A.C. 439 (1) Middx FINCHELEY FINCIS (Late Mrs. B) Urban District of Finchley. ANNUAL REPORTS for the Year 1928 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 1928. To the Chairman and Members of the Urban District Council of Finchley. April, 1929. Mr. Chairman, Mrs. Timberlake and Gentlemen, I have the honour to submit my annual report for 1928 on the health of the Urban District of Finchley. The vital statistics are very satisfactory. The general death-rate has fallen the birth-rate has risen, and the infantile mortality rate is the second lowest on record. During the year there were fairly wide-spread epidemics of whooping cough and measles, and I am sorry to say that parents still treat these diseases far too lightly in spite of the fact that they are the most deadly of the common infectious diseases of childhood. No less than 17 young children died from these two diseases in 1928. The incidence of the other infectious diseases was about the average. The district has been fortunate in keeping free from Smallpox, although there have been many cases throughout the London area. I am pleased to say that the whole staff of the department have done excellent work throughout the year, and my special thanks are due to the Chief Sanitary Inspector, Mr. Franklin, for his invaluable and everready assistance. I am, Mr, Chairman, Mrs. Timberlake and Gentlemen, Your obedient Servant, A. TURNER, 3 Natural and Social Conditions. Area 3,384 Population (Census, 1921) 46,716 Population (Estimated, 1928) 53,270 Number of Inhabited Houses (1921) 10,211 Number of Families or Separate Occupiers (1921) 11,623 Rateable Value (1928) £470,604 Sum represented by a Penny Rate £1,894 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Births: Males. Females. Total Legitimate 378 347 725 Illegitimate 19 16 35 Total 397 363 760 Birth-rate, 14.3 per 1,000 population. Males. Females. Total. Deaths 251 260 511 Death-rate, 9.6 per 1,000 population. Number of women dying, in or in consequence of, child birth: From sepsis 1 From other causes 2 Deaths of infants under one year of age: Legitimate, 24. Illegitimate, 4. Infantile Mortality Rate, 36.8. Deaths from measles (all ages) 10 Deaths from whooping cough (all ages) 7 Deaths from diarrhoea (under 2 years of age) 2 4 Death-rate from principal infectious diseases per 1,000 of population 41 Death-rate from tuberculosis (all forms) per 1,000 of population 49 Population. The Registrar-General's estimate of the population on the 30th June, 1928, is 53,270, which is an increase of 1,970 on the population of the previous year, and a total increase of 6,554 since the census of 1921. I have made an estimate of the population based upon the number of structurally separate dwellings occupied at the 30th June, 1928, and, after making due allowance for a decrease in the size of families, this works out at 56,500. The number of these dwellings has increased by over 20 per cent. since 1921, and the fact that the number of local government electors has increased by more than 25 per cent. in the same period goes to support my estimate rather than that of the RegistrarGeneral. Births. There were 760 births during the year, and of these 35 were illegitimate. In 1927 there were 709 births. The birth-rate for 1928 was 14.3 per 1,000 of the population (Registrar-General's estimate); giving an increase of .5 per 1,000 over 1927. I am inclined to think that this increase is more apparent than real, and is largely accounted for by under-estimation of the population. Deaths. Five hundred and eleven deaths occurred among Finchley residents, as compared with 515 in the previous year. This gives a recorded death-rate of 9.6 per 1,000, as compared with 10.0 for the previous year. The deathrate for England and Wales is 11.7, and for London 11.6. 5 Infantile Mortality. Twenty-eight deaths of infants under one year of age occurred in 1928, giving an infantile mortality rate of 36.8 per 1,000 births, as compared with a rate of 32.4 for 1927. This is the second lowest rate that has been recorded in Finchley, and may be considered to be very satisfactory. The corresponding rate for England and Wales is 65, and for London 67. Poor Law Relief. During the year 315 families were in receipt of outdoor relief, and the total amount expended on such relief was £5,329. Three hundred and ninety-six persons were admitted to the Wellhouse Hospital, and of these 52 were admitted to the Lying-in Ward. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Hospitals, I. 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.:— 6 Pulmonary Tuberculosis. Number of Beds. Type of Case. Adults. Children. Male. Female. Middlesex County 129 129 64 Sanatorium & 8 observation (children). Council Sanatorium, Harefield Middlesex County 9 7 — Observation. Council Dispensary, Bell road, Hounslow. Middlesex County 40 — — Hospital. Council Hospital, Twickenham Rd., Isleworth. Clare Hall, South 120 66 — Late Sanatorium and Hospital Mimms. 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. Fifty-two Finchley cases were admitted to this ward in 1928. 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. 7 4. Fever.—Cases of infectious disease are sent to the Isolation 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 Districts Joint Hospital District. Ample accommodation exists for persons suffering from small-pox. 6. Other Hospitals.—(a) The Finchley Memorial pital contains 54 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 1928 some 396 Finchley cases were admitted. Other Institutions. 1. Unmarried Mothers.—Nil. 2. Illegitimate Infants and Homeless Children:— Wright-Kingsford Home, 100 children. The Home is in no way supported by the local Authority. 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. 8 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 186 street accidents and 414 private cases. A sum amounting to £237 8s. was recovered from the various users. 