FINE 14 E INTELL. L1BRAR Urban District of Finchley. ANNUAL REPORTS for the Year 1925 OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER, together with the Annual Report of the CHIEF SANITARY INSPECTOR. ANNUAL REPORT OF THE Medical Officer of Health for the Year 1925. To the Chairman and Members of the Urban District Council of Finchley. Mr. Chairman and Gentlemen,— I have the honour to submit my annual report for 1925 on the health of the Urban District of Finchley. The report is drawn up in accordance with Circular 648 issued by the Minister of Health on 10th December, 1925, and deals with a period of five years. The vital statistics for the year are not so favourable as those for 1924. The death-rate has increased from 9.2 to 10.6 per 1,000, the rise being due mainly to an increase in the deaths from cancer, heart disease and violence. The infantile mortality rate has increased from 50 to 58 per 1,000 births, the rise being due to an increase in the number of deaths from congenital malformations, suffocation and whooping cough. The death-rate from tuberculosis has fallen from .7 to .5 per 1,000, while the death-rate from ' the principal infectious diseases is the same as in 1924. The birth-rate is 14.9 per 1,000 population, and with the exception of 1917-1919 is the lowest on record. The Public Health (Meat) Regulations, 1924, came into operation on 1st April, 1925. The satisfactory manner in which the provisions of these Regulations are being carried out in this district reflects considerable credit on the meat traders and your sanitary inspectors. My thanks are due to Mr. Franklin for his valuable co-operation and to the whole staff of the department for their ungrudging assistance during the year. I am, Mr. Chairman and Gentlemen, Your obedient servant, A. TURNER. 3 Natural and Social Conditions. Area (acres) 3,384 Population (Census 1921) 46,716 Population (Estimated, 1925) 48,500 Physical Features and General Character of the District. Finchley is situated to the north of London in the County of Middlesex. It is a somewhat straggling district, being roughly in the form of an elongated triangle, the apex of which points north. It is bounded on the north by Barnet; on the south by Hampstead and St. Pancras; on the east by Hornsey and Friern Barnet, and on the west by Hendon and Totteridge. The district, generally speaking, is composed of two watersheds with a high ridge running roughly along the centre of almost the whole length of the district. The land on either side drains into the valleys of the Lee and Brent respectively. The soil is for the most part boulder clay overlying London clay at depths varying from 20 feet to 50 feet. The boulder clay is interspersed with glacial drift, there being pockets of clean ferruginous sand mixed with clean gravel. The altitude of the district varies from 200 to 400 feet above sea level. Number of inhabited houses (1921) 10,211 Number of Families or Separate Occupiers (1921) 11,623 Rateable Value (1925) £395,420 Sum represented by a penny rate £1,58o Social Conditions. Finchley is to a considerable extent a dormitory for persons working in London. The district is largely residential in charactcr and there are very few factories. 4 The following particulars as to the chief occupations of Finchley residents are extracted from the Census report for 1921:— Chief Occupations. Males Over 12. Total occupied 13,253 Agricultural Occupations 621 Metal Workers 841 Electrical Apparatus—Workers and Fitters 253 Makers of Textile Goods and Articles of Dress 230 Workers in Wood and Furniture 535 Paper Workers, Printers, etc. 293 Builders, Bricklayers, etc. 594 Painters and Decorators 314 Transport Workers 1,428 Commercial, Finance and Insurance Occupations 2,591 Public Administration and Defence 758 Professional Occupations 890 Personal Service 328 Clerks, Draughtsmen, Typists 1,866 Other and Undefined Workers 702 Females Over 12. Total occupied 7.448 Makers of Textile Goods and Articles of Dress 465 Commercial, Finance and Insurance Occupations 658 Public Administration and Defence 256 Professional Occupations 898 Personal Service 3.227 Clerks, Typists 1.304 Other and Undefined Workers 539 There has been no evidence to show that any particular occupation has had a prejudicial effect on the public health ; conditions as to housing are dealt with later on in the report. 5 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Births: Males. Females. Total. Legitimate 346 345 691 Illegitimate 16 17 33 Total 362 362 724 Birth-rate 14.9 per 1,000 population. Males. Females. Total. Deaths 232 283 515 Death-rate 10.6 per 1,000 population. Number of women dying- in, or in consequence of, childbirth : From sepsis 0 From other causes 1 Deaths of infants under one year of age: Legitimate 37. Illegitimate 5 Infantile Mortality rate, 58, Deaths from measles (all ages) 4 Deaths from whooping cough (all ages) 3 Deaths from diarrhoea (under 2 years of age) 1 Death-rate from principal infectious diseases per 1,000 of population 23 Death-rate from tuberculosis (all forms) per 1,000 of population 5 6 Population. The Registrar-General's estimate of the population of Finchley for 1925 is 48,500, representing an increase of 690 over the population of the previous year, and an increase of 1,784 over the census population in 1921. In view of the rapid growth of the district during the past few years it would appear that the estimate of the Registrar-General is a very conservative one. The excess of births over deaths in the past 5 years is 1471. The number of new houses erected in the district in that time is approximately 1450, an increase of about 14 per cent, over the number of separate dwellings in existence at the time of the census in 1921, and it is well known that the greater number of these new houses have been occupied by immigrants into the district. I think it is safe to say that the population has increased by more than 5,000 since 1921, making the population at the present time approximately 52,000. Births. There were 724 births during the year, and of these 33 were illegitimate. Only on one occasion, namely 1918 have fewer births been recorded in Finchley during the past 20 years. The birth-rate for the year was 14.9 per 1,000 of the population, as compared with 15.9 for the previous year. The birth-rate for England and Wales was 18.3. Deaths. Five hundred and fifteen deaths occurred among Finchley residents, as compared with 449 in the previous year. This gives a recorded death-rate of 10.6 per 1,000 of the population, a considerable increase over the rate for the previous year, which was 9.2. 7 The causes of death which show a definite increase over the previous year are cancer, heart disease and violence, and from the following figures it will be seen that they account for the whole of the increase in the number of deaths in 1925. Deaths from Cancer. Heart Disease. Violence. 1924 50 63 11 1925 89 86 22 Of the persons dying in 1925, no less than 50 percent. were over 65 years of age, as compared with 36 percent. ten years ago. Infantile Mortality. Forty-two deaths of infants under one year of age occurred during 1925, giving an infantile mortality rate of 58 per 1,000 births, as compared with a rate of 50 for the previous year. Out of a total of 33 illegitimate births there were 5 deaths, giving an infantile mortality rate of 151 for these children. The rise in the infant mortality in comparison with that for 1924 was due mainly to an increase in the deaths from congenital malformations, suffocation and whooping cough. The infantile mortality rate for England and Wales for 1925 was 75, and for London 67. Poor Law Relief. During the year 366 families were in receipt of outdoor relief, and the total amount expended on such relief was ^8,082. Three hundred and three Finchley persons were admitted to the Wellhouse Hospital, and of these 15 were admitted to the Lying-in Ward. There have been no causes of sickness or invalidity in the area which call for special comment, and no conditions of environment or occupation have shown evidence of having a sinister effect on health. 8 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Hospitals, 1. Tuberculosis (County of Middlesex Scheme). I am indebted to Dr. Tate, the County Medical Officer, for the following information:— "Under the County Council's Scheme for the treatment of tuberculosis 570 beds are reserved for the institutional treatment of residents in the County of Middlesex, viz. Pulmonary Tuberculosis. Number of Adults. Beds. Children. Type of Case. Male. Female Middlesex County Council Sanatorium, Harefield. 129 129 64 Sanatorium and 8 observation (children). Middlesex County Council Dispensary, Bell Road, Hounslow. 9 7 Observation. Middlesex Country Council Hospital Twickenham Rd., Isleworth. 40 Hospital. Clare Hall, South Minims. 120 66 — Late Sanatorium and Hospital. Surgical Tuberculosis. The County Council has six beds for children reserved for its use at the Victoria Home, Margate. In all other cases, pulmonary and surgical, application for admission is made to one or other of the existing institutions approved by the Ministry of Health for the treatment of tuberculosis. 2. Maternity.—There is a well-equipped lying-in ward in the Wellhouse Hospital, Barnet. Fifteen Finchley cases were admitted to this ward in 1925. 9 3. Children.—A grant of ,£20 per annum is paid by the Local Authority to the Royal Northern Hospital, and in return the staff of the hospital see cases of difficulty referred to them by one or other of the Maternity and Child Welfare Centres. 4. Fever.—Cases of infectious disease are sent to the tion Hospital, Coppetts Road, Muswell Hill, which is now owned by the three districts of Hornsey, Wood Green and Finchley and managed by a Joint Hospital Committee. 5. Small-pox.—Finchley is included in the Middlesex tricts Joint Hospital District. Ample accommodation exists for persons suffering from small-pox. 6. Other Hospitals.—(a) The Finchley Memorial Hospital contains 47 beds and receives annually a grant of seventy-five pounds from the Local Authority. The Local Education Authority has arranged with the Memorial Hospital for the operative treatment of elementary school children suffering from adenoids or from enlarged tonsils. (b) The Wellhouse Hospital, Barnet. This is a modern institution of 200 beds provided by the local Board of Guardians. During 1925 some 303 Finchley cases were admitted. Other Institutions. 1. Unmarried Mothers.—Nil. 2. Illegitimate Infants and Homeless Children:— Wright-Kingsford Home, 76 children. Nether Street Home, 18 children. Neither Home is in any way supported by the Local Authority. 10 Ambulance Facilities. (a) Infectious Cases—Arrangements have been made by the Joint Hospital Committee with the Metropolitan Asylums Board for the conveyance of all cases of infectious disease from their homes to the Joint Isolation Hospital. A horse ambulance is maintained at the Council's Disinfecting Station for use within the district and for the conveyance of infectious cases belonging to Friern Barnet. (b) Non-Infectious and Accident Cases.—The Council provide a Motor Ambulance for the conveyance of non-infectious sick and cases of accident. During the year the ambulance was called out in connection with 100 street accidents and 327 private cases. A sum amounting to £182 was recovered from the various users. 11 Clinics and Treatment Centres. Name and Situation Nature of Accommodation. By whom provided. Maternity and Child Welfare (a) Centres. Congregational Hall, N.12. Accommodation for consultations, weighing of babies, waiting room, &c. Local Authority, Bourchier House, Oak Lane, N.2. Do. Do. (b) Creche. Do. Two large rooms. Do. School Clinics (a) Minor Ailments, Do. Waiting room and treatment room. Do. Congregational Hall, N.12. Waiting room and treatment room. Do. (6) Dental Clinic. Bourchier House, Oak Lane, N.2. Waiting room and treatment room. Do. (c) Ophthalmic Clinic. North Road School. Waiting room and retiniscopy room. Do. (d) X-Ray Clinic Surgery of Dr. Morrison, 30, South wood Lawn Road, High gate, N.6 (e) Tonsils and Adenoids Clinic Finchley Memorial Hospital. Tuberculosis Dispensary Chester Villa, High Road, N.12. ... Middlesex County Council. Venereal Disease Clinic Royal Northern Hospital, Holloway Road, N.7, Do. 17 MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Chair man: Councillor J. Broadbent. Councillor E. S. Bowen. Councillor G. H. Pateman. Councillor J. G. Lawrence. Councillor A. T. Pike. Councillor D. A. A. Merry. Councillor H. O. Syrett. Councillor E. Toyne. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: *A. A. Turner, m.c., m.d., d.p.h. Chief Sanitary Inspector: *E. J. Franklin, m.r.san.i. Assistant Sanitary Inspectors: fF. Hudson, cert.r.ban.i. C. W. Newbery, cert.r.san.i. JT. J. Moore, cert.r.san.i. §J. Yates, cert. r.san.i. Each of the Sanitary Inspectors holds the special diploma of the Royal Sanitary Institute for the inspection of meat and other foods. Health Visitors and School Nurses: *Miss J. Hull, c.m.b. *Miss W. B. Hudson, c.m.b. Clerks: Miss B. Alder. Miss K. M. Nichol. Miss N. Fear. Part-time Officers: *Miss C. A. King, m.d., m.r.c.f., d.p.h. * J. S. Boden, m.b., B.s. Veterinary Surgeon: W. D. Wallis, m.r.c.v.s. * Salary contribution made under the Public Health Acts or by Exchequer grants. † Resigned, 30th November, 1925. ‡ Commenced duties, 14th December, 1925. § Commenced duties, 29th December, 1925. 13 Professional Nursing in the Home. The Finchley District Nursing and Benevolent Societyprovides three nurses for attendance upon the sick poor of the district. The Society has indicated its readiness to co-operate with the Local Authority should the need arise. No financial contribution is paid to the Society by the Local Authority. The Finchley Women Citizens' Association have instituted a scheme whereby families can have the services of a visiting nurse on the payment of an entrance fee of 5s. and an annual subscription of 10s. The home nursing of cases of infectious disease is not undertaken by the Local Authority apart from what the health visitors are able to do in the course of their routine visits to the homes. Midwives. No midwives are employed or subsidised by the Urban District Council. During the year 8 midwives notified their intention to practise within the area. Legislation in Force. Local or Adoptive Acts. The Infectious Diseases (Prevention) Act, 1890 (23rd October, 1890). The Public Health Acts (Amendment) Act, 1890, Parts 2, 3 and 5 (23rd October, 1890). The Finchley Urban District Council Act, 1908. The Small Dwellings Acquisition Act, 1899 (1st June, 1908). The Public Health Acts (Amendment) Act, 1907, Part 2, Part 3, Sections 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, '62, 63, 64, 65, 67, and 68 comprised in Part 4, Part 5, Part 6 and Section 95 comprised in Part 10 (8th September, 1909). 