C.1 AC.439(3) ENFIELD (Late Man D.) 'Middx ENF 30 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 1946 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 1946 1 Public Offices, Enfield, Middlesex. July, 1947. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, 1946 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 1946. The incidence of infectious disease was low throughout the year, the most marked reduction on the previous year being in respect of measles, but it is gratifying to note also the reduction in cases of tuberculosis. In connection with cases of tuberculosis the paramount importance of satisfactory housing conditions in the prevention of the spread of infection must be realised, especially in those cases where there are young children in the household and the patient is awaiting admission to a Sanatorium. As detailed elsewhere in my report, the residents of Enfield were given the opportunity of investigation by the Mass X-Ray Unit of the Middlesex County Council, and the response to the public sessions as organised by the Enfield Council was most satisfactory. There were only three cases of diphtheria during the year— a remarkably low figure. These occurred in children, two of whom were sisters who contracted the disease concurrently, and none of the three children had been immunised. Unfortunately, two cases proved fatal. There still remains scope for a much greater acceptance of diphtheria immunisation, especially in the matter of reinforcing doses to maintain a high level of immunity throughout school life. The birth rate shows an appreciable increase over the previous year, having reached a figure of 20.86, there being 468 more births than the previous year, and the municipal midwives having attended 323 more cases. A new record in the Enfield municipal midwifery service was reached with the midwives having attended a total of 1,123 cases. The still-birth rate, death rate and maternal mortality rate all showed decreases, whilst the infant mortality rate of 33.17, comparing very favourably with that of England and Wales of 43.00, was only slightly higher than the two previous years when the figures were the two lowest recorded this century. Prematurity is associated with a large proportion of the infant deaths, and in the successful prevention of premature birth lies one of the best prospects of reducing infant mortality, although, of course, special attention is at present directed to the care of premature infants. During the year the Health Department co-operated with the Joint Committee of the Population Investigation Committee and the Royal College of Obstetricians and Gynaecologists in an 2 investigation aiming at collecting information which would enable the Joint Committee to make informed suggestions as to whether, and in what ways, it would be possible to help mothers with the social and economic problems that they meet in bearing children. The final report of this Committee is not yet available. The year was a busy one for all members of the Health Department, acute staffing difficulties being experienced in all services. Difficulty was experienced in coping with the volume of work involved in action under the Housing and Food and Drugs Acts. The more personal services provided by the Department are fully utilised by the public and attendances at all Clinics have been heavy, one exception being the post-natal clinics where, as yet, mothers are not fully appreciative of the importance of a medical overhaul shortly after childbirth. Arrangements were made for the showing of films on various health matters at one of the Welfare Centres, at a special session set aside for this purpose, but the attendance was disappointing. A subsequent film show on Nursery Schools and other subjects at another Welfare Centre was more successful. The former war-time nurseries of the Ministry of Health were transferred to the Local Authority who continued the provision of three as day nurseries on similar lines as formerly. They have been working to capacity with unfortunately long waiting lists, which have increased since the recall of mothers with young children to industry. It is disappointing that so few girls appear interested in becoming Student Nursery Nurses. The usefulness of the work and the excellent training, which should be of inestimable value to girls, no matter what sphere of life they ultimately choose, are factors which one would expect to appeal to many girls. One feature of considerable satisfaction was our ability to re-commence in a modified form the Home Help scheme, and the services of Home Helps were provided in 40 cases, priority being given to homes in which childbirth had occurred, although on a few occasions it was found possible to provide the services in cases of illness or other domestic emergencies. It can be said with emphasis that a Home Help scheme, although domestic rather than medical in nature, is one that plays a most important part in the health and well-being of mothers at the time of their confinement, and the importance of such a service cannot be over estimated. In conclusion I should like to record my appreciation of the efforts of the staff of the Health Department during a year when shortage of staff and frequent changes made their tasks more onerous. WILLIAM D. HYDE, Medical Officer of Health. 3 URBAN DISTRICT COUNCIL OF ENFIELD A. R. Kemp, Esq., J.P. Chairman Mrs. G. M. Jay, J.P. Vice-Chairman Mrs. I. A. Summers. D. Mason, Esq. W. C. Bennett, Esq. L. C. Merrion, Esq. G. Blandford, Esq. H. Muspratt, Esq., O.B.E. W. G. Bowyer, Esq. C. Partington, Esq., J.P., D. R. J. Boxall, Esq. M.R.S.T. H. A. D. Brown, Esq. P. L. Purnell, Esq. T. H. M. Clarke, Esq. E. S. Stock, Esq. G. Deacock, Esq. A. A. F. Tatman, Esq. J. Edwards, Esq. C. H. Thomas, Esq. A. M. Eeles, Esq. H. Thompson, Esq. F. Greenwood, Esq. R. A. Williams, Esq. H. D. Hyde, Esq. W. S. Williams, Esq. W. G. Jollie, Esq. G. Williams, Esq. HEALTH COMMITTEE Mrs. G. M. Jay, J.P. Chairman A. A. F. Tatman, Esq. Vice-Chairman also Mrs. Summers, and Messrs. Blandford, Boxall, Jollie, Muspratt, Purnell and R. A. Williams. 4 PUBLIC HEALTH STAFF Medical Officer of Health: Dr. W. D. Hyde. Assistant do Drs. L. Rivlin, D. M. Butler and M. Smith-Wilson. Senior Sanitary Inspector: Mr. A. N. Smith. Sanitary Inspectors : Mr. H. Wiggett, Mr. A. Ramsden, Mr. J. C. Quin (resigned March, 1946) and Mr. E. T. Jephcott. Shops and Housing Inspector: Mr. M. Wilson. Chief Clerk: Mr. Sydney Coulter. Deputy Chief Clerk: Miss E. W. Bowyer. Senior Clerks: Miss D. Hiller and Mr. C. W. Chapman. General Clerks: Miss W. B. Paynter, Mr. J. W. Viggers, Mrs. O. E Robertson, Mrs. L. Francis, Miss B. Dobson, Miss D. Hamer, Miss H. O'Connor, Miss J. Barwick and Miss B. R. Brooker. Shorthand-Typists: Mrs. K. E. Wood and Miss P. Gooday. Part-time General Clerk: Mrs. Law. Senior Health Visitor: Miss Garlick. Health Visitors: Miss C. Wilkinson, Miss M. Radford, Miss G. Helyar (resigned), Miss O. Tarling, Mrs. M. Putman (resigned) and Miss G. Hobbs. Midwives: Mrs. S. Barnes (resigned), Mrs. D. Harrison, Miss E. Butcher, Miss G. Payne, Miss J. Johnson, Miss A. Treherne, Mrs. I. Mitchell, Mrs. M. Cameron, Mrs K. Wasmuth, Miss E. Palfrey, Mrs. A. Wilkinson, Mrs. M. Hinkley, Miss E. Davies, Miss I. Lake, Miss F. Peters, Miss A. Emery and Miss D. Baldock. Matrons of Day Nurseries: Mrs. Robinson, Mrs. Merritt and Mrs. Squires. 