AC 439 ENFIELD (Later Mum.B. ENF.28 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 1944 1 2 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 1944 1 2 1 URBAN DISTRICT COUNCIL OF ENFIELD. E. S. Stock, Esq., J.P. Chairman W. G. Bowyer, Esq. Vice-Chairman Mrs. G. M. Jay, J.P D. Mason, Esq. H. Muspratt, Esq., O.B.E. T. H. M. Clarke, Esq. C. Partington, Esq., J.P., W. C. Bennett, Esq. M.R.S.T. H. Thompson, Esq. S. G. Rowlandson, Esq., M.B.E. W. S. Williams, Esq. F.C.A., C.C., J. Cottenham, Esq. H. A. D. Brown, Esq. C. H. Thomas, Esq. F. G. Greenwood, Esq. W. F. Lawrence, Esq. fH. H. Collier, Esq. W. Graham, Esq. A. R. Kemp, Esq. Mrs. E. M. Squire, C.C. A. M. Eeles, Esq. W. G. Jollie, Esq. L. R. Morris, Esq. H. G. Short, Esq. F. C. Watts, Esq. Derek Parker-Bowles, Esq. W. H. Bishop, Esq. H. D. Hyde, Esq. † Deceased. HEALTH COMMITTEE. H. Muspratt, Esq., O.B.E Chairman also Mrs. Jay, and Messrs. Bennett, Bowles, Brown, Greenwood, Jollie, Kemp and Watts. STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 12,400 2 POPULATION. The population as estimated by the Registrar General at the middle of the year was 92,760. The number of inhabited houses at the end of 1944, according to the Rate Books, was 29,820. The rateable value of the District is £918,498 The net product (after allowing for cost of collection) of a penny rate is £3,717 15s. 9d. SOCIAL CONDITIONS. The number of houses erected during the course of the year was 1. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total Male. Female. Legitimate 1,886 993 893 Illegitimate 65 35 30 Birth-rate—21.03 per 1,000 population. Still Births:— Total. Male. Female Legitimate 30 14 16 Illegitimate 5 4 1 Rate per 1,000 total births—17.62. Total. Male. Female. Deaths 987 513 474 Death-rate—-10.64 per 1,000 population. Number of women dying in, or in consequence of, childbirth:— Rate per 1,000 Deaths. Total Births. From Puerperal Sepsis 0 0.00 From other Puerperal causes 0 0.00 0 0.00 Death-rate of Infants under one year of age:— All infants per 1,000 live births 29.21 Legitimate infants per 1,000 legitimate live births 28.10 Illegitimate infants per 1,000 illegitimate live births 61.53 Deaths from Cancer (all ages) 150 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 4 Deaths from Diarrhoea (under 2 years of age) 8 3 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 Eingland and Wales 17.6 0.50 11.6 46.00 London 15.0 0.42 15.7 61.00 126 County Boroughs and Great Towns (including London) 20.3 0.64 13.7 52.00 148 Smaller Towns 20.9 0.61 12.4 44.00 ENFIELD 21.03 0.37 10.64 29.21 DEATHS. Of the 987 deaths of Enfield residents during the course of the year 150 were due to malignant diease: 249 to heart disease: 43 to pneumonia (all forms), 49 to bronchitis; 96 to Intra-cranial vascular lesions; 47 to tuberculosis of the respiratory system; and 50 to other diseases of the circulatory system. INFANT MORTALITY. Of the 57 infants who died before attaining the age of one year, 27 died within the first week of life. In 2 cases death was due to Pneumonia: in 11 to Congenital Malformation: in 16 to Premature Birth : in 2 to Atrophy, Debility and Marasmus and 9 to Enteritis. INQUESTS. Sixty-two inquests and sixty-nine P.M.'s without inquests were held on Enfield residents during the year. Out of these, 72 deaths were due to natural causes, 44 to accidental causes, 7 to suicide, 4 to misadventure, 3 to open verdict, and 1 to inattention at birth. AMBULANCE FACILITIES. For infectious Cases: 239 patients were removed from Enfield during the year. 2,907 other patients were conveyed during the year to local hospitals. 