9 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, etc. Local Authority. Wesleyan Hall, Newcomen Rd., N.3. Do. Do. Bourchier House, Oak Lane, N.2. Do. Do. (b) Ante-natal Clinic. Do. Do. Do. (c) 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. (b) 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, Southwood Lawn Road. Highgate, N.6. (e) Tonsils and Adenoids Clinic. Finchley Memorial Hospital Tuberculosis Chester Villa, ... Middlesex Dispensary High Rd., N.12. County Council. Yencreal Disease Clinic Royal Northern Hospital, Holloway Rd., N.7. Do. 10 MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Chairman: Councillor A. J. Briant. Councillor E. S. Bowen. Councillor H. V. Wells. Councillor E. Toyne. Councillor A. T. Pike. Councillor C. G. Ryan. Councillor H. O. Syrett. Councillor Mrs. E. V. Timberlake. 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, F.S.I.A., M.R.SAN.I. Assistant Sanitary Inspectors: J. Gray, CERT.R.SAN.I. T. 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. *Miss S. Hacking, C.M.B. Clerks: Miss G. E. Batty. Miss K. M. Nichol. Miss C. Sprules. Part-time Officers: *Dr. C. Alice King. *Dr. J. S. Boden. *Dr. Phillis Cunnington. *Dr. Phyllis Dixon. * Salary contribution made under the Public Health Acts or by Exchequer grants. 11 Professional Nursing in the Home. The Finchley District Nursing and Benevolent Society provides 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 5/- and an annual subscription of 10/-. 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 7 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, 1599 (1st June, 1908-1923). 12 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). 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 (18th 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). Sections 18, 22, 23, 25, 29, 30, 31, 32, 33 and 34 contained in Part 2, and Sections 37, 38 and 42 contained in Part 3 (27th September, 1927). Bye-Laws and Regulations. Public Health Act, 1875. With respect to— (a) 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. With respect to Common Lodging Houses (24th November, 1879). Public Health Act, 1875. With respect to Slaughterhouses (29th September, 1923). Public Health Act, 1875. With respect to Houses let in lodgings or occupied by members of more than one family (17th January, 1884). 13 Public Health Act, 1875. With respect to the trade of a Blood-boiler, Blood drier, Bone-boiler, Fellmonger, Tanner, Leather Dresser, Soap-boiler, Tallow-melter, Fat-melter or Fat extractor, Tripeboiler, Glue-maker, Size-maker, Gut-scraper (17th January, 1884), and Fish-frier (19th November, 1921). Public Health Act, 1875. With respect to New Streets and Buildings, Drainage of Buildings, keeping of Water-closets supplied with sufficient water for flushing and Alterations to Existing Buildings (31st December, 1926). Public Health Acts (Amendment) Act, 1890 With respect to Conduct of Persons using Sanitary Conveniences (8th December, 1913). Public Health Act, 1875. With respect to the management of a Mortuary (13th May, 1904). Public Health Act, 1875. With respect to Nuisances (16th November, 1912). Employment of Children Act, 1903, and the Education Act, 1918. With regard to the Employment of Children (31st May, 1921). SANITARY CIRCUMSTANCES OF THE AREA. Sewage Disposal Works. No important addition has been made to these works during the year. Samples of effluent from both high and low level works have been submitted to analysis periodically, and on occasions the effluent from the low level has been unsatisfactory. This is entirely due to the fact that these works are quite inadequate to deal with the ever-increasing volume of sewage. Plans have been approved by the Council for the necessary extensions. 14 Refuse Disposal. The amount of house refuse that has to be dealt with continues to increase, and this is only partly accounted for by the development of the district. As the coal-burning kitchen range is rapidly being replaced by the gas cooker, there is less opportunity for the housewife to burn the more combustible part of the refuse and, consequently, most of it finds its way into the dustbin. Judging by the very large number of tins and bottles of various kinds that are found in the refuse, it is evident that, especially during the summer months, a considerable proportion of the food consumed in the district is of the preserved variety. No doubt there are many good reasons why this should be so, but, nevertheless, I do not think it is to the credit of the presentday housewife, and I am sure it is not to the physical advantage of the family. The Council are at present considering means of improving the collection of house refuse, and it is hoped that the present vehicles will soon be replaced by others more in keeping with the standard of sanitation that is aimed at in the district. Schools. The sanitary condition of the elementary schools in the district is on the whole satisfactory. Water closets and urinals are adequate and are kept in a satisfactory manner. Drinking water from the main is available at all the schools. Measles and whooping cough were prevalent during the year, but it was not necessary to close any school or department. Certificates under Rule 23 2 (a) of Schedule IV. of the code were granted on one or two occasions on account of measles and whooping cough. 15 INFANT MORTALITY DURING THE YEAR 1928. Deaths from stated causes at various ages under one year of age. Cause 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. WARDS N. E. W. All Causes. Certified 8 1 4 2 15 5 5 2 1 28 15 8 5 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet- Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 ... ... 1 1 ... ... Diphtheria & Croup ... ... ... ... ... ... ... ... ... 1 1 ... ... Erysipelas ... ... • • • ... ... ... ... ... ... ... ... ... ... Tuberculous ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... 