ENF 32 AC 4439(1) ENFIEU (Later Mun. 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 1948 Urban Distirct 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 1948 3 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, 1948 To the Chairman and Members of the Urban District Council of Enfield. I have pleasure in presenting my Annual Report for the year 1948. Last year in my Annual Report, I referred to the fact that on 5th July, 1948, the National Health Service Act, 1946, would come into operation, and that the more personal health services formerly controlled by the Enfield Council would become the responsibility of the County Council, and I gave a detailed survey of the health services of Enfield since the beginning of the century, showing that Enfield could look back with satisfaction on its achievements in the sphere of personal health services, and hand over to the new Health Authority a sound, extensive and progressive service on which to base future developments. The appointed day duly arrived, and apart from the transfer of the personal health services to the major local authorities, many of the provisions of the National Health Service Act have had marked effects on local authorities' services, but the time and place do not seem opportune for discussion, as many points have yet to be clarified. Since the appointed day the County Council administration for the area has been taking shape. In view of this change in administration, I regret that my report for this year will be mainly statistical, and it must be noted that although the statistical figures for the personal health services in this report cover the whole year, the Enfield Council responsibilities were only for the first half. The main points regarding the vital statistics are the considerably decreased birth rate, decreased death rate, and an Infant Mortality rate of 27.67, which is the lowest ever recorded in Enfield. The incidence of Infectious Diseases was low, Measles and Scarlet Fever showing the greatest decline. There were only three cases of diphtheria, two of whom were brother and sister ill at the same time, and again this year, there were no deaths from Diphtheria. 4 Continual efforts are made to maintain a high degree of immunity against Diphtheria amongst the child population, and our efforts must not be relaxed although more parents this year accepted the service for their children. In addition to immunisation in infancy and a re-inforcing dose at school entry, steps were taken during the year to encourage a further re-inforcing dose at the age of 10 years, in order to try to ensure immunity throughout the whole of school life. Although no cases of food poisoning were notified during the year, the possibility of minor upsets for which medical attention is not sought, is in my view quite real, and food hygiene, both in the home, communal feeding places and all food premises, is of the utmost importance. With this in mind special attention was paid during the year to inspection and supervision of food premises under the Food and Drugs Acts and Regulations. Also a complete survey and inspection was made of all Public Houses. The results of an investigation into the possibility of the establishment of detailed Hygienic Codes for preparation, storage and handling of food, is awaited with interest, and every opportunity is taken to impress on housewives and food handlers the importance of strict food hygiene. In conclusion I should like to record my appreciation of the efforts of the staff of the Health Department, during a difficult transition period. William D. Hyde, Medical Officer of Health. 5 URBAN DISTRICT COUNCIL OF ENFIELD A. R. Kemp, Esq., J.P. Chairman Mrs. L. E. Daines, C.C. Vice-Chairman Mrs. G. M. Jay, J.P. J. G. Jamieson, Esq. Mrs. E. A. Williams. W. G. Jollie, Esq. A. D. Bates, Esq. W. E. Lonsdale, Esq. W. c. Bennett, Esq. L. Nicholls, Esq. G. Blandford, Esq. A. R. Oakden, Esq. W. G. Bowyer, Esq. c'. Partington Esa, J.P., d. R. J. Boxall, Esq. M.R.S.T. T. H. M. Clarke, Esq. P. L. Purnell, Esq. W. H. Cook, Esq. P. Robson, Esq. J. cottenham, ESQ. A. H. saunders, ESQ. G. Deacock, Esq. D. Storar, Esq. J. Edwards, Esq. A. A. F. Tatman, Esq. A. M. Eeles, Esq. C. H. Thomas, Esq. F. Greenwood, Esq. R. A. Williams, Esq. J. W. Howes, Esq. HEALTH COMMITTEE Mrs. G. M. Jay, J.P. Chairman A. A. F. Tatman, Esq. Vice-Chairman also Mrs. L, E. Daines, Mrs. E. A. Williams and Messrs. Bates, Boxall, Cottenham, Greenwood, Jollie and Kemp. 6 PUBLIC HEALTH STAFF Medical Officer of Health: Dr. W. D. Hyde. Deputy do. Dr. C. E. Jamison. Assistant do. Drs. L. Rivlin, M. Smith-Wilson and M. Gilmour. Senior Sanitary Inspector: Mr. A. N. Smith. Sanitary Inspectors: Mr. H. Wiggett, Mr. A. Ramsden, Mr. D. C. Turner, Mr. C. Day and Mr. G. E. A. Laney. Shops and Housing Inspector: Mr. M. Wilson. Rodent Investigator: Mr. P. W. Partridge. Chief Clerk: Mr. Sydney Coulter. Deputy Chief Clerk: Miss E. W. Bowyer. Senior Clerks: Miss D. Hiller and Mr. C. W. Chapman. General Clerks: Mr. J. W. Viggers, Miss D. Hamer, Miss R. C. Young, Miss H. O'Connor (resigned March, 1948), Miss J. Barwick (resigned September, 1948), Miss E. J. Hughes, Mrs. K. Everest, and Miss W. Rudd. 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 (resigned). Health Visitors: Miss C. Wilkinson, Miss M. Radford, Miss O. Tarling, Miss G. Hobbs and Miss O. Roberts. Non-Medical Supervisor of Midwives: Miss W. V. Smyth. Midwives: Mrs. D. Harrison, Miss G. Payne, Miss J. Johnson, Miss A. Treherne (resigned), Mrs. I. Mitchell, Mrs. M. Cameron, Miss E. Palfrey, Mrs. A. Wilkinson, Mrs. M. Hinkley, Miss E. Davies, Miss I. Lake, Miss F. Peters, Miss A. Emery, Miss M. Stow, Miss V. Hilderbrand, Miss K. Barratt. Matrons of Day Nurseries: Mrs. Robinson, Mrs. Merritt and Mrs. Squires. 7 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 12,400 POPULATION The population as estimated by the Registrar-General is 111,300. The number of inhabited houses at the end of 1948, according to the Rate Books, was 28,892. Explanatory Note:— Definition of "Houses"—Structurally separate dwellings including flats. The rateable value of the District is *£856,503 The net product (after allowing for cost of collection) of a penny rate is £3,934 *Note.