14 Also Sections 81 (modified) and 86 of Part 7, Part 8, and Part 9 (26th August, 1909). The Baths and Wash-houses Acts, 1846-1899 (i8tli March, 1912). The Local Government and Other Officers' Superannuation Act, 1922 (13th December, 1923). The Public Health Act, 1925, Sections 13, 14, 15, 16, 17, 19, 20, 21, 24, 26, 27, 28 and 35 comprised in Part 2, Sections 36, 39, 40, 41, 43 and 44 comprised in Part 3, Sections 45, 46, 47, 48, 49 and 50 comprised in Part 4, and Sections 51, 52, 53, 54 and 55 comprised in Part 5 (29th December, 1925). By-Laws and Regulations. Public Health Act, 1875. With respect to— (а) The cleaning of footways and pavements. (b) The removal of house refuse. (c) The cleansing of earth-closets, privies, ashpits and cesspools (24th November, 1879). Public Health Act, 1875. For the prevention of nuisances arising from snow, filth, dust, ashes and rubbish (24th November, 1879). Public Health Act, 1875. With respect to Common Lodging Houses (24th November, 1879). Public Health Act, 1875. With respect to Slaughterhouses (24th November, 1879). Public Health Act, 1875. With respect to New Streets and Buildings (17th January, 1884). Public Health Act, 1875. With respect to Houses let in Lodgings or occupied by members of more than one family (17th January, 1884). Public Health Act, 1875. With respect to the trade of a Blood-boiler, Blood-drier, Bone-boiler, Fell-monger, Tanner, Leather Dresser, Soap-boiler, Tallow-melter, IS Fat-melter or Fat extractor, Tripe-boiler, Gluemaker, Size-maker, Gut-scraper (17th January, 1884), and Fish-frier (19th November, 1921). Public Health Acts, 1875. With respect to New Streets and Buildings (17th September, 1888). Public Health Act, 1875. With respect to New Buildings (1st December, 1888). Public Health Act, 1875. For the Prevention of the Keeping of Animals on any premises so as to be injurious to health (6th July, 1897). Contagious Disease (Animals) Act, 1866, and the Dailies, Cowsheds and Milkshops Order 1885. With respect to Dairies, Cowsheds, Milkshops (26th November, 1900). Public Health Acts (Amendment) Act, 1890. With respect to Conduct of Persons using Sanitary Conveniences. Public Health Act, 1875. With respect to the Paving of Yards and Open Spaces (8th August, 1903). Public Health Act, 1875. With respect to the Management of a Mortuary (13th May, 1904). Public Health Act, 1875. With respect to the Drainage of Buildings (30th November, 1904). Public Health Act, 1875. With respect to Nuisances (16th November, 1912). Public Health Acts (Amendment) Act, 1890. With respect to the keeping of Water Closets supplied with Sufficient Water for Flushing (16th November, 1912). Public Health Acts (Amendment) Act, 1890. With respect to Alteration of Buildings (9th April, 1913). Employment of Children Act, 1903, and the Education Act, 1918. With regard to the Employment of Children (31st May, 1921). 16 SANITARY CIRCUMSTANCES OF THE AREA. Water. The district is supplied with water almost entirely from the mains of the Barnet District Gas and Water Company. The water is derived from deep wells in the chalk, and is of a high degree of purity, but owing to its source it is, unfortunately, comparatively "hard." The supply is constant and the average quantity supplied to residents in the district is about 25 gallons per head per day. A small part of the Hampstead Garden Suburb is supplied with water by the Metropolitan Water Board. Rivers and Streams. The streams in the district have been inspected from time to time, and on no occasion have they been found to be polluted. Drainage and Sewerage. Mr. Percival T. Harrison, M.I.C.E., the Council's Engineer and Surveyor, has kindly supplied me with the following details:— Sewerage. The Finchley sewage is collected by tributary sewers into two main sewers which discharge separately at the Sewage Disposal Works at two different levels. The low level trunk sewer, terminating in that portion of the works adjoining Coppetts Road, proceeds through the Rough Lots, crosses the Great North Road, and thence along Squires Lane and Long Lane to Ballards Lane; proceeding then along Lovers Walk to the north-west end of Lansdowne Road, at which point there enters the recentlyconstructed sewer from Totteridge Lane, and the sewer, now under re-construction in part, from Waverley Grove and East Finchley. At Waverley Grove the latter sewer receives the sewage from Broughton Avenue Pumping Station. This station, on the abolition of the temporary pumping Station at Addison Way, will receive the sewage from the Hampstead Suburb Trust area and from Village Road, etc., a large part of which already flows into it. 17 The high-level sewer terminates at a point near Summers Lane, proceeds along that road, and then northwards along the Great North Road to Totteridge Lane, another branch crossing the Great North Road and proceeding along Squires Lane and in an easterly direction along East End Road. A furthe branch from Creighton Avenue and the so-called "County" roads proceeds along Church Lane and Long Lane and enters the main sewer at Squires Lane. Sewage Disposal Works. The sewage of Finchley is received at the Sewage Disposal Works at two levels, the low level outfall sewer being 3ft. 6in. in diameter, and the high level sewer 21 in. in diameter. The storm water is diverted at both levels and the sewage proper is measured by automatic recording meters and dealt with separately by bacterial treatment in tanks and filter beds, 103 feet in diameter at the former, and fifteen filter beds of varying diameters at the latter level. The sludge gravitates from the bottom of the low level tanks to two ejector stations operated by an electricallydriven compressed air plant and raised to such points on the site as may be required, air dried and dug into the land. The sludge from the upper level tanks gravitates through a sludge main and is discharged into sludge lagoons in which it is air dried and then removed. The effluent from the filter beds before being discharged into the stream, which ultimately finds its way into the River Lea, is passed through humus tanks for the removal of solids in suspension. The total area of the sewage disposal works is 115½ acres, of which 33 acres are leased from the Burial Board. Scavenging. The house refuse is collected weekly by a contractor who supplies men, horses and vehicles. In addition to the weekly collection, a bi-weekly collection is made from hospitals, nursing homes and certain other institutions, and trade refuse is collected as required at an annual charge of £1. 18 The refuse is dumped and burned in the open at the sewage farm—a practice that has nothing to commend it, but the erection of an up-to-date destructor is to be commenced almost immediately. Smoke Abatement. As the district is practically devoid of factories, no action has been taken by the Local Authority with a view to the abatement of nuisance from smoke. Schools. The sanitary condition of the schools in the district is on the whole satisfactory. In some of the non-provided schools it is difficult to procure adequate ventilation and at the same time to maintain a sufficient degree of warmth. Water-closets and urinals are adequate and are kept in a clean condition. Drinking water from the main is available at all the schools, but the number of taps and drinking cups is by no means liberal. Infectious diseases were not very prevalent in the schools during the year, and it was not necessary to close any school or department of a school. Certificates under Rule 23 2 (a) of Schedule IV. of the code were granted in respect of several schools. Numerous visits to schools were paid by the Medical Officer of Health to investigate cases of infectious disease and to search for carriers. Individual children are excluded under Article 53b and Article 57 according to the nature of the complaint from which they are suffering. ■9 Infant Mortality during the Year 1925. Deaths from stated causes at various ages under one year of age. Causes of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. WARDS, N. E. W. All Causes. Certified 14 5 4 2 25 8 2 4 3 42 11 12 19 Uncertified ... ... ... • • • ... ... ... • •. ... ... ... ... ... Small-pox ... ... ... ... ... ... • • • ... ... ... ... ... ... Chicken-pox ... ... .... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 ... 1 ... Scarlet Fever .... ... ... ... ... ... ... ... .. ... Whooping Cough ... ... ... ... ... ... ... 1 1 2 ... 1 1 Diphtheria and Croup ... ... ... ... ... • • ... ... ... ... ... ... ... Erysipelas Tuberculous Meningitis .... ... ... ... ... ... ... ... 1 1 1 ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... 1 ... ... ...... 1 ... ... ... Larygitis ... ... ... • • • ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... .. ... ... ... Pneumonia (all forms) ... 1 ... ... 1 2 ... 2 ... 5 ... 2 2 Diarrhoea • • • ... ... ... ... 1 ... ... ... 1 ... 1 ... Enteritis ... .. ... ... ... ... ... ... ... ... ... ... Gastritis Syphilis ••• ... ... ... ...• ... ... .. ... ...• ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... 1 ... 1 ... ... 2 ... ... 1 Injury at Birth Atelectasis 1 ... ... ... 1 ... ... ... 1 ... ... ... 1 Congenital Malformations 3 ... 2 ... 5 2 1 ... ... 8 1 2 5 Premature Birth 5 4 1 1 11 • • ... ... ... 11 2 3 6 Atrophy, Debility and Marasmus 3 ... ... ... 3 3 ... ... ... 6 3 ... 3 Other Causes 1 ... 1 ... 2 ... 1 ... 3 1 2 ... Total 14 5 4 2 25 8 2 4 3 42 11 12 19 20 Causes of, and Ages at, Death during the Year 1925. CAUSES OF DEATH. NET DEATHS AT THE SUBJOINED AGES OF "RESIDENTS" WHETHER OCCURRING WITHIN OR WITHOUT THE DISTRICT. Total Deaths whether of ' Residents ' or ' NonResidents' in Institutions in the District WARDS. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and 65 and under up65. wards. North Ward. East Ward. West Ward. All Causes. Certified . 515 42 4 1 22 15 49 124 258 81 170 166 17 Q \Uncertified ... ... ... ... ... ... ... ... ... ... ... ... 7 Enteric Fever 1 ... ... ... ... ... 1 ... ... ... ... ... i Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 4 ... ... ... 1 ... ... ... ... ... 1 2 i Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 3 ... ... ... 1 ... ... ... ... ... 1 1 i Diphtheria 6 ... ... ... 6 ... ... ... ... ... 2 4 ... Influenza 12 ... ... ... 1 ... 4 ... 5 1 4 2 6 Encephalitis Lethargica 2 ... ... ... 1 ... 1 ... ... ... ... 2 ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Respiratory System 17 ... ... ... ... 4 6 5 2 ... 6 8 3 Other Tuberculous Diseases 6 ... ... ... ... 2 1 1 1 1 1 2 3 Cancer, Malignant Disease 89 ... ... ... 1 1 6 32 49 6 22 29 38 Rheumatic Fever 2 ... ... ... ... ... ... 2 ... ... 1 ... 1 Diabetes 4 ... ... ... ... ... ... 1 3 ... 1 1 2 Cerebral Haemorrhage, etc. 29 ... ... ... ... ... ... 4 25 2 14 8 7 Heart Disease 86 ... ... ... ... 1 4 26 55 7 26 33 27 Arteriosclerosis 23 ... ... ... ... ... ... 4 19 6 13 6 4 Bronchitis 27 ... ... ... ... ... 1 3 23 2 6 14 7 Pneumonia (all forms) 39 ... ... ... ... 2 5 8 16 7 13 14 12 Other Respiratory Diseases 5 ... ... ... ... ... 1 ... 4 1 1 1 3 Ulcer of Stomach or Duodenum 5 ... ... ... ... ... ... 4 1 2 1 2 2 Diarrhoea, etc. (under two years) 1 ... ... ... ... ... ... ... ... ... ... 1 ... Appendicitis and Typhlitis 1 ... ... ... ... ... ... 1 ... 1 1 ... ... Cirrhosis of Liver 3 ... ... ... ... ... 1 2 ... 1 1 1 Acute and Chronic Nephritis 14 ... ... ... ... 1 3 3 7 5 3 2 9 Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... Other accidents and diseases of Pregnancy and Parturition 1 ... ... ... ... ... 1 ... ... ... ... ... 1 Congenital Debility, Malformation and Premature Birth 25 25 ... ... ... ... ... ... ... 3 6 5 14 Suicides 7 ... ... ... ... ... 4 3 ... ... 2 1 4 Other Deaths from Violence 22 3 ... ... 7 1 4 2 4 11 11 3 8 Other Defined Diseases 81 4 ... ... 3 3 7 22 42 24 33 24 24 Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... TOTAL 515 42 4 1 22 15 49 124 258 81 170 166 179 21 22 Vital Statistics for the past Twenty Years. Year. Total Births. Birth Rate. Total Deaths. Death Rate. Total Infant Deaths. i Infantile mortality rate. Deaths from Measles. Deaths from Whooping Cough, Deaths from Diarrhoea, (under 2 years). 1906 773 25.1 360 11.7 91 117.7 7 1 31 1907 889 24.4 357 9.83 84 94.49 16 14 7 1908 888 22.2 339 7.31 54 60.81 10 3 5 1909 848 20.3 354 7.43 60 70.7 5 ... ... 1910 889 20.4 367 7.33 56 62.9 I 4 5 1911 960 24.1 355 8.9 71 73.9 3 10 31 1912 973 23.2 379 9.0 61 62.6 2 7 5 1913 930 21.0 392 8.86 60 64.5 ... 3 14 1914 963 20.9 423 9.24 64 66.45 • • • 3 14 1915 912 19.1 497 10.39 60 65.79 10 2 6 1916 835 17.3 403 8.18 48 56.27 2 4 11 1917 728 14.5 447 8.89 34 46.7 5 5 1 1918 620 12.1 548 10.69 31 50.0 3 8 2 1919 725 14.3 476 9.4 42 57.93 • • • ... 9 1920 1051 22.4 413 8.82 59 53.2 3 1 2 1921 879 18.8 524 11.3 64 71.6 ... 6 15 1922 781 16.6 496 10.5 37 47.3 • • • ... 4 1923 738 15.6 426 9.0 28 38.0 • • • 1 ... 1924 759 15.9 449 9.2 38 50.0 7 2 1 1925 724 14.9 515 10.6 42 58.0 4 3 1 23 HOUSING. The following figures with regard to housing conditions in Finchley have been extracted from the census returns of 1921 :— 1901 1911. 1921. Population 22,126 39.J49 46,718 Number of structurally separate houses 4,184 8,332 10,211 Increase in the number of dwellings 1911-1921 24.2% Increase in the number of private families 1911-1921 31% Number of private families 4,604 8,922 11,623 Average number of persons per family 4.8 4.33 3.93 Average number of families per structurally separate dwelling 5.6 5.1 4.8 Average number of families per occupied dwelling 1.16 1.16 1.19 Families in single occupation of separate dwellings 69.3% Families; two to a dwelling 26% Families; three or more to a dwelling 4.6% Percentage of total private families living more than two persons per room 4.4% 4.8% Percentage of families living in 1-3 rooms (2,906) 25% Percentage of families living in 4-5 rooms (3,565) 30.6% Percentage of families living in 6 or more rooms (5,152) 44.3% 24 From these figures it will be seen that, so far as census returns may be taken as a guide, "overcrowding" in Finchley was not materially worse in 1921 than it was before the war. The number of private families had increased by 31 per cent. since j 911, whereas the number of dwellings had increased by only 24.2 per cent., but the average number of persons per private family had fallen from 4.33 to 3.93. Though 25 per cent. of families occupied 1-3 rooms, structurally separate dwellings of 1-3 rooms formed only 4.5 per cent. of the total structurally separate dwellings in the district, and though structurally separate dwellings of 6 rooms and over formed 67 per cent. of the total dwellings, only 44.3 per cent. of families occupied 6 or more rooms. It is therefore evident that a large number of houses which were originally intended for occupation by one family have been sub-let to other families. Such a state of affairs is due not only to the shortage of houses, but also to the fact that many persons find themselves unable to pay the increased rents now demanded and resort to sub-letting as the only way out of the difficulty, and these families, though not necessarily "overcrowded" in the strict sense of the word, have none of the privacy and few of the conveniences that are conducive to a happy and contented home life. The general standard of housing in Finchley compares favourably with both the pre-war and post-war standards in England and Wales and in the County of Middlesex. The only urban districts in Middlesex which show a higher number of rooms per person than Finchley are Southgate, Harrow-on-the-Hill, Wembley and Ruislip and Northwood. Valuable information with regard to housing conditions is obtained by the Public Health Department as a result of house-to-house inspection. Mr. Franklin has very kindly made an analysis of the data in relation to 646 typical working class houses in the poorer Quarters of the district. These houses were inspected prior to the war, and have been re-inspected during the past few years. 