improvement of the condition of the teeth of school entrants since the outbreak of war, and in his opinion, this improvement is still maintained. In some schools, the percentage of entrants found dentally fit on their first examination has improved considerably. At George Spicer School this percentage was 2.19 in 1938 and in 1943 it was 20.17 ; at Southbury Road, the figure has improved from 2.4 to 27 ; at Alma Road from 4.7 to 22 and at Chase Side from 19 to 25. In addition to this, the number of teeth found to be carious or lost at the 5 year old inspection is between one or two per child less than in 1938. 38 I should find it hard, as would Mi. James, to give you definite reasons for this satisfactory state of progress. We would suggest, however, that changes in diet and the absence of sweets in quantity are largely responsible. I, personally, would add one further suggestion—the children who are being seen as school entrants to-day are the children who have been looked after by Maternity and Child Welfare during the past 5 years, that is, during 4½ years of war. They have been looked after not at nursery schools, not in any large number in war time nurseries, but in their own homes by Health Visitors, and also by attendance at welfare clinics. They are children whose diet has been regulated largely by the Ministry of Food in consultation and with the advice of the Ministry of Health. The Members of the Committee will be aware that for every child under 5 there is provided a special ration of milk, orange juice and vitamin D in the form of codliver oil at reduced cost, or even free, and there has been considerable propaganda to drive home to mothers and fathers that if their children are to be healthy, these food or vitamin supplements are absolutely essential, in a wiser diet, in more regular meals, and in the regular taking of these vitamins may lie the cause of the improvement we have found in the teeth of children aged 5 years. The Committee will realise that in a comprehensive report of this description I am indebted to the Assistant Medical Officers for much of the information that is set out therein. My remarks on children suffering from crippling defects are based on a report submitted to me by Dr. Mayes. Throughout the course of the year she has made these children her especial care. She has not only followed them to hospital, but she has visited them in their homes and secured that they have had every facility to enable them to make as complete a recovery as their condition will allow. Dr. Butler has presented me with a report on children found to be suffering from abnormalities of the heart. Her very careful survey of these children has enabled me to increase the activities of some children who have made a complete recovery and to regulate the life of others who need especial care. The Committee will know that the care of the physically or mentally defective child has always been a problem in which I have taken a particular interest and the assistance of both Dr. Mayes and Dr. Butler has been very helpful in this direction. The same remarks apply to Dr. Rivlin, to whose work I have referred in particular in another part of this report. During the course of the year we lost the services of Mrs. 39 Pearson and Mrs. Williams, the Senior and Junior Clerks in the School Medical Department, both of whom had recently married. I would like to pay a tribute to Mrs. Pearson, who, as Miss Ogilvie, came to us about 16 years ago. No Education Committee had a more faithful servant. No work was too much trouble for her. Not only was she a capable Clerk to me and my Medical Assistants, but she was well liked by all the nurses and teachers with whom she came in contact. The children of Enfield owe much to the work she did here. We wish her well and all happiness in her married life. Miss Ogilvie is replaced by Miss Cooper, who has been transferred from the Engineer and Surveyor's Department, to the position of Senior Clerk in the School Medical Department. We were also sorry to lose Mrs. Williams, who, as Miss Allen, had been in the School Medical Department since March, 1939. Her very pleasant and charming manner and her efficiency made her an excellent Junior Clerk who was always prepared and able to undertake with capability senior work when the occasion arose. Her position has not yet been permanently filled. In the general improvement in the health of school children there is one factor which must be considered as of equal importance as treatment clinics and medical aids, and that is the provision of school meals. During the course of the year no less than 2,770,741 1/3 pint bottles of milk were consumed in school by our children : no less than 633,530 mid-day meals were provided. An average child needs three things to thrive well physically and mentally. Affectionate and wise parents, a