5 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 104,210. The number of inhabited houses at the end of 1946, according to the Rate Books, was 30,263. The rateable value of the District is £922,581 The net product (after allowing for cost of collection) of a penny rate is £3,675 SOCIAL CONDITIONS The number of houses erected during the course of the year was 393, 259 of which were of the Pre-Fabricated Type. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Live Births:— Total. Male. Female. Legitimate 2,082 1,038 1,044 Illegitimate 92 53 39 Birth-rate—20.86 per 1,000 population. Still Births:— Total. Male. Female. Legitimate 53 27 26 Illegitimate 3 2 1 Rate per 1,000 total births—25.11 Total. Male. Female. Deaths 1,022 570 452 Death-rate—9.80 per 1,000 population. Number of women dying in, or in consequence of, childbirth:— Rate per 1,000 Deaths. Total Births. From Puerperal Sepsis 1 0.44 From other Puerperal causes 1 0.44 2 0.89 6 Death-rate of Infants under one year of age:— All infants per 1,000 live births 36.79 Legitimate infants per 1,000 legitimate live births 36.02 Illegitimate infants per 1,000 illegitimate live births 54.34 Deaths from Cancer (all ages) 171 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years of age) 17 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 19.10 0.53 11.50 43.00 London 21.50 0.54 12.70 41 00 126 County Boroughs and Great Towns (including London) 22.20 0.67 12.70 46.00 148 Smaller Towns 21.30 0.59 11.70 37.00 ENFIELD 20.86 0.53 9.80 36.79 DEATHS The number of deaths assigned to Enfield for 1946 was 1,022, showing an increase of 61 over last year. The more important causes of death during the year and the previous year were:— Cause of Death. 1946. 1945. ALL AGES:— Malignant Disease 171 155 Heart Disease 261 220 Other Diseases of Circulatory System 47 43 Pneumonia 49 44 Bronchitis 48 61 Intra-cranial Vascular Lesions 113 90 Tuberculosis of Respiratory System 48 44 CHILDREN UNDER 1 YEAR:— Premature Birth 23 14 Congenital Malformations 11 9 Pneumonia 6 8 Bronchitis 4 7 Diarrhœa and Enteritis 15 7 7 The net death-rate for the District is 9 80 per 1,000 population. Two hundred and seventy-five deaths registered in the District were perscns over 80 years of age, 132 being males and 143 females, one man dying at the advanced age of 96, three women at the same age, and three other women at the ages of 97, 98 and 100 respectively. The following tables give the causes of deaths at all ages and of children under the age of 1 year:— TABLE I. Causes of Death during Year 1946. Causes of Death. Males. Females. Total. Typhoid and Para-Typhoid Fevers — — — Cerebro-spinal Fever — — — Scarlet Fever — — — Whooping Cough — — — Diphtheria 1 2 3 Tuberculosis of Respiratory System 33 15 48 Other Forms of Tuberculosis 2 — 2 Syphilitic diseases 10 2 12 Influenza 2 2 4 Measles — — — Ac. Polio-myel: & polio-enceph. — — — Ac. Inf. Enceph. 1 — 1 Cancer of buc: cav. & oeseph (M) uterus (F) 8 11 19 Cancer of stomach & duodenum 21 8 29 Cancer of breast 1 19 20 Cancer of all other sites 65 38 103 Diabetes 1 4 5 Intracranial vascular lesions 41 72 113 Heart disease 138 123 261 Other diseases of Circulatory System 28 19 47 Bronchitis 28 20 48 Pneumonia 32 17 49 Other Respiratory Diseases 5 2 7 Ulcer of stomach or duodenum 11 4 15 Diarrhoea under 2 years 12 5 17 Appendicitis 2 — 2 Other Digestive Diseases 12 12 24 Nephritis 11 6 17 Puer. & Post-abort. Sepsis — 1 1 Other Maternal Causes — 1 1 Premature Birth 12 11 23 Con. mal; birth inj: infant dis. 19 8 27 Suicide 7 2 9 Road traffic accidents 9 3 12 Other violent causes 13 5 18 All other causes 45 40 85 Total 570 452 1,022 8 TABLE II. Infant Mortality Net Deaths from stated causes at various Ages under One Year of Age. Causes of Death. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under One Year. All Causes—Certified 33 14 5 2 54 11 9 3 2 79 Uncertified . 1 — - — 1 - — — — 1 Smallpox — - - - - - - - - - Chickenpox — - - - - - - - - - Measles — - - - - - - - - - Scarlet Fever — — - — — - — — — — Whooping Cough - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculosis Diseases - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - Convulsions — 1 - — 1 - 1 — — 2 Laryngitis - - - - - - - - - - Bronchitis — — - — — 2 2 — — 4 Pneumonia (all forms) — 1 - 1 2 1 1 2 — 6 Diarrhoea — — 1 — 1 — — — — 1 Enteritis — - 2 1 3 6 2 1 2 14 Epidemic Diarrhoea - - - - - - - - - - Gastritis - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation, overlying - - - - - - - - - - Injury at Birth 3 1 — — 4 — — — — 4 Atelectasis 5 - 1 — 6 — — — — 6 Congenital Malformation 7 3 1 — 11 2 — — — 13 Premature Birth 16 7 — — 23 — — — — 23 Atrophy, Debility and Marasmus 3 - - - 3 - 1 - - 4 Other Causes - 1 — — 1 — 2 — — 3 Totals 34 14 5 2 55 11 9 3 2 80 Net Births in the year: —Legitimate: Live births, 2,082; Stillbirths, 53. Illegitimate: Live births, 92; Still-births, 3. Net Deaths in the year:—Legitimate Infants, 75; Illegitimate, 5. It will be seen from Table II that of the 80 infants who died before attaining the age of 1 year, 34 died within the first week of life. The infant mortality rate for the District is 36 79 and this figure compares favourably with the rest of the country. 9 BIRTHS The actual number of births registered in the District was as follows:— Males. Females. Total. 600 612 1,212 including 17 male and 16 female illegitimate births. In addition 11 male and 10 female still births were registered. The corrected birth rates for both sexes, live and still births, which takes into consideration those born outside the District and those in the District not rightly recorded to the District, and also the corrected birth rates for the last five years are:— Year. Boys. Girls. Total. Birth-rate per 1.000 Population. Illegitimate Birth-rate per 1,000 Population. 1942 937 887 1,824 19.19 0.76 1943 1,017 948 1,965 20.63 0.83 1944 1,046 940 1,986 21.41 0.75 1945 923 843 1,766 18.65 1.15 1946 1,120 1,110 2,230 21.39 0.91 INQUESTS Fifty-three inquests and seventy-eight P.M.s without inquests were held on Enfield residents during the year. Out of these, 82 deaths were due to natural causes, 35 to accidental causes, 9 to suicide, 4 to misadventure, and in 1 case an open verdict was recorded. AMBULANCE FACILITIES General During the first full post-war year of the Civil Ambulance Service maintained by the Health Department, 3,474 patients were conveyed to Hospitals, the total mileage undertaken by the Ambulances being 29,774 miles. The Service has four Ambulances, two of which are maintained fully manned with interchangeable driver and attendant during the 24-hour period, it being possible in emergency to man the other Ambulances by withdrawing attendants to act as drivers. The Ambulance Service is housed at Carterhatch Depot in temporary accommodation, no arrangements having been made for a more permanent location in view of the complete re-organisation of Ambulance Services envisaged in the National Health Service Act. 10 Infectious Diseases During the year, 193 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 398 1 397 0.25 Sputa 95 3 92 3.15 Totals 493 4 489 0.81 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. 