ENF 31 Ac 439(1) ENFIELD (late Mum B.) 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 1947 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 1947 3 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, 1947 To the Chairman and Members of the Urban District Council of Enfield. I have pleasure in presenting my Annual Report for the year 1947. The year was a busy one for the Health Department. Work in connection with housing kept the depleted staff of Sanitary Inspectors very busy, but much achievement can be reported in this sphere, not only in endeavouring to maintain satisfactory standards in house property in general, but also in eliminating a few properties quite unsuitable for human habitation. At one period of the year there was a shortage of three Sanitary Inspectors and at the end of the year there were still two vacancies. This has had a serious effect on the scope of the work undertaken, and I am concerned that we have not been able to undertake as much inspection and supervision under the Food and Drugs Acts and Regulations as I feel to be necessary. I believe that this aspect of the work is one of the most important functions of a Health Department under present day conditions, with the extension of the habit of feeding outside the home and I believe that in this sphere there lie great opportunities and responsibilities for the Health Department. In regard to infectious diseases, the most serious event was the markedly increased incidence of poliomyelitis throughout the country, and Enfield had 18 cases. More detailed information on these cases is given elsewhere in this Report. Staffing difficulties, the shortage of Health Visitors in particular, have again handicapped the more personal Health Services. In spite of this, it was found possible to provide extra Clinic sessions to ease the pressure of large attendances, but this again was only possible at the expense of home visits by the Health Visitors—a situation which I deprecate, as I have so often stressed the importance of proper home visiting, in which the Health Visitors can advise and demonstrate to mothers in their own homes, the various aspects of child welfare. For the convenience of mothers attending our Clinics, arrangements were made for the sale of National Dried Milk at the Clinics. Difficulties continued to be experienced during the year in securing adequate supplies of Proprietary Baby Foods. 4 During the year a Maternity Department was opened at Chase Farm Hospital and most of the patients who formerly would have been admitted to the North Middlesex Hospital can now be admitted to Chase Farm Hospital. The Emergency Obstetrical Unit now operates from Chase Farm Hospital. Towards the end of the year, sufficient Gas and Air Analgesia Apparatus had been secured and a sufficient number of Midwives trained in its use, to contemplate commencing the Service in the district, and the Service was started soon after the end of the year. The three Day Nurseries continued to work to capacity, each Nursery having a continuously long waiting list. Some progress was made towards planning to open another Day Nursery to meet the heavy demand. Staffing difficulties were also experienced in this branch of the service, and it is surprising to me how few girls appear sufficiently interested in this type of work to become Student Nursery Nurses—a training, not only leading to an attractive and useful career, but one which would be expected to appeal to the natural instincts of many more girls. During the year we welcomed to the staff Doctor C. E. Jamison as Deputy Medical Officer of Health and Miss Smyth as Nonmedical Supervisor of Midwives. I take this opportunity of recording my appreciation of the efforts of all the staff when shortages and frequent changes made their duties more onerous. This Report for 1947, written as it is in 1948, seems a particularly appropriate occasion on which to comment on some aspects of the Health Services of Enfield during the present century, not only because 1948 has been selected for the commencement of the operation of the National Health Service Act, 1946, but also because Public Health services received their first statutory recognition in the Public Health Act of 1848, and the first Medical Officer of Health in this country had been appointed in 1847. Since these early days, much Public Health and Local Government Legislation has been passed and with the success attending Medical Officers of Health in their fight against adverse environmental conditions, new duties of a more clinical character were laid on Medical Officers of Health, culminating eventually in 1929 in Hospital administration. Now the National Health Service Act of 1946, in addition to the changes to be made in the Hospital, Specialist, General Medical and Dental Practitioner, and other Services, will take from local authorities like Enfield the more personal Health Services, and place this responsibility on the shoulders of the new Local Health Authorities, namely, County Councils, while removing from County Councils the responsibility for Hospital provision. It is to be hoped that complete co-operation will exist between the various statutory authorities concerned with 5 preventive and curative medicine, in order to ensure the smooth working of the services, but it appears that, in view of the many bodies concerned, this integration of the services must be dependent to a very large degree on the efforts of the officers concerned. It seems to me that Enfield's record of health service provision should not pass unnoticed, as its record is one of no inconsiderable achievement, and I have included in this report several graphs of particular interest. The first point of interest noted in the graphs is that Enfield has grown since the beginning of the century from a district with a population of 43,394 to an important town of 108,810, large enough by all standards to have outgrown its Urban District status, and surely of sufficient importance and achievement to be considered worthy of more comprehensive local government responsibility. The Birthrate which was 30.6 in 1902, steadily declined to 21.64 in 1915. In 1916 the figure rose slightly to 22.22, followed by a fall in 1917 to 17.91 and in 1918 to 15.78. The next two years saw a progressive rise to 22.87 in 1920, followed by a steady fall until it reached 14.72 in 1933, this being the lowest Birthrate recorded. A steady rise has since occurred with a remission in the early years of the last war. The deathrate shows a steady decline with frequent slight fluctuations. Steady progress in the reduction of the maternal mortality rate is also noted with particular emphasis on the last few years. Perhaps the most striking progress has been made in the case of the infant mortality rate which in the early part of the century was as high as 158.3 and in 1944 was as low as 29.21. In the province of infectious diseases some notable improvements are observed. In the case of Tuberculosis, the incidence of cases has shown on the whole a progressive reduction until 1929, when the figures remained more or less stationary until the beginning of the War, when there was a slight increase which has since shown signs of abating. In the case of deaths from Tuberculosis, the general trend has been a continual decrease. The Enteric Fever group—cases and deaths—in the early part of the century were at a steady level but have now reached the stage where only occasional fluctuations in the incidence draw comments. The incidence of Scarlet Fever cases has shown no marked reduction over the period under review, but the death rate from this disease has fortunately shown progressively marked improvement. 