good home and good food. The Education Committee can help to provide wise parents by giving sound teaching in parenthood to its elder students, a task that will be made easier when the school age is raised and Young People's Colleges are instituted. The provision of good homes lies with the Council rather than the Education Committee, but the Education Committee can, and has provided, school meals on a large scale and many of the figures of this report pay testimony to the value of this work—a combination of the foresight of the Committee, the administration of the Director and the hard work of the teachers. To all three am I deeply indebted, as to my staff, for the help and courtesy I have received during the past year. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, DENNIS H. GEFFEN, School Medical Officer. 40 REPORT OF THE SCHOOL MEDICAL OFFICER Average number on books of Elementary Schools 12,205 Average weekly attendance 10,213 Number of Schools 22 ROUTINE MEDICAL INSPECTION. The total number of children examined during the year was 5,169. 73.2 per cent, of the children examined were accompanied by their parents, and 28.5 per cent, were vaccinated. DEFECTS FOUND AT ROUTINE MEDICAL INSPECTION. Requiring Treatment. Requiring to be kept under observation. Enlarged tonsils and adenoids 222 62 Enlarged tonsils only 38 266 Adenoids 1 14 Other nose and throat conditions 8 5 Conjunctivitis 2 — Blepharitis 17 1 Other Eye Conditions 6 — Enlarged Cervical Glands — 10 Scabies 19 — Impetigo 25 — Other Skin Conditions 12 1 Defective Hearing 16 3 Otitis Media 8 1 Other Ear Conditions 3 — Defective Speech 16 9 Defective Vision 216 309 Bronchitis 9 9 Other Lung Conditions : Non-tuberculous 9 65 Organic Heart Disease — 10 Functional Heart Disease — 5 Anaemia 1 18 Chorea — — Epilepsy 2 — Other Nerve Conditions — 6 Spinal Curvature 17 7 Other Deformities 99 56 Other Diseases and Defects 31 48 41 Uncleanliness. Of 5,169 children examined 3 were found o have vermin in their heads, and 107 had nits, i.e., 2.18 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 5,169 Number of children classified "A" 596 Percentage of children classified " A " 11.5 Number of children classified " B " 3,868 Percentage of children classified " B " 74.8 Number of children classified " C " 578 Percentage of children classified " C " 11.2 Number of children classified " D " 127 Percentage of children classified " D " 2.5 A Excellent B Normal C Slightly sub-normal D Bad INFECTIOUS DISEASE. Measles 347 German Measles 2 Mumps 3 Whooping Cough 20 Chickenpox 2 Scarlet Fever 271 Diphtheria 1 Poliomyelitis 1 Cerebro-spinal Meningitis 3 THE WORK OF THE SCHOOL NURSES. Number of home visits 2,173 Number of school visits 388 Number of school visits for routine examination of heads 200 Total number of heads examined 43,206 Number of individual children found unclean 947 Number of cases in which legal proceedings were taken — 42 TREATMENT CLINICS. Tonsils and Adenoids :— Number of cases seen at clinic; 631 Number of cases operated under the Authority's Scheme 433 Ringworm,.—Thirteen cases were seen and treated at the clinics. Impetigo.—Two hundred and eighty six cases were treated at the clinics. Scabies.—One hundred and twenty nine cases were seen. Other Skin Diseases.—Six hundred and ninety nine cases were seen and treated at the clinics. Eye Diseases.—Two hundred and twenty nine cases were treated. Ear Diseases.—One hundred and sixty nine cases were seen at the Minor Ailment Clinics. Minor Injuries.—Two hundred and ninety five cases were seen and treated at the Clinics. Children examined after Scarlet Fever.—One hundred and fifty children were seen. Jaundice.—Fourteen cases were seen at the Clinics. The total number of children examined during the year, excluding those attending the Dental Department, was 10,545. This number was made up as follows:— Examined at Routine Medical Inspection 5,169 Examined at Minor Ailment Clinics 4,173 Examined at Ophthalmic Clinic 944 Examined at Aural Clinic 192 Examined under Juvenile Employment Bye-laws 28 Examined under Mental Deficiency Act 39 43 The following help was afforded to children who were found to require it:— Fourteen children were sent to residential schools for physically defective children. ORTHOPAEDIC CLINIC. During the course of the year 24 children were found to be suffering from orthopaedic defects needing treatment or observation. The following cases were referred to a special clinic, held at a local hospital, where they were seen by an Orthopaedic Specialist :— Curvature of Spine 5 Paralysis after poliomyelitis 3 Genu Valgum 3 Hammer toe 2 Sherman's Disease 2 Congenital Asymetry of Limbs 1 Talipes equino-varus 1 Spasmodic pes planus 1 Still's Disease 1 Hallux Valgus 1 Hallux Rigidis 1 Spastic Diplegia 1 Deformity of 5th Toes 1 Congenital shortening of limb 1 Ten other cases as set out below received treatment through the Schools Medical Service alone or in conjunction with other hospitals. Talipes equino-varus 2 Curvature of Spine 2 Paralysis after Poliomyelitis 2 Pes Planus 2 Spastic Paraplegia 1 Genu Valgum 1 The Education Committee aided in the supply of seven surgical appliances. 