—The reduction in the rateable value of the District is due to the fact that Electricity and Railway Undertakings have been taken out of Rating. SOCIAL CONDITIONS The number of houses erected during the course of the year was 335, which included 11 of the pre-fabricated type, 4 conversions into flats, 58 rebuilding of war-destroyed houses, and 1 reinstatement of extensively damaged house. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Live Births:— Total. Male. Female. Legitimate 1,843 949 894 Illegitimate 72 40 32 Birth-rate—17.20 per 1,000 population. Still Births:— Total. Male. Female. Legitimate 40 24 16 Illegitimate 1 — 1 Rate per 1,000 total births—21.40. Total. Male. Female. Deaths 944 477 467 Death-rate—8.48 per 1,000 population. Number of women dying in. or in consequence of, childbirth:— Deaths Rate per 1,000 Total Births. From Puerperal Sepsis 0 0.00 From other Puerperal couses . 1 0.52 1 0.52 8 Death-rate of Infants under one year of age:— All infants per 1,000 live births 27.67 Legitimate infants per 1,000 legitimate live births 28.21 Illegitimate infants per 1,000 illegitimate live births 13.88 Deaths from Cancer (all ages) 177 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 1 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. Mortality rate. Infant Live Still England and Wales 17.9 0.42 10.8 34.00 London 20.1 0.39 11.6 31.00 126 County Boroughs and Great Towns (including London) 20.0 0.52 11.6 39.00 148 Smaller Towns 19.2 0.43 10.7 32.00 ENFIELD 17.20 0.36 8.48 27.67 DEATHS The number of deaths assigned to Enfield for 1948 was 944, showing a decrease of 71 on last year. The more important causes of death during the year and the previous year were:— Cause of Death 1948. 1947. ALL AGES:— Malignant Disease 177 167 Heart Disease 247 294 Other Diseases of Circulatory System 36 38 Pneumonia 40 57 Bronchitis 45 59 Intra-cranial Vascular Lesions 103 102 Tuberculosis of Respiratory System 40 33 CHILDREN UNDER 1 YEAR:— Premature Birth 9 17 Congenital Malformations 11 16 Pneumonia 6 10 Meningitis 4 2 Injury at Birth 7 1 Atelectasis 7 6 9 The net death-rate for the District is 8.48 per 1,000 population Two-hundred-and-seventy-four deaths registered in the District were persons over 80 years of age, 98 being males and 176 females. one man dying at the advanced age of 96, one woman at the same age, and one other woman at the age of 100. The following tables give the causes of deaths at all ages and of children under the age of I year:— TABLE I. Causes of Death during Year 1948. Causes of Death. Males. Females. Total. Typhoid and Para-Typhoid Fevers. - - - Cerebro-spinal Fever — 1 1 Scarlet Fever — 1 1 Whooping Cough 1 — 1 Diphtheria — — - Tuberculosis of Respiratory System 25 15 40 Other Forms of Tuberculosis 2 — 2 Syphilitic diseases 4 1 5 Influenza 1 — 1 Measles — — — Ac. Polio-myel: & polio-enceph. — — Ac. Inf. Enceph. — 1 1 Cancer of buc: cav. & cesoph. (M), uterus (F) 4 3 7 Cancer of stomach & duodenum 18 12 30 Cancer of breast — 20 20 Cancer of all other sites 75 45 120 Diabetes 2 1 3 Intracranial vascular lesions 31 72 103 Heart disease 119 128 247 Other diseases of Circulatory System 20 16 36 Bronchitis 29 16 45 Pneumonia 20 20 40 Other Respiratory Diseases 7 6 13 Ulcer of stomach or duodenum 8 I 9 Diarrhoea under 2 years 6 — 6 Appendicitis 3 1 4 Other Digestive Diseases 7 6 13 Nephritis 11 10 21 Puer. & Post-abort. Sepsis — — — Other Maternal Causes — 1 1 Premature Birth 3 6 9 Con. mal; birth inj: infant dis. 16 15 31 Suicide 7 7 14 Road traffic accidents .. 9 6 15 Other violent causes 5 9 14 All other causes 44 47 91 Total. 477 467 944 10 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 of Age All Causes—Certified 31 6 1 1 39 9 4 1 - 53 Uncertified - - - - - - - - - Smallpox - - - - - - - - - - Chicken pox - - - - - - - - - — Measles - - - - - - - - - — Scarlet Fever - - - - - - - - - — Whooping Cough — — - - — 1 — - - 1 Diphtheria and Croup - - - - - - - - - — Erysipelas . - - - - - - - - — Tuberculous Meningitis — — - - — — — - - — Abdominal Tuberculosis — — - - — — — - - — Other Tuberculosis Diseases — — - - — — - - - — Meningitis (not Tuberculous) 2 — - 1 3 1 — - - 4 Convulsions — — - - — 1 - - - 1 Laryngitis - - - - - - - - - — Bronchitis — — - - — — - 1 - 1 Pneumonia (all forms) 2 — 1 - 3 2 1 - - 6 Diarrhoea — — - - — — - - - — Enteritis — — - - — 1 1 - - 2 Epidemic Diarrhoea - - - - - - - - - - Gastritis — — - - — — - - - — Syphilis — — - - — — — - - — Rickets - - - - - - - - - - Suffocation, overlying - - - - - - - - - - Injury at Birth 7 — - - 7 — — - - 7 Atelectasis 7 — - - 7 — — - - 7 Congenital Malformation 7 1 - - 8 3 — - - 11 Premature Birth 5 4 - - 9 — — - - 9 Atrophy, Debility and Marasmus - - - - - - - - - - Other Causes 1 1 - - 2 — 2 - - 4 Totals 31 6 1 1 39 9 4 1 - 53 Net Births in the year:—Legitimate: Live births, 1,843, Stillbirths, 40. Illegitimate: Live births, 72, Still-births, 1. Net Deaths in the year:—Legitimate Infants, 52; Illegitimate, 1. It will be seen from Table II that of the 53 infants who died before attaining the age of 1 year, 31 died within the first week of life. The infant mortality rate for the District is 27.67 and this figure compares most favourably with the rest of the country. BIRTHS The actual number of births registered in the District was as follows:— Males Females Total 857 827 1,684 including 24 male and 31 female illegitimate births. In addition 21 male and 15 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. 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 1948 1,013 943 1,956 17.57 0.36 INQUESTS Sixty-four inquests and eighty-two P.M.s without inquests were held on Enfield residents during the year. Out of these, 84 deaths were due to natural causes, 37 to accidental causes, 14 to suicide, 7 to misadventure, 1 to manslaughter, and in 3 cases an open verdict was recorded. NATIONAL ASSISTANCE ACT, 1948 No action was necessary during the year under Section 47 of the National Assistance Act, 1948, with regard to the removal to suitable premises of persons in need of care and attention. Such cases as were brought to the notice of the Health Department were dealt with by the Medical Officer of Health in co-operation with the medical attendants, and the patients voluntarily agreed to go to suitable institutions. AMBULANCE FACILITIES Under the National Health Service Act, 1946, the duty of providing an Ambulance Service devolves upon the County Council, and from the 5th July the Middlesex County Council Fire and Ambulance Service have been responsible for the Ambulance Scrvice previously controlled by the Health Department of the Enfield Council. 