25  Pre-war. Post-war. Number of houses inspected 646 646 Average number of rooms per house 5 5 Total number of persons over 14 years 2,442 2.653 Total number of persons under 14 years 1,495 1,194 Average number of persons per house 6.09 5.95 Average number of persons per room 1.21 1.18 Average number of persons per bedroom 2.20 2.11 Number of houses with more than 2 persons per room 35 29 Number of houses with more than 2.5 persons per bedroom 202 164 Number of houses sub-let 226 231 Of these 646 houses, it will be noted that in 164 there are more than 2.5 persons per bedroom (where a child under 14 is counted as 0.5 adult). This state of affairs, though not quite so bad as that which existed before the war, is still unsatisfactory. It will be observed that 231, or 35.7 per cent., of the houses are sub-let, and herein lies the cause of the overcrowding. Under section 91 of the Public Health Act, 1875, a Local Authority has powers to deal with overcrowding as a nuisance, but, as the standard adopted in proceedings under this section is extremely low—namely, 300 cubic feet for an adult, and 150 feet for a child under 10—it is not very often that one meets with cases which do not comply with such a standard. In the worst cases, endeavours have been made by frequent inspection and peaceful persuasion to limit the number of persons living in such houses and to abate overcrowding by re-arrangement of the sleeping accommodation. During the period under review it has not been considered desirable to take legal action in any case of overcrowding. 26 The following is a list of the new houses erected in the district during the past five years:— By the Local Authority. By Private Enterprise. Total. 1921 79 104 183 1922 102 86 188 1923 9 169 178 1924 0 441 441 1925 0 460 460 190 1260 1450 It will be seen that 1,450 houses have been erected since the commencement of 1921, and if one were to agree with the Registrar-General that the population had increased by only 1,784 in approximately the same time one would think that the shortage of houses in the district was rapidly disappearing. It is well known, however, that most of the new houses, apart from those owned by the Council, have been occupied by immigrants into the district. The Council now owns a total of 360 houses which vary in size from 3 rooms to 6 rooms, and it is regrettable to have to state that a very considerable number of the larger houses are sub-let. Towards the end of 1925 an analysis was made of the families of 348 applicants for Council houses, and it was found that in 70 per cent. the total family was 4 or less. If such applicants are given a house with living room, parlour and three bedrooms, the rent of which they have difficulty in paying, one must admit that there is a considerable temptation to sub-let, and unfortunately in a large number of cases in the past the temptation has been irresistible. In his report for the year 1924, my predecessor expressed the view that there was a considerable need for a number of small houses containing a living room, bathroom, scullery and two bedrooms, houses which could be let at a figure approaching an economic rent. I am in entire agreement with this view. 27 fitness of Houses. The general standard of houses in the district is good. Most of the houses are of the small villa type, but there is also a number of blocks of old houses which do not come up to the standard aimed at locally. As a rule owners of property have not been unwilling to carry out the recommendations of the Public Health Department for the improvement of dwellings. In certain instances tenants have shown a disinclination to do anything themselves towards safeguarding the sanitary condition of the houses in their occupation. Unhealthy Areas. It has not been considered necessary to represent any part of the district as an unhealthy area. Housing Statistics for the Year 1925. Number of new houses erected during the year:— (a) Total 460 (b) As part of a municipal housing scheme Nil 1.—Unfit Dwelling Houses. 1.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 691 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 Nil (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 132 28 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 126 3.—Action under Statutory Powers. A. Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling-houses which were rendered fit— (a) by owner 1 (b) by Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 3 (2) Number of dwelling-houses in which defects were remedied (a) by owners 3 (b) by Local Authority in default of owners Nil 29 C. Proceedings under Sections 17 and 18 of the Housing, Town Planning &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders Nil (2) Number of dwelling-houses in respect of which Closing Orders were made Nil (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit Nil (4) Number of dwelling-houses in respect of which Demolition Orders were made 1 (5) Number of dwelling-houses demolished (voluntarily by owner) Nil FOOD. Milk Supply. Finchley must be considered to be very fortunate in its milk supply. Several large and up-to-date establishments for the production and distribution of designated milk are situated in the district with the very desirable result that the delivery of milk in sealed bottles which are filled under hygienic conditions is rapidly becoming universal. The cow-sheds in the district have been visited periodically by the Council's Veterinary Inspector, Mr. Wallis, and all the cows have been inspected. Other Foods. Other premises where food is prepared, stored or exposed for sale are subject to periodical inspection, and the necessary steps are taken to ensure that the premises are kept in a proper sanitary condition and to secure, so far as possible, the wholesomeness of all foodstuffs intended for human consumption. 30 Sale of Food and Drugs Acts. Mr. Robinson, of the Public Control Department of the County of Middlesex, has been good enough to supply me with the following figures:— List of Samples taken in Finchley during the Year ended 31 st December, 1925. Article. Samples taken. Adulterated. Milk 190 3 Milk, Separated 1 — Apples 1 — Cinnamon 3 — Cocoa 2 — Iodine, Tincture of 1 — Nutmeg 1 — Pepper 2 — Prescription 5 1 Spice, Mixed 1 — Whisky 1 - White Precipitate Ointment 1 — 209 4 FACTORIES AND WORKSHOPS. All the factories and workshops in the district have been inspected during the year and the various sanitary defects remedied as a consequence. Very little homework appears to be given out in the district. At some of the workshops the work done is for firms in London, but the total amount is not large. The following tables are on the lines of those issued by the Home Office. Tables 1 and 2 are printed in full, table 3 only so far as the particulars affect this district. 31 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections Written Notices. Occupiers prosecuted. Factories (including Factory Laundries) 81 ... ... Workshops (including Workshop Laundries) 205 ... ... Workplaces ... (other then Outworkers' Premises) ... ... ... Total 286 ... ... 2.—Defects Found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of offences Found Remedied Referred to H. M. Inspector. in respect to which Prosecutions were instituted. Nuisances under the Public Health Acts :* Want of cleanliness 16 15 ... ... Want of Ventilation 1 1 ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... Other nuisances 10 10 ... ... Sanitary accommo dation. insufficient unsuitable or defective not separate for sexes 1 1 ... ... 5 5 ... ... ... ... ... ... Offences under the Factory and Workshop Acts: Illegal occupation of underground bakehouse ... ... ... ... Other Offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). 1 ... 1 ... Total 34 32 1 * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 32 3.—Outwork in Unwholesome Premises, Section 108. Nature of Work. Instances. Notices served. Prosecutions. Wearing Apparel : Making, &c 17 ... ... Lace : Lace Curtains and Nets 2 ... ... Total 19 ... ... PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. The following table shows the number of cases of the various infectious diseases notified and the number of return cases of scarlet fever for the past five years. 33 34 Notification of Infectious Diseases and Return Cases of Scarlet Fever for the past Five Years. Year, Diphtheria Enteric Fever. Influenzal Pneumonia. Pneumonia (other forms). Erysipelas. Encephalitis. Lethargica. Puerperal Septicaemia Ophthalmia Neonatorum. Malaria. Poliomyelitis Diphtheria and Sc. Fever. Scarlet Fever. Return cases of Scarlet Fever. 1921 102 11 ... 35 10 1 3 ... ... ... ... 171 6 1922 49 1 12 44 5 ... 1 1 ... ... 1 108 3 1923 35 ... 9 19 9 I ... 1 ... ... ... 79 2 1924 77 1 7 44 14 3 2 1 2 1 ... 139 7 1925 79 2 2 37 16 5 1 1 ... ... ... 94 2 In 1921 the incidence of scarlet fever and diphtheria was higher than in the subsequent years. Scarlet fever continues to be a mild disease, but during 1925 the infection in several cases of diphtheria has been virulent, there being 6 deaths out of a total of 79 cases. A supply of diphtheria antitoxin is kept at the Public Health Department for issue to local practitioners. It is not the usual practice in the district to administer antitoxin before the patient is removed to hospital. One occasionally finds that in doubtful cases too much reliance is placed on the bacterioligical report on a swab, which is often misleading, and when a case eventually proves to be one of diphtheria much valuable time has been lost before antitoxin is administered. The bacteriological work for the district is mostly carried out at the Joint Isolation Hospital, and during 1925 the following specimens were dealt with :— Positive. Negative. Doubtful. Total. Diphtheria 46 310 — 356 Pulmonary Tuberculosis 7 73 — 8O Enteric Fever 0 2 — 2 Ringworm 6 8 — 14 452 There was a small outbreak of enteric fever in the Autumn of 1921 involving 11 persons, children and adults being affected alike. The source of infection was not discovered. Cases of infectious disease are admitted to the Hornsey, Finchley and Wood Green Joint Isolation Hospital. At various times the accommodation has been found to be inadequate to meet the needs of the districts which it serves, resulting in Finchley cases having to be sent to Barnet 34 Isolation Hospital and various hospitals in London. It is gratifying that a scheme of extension has now been sanctioned, and it is hoped that the extra cubicle accommodation will meet the needs of the districts for some considerable time. The return cases of scarlet fever have remained comparatively low, varying from 2 per cent.—5 per cent. during the past five years. In some cases the infecting child has been found to have developed some nasal discharge after returning home, but in others nothing abnormal has been discovered. From time to time inspections have been conducted in schools in the search for carriers of scarlet fever, and in some instances whole classes have been swabbed in the hope of discovering diphtheria carriers. The disinfection of infected articles is carried out at the Council's Disinfecting Station in Summers Lane, and infected premises are dealt with by spraying and fumigation with formalin. The amount of work done under this heading is set out in the report of the Chief Sanitary Inspector. Schick Test and Immunization. In October, 1921, the Schick Test was applied to the nurses and children in the Wright-Kingsford Home, North Finchley. Seventy persons, whose ages ranged from 10 months to 30 years, were submitted to the test, and of these 46 were positive and 29 negative. Of the 29 negative ones, 4 had already had diphtheria and 3 were proved to be carriers. Fifty-seven persons in all were immunized, 14 to whom the Schick test had not been applied and 43 who gave a positive Schick. Three positive cases left the home before immunization. There was no instance of serious disturbance, either general or local, among those immunized. Up to the present time no case that was immunized and no case that gave a negative Schick has contracted diphtheria. 36 The notification of pneumonia is by no means complete. In several instances during the past five years the number of deaths has exceeded the number of notifications received, which would lead one to think that certainly less than 50 per cent. of the cases are notified. No cases of dysentery or trench fever have been notified during the past five years. Two cases of malaria were notified in 1924. No vaccinations or revaccinations have been performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. There have been several epidemics of measles and whooping cough during the period under review, but in all cases the mortality has been comparatively low. The mortality from influenza has remained almost stationary apart from a slight rise in 1922, while the mortality from cancer has steadily increased, except in 1924, when the figure was comparatively low. Death-Rates from Influenza and Cancer, 1921-1925. 1921. 1922. 1923. i924. 1925 Cancer 1.26 1.41 1.53 1.04 1.84 Influenza 27 43 .21 .2 .25 A cleansing station has been maintained by the Council since 1922 for dealing with verminous children under the Children's Act, 1908, and the station is now available for cleansing persons under Sections 48 and 49 of the Public Health Act, 1925. The disinfecting station is on the same premises so that infected clothing and other articles can be sterilised while the infested persons are being treated. Articles exposed to infection are treated by steam and premises are sprayed with formalin and fumigated with sulphur. 37 Notifiable Diseases other than Tuberculosis during the Year 1925. The table on pages 39 and 40 shows the number of cases of notifiable infectious disease during 1925. There were two more cases of diphtheria than in the previous year, and out of a total of 79 cases there were six deaths, giving a case mortality of 7.6 per cent. There were 94 cases of scarlet fever, as compared with 139 in 1924. The disease was of a very mild nature, and there was no death. There were 5 cases of encephalitis lethargica, two of which were fatal. The following table shows the conditions as to overcrowding of the households invaded by diphtheria and scarlet fever during the year 1925. The number of cases is too small to warrant one expressing an opinion as to the influence of overcrowding on the incidence of these diseases. Housing Conditions. Less than 1 person per room. 1-2 persons per room. More than 2 persons per room. Cases under 15 years of age. Suscepti. bles (including those attacked, under 15 years of age. Cases under 15 years of age. Susceptibles, including those attacked, under 15 years of age. Cases under 15 years of age. Susceptibles, including those attacked, under 15 years of age. Diphtheria ... ... ... ... ... ... Home Cases ... ... 4 6 ... ... Hospital Cases 1 1 32 68 28 80 Scarlet Fever ... ... ... ... ... ... Home Cases 3 5 23 41 4 4 Hospital Cases ... ... 24 46 19 56 4 6 83 161 51 140 These figures do not include one case which occurred in an Institution. Enteric Fever. Two cases of enteric fever were notified in 1925 affecting a husband and wife. The woman first contracted the disease and died from complications. The husband, presumably, was infected by his wife and had a comparatively mild attack. The primary cause of infection was not traced. 