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 This function was transferred to the new Housing Department when the appointment of a Housing Superintendent was made. MEDICAL EXAMINATION OF STAFF During the year, 177 medical examinations for the purposes of the Superannuation Act were carried out by the Medical Officers of Health. 11 INFECTIOUS DISEASES AND SCHOOLS 1946. 1945. Number of children notified to be absent from School due to:— (a) Infectious Disease or suspected Infectious Disease 332 39 (b) Contact with Infectious Disease 21 - Number of children notified as suffering from Infectious Disease 81 - HOUSING Number of New Houses erected during the year:— Perm. Temp. (a) Total (including number given separately under (b) and (c)) 134 259 (i) By the Local Authority 22 259 (ii) By other Local Authorities 79 Nil (iii) By other bodies or persons 21 Nil (b) With State Assistance under the Housing Act:— (i) By the Local Authority 22 259 (ii) By other Local Authorities 79 Nil (iii) By other bodies or persons Nil Nil (c) Re-building of houses destroyed by enemy action:— (i) By the Local Authority 4 (ii) By other Local Authorities Nil (iii) By other bodies or persons 8 1. Inspection of Dwelling-houses:— No. of houses. No. of inspections. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) and number of inspections made 2,644 8,859 12 (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 3 (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 (The number here given is of houses where any insanitary conditions were found.) 1,613 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 988 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 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 225 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices:— (o) By owners 138 (b) By Local Authority in default of owners 32 13 The number of house-to-house visitations made was:— Under Housing Regulations, 1925 and 1932 32 Apart from Do. Do. 806 THE MILK (SPECIAL DESIGNATIONS) ORDERS, 1936 and 1938 There are 23 Purveyors of Milk who sell or distribute Pasteurised Milk in the district. 5 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. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES The number of cases of Scarlet Fever was 168, compared with 169 in 1945: of Diphtheria 3, as compared with 20; of Pulmonary Tuberculosis 109, as compared with 119; and of Pneumonia 71, as compared with 69. There were two deaths from Diphtheria during the year, as against one death in 1945. The Registrar General's figures show three deaths from Diphtheria; this is due to the fact that one of the deaths which occurred at the end of 1945 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 1945. NOTIFIABLE DISEASES DURING THE YEAR 1946 No. Removed. Deaths. Smallpox — — — Cholera—Plague — — — Diphtheria (inc. Membranous Croup) 3 3 *2 Diphtheria Carriers — — — Erysipelas 29 9 1 Scarlet Fever 168 113 — 14 Typhus Fever — — — Typhoid Fever 1 1 — Paratyphoid Fever — — — Relapsing Fever — — — Continued Fever Puerperal Pyrexia 7 5 — Cerebro-Spinal Meningitis 1 1 — Poliomyelitis — — — Polio Encephalitis — — — Ophthalmia Neonatorum 4 2 — Pulmonary Tuberculosis 109 — 48 Other forms of Tuberculosis 18 — 2 Encephalitis Lethargica — — — Food Poisoning — — — Malaria 12 — — Pneumonia 71 — 49 Dysentery 46 7 — Measles 362 24 — Whooping Cough 197 7 — Totals 1,028 172 102 The above figures are in respect of Civilians and Non-Civilians. *See explanatory note in first paragraph on this page. The following table shows the number of notifications of cases of Infectious Diseases per 1,000 civilian population for Enfield as compared with England and Wales, 126 County Boroughs and Great Towns including London, 148 Smaller Towns with Resident population 25,000-50,000 (1931 Census) and London Administrative County. ENFIELD. England and Wales. 126 C.Bs. and Great Towns including London. 148 Smaller Towns Resident Pop. 25,000-50,000 1931 Census. London Adm. County. Typhoid Fever 0.00 0.01 0.01 0.01 0.01 Paratyphoid Fever 0.00 0.02 0.02 0.01 0.01 Cerebro-Spinal Fever 0.009 0.05 0.05 0.04 0.06 Scarlet Fever 1.61 1.38 1.51 1.33 1.42 Whooping Cough 1.89 2.28 2.48 2.05 2.22 Diphtheria 0.02 0.28 0.32 0.31 0.24 Erysipelas 0.27 0.22 0.25 0.22 0.27 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 3.47 3.92 4.73 3.70 7.35 Pneumonia 0.68 0.89 1.02 0.74 0.75 15 DIPHTHERIA During the year only three cases of Diphtheria occurred in the district, showing a decrease of 17 cases on the previous year's figure. The three cases, two of which were fatal, occurred in children who had not been immunised. DIPHTHERIA IMMUNISATION Through the services of the Council 1,321 children were immunised for the first time and 763 received subsequent reinforcing doses during the year. The number of parents accepting this service for their children is not sufficiently high to warrant any sense of security. TUBERCULOSIS The following Table gives particulars of the ages of the new cases notified and deaths from this disease during the year. Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory M. F. M. F. M. F. M. F. Under 1 - - - - - - - - 1 to 5 2 3 — 2 — — — — 5 to 10 2 — 1 2 — — — — 10 to 15 2 4 — — — 1 — — 15 to 20 5 7 2 1 — — 2 — 20 to 25 8 10 2 1 4 4 — — 25 to 35 11 14 2 2 9 2 — — 35 to 45 7 10 1 — 3 5 — — 45 to 55 12 4 — 1 8 1 — — 55 to 65 4 — 1 — 5 1 — — 65 and upwards 3 1 — — 4 1 — — Totals 56 53 9 9 33 15 2 - MASS RADIOGRAPHY FOR DETECTION OF TUBERCULOSIS Following upon representations by the Council to the Middlesex County Council, a County Council Mass X-Ray Unit visited Enfield in October and November and operated for five weeks at The Enfield Cable Works, Brimsdown. All the other local factories were invited to co-operate and arrangements were made for their employees to attend for the 16 purpose of being X-Rayed if they so desired; in addition members of the public were given an opportunity of attending for X-Ray. It was felt, however, that the situation of the Enfield Cable Works was not conducive to a satisfactory and successful campaign insofar as the public of Western Enfield was concerned. Arrangements were therefore made for the Unit to be installed for a week at the Methodist Church Hall adjoining the Public Offices, and the large attendance at each Session exceeded all expectations. It is most gratifying to know that the Western Enfield campaign was a complete and outstanding success, more especially when it is realised