12 Infectious Diseases During the year, 151 patients were removed to the Isolation Hospital. LABORATORY FACILITIES The following work was carried out in the Council's laboratory during the year: Specimen. No. Positive. Negative. Percentage of Positives. Swabs 595 2 593 0.33 Sputa 98 17 81 17.34 Totals 693 19 674 2.74 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 four dwellings in Enfield which receive their water supply other than from a public company; these are under constant supervision. There are no houses in the district which receive their water supplies by means of standpipes. The question of well-water supplies, both in connection with dwelling-houses and industrial premises, throughout the district has received the careful attention of the Department during the year, and every care has ben exercised to see that such supplies are not used for drinking purposes where mains water supply is available. 81 visits were made by the Sanitary Inspectors during the year in connection with wells, and 9 samples were taken and submitted for bacteriological examination. The results of the analyses were as follows:— Satisfactory 5 Unsatisfactory 3 Doubtful 1 Total 9 13 MEDICAL EXAMINATION OF STAFF During the year, 76 medical examinations for the purposes of the Superannuation Acts were carried out by the Medical Officers. INFECTIOUS DISEASES AND SCHOOLS 1948 1947. Number of children notified to be absent from School due to:— (a) Infectious Disease or suspected Infectious Disease 176 250 (b) Contact with Infectious Disease 4 99 Number of children notified as suffering from Infectious Disease 513 685 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 11 Nil Nil 11 Nil Nil * Permanent Houses ... 223 Nil 37 223 Nil Nil Conversions into Flats 2 Nil 2 2 Nil Nil Conversion into Halfway House 1 Nil Nil 1 Nil Nil Rebuilding of War Destroyed Houses Nil Nil 58 Nil Nil Nil Reinstatement of Extensively Damaged Houses Nil Nil 1 Nil Nil Nil Totals 237 Nil 98 237 Nil Nil *223 Dwellings, i.e., 52 flats and 171 houses. 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 2,956 12,815 14 (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 5 (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 1,626 (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. 1,430 3. Action under Statutory Powers. A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Notices were served requiring repairs 1 (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 334 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 246 (b) By Local Authority in default of owners 1 The number of house-to-house visitations made was:— Under Housing Regulations, 1925 and 1932 8 Apart from Do. Do. 4,725 SLAUGHTER-HOUSES There are eight slaughter-houses in Enfield, none of which is in use at present, 15 THE MILK (SPECIAL DESIGNATIONS) REGULATIONS 1936 to 1946 There are 21 Purveyors of Milk who sell or distribute Pasteurised Milk in the district. Twelve samples taken and tested were found to be satisfactory. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES The number of cases of Scarlet Fever was 124, compared with 188 in 1947; of Diphtheria 3, as compared with 6; of Pulmonary Tuberculosis 147, as compared with 152; and of Pneumonia 61, as compared with 67. There were no deaths from Diphtheria during the year, as was also the case in 1947. There was one death from Scarlet Fever during the year, as against no deaths in 1947. NOTIFIABLE DISEASES DURING THE YEAR 1948 No. Removed. Deaths. Smallpox — — — Cholera—Plague — — — Diphtheria (inc. Membranous Croup) 3 3 — Diphtheria Carriers — — — Erysipelas 28 5 — Scarlet Fever 124 81 1 Typhus Fever — — — Typhoid Fever — — — Paratyphoid Fever — — — Relapsing Fever — — — Continued Fever — — — Puerperal Pyrexia 25 18 — Cerebro-Spinal Meningitis 3 3 1 Poliomyelitis 4 4 - Polio-Encephalitis — — Ophthalmia Neonatorum 6 6 — Pulmonary Tuberculosis 147 — 40 Other forms of Tuberculosis 14 — 2 Encephalitis Lethargica — — — Food Poisoning — — — Malaria 3 1 — Pneumonia 61 2 40 Dysentery 3 1 — Measles 584 13 — Whooping Cough 367 23 1 Totals 1,372 160 85 The above figures are in respect of Civilians and NonCivilians. 16 The following table shows the number of notifications of cases of Infectious Disease per 1,000 civilian population in 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.B.s 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 0.00 0.01 0.00 Paratyphoid Fever 0.00 0.01 0.01 0.01 0.01 Cerebro-Spinal Fever 0.02 0.03 0.03 0.02 0.03 Scarlet Fever 1.11 1.73 1.90 1.82 1.37 Whooping Cough 3.28 3.42 3.51 3.31 3.13 Diphtheria 0.02 0.08 0.10 0.09 0.10 Erysipelas 0.25 0.21 0.23 0.21 0.22 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 5.24 9.34 9.75 8.84 9.17 Pneumonia 0.54 0.73 0.84 0.60 0.57 Acute Poliomyelitis 0.03 0.04 0.05 0.04 0.04 Acute Polioencephalitis 0.00 0.00 0.00 0.00 0.00 DIPHTHERIA During the year only three cases of Diphtheria occurred in the district, a decrease of three on the previous year's figure. The three cases, none of which were fatal, occurred in children aged 4, 10, and 14½ years. DIPHTHERIA IMMUNISATION 2,111 children were immunised for the first time and 1,834 received subsequent reinforcing doses during the year. The number of parents accepting this service for their children is not yet sufficiently high to warrant any sense of security, although an improvement is noted. POLIOMYELITIS AND POLIO-ENCEPHALITIS The epidemic of 1947 abated, and during 1948 only 4 confirmed cases of Poliomyelitis occurred in the District. 