4 LABORATORY FACILITIES. The following work was carried out in the Council's laboratory during the year. Specimen. No. Positive. Negative. Percentage of Positives. Swabs 625 7 618 1.12 Sputa 151 6 145 3.97 Totals 776 13 763 1.67 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 1944 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 31 Number granted permission to sub-let 30 Number refused permission 1 Number of visits made by Sanitary Inspectors 6 INFECTIOUS DISEASES AND SCHOOLS. Number of children notified to be absent from School due to suspected Infectious Disease 38 Number of children found to be suffering from Infectious Disease 25 This compares with the following figures for last year:— 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 5 HOUSING. Number of New Houses erected during the year:— (a) Total (including numbers given separately under (ft)) 1 (i) By the Local Authority Nil. (ii) By other Local Authorities Nil. (iii) By other bodies or persons 1 (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 Hotises:— 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 1,792 5,987 (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 782 (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 675 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 1 6 (2) Number of dwelling-houses which were rendered fit after service of formal Notices:— (a) By owners Nil. (b) By Local Authority in default of Owner 1 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 59 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices:— (a) By Owners 53 (b) By Local Authority in default of owners 6 The number of house-to-house inspections made was:— Under Housing Regulations, 1925 and 1932 Nil. THE MILK (SPECIAL DESIGNATIONS) ORDERS, 1936 and 1933. There are 23 Purveyors of Milk who sell or distribute Pasteurised Milk in the district. Samples of milk have been taken and tested SLAUGHTER-HOUSES. There are eight slaughter-houses in Enfield, none of which is in use at present. During the course of the year 192 carcases were examined, and the surrender of 3 carcases and 75 parcels of diseased organs were secured. The weight of these carcases and parcels was 1 ton 7 cwts. lqtr. 71bs. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The number of cases of Scarlet Fever was 219, compared with 408 in 1942: of Diphtheria 11, as compared with 5; of Pulmonary Tuberculosis 125, as compared with 126; and of Pneumonia 50, as compared with 59. There were no deaths from Diphtheria during the year, as was also the case in 1943. There were no deaths from Scarlet Fever during the year, as was also the case in 1943. 7 NOTIFIABLE DISEASES DURING THE YEAR 1944. No. Removed. ] Deaths Smallpox — — — Cholera—Plague - - - Diphtheria (inc. Membranous Croup 11 11 - Diphtheria Carriers — — - Erysipelas 31 8 - Scarlet Fever 219 160 - Typhus Fever — — - Typhoid Fever - - - J Paratyphoid Fever 13 1 1 Continued Fever — — - Relapsing Fever Puerperal Pyrexia 4 2 - Cerebro-Spinal Meningitis 5 5 3 Poliomyelitis 2 2 — Ophthalmia Neonatorum — — — Pulmonary Tuberculosis 125 — 47 Other forms of Tuberculosis 20 — 12 Encephalitis Lethargica — — — Food Poisoning 3 — — Malaria 1 1 — Pneumonia 50 — 43 Dysentery 26 20 — Polio Encephalitis — - — Measles 212 4 — Whooping Cough 357 18 4 Totals 1,079 232 110 The above figures are in respect of Civilians and Non-Civilians. DIPHTHERIA IMMUNISATION. Through the services of the Council 1,538 individuals were immunised during 1944. RATS AND MICE DESTRUCTION. The Middlesex County Council was the authority responsible for the operation of the Rats and Mice (Destruction) Act, 1919 until 1st April, 1944. On that date the responsibility was delegated to the Enfield Urban District Council. The Infestation Division of the Ministry of Food inaugurated a scheme of rodent control throughout the County, and the Council co-operated in every way. A publicity campaign launched towards the end of 1943 continued until April, 1944, and as a result very 8 many intimations of the presence of one or more rats were received. All these were investigated and appropriate action taken. A survey of the district revealed very little serious or "major" rat-infestation. The ridding of any premises