6 The most striking figures in connection with infectious diseases are those concerned with Diphtheria, where both the case and death rates have been reduced from a high steady level to a very low level during the last few years. Although Diphtheria immunisation was started in Enfield in 1934 it was not until the early years of the last war that an intensive country-wide effort was made to have the child population immunised and it is coincidental with that effort that the marked reduction in cases and deaths from Diphtheria has occurred. A glance through the Annual Reports of the Medical Officers of Health since the beginning of the century shows some interesting features, which are worthy of mentioning in passing as they throw some light on the progress made and the difficulties met and overcome throughout these years. In 1911 the Medical Officer of Health was perturbed at the diminishing birth rate in Enfield, although at that time the figure was 23.14 per 1,000 as compared with today's figure of 21.42. In 1907 the Notification of Births Act, 1907, was passed and the Medical Officer of Health's Annual Report for 1913 makes a strong plea for its adoption and for the appointment of a Health Visitor. In 1914 the Medical Officer of Health reported on a memorandum issued by the Local Government Board on the subject of Maternity and Child Welfare and he again recommended the adoption of a full service in Enfield. On the passing of the Notification of Births (Extension) Act in 1915, the Medical Officer of Health made a further detailed report on the provision of a Maternity and Child Welfare Service. This was approved by the Council and in 1916 the first Health Visitor was appointed, and Clinic Services provided in four centres in the district. In 1918, the Medical Officer of Health refers to an arrangement with the Edmonton Board of Guardians for the admission of Maternity Cases and the benefits to many mothers in view of the shortage of housing accommodation. In 1933, an important arrangement was inaugurated whereby regular and frequent routine medical inspections by appointment were offered to children under the age of 5 years. The following year arrangements were made for the services of a Consultant Obstetric Unit from the North Middlesex Hospital to be available to assist any general practitioner who required this help. A Home Help scheme was inaugurated and the free issue to mothers of that useful publication "To Mothers and Fathers " was commenced. 7 In 1935 the Medical Officer of Health stated that he had no hesitation in looking upon 1935 as one of Enfield's most important years in respect of Maternity and Child Welfare as it was in this year that three new maternity and child welfare clinics were opened. These clinics, designed and built specifically for Maternity and Child Welfare purposes were a great advance on the previous premises, which were hired halls. In 1936 was passed the Midwives' Act 1936 and 1937 was perhaps an equally important year for Enfield, as in that year Enfield became the Local Supervising Authority under the Midwives' Acts, thus becoming responsible not only for the supervision of the midwives of the district, but also for preparing and putting into force a municipal midwifery scheme. In the same year, the duties in connection with the registration of Nursing Homes also were given to Enfield. Thus Enfield became one of the 7 Local Supervising Authorities in Middlesex, and one of the 6 Authorities who were both Supervising Authorities and Local Education Authorities. By 1941, the inevitable temporary dislocation of some of the Maternity and Child Welfare services by the outbreak of war had been successfully overcome and an addition to the service was made in the opening of the first Day Nursery in the district. By 1944 four Day Nurseries had been opened. In 1946, one Day Nursery, for various reasons, had been converted to a Nursery School, and now in view of the continued demand for Day Nursery accommodation, plans are being prepared for the erection of a further Nursery. This brief review of the development of Maternity and Child Welfare in Enfield shows that Enfield can look back with satisfaction on its achievement in this sphere of personal health services, and hand over to the new Health Authority a sound, extensive and progressive service on which can be based the developments of the future William D. Hyde, Medical Officer of Health. 8 URBAN DISTRICT COUNCIL OF ENFIELD Mrs. G. M. Jay, J.P. Chairman H. D. Hyde, Esq. and A. A. F. Tatman, Esq. Vice-Chairmen on Cr. Hyde's resignation from Vice-Chairmanship Mrs. L. E. Daines. W. G. Jollie, Esq. Mrs. I. A. Summers. A. R. Kemp, Esq. A. D. Bates, Esq. W. F. Lawrence, Esq. W. C. Bennett. Esq. W. E. Lonsdale, Esq. G. Blandford, Esq. L. C. Merrion, Esq. W. G. Bowyer, Esq. L. Nicholls, Esq. D. R. J. Boxall, Esq. C. Partington, Esq., J.P., T. H. M. Clarke, Esq. M.R.S.T. G. Deacock, Esq. P. L. Purnell, Esq. J. Edwards, Esq. P. Robson, Esq. A. M. Eeles, Esq. E. S. Stock, Esq. F. Greenwood, Esq. C. H. Thomas, Esq. H. D. Hyde, Esq. H. Thompson, Esq. J. G. Jamieson, Esq. R. A. Williams, Esq. W. S. Williams, Esq. HEALTH COMMITTEE Mrs. G. M. Jay, J.P. Chairman A. A. F. Tatman, Esq Vice-Chairman also Mrs. Summers, Mrs. L. E. Daines, and Messrs. Boxall, Greenwood, Jollie, Kemp, Lawrence and W. S. Williams. 9 PUBLIC HEALTH STAFF Medical Officer of Health: Dr. W. D. Hyde. Deputy do. Dr. C. E. Jamison. Assistant do. Drs. L. Rivlin, D. M. Butler (resigned October, 1947), M. Smith-Wilson and M. Gilmour. Senior Sanitary Inspector: Mr. A. N. Smith. Sanitary Inspectors: Mr. H. Wiggett. Mr. A. Ramsden, Mr. E. T. Jephcott (resigned July, 1947) and Mr. D. C. Turner. 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 (resigned July, 1947), Mr. J. W. Viggers, Mrs. O. E. Robertson (resigned April, 1947), Mrs. L. Francis (resigned June, 1947), Miss B. Dobson (resigned May, 1947), Miss D. Hamer, Miss R. C. Young, Mrs. V. Robinson (resigned November, 1947), Miss H. O'Connor, Miss J. Barwick, Miss B. R. Brooker (resigned August, 1947), Miss E. J. Hughes and Mrs. K. Everest. Shorthand-Typists: Mrs. K. E. Wood, Miss P. Gooday and Mrs. K. S. Moore. Part-time General Clerk: Mrs. Law. Senior Health Visitor: Miss Garlick. Health Visitors: Miss C. Wilkinson, Miss M. Radford, Miss O. Tarling, Miss G. Hobbs and Miss O. Roberts. Non-Medical Supervisor of Mid wives: Miss W. V. Smyth. Midwives: Mrs. D. Harrison, Miss E. Butcher (resigned September, 1947), Miss G. Payne, Miss J. Johnson, Miss A. Treherne, Mrs. I. Mitchell, Mrs. M. Cameron, Mrs. K. Wasmuth (resigned December, 1947), Miss E. Palfrey, Mrs. A. Wilkinson, Mrs. M. Hinkley, Miss E. Davies, Miss I. Lake, Miss F. Peters, Miss A. Emery, Miss D. Baldock (resigned April, 1948) Miss M. Stow, Miss V. Hilderbrand, Miss K. Barratt, Miss E. Rawson (resigned January, 1948). Matrons of Day Nurseries: Mrs. Robinson, Mrs. Merritt and Mrs. Squires. 