C, 434 ENFIELD (hates Mun. B) ENF 29 M??? Urban District Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health and School Medical Officer (WILLIAM D. HYDE, M.B., Ch.B., D.P.H.) FOR 1945 Urban District Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health and School Medical Officer (WILLIAM D. HYDE, M.B., Ch.B., D.P.H.) FOR 1945 1 Public Offices, Enfield, Middlesex. August, 1946. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, 1945 To the Chairman and Members of the Urban District Council of Enfield. I have pleasure in presenting my Annual Report on the Health and Sanitary circumstances of the District for the year 1945. The most important event of the year was the termination of hostilities with the consequent disbandment of the Civil Defence Services which gave to the Health Department the happy prospect of being able to apply its whole energy to its preventive health functions. The vital statistics of the past six years have been satisfactory in most respects although in the field of infectious diseases the incidence of tuberculosis and venereal disease has increased. Notwithstanding this generally satisfactory statistical achievement, it does appear that the dangers, deprivations, difficulties and disturbances of the war years must have had some adverse but indefinably assessable effect on the health and well-being of the local civilian population. This was particularly noticeable when the immediate post-war period of stimulation was followed by complaints of lassitude. The greatest single factor affecting public health now is the housing problem, affecting not only the physical but the mental well-being of the population. In this sphere of public health there is much work for the Department. During the year under review the incidence of notifiable infectious disease was not high except in the case of measles in which there was a marked increase over the previous year's figures, but only one patient died. The threatened epidemic of influenza did not materialise although at one period it appeared to be imminent. The number of children immunised against diphtheria during the year showed an increase over the previous year, but the numbers accepting this service are not sufficiently high to warrant any sense of security. Another danger to public health during the year was the possibility of importation into the district of Smallpox and Typhus Fever, with the large volume of air and sea passengers arriving in this 2 country from infected areas. The vigilance of Port Health Authorities minimised this danger considerably but many contacts were kept under surveillance in the district for the appropriate incubation periods and the year passed without any cases occurring. The Infant Mortality Rate of 33.17, comparing very favourably with that of England and Wales which is 46, is the second lowest recorded this century, only taking second place to the figure of 29 21 for the previous year. In all respects Enfield may be proud of this achievement in the care of infants. One of the main difficulties experienced during the year was the inability to secure Maternity Hospital accommodation for all those expectant mothers desiring this Service. The demand greatly exceeded the beds available in the County Hospitals, the London Voluntary Hospitals and those Hospitals in the country provided by the War-time Evacuation Scheme. With housing conditions as they are, many confinements had to be undertaken by our domiciliary midwives in circumstances far from satisfactory. The Council planned to open a Municipal Maternity Home in the district but in spite of strong representations the approval of the Ministry of Health was not forthcoming, as more local maternity hospital accommodation was to be provided by the Middlesex County Council. Staffing difficulties were again experienced in all branches of the Public Health Service, but the Health Department was able to function satisfactorily through the loyal co-operation of all concerned. I should like to record my appreciation of their efforts during a difficult period and also to thank the voluntary helpers whose continued efforts have again contributed so much to the successful running of the Infant Welfare Centres where the attendances have been so heavy. WILLIAM D. HYDE, Medical Officer of Health. 3 URBAN DISTRICT COUNCIL OF ENFIELD F. G. Greenwood, Esq., J.P. Chairman D. Mason, Esq. Vice-Chairman Mrs. G. M. Jay, J.P. W. F. Lawrence, Esq. Mrs. E. M. Squire, C.C. L. R. Morris, Esq. W. C. Bennett, Esq. H. Muspratt, Esq., O.B.E. W. H. Bishop, Esq. C. Partington, Esq., J.P., Derek Parker-Bowles, Esq. M.R.S.T W. G. Bowyer, Esq. S. G. Rowlandson, Esq., M.B.E., H. A. D. Brown, Esq. F.C.A., C.C T. H. M. Clarke, Esq. H. G. Short, Esq. J. Cottenham, Esq. F. S. Stock, Esq. A. M. Eeles, Esq. C. H. Thomas, Esq. W. Graham, Esq. H. Thompson, Esq. H. D. Hyde, Esq. F. C. Watts, Esq. W. G. Jollie, Esq. W. S. Williams, Esq. A. R. Kemp, Esq. HEALTH COMMITTEE H. Muspratt, Esq., O.B.E Chairman also Mrs. Jay, and Messrs. Bennett, Bishop, Bowles, Brown, Jollie, Kemp and Watts. 4 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 12,400 POPULATION The population as estimated by the Registrar General at the middle of the year was 94,690. The number of inhabited houses at the end of 1945, according to the Rate Books, was 29,860. The rateable value of the District is £919,999 The net product (after allowing for cost of collection) of a penny rate is £3,775 SOCIAL CONDITIONS The number of houses erected during the course of the year was 21—all of Pre-Fabricated type. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Live Births: — Total. Male. Female. Legitimate 1,614 847 767 Illegitimate 104 54 50 Birth-rate—18 14 per 1,000 population. Still Births: — Total. Male. Female. Legitimate 43 19 24 Illegitimate 5 3 2 Rate per 1,000 total births—27.18. Total. Male. Female Deaths 961 503 458 Death-rate—10 14 per 1.000 population. Number of women dying in. or in consequence of, childbirth: — Deaths. Rate per 1,000 Total Births. From Puerperal Sepsis 1 0.56 From other Puerperal causes 2 1.13 3 1.69 5 Death-rate of Infants under one year of age: — All infants per 1,000 live births 3317 Legitimate infants per 1,000 legitimate live births 34 07 Illegitimate infants per 1,000 illegitimate live births 19.23 Deaths from Cancer (all ages) 155 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 8 The following table gives the birth-rate, death-rate and infant mortality rate 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. Death-rate. Infant Mortality rate. Live Still England and Wales 16.1 0.46 11.4 46.00 London 15.7 0.40 13.8 53.00 126 County Boroughs 19.1 0.58 13.5 54.00 and Great Towns (including London) 148 Smaller Towns 19.2 0.53 12.3 43.00 ENFIELD 18.14 0.50 10.14 33.17 DEATHS Of the 961 deaths of Enfield residents during the course of the year 155 were due to malignant disease; 220 to heart disease; 43 to other diseases of the circulatory system; 44 to Pneumonia (all forms); 61 to Bronchitis; 90 to Intra-cranial vascular lesions; and 44 to Tuberculosis of the respiratory system. INFANT MORTALITY Of the 57 infants who died before attaining the age of one year, 22 died within the first week of life. In 8 cases death was due to Pneumonia; in 7 to Bronchitis; in 9 to Congenital Malformation; in 14 to Premature Birth; and 7 to Enteritis. INQUESTS Seventy-six inquests and fifty-nine P.M.s without inquests were held on Enfield residents during the year. Out of these, 66 deaths were due to natural causes. 44 to accidental causes, 13 to suicide, 9 to misadventure, and 3 to open verdict. 6 AMBULANCE FACILITIES General The civil ambulances in Enfield were manned during the war years by members of the Civil Defence Ambulance Service under the general supervision of the Health Department, and I wish to record the valuable service so rendered during that difficult period. With the disbandment of the Civil Defence Services on the 16th May, 1945, the Health Department was charged with the formation of a separate Ambulance Service. Drivers and Attendants were recruited from the Civil Defence Services, redundant Civil Defence premises at the Refuse Destructor were secured, and an Ambulance Service of two Ambulances fully manned, day and night, was inaugurated. During the period 16th May to 31st December, 1945, 3,418 patients were conveyed by the Ambulances, the total mileage being 17.436. Infectious Diseases During the year, 248 patients were removed to the Isolation Hospital by the Hospital Ambulances. LABORATORY FACILITIES The following work was carried out in the Council's laboratory during the year: — Specimen. No. Positive. Negative. Percentage of Positives. Swabs 845 8 837 0.94 Sputa 96 3 93 3.12 Totals 941 11 930 1.16 WATER SUPPLY The District of Enfield is supplied with water by the Metropolitan Water Board, except for part of the Hadley Wood and Cockfosters area, which is supplied by the Barnet District Gas and Water Company. Both of these Authorities take regular and frequent samples for analysis. Copies of these reports are sent to the Health Department, and have shown satisfactory results. 7 There was no cause to suspect any contamination during the year and no complaints were received as to the quality and quantity of water supplied by the above-mentioned undertakings. 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 1945 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 34 Number granted permission to sub-let 33 Number refused permission 1 Number of visits made by Sanitary Inspectors 54 INFECTIOUS DISEASES AND SCHOOLS Number of children notified to be absent from School due to suspected Infectious Disease 39 Number of children found to be suffering from Infectious Disease 23 This compares with the following figures for last year: — 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 HOUSING Number of New Houses erected during the year: — (a) Total (including numbers given separately under (b)) (Temporary Pre-fabricated houses) 21 (i) By the Local Authority (Temporary fabricated houses) 21 (ii) By other Local Authorities Nil (iii) By other bodies or persons Nil (b) With State Assistance under the Housing Act: — (i) By the Local Authority Nil (ii) By other bodies or persons Nil 8 1. Inspection of Dwelling-houses: — No. of No. of inspechouses. tions. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) and number of inspections made 3,074 10,011 (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 sub-heading) found not to be in all respects reasonably fit for human habitation 1,044 (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 718 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 (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 Nil 9 B.—Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 80 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices: — (a) By owners 49 (b) By Local Authority in default of owners 5 The number of house-to-house visitations made was: — Under Housing Regulations, 1925 and 1932 2 Apart from Do. Do. 524 THE MILK (SPECIAL DESIGNATIONS) ORDERS, 1936 and 1938 There are 22 Purveyors of Milk who sell or distribute Pasteurised Milk in the district. 13 samples taken and tested were found to be satisfactory. SLAUGHTER-HOUSES There are eight slaughter-houses in Enfield, none of which is in use at present. During the course of the year 216 carcases were examined; 3 carcases and 100 parcels of organs were found to be diseased and were surrendered. The weight of these carcases and parcels was 15 cwts. 3 qtrs. 12 lbs. The examination of the above-mentioned carcases was carried out by the Council's Meat and Food Inspectors at a slaughterhouse in an adjoining District and at the request of the Authority for that area. PREV ALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES The number of cases of Scarlet Fever was 169, compared with 219 in 1944: of Diphtheria 20, as compared with 11; of Pulmonary Tuberculosis 119, as compared with 125; and of Pneumonia 69, as compared with 50. 