that this was the first occasion on which the Unit had held public sessions directly under the auspices of a local authority and on any premises other than a factory. The following is an extract from a report I received from the County Physician-in-charge of the Mass X-Ray Unit:— "The Urban District Council of Enfield are to be con"gratulated on making such a success of the experiment. The "undoubted success of the Mass X-Ray Scheme in Enfield "demonstrates that the public are interested in a health pro"tection measure of this kind and will make full use of the "Service when it is put at their disposal." The following Table gives details of the results of the campaign:— W. Enfield. E. Enfield. Totals. Number examined 1,815 5,974 7,789 Recalled for large films 86 222 308 DISPOSAL OF LARGE FILM CASES: No further action 64 119 183 Further medical advice recommended 19 73 92 Known cases had or having treatment 1 3 4 Failed to attend for large film 1 2 3 Report not completed 1 14 15 To return to Unit for further X-Ray - 11 11 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. 17 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 scheme sponsored by the Ministry of Food (Infestation Division) for the systematic treatment of the sewers in the district with a view to the extermination of rats has been in operation during the year. Such sewers as are found to need further attention will be dealt with in accordance with the Ministry's recommendation. During the year the Sanitary Inspectors made 865 visits concerning rat infestation. ERADICATION OF BED BUGS Number of Council houses found to be infested 12 Number of Council houses disinfested 12 Number of other houses found to be infested 39 Number of other houses disinfested 39 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 1946. The total number of inspections made during the year for all purposes was 12,448. NOTICES ISSUED Statutory 446 Informal 909 Other Notices 1,691 Total 3,046 18 Other Letters sent 9,997 Number of Certificates issued in connection with plans 6 Number of Certificates issued in connection with disinfection 10 Number of Certificates issued in connection with unsound foods 464 Number of Requisitions for Information dealt with 1,281 Number of Certificates issued under Rent Restrictions Act, 1933 23 Number of Essential Works Certificates issued 530 Result of Service of Statutory and Informal Notices:— Statutory. Informal. Number complied with 320 683 Number outstanding 126 226 446 909 TOTAL INSPECTIONS Four hundred and fifty-two visits were paid in respect of infectious diseases during the year, and the total number of inspections and visits for all purposes made by the Sanitary Inspectors was 12,448. This is a decrease on last year's figure, and is due to the fact that the Department lost the services of one of its Sanitary Inspectors in the early part of the year, and the vacancy thus occasioned has not yet been filled. An Inspector was appointed in June for the purpose of carrying out the requirements of Section 58 of the Housing Act, 1936, and the provisions of the Shops Acts, 1912 to 1936. From the date of his appointment until the end of the year he made the following number of visits:— Housing Act, 1936 806 Shops Acts, 1912-1936 2,418 Total 3,224 DISINFECTION Number of houses disinfected after infectious disease and verminous cases 363 Number of articles of clothing, bedding, etc., disinfected 2,097 Number of Library books disinfected 118 19 FACTORIES ACT, 1937 Defects Found A register is kept of all the factories in the District, and during the year 89 inspections were carried out; as a result the following defects were discovered:— Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. Referred by H.M. Inspector. Want of Cleanliness 4 3 - 2 Inadequate Ventilation — — 3 1 Overcrowding — — — — Ineffective Drainage of Floors — — — — Unreasonable temperature — — — — Sanitary Conveniences:— Insufficient 9 2 — 7 Unsuitable or Defective 13 7 — 21 Not separate for sexes — — — — Other Offences 1 — 2 1 Total 27 12 5 32 OUTWORKERS Eighteen lists containing the names and addresses of 79 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. The following table gives details of the work carried out:— Outwork Nature of Work. No. of Outworkers. Prosecutions. Notices served. Umbrellas 1 - - Carding, etc., of Buttons 2 — — Brass and Brass Articles 5 — — Making Wearing Apparel 46 — — Cardboard Boxes, etc. 14 — — Artificial Flowers 1 — — Feather Curling 5 — — Furniture and Upholstery 4 — — Brush Making 1 — — Totals 79 — - 20 PLACES OF PUBLIC ENTERTAINMENT Number of inspections 17 OFFENSIVE TRADES Four offensive trade premises are established in the district, and during the year no complaints were received in connection therewith. SMOKE ABATEMENT During the course of the year observations have been kept on the factory chimneys of the district for nuisances due to the issue of an excessive amount of smoke. SWIMMING BATHS AND POOL The water at each of the Baths in Enfield is tested twice daily by the Superintendents to ascertain the concentration cf Chlorine in the water. In addition, samples are taken each week by my Department and examined in the Laboratory at the Office for chlorine content and alkalinity. During the warm part of the Season samples of the water have been sent to the Emergency Public Health Laboratories where a full chemical and bacteriological examination is carried out. I was satisfied that throughout the Season the purity of the water in the Baths was satisfactorily maintained. SCHOOLS The sanitary condition of the County Schools in the District is under the constant supervision of the Sanitary Inspectors and any defects found are immediately remedied by the Authorities concerned. The sanitary conveniences at all the non-provided schools are attended to daily by an employee of the Health Department. MILK Seventeen cowkeepers in the District maintain herds of milch cows. Despite difficulties the standard of cleanliness has been fairly well maintained. Three of the farms produce Tuberculin tested milk, and six produce Accredited milk. Regular sampling of these specially designated milks by the Middlesex County Council have shown consistently satisfactory results throughout the year. Number of Licences in force on 31st December, under the Milk (Special Designations) Orders, 1936 and 1938 37 21 PUBLIC HEALTH (MEAT) REGULATIONS, 1924 Total number of carcases examined 15 Number, or parts, found to be diseased 17 Weight of do. do. 4 cwts. 2 qrs. 20¼ lbs. No. of Certificates issued 17 FOOD AND DRUGS ACT, 1938 (UNSOUND MEAT AND FOODS) The number of Food Preparing and Ice-Cream premises registered in the District and number of inspections and visits made by the Sanitary Inspectors in regard thereto are as follows:— Premises No. No. of Inspections and Visits Food Preparing 84 593 Ice-Cream (Sale and/or manufacture) 82 173 Number of inspections made to Meat Depot, shops, stalls in markets and food-preparing shops 887 Total No. of articles, etc., condemned 6,300 Total No. of Certificates issued 464 Total weight of foodstuffs condemned as unfit for food 9 tons 19 cwts. 3 qrs. 21½ lbs. MIDDLESEX COUNTY COUNCIL ACT, 1944 SECTION 279 The provisions of the above requiring all Hawkers of Meat, Fish, Fruit and Vegetables and Storage Premises used in connection therewith to be registered by the Council came into force on the 1st May, 1946 and from that date until the end of the year 32 Hawkers were registered, and 38 inspections made. 