of rats and mice is the legal responsibility of the occupier of the premises. A scheme based on the recommendations of the Infestation Division of the Ministry of Food, is in operation. The Council employ a trained rat-catcher whose services are available on payment of the appropriate charges. This service has been fully used and has proved very efficient. Factories and industrial concerns have contracts with the Council for regular servicing of their works. During the year 877 visits concerning rat-infestation have been made by the sanitary inspectors. ERADICATION OF BED BUGS. Number of Council houses found to be infested 27 Number of Council houses disinfested 27 Number of other houses found to be infested 47 Number of other houses disinfested 47 The marked increase in the numbers this year compared with 1943 is due to the fact that the present figures include many minor cases of infestation brought to light during the course of bombdamage repairs. The following report, in condensed form, gives details of the work of the Sanitary Inspectors during the year 1944. The total number of inspections made during the year for all purposes was 10,372. NOTICES ISSUED. Statutory 112 Informal 558 Other Notices 2,122 Total 2,792 Letters re Air Raid Precautions 920 Other Letters sent 7,375 Number of Certificates issued in connection with plans 6 Number of Certificates issued in connection with disinfection 23 Number of Certificates issued in connection with unsound foods 765 9 Result of Service of Statutory and Informal Notices:— Statutory Informal Number complied with 98 375 Number outstanding 14 183 112 558 Twenty-eight visits were paid in respect of children excluded from elementary schools during the year, and the total number of inspections and visits for all purposes made by the staff of the Public Health Department was 10,372. DISINFECTION. Number of houses disinfected after infectious disease, Phthisis and verminous cases 481 Number of articles of clothing, bedding, etc., disinfected 24,729 Number of Library Books disinfected 249 FACTORY AND WORKSHOP ACT, 1901, AND FACTORIES ACT, 1937. Number of inspections 178 Number of defects found 25 HOMEWORK. Twelve lists containing the names and addresses of 90 outworkers were received during the year. Six addresses of outworkers were forwarded to other districts. PLACES OF PUBLIC ENTERTAINMENT. Number of inspections 12 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 10 PUBLIC HEALTH (MEAT) REGULATIONS, 1924. Total number of carcases examined 192 Number, or parts, found to be diseased 78 Weight of do. do. 1 ton 7 cwt. 1 qr. 7 lbs. No. of Certificates issued 62 UNSOUND MEAT AND FOODS. Number of inspections made to Meat Depot, slaughterhouses, shops, stalls in markets and food-preparing shops 754 Total No. of articles etc. condemned 6,423 Total No. of Certificates issued 765 Total weight of foodstuffs condemned as unfit for food 8 tons 13 cwt. 0 qr. 27 lbs. 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 under the control of the Engineer and Surveyor's Department. PUBLIC MORTUARY. The public mortuary is still maintained, but in view of staffing difficulties and convenience for post-mortem examinations use is made at present of a Hospital Mortuary. MATERNITY and CHILD WELFARE SECTION 12 MATERNITY AND CHILD WELFARE COMMITTEE. 1944-45. Chairman Mrs. G. M. Jay, J.P. Mrs. E. Squire Mrs. M. M. Howard Mrs. S. M. Lowe Mrs. A. Perkins Mrs. L. Turvey Miss N. Hill W. C. Bennett, Esq. D. Parker-Bowles, Esq. H. A. Deshborough Brown, Esq. E. Greenwood, Esq. W. G. Jolt.ie, Esq. A. R. Kemp, Esq. L. R. Morris, Esq. H. Muspratt, Esq. C. Partington, Esq. 13 BIRTHS. 