38 Notifiable Diseases during the Year 1925. DISEASE. Under 1 year. 1 and under 2 years. 2 and under 3 years. 3 and under 4 years. 4 and under 5 years. 5 and under to years. 10 and under 15 years. 15 and under 20 years. 20 and under 35 years. 35 and under 45 years. 45 and under 65 years. 65 years and over. Total. WARDS. Removed to Hospital. N. E. W. Diphtheria Cases notified 2 1 ... 1 4 37 21 6 6 ... 1 ... 79 15 58 6 72 Deaths ... ... ... ... ... 4 2 ... ... ... ... ... 6 2 4 ... ... Scarlet Cases notified ... 2 ... 4 3 42 20 9 9 3 ... ... 94 42 22 30 50 Fever Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenzal Cases notified ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 1 1 ... Pneumonia Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia Cases notified 4 1 ... ... ... 8 1 1 3 6 4 5 37 8 22 7 ... (other forms) Deaths 5 2 ... ... ... 1 ... 2 2 3 7 15 37 13 12 12 ... Erysipelas Cases notified 1 ... ... ... ... ... ... 3 1 6 3 1 16 4 7 5 ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Cases notified ... ... ... ... ... ... 1 ... 1 ... 2 ... 5 2 2 1 2 Lethargica Deaths ... ... ... ... ... ...1 ... ... 1 ... ... 2 ... 2 ... ... Puerperal Cases notified ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... Septicaemia Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Cases notified 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... Neonatorum Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Cases notified ... ... ... ... ... ... ... ... 1 1 ... ... 2 2 Fever Deaths ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 TOTAL Cases 8 4 6 5 8 88 43 19 22 16 12 6 237 71 113 53 125 Deaths 5 2 ... ... ... 5 3 2 3 4 7 15 46 15 18 13 ... 39 40 Tuberculosis, During the year, 43 new cases of pulmonary tuberculosis were notified, comprising 21 males and 22 females, Fourteen non-pulmonary cases were nolificd, consisting of 9 males and 8 females, Thcrc were 17 deaths from pulmonary tuberculosis, 9 males and 8 females, and 6 deaths from non-pulmonary tuberculosis, 3 males and 3 females. As regards males, 19 percent. of the notifications of pulmonary tuberculosis and 11 percent. of the deaths were of persons below the age of 35 years, while as regards females, yj percent. of the cases notified and 50 percent. of the deaths were below 35 years. During the last decade the age of maximum mortality from phthisis in females has been transferred from the ages 35-45 to 20-25, or even earlier, and from the notifications received during recent years it would appear that the age of incidence of the disease is earlier, or that the disease develops more rapidly in females than in males. In 39.13 percent. of the cases dying from tuberculosis no previous notification had been received. Dr. Dobson, the Tuberculosis Officer, has been good enough to supply me with the following figures:— Number of patients examined for first time during 1925. Diagnosed as tubercular 33 Diagnosed ;is non-tubercular Undiagnosed and under observation 2 Insured 25 Non-Insured 47 Number of cases suffering from tuberculosis examined at the dispensary during 1925. Insured 96 Noil-Insured 76 Number of cases under observation at the dispensary, etc., on 3!/l2/25 Insured 68 Non-Insured 51 No cases were dealt with during the year under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or the Public Health Act, 1925, Section 62. 41 Tuberculosis during the Year 1925. Age-Periods, New Cases. Deaths. Pulmonary NonPulmonary Pulmonary. NonPulmonary M F. M. F. M. F. M. F. 0 ... ... 1 1 ... ... 1 ... 1 ... ... 1 ... ... ... ... ... 5 ... ... 1 ... ... ... ... ... 10 ... 1 1 ... 1 ... ... ... 15 ... 3 ... ... ... 1 1 ... 20 2 3 1 ... ... 2 1 ... 25 2 6 2 ... ... 1 ... ... 35 11 5 1 ... 4 ... ... 1 45 3 3 ... ... 3 ... ... ... 55 2 1 ... ... ... ... ... 1 65 and upwards 1 ... ... ... 1 1 ... 1 Totals 21 22 8 6 9 8 3 3 North 4 7 4 3 3 2 1 ... Wards: East 11 8 4 2 5 3 2 ... West 6 7 ... 1 1 3 3 Removed to Hospital or Sanatorium 11 11 6 6 ... ... ... ... 42 MATERNITY AND CHILD WELFARE. The Local Authority maintains two Infant Welfare Centres, one at Bourchier House, Oak Lane, and the other at the Congregational Hall, North Finchley. Each centre is open two afternoons a week, on one afternoon a Medical Officer attends for consultations, and on the other afternoon the Health Visitor attends for the weighing of infants. Apart from the Medical Officer and the Health Visitor, the staff at the two centres consists of Voluntary Workers of the Finchley Infant Welfare Association who are responsible for a large amount of valuable work. All drugs, foods and clothing, etc., are provided by the Voluntary .Association. The attendances at the centres during the year 1925 are shown in the following table:— East North Finchley. Finchley. 1925. 1924. Mothers attending 538 210 568 650 Children attending 458 249 707 867 New Cases 198 140 338 479 Total attendances 3,732 3,003 6,735 7.215 From the following figures it will be seen that the attendances at the Creche show an increase over those of the previous year. 1925. 1924. Children attending 103 88 Total attendances under 3 years 3,572 2,574 Total attendances 3 years and over 1,712 1,519 Total receipts from mothers £194 o 1 ^154 6 6 During the year the following home visits have been made by the Health Visitors:— Domiciliary visits 1,792 Visits to centres 180 No investigations have been made into maternal deaths, still births or infant deaths. 43 No maternity homes or institutions for the reception of expectant and nursing mothers and young children are provided by the Local Authority, and no provision is made for dealing with unmarried mothers and illegitimate children. The maternal mortality for the past five years is shown in the following table. [##]YEAR. Number of Births. Maternal Mortality, Number of Deaths. Deaths Sepsis per 1,000 Other Causes Births. Total Child birth 1921 879 ... ... 1922 781 2 ... 2.6 2.6 1923 738 4 ... 5.4 5.4 1924 759 3 2.6 1.3 4 1925 724 1 ... 1.4 1.4 In previous reports the need for a scheme of ante-natal supervision has been emphasised, and I am glad to be able to report that the Council have agreed to establish an AnteNatal Clinic at Bouchier House to commence in April, 1926 —a session to be held once a fortnight. The more recently qualified midwives have been trained to regard efficient ante-natal supervision as essential to the successful practice of midwifery, and mothers are beginning to realise the benefits that accrue from periodical medical examination during pregnancy. The incidence of puerperal fever and ophthalmia neonatorum in the district continues to be low. The numbers notified during the last five years are as follows :— 1921. 1922. 1923 1924. 1925. Puerperal Fever 3 1 — 2 1 Ophthalmia ... ... ... ... ... Neonatorum — 1 1 1 1 It is difficult to obtain hospital treatment tor such cases, but it is hoped that when the extension of the Joint Isolation Hospital is completed this difficulty will be removed. One case of ophthalmia neonatorum was notified in 1925. The child was treated at home and made a complete recovery. 44 ANNUAL REPORT OF THE Chief Sanitary Inspector for the Year 1925. Finchley Urban District Council ANNUAL REPORT OF THE Chief Sanitary Inspector for the Year 1925. To the Chairman and Members of the Urban District Council of Finchley. Mr. Chairman and Gentlemen, I have the honour to present to you my Twentyfourth Annual Report dealing with the work carried out by your Sanitary Inspectors during the year 1925. The total number of inspections made during the year was 9,315, as compared with 10,283 in 1924. The decrease in the total number of inspections in 1925 was due to the fact that it was found necessary to devote a large amount of time to the work of meat inspection in the slaughterhouses. On 606 of the premises visited, defects or nuisances to the number of 1,481 were discovered, and at the end of the year 1,394 of these defects or nuisances had been abated, the work of remedying 16 was in hand, and the remaining 71 were outstanding. In order to ascertain that the sanitary defects were being properly remedied 849 visits were paid to the respective premises while the work was in progress. 46 Inspections. The total number of inspections made in regard to each section of work is recorded in the appended table, together with a summary of the sanitary improvements carried out:— House-to-House Inspections — Special Inspections 3122 Re-Inspeotions 2747 Visits to Works in Progress 849 Visits to Factories and Workshops (including Bakehouses and Outworkers) 312 Visits to Slaughterhouses 855 Visits to Cowsheds, Dairies, and Milkshops 71 Visits to Ice Cream Premises 39 Visits to Food Shops 258 Visits re Infectious Disease 1022 Miscellaneous 40 Total number of Inspections and Re-Inspections 9315 Total number of houses inspected under Public Health or Housing Acts 691 Notices Served. Informal Notices 336 Statutory Notices 14 Summary of Sanitary Improvements Carried Out. Drainage. Number of Houses and Premises re-drained 21 Repairs or Amendments to existing drains 36 Drains or Gullies unstopped or cleansed 46 Length in yards of Stoneware Drains laid 554 Length in yards of Heavy Cast-iron Drains laid 27 Manholes provided 34 Manholes altered and repaired 46 Intercepting traps fixed 9 47 Fresh Air Inlets provided or repaired 46 New Gully Traps fixed 72 New Soil Pipes and Ventilating Shafts fixed 20 Soil Pipes and Ventilating Shafts repaired 8 Water Tests applied 198 Smoke Tests applied 51 Air Tests applied 14 Water Closets and Sanitary Fittings. New W.C. Basins fixed 86 W.C.'s unstopped, cleansed or repaired 24 New Flushing Boxes fitted to W.C.'s 15 Existing Flushing Boxes repaired 47 Joints between W.C.'s and flush pipes repaired 28 New W.C. Apartments provided 5 W.C. Apartments ventilated 1 Lavatory Basins provided 16 Baths provided 6 New Impervious Sinks provided 14 New Waste Pipes fixed 23 Waste Pipes trapped, repaired or unstopped 43 Miscellaneous. Roofs repaired 79 Eaves Guttering renewed, cleansed or repaired 66 Stack Pipes provided, repaired or unstopped 38 Stack Pipes disconnected from drains 2 Damp Walls remedied 12 Walls repointed or repaired 17 Ventilation under floors provided 9 Yards paved 8 Paving of Yards repaired 46 Floors of Rooms relaid 1 Floors of Rooms repaired 42 48 Rooms cleansed, distempered or reappeared 410 Windows repaired and/or made to open 26 New Sash Cords provided 164 Window Sills provided or repaired 15 Doors provided or repaired 12 Staircases repaired 5 Workrooms cleansed and repaired 10 Cisterns provided 9 Cisterns repaired, cleansed and covered 57 Water Service Pipes repaired 4 Movable Sanitary Dustbins provided 127 Offal Bins provided 11 Nuisances from overcrowding abated 1 Nuisances from the keeping of animals abated 1 Accumulations of manure and refuse removed 15 New Ranges provided 2 Stoves and Ranges repaired 48 Coppers provided 1 Coppers repaired 43 Miscellaneous 56 Infectious Disease and Disinfection. Cases of infectious disease notified 237 Cases of Phthisis notified (new cases) 57 Number of rooms fumigated after infectious disease 271 Verminous rooms fumigated 12 Number of articles disinfected 5086 N.B.— In addition to the above work of disinfection, 49 stovings of bedding, etc. (687 articles) were carried out, and 38 patients were removed to Hospital for. the Friern Barnet District Council. 49 Complaints. Two hundred and seventy-eight complaints were received with reference to the following matters, viz.:— Blocked or defective drains 32 Insanitary condition of mews and passages 15 Insanitary condition of houses 55 Defective roofs 15 Insufficient water supply 2 Nuisance from dampness 5 Nuisance from flooding 5 Nuisance from overcrowding 7 Nuisance from the keeping of animals 3 Accumulations of refuse or manure 25 Absence of or defective dustbins 30 Smoke nuisances 7 Foul ponds and ditches 8 Smells from public sewers 8 Insanitary condition of piggeries 5 Nuisance from rats 9 Other complaints 47 The complaints were investigated promptly, and in those cases in which the Council had power to interfere, the necessary steps were taken to remove the cause of complaint. Premises Periodically Inspected. The following premises were visited periodically during the year and any matters found requiring attention were dealt with. Description of Premises. No. in District. Dairies, Cowsheds and Milkshops 25 Ice Cream Premises 50 Bakehouses 21 Dining Rooms 21 Slaughterhouses 8 Fried Fish Shops 7 Shops re Food Supplies 145 Factories, Workshops and Workplaces 224 Public House Conveniences 26 Places of Public Entertainment 24 50 Factory and Workshop Acts, 1901 and 1907. The total number of Factories, Workshops and Workplaces on the register is 224. The businesses carried on at the respective premises are as follows:— Bakehouses 21 Dressmakers and Milliners 23 Bootmakers 36 Tailors 11 Laundries 10 Motor and Cycle Engineers 44 Restaurant Kitchens 21 Other Trades 58 224 These premises have been visited from time to time, and as a result of action taken by the department the following works have been carried out:— W.C. Apartments provided 1 W.C. Apartments ventilated 1 New W.C. basins fixed 1 W.C.'s cleansed or repaired 9 Flushing Cisterns provided or repaired 3 Dustbins provided 4 Workshops cleansed 10 Workshops ventilated 1 Yards and floors cleansed 2 House-to-House Inspection. There were no house-to-house surveys carried out during the year 1925, as your Inspectors were fully occupied with other work, it being especially necessary to devote a considerable amount of time to the administration of the Public Health (Meat) Regulations, 1924, particularly in regard to the inspection of meat in the slaughterhouses. 51 During the five years, 1921—25, covered by this survey report, the following houses were dealt with under this heading:, namelv:— Albert Place 7 Lodge Lane 55 Albert Street 11 Long Lane 137 Avenue Road 54 Manor Cottages, Long Lane 21 Aveton Road \25 Birkbeck Road 3° Market Place 61 Brighton Road 12 Naylor Road 20 Brittania Road 4 New Oak Road 8 Brackenbury Road 33 Oak Lane 6 Brownlow Road 2 Oakleigh Road 2 Chamberlain Road 18 Park Road 31 Chapel Street 26 Percy Road 23 Church Path 9 Prospect Place 26 Coleridge Road 35 Richmond Road 20 College Terrace 8 Shakespeare Road 4 Elmfield Road 3° Sherwood Street 15 East End Road 7 Stanhope Road 15 Finchley Park 17 Summers Lane 23 Fredericks Place 15 Swan Lane 38 Grange Avenue 100 Theob-dds Avenue 22 Granville Road 9 The Walks 7 Green Road 15 Totteridge Lane 4 Grove Road 10 Trinity Road 52 High Road, N.12 19 William Street . 