10 There was one death from Diphtheria during the year, as against no deaths in 1944. The Registrar General's figures show no deaths from Diphtheria; this is due to the fact that the one death which did occur at the end of the year was not registered until the first week in 1946. There were no deaths from Scarlet Fever during the year, as was also the case in 1944. NOTIFIABLE DISEASES DURING THE YEAR 1945 No. Removed. Deaths. Smallpox — — — Cholera—Plague — — — Diphtheria (inc. Membranous Croup) 20 20 *1 Diphtheria Carriers — — — Erysipelas 27 14 — Scarlet Fever 169 124 — Typhus Fever — — — Typhoid Fever 1 1 — Paratyphoid Fever — - — Relapsing Fever Continued Fever — — — Puerperal Pyrexia 4 2 — Cerebro-Spinal Meningitis 3 — — Poliomyelitis 5 4 — Polio Encephalitis — — — Ophthalmia Neonatorum 1 1 — Pulmonary Tuberculosis 119 — 44 Other forms of Tuberculosis 21 — 6 Encephalitis Lethargica — — — Food Poisoning — — — Malaria 5 — — Pneumonia 69 3 44 Dysentery 45 9 — Measles 1,223 40 1 Whooping Cough 214 9 1 Totals 1,926 227 97 The above figures are in respect of Civilians and Non-Civilians. *See explanatory note in first paragraph on this page. DIPHTHERIA There was an increase, of 9 cases of Diphtheria over last year's figures, due to the fact that 10 cases occurred amongst children in a Residential School, and a further 2 cases appeared to be contact cases of these school children. Clinically, the cases were mild in type but were confirmed bacteriologically. 11 DIPHTHERIA IMMUNISATION Through the services of the Council 1,518 individuals were immunised during 1945. RATS AND MICE DESTRUCTION Responsibility for the prevention of infestation by rats and mice under The Rats and Mice (Destruction) Act, 1919, rests on the occupier of the premises. The Council employ a trained rat-catcher whose services are available to occupiers on payment of the appropriate charges. This service has been used to the full and has proved very effective in reducing the rat population. Factories and industrial concerns have arrangements with the Council for regular visits to their premises. The Ministry of Food (Infestation Division) initiated a scheme for systematic treatment against rats in sewers throughout the country. The Council have been anxious to carry out such treatment in Enfield but labour shortage has made it impossible during the year under review. It is hoped that a comprehensive scheme will be in operation by the time this report is published. During the year the Sanitary Inspectors made 1,046 visits concerning rat infestation. ERADICATION OF BED BUGS Number of Council houses found to be infested 13 Number of Council houses disinfested 13 Number of other houses found to be infested 78 Number of other houses disinfested 78 Many of the infestations included in these figures were reported by tenants or discovered by the Sanitary Inspectors before they became difficult to remedy. When the vermin are allowed to " settle in." the work of disinfestation is disproportionately more difficult, and entails much more disturbance of the household. Householders are urged to seek the assistance of the Health Department immediately they suspect the presence of bugs or similar pests. SANITARY INSPECTOR'S REPORT The following report, in condensed form, gives details of the work of the Sanitary Inspectors during the year 1945. The total number of inspections made during the year for all purposes was 14,550. 12 NOTICES ISSUED Statutory 160 Informal 786 Other Notices 1.732 Total 2,678 Letters re Air Raid Precautions 208 Other Letters sent 7,999 Number of Certificates issued in connection with plans 3 Number of Certificates issued in connection with disinfection 17 Number of Certificates issued in connection with unsound foods 647 Number of Requisitions for Information dealt with 345 Number of Certificates issued under Rent Restrictions Act, 1933 6 Result of Service of Statutory and Informal Notices: — Statutory. Informal Number complied with 104 591 Number outstanding 56 195 160 786 TOTAL INSPECTIONS Thirty-two visits were paid in respect of children excluded from elementary schools during the year, and the total number of inspections and visits for all purposes made by the Sanitary Inspectors was 14,550. This figure shows a considerable increase over last year's figure, and is appreciably due to the fact that the Department had a full complement of Sanitary Inspectors throughout the year. DISINFECTION Number of houses disinfected after infectious disease and verminous cases 380 Number of articles of clothing, bedding, etc., disinfected 6,102 Number of Library books disinfected 158 It will be seen that there is a considerable decrease in the number of articles of clothing, bedding, etc., disinfected during the year. This is accounted for by the cessation of hostilities; all Civil Defence and Fire Guard activities and schemes were cancelled, and there was no necessity for bedding, etc., used in connection therewith to be regularly disinfected as had been the case throughout the period of the war. 13 FACTORIES ACT, 1937 Number of inspections 108 Number of defects found 15 OUTWORKERS Twelve lists containing the names and addresses of 43 outworkers were received during the year. Five addresses of outworkers were forwarded to other districts. No cases of Infectious Disease occurred at Outworkers' premises in Enfield during the year. PLACES OF PUBLIC ENTERTAINMENT Number of inspections 15 OFFENSIVE TRADES Four offensive trade premises are established in the district, and during the year no complaints were received in connection therewith. MILK Number of Licences in force on 31st December, under the Milk (Special Designations) Orders, 1936 and 1938 37 PUBLIC HEALTH (MEAT) REGULATIONS, 1924 Total number of carcases examined 216 Number, or parts, found to be diseased 103 Weight of do. do. 15 cwts. 3 qrs. 12 lbs. No. of Certificates issued 35 UNSOUND MEAT AND FOODS Number of inspections made to Meat Depot, slaughterhouses, shops, stalls in markets and food-preparing shops 889 Total No. of articles, etc., condemned 4,995 Total No. of Certificates issued 647 Total weight of foodstuffs condemned as unfit for food 7 tons 0 cwts. 0 qrs. 5 lbs. CARAVANS Number of applications received for consent Nil Number of applications granted Nil 14 REMOVAL OF HOUSE REFUSE CESSPOOL EMPTYING SEWER FLUSHING The above Services are under the control of the Engineer and Surveyor's Department. DUSTBINS The replacement of defective dustbins has been a difficult problem for property owners in recent years. During the past three years the Council has had in operation a scheme whereby the Council purchased a quantity of bins through local tradesmen, and delivered a new dustbin to any house on payment of the cost and delivery charge. This scheme appears to have met with approval by 110 owners to whom dustbins were supplied during the year. 