1944 1943 Live births 1,951 1,908 Still births 35 57 INFANT MORTALITY. Number of deaths of children under 1 year 57 The infant mortality rate was 29.21 Special investigations have been carried out concerning these deaths and of the 28 cases investigated the following were the conditions notified as the cause of death. Under one week. Between 1 and 4 weeks. Between 1 month and 12 months9 Developmental malformation 3 3 1 Atelectasis 3 — — Prematurity 9 3 — Toxaemia of pregnancy 1 — — Asphyxia 1 — — Gastro-Enteritis 1 1 5 Misadventure — — 1 Pneumonia — 1 2 Uraemia — — 1 Bronchitis — — 1 Intussusception — — 1 PUERPERAL PYREXIA. During the year, four cases of Puerperal Pyrexia were notified, two of which were removed to Hospital. MATERNAL MORTALITY. There was one maternal death resulting from Pregnancy; the mother died in an Institution. SUPERVISION OF NURSING HOMES. The Nursing Homes in the district were inspected regularly by the Medical Officers. 14 During the year the Home for the reception of Maternity cases was closed down. 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 ADMINISTRATION OF MIDWIVES ACTS, 1902-1936. At the end of the year 1944 there were fifteen Midwives practising in Enfield, all of whom were employed by the Council as whole time Municipal Midwives. The Midwives were visited regularly by the Medical Officers and their records and equipment inspected. The following table shows the cases attended during 1944 and 1943. MUNICIPAL MIDWIVES. 1944. 1943. Cases attended as Midwives 616 678 Cases attended as Maternity Nurses 309 316 PRIVATE MIDWIVES. Cases attended as Midwives 29 108 Cases attended as Maternity Nurses Nil 4 NOTIFICATIONS. In accordance with the rules of the Central Midwives Board, the following notifications were received from Midwives 1944 1943 Sending for Medical Aid 159 198 Still Births 4 9 Laying out of the Dead — 4 Artificial Feeding 31 18 Liabilities to be a source of notification 8 9 Notification of death 3 4 15 Th; notifications in connection with Medical Aid can be classified as follows:— During Pregnancy 18 During Labour 108 During Lying-in Period 13 Infant 20 HELP WITH COST OF MIDWIFE S FEE. During the year 214 cases were helped with the cost of their Midwife's fee, compared with 164 in 1943. OBSTETRIC SPECIALIST. On one occasion 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. This scheme ceased to function in August 1943, owing to the inability to obtain persons to do the work. The need for such a service was as great in 1944 as it was in 1943, but no help could be provided as it was still impossible to obtain persons to undertake his type of work. 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 1,535 mothers attended the Enfield Ante Natal Clinics. This number included some mothers whose confinement had not taken place by the end of the year. 16 POST-NATAL CLINICS. During the course of the year, 422 mothers attended for examination after their confinement. This examination takes place by appointment six weeks after the confinement, and is an attempt to secure that complete recovery to normal health is made. The appointments are given to every mother whose confinement has been conducted under the responsibility of one of the Council's Midwives, and also to every mother whose confinement takes place in the North Middlesex County Hospital. Appointments are not made where the confinement has been conducted by a Private Practitioner unless specially asked for by them. INFANT WELFARE CENTRES. The total number of children who made their first attendance at the Infant Welfare Clinics was 1,794. VISITS. The Council's Health Visitors paid 489 visits to Expectant Mothers, 3,266 to children under one year of age, and 5,822 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 1,035 lbs. cost £90 3s. Od. In addition 266 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. The routine Medical Inspection of children under 5 years of age was carried out as heretofore. The number of appointments kept during the year 1944 was 2035. AURAL TREATMENT. Mothers and children under 5 years of age suffering from aural defects were referred to the School Ear, Nose and Throat Specialist. 