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. 22 DUSTBINS The replacement of defective dustbins has been a difficult problem for property owners in recent years. During the past four 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 138 owners to whom dustbins were supplied during the year. PUBLIC MORTUARY There is now no public mortuary in Enfield, but use is made at present of a Hospital Mortuary. MATERNITY and CHILD WELFARE SECTION 24 MATERNITY AND CHILD WELFARE COMMITTEE 1946-1947 Chairman Mrs. G. M. Jay, J.P. Vice-Chairman Mrs. I. A. Summers. Mrs. Cottenham. Mrs. Eeles. Miss Hill. Mrs. Martin. Mrs. Turvey. G. Blandford, Esq. D. R. J. Boxall, Esq. H. A. Deshborough Brown, Esq. W. G. Jollie, Esq. A. R. Kemp, Esq. H. Muspratt, Esq. P. L. Purnell, Esq. A. A. F. Tatman, Esq. R. A. Williams, Esq. 25 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. Thursday, 9.30 to 11.30 a.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, Thursday and Friday, 1.30 to 3.30 p.m. Enfield West. Laing's Estate Office, Enfield West. Friday, 10.30 to 12 noon. 26 District Situation of Centre Day and times open Post-Natal Clinics Ponders End. School Clinic, Southbury Road, Enfield. Every third Friday in each month at 10.30 a.m. Bush Hill Park Lincoln Road, Bush Hill Park. Every first Friday in each month at 2 p.m. Town and Chase. Rosemary Avenue, Enfield. Every first Tuesday in each month at 2 p.m. Ordnance. St. Stephen's Road, Enfield Wash. Every 1st and 2nd 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. Dental Clinics Ponders End. School Dental Clinic, bury Road, Ponders End. Saturday mornings, 9.30 to 11.30 a.m. Wednesday afternoons, 2 to 4 p.m. Enfield Wash. Albany Clinic, Bell Lane, Enfield Wash. Alternate Saturday mornings, 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. 27 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Live Births:— Total Male Female Legitimate 2,082 1,038 1,044 Illegitimate 92 53 39 Birth-rate—20.86 per 1,000 population Still Births:— Total Male Female Legitimate 53 27 26 Illegitimate 3 2 1 Rate per 1,000 total births—25.11 Death rate of infants under one year of age:— All infants per 1,000 live births 36.79 Legitimate infants per 1,000 legitimate live births 36.02 Illegitimate infants per 1,000 illegitimate live births 54.34 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 19.10 0.53 11.50 43.00 London 21.50 0.54 12.70 41.00 126 County Boroughs and Great Towns (including London) 22.20 0.67 12.70 46.00 148 Smaller Towns 21.30 0.59 11.70 37.00 ENFIELD 20.86 0.53 9.80 36.79 INFANT MORTALITY Of the 80 infants who died before attaining the age of one year, 34 died within the first week of life. In 6 cases death was due to Pneumonia, in 4 to Bronchitis, in 13 to Congenital malformation, in 23 to Premature Birth and 14 to Enteritis. On page 8 appears Table II which gives the ages and cause of death of all children under the age of one year. 28 PUERPERAL PYREXIA During the year 7 cases of Puerperal Pyrexia were notified, five of which were admitted to the Enfield, Edmonton and Potters Bar Joint Isolation Hospital. MATERNAL MORTALITY There were two maternal deaths during the year and the cause was as follows:— Hæmorrhage into Suprarenal Glands, due to Septic Abortion due to Chronic Uterine Cervicitis In Hospital Inevitable abortion, Intractable Uterine Hæmorrhage In Hospital The ages of these two mothers were 36 and 37 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 is one Home for chronic, aged and infirm patients, and during the year a Maternity Home was established. Both these Homes are kept under regular supervision by your Medical Officers. Particulars of the Homes are as follows:— Address No. of Medical Beds No. of Maternity Beds "Claremont," Baker Street, Enfield 7 — "Windsmill," Windmill Hill, Enfield — 20 ADMINISTRATION OF MIDWIVES ACTS, 1902-36 At the end of the year 1946 there were 20 Midwives practising in the district, 16 of whom were employed by the Council as wholetime domiciliary midwives, and 4 employed in the private Maternity Home. 29 The following table shows the cases attended during 1946 and 1945:— 1946 1945 Municipal Midwives— Cases attended as maternity nurses 682 559 Cases attended as midwives 441 241 Private Midwives— Cases attended as maternity nurses — — Cases attended as midwives 8 - The number of cases attended by the Municipal Midwives shows a very marked increase over the previous year, 323 more cases having been attended. This extra work, combined with the difficulty in securing an adequate number of Midwives throughout the year, placed a heavy strain on the service, but nevertheless, a high degree of efficiency was maintained. NOTIFICATIONS In accordance with the rules of the Central Midwives Board the following notifications were received:— 1946 1945 Sending for Medical Aid 233 158 Still Births 9 3 Laying out of the dead 5 — Artificial feeding 17 12 Liability to be a source of infection 6 3 Notification of death 3 2 The notifications in connection with Medical Aid can be classified as follows:— During pregnancy 14 During labour 144 During lying-in period 29 Infant 46 FINANCIAL ASSISTANCE IN RESPECT OF MIDWIFERY FEES Financial assistance was given in 130 cases. This compares with 206 in 1945 and 214 in 1944. 30 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. HOME HELPS It was found possible in the early part of the year to recommence the Home Help Scheme which had fallen into abeyance during the war years on account of the difficulty experienced in obtaining women to undertake this type of work. It was a source of considerable satisfaction to the Department to be able to restart this scheme, as the need for such domestic assistance in many homes at the time of confinement was fully realised. Although the number of Home Helps employed at the end of the year was only 6 full time and 1 part time their services had been greatly appreciated by the families concerned. The following figures show the work undertaken:— 36 maternity cases, 4 domestic cases. 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. ANTE-NATAL CLINICS During the year 2,077 mothers attended the ante-natal clinics. The figure for the previous year was 1,719 which shows a considerable increase in the work involved. 