1 ... ... ... 1 ... 1 ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... ... ... 1 ... 1 ... Pneumonia (all forms) ... ... ... ... ... 2 ... 1 ... 3 1 1 1 Diarrhoea ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... 1 ... 1 ... ... 2 2 ... ... Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... 1 ... 1 ... ... ... ... 1 1 ... ... Rickets ... ... ... ... ... ... ... 1 ... 1 1 ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 ... ... 1 Atelectasis ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Malformations 1 ... ... ... 1 ... ... ... ... 1 1 ... ... Premature Birth 5 ... 3 ... 8 ... ... ... ... 8 4 2 2 Atrophy, Debility and Marasmus 1 ... ... 1 2 1 3 ... ... 6 3 2 1 Other Causes ... 1 ... ... 1 ... ... ... ... 1 ... 1 ... Total 8 1 4 2 15 5 5 2 1 28 15 8 5 16 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR. CAUSES OP 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 Causes Certified 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 under 65. 65 and Upwards. North Ward. East Ward. West Ward. Uncertified Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 10 ... 3 4 3 ... ... ... ... ... 3 6 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 7 1 3 3 ... ... ... ... ... ... 1 4 2 Diphtheria 5 1 ... 1 3 ... ... ... ... ... 2 3 ... Influenza 11 ... ... ... ... ... 2 6 3 3 3 3 5 Encephalitis Lethargica 1 ... ... 1 ... ... ... ... ... ... ... ... 1 Meningococcal Meningitis 2 1 ... ... ... ... ... 1 ... 1 ... 2 ... Tuberculosis of Respiratory System 17 ... ... 1 ... 1 10 5 ... 1 9 3 5 Other Tuberculous Diseases 9 ... 1 1 3 2 1 1 ... 2 3 5 1 Cancer, Malignant Disease 73 ... ... ... ... ... 6 36 31 9 30 25 18 Rheumatic Fever 2 ... ... ... ... ... ... ... 2 ... ... 1 1 Diabetes 3 ... ... ... ... ... ... 2 1 1 2 1 ... Cerebral Haemorrhage 14 ... ... ... ... ... ... 5 9 5 8 2 4 Heart Disease 107 ... ... ... ... 3 4 18 82 9 43 46 18 Arterio-sclerosis 29 ... ... ... ... ... 1 7 21 3 11 6 12 Bronchitis 13 1 ... ... ... ... ... ... 12 1 5 5 3 Pneumonia (all forms) 33 3 1 1 ... ... 4 13 11 11 9 12 12 Other Respiratory Diseases 7 ... ... ... ... ... 2 1 4 ... 7 ... ... Ulcer of Stomach or Duodenum 8 ... ... ... ... ... 2 5 1 4 2 3 3 Diarrhoea, etc. (under 2 years) 2 2 ... ... ... ... ... ... ... ... 2 ... ... Appendicitis and Typhilitis 9 ... ... ... ... 1 3 2 3 4 2 2 5 Cirrhosis of Liver 1 ... ... ... ... ... 1 ... 11 2 ... ... 1 Acute and Chronic Nephritis 19 ... ... 1 ... 1 ... 6 ... ... 6 4 9 Puerperal Sepsis 1 ... ... ... ... ... 1 ... ... ... ... 1 ... Other accidents and diseases of Pregnancy and Parturition 2 ... ... ... ... ... 2 ... ... ... 2 ... Congenital Debility and Malformation, Premature Birth 17 16 ... 1 ... ... ... ... ... ... 9 5 3 Suicides 9 ... ... ... ... ... 4 2 3 ... 1 5 3 Other Deaths from Violence 20 ... ... ... 3 2 4 5 6 14 9 4 7 Other defined Diseases 80 3 ... 3 2 3 13 12 44 21 26 30 24 Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... TOTALS 511 28 8 17 14 13 60 127 244 91 193 180 138 17 18 VITAL STATISTICS FOR THE PAST TWENTY YEARS. Year. Total Births. Birth Rate. Total Deaths. Death Rate. Total Infant Deaths. Infantile mortality late. Deaths from Measles. Deaths from Whooping Cough. Deaths from Diarrhoea. (under 2 years). 1909 848 20.3 354 7.43 60 70.7 5 ... ... 1910 889 20.4 367 7.33 56 62.9 1 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 1926 722 14.3 480 9.5 37 51.2 2 1 3 1927 709 13.8 515 10.0 23 32.4 ... ... ... 1928 760 14.3 511 9.6 28 36.8 10 7 2 19 HOUSING. During the year 415 houses were erected in the district, but only 54 of these were of the type suitable for occupation by the working classes, and all of them were erected by the Council. At the beginning of the year 76 houses where overcrowding existed were known to the department, and 66 were added during the year, while in 56 houses the overcrowding was abated, leaving 86 still overcrowded at the end of the year. These cases have come to our notice in the course of the ordinary work of the department, and not as the result of a comprehensive survey of the district, and they only represent a fraction of the overcrowding that actually exists. Considerable difficulty has been experienced in preventing overcrowding recurring in houses from which families have been given accommodation in Council Houses, and in order to strengthen their powers in this direction the Council have decided to adopt Bye-laws in respect of Houses Let in Lodgings. The Council are now considering further housing schemes, and when these are completed they should cause a dccided improvement in the housing conditions of the district. Housing Statistics for the Year 1928. Number of new houses erected during the year:— (a) Total (including numbers given separately under b) 415 (b) With State assistance under the Housing Acts:— (i.) By the Local Authority 54 (ii.) By other persons or bodies Nil 20 1.—Unfit Dwelling Houses. 1.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 991 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 370 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 959 (This number includes all houses where defects or nuisances were found). 2.—Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 752 3.—Action Under Statutory Powers. A. Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 9 21 (2) Number of dwelling-houses which were rendered fit— (a) by owners 1 (b) work in hand 6 (c) by Local Authority in default of owners 2 (3) Number of dwelling-houses in respect of which Closing Orders became operative ia 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 11 (2) Number of dwelling-houses in which defects were remedied (a) by owners 10 (b) in hand 1 (c) by Local Authority in default of owners Nil C. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders 1 (2) Number of dwelling-houses in respect of which Closing Orders were made 1 22 (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 Nil (5) Number of dwelling-houses demolished (voluntarily by owner) Nil FOOD. Meat and Other Foods. Under the Public Health (Meat) Regulations, 1924, 13,070 carcases were inspected, and a large amount of meat was condemned as unfit for the food ot man. A full account of this work will be found in the report of the Chief Sanitary Inspector. Milk Supply. Finchley must be considered fortunate in its milk supply. Several up-to-date establishments for the production and distribution of designated milk are situated within the district, and the delivery of milk in sealed bottles, which are filled under hygienic conditions, is almost universal. The dairies, cowsheds and milkshops have been regularly inspected during the year. 23 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 31st December, 1928. Article. Samples taken. Adulterated. Milk 116 2 Cream 5 — Alum 1 — Bacon 3 — Brawn 2 — Cakes 2 — Cream Pastry 5 — Food Preservative 3 1 Fruit, dried 2 — Jam 2 — Meat 9 1 Minced Beef 1 1 Rice, ground 1 — Sausages 33 10 Sausages, cooked 1 — Seasoning 2 — 188 15 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. 24 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:— 1—Inspection of Factories, Workshops and Workplaces. Inspections made by the Sanitary Inspectors:— Premises. Number of . Inspections Written Notices. Occupiers prosecuted. Factories (including Factory Laundries) 323 10 ... Workshops (including Work shop Laundries) 272 3 ... Workplaces (other than Outworkers' Premises) ... ... ... Total 595 13 ... 25 2.—Defects Found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of offences in respect of which Prosecutions were instituted. Found. Remedied Referred to H M. Inspector. Nuisances under the Public Health Acts: Want of Cleanliness 66 59 ... ... Want of Ventilation 1 ... ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 66 56 ... ... Sanitary accommodation insufficient 3 1 ... ... unsuitable or ... ... ... ... fective 45 38 ... ... not separate for sexes 1 ... ... ... 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). Total 181 154 ... ... *Including those specified in Sections 2. 3, 7, and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 26 3.—Outwork in Unwholesome Premises, Section 108, Nature of Work. Instances. Notices served. Prosecutions Wearing Apparel; Making, &c 25 ... ... Lace: Luce Curtains and Nets ... ... ... Total 25 ... ... PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Diphtheria. Seventy-nine cases of Diphtheria were notified during the year, as compared with 56 in 1927, and 73 cases were removed to hospital. In a considerable number of cases the disease was of a severe type and there were 5 deaths, giving a case mortality of 6.3 percent. A supply of Diphtheria antitoxin is kept at the Public Health Department for use by local practitioners, but as a rule antitoxin is not given before the patient is moved to hospital. Scarlet Fever. One hundred and twenty-seven cases of Scarlet Fever were notified during the year, as compared with 93 cases in 1927, and 82 cases were removed to hospital. There was no death from this disease. Scarlet Fever continues to be of a very mild type, and in many cases the rash is so fleeting or so poorly developed or others of the old-standing cardinal symptoms are so often wanting that diagnosis is often exceedingly difficult. Yet, this mild type appears to be just as infectious as the more severe type of past years. 27 In no instance were the Schick or Dick test applied and no immunisation against Diphtheria or Scarlet Fever was carried out. Enteric Fever. Two cases of Enteric Fever were notified during the year one a case of true typhoid and one of paratyphoid B. Both cases recovered, and in each case the source of infection remained undiscovered. Smallpox. The district has been fortunate in having no case of Smallpox during the year. From time to time we have had a large number of persons who had been in contact with cases of Smallpox, mostly in the London area, but in no case did any of these contacts develop the disease. When a contact is brought to the notice of the department the person concerned is visited as soon as possible and vaccination is urged, and further visits are paid at frequent intervals for sixteen days after the date of exposure to infection. The supervision of these contacts throws a considerable amount of work on the department, but it is essential if cases of the disease are to be discovered at the earliest possible moment. Pneumonia. Fifty-six cases of Pneumonia were notified, and there were 33 deaths. It would appear that practitioners are becoming more alive to their obligations in respect of this disease as this is the first year since notification became compulsory in which the number of notifications has exceeded the number of deaths. Measles. Measles was very prevalent during the year and was of a severe type. There were 10 deaths. 28 Whooping Cough. Whooping Cough was also prevalent during the year, and there were 7 deaths. Measles and Whooping cough are two of the most fatal diseases that attack young children, and many parents are still obsessed with the fatalistic idea that their children must have these diseases and the sooner they have them the better. In consequence they make no real effort to prevent them being infected. No opportunity is missed of impressing upon mothers that if they can keep their children free from these diseases until they reach school age then, when they are attacked, they have a very much better chance of pulling through unharmed. This is amply borne out by the fact that all the deaths from Whooping Cough, and 70 percent, of those from Measles, were of children under five years of age. Vaccinations. No primary vaccinations or re-vaccinations have been performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. Bacteriological Work. The bacteriological work for the district is carried out at the Joint Isolation Hospital, and