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 16 MATERNITY AND CHILD WELFARE COMMITTEE 1945-1946 Chairman H. A. Deshborough Brown, Esq. Mrs. G. M. Jay, J.P. Mrs. M. Martin. Mrs. E. Squire. Mrs. J. Threadgold. Mrs. B. C. Townsend. Mrs. L. Turvey. W. C. Bennett, Esq. W. H. Bishop, Esq. D. Parker-Bowles, Esq. W. G. Jollie, Esq. A. R. Kemp, Esq. L. R. Morris, Esq. H. Muspratt, Esq. C. Partington, Esq. 17 MATERNITY AND CHILD WELFARE CLINICS UNDER THE CONTROL OF THE LOCAL AUTHORITY. District. Situation of Centre. Day and times open. Infant Welfare Clinics Ponders End: School Clinic, Southbury Road, Ponders End. Tuesday and Thursday, 1.30 to 3.30 p.m. Bush Hill Park: Lincoln Road, Bush Hill Park. Tuesday and Thursday, 1.30 to 3.30 p.m. Town and Chase: Rosemary Avenue. Enfield. Monday, 1.30 to 3.30 p.m. Wednesday, 9.30 to 11.30 a.m. Ordnance: St. Stephen's Road, Enfield Wash. Monday and Wednesday, 1.30 to 3.30 p.m. Grange Park: Church-in-the-Orchard, Grange Park. Alternate Mondays, 2 to 4 p.m. Enfield West: Laing's Estate Office, Enfield West. Every Tuesday, 2 to 4 p.m. Ante-Natal Clinics Ponders End: School Clinic, Southbury Road, Ponders End. Monday and Friday, 1.30 to 3.30 p.m. Bush Hill Park: Lincoln Road, Bush Hill Park. Wednesday, 1.30 to 3.30 p.m. Town and Chase: Rosemary Avenue, Enfield. Wednesday, 1.30 to 3.30 p.m. Ordnance: St. Stephen's Road, Enfield Wash. Tuesday and Thursday, 1.30 to 3.30 p.m. Enfield West: Laing's Estate Office, Enfield West. Friday, 10.30 to 12 noon. Post-Natal Clinics Ponders End: School Clinic, Southbury Road, Ponders End. Every third Friday in each month at 10.30 a.m. Bush Hill Park: Lincoln Road, Bush Hill Park. Every first Wednesday in each month at 3.45 p.m. Town and Chase: Rosemary Avenue, Enfield. Every second Monday in each month at 9.30 a.m. Ordnance: St. Stephen's Road, Enfield Wash. Every fourth Friday in each month at 10.30 a.m. Enfield West: Laing's Estate Office, Enfield West. Every second Friday in each month at 11.15 a.m. 18 Situation of Centre. Day and times open. Dental Clinics School Dental Clinic, Southbury Road. Saturday mornings, 9.30 to 11.30 a.m. Wednesday afternoons, 2 to 4 p.m. Albany Clinic, Bell Lane, Alternate Saturday mornings, Enfield Wash. 9.30 to 11.30 a.m. Wednesday afternoons, 2 to 4 p.m. Each of the above Centres is provided and maintained by the Council. 19 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Live Births: — Total. Male. Female. Legitimate 1,614 847 767 Illegitimate 104 54 50 Birth-rate—18.14 per 1,000 population. Still Births: — Total. Male. Female. Legitimate 43 19 24 Illegitimate 5 3 2 Rate per 1,000 total births—27-18. Death rate of infants under one year of age: — All infants per 1,000 live births 33.17 Legitimate infants per 1,000 legitimate live births 34 07 Illegitimate infants per 1,000 illegitimate live births 1923 The following table gives the birth-rate, death-rate, and infant mortality rate 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 Death Rate Infant Mortality Rate Live Still England and Wales 16.1 0.46 11.4 46.00 London 15.7 0.40 13.8 53.00 126 County Boroughs 19.1 0.58 13.5 54.00 and Great Towns (including London) 148 Smaller Towns 19.2 0.53 12.3 43.00 ENFIELD 18.14 0.50 10.14 33.17 INFANT MORTALITY Of the 57 infants who died before attaining the age of one year, 22 died within the first week of life. In 8 cases death was due to Pneumonia, in 7 to Bronchitis, in 9 to Congenital Malformation, in 14 to Premature Birth and 7 to Enteritis. PUERPERAL PYREXIA During the year 4 cases of Puerperal Pyrexia were notified, two of which were admitted to the Enfield, Edmonton and Potters Bar Joint Isolation Hospital. 20 MATERNAL MORTALITY There were three maternal deaths during the year and the cause was as follows: — Broncho-Pneumonia; chronic valvular disease of the heart; death accelerated by spontaneous abortion In Hospital Post-partum haemorrhage; 26 weeks' twin abortion; acute hydramnios, hysterectomy In Hospital Post-partum haemorrhage and shock In Hospital The ages of these three mothers were 22, 24 and 29 years. All cases of deaths arising in connection with pregnancy or child-birth are investigated and a private and confidential report thereon transmitted to the Ministry of Health. SUPERVISION OF NURSING HOMES The Supervision of Nursing Homes in the district is carried out by this Council. There are no Maternity Homes in the district, but there is one Home for chronic, aged and infirm patients, and it has been kept under regular supervision by your Medical Officers. During the year a change of management took place. Proprietress Address Total No. of beds. No. of Maternity beds. Miss A. Greenwood 240, Baker Street, Enfield. 7 — ADMINISTRATION OF MIDWIVES ACTS, 1902-36 At the end of the year 1945 there were 14 Midwives practising in the district, all of whom were employed by the Council as wholetime domiciliary midwives. The following table shows the cases attended during 1945 and 1944: — Municipal Midwives. 1945 1944 Cases attended as midwives 559 616 Cases attended as maternity nurses 241 309 Private Midwives. Cases attended as midwives Nil 29 Cases attended as maternity nurses Nil Nil Although the number of cases attended was less than the previous year, considerable difficulties were experiencd owing to the resignation of midwives and illness, the result being that there were periods when the staff was placed under considerable strain to cope with the calls made upon them. 21 NOTIFICATIONS In accordance with the rules of the Central Midwives Board, the following notifications were received: — 1945 1944 Sending for Medical Aid 158 159 Still Births 3 4 Laying out of the dead — - Artificial feeding 12 31 Liability to be a source of infection 3 8 Notification of death 2 3 The notifications in connection with Medical Aid can be classified as follows: — During Pregnancy 24 During Labour 94 During Lying-in Period 15 Infant 25 FINANCIAL ASSISTANCE IN RESPECT