17 The following is a summary of the work carried out during 1944. 51 Children and 6 mothers were referred for treatment. 3 Mothers were treated for deafness and discharged cured. 3 Mothers were referred to the Golden Square Hospital for treatment and discharged cured. 1 Mother was referred to the Golden Square Hospital for removal of Nasal Polypi. These were successfully removed. 9 Children were referred for removal of Tonsils and Adenoids. 6 Children were referred for removal of Adenoids. 33 Children referred for treatment of rhinitis and acute otorrhoea. 3 Children were found to have no abnormality. OPHTHALMIC TREATMENT. The scheme whereby Ante-Natal and Nursing Mothers and Children under 5 years of age, with eye defects, are referred to the School Opthalmic Surgeon was continued. The following are particulars of the cases referred during the year 1944: Mothers. Children. Total attendances 22 145 New Cases 15 84 Glasses prescribed 8 24 No glasses required 4 5 Attendance other than for refractions Nil 30 Referred to Hospital Nil 8 SPEECH CLINIC. Six children were referred to the Speech Clinic for treatment. CHILD LIFE PROTECTION—PUBLIC HEALTH ACT, 1936. At the end of 1944, ten persons in Enfield were receiving children for reward; the total number of children concerned was 23. Each of these was visited at least monthly by the Infant Life Protection Visitors (Health Visitors). 18 DENTAL TREATMENT. Five hundred and thirty-eight attendances were made at the Dental Clinic by Ante-Natal and Nursing Mothers and 180 children under the age of five years. Dentures were provided to 68 mothers. CONVALESCENT TREATMENT. Four children were sent away to Convalescent Homes. EVACUATION OF EXPECTANT MOTHERS. The London County Council scheme whereby expectant mothers are evacuated to the country because of air-raids, continued throughout the year, 137 mothers being registered for this purpose. The scheme continued to work satisfactorily and the mothers appreciated the facilities afforded them. SPECIAL EVACUATION OF MOTHERS AND CHILDREN UNDER 5 YEARS. Owing to the increase in aerial activity during the summer months evacuation facilities for expectant mothers and children under 5 years of age were extended and a number of such mothers and children took advantage of the scheme. ORTHOPAEDIC TREATMENT. During the course of the year 6 children suffering from Orthopaedic defects received treatment either from your Medical Officers or as a result of reference to Hospital and 7 were re-examined. The following are the conditions from which the six children suffered : Knock-knees 1 Metatarsal Varus 2 Deformity of Toes 2 Webbed fingers 1 DIPHTHERIA IMMUNISATION. The campaign for the immunisation of children against diphtheria continued throughout the year and 1133 children under the age of five years were so immunised. 19 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, not only to be medically examined, but also to be immunised against diphtheria. It is pleasing to note that these invitations are accepted. All children when reaching the age of years are invited to attend a Maternity and Child Welfare Clinic to be immunised or to receive a supplementary reinforcing dose. WHOOPING COUGH. During the year 81 children under the age of 5 years were immunised against whooping cough. 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 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 have been distributed through the Maternity and Child Welfare Centres : Orange Juice 76589 bottles. Cod Liver Oil 8074 bottles. Vitamin A Capsules 862 packets. ILLEGITIMACY—CIRCULAR 2866. In regard to this Circular a contract has now been made with the Middlesex County Council whereby women and babies are admitted to suitable Hostels. ADOPTION OF CHILDREN (REGULATION ACT) 1939. Under the above Act, the Health Visitors are responsible for the carrying out of this work. Number of Persons who gave notice under Section 7 (3) during