10 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 107,920. The number of inhabited houses at the end of 1947, according to the Rate Books, was 28,466. Explanatory Note:— Definition of "Houses"—Structurally separate dwellings including flats. The decrease in the actual number of houses from that shown last year, is due to the fact that only those dwellings structurally separate are now included and those incorporated with business premises are excluded. The rateable value of the District is £945,604 The net product (after allowing for cost of collection) of a penny rate is £3,860 SOCIAL CONDITIONS The number of houses erected during the course of the year was 568, which included 56 of the Pre-Fabricated Type, 23 conversions into flats, 41 re-building of war destroyed houses, and 1 re-instatement of extensively damaged houses. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Live Births: — Total. Male. Female. Legitimate 2,239 1,151 1,088 Illegitimate 73 37 36 Birth-rate—21.42 per 1,000 population. Still Births:— Total. Male. Female Legitimate 41 23 18 Illegitimate 2 2 — Rate per 1,000 total births—18.59. Total. Male. Female. Deaths 1,015 530 485 Death-rate—9.40 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 0.43 From other Puerperal causes 3 1.29 4 1.73 11 Death-rate of Infants under one year of age:— All infants per 1,000 live births 32.43 Legitimate infants per 1,000 legitimate live births 33.49 Illegitimate infants per 1,000 illegitimate live births 00.00 Deaths from Cancer (all ages) 167 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under 2 years of age) 6 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 20.50 0.50 12.00 41.00 London 22.70 0.49 12.80 37.00 126 County Boroughs and Great Towns (including London) 23.30 0.62 13.00 47.00 148 Smaller Towns 22.20 0.54 11.90 36.00 ENFIELD 21.42 0.39 9.40 32.43 DEATHS The number of deaths assigned to Enfield for 1947 was 1,015, showing a decrease of 7 of last year. The more important causes of death during the year and th previous year were:— Cause of Death 1947. 1946. ALL AGES:— Malignant Disease 167 171 Heart Disease 294 261 Other Diseases of Circulatory System 38 47 Pneumonia 57 49 Bronchitis 59 48 Intra-cranial Vascular Lesions 102 113 Tuberculosis of Respiratory System 33 48 CHILDREN UNDER 1 YEAR:— Premature Birth 17 23 Congenital Malformations 16 11 Pneumonia 10 6 Bronchitis 5 4 Diarrhoea and Enteritis 7 15 12 The net death-rate for the District is 9.40 per 1,000 population. Two-hundred and eighty three deaths registered in the District were persons over 80 years of age, 109 being males and 174 females, one man dying at the advanced age of 97, one woman at the same age, and one other woman at the age of 98. 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 1947. Causes of Death. Males. Females. Total. Typhoid and Para-Typhoid Fevers 1 — 1 Cerebro-spinal Fever 1 1 2 Scarlet Fever - - — Whooping Cough 1 1 2 Diphtheria — — — Tuberculosis of Respiratory System 24 9 33 Other Forms of Tuberculosis 2 1 3 Syphilitic diseases 6 3 9 Influenza 6 6 12 Measles 1 — 1 Ac. Polio-myel: & polio-enceph. 2 1 3 Ac. Inf. Enceph. 1 — 1 Cancer of buc: cav. & oeseph (M) uterus (F) 6 7 13 Cancer of stomach & duodenum 17 15 32 Cancer of breast — 18 18 Cancer of all other sites 58 46 104 Diabetes 3 1 4 Intracranial vascular lesions 34 68 102 Heart disease 154 140 294 Other diseases of Circulatory System 13 25 38 Bronchitis 40 19 59 Pneumonia 31 26 57 Other Respiratory Diseases 6 6 12 Ulcer of stomach or duodenum 9 2 11 Diarrhœa under 2 years 4 2 6 Appendicitis 3 1 4 Other Digestive Diseases 11 8 19 Nephritis 13 8 21 Puer. & Post-abort. Sepsis — 1 1 Other Maternal Causes — 3 3 Premature Birth 12 5 17 Con. mal; birth inj: infant dis. 15 14 29 Suicide 6 5 11 Road traffic accidents 5 2 7 Other violent causes 11 10 21 All other causes 34 31 65 Total. 530 485 1,015 13 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 All Causes—Certified 27 6 5 1 39 11 9 9 7 75 Uncertified — — — - — — - — — — Smallpox - - - - - - - - - — Chickenpox - - - - - - - - - - Measles - - - - - 1 - - - 1 Scarlet Fever - - - - - - - - - — Whooping Cough - - - - - - - 1 - 1 Diphtheria and Croup - - - - - - - - - — Erysipelas - - - - - - - - - — Tuberculous Meningitis - - - - - - - - - — Abdominal Tuberculosis - - - - - - - - - — Other Tuberculosis Diseases - - - - - - - - 1 1 Meningitis (not Tuberculous) — — - - - - - 1 1 2 Convulsions 1 - - - 1 1 - - 2 4 Laryngitis - - - - - - - - - - Bronchitis - — 1 - 1 2 1 — 1 5 Pneumonia (all forms) — 1 — - 1 2 5 2 — 10 Diarrhœa - — — - - - - - - - Enteritis - - - - - 2 2 2 1 7 Epidemic Diarrhœa - - - - - - - - - - Gastritis - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation, overlying - - - - - - - - - - Injury at Birth 1 - - - 1 - - - - 1 Atelectasis 5 — 1 - 6 - — — - 6 Congenital Malformation 5 3 2 - 10 2 1 2 1 16 Premature Birth 14 2 1 - 17 - — — - 17 Atrophy, Debility and Marasmus 1 - - - 1 - - - - 1 Other Causes — — — 1 1 1 — 1 - 3 Totals 27 6 5 1 39 11 9 9 7 75 Net Births in the year:—Legitimate: Live births, 2,239; Stillbirths, 41. Illegitimate: Live births, 73; Still-births, 2. Net Deaths in the year:—Legitimate Infants, 75; Illegitimate, 0. It will be seen from Table II that of the 75 infants who died before attaining the age of 1 year, 27 died within the first week of life. The infant mortality rate for the District is 32.43 and this figure compares favourably with the rest of the country. 14 BIRTHS The actual number of births registered in the District was as follows:— Males Females Total 759 760 1,519 including 14 male and 22 female illegitimate births. In addition 14 male and 11 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. 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 1947 1,213 1,142 2,355 21.82 0.69 INQUESTS Sixty-two inquests and eighty-six P.M.s without inquests were held on Enfield residents during the year. Out of these, 91 deaths were due to natural causes, 35 to accidental causes, 16 to suicide, 4 to misadventure, and in 2 cases an open verdict was recorded. AMBULANCE FACILITIES General During the year the Civil Ambulance Service was maintained by the Health Department; 3,841 patients were conveyed to Hospitals, the total mileage undertaken by the Ambulances being 35,653 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. Annual Report Prior to the War, The Enfield Ambulance Service was under the control of the Fire Brigade. Immediately on the outbreak of War the Ambulances were handed over to the health department to be run in conjunction with the Civil Defence Casualty Service then being set up. Throughout the War years the Ambulance Service continued to be staffed and run on this basis, until cessation of hostilities in 1945 when, on 15 the disbandment of the Civil Defence Services, the Health Department took over temporary premises at Carterhatch Lane, and, having recruited personnel from the Civil Defence Casualty Service, the Ambulance Service has been controlled by the Health Department until now. Under the National Health Service Act, 1946, the duty of providing an Ambulance Service will devolve upon the County Council, and, it is understood, will again be run in close co-operation with the Fire Brigade. Much credit is due to the Ambulance Superintendent and staff for the able manner in which they have performed their duties during these past years in the Council's service. Infectious Diseases During the year, 252 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 771 10 761 1.29 Sputa 61 6 55 9.83 Totals 832 16 816 1.92 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. MEDICAL EXAMINATION OF STAFF During the year, 131 medical examinations for the purposes of the Superannuation Acts were carried out by the Medical Officers. 