17 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 4 2 1 — — 1 5 to 10 1 1 — 1 — — 1 — 10 to 15 — — 1 - - - - - 15 to 20 9 5 — — 2 1 — — 20 to 25 12 12 — 4 2 2 — — 25 to 35 18 27 1 - 2 2 - — 35 to 45 17 10 1 2 5 3 1 2 45 to 55 9 2 — — 5 3 1 — 55 to 65 6 2 — — 3 - - — 65 and upwards 7 3 — 1 4 4 - — Totals 81 66 5 9 23 15 4 2 The following table shows the incidence of Tuberculosis and death-rates from this disease in the various Wards in the District during 1948. Ward Estimated Population. No. of Cases. T.B. Case-rate. T.B. Death-rate. Pulm. Other. Pulm. Other. Pulm. Other. North-East 26,264 42 1 1.59 0.03 0.49 0.07 South-East 21,021 29 2 1.37 0.09 0.23 0.00 Central 21,151 35 4 1.65 0.18 0.37 0.09 South-West 18,854 18 2 0.95 0.10 0.21 0.05 West 24,010 23 5 0.95 0.20 0.33 0.04 Total 111,300 147 14 1.30 0.12 0.34 0.05 RATS AND MICE DESTRUCTION During the year a Rodent Investigating Officer and two additional operators were engaged for the control of rat infestation at dwelling-houses and other premises and of the sewers in the district. The Couicil decided that this service should be available to the occupiers of all dwelling-houses free of charge; industrial and business premises are dealt with at the request of the proprietors who pay the full cost of any disinfestation undertaken at their premises. During the year the Sanitary Inspectors made 1,009 visits concerning rat infestation. 18 Ail the sewers in the district have been systematically examined and the Ministry's scheme for the extermination of rats in sewers has been closely followed. Experience gained during these investigations has proved extremely useful to the Department, and it has been possible to trace any colony or heavy infestation; such infestations as were discovered were confined to small areas far apart from one another. During the initial investigations 2,145 manholes were examined and 2,060 pre-baits and poison-bait;; were laid. The necessary follow-up treatment continues so that the rat population of the sewers may be kept under control. ERADICATION OF BED BUGS Number of Council Houses found to be infested 31 Number of Council houses disinfested 31 Number of other houses found to be infested 65 Number of other houses disinfested 65 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 1948. The total number of inspections made during the year for all purposes was 23,420. The following table shows the number of inspections carried out by the Sanitary Inspectors during the year. No. of Inspections Housing Act, 1936 23 On account of Infectious Disease 130 „ Tuberculosis 78 „ Complaint or otherwise 12,445 „ Vermin 139 Rag Flock Acts 4 Public Conveniences 78 Ice-Cream Shops 872 Schools 11 Cinemas, Halls, etc. 25 Public Houses 62 Hairdressers 24 Cowsheds 23 Milkshops and Dairies 46 Food Preparing Premises 822 Food Hawkers' Stands 23 19 Food Hawkers (Storage) 39 Bakehouses 39 Outworkers' Premises 125 Factories 202 Smoke Observations 21 Visits re Infectious Diseases 129 Tuberculosis 63 Housing Act, 1936 (Sec. 62)—Permitted Numbers 4,725 Shops Acts 1,645 Gipsy Vans 22 Rats 1,009 Overcrowding 18 Scabies 2 Piggeries 19 Stables 15 Well Water Supplies 81 Wasps, Beetles, etc. 41 Other Visits 420 23,420 Samples taken—Water—Wells 9 Swimming Baths 23 Milk 12 Ice-Cream 177 Rag Flock 5 The following list of repairs executed during the course of the year shows that the defects found as the result of the Sanitary Inspectors' visits were varied and general in character. Houses or parts of houses cleansed, repaired, etc. 822 Roofs repaired 649 Gutters and downpipes repaired 381 Downpipes disconnected from drains 6 Dampness remedied 256 Ventilation provided under floors 16 Floors repaired 160 Yards paved or made good 35 Rooms stripped, etc., after infectious disease 2 Dustbins provided or renewed 132 Food stores provided 1 Drains—Examined 222 Tested—Smoke 30 Water 33 Reconstructed 33 Repaired, etc. 170 20 Vents provided 1 Vents repaired 8 Sink wastes repaired 37 New sinks provided 39 Water-closets—New ones provided. 52 Provided with flushing cistern or water supply 16 Repaired 233 Water—Cistern provided 6 Cisterns cleansed, covered, etc. 14 Wells cleansed, repaired, etc 2 Water laid on or restored 10 Nuisances—Fowls, etc., removed 1 Manure, etc., removed 5 Ditches, etc., cleaned out 1 Other nuisances abated—Coppers repaired, etc. 7 Stoves repaired or renewed 155 Windows repaired or renewed. 372 Gipsy vans removed 14 Miscellaneous 201 Houses demolished 5 NOTICES ISSUED Statutory (Insanitary Conditions) 335 Informal ( Do. ) 1,429 Other Notices (Infectious Diseases) 1,945 3,709 Other Letters sent 8,308 Number of Certificates issued in connection with plans 3 Number of Certificates isued in connection with disinfection 39 Number of Certificates issued in connection with unsound foods 496 Number of Requisitions for Information dealt with 1,845 Number of Certificates issued under Rent Restrictions Acts, 1920 to 1939 34 Result of Service of Statutory and Informal Notices:— Statutory. Informal. Number complied with 247 1,148 Number outstanding 88 281 335 1,429 21 TOTAL INSPECTIONS One-hundred-and-ninety-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 23,420. During the latter half of the year two vacancies in the Inspectorial Staff were filled, and this increase of staff is reflected in the number of inspections, which, during the year under review, was 23,420, as compared with 17,405 in the year 1947. It is appropriate here to mention that a great deal of the Sanitary Inspectors' time is taken up by numerous interviews with members of the public each day. 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 4.725 Shops Acts, 1912-1936 1,645 Total 6,370 STUDENT SANITARY INSPECTORS The Council co-operated with the Ministry of Health in a Government-sponsored scheme for the post-war training of Sanitary Inspectors. Six students were given a special course of training in practical work with the Enfield Sanitary Inspectors, and all the students passed the qualifying examination. DISINFECTION Number of houses disinfected after infectious disease and verminous cases 427 Number of articles of clothing, bedding, etc., disinfected 1,583 Number of Library books disinfected 73 Number of articles of clothing, bedding, etc., destroyed 98 22 FACTORIES ACT, 1937 A register is kept of all the factories in the District, and during the year 241 inspections were carried out. 1.