the year 3 Number of children in respect of whom notice was given under Section 7 (3) 3 Number of such children under supervision at the end of the year 3 20 During the year requests have been received 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. WAR-TIME NURSERIES. At the end of 1944 there were four War-time Nurseries in Enfield. Name of Nursery. No. of Places. Average Attendances. Suffolks—Opened December, 1941 60 48 Green Street—Opened Julv, 1942 60 46 High Street—Opened July, 1943 60 50 Baker Street—Opened February, 1944 60 48 The children in the Nurseries have been immunised against diphtheria and whooping cough. No case of diphtheria occurred but some children contracted whooping cough. During the year the Senior Dental Surgeon inspected the teeth of all children aged 2-5 years. PREMATURE BABIES. Circular 20/1944 from the Ministry of Health was received during the year. Where the weight of a baby is 5½ lbs or less, this is recorded upon the birth notification and these babies receive special care and attention. Where the birth occurs in Hospital a visit is paid by the Health Visitor immediately on discharge. Consideration is being given to the provision of suitable equipment for the care of premature babies. BABY BATHING DEMONSTRATIONS. During the year the Health Visitors attended the Senior girls departments of the Elementary Schools, in order to demonstrate to the girls the bathing of a baby. On several occasions the Domestic Science Class from these schools has visited the Day Nurseries in order to receive further instruction. 21 PRIORITY DOCKETS FOR SHEETS. The Scheme whereby Expectant Mothers obtain priority dockets in order to obtain sheets, came into force in November, 1944 and up to the end of December, 1944, 91 dockets had been issued. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER For the year ending 31st December, 1944 24 MEMBERS OF THE ENFIELD EDUCATION COMMITTEE. 1944-45. Chairman Mr. H. A. Deshborough Brown. Vice-Chairman Mr. S. G. Rowlandson, M.B.E., F.C.A., C.G Representative Members. Mrs. E. M. Squire, C.C. Mr. W. C. Bennett Mr. H. A. Deshborough Brown Mr. T. H. M. Clarke Mr. W. F. Lawrence 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. E. S. Stock Co-optative Members. Mrs. L. Daines Mrs. A. L. Henry Mrs. E. M. Toomer Mr. A. J. Crofts Mr. A. J. Neaves Mr. B. D. Bowyer Mrs. H. B. Hyde Director of Education. E. Pascal, Esq., M.A. 25 STAFF OF THE SCHOOL MEDICAL DEPARTMENT. School Medical Officer: Dennis H. Geffen,(Resigned 31.10.44.) 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. (Resigned 31.8.44) J. B. Cranston, L.D.S., (Resigned 31.12.44) School Ophthalmic Surgeon: S. Macky, M.B., B.S., D.O.M.S. School A v.ral Surgeon: J. C. Hogg, M.A., F.R.C.S. (Released) F. Popper, M.D. (Prague) Speech 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. E. Horgan, S.R.N., C.M.B., (Resigned 10.9.44) I. J. Muncer, S.R.N., H.V.'s Cert. (Appointed 7.2.44) M. Rogers, S.R.N., (Appointed 4.12.44) Dental Nurse: F. Anderson, R.S.C.N. Dental Attendants: M. Freeman. M. A. Morter. Clerks: A. Cooper. J. Wingfield (Appointed 8.5.44.) P. Roberts (Appointed 5.10 44.) 26 REPORT OF THE SCHOOL MEDICAL OFFICER Jan.- Sep.- June Dec. Average number on books of Elementary Schools. . 12,288 9,447 Average weekly attendance 10,334 7,927 Number of Schools 22 ROUTINE MEDICAL INSPECTION. The total number of children examined during the year was 3,703. 