31 POST-NATAL CLINICS During the course of the year, 417 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. INFANT WELFARE CLINICS The total number of children who made their first attendance at the Infant Welfare Clinics was 2,173. VISITS The Health Visitors paid 1,031 visits to Expectant Mothers, 4,850 to children under one year of age, and 4,659 to children between the ages of one and five years. The number of visits paid by the Health Visitors to expectant mothers, and children under one year of age, shows a marked increase over the previous year, but there is a decrease in the number of visits to children between the ages of one year and five years. Owing to the shortage of Health Visitors, it was found necessary to concentrate on visits to expectant mothers and to the younger children, and unfortunately a large proportion of the time of the Health Visitors has been spent in investigating home conditions with a view to ascertaining the possibility of a home confinement because of the acute shortage of Maternity Hospital accommodation. It is hoped, that with adequate staff and with an improvement in the Maternity Hospital accommodation in the district, the Health Visitors will be able to utilize their time in proper home visiting in which they can advise and demonstrate to the mothers in their own homes the various aspects of Child Welfare. It still seems inevitable, however, that for some time to come, this aspect of the Health Visitors' work may not be able to receive the full attention which is the very basis of their activities. 32 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 326 lbs. Cost £29 15s. Od. In addition 42 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 2,893 (31%) as compared with 2,569 in 1945. 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. The following is a summary of the work carried out during 1946:— 6 mothers were referred, one of whom was sent to Hospital for antrum washouts. 46 children were referred, 16 of whom were advised adenectomy. 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 1946:— Mothers. Children. Total attendances 26 148 No. of individual cases 16 86 New cases 15 54 No. of glasses prescribed 10 24 Attendances for other than refraction 1 6 Referred to Hospital 4 4 33 SPEECH CLINIC The arrangement whereby children can be referred to the Speech Therapist for training continued throughout the year. CHILD LIFE PROTECTION—PUBLIC HEALTH ACT, 1936 At the end of 1946 there were 14 persons receiving children for reward; the total number of children concerned was 29. 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. 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 1946:— Mothers. Children. Totals. Attendances 1,028 234 1,262 Treated 266 137 403 Administrations of Local Anæsthetics 162 35 197 Patients having L.A. 63 30 93 Extractions with L.A. 225 47 272 Administrations of N2O 105 45 150 Patients having N2O 59 42 101 Extractions under N2O 596 116 712 Total extractions 821 163 984 N2O sessions 44 — 44 Ordinary sessions 60 — 60 Total sessions 104 — 104 Dentures fitted 153 — 153 Patients having dentures 87 — 87 Repairs fitted 12 — 12 Patients having repairs 12 — 12 Fillings 164 131 295 Other operations 554 38 592 CONVALESCENT TREATMENT During the year it was possible to send three children away for a period of convalescence. 34 EMERGENCY MATERNITY HOMES During 1946 the Ministry of Health continued to make available to Local Authorities the facilities of these Emergency Maternity Homes. Unfortunately, maternity accommodation available under this scheme was so limited that few Enfield mothers were able to receive this advantage, in spite of the difficulty in securing Maternity Hospital accommodation locally. The number of mothers who were able to avail themselves of these facilities was 61, in comparison with 68 during the previous year. ORTHOPAEDIC TREATMENT During the course of the year 75 children were found to be suffering from orthopaedic defects needing treatment or observation. The following are the defects from which they suffered:— Little's disease 2 Genu valgum 31 Pes planus 16 Congenital foot deformity 16 C.D. hip 1 Bow legs 7 Toe deformity 2 DIPHTHERIA IMMUNISATION The campaign for the immunisation of children against diphtheria continued throughout the year and 1,201 children under the age of five years were immunised for the first time. 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, 120 children between the ages of 5 and 14 years were also immunised for the first time. 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. 35 In addition to the above numbers of children who were immunised for the first time, 763 received reinforcing doses which are important in order to maintain a high level of immunity amongst the child population. The importance of this reinforcing dose prior to school entry, and also possibly about the age of 10 years, is becoming more apparent. WHOOPING COUGH During the year 193 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 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 55,184 bottles Cod Liver Oil 9,007 bottles Vitamin A Capsules 1,017 packets ILLEGITIMACY—CIRCULAR 2566 Arrangements have 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, and during the year there has been a marked increase in the number of adoptions coming within the scope of the Health Department. Number of persons who gave notice under Section 7 (3) during the year 8 Number of children in respect of whom notice was given under Section 7 (3) 14 Number of such children under supervision at the end of the year 13 Many requests were also received from 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. 36 DAY NURSERIES On the 1st April, 1946, the war-time nurseries in the district which had been sponsored by the Ministry of Health, became the direct responsibility as Day Nurseries of the local Welfare Authorities, and three were continued as Day Nurseries and one as a Nursery School. Name of Nursery No. of places No. on Register at end of year Green Street 60 66 High Street 60 69 Baker Street 60 56 Children attending the Nurseries are immunised against diphtheria and whooping cough. CARE OF PREMATURE INFANTS—CIRCULAR 20/44 The number of babies notified during 1946 who weighed 5½ lbs. or less at birth was 106. The number who were nursed entirely at home was 55. Three died during the first 24 hours, and 52 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 the 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 2,268 dockets were issued to expectant mothers. 