—INSPECTIONS for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises. Number on Register. Number of Inspections. Written notices. Occupiers prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 55 17 2 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 332 224 9 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 15 - - - Total 402 241 11 — 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) 11 6 1 4 Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) — — — Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 7 4 2 - (b) Unsuitable or defective 7 4 — - (c) Not separate for sexes — — — Other offences (not including offences relating to Homework) 1 1 — — Total 26 15 1 6 — 23 OUTWORKERS Forty-nine lists containing the names and addresses of 358 outworkers were received during the year. Twenty-two addresses of outworkers were forwarded to other districts. The following table gives details of the work carried out:— Outwork Nature of Work. No. of Outworkers. Prosecutions. Notices served. Small Ware 5 - - Textiles 1 — — Electrical Appliances 3 — — Office Equipment 5 — — Making Wearing Apparel 108 — — Cardboard Boxes, etc. 7 — — Shoes and Slippers 10 — — Furs 1 — — Leather Goods 1 — — Artificial Flowers 4 — — Embroidery and Trimmings 2 — — Cellulose Paper Bags 2 — — Brush Making 2 — — Buckles 3 — — Toys and Games 107 — — Cords 1 — — Stationery 9 — - Gloves 3 — — Cotton Goods 83 — — Christmas Crackers 1 — — Total 358 — — PLACES OF PUBLIC ENTERTAINMENT Number of inspections 25 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. 24 SWIMMING BATHS AND FOOL The water at each of the Baths in Enfield is tested twice daily by the Superintendents to ascertain tne concentration of Chlorine in the water. In addition, samples are taken each week by my Department and examined in tne 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 Public Health Laboratories where a full 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 brought to the notice of the Authorities concerned. The sanitary conveniences at all the voluntary schools are attended to daily by an employee of the Health Department. MILK Sixteen 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 PUBLIC HEALTH (MEAT) REGULATIONS, 1924 Total number of carcases examined Nil. Number, or parts, found to be diseased (in Butchers' shops) 8 Weight of do. do. do. 740 lbs. Number of Certificates issued 8 FOOD AND DRUGS ACT, 1938 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 181 822 Ice-Cream (Sale and/or Manufacture) 145 872 25 Ice-Cream As will be seen from the tabulated statement above, frequent inspections of ice-cream premises were made during the year. During these visits 177 samples of ice-cream were taken and the reports on these samples are summarised as follows:— Grade No. of Samples I 18 II 38 III 45 IV 76 Total 177 Number of inspections made to retail shops, stalls and food-preparing premises 1,795 Total No. of articles, etc., condemned 12,385 Total No. of Certificates issued 496 Total weight of foodstuffs (other than fresh meat) condemned as unfit for food:— 7 tons 4 cwts. 2 qrs. 13 lbs. Meat and Other Foods Although there are 8 slaughterhouses in the district, none are now in use for slaughtering purposes, and therefore no examinations or inspections of animals or carcases were carried out during the year. 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 13 Hawkers were registered. 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 64 62 FOOD POISONING No cases of food poisoning were reported during the year. CARAVANS Number of applications received for consent Nil Number of applications granted Nil 26 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 six 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 22 owners to whom dustbins were supplied during the year, but as the position with regard to the supply of dustbins through normal channels has become much easier, the Council has now discontinued the scheme. 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 28 MATERNITY AND CHILD WELFARE COMMITTEE 1948 (to June) Chairman Mrs. G. M. Jay, J.P. Vice-Chairman Mrs. L. E. Daines Mrs. E. Williams A. D. Bates, Esq. D. R. J. Boxall, Esq. W. H. Cook, Esq. J. cottenham, esq. F. Greenwood, Esq. W. G. Jollte, Esq. A. R. Kemp, Esq. A. A. F. Tatman, Esq. 29 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. 30 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 31 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Live Births:— Total Male Female Legitimate 1,843 949 894 Illegitimate 72 40 32 Birth-rate:—17.20 per 1,000 population. Still Births:— Total Male Female Legitimate ... 40 24 16 Illegitimate ... 1 — 1 Rate per 1,000 total births—21.40. Death rate of infants under 1 year of age:— All infants per 1,000 live births 27.67 Legitimate infants per 1,000 legitimate live births 28.21 Illegitimate infants per 1,000 illegitimate live births 13.88 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 17.90 0.42 10.80 34.00 London 20.10 0.39 11.60 31.00 126 County Boroughs and Great Towns (including London) 20.00 0.52 11.60 39.00 148 Smaller Towns 19.20 0.43 10.70 32.00 ENFIELD 17.20 0.36 8.48 27.67 32 INFANT MORTALITY Of the 53 infants who died before attaining the age of one year, 31 died within the first week of life. In 6 cases death was due to Pneumonia, in 11 to Congenital malformation, in 9 to Premature Birth and 7 to Injury at Birth. On page 31 appears Table II wihch gives the ages and cause of death of all children under the age of one year. PUERPERAL PYREXIA During the year 25 cases of Puerperal Pyrexia were notified. MATERNAL MORTALITY There was 1 maternal death during the year. 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 There are two registered Nursing Homes in the District, both of which are kept under regular supervision. The conduct of these Homes has been satisfactory. Address. Number of Beds. " Windsniill," Windmill Hill, Enfield 20 Maternity Beds Beech Hill, 8 Maternity Beds Hadley Wood 6 Medical Beds ADMINISTRATION OF MIDWIVES ACTS, 1902-36 At the end of the year 1948 there were 29 Midwives practising in the district, 17 of whom were employed by the Council as wholetime domiciliary midwives, and 12 employed in private Maternity Homes and Hospital. The following table shows the cases attended during 1948 and 1947:— 1948 1947 Municipal Midwives— Cases attended as Midwives 560 902 Cases attended as Maternity Nurses 189 239 Private Midwives— Cases attended as Midwives in Institutions 844 214 Cases attended as Maternity Nurses in Institutions 62 42 Cases attended as Maternity Nurses domiciliary 1 2 The reduced Birth-rate and greater Maternity Hospital facilities are reflected in the considerable reduction in the number of confinements attended by Municipal Domiciliary Midwives. 