76.6 per cent. of the children examined were accompanied by their parents, and 28.6 per cent. were vaccinated. DEFECTS FOUND AT ROUTINE MEDICAL INSPECTION. Requiring Treatment. Requiring to be kept under observation. Enlarged tonsils and adenoids 103 40 Enlarged tonsils only 3 97 Adenoids 6 5 Other nose and throat conditions 6 5 Conjunctivitis 7 — Blepharitis 4 5 Other Eye Conditions 1 1 Enlarged Cervical Glands 1 11 Scabies 6 — Impetigo 6 — Other Skin Conditions 8 5 Defective Hearing 8 2 Otitis Media 3 1 Other Ear Conditions 12 2 Defective Speech 3 2 Defective Vision 305 123 Bronchitis 1 6 Asthma 1 1 Other Lung Conditions: Non-tuberculous — 38 Organic Heart Disease 1 2 Functional Heart Disease 2 11 Anaemia 1 4 Chorea — 1 Epilepsy — 1 Other Nerve Conditions — 6 Spinal Curvature 7 4 Other Deforruities 24 62 Other Diseases and Defects 14 53 27 Uncleanliness. Of 3,703 children examined 3 were found to have vermin in their heads, and 123 had nits, i.e., 3.4 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 3,703 Number of children classified "A" 462 Percentage of children classified "A" 12.5 Number of children classified "B" 2,753 Percentage of children classified "B" 74.3 Number of children classified " C " 458 Percentage of children classified "C" 12.4 Number of children classified "D" 30 Percentage of children classified "D" .81 A Excellent B Normal C Slightly sub-normal U Bad INFECTIOUS DISEASE Measles 128 German Measles 4 Whooping Cough 117 Chickenpox 16 Scarlet Fever 146 Diphtheria. 9 Dysentry 1 THE WORK OF THE SCHOOL NURSES. Number of home visits 1,602 Number of school visits 256 Number of school visits for routine examination of heads 135 Total number of heads examined 22,638 Number of individual children found unclean 396 Number of cases in which legal proceedings were taken — 28 TREATMENT CLINICS. Tonsils and Adenoids:- Number of cases seen at clinics 356 Number of cases operated under the Authority's Scheme 238 Ringworm.—Seventeen cases were seen and treated at the clinics. Impetigo.—One hundred and ninety cases were treated at the clinics. Scabies.—Forty-seven cases were seen. Other Skin Diseases.—Sixty-seven cases were seen and treated at the clinics. Eye Diseases.—Two hundred and two cases were treated. Ear Diseases.—One hundred and twenty-eight cases were seen at the Minor Ailment Clinics. Children examined after Scarlet Fever.—Seventy-eight children were seen. The total number of children examined during the year, excluding those attending the Dental Department, was 7,746. This number was made up as follows:— Examined at Routine Medical Inspection 3,703 Examined at Minor Ailment Clinics 2,905 Examined at Ophthalmic Clinic 932 Examined at Aural Clinic 141 Examined under Juvenile Employment Bye-laws 17 Examined under Mental Deficiency Act 48 The following help was afforded to children who were found to require it Six children were sent to residential schools for physically defective children. 29 ORTHOPAEDIC CLINIC. During the course of the year 21 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 1 Paralysis associated with mental deficiency 1 Genu Valgum 2 Pes Planus 3 Sherman's Disease 2 Hallux Valgus 6 Congenital deformity of foot 1 The Education Committee aided in the supply of six surgical appliances. CARDIAC CLINIC. Two sessions of this special clinic were held and eighteen children were seen. Of these, six were found to have no cardiac disease and were taken off the register. Five children had congenital lesions, in one case causing interference with normal life, in the others giving rise to no inconvenience at all. It is hoped to get the more seriously affected child away to a special school where her education will be continued while she is under medical supervision. Six children had rheumatic affections of the heart, and one had suffered from chorea, but all these children were making good progress and were able to lead a normal life. SPEECH CLINIC. During the year 30 children received treatment for various defects, being classified as follows: Stammerers 10 Lispers 2 Cleft palate 1 Dyslalia 14 Dysarthria 1 Huskiness 1 Poor speech due to mental retardation 1 30 Of these : 4 were discharged cured. 3 were about, to be discharged but final reports had not been received from Head Teachers. 3 left school—one was almost cured. 1 discontinued treatment on going to the County School. 1 was discharged as no progress had been made. 11 ceased to attend during the evacuation period. 