16 INFECTIOUS DISEASES AND SCHOOLS 1947. 1946. Number of children notified to be absent from School due to:— (a) Infectious disease or suspected Infectious Disease 250 332 (b) Contact with Infectious Disease 99 21 Number of children notified as suffering from Infectious Disease 685 81 HOUSING Number of new houses erected during the year:— Totals. With State Assistance (included in Totals). Local Authority. Other Local Authorities. Other Bodies or Persons. Local Authority. Other Local Authorities. Other Bodies or Persons. Temporary Houses 56 Nil Nil 56 Nil Nil Permanent Houses 249 87 111 249 87 Nil Conversions into Flats 9 Nil 14 9 Nil Nil Rebuilding of War Destroyed Houses Nil Nil 41 Nil Nil Nil Reinstatement of Extensively Damaged Houses Nil Nil 1 Nil Nil Nil Totals 314 87 167 314 87 Nil 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 2,571 8,168 (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 9 17 (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 1,142 (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 736 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 149 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices:— (a) By owners 73 (b) By Local Authority in default of owners 13 The number of house-to-house visitations made was:— Under Housing Regulations, 1925 and 1932 79 Apart from Do. Do. 4,671 THE MILK (SPECIAL DESIGNATIONS) REGULATIONS 1936 to 1946 There are 21 Purveyors of Milk who sell or distribute Pasteurised Milk in the district. Five 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. 18 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES The number of cases of Scarlet Fever was 188, compared with 168 in 1946 : of Diphtheria 6, as compared with 3, of Pulmonary Tuberculosis 152, as compared with 109; and of Pneumonia 67, as compared with 71. There were no deaths from Diphtheria during the year, as against two deaths in 1946. There were no deaths from Scarlet Fever during the year, as was also the case in 1946. The above figures are in respect of Civilians and NonCivilians. NOTIFIABLE DISEASES DURING THE YEAR 1947 No. Removed. Deaths. Smallpox — — — Cholera—Plague — — — Diphtheria (inc. Membranous Croup) 6 6 — Diphtheria Carriers — — — Erysipelas 22 9 — Scarlet Fever 188 124 — Typhus Fever — — — Typhoid Fever — — — Paratyphoid Fever — — — Relapsing Fever — — — Continued Fever — — — Puerperal Pyrexia 8 2 — Cerebro-Spinal Meningitis 7 7 2 Poliomyelitis 16 15 3 Polio Encephalitis 2 1 Ophthalmia Neonatorum 1 1 — Pulmonary Tuberculosis 152 — 33 Other forms of Tuberculosis 14 — 3 Encephalits Lethargica — — — Food Poisoning 5 — — Malaria 3 — — Pneumonia 67 3 57 Dysentery 4 1 — Measles 1,030 32 1 Whooping Cough 441 37 2 Totals 1,966 238 102 19 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 0.00 0.01 Paratyphoid Fever 0.00 0.01 0.01 0.01 0.01 Cerebro-Spinal Fever 0.06 0.05 0.06 0.05 0.05 Scarlet Fever 1.74 1.37 1.54 1.37 1.31 Whooping Cough 4.08 2.22 2.41 2.02 2.80 Diphtheria 0.05 0.13 0.15 0.14 0.14 Erysipelas 0.20 0.19 0.21 0.18 0.22 Smallpox 0.00 0.00 0.00 0.01 0.00 Measles 9.05 9.41 9.13 9.58 5.29 Pneumonia ... 0.62 0.79 0.89 0.68 0.64 DIPHTHERIA During the year only six cases of Diphtheria occurred in the district, an increase of three on the previous year's figure. The six cases, none of which were fatal, occurred in children between the ages of one and nine years. DIPHTHERIA IMMUNISATION Through the services of the Council 1,581 children were immunised for the first time and 701 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. POLIOMYELITIS AND POLIO-ENCEPHALITIS During the year, 18 confirmed cases of Poliomyelitis and Polioencephalitis occurred in Enfield, of which 16 cases were notified during the months of July, August, September and October, when there was a widespread epidemic of these diseases throughout the country. There were no cases of either disease in the district during 1946. Of the 18 cases, five occurred in adults. There were three deaths, two of which were in adult patients. Varying degrees of residual paralysis occurred in a few patients, one child being transferred to the Royal National Orthopædic Hospital, Stanmore, for 20 further in-patient treatment, while several patients were referred to Chase Farm Hospital, for further out-patient treatment. Tonsil operations and dental extractions in school children were temporarily suspended during the worst phase of the epidemic, as a precautionary measure, but were re-commenced in November. The usual routine precautions to prevent spread of infection were also taken. It was not found necessary to close the local swimming baths at any period, and there was no evidence of any spread of infection through their use. It is considered that, relative to the population of the district, the incidence of infection was not unduly high in Enfield, as compared with the country as a whole. 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. 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 3 2 - - 1 - - - 1 to 5 1 2 1 - - - - - 5 to 10 3 3 3 2 — — — — 10 to 15 1 — 1 - - - - - 15 to 20 14 1 1 1 1 - 2 — 20 to 25 11 17 — 1 2 2 - — 25 to 35 19 22 1 2 6 3 - — 35 to 45 15 13 - - 3 - - - 45 to 55 10 3 — — 8 4 - - 55 to 65 9 1 — — 3 - - — 65 and upwards 2 — — 1 — — - 1 Totals 88 64 7 7 24 9 2 1 21 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 655 visits concerning rat infestation. ERADICATION OF BED BUGS Number of Council houses found to be infested 25 Number of Council houses disinfested 25 Number of other houses found to be infested 71 Number of other houses disinfested 71 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 1947. The total number of inspections made during the year for all purposes was 17,405. NOTICES ISSUED Statutory 141 Informal 1,593 Other Notices 2,956 Total 4,690 22 Other Letters sent 11,243 Number of Certificates issued in connection with plans 3 Number of Certificates issued in connection with disinsection 8 Number of Certificates issued in connection with unsound foods 538 Number of Requisitions for Information dealt with 1,477 Number of Certificates issued under Rent Restrictions Act, 1933 32 Number of Essential Works Certificates issued 407 Result of Service of Statutory and Informal Notices:— Statutory. Informal. Number complied with 86 1,196 Number oustanding 55 397 141 1,593 TOTAL INSPECTIONS One hundred and fifty-seven 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 were 17,405. This is an increase on last year's figure, although the Department lost the services of one of its Sanitary Inspectors in the early part of 1946, and the vacancy thus occasioned was not filled until the latter part of 1947. The Inspector appointed to carry out the requirements of Section 58 of the Housing Act, 1936, and the provisions of the Shops Acts, 1912 to 1936, made the following number of visits during the year :— Housing Act, 1936 4,671 Shops Acts, 1912-1936 1,935 Total 6,606 DISINFECTION Number of houses disinfected after infectious disease and verminous cases 521 Number of articles of clothing, bedding, etc., disinfected 3,025 Number of Library books disinfected 128 23 FACTORIES ACT, 1937 A register is kept of all the factories in the District, and during the year 107 inspections were carried out. 1.