33 NOTIFICATIONS In accordance with the provisions of the Midwives Acts, 19021936, and the rules of the Central Midwives Board, the following notifications were received:— 1948 1947 Sending for Medical Aid 168 249 Still Births 1 4 Laying out of the dead 1 3 Artificial feeding 19 18 Liability to be a source of infection 6 11 Notification of death 3 3 The notifications in connection with Medical Aid can be classified as follows:— During pregnancy 15 During labour 106 During lying-in period 10 Infant 37 OBSTETRIC SPECIALIST The scheme whereby the General Practitioners of the district may call in the help of the Obstetric Unit at Chase Farm Hospital in cases of difficulty during the ante-natal period or at the confinement was continued. HOME HELPS 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-emphasised, and our efforts to extend and make more readily available this valuable service met with considerable success, 145 homes receiving domestic help during the year compared with 104 last year. At the end of the year there were employed 10 whole-time and 32 part-time Home Helps. BIRTH CONTROL In accordance with the authority given by the Minister of Health, the Medical Officers continued to give advice on this subject to thosa mothers attending the Maternity and Child Welfare Centres for whom further pregnancy would be detrimental to health. 34 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 the Chase Farm Hospital for their confinement, and also to those other mothers whose confinements were notified. ANTE-NATAL CLINICS During the year, 1,731 mothers attended the ante-natal clinics. This is a decrease of 7 on last year's figures. POST-NATAL CLINICS During the course of the year, 309 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, has decreased this year, and is very 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 2,002. VISITS The Health Visitors paid 895 visits to Expectant Mothers, 4,395 to children under one year of age, and 5,523 to children between the ages of one and five years. This field of activity still has scope for development with adequate Health Visiting Staff. 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, and also in investigating home conditions of applicants for ie-housing. 35 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 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 31 lbs. Cost £3 7s. 11d. In addition 46 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. During the course of the year, the following have been distributed through the Maternity and Child Welfare Centres:— Orange Juice 53,017 bottles Cod Liver Oil 13,033 bottles Vitamin A and D Capsules 1,755 packets National Dried Milk 12,999 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 2,716 (25%) as compared with 3,380 in 1947. 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, as in former years. 36 OPHTHALMIC TREATMENT Expectant and nursing mothers and children under 5 years of age, with eye defects, were referred to the School Ophthalmic Surgeon, until 5th July. The following is a summary of the cases referred during that period:— Mothers. Children. Total attendances 22 124 No. of individual cases 17 74 New cases 15 40 No. of glasses prescribed 8 27 Attendances for other than refraction 1 13 Referred to Hospital 3 4 SPEECH CLINIC The arrangement whereby pre-school children can be referred to the Speech Therapist for training continued throughout the year. CHILD LIFE PROTECTION—PLBLIC HEALTH ACT, 1936, AND CHILDREN ACT, 1948 The commencement of operation of the Children Act on 5th July, 1948, placed responsibility for the Child Life Protection provisions of the Public Health Act, 1936, on the newly created Children's Committee of the County Council. During the transition period, however, the Health Visitors have continued their Infant Life Protection visits and the Department has given all possible assistance to the Children's Officer. 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 1948:— Mothers. Children. Totals. Attendances 896 351 1,247 Treated 281 224 505 Administration of local Anaesthetic 95 20 115 Patients having local Anaesthetic 95 18 113 Extractions with local Anæsthetic 178 28 206 Administrations of nitrous oxide gas 101 134 235 Patients having nitrous oxide gas 79 128 207 Extractions under nitrous oxide gas 685 346 1,031 Total extractions 863 374 1,237 Nitrous oxide gas sessions 44 — 44 37 Ordinary sessions 56 — 56 Total sessions 100 — 100 Dentures fitted 112 —- 112 Patients having dentures 60 — 60 Repairs fitted 13 — 13 Patients having repairs 13 — 13 Fillings 159 67 226 Other operations 516 71 587 ORTHOPÆDIC TREATMENT During the course of the year 72 children were found to be suffering from orthopaedic defects needing treatment or observation. The following are the defects from which they suffered:— Genu valgum 27 Pes planus valgus 22 Valgus ankles 5 Valgus deformity 3 Talipes Equino Varus 2 Metatarsus Varus 2 Deformity of Toes 2 Knock Knees 2 Torticollis 1 Other conditions 6 DIPHTHERIA IMMUNISATION The campaign for the immunisation of children against diphtheria continued throughout the year and 1,939 children under the age of 5 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 4½ 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, 172 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. 