OF MIDWIFERY FEES Financial assistance was given in 206 cases. This compares with 214 in 1944, and 164 in 1943. OBSTETRIC SPECIALIST The scheme whereby the General Practitioners of the district may call in the help of the Obstetric Unit at the North Middlesex County Hospital in cases of difficulty during the ante-natal period or at the confinement, continued throughout the year. On only one occasion was the Unit called and a successful blood transfusion was given. HOME HELPS Despite repeated efforts during the year it was still impossible to obtain women for this type of work. BIRTH CONTROL In accordance with the authority given by the Minister of Health, your Medical Officers continued to give advice on this subject to those mothers attending the Maternity and Child Welfare Centres, for whom further pregnancy would be detrimental to health. CIRCULATION OF BOOKLET ON REARING OF CHILDREN The booklet on child welfare called "To Mothers and Fathers" was circulated to all mothers who were to be attended at their confinement by one of the Council's Midwives, either as a midwife or maternity nurse, and to all those who were to be admitted to the North Middlesex County Hospital for their confinement, and also to those other mothers whose confinements were notified. 22 ANTE-NATAL CLINICS During the year 1,719 mothers attended the ante-natal clinics. The figure for the previous year was 1,535 which shows a considerable increase in the work involved. POST-NATAL CLINICS During the course of the year, 425 mothers attended the PostNatal Clinics for examination. This examination takes place by appointment six weeks after the confinement, and is an attempt to ensure that complete return 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. The number of mothers availing themselves of this valuable and in some cases most necessary service is on the whole disappointing, as a post-natal examination may enable many mothers to avoid ill-health, and disappointment. INFANT WELFARE CLINICS The total number of children who made their first attendance at the Infant Welfare Clinics was 1,962. VISITS The Health Visitors paid 835 visits to Expectant Mothers, 3,849 to children under one year of age, and 6,333 to children between the ages of one and five years. The number of visits paid by the Health Visitors for all purposes shows a marked increase over the previous year. The full benefit of these visits has, unfortunately, not been attained, as much of the time is spent in investigating home conditions with a view to ascertaining the possibility of a home confinement. This has been caused by the acute shortage of hospital maternity accommodation. It is hoped that it will soon be possible for the Health Visitors to utilise their time on proper home visiting in which they can advise and demonstrate to the mothers in their own homes the various aspects of child welfare. It seems inevitable, however, that for some time to come this aspect of the Health Visitors' work may not receive that full attention which is the very essence of their activities. 23 ASSISTED 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 ... 548 lbs. cost £48 9s. 6d. In addition 212 lbs. of other food adjuncts were supplied in cases where the products supplied by the Ministry of Food were not satisfactory for the individual case. 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 was 2,569, as compared with 2,035 in 1944. EAR, NOSE AND THROAT TREATMENT Mothers, and children under 5 years of age, suffering from such defects were referred to the School Ear, Nose and Throat Specialist. OPHTHALMIC TREATMENT Ante-Natal and Nursing Mothers and Children under 5 years of age, with eye defects, were referred to the School Ophthalmic Surgeon. The following is a summary of the cases referred during 1945:— Mothers. Children. Total attendances 22 184 No. of individual cases 22 110 New cases 20 68 No. of glasses prescribed 7 22 No glasses required 10 10 Attendances for other than refraction 1 17 Referred to Hospital Nil 12 SPEECH CLINIC Two children were referred to the Speech Therapist for training. CHILD LIFE PROTECTION—PUBLIC HEALTH ACT, 1936 At the end of 1945 there were ten persons receiving children for reward; the total number of children concerned was 21. Regular visits to these homes were paid during the year by the Infant Life Protection Visitors (Health Visitors), and it was found that the children were being properly cared for. 24 DENTAL TREATMENT The following particulars show the work carried out at the Dental Clinics for Ante-Natal and Nursing Mothers and children under the age of 5 years for the year 1945: — Mothers. Children. Totals. Attendances 830 176 1,006 Treated Administration of Local 185 115 300 Anaesthetics 53 38 91 Patients having L.A 42 34 76 Extractions with L.A. 90 46 136 Administrations of N2O 114 54 168 Patients having N2O 84 51 135 Extractions with N20 712 143 855 Total extractions 802 189 991 N20 Sessions 31 – 31 Ordinary sessions 39 – 39 Dentures fitted 97 – 97 Patients having dentures 56 – 56 Repairs fitted 21 – 21 Patients having repairs 21 – 21 Fillings 107 70 177 Other operations 491 31 522 CONVALESCENT TREATMENT During the year it was possible to send one child away for a period of convalescence. EVACUATION OF EXPECTANT MOTHERS The Ministry of Health Scheme which was administered by the London County Council whereby expectant mothers were evacuated to the country in order to have their confinements under more peaceful conditions continued until the 31st August, 1945. The number of mothers taking advantage of this scheme up to that date was 26. From the 1st September, 1945, the Ministry of Health continued to make available to Local Authorities the facilities of these emergency maternity homes, but the financial arrangements were so altered as to make the Local Authorities responsible for the cost, and it was the duty of the Local Authorities to recover from the mother such sum as they thought fit. In view of the heavy 25 financial burden so imposed on the Local Authorities, particularly as a result of inadequate maternity hospital facilities in the Enfield area, the Middlesex County Council agreed to accept the responsibility. The number of mothers