during 1928 the following specimens were dealt with:— Positive. Negative. Doubtful. Total. Diphtheria 56 333 389 Pulmonary Tuberculosis 10 82 92 Enteric Fever 1 6 7 Other Specimens 1 5 6 494 29 Health Education During the year 500 copies of "Better Health" have been distributed monthly through the medium of the senior departments in the Elementary Schools and the Infant welfare Centres. These periodicals are utilized in the schools for the teaching of hygiene and are then taken home and given to parents. I have received many reports as to the excellence of the material contained in "Better Health," and I am satisfied that the small expenditure incurred in distributing this publication is amply justified. I the following table shows the conditions as to overcrowding of the households invaded by diphtheria and scarlet fever during 1928:— 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. Susceptibles, including those attacked, under 15 years of age. Cases under 15 years of age. Susceptibles, including those attacked, under 15 years of J age. Cases under 15 years of age. Susceptibles, including those attacked, under 15 years of age. Diphtheria: Home Cases 1 5 - 1 — — Hospital Cases 9 18 44 151 3 16 Scarlet Fever: Home Cases 27 44 11 18 — — Hospital Cases 27 66 29 95 — — 64 133 84 265 3 16 (These figures do not include 1 case which occurred in an Institution.) 30 NOTIFIABLE DISEASES DURING THE YEAR 1928. 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 10 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 1 1 5 4 6 24 21 9 4 3 ... 1 79 41 29 9 73 Deaths 1 ... ... 1 ... 3 ... ... ... ... ... ... 5 2 3 ... ... Scarlet Fever Cases notified ... ... 1 2 6 61 28 16 10 3 ... ... 127 45 42 40 82 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia Influenzal Cases notified ... ... ... ... ... ... ... 1 ... 2 2 ... 5 ... 4 1 5 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (Other forms) Cases notified 1 2 2 ... ... 10 ... ... 6 7 9 3 51 19 18 14 4 Deaths 3 1 1 ... ... ... ... ... 1 3 14 10 33 9 1Z 12 ... Erysipelas Cases notified ... ... ... ... ... ... ... ... 2 3 5 4 14 3 7 4 1 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever Cases notified ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 1 1 ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...- ... ... Puerperal Fever Cases notified ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... Deaths ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 ... 1 Puerperal Pyrexia Cases notified ... ... ... ... ... ... ... ... 3 ... ... ... 3 3 ... ... 1 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis Cases notified ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... 1 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica Cases notified ... ...... ... ... ... ... ... ... ... ... ...i ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... 1 .... 1 ... ... 1 1 Cerebro-spinal Fever Cases notified ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... Deaths 1 ... ... ... ... ... ... ... ... ... 1 ... 2 ... 2 ... ... Ophthalmia Neonatorum Cases notified 4 ... ... ... ... ... ... ... ... ... ... ... 4 1 2 1 2 Deaths ••• ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 3 8 10 15 95 51 28 27 18 19 8 288 113 105 70 | 170 5 | 1 1 1 ... 3 ... ... 1 4 16 10 42 11 18 13 ... 31 32 Tuberculosis. During the year 54 new cases of pulmonary tuberculosis were notified, comprising 28 males and 26 females. Fifteen non-pulmonary cases were notified, consisting of 9 males and 6 females. There were 17 deaths from pulmonary tuberculosis, 7 males and 10 females, and 9 deaths from non-pulmonary tuberculosis, 7 males and 2 females. In 7.7 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 Diagnosed as tubercular 42 examined for first Diagnosed as non-tnbereular 56 time during 1928. Undiagnosed and under observation 3 Insured 42 Non-Insured 59 Number of cases sufInsured 85 faring from tuberNon-Insured 75 culosis examined at the dispensary during 1928. Number of cases Insured 69 under observation Non-Insured 60 at the dispensary, etc., on 31/12/28. 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. 33 TUBERCULOSIS DURING THE YEAR I928. Age-periods. New cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year ... ... ... ... ... ... ... ... 1 to 5 yeaars ... ... 2 ... ... 1 2 ... 5 to 10 years ... ... 5 1 ... ... 2 ... 10 to 15 years 1 ... ... 3 ... ... 1 ... 15 to 20 years 1 2 1 1 1 1 20 to 25 years 3 6 ... ... ... ... 1 ... 25 to 35 years 5 12 ... 1 2 3 ... 1 35 to 45 years . 8 5 ... ... 4 ... ... ... 45 to 55 years 4 ... ... ... ... 3 ... ... 55 to 65 years 5 1 1 ... 1 2 1 ... 65 and upwards 1 ... ... ... ... ... ... ... Totals 28 26 9 6 7 10 7 2 North 7 11 3 3 4 5 2 1 Wards: East 10 3 2 1 2 4 1 West 11 6 3 1 2 3 1 ... Removed to Hospital or Sanatorium 15 19 3 1 ... ... ... ... 34 MATERNITY AND CHILD WELFARE. There has been no important extension of the Maternity and Child Welfare Scheme during the year, but progress has been made in all directions. Infant Welfare Centres. The new Centre in Newcomen Road continues to prosper, and during the year the attendances have almost doubled. The attendances at the North Finchley Centre show a considerable increase on the previous year, while at East Finchley there is an appreciable decrease. The chief reason for this is that all the Council Houses have been built in North Finchley, and a considerable number of infants have been transferred to the north ward from the east ward. That large numbers attend the Clinics on the days when the Health Visitors alone are present bears testimony to the value that mothers place upon the advice and help given by these nurses. Attendances at Centres. 1928. 