—INSPECTIONS for purposes of provisions as to health (including inspections made by Sanitary Inspectors. Premises. Number on Register. Inspections. Number of Written notices. Occupiers prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 53 39 - - (ii) Factories not included in (i) to which Section 7 applies (a) Subject to the Local Authorities (Transfer of Enforcement) Order, 1938 Nil - - - (b) Others 318 68 16 - (iii) Other Premises under the Act (excluding out-workers' premises) 11 - - - Total 382 107 16 - 2.—Cases in which DEFECTS were found. Particulars. Number of cases in which defects were found. Number of cases in which prosecutions were instituted. Found. Remedied. Referred. To H.M. Inspector. By H.M. Inspector. Want of cleanliness (S.l) - - - - - Overcrowding (S.2) — — - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) — — - - - Ineffective drainage of floors (S.6.) 1 1 - - - Sanitary Conveniences (S.7.) (a) Insufficient 3 1 - 3 - (b) Unsuitable or defective 8 7 - 8 - (c) Not separate for sexes- — — - — - Other offences (not including offences relating to Homework) 3 3 1 — — Total 15 12 1 11 — 24 OUTWORKERS Twenty-six lists containing the names and addresses of 185 outworkers were received during the year. Fifteen addresses of outworkers were forwarded to other districts. One case of Infectious Disease occurred at Outworkers' premises in Enfield during the year, the premises and out-work therein were disinfected by the Health Dept. The following table gives details of the work carried out Outwork Nature of Work. No. of Outworkers. Prosecutions. Notices served. Umbrellas 1 — — Electrical Appliances 5 — — Office Equipment 4 — — Making Wearing Apparel 98 — — Cardboard Boxes, etc. 2 — — Carbon Paper Manufacture 4 — — Gas Appliances 1 — — Embroidery 1 — — Brush Making 2 — — Toys 6 — — Table Stationery 1 — — Cotton Goods 60 — — Totals 185 — __ 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. 25 SWIMMING BATHS AND POOL The water at each of the Baths in Enfield is tested twice daily by the Superintendents to ascertain the concentration of 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. During the outbreak of Poliomyelitis, the Baths and Pool were kept open as usual but the Superintendents were advised to take all necessary steps to prevent undue overcrowding, and to ensure that the chlorine content of the water was kept at a high level. From the beginning of the Season in May until the end of September, samples were taken twice weekly and examined in our own Laboratory for free chlorine and alkalinity, and in addition, samples were subjected weekly to independent bacteriological and chemical examination. 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 brought to the notice of 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) Regulations, 1936 to 1946 36 26 PUBLIC HEALTH (MEAT) REGULATIONS, 1924 Total number of carcases examined 21 Number, or parts, found to be diseased 1 Weight of do. do. 20 lbs. No. of Certificates issued 1 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 84 526 Ice-Cream (Sale and/or manufacture) 99 56 Number of inspections made to Meat Depot, shops stalls in markets and food-preparing shops 641 Total No. of articles, etc., condemned 7,764 Total No. of Certificates issued 538 Total weight of foodstuffs condemned as unfit for food 11 tons 6 cwts. 2 qrs. 26¼ lbs. MIDDLESEX COUNTY COUNCIL ACT, 1944 SECTION 279 The provisions of the above require all Hawkers of Meat, Fish, Fruit and Vegetables and Storage Premises used in connection therewith to be registered by the Council; during the year 19 Hawkers were registered. 27 The following table shows the number of Hawkers' Premises, etc., registered and the number of inspections made by the Sanitary Inspectors during the year in connection therewith. No. of Premises, etc., on Register No. of inspections 51 23 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. DUSTBINS The replacement of defective dustbins has been a difficult problem for property owners in recent years. During the past five 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 71 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 30 MATERNITY AND CHILD WELFARE COMMITTEE 1947 -1948 Chairman Mrs. G. M. Jay, J.P. Vice-Chairman Mrs. I. A. Summers Mrs. Daines Miss Hill Mrs. Hynd Mrs. Martin Mrs. Oakden Mrs. Turvey A. D. Bates, Esq. D. R. J. Boxall, Esq. F. Greenwood, Esq. W. G. Jollie, Esq. A. R. Kemp, Esq. W. F. Lawrence, Esq. A. A. F. Tatman, Esq. W. S. Williams, Esq. 31 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, 2 to 4 p.m. Town and Chase. Rosemary Avenue, Enfield. Monday, 2 to 4 p.m. Wednesday and Friday, 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. Enfield West. Laing's Estate Office, Enfield West. Every Tuesday, 2 to 4 p.m. Grange Park. Church-in-the-Orchard, Grange Park. Alternate Mondays, 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, 2 to 4 p.m. Town and Chase. Rosemary Avenue, Enfield. Wednesday, 2 to 4 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. 32 District. Situation of Centre. Post-Natal Clinics Ponders End. School Clinic, Southbury Road, Enfield. Bush Hill Park. Lincoln Road, Bush Hill Park. Town and Chase. Rosemary Avenue, Enfield. Ordnance. St. Stephen's Road, Enfield Wash. Enfield West. Laing's Estate Office, Enfield West. BY APPOINTMENT ONLY Dental Clinics Ponders End. School Dental Clinic, Southbury Road, Enfield. Enfield Wash. Albany Clinic, Bell Lane, Enfield Wash. BY APPOINTMENT ONLY Each of the above Centres is provided and maintained by the Council. 33 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Live Births:— Total Male Female Legitimate 2,239 1,151 1,088 Illegitimate 73 37 36 Birth-rate—21.42 per 1,000 population. Still Births:— Total Male Female Legitimate 41 23 18 Illegitimate 2 2 — Rate per 1,000 total births—18.59 Death rate of infants under one year of age:— All infants per 1,000 live births 32.43 Legitimate infants per 1,000 legitimate live births 33.49 Illegitimate infants per 1,000 illegitimate live births Nil 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 Engand and Wales 20.50 0.50 12.00 41.00 London 22.70 0.49 12.80 37.00 126 County Boroughs and Great Towns (including London) 23.30 0.62 13.00 47.00 148 Smaller Towns 22.20 0.54 11.90 36.00 ENFIELD 21.42 0.39 9.40 32.43 34 INFANT MORTALITY Of the 75 infants who died before attaining the age of one year, 27 died within the first week of life. In 10 cases death was due to Pneumonia, in 5 to Bronchitis, in 16 to Congenital malformation, in 17 to Premature Birth and 7 to Enteritis. On page 13 appears Table II which gives the ages and cause of death of all children under the age of one year. PUERPERAL PYREXIA During the year 8 cases of Puerperal Pyrexia were notified, 2 of which were admitted to the Enfield, Edmonton and Potters Bar Joint Isolation Hospital. MATERNAL MORTALITY There were 4 maternal deaths during the year and the causes were as follows:— 1. Post Partum hæmorrhage. 2. Heart Failure, Puerpural Fever, Miscarriage. 3. Pulmonary Embolus, Chronic Nephritis, Toxæmia of Pregnancy. 4. Obstetric Shock, Post Partum hæmorrhage. 