availing themselves of these facilities was 42. ORTHOPAEDIC TREATMENT During the course of the year 28 children were found to be suffering from orthopaedic defects needing treatment or observation. The following are the defects from which they suffered:— Ankle valgus 3 Flat feet 5 Bow legs 4 Bilateral intoeing 1 Knock-knee 8 Metatarsal varus 1 Flat feet and ankle valgus 1 Congenital deformity of toes 1 Slight talipes 2 Left Hemiplegia 1 Flat feet and Knock-knee 1 Four old cases were also kept under observation. DIPHTHERIA IMMUNISATION The campaign for the immunisation of children against diphtheria continued throughout the year and 1,238 children under the age of five years were so immunised. On a child's first birthday, it is the practice to send him a birthday card 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 many of these invitations are accepted. All children on reaching the age of 4½ years are invited, by post-card, to attend a Maternity and Child Welfare Clinic to be immunised or to receive a supplementary reinforcing dose. In addition to the above, 280 children between the ages of 5 and 14 years were also immunised during the year. Although this routine method of notification to attend the Clinics for immunisation is important, the most successful propaganda is found to be by personal advice and the Medical Officers and Health Visitors are continually bringing to the notice of parents the importance and the benefits to be gained therefrom. 26 WHOOPING COUGH During the year 109 children under the age of 5 years were immunised against Whooping Cough by your Medical Officers. DISTRIBUTION OF VITAMINS The distribution of Orange Juice, Cod Liver Oil and Vitamin A and D 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 in the district. During the course of the year, the following have been distributed through the Maternity and Child Welfare Centres: — Orange Juice 65,792 bottles. Cod Liver Oil 6,861 bottles. Vitamin A and D Capsules 638 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 4 Number of children in respect of whom notice was given under Section 7 (3) 4 Number of such children under supervision at the end of the year 4 Many requests were also received from Registered Adoption Societies that we should investigate homes at which persons are living who are desirous of adopting children. In all these cases visits were paid by the Health Visitors and confidential reports submitted to the appropriate Society. 27 WAR-TIME NURSERIES At the end of 1945 there were four War-time Nurseries in Enfield. Name of Nursery. No. of Places. Average Daily Attendances. Suffolks—Opened December, 1941 60 38 Green Street—Opened July, 1942 60 47 High Street—Opened July, 1943 60 49 Baker Street—Opened February, 1944 60 50 Children attending the Nurseries are immunised against diphtheria and whooping cough. During the year the Senior Dental Surgeon inspected the teeth of all children aged 2-5 years. CARE OF PREMATURE INFANTS—CIRCULAR 20/44 The number of babies notified during 1945 who weighed 5½ lbs. or less at birth was 37. This number included 4 sets of twins. The number who were nursed entirely at home was 34. Three died during the first 24 hours, 1 before reaching the age of one month, and 33 were alive at the end of one month. Where the birth occurs in Hospital, a visit is paid by the Health Visitor immediately on discharge. BABY BATHING DEMONSTRATIONS The co-operation with Head Teachers has continued, and during the year the Health Visitors have attended the Senior Girls' Departments in order to demonstrate to the older girls the bathing of a baby. These girls have also visited the Infant Welfare Clinics and the Day Nurseries. STUDENT HEALTH VISITORS In conjunction with the Royal College of Nursing, practical training in Maternity and Child Welfare and School Medical work to students studying for the Health Visitor's Certificate is given by the Department. Several students were so trained during the year. PRIORITY DOCKETS FOR SHEETS This scheme continued and during the year 1.436 dockets were issued to expectant mothers. 28 DOMICILIARY NURSING A grant of £25 per annum is paid by the Council to The Eastern Enfield District Nursing Association and The Enfield District Nursing Association on condition that they carry out such domiciliary nursing as may be required in connection with expectant and nursing mothers and children under 5 years of age. Both Associations carried out a number of such nursings during the year. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER For the year ending 31st December, 1945 30 MEMBERS OF THE ENFIELD EDUCATION COMMITTEE 1945 Chairman Mr. E. S. Stock, J.P. Vice-Chairman Mr. D. Mason. Representative Members Mrs. G. M. Jay, J.P. Mr. W. C. Bennett Mr. D. H. Parker Bowles Mr. W. G. Bowyer Mr. H. A. Deshborough Brown Mr. T. H. M. Clarke Mr. A. M. Eeles Mr. W. Graham Mr. F. Greenwood, J.P. Mr. H. D. Hyde Mr. A. R. Kemp Mr. W. F. Lawrence Mr. D. Mason Mr. L. R. Morris Mr. H. Muspratt, O.B.E. Mr. C. Partington, J.P.,M.R.S.T. Mr. H. G. Short Mr. E. S. Stock, J.P. Appointed Members Mrs. E. M. Squire, C.C. Mr. S. G. Rowlandson, M.B.E., F.C.A., C.C. Co-optative Members Mrs. L. Daines Mrs. A. L. Henry Mrs. H. B. Hyde Mr. J. Bailey Mr. D. Boxall Mr. G. W. Chapman Mr. A. J. Crofts District Education Officer E. Pascal, Esq., M.A. 31 STAFF OF THE SCHOOL MEDICAL DEPARTMENT School Medical Officer: William D. Hyde, M B., Ch.B.. D.P.H. A ssistanr 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.) N. D. Miller, L.D.S., R.C.S. (Eng.), (Appointed September, 1945) I. Frischmann, L.D.S. (Eng.), D.M.D. (Berlin), (Appointed September, 1945) School Ophthalmic Surgeon: S. Macky, M.B., B.S., D.O.M.S. School Orthoptist: Miss F. B. Stephenson School Aural Surgeon : L. Boss, M.D. (Breslau), (Appointed July, 1945) Speech Therapist: Miss E. Richnell, L.R.A.M., A.S.S.T., M.A.S.T. (Resigned August, 1945) Miss E. N. Dorey, L.C.S.T. (Appointed November, 1945) School Nurses: Miss I. Fowler, S.R.N. Miss V. Murphy, S.R.N., S.C.M., M.S.S.Ch. Miss I. J. Muncer, S.R.N., H.V.'s Cert. Miss M. Rogers, S.R.N. Dental Nurse : Miss F. Anderson, R.S.C.N. Dental Attendants: Mrs. M. Freeman (Resigned 30.11.45) Miss M. A. Morter