1927. East Finchley Centre 3906 4601 North Finchley Centre 4113 3786 Church End Centre 3165 1645 Total Attendances 11184 10032 Increase in Attendance 1152 Ante natal Clinic. The Ante-natal Clinic is held once a fortnight at Bourchier house. During the year the attendances have continued to increase. Twenty-six sessions were held, with a total of 447 attendances, giving an average of 17 per session, as compared with 15 per session in 1927. The lack of maternity beds within the district is keenly felt. A large proportion of the mothers attending the ante-natal clinic desire to be confined in hospital, 35 and have to apply to Wellhouse or one of the London Hospitals. Application to these hospitals has to be made early if a bed is to be assured, and between the time of application and admission the hospitals insist on the women attending the ante-natal clinics attached to the hospitals and, in consequence, they cease to attend the local clinic. It is a considerable hardship for these ante-natal women to have to make frequent journeys to Barnet or to London at a time when travelling causes them considerable discomfort. Dental Treatment. Expectant and nursing mothers who are in need of dental treatment are referred by the doctors at the Centres to the Council's dentist. Under the Council's scheme treatment is limited to extractions and fillings, but the Voluntary Association give assistance to necessitous mothers to enable them to obtain dentures. Periodic visits are made by the dentist to the Centres to carry out inspections of children under school age, and the necessary treatment is carried out at the dental clinic. The following table shows the work carried out by the dentist during: the year:— Mothers. Children. Number inspected 67 247 Number treated 54 109 Number of attendances 125 194 Fillings 36 129 Extractions 262 79 Gas administrations 15 48 Other operations 84 72 Dentures supplied 18 — 36 Creche. The attendances at the Creche show a decrease on those of the previous year, but they are quite big enough for the available accommodation:— 1928. 1927. Children attending 131 138 Total attendances 6,475 7,208 Receipts from mothers £218 9 9 £248 14 8 Home Visiting. During the year the Health Visitors made 2,667 visits in connection with Maternity and Child Welfare work, as compared with 2,394 in the previous year. Four cases of Ophthalmia Neonatorum were notified during the year. Two severe cases were admitted to the Metropolitan Asylums Board Special Hospital and the other two were treated at home. All recovered without any impairment of vision. PUERPERAL FEVER AND PUERPERAL PYREXIA. One case of Puerperal Fever was notified. The case was a mild one, and the woman made a complete recovery. One death took place in the Wellhouse Hospital in a case which was not notified to me and first came to my knowledge when, some months later, I received intimation of the death from the RegistrarGeneral. Three cases of Puerperal Pyrexia were notified, and one case was removed to the Metropolitan Asvlums Board Special Hospital under the Council's scheme for dealing with such cases. All these cases recovered. The nett cost to the rates for the whole of the Maternity and Child Welfare work is only 0.36 of a penny in the pound. OPHTHALMIA NEONATORUM. 37 1 2 ANNUAL REPORT OF THE Chief Sanitary Inspector for the Year 1928. 39 Finchley Urban District Council. ANNUAL REPORT OF THE Chief Sanitary Inspector for the year 1928. To the Chairman and Members of the Urban District Council of Finchley. Mr. Chairman, Mrs. Timberlake and Gentlemen, I have the honour to present to you my Twenty-seventh Annual Report dealing with the work carried out by your Sanitary Inspectors during' the year 1928. The total number of inspections made during the year was 12,223, as compared with 12,072 in 1927. At 1,217 of the houses and other premises visited, defects or nuisances to the number of 4,294 were discovered, and at the end of the year, 3,696 of these defects or nuisances had been abated, the work of remedying 419 was in hand, and the remaining 179 were outstanding. In order to ascertain that the sanitary defects were being properly remedied 1,644 visits were paid to the respective premises while the work was in progress. 40 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 370 Special Inspections 3008 Re-Inspections 3160 Inspections of Works in Progress 1644 Inspections of Factories and Workshops (including Bakehouses and Outworkers) 618 Inspections of Slaughterhouses 1617 Inspections of Cowsheds, Dairies, and Milkshops104 Inspections of Ice Cream Premises 72 Inspections of Butchers' and other Food Shops 221 Inspections of Shops (Shops' Acts) 240 Visits re Infectious Disease 1052 Miscellaneous 117 Total number of Inspections and Re-Inspections 12223 Total number of houses inspected under Public Health or Housing Acts 991 Notices Served. Informal Notices 705 Statutory Notices 35 Summary of Sanitary Improvements Carried Out. Drainage. Number of Houses and Premises re-drained 15 Repairs or Amendments to existing drains 45 Drains or Gullies unstopped or cleansed 79 Length in yards of Stoneware Drains laid 480 41 Length in yards, of Heavy Cast-iron Drains laid 171 Manholes provided 45 Manholes repaired 22 Intercepting traps fixed 8 Fresh Air Inlets provided or repaired 99 New Gully Traps fixed 86 Gully Curbs provided or repaired 61 New Soil Pipes and Ventilating Shafts fixed 28 Soil Pipes and Ventilating Shafts repaired 8 Water Tests applied 189 Smoke Tests applied 29 Air Tests Applied 30 Water Closets and Sanitary Fittings. New W.C. Basins fixed 126 W.C.'s unstopped, cleansed or repaired 68 New Flushing Boxes fitted to W.C.'s 30 Existing Flushing Boxes repaired 41 Joints between W.C.'s and flush pipes repaired 28 New W.C. Apartments provided 8 Lavatory Basins provided 9 Baths provided 4 New Impervious Sinks provided 40 New Waste Pipes fixed 34 Waste Pipes trapped, repaired or unstopped 43 Miscellaneous. Roofs repaired 229 Eaves Guttering renewed, cleansed or repaired 176 Stack Pipes provided, repaired or unstopped 64 Damp Walls remedied 76 Walls repointed or repaired 83 42 Ventilation under floors provided 9 