44 CARDIAC CLINIC. During the course of each year a number of children are found to be suffering from abnormalities of the heart which may or may not be pathological, i.e., a result of disease, and it was determined to give each of these children a special examination. In all, 63 such children were examined. Of these, 33 were found to have no permanent cardiac defects, the condition of the heart at the primary examination having been due to some temporary debility from which recovery was complete. In 10 other cases, the condition present was not due to any abnormality of the heart. The remaining children were kept under observation, except in one case, where it was considered inadvisable that the child should remain at school. SPEECH CLINIC. A clinic for children suffering from defective speech is held twice a week. During the course of the year 32 children received treatment. Of these 5 were discharged cured, 7 made marked progress and 4 satisfactory progress ; the remaining 16 either left the district, went to special schools or made so little progress that it was not considered profitable to continue treatment. There is still a long list of children waiting to be treated. Of the children treated the following are the defects from which they were suffering : Stammerers 8 Cleft Palate 3 Motor Aphasia 2 Poor speech due to mental retardation 2 Lispers 2 Dyslalia 15 DEATHS AMONGST SCHOOL CHILDREN. There were ten deaths among school children during the year. The causes were as follows :— 3 Appendicitis. 1 Cerebral Convulsions. 1 Leukaemia 1 Septicaemia 1 Pyaemia 1 Meningitis. 2 Accident. (1 Road. 1 Ether convulsions during operation.) 45 PROVISION OF MEALS. Meals were provided for children at all the schools. During 1943 24,704 dinners were provided free, and 608,826 were provided and paid for. 2,770,741 1/3 pint bottles of milk were provided and paid for, and 46,681 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. Eleven children are in attendance at Philip Lane School for the Deaf, Tottenham ; these may be classified as follows:— 6 suffering from acquired deafness. 5 suffering from motor aphasia. Thirty-nine children were examined under the Mental Deficiency Act (1913) during 1943. These were scheduled as follows:— Dull and backward but capable of instruction in an elementary school 4 Mentally defective but capable of instruction in a special school 19 Incapable of further instruction in a special school 1 Imbecile 9 Not scheduled (to be seen again) 6 EXAMINATION AND TREATMENT OF SECONDARY SCHOOL CHILDREN. Average number on books of Junior Technical School 300 Average number on books of Grammar School 622 Average number on books of County School 510 46 The number of children examined in the course of Routine Medical Inspection at the secondary schools was as follows:— Junior Technical School 273 Grammar School 452 County School 205 The classification of the nutrition of these children was as follows:— School. Classification. "A" " B " " C " " D " Junior Technical 70 184 19 - Grammar 94 311 14 3 County 11 173 20 1 The following defects were found:— Defects. School. Jnr. Technical. Grammar. County. Defective Vision 47 96 67 Defective Hearing 1 2 — Functional Heart Disease 1 — 1 Kyphosis — #' — Other Deformities 32 21 16 Blepharitis - 2 1 Impetigo — •— — Enlarged Tonsils '— 3 5 Enlarged Glands — 7 2 Anaemia 1 — •— Other Diseases and Defects 4 13 10 Dental Caries 1 1 — Defective Speech 1 1 — » Organic Heart Disease — 1 — Four hundred and sixty-six children were treated at the School Dental Clinic and one hundred and fifty-seven at the School Ophthalmic Clinic during 1943. 47 SCHOOL DENTAL CLINICS. Elementary Schools. Secondary Schools. Number Inspected 10,326 433 Number Treated 4,842 466 Number of Fillings 7,086 907 Number of Extractions 6,970 271 SCHOOL OPHTHALMIC CLINIC. Elementary Schools. Secondary Schools. Total attendance 1,662 260 New Cases 944 170 Prescriptions for glasses 315 72 Number not requiring glasses 133 11 Sixteen children were referred to the Western Ophthalmic Hospital for operation for squint, and two children attended the hospital for investigation of other eye conditions. SCHOOL AURAL CLINIC. Number of cases dealt with 302 Number of new cases 192 Total number of attendances 715 Number of cases discharged cured 182 Number of cases of a recurrent nature requiring occasional treatment 4 Number of cases still under treatment 97 Number of cases who have refused treatment, or sought treatment elsewhere 10 Entield: Stanley Woodfield Printer 8-12 Windmill Hill