Clerks : Miss A. I. Cooper Miss J. B. Wingfield Miss P. E. Roberts 32 ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER William D. Hyde, MB., Ch.B., D.P.H. For the year ending 31st December, 1945. To The Chairman and Members of the Enfield Education Committee. I have pleasure in presenting my Annual Report on the work of the School Medical Department for the year ending 31st December, 1945. The year was outstanding, firstly because of the termination of hostilities and secondly because of the commencement of the operation on the 1st April of the major portion of the Education Act 1944. The first event brought a welcome relief to all, but it occasioned several staff resignations of those who had retained appointments during the war and who then desired to retire from the School Medical Service. Consequently, all branches of the service suffered to some extent from periods of disorganisation. However, by the end of the year it had been possible to replace all vacancies, and in regard to the Dental Service in particular, even to attain the pre-war complement of staff. The operation of the Education Act 1944 has caused considerable changes in administration and procedure and the full benefits of the Act can only gradually be realised. There is no doubt, however, but that the handicapped school child will benefit considerably as the facilities envisaged in the Act become available. More than ever it is the responsibility of the School Medical Service to ensure that every school child, no matter what may be the degree and type of handicap, shall receive the medical attention and educational facilities which are required. In addition to the efforts being made along these lines, the main aim of the School Medical Service must be a steady expansion of its various functions, although it may be that its identity will ultimately merge into a National Health Service. It would appear that the immediate needs of the Enfield School Medical Service are an expansion in the School Dental Service (including orthodontic treatment) and the Orthopaedic Service. There is also need for facilities to be provided locally for Special School education for physically handicapped pupils and also Child Guidance treatment. In conclusion I wish to record my appreciation of the loyal service given by the Members of the School Medical Staff. William D. Hyde, School Medical Officer. 33 ROUTINE MEDICAL INSPECTION AT PRIMARY AND SECONDARY MODERN SCHOOLS Average number on books 12,228 Average weekly attendance 10.787 Number of Schools 22 The total number of children examined during the year was 3,618. 75.2 per cent. of the children examined were accompanied by their parents, and 26.7 per cent. were vaccinated. DEFECTS FOUND AT ROUTINE MEDICAL INSPECTION Requiring Treatment Requiring to be kept under observation Enlarged tonsils and adenoids 70 20 Enlarged tonsils only 9 70 Adenoids 4 3 Other nose and throat conditions 4 4 Conjunctivitis 2 – Blepharitis 5 1 Other Eye Conditions 3 – Enlarged Cervical Glands – 2 Scabies 7 – Impetigo 5 – Other Skin Conditions 5 1 Defective Hearing 7 4 Otitis Media 2 – Other Ear Conditions 7 2 Defective Speech 4 2 Defective Vision 160 98 Squint 9 – Bronchitis – 1 Asthma 1 1 Other Lung Conditions: Nontuberculous – 21 Organic Heart Disease 1 2 Functional Heart Conditions 1 10 Anaemia – 2 Epilepsy – 1 Spinal Curvature 6 1 Other Deformities 33 35 Other Diseases and Defects 4 67 Tuberculous Gland – 1 34 Uncleanliness. Of 3,618 children examined one was found to have vermin in her head, and 132 had nits, i.e., 3.6 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 3,618 Number of children classified "A" 559 Percentage of children classified "A" 15.5 Number of children classified "B" 2,668 Percentage of children classified "B" 73.7 Number of children classified " C" 362 Percentage of children classified "C" 10.0 Number of children classified "D" 29 Percentage of children classified "D" .8 A Excellent B Normal C Slightly sub-normal D Bad ROUTINE MEDICAL INSPECTION AT SECONDARY GRAMMAR AND TECHNICAL SCHOOLS The number of children examined during the year was as follows:— Junior Technical School 194 Boys' Grammar School 280 Girls' County School 287 The classification of the nutrition of these children was as follows:— School. Classification. "A" "B" "C" "D" Junior Technical 28 141 25 – Boys' Grammar 38 221 21 – Girls' County 85 198 3 1 35 The following defects were found:— Defects. School. Jnr. Technical Grammar. County. Defective Vision 29 15 26 Defective Hearing – – 1 Blepharitis – – 1 Enlarged Tonsils 2 1 – Adenoids – 3 – Other Nose and Throat Conditions – 2 Other Lung Conditions (Non-tuberculous) – 1 Spinal Curvature – 3 4 Other Deformities 10 3 3 Other Diseases and Defects 4 7 1 NOTIFIABLE INFECTIOUS DISEASES Diphtheria 16 Scarlet Fever 109 Dysentery 9 Pneumonia 16 Erysipelas 1 4 Cerebro-Spinal Fever 1 Poliomyelitis 3 Measles 621 Whooping Cough 79 THE WORK OF THE SCHOOL NURSES Number of home visits 1,822 Number of school visits 244 Number of school visits for routine examination of heads 180 Total number of heads examined 32,945 Number of individual children found unclean 1,028 Number of cases in which legal proceedings were taken Nil 36 TREATMENT CLINICS Cases dealt with at Minor Ailment Clinics:— Requiring Treatment. Requiring to be kept under observation. Ringworm 25 – Scabies 31 5 Impetigo 191 – Other skin conditions 180 7 Blepharitis 50 1 Conjunctivitis 45 2 Other eye conditions 123 11 Defective vision 134 29 Otitis media 8 2 Other ear conditions 142 10 Other nose and throat conditions 102 45 Defective hearing 16 9 Bronchitis 18 4 Other lung conditions 12 17 Asthma 2 6 Enlarged tonsils and adenoids 188 49 Spinal curvature – 4 Heart conditions 2 7 Post-scarlet fever 43 5 Other deformities 30 78 Other defects 731 325 DENTAL CLINICS Primary and Secondary Modern Schools. Secondary Grammar and Technical Schools. Number inspected 6,999 550 Number treated 3,204 293 Number of fillings 2,560 485 Number of extractions 4,669 181 Total attendances 4,907 668 37 OPHTHALMIC CLINIC Primary and Secondary Modern Schools. Secondary Grammar and Technical Schools. Total attendances 1,628 372 New cases 364 49 Prescriptions for glasses 310 60 