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 admitting maternity patients, which is kept under regular supervision by your Medical Officers. Particulars of the Home are as follows:— Address. Number of Maternity Beds. "Windsmill," Windmill Hill, Enfield 20 During the year, the Home for chronic, aged and infirm patients, closed down and registration was withdrawn, 35 ADMINISTRATION OF MID WIVES ACTS, 1902-36 At the end of the year 1947 there were 26 Midwives practising in the district, 19 of whom were employed by the Council as wholetime domiciliary midwives, and 7 employed in the private Maternity Home and Chase Farm Hospital. The following table shows the cases attended during 1947 and 1946:— 1947 1946 Municipal Midwives— Cases attended as Midwives 902 682 Cases attended as Maternity Nurses 239 441 Private Midwives— Cases attended as Midwives in Institutions 214 8 Cases attended as Maternity Nurses in Institutions 42 - Cases attended as Maternity Nurses domiciliary 2 - The total number of cases attended by the municipal midwives shows a slight increase over the previous year's high number and one interesting point is the greatly increased number of cases attended by our midwives in their full capacity of midwife, compared with those cases attended in the capacity of maternity nurse. The effect of this, of course, has been materially to increase the work and responsibility of the midwives. NOTIFICATIONS In accordance with the provisions of the Midwives Acts 19021936 and the rules of the Central Midwives Board, the following notifications were received:— 1947 1946 Sending for Medical Aid 249 233 Still Births 4 9 Laying out of the dead 3 5 Artificial feeding 18 17 Liability to be a source of infection 11 6 Notification of death 3 3 36 The notifications in connection with Medical Aid can be classified as follows:— During pregnancy 7 During labour 157 During lying-in-period 38 Infant 47 FINANCIAL ASSISTANCE IN RESPECT OF MIDWIFERY FEES Financial assistance was given in 42 cases. This compares with 130 in 1946 and 206 in 1945. 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 was, on the opening of the Maternity Department at Chase Farm Hospital, replaced by a similar arrangement with Chase Farm Hospital. On one occasion was the Unit called. HOME HELPS Although it was not possible to increase to any great extent the number of Home Helps available, 104 households received this service during the year, compared with 40 the previous year. The benefit, if indeed not the necessity, of a Home Help in many homes at the time of confinement or domestic emergency, cannot be over emphasized and our aim must be to extend and make more readily available this valuable service. The following figures show the work undertaken:— 82 maternity cases. 22 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. 37 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 and Chase Farm Hospital for their confinement, and also to those other mothers whose confinements were notified. ANTE-NATAL CLINICS During the year, 1,738 mothers attended the ante-natal clinics. This decrease on last year's figure points to an expected fall in the birth-rate in the early part of 1948 at least. POST-NATAL CLINICS During the course of the year, 529 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 and Chase Farm 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, has increased this year, but 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 2,432. 38 VISITS The Health Visitors paid 961 visits to Expectant Mothers, 5,747 to children under one year of age, and 5,541 to children between the ages of one and five years. In spite of stalling difficulties, it was found possible to increase to some extent the number of visits paid by Health Visitors to children under one year of age, and to children between the ages of one year and five years. This field of activity still has scope for development with adequate Health Visiting Staff. In spite of the opening of the Maternity Department at Chase Farm Hospital, much of the Health Visitors' time has been spent in investigating home conditions with a view to ascertaining the possibility of a home confinement because of limited Maternity Hospital accommodation. BABY FOODS AND FOOD ADJUNCTS SUPPLIED During the year, many kinds of proprietary baby foods, food adjuncts and vitamin preparations were available for sale at the Clinics to those mothers who had been recommended their use. In addition, National Dried Milk was made available for sale at the Clinics for those mothers who regularly attended and found it more convenient to purchase this milk at the Clinic rather than at the Food Office. The quantity of dried milk supplied free to necessitous cases under the Council's Milk Supply Scheme during the year was as follows:— Dried Milk 135 lbs. Cost £13 3s. 3d. In addition 43 tins of other food adjuncts were supplied free in cases where the products supplied by the Ministry of Food were considered less satisfactory for the individual case. DISTRIBUTION OF VITAMINS The distribution of Orange Juice, Cod Liver Oil and Vitamin A and D Capsules to expectant 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 sub-offices. In this way it has been possible to secure adequate facilities for all the residents in the district. 39 During the course of the year, the following have been distributed through the Maternity and Child Welfare Centres:— Orange Juice 55,678 bottles Cod Liver Oil 11,965 bottles Vitamin A and D Capsules 1,179 packets National Dried Milk 124 tins ROUTINE INSPECTION OF CHILDREN UNDER FIVE YEARS OF AGE The routine medical inspection of children under 5 years of age was carried out as in previous years. The number of appointments kept was 3,380 (33%) as compared with 2,893 in 1946. EAR, NOSE AND THROAT TREATMENT Expectant and nursing 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 1947:— New Cases (Mothers 4, Babies 51) 55 Total Attendances 70 Referred—Ts. As. 7 do. Adenectomy 14 do. Hospital for other reasons 1 Suffering from Otitis Media 10 do. Rhinitis 3 do. S.Y. (referred to Hospital for treatment) 1 Found to be N.A.D 9 Other conditions 10 OPHTHALMIC TREATMENT Expectant 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 1947:— Mothers. Children. Total attendances 24 182 No. of individual cases 19 109 New cases 18 70 No. of glasses prescribed 8 22 Attendances for other than refraction 5 23 Referred to Hospital 5 3 40 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 1947 there were 9 persons receiving children for reward; the total number of children concerned was 23. 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 expectant and nursing mothers and children under the age of 5 years, for the year 1947:— Mothers. Children. Totals. Attendances 937 330 1,267 Treated 254 194 448 Administration of local Anæsthetic 113 28 141 Patients having local Anæsthetic 44 24 68 Extractions with local Anæsthetic 194 38 232 Administrations of nitrous oxide gas 68 99 167 Patients having nitrous oxide gas 52 96 148 Extractions under nitrous oxide gas 499 261 760 Total extractions 693 299 992 Nitrous oxide gas sessions 47 — 47 Ordinary sessions 52 — 52 Total sessions 99 — 99 Dentures fitted 110 — 110 Patients having dentures 71 — 71 Repairs fitted 6 — 6 Patients having repairs 6 — 6 Fillings 170 120 290 Other operations 470 78 548 41 CONVALESCENT TREATMENT During the year it was possible to send 2 children away for a period of convalescence. ORTHOPÆDIC TREATMENT During the course of the year 33 children were found to be suffering from orthopaedic defects needing treatment or observation. The following are the defects from which they suffered :— Genu valgum 13 Pes planus 4 Toe deformity 2 Genu varum 10 Metatarsus Varus 1 Equinus Varus 1 Valgus Ankles 2 DIPHTHERIA IMMUNISATION The campaign for the immunisation of children against diphtheria continued throughout the year and 1,494 children under the age of five years were immunised for the first time. When a child attains the age of eight months, it is the practice to send him a 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 years are invited, by postcard, to attend a Maternity and Child Welfare Clinic to be immunised or to receive a supplementary reinforcing dose. In addition to the above, 87 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. In addition to the above numbers of children who were immunised for the first time, 701 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 about the age of 10 years, is becoming more apparent. 