38 In addition to the above numbers of children who were immunised for the first time, 1,834 received reinforcing doses which are important in order to maintain a high level of immunity amongst the child population. Of the 1,834 children who received reinforcing doses, 862 received the doses at about the age of school entry and 972 at about the age of 10 years, in order to try to maintain a high level of immunity throughout school life. WHOOPING COUGH During the year 876 children under the age of 5 years were immunised against Whooping Cough. ILLEGITIMACY—CIRCULAR 2556 Arrangements are in force whereby women and babies are admitted to suitable Hostels. ADOPTION Adoption of Children (Regulation) Act, 1939; Children Act, 1948 The commencement of operation of the Children Act on 5th July, 1948, placed responsibility for the appropriate sections of the Adoption of Children (Regulation) Act, 1939, on the newly created Children's Committee of the County Council. During the transition period, however, the Health Visitors have continued to carry out certain investigations and supervision, and the Department has given all possible assistance to the Children's Officer. DAY NURSERIES Name of Nursery No. of places No. on Register at end of year Green Street 60 70 High Street 60 62 Baker Street 60 61 Children attending the Nurseries are immunised against Diphtheria and Whooping Cough. CARE OF PREMATURE INFANTS—CIRCULAR 20/44 The number of babies notified during 1948 who weighed 5½ lbs. or less at birth was 76. The number who were nursed entirely at home was 26, of whom 23 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. 39 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. DOMICILIARY NURSING On the 5th July, the Middlesex County Council became responsible for the work formerly undertaken by the District Nursing Associations, and at the end of the year there were employed 5 whole-time and 1 part-time Nurses. SCHOOL HEALTH SERVICE 43 ANNUAL REPORT ON THE SCHOOL HEALTH SERVICE William D. Hyde, M B., Ch.B., D.P.H. For the year ending 31st December, 1948. 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, 1948. The operation of the National Health Service Act, 1946, as from the 5th July, 1948, had its effect on the School Health Service as well as the other personal Health Services of the Council. The School Health Service has been more closely integrated with the personal Health Services now administered by the County Council. The other sections of the National Health Service have also necessitated changes, the full effects of which, beneficial or otherwise, are not yet clear. In my last report I referred to the difficulties experienced in our endeavours to set up a Child Guidance Service and I regret that no progress has been made. Further, it has not been possible to provide improved school health clinic premises which are urgently needed, but continual efforts will be made to achieve this end, either as part of, or independent of, the general provision of health centres. The advent of the National Health Service has, of course, created many difficulties in administration which it is hoped will soon be successfully overcome. I am glad to say that the basic functions of the School Health Service have been well maintained, apart from dentistry, which suffered a severe loss in the sudden death of Mr. C. E. James, Senior Dental Officer, who had served as School Dentist in Enfield since May, 1921. Further resignations from the Dental Service in favour of general practice have caused disorganisation, which shows no immediate prospect of improvement. This is particularly unfortunate in view of the co-ordination of the School Dental Service with the Priority Dental Service for women and children under the National Health Service, with the naturally increased demands which are now being made. 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, 44 MEMBERS OF THE ENFIELD EDUCATION COMMITTEE 1948 Chairman A. A. F. Tatman, Esq. Vice-Chairman Mrs. L. E. Datnes. Representative Members: Mrs. L. E. Daines Mrs. G. M. Jay, J.P. Mrs. E. A. Williams A. D. Bates, Esq. W. G. Bowyer, Esq. D. R. J. Boxall, Esq. W. H. Cook, Esq. J. Cottenham, Esq. G. Deacocic, Esq. J. Edwards, Esq. A. M. Eeles, Esq. A. R. Kemp, Esq., J.P. W. E. Lonsdale, Esq. A. R. Oakden, Esq. C. Partington Esq., J.P., M.R.S.T. P. L. Purnell, Esq. D. Storer, Esq. A. A. F. Tatman, Esq. Appointed Members: Mrs. E. M. Squire, C.C. Ald. J. E. Hutton Co-opted Members: Rev. J. B. Harrington-Evans. A. H. Chambers, Esq. A. J. Crofts, Esq., B.Sc. W. Graham, Esq. T. W. Moore, Esq. E. S. Stock, Esq. W. Threadgold, Esq. 45 STAFF OF THE SCHOOL HEALTH SERVICE Medical Officer: William D. Hyde, M.B., Ch.B., D.P.H. Deputy Medical Officer: C. E. Jamison, M.B., B.Ch., B.A.O., D.P.H., B.A. Assistant Medical Officers: Lilian Rivlin, M.R.C.S., L.R.C.P. Marjorie Smith-Wilson, M.B., Ch.B., D.P.H. Margaret R. Gilmour, M.B. Ch,B„ D.P.H. Dental Officers: C. E. James, L.D.S., R.C.S. (until July, 1948) I. Frischmann, L.D.S. (Resigned October, 1948) R. M. H. Williams, L.D.S. Mrs. O. Smallpiece, L.D.S., R.C.S. (November and December) Ophthalmic Surgeon: Jean M. G. Shaw, M.B, Ch.B., D.O.M.S., D.O. Ear, Nose and Throat Surgeon: William Ibbotson, F.R.C.S. Speech Therapist: Miss Mary Wicks, L.C.S.T. (Appointed Sept., 1948) 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. (Resigned April, 1948) 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 (Resigned June, 1948) Miss P. E. Roberts Miss P. C. Burch (Appointed August. 1948) 46 ROUTINE MEDICAL INSPECTION Number of school children on register 15,065 Number of schools 43 The total number of children examined during the year was 4,181. 65.84 percent. of the children examined were accompanied by their parents. 36.61 percent. of the children were vaccinated. DEFECTS FOUND AT ROUTINE MEDICAL INSPECTION Requiring Treatment Requiring to be kept under observation Skin 16 7 Eyes: (a) Vision 329 95 (b) Squint 40 3 (c) Other 17 1 Ears: (a) Hearing 13 32 (b) Otitis Media 13 4 (c) Other 7 5 Nose or Throat 79 134 Speech 9 5 Cervical Glands 3 32 Heart and Circulation 4 20 Lungs 14 45 Developmental: (a) Hernia 1 1 (b) Other 3 7 Orthopedic: (a) Posture 19 18 (b) Flat Foot 55 36 (c) Other 12 33 Nervous System: (a) Epilepsy 3 — (b) Other — 4 Psychological: (a) Development — — (b) Stability 2 11 Other 13 14 47 The following table shows the general condition of pupils inspected during the year in the age groups:— 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 2,057 505 24.6 1,510 73.4 42 2.0 Second Age Group 1,382 274 19.8 1,023 74.0 85 6.2 Third Age Group 742 210 28.3 490 66.0 42 5.7 Total 4,181 989 23.7 3,023 72.3 169 4.0 A. Better than normal, or "good." B. Normal, or "fair." C. Below normal, or "poor." Six hundred and eighty-five children of eight years old were given a routine eye check, of whom 83 were referred to the Eye Clinic for treatment and 51 were referred for