22 High Road N.20 69 Winifred Place 15 Holly Terrace, Swan Lane 28 Woodhouse Road 2 Woodside Lane 4 Kitchener Road 66 1340 Leopold Road 48 As a result of these inspections no less than 6,828 defects or nuisances were discovered and dealt with, and these are enumerated in the appended summary:— Defective drains 39 Blocked drains 17 Defective and short ventilating shafts to drains 46 Defective and insanitary w.c. basins 77 Insanitary pail closets 2 Defective joints between flush pipes and w.c. basins 71 Defective w.c. seats 23 52 W.C. Flushing boxes out of order 117 Defective manholes 22 Defective fresh air inlets to drains 83 Defective house roofs 414 Dirty and defective ceilings and walls of rooms 1533 Defective brickwork and pointing to walls 132 Defective doors 78 Defective doorsteps 47 Defective stairs 64 Defective floors of rooms 245 Insanitary stone troughs 23 Defective and untrapped waste pipes 128 Defective, absence of, or insufficient yard paving 238 Rain water stack pipes in direct connection with drains 8 Absence of or defective eaves guttering and stack pipes 561 No proper outfall for stack pipes 3 Nuisances from dampness 190 Absence of ventilation under floors 25 Absence of, or defective gratings to ventilation openings under floors 87 Windows not made to open 494 Defective window sills 269 Dirty and uncovered service water cisterns 201 Defective service water cisterns 25 Defective kitchen ranges 243 Defective stoves 69 Defective coppers 210 Broken sash cords 394 Defective service water pipes 2 Defective dustbins 206 Absence of or defective gully curbs 90 Insufficient ventilation to rooms 3 Miscellaneous 349 6828 53 An analysis of the house-to-house records for the years 1921-25 has been made and the following statistical information compiled therefrom:— Dwelling-houses. Number of -houses inspected 1340 Number of Rooms. Living Rooms 2856 „ Sleeping Rooms 3441 „ Bed-living Rooms 235 6532 Occupants. Number of Occupants. Adults 5307 „ Children 1811 Average number of persons per house 5.31 „ „ room 1.08 „ „ bedroom 1.90 Rents. *Annual Rental of £16 or under 24 „ „ £16 to £26 176 „ „ £26 to £40 566 „ „ over £40 496 Owned by Occupiers 78 1340 *Number of houses in regard to which Section 15 of the Housing, Town Planning, etc., Act, 1909, applied by reason of contracts for letting having been made after the passing of the Act (3rd December, 1909) 14 Sanitation. Number of houses where defects were found 1,165 or 86.94% Food Storage. Number of houses not provided with larder accommodation 859 or 64.11% Number of houses provided with larder accommodation 481 or 35.89% 54 Houses Unfit for Human Habitation. During the period 1921-25, only those dwelling houses which were in a very serious and dangerous state were represented as being unfit for human habitation owing to it being extremely difficult for the occupiers of such houses to obtain other suitable accommodation. The following are the houses in respect of which closing orders were made, namely:— Nos. 1, 2, 3 and 4, Murray Terrace, High Road, N.20. Since demolished. No. 7, Church Path Cottages, Woodside Lane. Since demolished. Edgell Cottage, High Road, East Finchley. Made fit for habitation. No. 1, The Gardens, Red Lion Hill, East Finchley. Made fit for habitation. Mansion House, The Walks, East Finchley. Since demolished. Of the families displaced from 1—4, Murray Terrace, 1, The Gardens, 7, Church Path Cottages, and the Mansion House, 30 adults and 20 children were found accommodation in certain of the Council houses on the Woodhouse and Queen's Road Estates. No. 4, Murray Terrace had been occupied for many years in circumstances which were very similar to those obtaining in a common lodging house. Unfortunately the premises were exempt from the operation of the bylaws and therefore escaped effective supervision, owing to the fact that persons given accommodation were received on the basis of permanent lodgers and remained in residence on the premises for long periods. The owner of the Mansion House appealed to the Minister of Health against the Order made by the Local Authority to demolish the premises, but the Minister dismissed the appeal. The property has since been sold and the building has been pulled down. 55 The Rent and Mortgage Interest Restriction Acts, 1920 and 1923. A number of communications has been received from tenants who were dissatisfied with the condition of the houses in their occupation. The houses were inspected, and, as the tenants wished to secure the execu tion of certain repairs and not merely to obtain certificates under the Acts, schedules of the work required to put the premises into a reasonable state of repair were sent to the owners of the property. In each case the needful works were carried out. It not infrequently happens that a tenant is under the impression that he is entitled to call upon the owner to carry out extensive redecoration of his house, and, on the other hand, an owner is sometimes unwilling to carry out repairs reasonably required. In dealing with such cases the department has endeavoured to be absolutely fair and impartial, and it is satisfactory to state that during 1925 in no case did it become necessary for a tenant to make a formal application for a certificate under the Rent Acts. Public Health (Meat) Regulations, 1924. Inspection of Meat and Other Food. An ideal system of meat inspection requires that the Inspector shall be present at the time of slaughter when the carcase and all the organs are available for examination. Such a system of inspection is feasible in a wellconducted public abattoir, but in a district in which there exists a number of private slaughter-houses scattered in various parts of the area it would be extremely difficult to arrange for inspectors to be present 56 at all times when slaughtering takes place. Moreover, in the past, the butcher could slaughter at any hour of the day or night without any obligation to notify the Local Authority when such slaughtering was to take place. It is obvious that in such circumstances much of the meat prepared for human consumption escaped official inspection at a time when it is especially necessary that the examination should take place. This unsatisfactory state of affairs has largely been remedied by the provisions of the Public Health (Meat) Regulations, 1924, which (inter alia) require the butcher to give notice to the Local Authority prior to slaughtering any animal intended for human consumption. Having regard to the economic conditions prevailing in the country at the present time, the provision of public abattoirs will, doubtless, remain a dream for many years to come, but much good work may be accomplished by making the best use of the Regulations referred to above. With this object in view, a serious effort has been made to obtain the maximum benefit from the powers conferred on the Council by these Regulations and from the time they came into operation on the 1st April, 1925, every endeavour has been made to inspect the carcases and offal of the animals which have been slaughtered in the district. The amount of slaughtering carried on in Finchley has increased considerably, and, in addition to meat prepared for local consumption, a proportion of the carcases are removed for sale to a number of other districts and to the Smithfield Market. The work of inspection proved somewhat strenuous and absorbed a considerable amount of your Inspectors' time, not only during ordinary hours, but in the mornings and evenings. Unfortunately, the administration of the Regulations, particularly in regard to visits to slaughterhouses, seriously interfered with the other work of the department, especially house-to-house inspection, which had to be entirely discontinued. A report on this aspect 57 of the subject was submitted to the Public Health Committee in September, 1925, and on the recommendation of the Committee, the Council appointed an additional Inspector. This extra assistance will enable us to resume the routine duties which were temporarily dis- Continued During the year 1925 the slaughterhouses have been visited on no less than 855 occasions, and the number of animals inspected was as follows:— Bovines 270 Swine 1750 Sheep 1499 Calves 11 3530 The work of inspection was not without tangible results, as indicated by the following list of diseased or unsound meat which was detected by your Inspectors and subsequently destroyed:— Tuberculosis. Bovines. 1 Carcase and offal of a cow (weight 5cwts. 3qrs.). 2 Forequarters (weight 5cwts. lib.). 1 Head and tongue. 5 Sets of lungs. 1. T.iver. Swine. 8 Carcases and offals. 2 Forequarters. 2 Shoulders. 75 Heads. 16 Plucks. 1 Set of lungs. 5 Mesenlteries. 3 Spleens. 58 Other Conditions. Bovines. 2 Heads and Tongues Actinomycosis. 8 Livers Parasitic. Swine. 1 Carcase Pleurisy and Peritonitis. 1 Carcase and Offal Septicaemia. 2 Forequarters Pleurisy and Pneumonia. 2 Hindquarters and Trimmings, 2 Legs and Trimmings (weight 23 stone 4 lbs.) Bruised. 3 Plucks Parasitic. 5 Plucks Cirrhosis and Congestion. 6 Sets of Lungs Congestion. 11 Livers Parasitic. 9 Livers Cirrhosis. 1 Mesentery Parasitic. 2 Spleens Parasitic. Sheep. 1 Carcase of a Sheep Rot. 43 Livers Parasitic. Butchers' Shops. A systematic inspection of the 35 butchers' shops in the district was also undertaken in order to secure compliance with the Meat Regulations in regard to the storage and the prevention of contamination of meat. Suggestions were made for the improvement of certain shops and these were favourably considered by the traders concerned and the necessary alterations have been carried out. Improvements in the methods of storage, handling, etc., of meat have been effected in many instances and the conditions generally are satisfactory. Some controversy has taken place as to the exact requirements of the Regulations regarding the protection of meat exposed for sale in shops from contamination bodies, dust or mud. In this connection, the Minister of 59 Health advised local authorities that: "It was not con"templated that the Regulations should be construed as "requiring all butchers' shops to be provided with glass "fronts and that the precautions which it may be "reasonable to require under this provision must depend "upon the circumstances of individual cases "In no circumstances, however, should meat be allowed "to project outside the limits of the wall or screen of "the shop Where meat has to be kept near "to an open window, the general rule should be that it "should be covered with muslin or other suitable "material, with the qualification that, in cases where a "brisk trade is carried on, this provision may have to be "suspended so that meat may be readily accessible." In practice, I think considerable difficulty will be experienced in attempting effectually to protect meat from contamination by covering it with muslin. The meat traders in Finchley, with two exceptions, have provided glass fronts to their shops, and it is hoped that similar provision will be made at an early date in the two outstanding cases. Periodical inspection will reveal the need or otherwise of such glass fronts being permanently closed. In the meantime, where movable windows are in use, the butchers have been requested to close them in windy and dusty weather. Cooked and Prepared Meats. With respect to the question of the application of the Public Health (Meat) Regulations, 1924, to cooked meat, etc., an announcement was made in Circular No. 604 issued by the Ministry of Health, as follows:— "Article 2(1) (Definition of Meat)— The Minister's "intention in making the Regulations was that, apart "from the special case of bacon and ham, they should "apply to what is ordinarily known as butcher's meat, "that is to say, the raw and untreated edible parts of "the carcases of slaughtered cattle, swine, sheep and 60 "goats. Questions have been raised whether the Regu"lations apply to rabbits, poultry, fish, butter, mar"garine and cheese. It is clear that the definition of "meat would not include these articles, and the "Minister thinks that Local Authorities might also "properly treat cooked meat, lard, sausages and other "preparations of or containing meat as outside the "scope of the Regulations." The Public Health Committee felt that it was rather difficult to reconcile the foregoing statement with the definition of meat contained in the Regulations, which reads as follows:— "'Meat' means the flesh of cattle, swine, sheep or "goats, including bacon and ham and edible offal and "fat, which is sold, or intended for sale, for human "consumption." If a Local Authority desires strictly to construe the definition of meat as stated above, it is submitted that cooked meat, sausages and food preparations which contain the flesh of cattle, swine, sheep or goats come within the Regulations, and if such is the case, any shop, room, or stall in which such an article is sold, or exposed for sale or deposited for the purpose of sale or preparation for sale would be subject to the provisions of Parts IV. and V. of the Regulations. The before-mentioned provisions are designed to prevent contamination of meat, and while it is important that what is ordinarily known as butchers' meat should be effectually protected from contamination, it is equally important that similar precautions should be taken in regard to cooked meat, sausages, brawn, meat pastes and other similar preparations. It has been suggested that the powers conferred on the Council by the adoption of Section 72 of the Public Health Act, 1925, enable them to secure that precautions are taken against contamination of any food intended for sale. The scope of this section is largely 61 negatived, however, by the exemption from the operation of the section of any room, etc., to which the Factory and Workshop Act, 1901, applies. It will be realised that practically any room in which the work of preparation or adaptation of the article of food takes place would constitute either a factory or a workshop. Slaughterhouses. The number of private slaughterhouses in use in Finchley at the dates mentioned hereunder was as follows:— Type of Slaughterhouse 1920 In January, 1925 In December, 1925 Registered Nil. Nil. Nil. Licensed 10 10 8 Totals 10 10 8 During the five years under review, there have been changes of occupation of slaughterhouses in four cases. One slaughterhouse was vacated at Kenwood Farm, Hampstead Lane, and the premises subsequently demolished and the use of another slaughterhouse of an unsatisfactory type at the rear of 3, High Street, North Finchley, was discontinued and the licence lapsed. A licence was granted by the Council for the adaptation and use of a building as a slaughterhouse at Park Farm, East End Road, East Finchley, in 1921, and an application for a licence for the use and occupation of a building as a slaughterhouse at Dollis Park Farm, Nether Street, Church End, was refused in 1923. At the end of 1925 there were eight private slaughterhouses in the district, each of the premises being licensed for a period of twelve months. Of this number five cannot be regarded as reaching a really satisfactory hygienic standard owing to their unsuitable position in relation to other premises or otherwise being of insufficient size, badly planned and so constructed as to make it extremely difficult to effect structural improvement. The early history of some of these buildings is somewhat obscure, but they were probably not 63 originally constructed for the purpose for which they are now used. They have, however, been adapted and used as slaughterhouses for very many years. The slaughterhouses are inspected frequently and steps are taken to ensure the observance of the provisions of the byelaws in force in the district, which require (inter alia) that the premises be kept in a cleanly state, the provision of proper drainage, ventilation, water supply, etc., the removal of hides, garbage and offensive refuse within 24 hours, the limewashing of the premises at certain intervals and the prevention of cruelty. In 1922 an extensively signed petition was received urging the Council to take steps to enforce the use in the local slaughterhouses of the instrument commonly known as the "Humane Killer" which consists of a shooting apparatus designed to discharge a free bullet or a captive bolt. A very full and careful investigation of this problem was made by the Public Health Committee, to whom special reports on the subject were made by the Medical Officer of Health and the Sanitary Inspector. The Committee attended a practical demonstration, when animals were slaughtered by the use of the "Humane Killer" and by the pole axe, etc. A meeting was also held, when representatives of the Petitioners, the various Societies interested, and the butchers were heard. The Council ultimately decided against the adoption of the byelaw which enforced the use of a mechanically operated instrument for the stunning of animals prior to slaughter, but they adopted the model byelaws prepared by the Ministry of Health (with the exception above referred to) which, in addition to being more in keeping with recent development than the code then in operation, provides that "A person shall not, in a slaughterhouse, proceed to slaughter any bull, ox, cow, heifer, steer, calf or pig, until the same shall have been effectually stunned." These byelaws came into operation in September, 1923. 