42 WHOOPING COUGH During the year 331 children under the age of 5 years were immunised against Whooping Cough by your Medical Officers. 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 certain investigations and supervision and during the year there was 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 25 Number of children in respect of whom notice was given under Section 7 (3) 25 Number of such children under supervision at the end of the year 7 Many requests were also received from Registered Adoption Societies that we should investigate homes where the occupants wish to become adoptors. In all these cases visits were paid by the Health Visitors and confidential reports submitted to the appropriate Society. DAY NURSERIES Name of Nursery No. of places No. on Register at end of year Green Street 60 63 High Street 60 61 Baker Street 60 56 Children attending the Nurseries are immunised against Diphtheria and Whooping Cough. 43 CARE OF PREMATURE INFANTS—CIRCULAR 20/44 The number of babies notified during 1947 who weighed 5½ lbs. or less at birth was 96. The number who were nursed entirely at home was 52, of whom 50 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 1,537 dockets were issued to expectant mothers. 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 47 ANNUAL REPORT ON THE SCHOOL HEALTH SERVICE William D. Hyde, M B., Ch.B., D.P.H. For the year ending 31st December, 1947. 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, 1947. The year may be considered as one of consolidation rather than expansion, and 1 am unable to report any marked progress in the provision of more extensive medical facilities or more adequate clinic provision. Indeed, although it has been possible to increase the number of sessions available for Orthoptic treatment from four to six per week, and to increase the Orthopaedic sessions from one to two per month, it is necessary to record that it was not possible to make an appointment of Speech Therapist to fill the vacancy created by the resignation of the previous Speech Therapist. Further, our arrangements for Child Guidance Treatment with the Woodside Child Guidance Training Centre have ceased as this clinic has removed to a new and more distant address, and is unable to continue to provide its services as formerly. Unsuccessful efforts have been made to make arrangements with various London Hospitals. It was hoped to secure suitable premises in Enfield or erect a new building in order to set up our own Child Guidance Service but various proposals in this direction have not yet come to fruition. The inadequacy and unsuitability of some of the School Health Clinics have been realised for a long time, and, although schemes have been outlined for extensions and new buildings, the immediate prospects are not bright. However, efforts will continue to be made to overcome all difficulties and the enthusiasm of Members and Officers should lead to satisfactory results in due course. In conclusion, I wish again to record my appreciation of the loyal service given by the members of the School Health Staff. William D. Hyde, Medical Officer. 48 MEMBERS OF THE ENFIELD EDUCATION COMMITTEE 1947 Chairman A. R. Kemp, Esq., J.P. Vice-Chairman A. A. F. Tatman, Esq. Representative Members : Mrs. L. E. Daines Mrs. G. M. Jay, J.P. A. D. Bates, Esq. G. Blandford, Esq. D. R. J. Boxall, Esq. T. H. M. Clarke, Esq. G. Deacock, Esq. J. Edwards, Esq. A. M. Eeles, Esq. H. D. Hyde, Esq. A. R. Kemp, Esq. W. F. Lawrence, Esq. W. E. Lonsdale, Esq. C. Partington, Esq., J.P., M.R.S.T. P. L. Purnell, Esq. E. S. Stock, Esq. A. A. F. Tatman, Esq. R. A. Williams, Esq. A ppointed Members: Mrs. E. M. Squire, C.C. Ald. J. E. Hutton Co-opted Members: Rev. J. B. Harrington-Evans A. J. Crofts, Esq., B.Sc. L. E. Daines, Esq. W. Graham, Esq. H. H. Moores, Esq. D. Storer, Esq. W. Threadgold, Esq. 49 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. Dora M. Butler, M.B., B.S., D.P.H. (Resigned October, 1947) Marjorie Smith-Wilson, M.B., Ch.B., D.P.H. Margaret R. Gilmour, M B., Ch.B., D.P.H. (Appointed Nov., 1947) Dental Officers : C. E. James, L.D.S., R.C.S. I. Frischmann, L.D.S. S. R. Storey, L.D.S., R.C.S. (Resigned March, 1947) R. M. H. Williams, L.D.S. Ophthalmic Surgeon : Jean M. G. Shaw, M B., Ch.B., D.O.M.S., D.O. Ear, Nose and Throat Surgeon : L. Boss, M.D. (Breslau) Speech Therapist: Miss Jean Fowler, L.C.S.T. (Resigned October, 1947) School Nurses : Miss I. L. Fowler, S.R.N. 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. Dental Nurse : Miss F. C. Anderson, R.S.C.N. Dental A ttendants : Miss J. E. M. Hill Miss D. A. Watson Clerks : Miss A. I. Cooper Miss J. B. Wingfield Miss P. E. Roberts 50 ROUTINE MEDICAL INSPECTION Number of school children on register 14,042 Number of schools 43* The total number of children examined during the year was 4,710. 76.26 per cent. of the children examined were accompanied by their parents. 34.75 per cent. of the children were vaccinated. DEFECTS EODND AT ROUTINE MEDICAL INSPECTION Requiring Treatment Requiring to be kept under observation Skin 12 2 Eyes: (a) Vision 371 132 (b) Squint 48 2 (c) Other 6 1 Ears : (a) Hearing 20 11 (b) Otitis Media 14 2 (c) Other 5 2 Nose or Throat 146 194 Speech 10 8 Cervical Glands 1 8 Heart and Circulation 4 13 Lungs 10 22 Developmental: (a) Hernia 1 1 (b) Other 2 5 Orthopaedic: (a) Posture 17 5 (b) Flat Foot 24 9 (c) Other 36 8 Nervous System : (a) Epilepsy — 1 (b) Other 2 6 Psychological : (a) Development — 3 (b) Stability 4 — Other 9 16 The following table shows the general condition of pupils inspected during the year in the age groups:— *Forty-three includes as separate schools what have been formerly considered as departments of one school. 51 Age Groups. No. of Pupils Inspected A B C No. % of col. 2 No. % of col. 2 No. % of col. 