7 required a further period of treatment. DEATHS AMONGST SCHOOL CHILDREN. There were twenty-one deaths among school children during the year. The causes were as follows : 6 Meningitis. 1 Asphyxia. 1 Sarcoma. 1 Heart failure. 1 Peritonitis. 1 Septicaemia. 1 Mastoid disease. 1 Uraemia. 1 Leukaemia. 3 Enemy action. 4 Accident. (1 burns ; 2 road ; 1 under anaesthetic.) PROVISION OF MEALS. Meals were provided for children at all the schools. During 1944 24,826 dinners were provided free, and 567,478 were provided and paid for. 2,200,3002153,⅓ pint bottles of milk were provided and paid for, and 39,568 were provided free. BLIND, DEAF, EPILEPTIC AND MENTALLY DEFECTIVE CHILDREN. There are three blind children in Enfield, two of whom are attending Residential Schools for the Blind. 31 Eight children are in attendance at Philip Lane School for the Deaf, Tottenham; these may be classified as follows:— 6 suffering from acquired deafness. 2 suffering from motor aphasia. One deaf child is at a residential school and 2 deaf children are evacuated. Forty-eight children were examined under the Mental Deficiency Act (1913) during 1944. 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 18 Incapable of further instruction in a special school 3 Imbecile 10 Not scheduled (to be seen again) 7 EXAMINATION AND TREATMENT OF SECONDARY SCHOOL CHILDREN. Average number on books of Junior Technical School 320 Average number on books of Grammar School 626 Average number on books of County School 520 The number of children examined in the course of Routine Medical Inspection at the secondary schools was as follows:— Junior Technical School 121 Grammar School 294 County School 207 The classification of the nutrition of these children was as follows:— School. Classification. "A" "B" "C" "D" Junior Technical 20 94 7 - Grammar 60 203 31 - County 52 147 8 - 32 The following defects were found:— Defects. School. Jnr. Technical. Grammar. County. Defective Vision 13 44 17 Defective Hearing — 1 — Functional Heart Disease — — 1 Kyphosis — 1 4 Other Deformities 1 17 6 Blepharitis — 1 1 Impetigo — — — Enlarged Tonsils — — — Enlarged Glands — — — Anaemia — 1 — Other Diseases and Defects — 4 — Dental Caries 5 5 2 Defective Speech — — — Organic Heart Disease — 1 — Five hundred and sixty-seven children were treated at the School Dental Clinic and one hundred and ninety-two at the School Ophthalmic Clinic during 1944. SCHOOL DENTAL CLINICS. Elementary Schools. Secondary Schools. Number Inspected 6,089 1,237 Number Treated 3,083 567 Number of Fillings 3,979 893 Number of Extractions 4,055 177 SCHOOL OPHTHALMIC CLINIC. Elementary Schools. Secondary Schools. Total attendance 1,530 329 New Cases 932 204 Prescriptions for glasses 276 79 Number not requiring glasses 160 11 33 Twelve children were referred to the Western Ophthalmic Hospital for operation for squint, and six children attended the hospital for investigation of other eye conditions. SCHOOL ORTHOPTIC CLINIC. Four sessions a week have been held since the opening of the Clinic on the 24th May, 1944 and 113 new cases of strabismus and heterophoria were seen. Of these:— 40 were seen for classification and are awaiting treatment. 34 underwent courses of occlusion. 8 were given homework exercises. 2 were unsuitable for treatment. 9 were evacuated. 20 were discharged with the following results : 8 with good binocular vision. 3 with partial binocular vision. 2 improved. 7 with cosmetic results. The total attendances at the Clinic were 621. SCHOOL AURAL CLINIC. Number of cases dealt with 227 Number of new cases 141 Total number of attendances 625 Number of cases discharged cured 149 Number of cases of a recurrent nature requiring occasional treatment 5 Number of cases still under treatment 68 Number of cases who have refused treatment, or sought treatment elsewhere 10 Enfield: Stanley Woodfield Printer 8-12 Windmill Hill