63 Dairies, Cowsheds and Milkshops. In 1920 twenty-eight persons were registered as Dairymen, Cowkeepers or Purveyors of Milk with premises situated within the district, whilst nine persons retailing milk in the district whose premises were outside Finchley were also registered. During the five years 1921—1925 one cowshed and 7 milkshops have been closed, and in each case the premises have not been re-opened for either the production or sale of milk. At the passing of the Milk and Dairies (Amendment) Act, 1922, when re-registration of all retail purveyors of milk and producers of milk took place, improvements in the structure of premises or in the facilities for the handling of milk were effected before applications for registration were granted. At the present time there are 25 Dairies, Cowsheds and Milkshops in the district, and in addition seven purveyors whose premises are not in Finchley are registered for the purpose of retailing milk within the district. Periodical inspections at regular intervals of all dairy premises are made, and generally speaking such premises are maintained in accordance with the Orders and Regulations in force. There appears to be a progressive and increasing tendency for the sale of milk from small general shops to diminish. Further, the growth of the larger milk trading concerns and the development of treating and bottling milk in large well equipped factories for immediate retail distribution has resulted in many small and somewhat unsatisfactory dairy premises being no longer used for the actual handling of milk beyond retail sale in sealed bottles. This is a helpful advance towards the production and sale of clean milk. 64 Milk and Dairies (Amendment) Act, 1922. Under the Milk (Special Designations) Order, 1923, licences may be granted by the Council to dealers to sell milk designated as "Certified," "Grade A (Tuberculin Tested)," "Grade A" and "Pasteurised." Such milk must conform to certain prescribed standards of purity. During the year 1925, eleven licences were granted by the Council to dealers to sell designated milk as follows:— "Certified," 6; "Grade A (Tuberculin Tested)," 1; " Grade A," 2; and " Pasteurised," 2. At the request of the Ministry of Health, seven samples of "Certified" milk were obtained and delivered in London for bacteriological examination. Two samples of "Pasteurised" milk were also taken on behalf of the Council. behalf of the Council. The following is a summary of the Bacteriologists' reports upon these samples:— No. cf Sample. Bacteria per c.c. Presence of 3acillus Coli in 48 hours. Remarks. CERTIFIED MILK. 1 28700 Absent. Sample passed requirements. 2 1180 Ditto. Very good sample. 3 2 53 5 Ditto. Good sample. 4 326000 Present in 0.01c.c. Sample contained considerably more bacteria 5 2900 Absent. than permissible. Failed to pass the required standard. Excellent. 6 2300 Ditto. Excellent sample. 7 1370 Ditto. Ditto. PASTEURISED MILK 8 13000 — Sample readily passed standard. 9 658000 Sample did not conform to standard. Contained excessive number of bacteria. 65 Coffee Stalk. There are ten coffee stalls in Finchley, and with one exception all are situated upon the main roads where they cater for the needs of a large amount of traffic passing to and from the Metropolis. These stalls are visited at intervals and action is taken to secure the provision of a satisfactory water supply, suitable means of food storage, cleanliness of the stall and utensils, proper means for the storage and disposal of liquid and solid refuse, etc. Offensive Trades or Businesses. There are no offensive trades carried on in Finchley as prescribed by Section 112 of the Public Health Act, 1875. The provisions of Section 51 of the Public Health Acts Amendment Act, 1907, empower the Council, with the consent of the Minister of Health, to declare that any trade, business or manufacture to be an offensive trade. Under this Section the Council were allowed to schedule the business of a Fish Frier as an offensive trade, and bye-laws controlling these premises were made by the Council and approved by the Minister of Health on the 19th November, 1921. This action was taken by the Council, not with a view to exercising unreasonable control over these premises, but in order to provide that the businesses were carried on under proper sanitary conditions and that adequate precautions were taken to prevent the occurrence of nuisance, especially from the emission of fumes during the process of frying fish and potatoes. There are seven premises in Finchley in which the business of a fish frier is carried on, and these have been inspected periodically during the year. 66 In 1921 the business of a soap boiler was carried on for some months in a building in premises abutting on Hall Street, North Finchley. The Council did not give their consent to the establishment of this business, but as considerable care was exercised and no nuisance was caused, proceedings were not taken against the occupier, as in a comparatively short time he obtained more suitable accommodation in another district. Nuisance from the Keeping of Animals. During the years 1924 and 1925, and particularly in the latter year, strong complaints were received regarding the keeping of pigs on the Summers Lane Allotments. Considerable nuisance arose from accumulations of pig manure and overflowing cesspools which, apart from the objectionable smell, gave rise to the extensive breeding of house flies which invaded the houses abutting on to Summers Lane. The allottees were requested to keep the pig-styes and surrounding areas in a proper sanitary condition and were advised as to the special precautions necessary to obviate nuisance and particularly to suppress flybreeding. As a result of an interview with the Allotment Holders' Committee and constant supervision of the styes, a marked improvement was effected in 1925. This supervision will be more necessary in the coming year owing to the increasing number of new houses in close proximity to the allotments. During the summer of 1925 it was necessary to secure abatement of a nuisance arising from the keeping of pigs and the existence of extensive accumulations of manure at Kenwood Farm, Hampstead Lane. Here again neighbouring premises were infested with flies. The nuisance will not recur since the pig keeping has been discontinued and the farm premises have now been demolished. 67 The whole of the pig-styes throughout the district are subject to periodical visitation, and stables are also being inspected with a view to securing compliance with the By-laws regarding the provision of manure receptacles and the cleansing and limewashing of stables, etc. The number of stables in the district is rapidly decreasing with the growing use of motor vehicles. Cleansing of Courts and Passages. It has been necessary to pay a considerable amount of attention to mews at the rear of trade premises which were not regularly and effectually swept and kept clean and free from rubbish or other accumulation. Difficulty often arises in those cases where a number of occupiers use the mews in common and are jointly responsible for their cleanliness. In such instances it may be necessary in the future to recommend the Local Authority to exercise their powers under Section 27 of the Public Health Acts Amendment Act, 1890. Accumulations of Refuse on Unfenced Plots of Land. During the period under review complaints have been received and dealt with relative to the deposition of refuse upon unfenced plots of land. A considerable number of these plots exisited, but they are now being gradually absorbed for building purposes. As a general rule no nuisance within the meaning of the Public Health Acts arises from these accumulations, as they consist mainly of innocuous refuse such as that which is disposed of by builders and gardeners. In order to obviate as far as possible this very undesirable practice the department has endeavoured to secure the fencing in of these vacant plots, and in those cases where the owners were not prepared to carry out this suggestion they have been requested to fix notices prohibiting the dumping of refuse. 68 Sanitary Conveniences. There are 25 sanitary conveniences attached to licensed houses within the district. Of these 17 are so situated as to be more or less available for use by members of the public. As the result of action taken by the department in past years these conveniences are generally of good construction and they are inspected at frequent intervals to ensure that they are kept in a cleanly condition. One urinal adjoining the Bald Faced Stag Public House at East Finchley has been abolished in consequence of the erection by the Council of a convenience adjoining the site. There are now two public conveniences within the district at which accommodation is provided for both sexes, and in two instances the Council (under agreement with the landlords) maintain the conveniences attached to licensed houses as such conveniences are much used by the public. At the end of the year 1925 negotiations were proceeding regarding the acquisition of the site upon which an old insanitary iron urinal stands. It is hoped that these negotiations will prove successful and that, as a result, the old urinal will be abolished and a new public convenience of a modern character erected in its place. Places of Public Entertainment. In accordance with the request of the Minister of Health contained in Circular 120 the cinemas, dance halls and other places of public entertainment have been inspected, special attention being given to the condition and the adequacy of the sanitary accommodation. The defects discovered as a result of these inspections were promptly remedied and a report upon the premises has been submitted each year to the Middlesex County Council, which is the Licensing Authority for the district of Finchley. The number of premises dealt with in 1925 was 24. 69 Game Licences. Thirteen applications were received under Section 27 of the Local Government Act, 1894, from tradesmen in the district for licences to deal in game. A licence was granted in each instance. Petroleum Acts, 1871—1881. Two-gallon Tin Bulk Stores. Stores. Number of applications for licences SO 29 Number of applications refused — — Number of applications granted 50 29 Carbide of Calcium. Number of applications for licences 9 Number of applications granted 9 Quantity of petroleum which may be kept in licensed stores. 43,094 gallons as compared with 31,478 gallons in 1924. Quantity of carbide of calcium which may be kept in licensed stores. 2,312 pounds. 79 Staff. The following changes in the Sanitary Staff have taken place:— Mr. F. Hudson, the Senior Assistant Inspector, resigned in November, 1925, to take up an appointment as a Sanitary Inspector under the Willesden Urban District Council. Mr. C. W. Newbery was promoted to the position of Senior Assistant Inspector, and owing to the general increase in work, particularly in regard to meat inspection, the Council decided to increase the staff of Assistant Inspectors from two to three. The officers appointed to fill the vacancies were Messrs. T. J. Moore and J. Yates, who commenced their duties about the end of 1925. Mr. A. F. Steele resigned in March, 1925, to take up an appointment as a Sanitary Inspector under the Woking Urban District Council, and his position was filled by Miss K. Nichol. It is with much pleasure that I take this opportunity to express my appreciation of the valuable help given by the Assistant Inspectors and other members of the Sanitary Staff in carrying out the work recorded in this report. I am, Mr. Chairman and Gentlemen, Your obedient servant, E. J. FRANKLIN, Chief Sanitary Inspector. Public Health Department, 3, The Hawthorns, Regents Park Road. N.3. April, 1926. 71 Finchley Urban District Council. REPORT of the School Medical Officer for the Year 1925. 73 Finchley Urban District Council. MEMBERS OF THE EDUCATION COMMITTEE. Chairman: Councillor C. S. Syrett. Vice-C hair man: Councillor E. Toyne. Councillor C. H. P. Alderton.Councillor J. G. Lawrence. Councillor L. W. Bennett. Councillor D. A. A. Merry. Councillor J. R. Leslie. Councillor H. O. Syrett. Co-opted Members: Mrs. A. S. Miall, Mr. A. C. D. Collis, Mrs. E. V. Timberlake. Ex-officio Members: County Councillor W. C. Cope, County Councillor T. W. Hicks, m.d., County Alderman F. Goodyear. Secretary to the Education Committee: J. Cogdalf.. 74 Finchley Urban District Council. SCHOOL MEDICAL STAFF. School Medical Officer: A. A. Turner, M.C., M.D., D.P.H. Ophthalmic Surgeon: J. R. Prior, M.D., D.P.H. School Dentist: G. H. W. Randell, L.D.S., Eng. School Nurses and Health Visitors: Miss J. Hull, C.M.B. Miss W. B. Hudson, C.M.B. Clinic Nurse: Miss L. E. B. Auger, C.M.B. Clerk: Miss G. E. Batty. 75 FINCHLEY SCHOOLS. ELEMENTARY SCHOOLS. School. Department. Accommodation. Average attendance 1925. Long Lane Mixed 720 407 Long Lane Infants 382 138 Albert Street Senior Mixed 594 486 Albert Street Junior Mixed 410 265 Squires Lane Boys 300 255 Squires Lane Girls 300 262 Squires Lane Infants 390 224 North Road Senior Mixed 500 170 North Road Junior Mixed 500 251 St. Mary's Mixed 354 277 St. Mary's Infants 180 95 St. John's Mixed 184 135 St. John's Infants 140 87 Christ Church Mixed 429 365 Holy Trinity Mixed 248 178 Holy Trinity Infants 184 88 6135 3683 SECONDARY SCHOOLS. On Roll. County School Boys & Girls 330 387 Christ's College Boys 340 385 Woodhouse Boys & Girls 320 283 990 1055 76 To the Chairman and Members of the Education Committee of the Urban District Council of Finchley. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit my report on the work of the School Medical Service during the year 1925. No material alterations in the scheme of treatment have been made during the year. Fewer defects have been found in the children than in the previous year, but the incidence of dental caries continues to be relatively high. The arrangements for dental inspection and treatment have recently been remodelled and it is hoped thereby to encourage the acceptance of treatment to an extent not attained at present. The health of the children has been good and there has been no widespread epidemic during the year. I wish to express my thanks to Mr. Cogdale, the Secretary of the Education Committee, for his invaluable assistance at all times, and to the head teachers and members of my staff, who have done everything in their power to promote the efficiency of the service. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, A. TURNER, School Medical Officer. 77 CO-ORDINATION WITH OTHER HEALTH SERVICES. (a) Infant and Child Welfare.— The school medical work is an integral part of the general public health work of the district. The health visitors who supervise the school children are responsible for the home visiting of children under school age and for attendance at the Infant Welfare Centres. Arrangements have been made whereby details of importance are transferred from the infant welfare clinic cards to the school medical cards when the children reach school age. (b) Nursery Schools.— There are no nursery schools in the district. (c) The Care of Debilitated Children under School Ag.— The physical condition of these children is watched alt the Welfare Centres and by visits to the homes by the health visitors under the Maternity and Child Welfare Scheme. A considerable number of children are sent for convalescent treatment by the Voluntary Infant Welfare Association. THE SCHOOL MEDICAL SERVICE IN RELATION TO THE PUBLIC ELEMENTARY SCHOOLS. School Hygiene. There are four Council Schools and four Nonprovided Schools in the district. Three of the Council Schools are of the central hall type and one of the pavilion type. The Non-provided Schools are old and compare unfavourably with the more modern Council buildings. The immediate surroundings of the schools are fairly satisfactory, although in some instances the buildings arc in too close proximity to busy thoroughfares. Natural means of ventilation are employed in all cases 78 but in some class rooms of the Non-provided Schools it is difficult to attain adequate through ventilation. Lighting and heating are on the whole satisfactory, although in very cold weather it has been found difficult to maintain a sufficiently high temperature in some of the buildings. Equipment as a rule is good, and desks are mainly of the dual pattern. Water closets and urinals are adequate, and on the whole are kept in a clean condition. Most of the schools have a sufficient number of lavatory basins supplied with cold water, and the supply of clean towels is fairly satisfactory. Drinking water from the main is available at all schools, but the number of taps and drinking cups is by no means liberal. Drinking fountains which do not require the use of cups are much less likely to assist the spread of infectious diseases. The cloak rooms in the Non-provided Schools are unsatisfactory and in certain cases they are not heated. In no school is there any special provision for the drying of children's clothes and boots. In all cases the school premises are kept reasonably clean. In some schools meals brought by the children are warmed up under the supervision of one of the assistant teachers. No meals are served in any of the schools. Medical Inspection. Routine medical inspection is carried out on the elementary school premises, with one exception, where an adjoining hall is used. The School Nurses weigh and measure the children and test their eyesight beforehand, and they are also present at the medical inspections. Head Teachers, Nurses and Attendance Officers 79 are encouraged to refer for examination as "specials" all children in whom they suspect any physical or mental defect. These special examinations are carried out in the schools, at the clinics or at the office of the School Medical Officer. Three main age groups have been inspected at the routine examinations:— Entrants, eight year olds and leavers. The Board's Schedule of Medical Inspection has been followed in its entirety. Findings of Medical Inspection. Details of the defects found during medical inspection are set out in Tables IIa. and IIb. at the end of the Report. (a) Uncleanliness. That the measures adopted to deal with verminous conditions in school children are proving satisfactory is shown by the following figures:— Discovered at routine medical inspection:— VERMINOUS HEADS. 1921 1922 1923 1924 1925 296(19.7%) 170(11.5%) 136(10.4%) 167(10.5%) 100(8.8%) DIRTY BODIES. 234 (15.6%) 184(12.4%) 159(12.2%) 172(10.8%) 87(7,7%) During 1925 the School Nurses made 23,035 examinations of children and 336 individual children were found to be unclean. Twenty-one children were cleansed at the Council's Cleansing Station, and it is noteworthy that certain children require cleansing repeatedly. This is largely due to the fact that these children live in vermin infested homes along with vermin infested adults, so that cleansing of the children alone affords only temporary relief. Sections 45 to 48 of the Public Health Act, 1925, give 8o the Local Authority power to cleanse verminous persons (apart from elementary school children), verminous premises and verminous articles, so there is every prospect of achieving better results in the future. (b) Minor Ailments. Few cases of minor ailments are discovered at routine medical inspection, as these are sent to the clinic by Teachers and School Nurses as soon as they are discovered. (c) Tonsils and Adenoids. Of the children examined at routine inspections 71 or 6.3% were found to be suffering from enlarged tonsils and adenoids. Operation was advised in 31 of these cases and in 35 other cases discovered as a result of special examinations. Fonty-six children were operated on during the year under the Education Authority's scheme, and 4 children received private treatment. (d) Tuberculosis. No case of pulmonary tuberculosis was discovered at routine inspections. One case of tubercular cervical glands and two cases of tuberculosis of bones and joints were discovered; while ten cases of non-pulmonary tuberculosis were found at special examinations. (e) Skin Disease. Two cases of scabies, nine of impetigo and three of other skin diseases were found at routine inspections; while, at special inspections, ten cases of ringworm of the scalp, four of ringworm of body, eighteen cases of impetigo and five of other skin diseases were discovered. 81 (/) External Eye Disease. Seven cases of blepharitis were found at routine inspections, and at special inspections one case of blepharitis, four of conjunctivitis and two of corneal opacity. (g) Vision. Forty or 3.6% of the children at routine inspections were found to be suffering from some fairly serious defect of vision, and a total of 151 children were referred from various sources for refraction by the School Oculist. (It) Ear Disease and Hearing. As a result of routine and special examinations 36 cases of discharging ears and 4 cases of deafness were referred for treatment. (i) Dental Defects. Seven hundred and seven or 62.6% of the children were found to be suffering from dental decay, 12.6% having more than four teeth decayed and 50% having less than four. (/) Crippling Defects. Two cases of spinal curvature and 20 cases of other forms of deformities were discovered at routine and special examinations. Infectious Diseases. Infectious diseases were not very prevalent during the year, apart from a fairly general outbreak of whooping cough and chicken-pox in May, June and July. It was not necessary to close any school or department of a school on account of infectious disease. 82 Certificates under Rule 23, 2 (a) of Schedule IV. of the Code, were granted by the School Medical Officer in respect of the following schools:— Holy Trinity Infants, for 4 weeks in May, June and July. St. John's Infants, for 2 weeks in June. Squires Lane Infants, for 3 weeks in July. Numerous visits to schools were paid by the School Medical Officer and the School Nurses to investigate cases of infectious disease and to search for carriers. The School Medical Officer is informed of all cases of infectious disease that come under the notice of the School Attendance Officers. Individual children are excluded under Article 53b or Article 57, according to the nature of the complaint from which they are suffering. 83 Exclusion of School Children on account of Infectious Disease. Disease. PATIENTS. Period of exclusion. CONTACTS. Period of exclusion. SCARLET FEVER: (a) Hospital Cases Until 14 days after discharge from hospital. All children in the family must be excluded until 10 days after disinfection of premises. (b) Home cases Until 14 days after disinfection of premises. DIPHTHERIA: (a) Hospital Cases Until 28 days after discharge from hospital. All children in the family must be excluded until 10 days after disinfection of premises. (b) Home cases Until 28 days after disinfection op premises. SMALL-POX Until Medical Officer of Health certifies that child may attend. All children in the family must be excluded until Medical Officer of Health certifies that they may attend. MEASLES Until 28 days after commencement of illness. All children in the family who have not had the disease must be excluded until 16 days after the commencement of the last case in the house. MUMPS Until at least 21 days after commencement of illness. No exclusions. GERMAN MEASLES Until 14 days after commencement of illness. No exclusions. CHICKEN-POX Until at least 14 days after commencement of illness, and longer if scabs have not fallen off head and body. No exclusions. No exclusions. WHOOPING COUGH Until at least 5 weeks after commencement of illness, and so long as characteristic cough continues. N.B.— These periods may be modified by the medical practitioner in attendance or by the Medical Officer of Health, but in such cases a special certificate will be sent to the Head Teacher from the Education Office. 84 Following Up. There are three School Nurses concerned with the School Medical Service— one spends her whole time in the various school clinics, while the other two devote half their time to school work and half to maternity and child welfare work. This means that one whole-time Nurse is available for visiting the schools and following up cases recommended for treatment. The following up of cases referred for dental treatment by the School Dentist has not been attempted. When a child is found at medical inspection to be suffering from a defect which requires treatment the School Nurse calls at the home and advises the parents as to what treatment is required and how it may be obtained. The child is then re-examined by the Medical Officer at his next visit to the school. The following is a summary of the work done by the School Nurses during the year:— Visits to schools 1232 Visits to clinics 571 Home visits 957 2760 Number of examinations of childrenheads, bodies, clothing, etc. 23,035 Medical Treatment. (a) Minor Ailments. The Minor Ailments Clinic at Bourchier House, East Finchley, is open every morning from 8.30 a.m. and the clinic at the Congregational Hall, North Finchley, is open every Friday morning from 9 a.m. The School Medical Officer sees cases at North Finchley every Friday and at Bourchier House every Thursday, and at such other times as may be necessary. 85 Five hundred and sixty-four children received treatment at these clinics during the year, making 5355 attendances. Six cases of ringworm of the scalp were submitted to X-Ray treatment and made a speedy return to school. (b) Tonsils and Adenoids. Forty-six children were operated on for tonsils and adenoids at the Finchley Memorial Hospital. The arrangements whereby the children are detained in hospital for two days following the operation is greatly appreciated by the parents, and it minimises the risk of haemorrhage and sepsis which are apt to occur when children are taken home immediately after operation. (c) Tuberculosis. All cases of tuberculosis occurring among school children are referred to the Tuberculosis Officer of the Middlesex County Council. (d) Skin Disease. The treatment of cases of skin disease is carried out at the Minor Ailments Clinics; 279 children were treated during the year. (e) External Eye Disease. Children suffering from external eye disease are treated at the Ophthalmic Clinic and the Minor Ailments Clinic; 32 children were treated during the year. (/) Vision. The Ophthalmic Surgeon attends one session per week at the clinic at the North Road School and examines all children suffering from defects of vision or other eye conditions referred to him. 86 During 1925, 163 children were referred for examination. 151 were submitted to refraction— spectacles were prescribed in 80 cases and 76 actually obtained spectacles. In 15 of these cases the parents were unable to pay the whole cost of the spectacles and the Children's Care Committee subscribed varying sums towards the purchase. (g) Ear Disease and. Hearing. Children suffering from ear discharge and defective hearing are dealt with at the Minor Ailments Clinic at Bourchier House. During the year 80 children were treated. 31 children were seen by Mr. C. Hamblen Thomas, and his advice has been of the greatest assistance. (h) Dental Defects. 2,988 children of all ages were inspected by the Dental Surgeon, and 1,789 or 60% of these were found to be in need of treatment. 856 or 48.3% of those found to be in need of treatment were actually treated. The number of children who obtained treatment from a private source is very small and it is disappointing to find that more parents do not avail themselves of the treatment offered at the School Dental Clinic. By inviting the parents to be present at dental inspections and by reducing the scale of charges it is hoped to stimulate the interest of parents and to effect a considerable increase in the numbers accepting treatment. 87 Parents' Contributions Towards Cost of Treatment. The sums recovered from parents in respect of dental and medical treatment are as follows:— £ s. d. Dental Treatment 82 13 9 Operative Treatment of Tonsils and Adenoids 26 0 6 Treatment of Minor Ailments 1 19 0 £110 13 3 Open Air Education. No organised scheme of open air education exists in the district. In a few of the schools classes are conducted in the playground during the summer months, and occasional school journeys are undertaken. No school camps have been held, and there are no open air class rooms in any of the elementary schools. The provision of a day open air school is greatly to be desired and would be of the greatest benefit to a number of anaemic and debilitated children who by reason of their health cannot derive proper benefit from education in an ordinary elementary school. 61 such children are known to the School Medical Officer. Four places, two for boys and two for girls, are reserved by the Education Committee at the Russell Cotes School of Recovery, Parkstone. Early in the year children were sent there for a period of six weeks, but it was considered that such a period was too short, and now they make a stay of three months. During the year 13 children were sent to Parkstone, and without exception their health was greatly improved. 