37 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. SCHOOL HEALTH SERVICE 40 MEMBERS OF THE ENFIELD EDUCATION COMMITTEE 1946 Chairman Mr. A. R. Kemp, J.P. Vice-Chairman Mr. C. Partington, J.P., M.R.S.T. Representative Members: Mr. W. C. Bennett Mr. G. Blandford Mr. D. R. J. Boxall Mr. T. H. M. Clarke Mr. G. Deacock Mr. J. Edwards Mr. A. M. Eeles Mr. F. Greenwood Mr. H. D. Hyde Mrs. G. M. Jay Mr. A. R. Kemp, J.P. Mr. D. Mason Mr. Partington, J.P., M.R.S.T. Mr. P. L. Purnell Mr. E. S. Stock Mrs. I. A. Summers Mr. A. A. F. Tatman Mr. R. A. Williams A ppointed Members: Mrs. F. Long, C.C. Mrs. E. M. Squire, C.C. Co-opted Members: Mrs. L. E. Daines Mr. A. W. Bax Mr. A. J. Crofts Rev. J. B. Harington-Evans Mr. W. Graham Mr. W. Threadgold Mr. C. C. S. Reeves 41 STAFF OF THE SCHOOL HEALTH SERVICE Medical Officer: William D. Hyde, M.B., Ch.B., D.P.H. Assistant Medical Officers : Lilian Rivlin, M.R.C.S., L.R.C.P. Brenda M. Mayes, M.B., B.S., D.P.H. (Resigned July, 1946) Dora M. Butler, M.B., B.S., D.P.H. Dental Officers: C. E. James, L.D.S., R.C.S. (Eng.) I. Frischmann, L.D.S., (Eng.), D.M.D. (Berlin) S. R. Storey, L.D.S., R.C.S. (Appointed February, 1946) Ophthalmic Surgeon: S. Macky, M.B. B.S., D.O.M.S. (Resigned April, 1946) Jean M. G. Shaw, M.B., Ch.B., D.O.M.S., D.O., (Appointed September, 1946) Ear, Nose and Throat Surgeon: L. Boss, M.D. (Breslau) Speech Therapist: Miss E. N. Dorey, L.C.S.T. (Resigned August, 1946) Miss J. Fowler, L.C.S.T. (Appointed September, 1946) School Nurses: Miss I. L. Fowler, S.R.N. Miss V. Murphy, S.R.N., S.C.M., M.S.S.Ch. (Resigned April, 1946) Miss I. J. Muncer, S.R.N., H.V.'s Cert. Miss M. Rogers, S.R.N. Mrs. A. M. Bone, S.R.N., H.V.'s Cert. (Appointed June, 1946) Dental Nurse: Miss F. C. Anderson, R.S.C.N. Dental Attendants: Miss J. E. M. Hill Miss D. A. Watson Clerks: Miss A. I. Cooper Miss J. B. Wingfield Miss P. E. Roberts 42 ANNUAL REPORT ON THE SCHOOL HEALTH SERVICE William D. Hyde, M.B., Ch.B., D.P.H. For the year ending 31st December, 1946. To the Chairman and Members of the Enfield Education Committee. I have pleasure in presenting my Annual Report on the School Health Service for the year ending 31st December, 1946. The year was marked by an increase in the amount of work carried out in all departments of the Service, during what was the first complete year of post-war conditions. Many of the immediate difficulties encountered in the new administration consequent upon the passing of the Education Act, 1944, have been overcome, but the steady expansion of the Service as envisaged in my last report will, of necessity, take time to develop. Staffing difficulties have been less acute during the year, but on the provision of further clinic premises depends the future development of the Service, and this aspect has had the consideration of the Committee and preliminary steps have been taken in this matter. The services of a full-time Speech Therapist are now available and arrears of work in this sphere are receiving attention. The Dental Service requires expansion but this is dependent upon the provision of new clinic premises. Arrangements have, however, been made for children to receive Specialist Orthodontic treatment. The work of the orthopaedic clinic showed a marked increase, facilities continuing to be available at Chase Farm Hospital. The arrangements for Child Guidance treatment cannot be considered adequate nor convenient for the district and it is hoped that a local service, consisting of Psychiatrist, Psychologist and Social Worker, will be inaugurated when accommodation is available. In conclusion, I wish again to record my appreciation of the loyal service given by the Members of the School Medical Staff, and in particular to refer to the departure of Mr. S. Macky who for 14 years gave such excellent service as School Ophthalmic Surgeon. William D. Hyde, Medical Officer. 43 ROUTINE MEDICAL INSPECTION Average number of school children on register 13,803 Number of Schools 25 The total number of children examined during the year was 3,829. 72 per cent. of the children examined were accompanied by their parents. 30.4 per cent of the children were vaccinated. DEFECTS FOUND AT ROUTINE MEDICAL INSPECTION Requiring Treatment Requiring to be kept under observation Skin: (a) Scabies 6 - (b) Impetigo 1 — (c) Other skin conditions 4 2 Eyes: (a) Vision 177 132 (b) Squint 8 1 (c) Other eye conditions 13 5 Ears: (a) Hearing 6 12 (b) Other ear conditions 4 1 Nose or Threat conditions 93 105 Speech 12 — Cervical Glands — 1 Heart and Circulation — 6 Lung conditions — 12 Orthopaedic: (a) Posture 10 1 (b) Other conditions 53 34 Other defects 2 27 The following table shows the state of nutrition among the children examined:— Number of children examined 3,829 Number of children classified "A" 722 Percentage of children classified "A" 18.8 Number of children classified "B" 2,802 Percentage of children classified "B" 73.2 Number of children classified "C" 287 Percentage of children classified "C" 7.5 Number of children classified "D" 18 Percentage of children classified "D" .5 A Excellent B Normal C Slightly sub-normal D Bad 44 THE WORK OF THE SCHOOL NURSES Number of home visits 1,211 Number of special school visits 147 Number of school visits for routine examination of heads 235 Total number of heads examined 32,038 Number of individual children found unclean 513 Number of Nurses' minor ailment clinics held 707 Total attendances of children at Nurses' clinics 19,161 Number of routine medical inspection sessions attended by Nurses 199 TREATMENT CLINICS Defects dealt with at Minor Ailment Clinics by Assistant School Medical Officers:— Requiring Treatment Requiring to be kept under observation Skin: (a) Ringworm of head 2 — Ringworm of body 19 1 (b) Scabies 51 4 (c) Impetigo 159 2 (d) Other skin conditions 291 15 Eyes: (a) Vision 157 13 (b) Squint 2 1 (c) Other conditions 163 21 Ears: (a) Hearing 3 12 (b) Otitis Media 10 — (c) Other conditions 138 23 Nose or Throat 283 107 Heart and Circulation 4 4 Lung Conditions 36 31 Orthopaedic: (a) Posture 1 8 (b) Other conditions 45 85 Other defects 1,044 490 DENTAL CLINICS The Senior School Dental Surgeon refers in his report to the need for expansion of the Service to meet the growing demands of the district and he reports with satisfaction the Specialist Orthodontic facilities now available. The majority of extractions were carried out under local anaesthesia but 453 general anaesthetics were administered. 45 In addition to the large numbers of fillings and extractions carried out, 1,430 other operations were performed, consisting of root dressings, root fillings, scaling and polishing teeth, gum treatments and adjustments to regulation apparatus, etc. A comparison of the dental condition of children five to six years old attending three schools in the district shows that there was during 1946 a marked increase in two schools and a slight decrease in one school, of the percentage of children found to be "naturally fit" in 1939. "Naturally fit" means that all teeth were present in a naturally perfect condition, no tooth having suffered from dental caries at any time. The number of carious teeth and the number of teeth lost per child inspected also showed an appreciable decrease in these three schools. (1) Number of pupils inspected by the Dentists— (a) Routine Age-groups 9,695 (b) Specials 847 (c) TOTAL (Routine and Specials) 10,542 (2) Number found to require treatment 6,332 (3) Number actually treated 5,515 (4) Attendances made by pupils for treatment 9,474 (5) Half-days devoted to:— Inspection 80 Treatment 1,261 TOTAL 1,341 (6) Fillings:— Permanent teeth 5,867 Temporary teeth 995 TOTAL 6,862 (7) Extractions:— Permanent teeth 982 Temporary teeth 5,216 TOTAL 6,192 46 (8) Administrations of general anaesthetics for extractions 453 (9) Other operations:— Permanent teeth 1,245 Temporary teeth 185 TOTAL 1,430 OPHTHALMIC CLINIC Total attendances 2,056 Number of children attending 1,189 New cases 414 Prescriptions for glasses 476 Attendances for other than refraction 26 Children requiring operative treatment for squint 10 Children requiring other hospital treatment 13 ORTHOPTIC CLINIC Total attendances 1,100 Number of children attending 213 New cases 79 Number of cases discharged with following results:— 23 with good binocular vision 2 with partial binocular vision 6 improved 6 with cosmetic results 7 discontinued after trial course 2 transferred to other clinics 3 left school before completing treatment 3 refused to continue treatment 52 During the year four children had operations for squint at the Western Ophthalmic Hospital and subsequent courses of treatment at the clinic. EAR, NOSE AND THROAT CLINIC Total number of attendances 523 Number of cases dealt with 304 Number of new cases 190 Number of cases discharged cured 122 Number of cases of a recurrent nature requiring occasional treatment 24 Number of cases still under treatment 65 Number of cases who have refused treatment or sought treatment elsewhere 7 47 Referred to Speech Therapist 4 Recommended for School for Deaf Pupils 1 Supplied with Hearing Aid and attending ordinary school 1 TONSILS AND ADENOIDS Number of cases operated under the Authority's Scheme 316 ORTHOPAEDIC CLINIC This clinic continued to be held once a month at Chase Farm Hospital. Total attendances 264 New cases 107 Number of individual children 171 Classification:— Curvature of spine 17 Semi-membranosus bursa 1 Paralysis (Anterior Poliomyelitis) 5 Little's Disease 2 Pes planus 64 Sheuerman's disease 8 Hallux valgus 6 Toe deformity 11 Congenital foot deformity 2 Post-osteomyelitis 1 Poor posture 7 Hemiplegia 1 Spina bifida 1 Osgood's disease 1 CARDIAC CLINIC Three sessions were held during 1946 with eighteen attendances. Some children who are on the register were seen in the course of routine inspection, and as their progress was satisfactory they were not asked to make a special visit. Six of the cases seen were discharged as needing no more supervision, the heart having resumed its normal tone; these were post-febrile conditions originally. There were two new cases of congenital heart disease which had been previously diagnosed and had been under supervision at the Infant Welfare Clinics 48 It is very satisfactory to note that there were only two new cases due to rheumatic origin, and in both of these there was little permanent damage owing to early diagnosis and efficient co-operation of the parent with the general practitioner. It is found that when parents are willing to attend the clinic they endeavour to follow out the advice given, with beneficial results to the child. SPEECH CLINIC The total number of children who received treatment during the year was 111. These are classified under the following defects:— Dyslalia 45 Stammering 37 Cleft palate and/or hare lip 10 Stigmatism 10 Dysarthria 3 Dysphonia 3 Dysphasia 1 Hyper-rhinophonia 2 Seventeen cases were discharged cured. Four discontinued treatment on leaving school. Treatment for 10 children was temporarily postponed or deferred until after further operations or other kinds of treatment. Five children left the clinic at the request of their parents. Two children left the district. At the end of the year there were 72 children on the register who were receiving treatment. SPECIAL EDUCATIONAL TREATMENT—HANDICAPPED PUPILS Blind and Partially sighted pupils. No blind nor partially sighted pupils were discovered during the year. There were four blind pupils in Enfield, two of whom attended residential schools for the blind. Deaf and partially deaf pupils. One pupil was recommended admission to the Philip Lane School for the Deaf, Tottenham, and one pupil for a special residential school. One pupil was supplied with a hearing aid and attended ordinary school. There were ten pupils in attendance at Philip Lane School for the Deaf, Tottenham, and one child was at a residential school. Delicate pupils. Thirty-five pupils were recommended periods at a residential open-air school. 49 Diabetic pupils. Two diabetic pupils were in attendance at a special residential school. Educationally sub-normal pupils. Twenty-three pupils were recommended admission to Durants Special Day School and one pupil was recommended admission to a special residential school. There were sixty-nine children in attendance at Durants Special School. Epileptic pupils. One pupil was admitted to a special residential school. Maladjusted pupils. One pupil was recommended for a special residential school. Physically handicapped pupils. Six pupils were recommended for a special day school and one pupil for a special residential school. Four pupils were attending a residential school and seven pupils attended the Special Day School for Physically Defective Children, Tottenham. Speech defects. See report on Speech Therapy. Pupils suffering from disability of mind. Thirty-eight pupils were examined under Sections 34 and 57 of the Education Act, 1944, with the following recommendations:— To remain at an ordinary school 1 To be re-examined 5 To attend special day school 23 To attend special residential school 1 Referred for Psychiatric report 1 Referred to Local Authority for the purposes of the Mental Deficiency Act, 1913 6 SPECIAL EXAMINATIONS Eighty-five children had special examinations during the year, twenty-two of whom were referred to Child Guidance Clinics, thirty-five were recommended a short stay at a residential open-air school, five were recommended for admission to special residential schools and eight were recommended for admission to a special day school. 50 SUMMARY OF EXAMINATIONS The total number of children examined during the year, excluding those attending the Dental Department, was 9,163. This number was made up as follows:— Examined at Routine Inspection 3,829 Examined at Minor Ailment Clinics 3,177 Examined at Ophthalmic Clinic 1,189 Examined at Orthoptic Clinic 213 Examined at Ear, Nose and Throat Clinic 304 Examined under Juvenile Employment Bye-laws 28 Examined under Sections 34 and 57 of the Education Act, 1944 38 Examined at Orthopaedic Clinic 171 Examined at Cardiac Clinic 18 Examined at Speech Clinic 111 Special examinations 85 NOTIFIABLE INFECTIOUS DISEASES Diphtheria 2 Scarlet fever 114 Dysentry 4 Pneumonia 7 Measles 199 Whooping cough 56 Erysipelas 1 DEATHS AMONGST SCHOOL CHILDREN There were thirteen deaths during the year. The causes were as follows:— 2 Rheumatic Myocarditis 1 Cerebral Tumour 1 Diphtheria 2 Leukaemia 2 Asphyxia 5 Accident (3 road; 2 drowning) PROVISION OF SCHOOL MEALS During 1946, 50,989 dinners were provided free, and 1,011,322 provided and paid for. 1,703,719 bottles of milk were provided and paid for, and 920,032 were provided free. Enfield Bennett & Starling, Ltd. —Printers— Windmill Hill