Number not requiring glasses 164 16 Number of children attending 1,010 209 ORTHOPTIC CLINIC During the year the total number of attendances at the Orthoptic Clinic was 1,124. Of this total, 128 were new cases of strabismus and heterophoria referred by the Ophthalmic Specialist to the department for treatment and/or report. Of the children seen, 37 were discharged:— 23 with good binocular vision 4 with partial binocular vision 5 improved 5 with cosmetic results Eight children were referred for report but were found to be unsuitable for treatment because either binocular vision was already well established or they were cosmetically good. Two cases were discontinued after trial courses. Two children were referred to other clinics as no longer eligible to attend. Two patients refused to attend for regular treatment. During the year eleven children had operations at the Western Ophthalmic Hospital and subsequent courses of treatment at the clinic. EAR, NOSE AND THROAT CLINIC Number of cases dealt with 189 Number of new cases 141 Total number of attendances 482 Number of cases discharged cured 115 Number of cases of a recurrent nature requiring occasional treatment 2 Number of cases still under treatment 56 Number of cases who have refused treatment or sought treatment elsewhere 13 38 TONSILS AND ADENOIDS Number of cases operated under the Authority's Scheme 240 ORTHOPAEDIC CLINIC During the course of the year 77 children attended the Orthopaedic Clinic. Of these 56 were new cases classified as follows:— Pes Planus 20 Poor posture 4 Curvature of spine 6 Metatarsal varus 2 Sheuermann's Disease 5 Deformity of toes 4 Knock-knee 1 Fracture of femur 1 Hemiplegia 2 Still's Disease 1 Hallux rididis 1 Pes cavus 1 Shortening of leg 1 Hammer toe 1 Spasmodic flat foot 2 Spina bifida occulta 1 Spastic diplegia 1 Talipes equino varus 1 Injury to knee 1 CARDIAC CLINIC In 1945, six special sessions were held at which children with suspected heart lesions were examined. Twenty-nine children were seen, a total of thirty-three attendances being made. Of these, nine children who had been under observation were finally discharged as having no signs nor symptoms of cardiac disease; ten were kept on the list for further observation and examination, although their symptoms were thought to be probably due to debility. Of the remaining ten, five had congenital heart disease which was not of sufficiently severe degree to prevent them from leading a comparatively normal life. They did not participate in organised drill and games at school, but there is little doubt that they took part in ordinary games with their playfellows, which enabled each child's heart-muscle to undertake sufficient exercise. Five other children had previously suffered from rheumatic fever, and their progress was very good. They were attending school regularly, and suffering no ill effects. It is particularly 39 able how well the heart muscle responds to adequate rest, care, and attention on the part of the parent. Those children who are fortunate in their parents have fewer relapses, and a higher degree of general health. SPEECH CLINIC The total number of children receiving treatment during the year was 50. These are classified under the following defects:— Dyslalia 22 Stammering 14 Cleft palate 6 Stigmatism 4 Dysarthria 2 Dysphonia 2 Ten cases were discharged cured. Four discontinued treatment on leaving school. Treatment for three children was temporarily postponed until after further operations. The remaining 33 names are still on the register. There is a very long waiting list, and it has become increasingly apparent that Enfield requires the services of a full-time Speech Therapist. Arrangements are being made for this to be provided as soon as circumstances permit. Closer co-operation has been established between the Medical Staff and the Speech Therapy Clinic. Consequently before treatment children are now examined by a Medical Officer, and referred witn appropriate medical notes. PHYSICALLY HANDICAPPED AND EDUCATIONALLY SUB-NORMAL CHILDREN There were four blind children in Enfield, two of whom were attending residential schools for the blind. Nine children were in attendance at Philip Lane School for the Deaf, Tottenham; these may be classified as follows: — Six suffering from acquired deafness Three suffering from motor aphasia There was one deaf child at a residential school and one deaf child was evacuated. Four children were attending the Special Day School for Physically Defective Children, Tottenham. 40 Thirty-nine children were examined under the Mental Deficiency and Education Acts during 1945. These were scheduled as follows:— Dull and backward but capable of instruction in an elementary school 3 Mentally backward but capable of instruction in a special school 19 Imbecile 7 Not scheduled (to be seen again) 10 SPECIAL EXAMINATIONS Sixty children had special examinations during the year, eighteen of whom were referred to Child Guidance Clinics, twentysix were recommended a short stay at a residential open-air school, and five were recommended for admission to special residential schools. SUMMARY OF EXAMINATIONS The total number of children examined during the year, excluding those attending the Dental Department, was 9,473. This number was made up as follows:— Examined at Routine Medical Inspection 4.379 Examined at Minor Ailment Clinics 3,287 Examined at Ophthalmic Clinic 1,219 Examined at Orthoptic Clinic 128 Examined at Ear. Nose and Throat Clinic 189 Examined under Juvenile Employment Bye-laws 16 Examined under Mental Deficiency and Education Acts 39 Examined at Orthopaedic Clinic 77 Examined at Cardiac Clinic 29 Examined at Speech Clinic 50 Special examinations 60 DEATHS AMONGST SCHOOL CHILDREN There were fourteen deaths during the year. The causes were as follows:— 1 Meningitis. 1 Asphyxia. 3 Pneumonia. 2 Heart failure. 1 Rheumatic fever. 1 Leukaemia. 2 Enemy action. 3 Accident (2 road: 1 fungus poisoning). PROVISION OF SCHOOL MEALS During 1945, 27,417 dinners were provided free, and 808,493 provided and paid for. 2,375,653 bottles of milk were provided and paid for, and 44,453 were provided free. Enfield Bennett & Starling, Ltd. — Printers — Windmill Hill