88 Physical Training. No direct control over physical training is exercised by the School Medical Officer, but Head Teachers refer for examination any children who appear to them to be unfit to take part in the games and exercises practised in the various schools. The Non-provided Schools are severely handicapped by the fact that they have no central hall in which physical training can be carried on during inclement weather. There is no class for remedial exercises and there is no organiser of physical training. Provision of Meals. No meals are provided by the Education Committee at any of the elementary schools. School Baths. The Council's baths in Squires Lane are available for the use of the children of all the elementary schools, and during the year 27,799 attendances were made by 1,678 children. In 1925 there were 900 children who could swim, and 251 held life saving certificates. In the competitions of the London Schools' Swimming Association, Finchley took first place for the highest average number of first class swimmers per department. It is unfortunate that some of the schools are a considerable distance from the baths, so that a large amount of the time allotted to swimming is spent in the journey to and from the baths. 89 Co-operation of Parents. Parents are invited to be present when their children are being examined at routine inspections, and the increasing interest that is taken in medical inspection is shown by the following table, which gives the percentage of parents attending during the last five years:— PERCENTAGE OF PARENTS ATTENDING. 1921 1922 1923 1924 1925 56% 56.2% 56.13% 62.2% 66% Before any treatment of a school child is undertaken, the parents are interviewed by one of the School Nurses and an endeavour is made to secure the attendance of the mother at the treatment centre. Co-operation of Teachers. The closest co-operation exists between the Teachers and the school medical service, and in many instances the Teachers have been instrumental in persuading parents to obtain the treatment for their children which has been recommended by the School Medical Officer. Many children are referred by Head Teachers for special examination and children found to be suffering from minor ailments are sent to the school clinics at the earliest opportunity. Co-operation of School Attendance Officers. Weekly lists are prepared by the School Attendance Department of all children absent from school on account of illness and a weekly list of all children who enter or leave school is submitted to the School Medical Officer. The names of all children excluded from school by the School Medical Officer are notified forthwith to the Attendance Department. 90 The Attendance Officers also inform the School Medical Officer of any children in their districts who are suspected to be physically or mentally defective and thus give valuable assistance in drawing attention to children who might otherwise escape medical supervision. Co-operation of Voluntary Bodies. During the year the Children's Care Committee sent 66 children to Heme Bay for a period of one week, and in 15 cases assistance was granted in the purchase of spectacles. Blind, Deaf, Defective and Epileptic Children. (a) During the year the register of defective children has been revised and brought up to date. Head Teachers and Attendance Officers and Health Visitors were requested to notify the School Medical Officer of all children whom they suspected to be physically or mentally defective, and all these children were examined and classified. The names of several children have been removed from the register as they were found to be suffering from defects which did not require treatment and were not sufficiently serious to prevent the children from deriving adequate benefit from education in a public elementary school. It is reasonably certain that practically every defective child in the area is known to the School Medical Officer. The Education Committee have agreed to be responsible for the maintenance in the Royal Orthopaedic Hospital of any cripple children recommended for admission by the School Medical Officer. So far no arrangement has been made for the treatment of these children by massage or electricity after their discharge from 91 hospital, but such treatment is usually obtained by the parents from a local masseuse. The number of children found to be in need of treatment is very small, and the steps taken by the Committee to deal with them are considered to be adequate. No difficulty has been experienced in placing blind, deaf and epileptic children in certified special schools. Sixteen mentally defective children are in attendance at the Joint Special School situated within the area. (b) There are only two feeble-minded children not in attendance at the Special School, and these are supervised by the School Medical Officer and the Attendance Officers. The statutory cases are supervised by the Middlesex County Council. (c) The Education Authority has no Special Schools. When feeble-minded children leave the Joint Special School at the age of 16 they are taken over by the County Council. Nursery Schools. No nursery schools have been established in the district. Secondary Schools. The School Medical Officer conducts the medical inspections in the three Secondary Schools on behalf of the Middlesex County Council. This arrangement has the advantage of co-ordinating the work in the Secondary Schools with that in the Elementary Schools. 581 pupils were examined during the year. Continuation Schools. There are no Continuation Schools in the district. 92 Employment of Children and Young Persons. (1) The children employed in Finchley are mostly engaged in the distribution of milk and newspapers. The conditions of employment have been satisfactory and in no instance has a child been found to have suffered in health owing to such employment. (2) All children are referred to the School Medical Officer for examination prior to their commencing work. Thirty-five children were examined during the year and one boy was rejected owing to poor physical development. No young persons have been referred to the School Medical Officer during the year. Special Inquiries. No special inquiries have been conducted during the year. Miscellaneous. All school teachers appointed by the Education Committee are examined by the School Medical Officer before they take up their duties. During the year no candidate has been rejected on medical grounds. 93 STATISTICAL TABLES for the Year 1925. 95 TABLE I. Return of Medical Inspections. A.— Routine Medical Inspections. Number of Code Group Inspections:— Entrants 355 Intermediates 359 Leavers 324 1038 Number of other Routine Inspections 93 B.—Other Inspections. Number of Special Inspections 480 Number of Re-inspections 205 Total 685 96 TABLE II A.— Return of Defects found by Medical Inspection in the year ended 31st December, 1925. Routine Inspections. Special Inspections. Requiring Treatment. Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment. Malnutrition 1 11 4 6 Uncleanliness (See Table IV. Group V) ... ... ... ... Skin— Ringworm— Scalp ... ... 10 ... Body ... ... 4 ... Scabies 2 ... ... ... Impetigo 9 ... 18 ... Other Diseases (Non-Tuberculous) 3 ... 5 2 Eye — Blepharitis 6 1 1 ... Conjunctivitis 4 ... Keratitis ... Corneal Opacities ... 2 ... Defective Vision (excluding Squint) 40 1 4 ... Squint 1 1 ... Other Conditions 1 *2 ... Ear- Defective Hearing 4 2 ... 5 Otitis Media 5 2 31 4 Other Ear Diseases ... ... 1 2 Nose and Throat- Enlarged Tonsils only 21 28 6 5 Adenoids only ... 5 6 1 Enlarged Tonsils and Adenoids 10 7 23 5 Other Conditions ... 1 1 2 Enlarged Cervical Glands (NonTuberculous) ... 8 ... 4 Defective Speech ... ... ... ... Teeth—Dental Diseases (See Table IV, Group 4) 95 1 3 ... Heart and Circulation— Heart Disease : Organic ... 5 ... ... Functional ... 7 ... I Anaemia ... 12 2 ... Lungs- Bronchitis ... 8 1 1 Other Non-Tuberculous Diseases ... 2 ... ... T uberculosis— Pulmonary: Definite ... ... ... ... Suspected ... ... ... ... Non-Pulmonary: Glands ... 1 1 2 Spine ... ... ... ... Hip ... 1 1 1 Other Bones and Joints ... l 2 1 Skin ... ... ... 1 Other forms ... ... ' 1 ... Nervous System— Epilepsy ... ... ... ... Chorea ... 2 1 ... Other Conditions ... 1 ... ... Deformities— Rickets ... I ... ... Spinal Curvature ... ... ... 2 Other forms 3 2 5 10 Other Defects and Diseases- ... 1 25 97 TABLE II. B.— Number of Individual Children found at Routine Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Group. Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. Code Groups: Entrants 355 22 6.2 Intermediates 359 28 7.8 Leavers 324 24 7.4 Total (code groups) 1038 74 7.1 Other routine inspections 93 6 6.5 98 99 100 TABLE III. Return of all Exceptional Children in the Area. Boys. Girls. Total. Blind (including partially blind). (1) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 2 — 2 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — (2) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind - - - Attending Public Elementary Schools 2 3 5 At other Institutions — — — At no School or Institution — — — Deaf (including deaf and dumb and partially deaf). (1) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 1 3 4 Attending Public Elementary Schools — — — At other Institutions 1 - 1 At no School or Institution - — - (2) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf - - - Attending Public Elementary Schools - - - At other Institutions - — — At no School or Institution — — — Mentally Defective. Feeblemined (cases not notifiable to the Local Control Authority.) Attending Certified Schools for Mentally Defective Children 9 7 16 Attending Public Elementary Schools - 1 1 At other Institutions — 1 1 — - — Notified to the Local Control Authority during the year. Feebleminded - - - Imbeciles - 1 1 Idiots — - - Epileptics. Suffering from severe epilepsy. Attending Certified Schools for Epileptics 1 - 1 In Institutions other than Certified Special Schools - - - Attending Public Elementarv Schools — - - At no School or Institution — — — Suffering from epilepsy which is not severe. Attending Public Elementary Schools 1 4 5 At no School or Institution - - - Physically Defective. Infectious pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At other Institutions - — — At no School or Institution — — — Non-infectious but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 2 1 3 At other Institutions - - - At no School or Institution — — — Dedicate children, e.g., pre-or latent tuberculosis, malnutrition, debility, anaemia, etc. At Certified Residential Open Air Schools 2 2 4 At Certified Day Open Air Schools — - - At Public Elementary Schools 4 23 57 At other Institutions —— — — At no School or Institution — — — Active non-pulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board - - - At Public Elementary Schools 3 — 3 At other Institutions — — — At no School or Institution — — — Crippled Children (other than those with active tuberculous disease) e.g., children suffering from paralysis, &c., and including those with severe heart disease. At Certified Hospital Schools 1 1 2 At Certified Residential Cripple Schools At Public Elementary Schools 9 9 18 At other Institutions - - - At no School or Institution TABLE IV. Return of Defects Treated during the year ended 31st December, 1925. Treatment Table. Group I.—Minor Ailments (excluding uncleanliness, for which see Group V.). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. SKIN— Ringworm—Scalp 6 3 9 Ringworm—Body 9 9 Scabies - - Impetigo 157 157 Other skin disease 7 7 MINOR EYE DEFECTS— (External and other, but excluding cases falling in Group II 32 32 MINOR EAR DEFECTS- 80 80 MISCELLANEOUS— (e.g., minor injuries, bruises, sores, chilblains, etc.) 273 23 296 Total 564 26 590 101 TABLE IV. (continued). Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments— Group I.). Defect or Disease. Number of Defects dealt with. Under the Authority's Scheme, Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. Errors of Refraction (including Squint) 151 151 Other Defect or Disease of the eyes (excluding those recorded in Group 1) 12 12 Total 163 163 Total number of children for whom spectacles were prescribed:— (a) Under the Authority's Scheme 80 (b) Otherwise — Total number of children who obtained or received spectacles:- (a) Under the Authority's Scheme 76 (b) Otherwise — Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment, Received other forms of treatment. Total number treated. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme Total. 46 4 50 50 102 TABLE IV. (continued). Group IV.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist: Aged: 5 101 6 221 7 222 8 341 Routine Age Groups, 9 425 Total 2988 10 442 11 364 12 499 13 287 14 86 Specials 64 Grand Total 3052 (b) Found to require treatment 1789 (c) Actually treated 856 (d) Re-treated during the years as the result of periodical examination 364 (2) Half-days devoted to Inspection 40 Total 228 Treatment 188 (3) Attendances made by children for treatment 1495 (4) Fillings Permanent Teeth 634 Total 758 Temporary Teeth 124 (5) Extractions Permanent Teeth 76 Total 362 Temporary Teeth 286 (6) Administrations of general anaesthetics for extractions. 40 (7) Other operations Permanent Teeth 570 Total 860 Temporary Teeth 290 Group V.—Uncleanliness and Verminous Conditions. (1) Average number of visits per school made during the year by the School Nurses 141 (2) Total number of examinations of children in the Schools by the School Nurses 23035 (3) Number of individual children found unclean 336 (4) Number of children cleansed under arrangements made by the Local Education Authority 21 (5) Number of cases in which legal proceedings were taken: (a) Under the Education Act, 1921 — (b) Lender the School Attendance Bye-laws 1 103 INDEX. Page. Report of the Medical Officer of Health 1 Natural and Social Conditions 4 Vital Statistics 6 General Provision of Health Services in the Area 9 Members of Public Health Committee and Staff, Public Health Department 13 Professional Nursing in the Home 14 Legislation in Force 14 Sanitary Circumstances of the Area 17 Statistical Tables—Mortality, etc. 20 Housing 24 Food 30 Factories and Workshops 31 Infectious Disease 34 Statistical Tables—Infectious Disease 34, 39 & 42 Maternity and Child Welfare 43 Report of the Chief Sanitary Inspector. 45 Inspections 47 Notices Served 47 Sanitary Improvements—summary 47 Infectious Disease and Disinfection 49 Complaints 50 Premises Periodically Inspected 50 Factories and Workshops 51 House-to-House Inspection 51 Houses Unfit for Human Habitation 55 The Rent and Mortgage Interest Restriction Acts, 1920 and 1923 56 Public Health (Meat) Regulations, 1924 56 Dairies, Cowsheds and Milkshops 64 Milk and Dairies (Amendment) Act, 1922 65 Coffee Stalls 66 104 Page. Offensive Trades or Businesses 66 Nuisance from the Keeping of Animals 67 Cleansing of Courts and Passages 68 Accumulations of Refuse on Unfenced Plots of Land 68 Sanitary Conveniences 69 Places of Public Entertainment 69 Game Licences 70 Petroleum Acts, 1871-1881 70 Staff 71 Report of School Medical Officer 73 School Medical Staff 75 Co-ordination with other Health Services 78 School Hygiene 78 Medical Inspection 79 Infectious Diseases 82 Medical Treatment 85 Open-Air Education 88 Physical Training 89 Provision of Meals 89 School Baths 89 Co-operation of Parents, Teachers, School Attendance Officers and Voluntary Bodies 90 & 91 Blind, Deaf, Defective and Epileptic Children 91 Nursery, Secondary and Continuation Schools 92 Employment of Children and Young Persons 93 Special Enquiries and Miscellaneous 93 Statistical Tables 95 105 Warden & Co. Ltd Printers 71, Church Road, H e n D o n, N.W.4