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants 2,651 865 32.6 1,660 62.6 126 4.8 Second Age Group 1,810 498 27.5 1,199 66.2 113 6.3 Third Age Group 249 58 23.3 188 75.5 3 1.2 Total 4,710 1,421 30.2 3,047 64.7 242 5.1 A. Those better than normal, or " good " (formerly " excellent " -A). B. The normal, or " fair " (formerly " normal B). C. Those below normal, or " poor" (formerly " slightly subnormal "—C, and " bad "—D). Five hundred and thirty-four children of eight years old were given a routine eye check, of whom 63 were referred to the Eye Clinic for treatment and 49 were referred for observation. THE WORK OF THE SCHOOL NURSES Number of home visits 799 Number of special school visits 201 Number of school visits for routine examination of heads 163 Total number of heads examined 28,422 Number of individual children found unclean 522 Number of Nurses' minor ailment clinics held 749 Total attendances of children at Nurses' clinics 16,405 Number of routine medical inspection sessions attended by Nurses 252 52 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 Scalp 6 — (b) Ringworm of Body 7 — (c) Scabies 21 2 (d) Impetigo 73 — (e) Other skin conditions 234 7 Eyes : (a) Defective vision 147 19 (b) Squint 21 2 (c) Other eye conditions 184 17 Ears : (a) Defective hearing 18 7 (b) Other ear conditions 164 10 Nose or Throat 230 8 Cervical Glands 10 11 Heart and Circulation 1 3 Lung conditions 28 23 Developmental: (a) Hernia 3 — (b) Other 2 — Orthopaedic : (a) Posture 1 2 (b) Flat foot 12 6 (c) Other 46 16 Nervous system 25 17 Psychological: (a) Development — — (b) Stability 3 6 Post Scarlet Fever examinations 21 51 Other conditions 1,172 378 The total of attendances at the Doctors' Minor Ailment Clinics was 3,444 and the number of individual children attending was 2,911, 53 DENTAL CLINICS (1) Number of pupils inspected: — (a) Periodic Age-groups— 4 35 5 512 6 470 7 617 8 821 9 958 10 849 11 656 7,491 12 647 13 738 14 727 15 214 16 138 17 75 18 25 19 9 (b) Specials 884 (c) TOTAL (Periodic and Specials) 8,375 (2) Number found to require treatment 4,851 (3) Number actually treated 4,388 (4) Attendances made by pupils for treatment 8,751 (5) Half-days devoted to :— (a) Inspection 64 (b) Treatment 1,189 TOTAL (a) and (b) 1,253 (6) Fillings :— Permanent Teeth 5,270 Temporary Teeth 979 TOTAL 6,249 54 (7) Extractions :— Permanent Teeth 678 Temporary Teeth 4,296 TOTAL 4,974 (8) Administration of general anaesthetics for extractions 430 (9) Other Operations:— (a) Permanent Teeth 378 (b) Temporary Teeth 1,352 TOTAL (a) and (b) 1,730 Owing to the prevalence of anterior poliomyelitis in the district it was found advisable, in conjunction with the other districts in the County, to suspend dental extractions for several weeks at the height of the epidemic. The number of children referred to the Orthodontic Clinic, Bowes Road, was 43. OPHTHALMIC CLINIC Total attendances 2,068 Number of children attending 1,251 New cases 416 Prescriptions for glasses 465 Attendances for other than refraction 30 Children requiring operative treatment for squint 8 Children requiring other hospital treatment 8 Children recommended for special schools 3 55 ORTHOPTIC CLINIC Total attendances 1,152 Number of children attending 196 New cases 155 Number of cases discharged with following results:— 3 with good binocular vision 4 improved 3 with cosmetic results 10 discontinued after trial course 5 refused to continue treatment 4 left district 29 During the year ten 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 567 Number of cases dealt with 314 Number of new cases 254 Number of cases discharged cured 172 Number of cases of a recurrent nature requiring occasional treatment 6 Number of cases still under treatment 52 Number of cases who have refused treatment or sought treatment elsewhere 11 Referred to Speech Therapist 1 Recommended for School for Deaf Pupils 2 Supplied with Hearing Aid 3 Referred for X-ray 28 56 TONSILS AND ADENOIDS Number of cases operated under the Authority's Scheme 151 There was a marked reduction in the number of cases undergoing operation for tonsils and adenoids during the year as operations were suspended during the height of the anterior poliomyelitis epidemic in the summer. ORTHOPÆDIC CLINIC This clinic continued to be held at Chase Farm Hospital but since April two sessions a month have been held instead of one as previously. Total attendances 340 New cases 120 Number of individual children 185 Classification :— Pes planus 61 Genu valgum 23 Genu varum 3 Hallux valgus 15 Hallux rigidis 1 Ankle valgus 2 Tendo achilles 3 Curvature 11 Poor posture 11 Paralysis 6 Little's disease 2 Osteomyelitis 1 Sheuerman's disease 2 Talipes equino-varus 1 Toe deformities 9 Semi-membranosus bursa 1 Osteochondritis 1 Metatarsus varus 1 Arthrodesis 2 Muscular wasting 1 Miscellaneous 28 57 CARDIAC CLINIC Number of sessions 3 Total attendances 17 SPEECH CLINIC The total number of children who received treatment up to the end of October, since when no clinic has been held, was 135. These are classified under the following defects :— Dyslalia 57 Stammering 41 Cleft palate and/or hare lip 8 Sigmatism 13 Dysarthria 2 Dysphonia 4 Dysphasia 1 Hyper-rhinophonia 3 Mental retardation 3 Chronic mouth-breathers 3 Fifty one cases were discharged cured. Two discontinued treatment on leaving school. Treatment for seven children was temporarily postponed or deferred until after further operations or other kinds of treatment. One child left the clinic at the request of the parents. Two children were discharged for non-attendance. Treatment for eleven children was temporarily deferred prior to discharge. The number of children on the register at the end of October was sixty one. 58 SPECIAL EDUCATIONAL TREATMENT—HANDICAPPED PUPILS Category. Recommendations made during year. Pupils attending Special Schools at 31st Dec., 1947 Special Residential School. Special Day School. Residential. Day. Blind and partially sighted 3 - 3 — Deaf and partially deaf — 2 1 7 Delicate pupils 26 — 21 — Diabetic pupils — - 3 — Educationally subnormal 1 24 — 59 Epileptic pupils 1 — 1 — Physically handicapped pupils 4 2 5 12 Two pupils recommended home teaching. Pupils suffering from disability of mind. Fifty pupils were examined under Sections 34 and 57 of the Education Act, 1944, with the following recommendations :— To remain at an ordinary school 5 To be re-examined 3 To attend special day school 24 To attend special residential school 1 Referred for Psychiatric report 2 Referred to Local Authority for the purposes of the Mental Deficiency Act, 1913 15 SPECIAL EXAMINATIONS Sixty-three children had special examinations during the year, of whom twenty-four were recommended Child Guidance treatment, twenty-six were recommended a short stay at a residential open-air school, eight were recommended for admission to special residential 59 schools, three were recommended for admission to a special day school and two were recommended for home teaching. Eight of the children recommended for Child Guidance are still awaiting to be referred through, as there are no facilities at present. SUMMARY OF EXAMINATIONS The total number of individual children examined during the year, excluding those attending the Dental Department, was 9,874. This number was made up as follows :— Examined at Routine Inspection 4,710 Examined at Minor Ailment Clinics 2,911 Examined at Ophthalmic Clinic 1,251 Examined at Orthoptic Clinic 196 Examined at Ear, Nose and Throat Clinic 314 Examined under Juvenile Employment Bye-laws 34 Examined under Sections 34 and 57 of the Education Act, 1944 50 Examined at Orthopaedic Clinic 193 Examined at Cardiac Clinic 17 Examined at Speech Clinic 135 Special Examinations 63 NOTIFIABLE INFECTIOUS DISEASES Diphtheria 3 Scarlet fever 126 Pneumonia 11 Measles 460 Whooping cough 156 Erysipelas 1 Cerebro-spinal fever 2 Acute anterior poliomyelitis 7 Acute polioencephalitis 2 60 DEATHS AMONGST SCHOOL CHILDREN There were twelve deaths during the year. The causes were as follows :— 1 Cerebro-spinal fever 2 Pneumonia 1 Rheumatic fever 1 Peritonitis 1 Asphyxia 1 Poliomyelitis 1 Meningitis 1 Haemorrhage 3 Accident PROVISION OF SCHOOL MEALS During 1947, 38,045 dinners were provided free, and 1,142,865 provided and paid for. 2,378,148 bottles of milk were provided free. Printed by Bennett & Starling Ltd., Enfield.