observation. THE WORK OF THE SCHOOL NURSES Number of home visits 619 Number of special school visits 81 Number of school visits for routine examination of heads 107 Total number of heads examined 17,693 Number of individual children found unclean 402 Number of Nurses' minor ailment clinics held 583 Total attendances of children at Nurses' clinics 14,633 Number of routine medical inspection sessions attended by Nurses 147 48 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 2 — (b) Ringworm of Body 29 — (c) Scabies 11 — (d) Impetigo 56 —. (e) Other skin conditions 275 8 Eyes: (a) Defective vision 253 82 (b) Squint 11 1 (c) Other eye conditions 166 17 Ears: (a) Defective hearing 27 14 (b) Other ear conditions 158 16 Nose or Throat 195 109 Speech 27 3 Cervical Glands 5 17 Heart and Circulation 1 4 Lung conditions 22 12 Developmental: (a) Hernia 2 1 (b) Other — — Orthopædic: (a) Posture 1 1 (b) Flat foot 16 5 (c) Other 56 3 Nervous system 3 6 Psychological: (a) Development — — (b) Stability 7 3 Post Scarlet Fever examinations 16 57 Other conditions 1,218 427 The total of attendances at the Doctors' Minor Ailment Clinics was 4.035, and the number of individual children attending was 3,277 49 DENTAL CLINICS (1) Number of pupils inspected:— (a) Periodic Age-groups— 5 192 5,385 6 523 7 528 8 603 9 480 10 450 11 403 12 457 13 482 14 453 15 409 16+ 415 (b) Specials 1,385 (c) TOTAL (Periodic and Specials) 6,770 (2) Number found to require treatment 4,252 (3) Number actually treated 4,305 (4) Attendances made by pupils for treatment 7,989 (5) Half-days devoted to:— (a) Inspection 42 (b) Treatment 951 TOTAL (a) and (b) 993 (6) Fillings:— Permanent Teeth 3,722 Temporary Teeth 590 TOTAL 4,312 50 (7) Extractions:— Permanent Teeth 915 Temporary Teeth 6,361 TOTAL 7,276 (8) Administration of general anesthetics for extractions 545 (9) Other Operations:— (a) Permanent Teeth 1,623 (b) Temporary Teeth 267 TOTAL (a) and (b) 1,890 The number of children referred to the Orthodontic Clinic, Bowes Road, was 40. OPHTHALMIC CLINIC Total attendances 2,542 Number of children attending 1,433 New cases 440 Prescriptions for glasses 729 Attendances for other than refraction 27 Children requiring operative treatment for squint 5 Children requiring other hospital treatment 9 ORTHOPTIC CLINIC Total attendances 1,649 Number of children attending 233 New cases 177 Number of cases discharged 34 During the year twenty-one children had operation for squint at the Western Ophthalmic Hospital and subsequent courses of treatment at the clinic. 51 EAR, NOSE AND THROAT CLINIC Total number of attendances 587 Number of cases dealt with 488 Number of new cases 202 Number of cases discharged cured 148 Number of cases of a recurrent nature requiring occasional treatment 6 Number of cases still under treatment 37 Number of cases who have refused treatment or sought treatment elsewhere 9 Referred to Speech Therapist 6 Recommended for School for Deaf Pupils 2 Referred for X-ray 7 TONSILS AND ADENOIDS Number of cases operated under the Authority's Scheme 409 ORTHOPÆDIC CLINIC Total attendances 406 New cases 141 Number of individual children 249 Classification:— Pes planus 114 Genu valgum 24 Genu varum 1 Hallux valgus 16 Ankle valgus 3 Tendo achilles 2 Scoliosis 16 Kyphosis 2 Poor posture 5 Paralysis 2 Little's disease 2 Osteomyelitis 1 Sheuerman's disease 1 Talipes equino-varus 1 Toe deformities 4 Osteochondritis 1 Metatarsus varus 1 Hemiplegia 1 Post Poliomyelitis 4 Miscellaneous 48 Recommendations for Special Schools 4 52 SPEECH CLINIC The total number of children who received treatment between September and December was 73. These are classified under the following defects:— Dyslalia 28 Stammering 19 Cleft palate and / or hare lip 4 Sigmatism 17 Alalia 1 Dysphasia 1 Hyper-rhinophonia 3 14 cases were discharged cured. 1 left the district. The number of children on the register at the end of December was 58. SPECIAL EDUCATIONAL TREATMENT—HANDICAPPED PUPILS Category. Recommendations made during year. Pupils attending Special Schools at 31st December, 1948. Special Residential School. Special Day School. Residential. Day. Blind and partially sighted - - 3 - Deaf and partially deaf - 2 - 8 Delicate pupils 25 — 21 — Diabetic pupils 1 — 3 — Educationally subnormal 5 7 - 57 Epileptic pupils 1 — 1 — Physically handicapped pupils — 7 4 11 Pupils suffering from disability of mind. Forty pupils were examined under Sections 34 and 57 of the Education Act, 1944, with the following recommendations:— To remain at an ordinary school 2 To be re-examined 15 To attend special day school 7 To attend special residential school 5 Referred to Local Authority for the purposes of the Mental Deficiency Act, 1913 8 Referred for further report 3 53 SPECIAL EXAMINATIONS Forty-one children had special examinations during the year, of whom five were recommended Child Guidance treatment, twentyfive were recommended a short stay at a residential open-air school, two were recommended for admission to special residential schools and nine were recommended for admission to a special day school. SUMMARY OF EXAMINATIONS The total number of individual children examined during the year, excluding those attending the Dental Department, was 10,042. This number was made up as follows:— Examined at Routine Inspection 4,181 Examined at Minor Ailment Clinics 3,277 Examined at Ophthalmic Clinic 1,433 Examined at Orthoptic Clinic 233 Examined at Ear, Nose and Throat Clinic 488 Examined under Juvenile Employment Bye-laws 27 Examined under Sections 34 and 57 of the Education Act, 1944 40 Examined at Orthopaedic Clinic 249 Examined at Speech Clinic (Sept. to Dec.) 73 Special Examinations 41 NOTIFIABLE INFECTIOUS DISEASES Diphtheria 2 Scarlet fever 83 Pneumonia 5 Measles 291 Whooping cough 122 Acute anterior poliomyelitis 3 DEATHS AMONG SCHOOL CHILDREN There were 10 deaths during the year. The causes were as follows:— 1 Blood disease 1 Congenital heart disease 1 Rheumatic heart disease 1 Endocarditis 1 Pneumonia 1 Peritonitis 1 Cerebral tumour 1 Mediastinal tumour 2 Accident PROVISION OF SCHOOL MEALS During 1948, 30,614 dinners were provided free, and 1,283,253 provided and paid for. 2,090,564 bottles of milk were provided free. 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