Yards paved 34 Paving of Yards repaired 88 Floors of rooms relaid 13 Floors of rooms repaired 131 Rooms cleansed, distempered or repapered 786 Windows repaired and/or made to open 60 New Sash Cords provided 431 Window Siils repaired or provided 28 Doors provided or repaired 47 Staircases repaired 27 Workrooms (including Bakehouses) cleansed and repaired 26 Cisterns provided 9 Cisterns repaired, cleansed and covered 47 Water Service Pipes repaired 10 Movable Sanitary Dustbins provided 56 Offal Bins provided 12 Nuisances from overcrowding abated 56 Nuisances from the keeping of animals abated 17 Accumulations of refuse removed 18 Accumulations of manure removed 10 Manure receptacles provided 3 New Ranges and Stoves provided 80 Stoves and Ranges repaired 133 Coppers provided 10 Coppers repaired 55 Miscellaneous 117 43 Infectious Disease and Disinfection. Cases of infectious disease notified 288 Cases of Phthisis notified (new cases) 54 Number of rooms fumigated after infectious disease 299 Verminous rooms fumigated 34 Number of articles disinfected N.B.—In addition to the above work of disinfection, 20 stovings of bedding, etc. (272 articles) were carried out, and 65 patients were removed to Hospital for the Friern Barnet District Council. House-to-House Inspection. The Housing Consolidated Regulations, 1925, require the Local Authority to make provision for a thorough inspection to be carried out from time to time of the dwelling houses in their district. The chief object of the inspections is to ascertain the state of the houses in relation to the following matters, namely:— (1) The arrangements for preventing the contamination of the water supply. (2) Closet accommodation. (3) Drainage. (4) The condition of the house in regard to light, the free circulation of air, dampness and cleanliness. (5) The paving, drainage and sanitary condition of any yard or outhouses belonging to or occupied with the house. (6) The arrangements for the storage of refuse. (7) The existence of any room which would by virtue of Sub-Section (1) of Section 8 of the Housing Act, 1925, be a house so dangerous or injurious to health as to be unfit for human habitation. (8) Any defects which may tend to render the house dangerous or injurous to the health of an inhabitant. 44 Proper records of these inspections have to be made containing information as to the state of the house, the action taken to secure the remedy of any defects, and the result of such action. The making of systematic house-to-house surveys is a work of considerable importance. It results in many houses being prevented from becoming unfit for human habitation, and enables Local Authorities to enforce a reasonable standard of fitness. The standard we endeavour to attain is that laid down in the manual published by the Ministry of Health, in which it is stated that a fit house should be free from dampness, satisfactorily lighted and ventilated, properly drained and provided with adequate sanitary conveniences and with a sink and suitable arrangements for disposing of slop water. It should be in good general repair, and should have a satisfactory water supply, adequate washing accommodation, adequate facilities for preparing and cooking food, and a well ventilated food store. Owners of property in the district, as a rule, carry out the work specified by the department without it being necessary to serve statutory notices under the Housing Act, and work for the reconditioning of existing dwelling houses is constantly in progress. During the year 1928, 370 house-to-house surveys were made; as compared with 439 in 1927. 45 The following is a list of the houses dealt with under this heading, namely:— Albert Street, N.12.11 Avenue Road, N.12. 1 Birkbeck Road, N.12. 33 Dale Grove, N.12. 23 Friern Lane, N.20.10 Hendon Lane, N.3. 10 High Road, N.2.20 Hutton Grove, N.12. 38 Lodge Lane, N.12. 64 Long Lane, N.2. 113 Squires Lane, N.3. 25 William Street, N.12. 22 370 The 370 premises comprise 420 separately rated Houses and tenements. As a result of these inspections 110 less than 2,911 defects or nuisances were discovered and dealt with, and these are enumerated in the appended summary:— Defective drains 12 Blocked drains 12 Defective and short ventilating shafts to drains 16 Defective and insanitary w.c. basins 20 Defective joints between flush pipes and w.c. basins 17 Defective w.c. seats 30 W.C. flushing boxes out of order 23 Defective manholes 7 Defective fresh air inlets to drains 35 Defective house roofs 153 46 Dirty and defective ceilings and walls of rooms 706 Defective brick work and pointing to walls 73 Defective doors 52 Defective doorsteps 21 Defective stairs and handrails, etc. to staircases 29 Defective floors of rooms 120 Insanitary stone troughs and/or defective sinks 31 Defective and untrapped waste pipes 53 Defective, absence of, or insufficient yard paving 126 Rain water pipes direct to drains 3 Absence of, or defective eaves guttering and stack pipes 155 Nuisances from dampness 83 Absence of ventilation under floors 6 Absence of, or defective gratings to ventilation openings under floors 7 Windows, defective or not made to open 127 Defective window sills 23 Dirty and uncovered service water cisterns 43 Defective kitchen ranges 110 Defective stoves 105 Defective coppers 58 Broken sash cords 498 Defective service water pipes 2 Defective dustbins 63 Absence of, or defective gully curbs 8 Miscellaneous 84 An analysis of the house-to-house records for the year 1928 has been made and the following statistical information compiled therefrom:— Dwelling Houses. Number of houses inspected 370 Number of rooms. Living Rooms 884 ,, Sleeping Rooms 962 ,, Bed-living Rooms 101 1947 47 Occupants. Number of Occupants. Adults 1719 ,, Children 341 Average number of persons per house 5.56 ,, ,, room 1.05 ,, ,, bedroom 1.93 sub-letting. Houses occupied by one family 204 ,, ,, two families 147 ,, „ three ,, 16 ,, ,, four ,, 2 ,, ,, five ,, 1 166 or 44.86% Rents. Annual Rental of £16 or under 3 ,, £16 to £26 41 ,, £26 to £40 141 ,, over £40 149 Owned by Occupiers 46 370 Sanitation. Number of houses where defects were found 338 or 91.35% Food Storage. Number of houses not provided with larder accommodation 243 or 65.68% Number of houses provided with larder accommodation 127 or 34.32% 48 Houses Unfit For Human Habitation. In November of the year under review the dwellinghouse known as 41, Station Road, N.3., was represented as being in a state so dangerous or injurious to health as to be unfit for human habitation. A Closing Order was made by the Council and has since become operative. The house is occupied by three families consisting of six adults and seven children. These families had not found other accommodation at the end of the year. One small dwelling-house known as 10, St. John's Terrace, Friern Lane, which had been unfit for human habitation and unoccupied for several vears was put into a proper state of repair and is now occupied. The following houses were closed voluntarily by the owners during the year, namely Prospect House, East End Road, N.2., and 1, 2 and 3, Memell Cottages, Ballards Lane, N.3. These houses will probably be demolished at an early date. Overcrowding. The following cases of overcrowding of one or more rooms in dwelling-houses have been recorded, namely :— Overcrowded houses (on 31st December, 1927) 76 Overcrowded houses recorded during 1928 66 142 Overcrowding abated during 1928 56 Overcrowded houses outstanding 31st Dec., 1928 86 The Rent & Mortgage Interest Restrictions Acts, 1920 & 1923. Three formal applications were received from tenants for certificates under the above Acts to the effect that the houses were not in a good and tenantable state of repair Two applications were refused, and in one case the owner carried 49 out the schedule of repairs prepared by your inspector thus avoiding the necessity of issuing a certificate. A number of informal applications were received and dealt with to the satisfaction of the tenants and the owners. Complaints. Three hundred and ten complaints were received with reference to the following matters, viz.: — Blocked or defective drains 20 Insanitary condition of mews and passages 6 Insanitary condition of houses 89 Defective roofs 18 Insufficient water supply 3 Nuisance from dampness 10 Nuisance from flooding 4 Nuisance from overcrowding 15 Nuisance from the keeping of animals 7 Accumulations of refuse or manure 33 Absence of, or defective dustbins 27 Smoke nuisances 15 Foul ponds and ditches 5 Smells from public sewers 9 Nuisance from rats 16 Other complaints 33 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. Nuisance from the Keeping of Animals. The piggeries and stables in the district have been inspected from time to time, especially during the summer months, and, where necessary, steps have been taken to enforce compliance with the Council's byelaws with respect to nuisances. 50 A somewhat serious nuisance occurred at a large piggery at East Finchley owing to the absence of drainage, accumulation of filth, etc., but, as the result of action taken by the department, the keeping of pigs on the premises was discontinued. For some years strong complaints were received at different periods with respect to nuisances arising from the keeping of pigs on the allotments in Summers Lane. This land has now been acquired by the Council for use as a playing field, and the displaced allottees have been accommodated on other land in the immediate vicinity. The Council have, however, imposed a condition in regard to the occupation of the new allotments to the cffect that no pigs shall be kept thereon. Sanitary Conveniences. There are 25 sanitary conveniences attached to licensed houses within the district. Three of these were demolished during the year and replaced by new modern conveniences These premises are inspected periodically. There are three public conveniences in the district, two of these provide accommodation for both sexes and one accommodation for males only. In two instances the Council (under agreement with the owners) maintain conveniences attached to licensed houses, as these conveniences are much used by the public. 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 adequacy of the sanitary accommodation. Defects discovered as a result of these inspections were promptly remedied, and a report upon the premises was submitted to the Middlesex County Council which is the licensing authority for the district of Finchley. The number of premises dealt with was 25. 51 Accumulations of Refuse on Unfenced Plots of Land. A number of complaints were received during the year directing the Council's attention to "nuisances" arising from the depositing of refuse on unfenced plots of land. It is a fairly common practice among jobbing gardeners, and one not infrequently adopted by the occupiers of houses near open plots of land to deposit thereon their garden refuse. Workmen employed by builders and others also find it convenient to deposit their refuse on these vacant building plots, thus avoiding the trouble and expense of disposing of their refuse in a more suitable manner. The result is that these plots of land become most unsightly, but if the accumulations are not noxious or offensive, it would appear that appropriate action cannot be taken under the nuisances clauses of the Public Health Acts. During the year a joint report by your Medical Officer of Health and myself respecting the condition of a number of these unfenced plots of land was submitted to the Public Health Committee, and an application was made by the Council to the Minister of Health with a view to an Order being made under Section 31 of the Public Health Acts Amendment Act, 1907, requiring the owners of the land to properly fence the same. One plot of land has since been fenced in, and the fencing of three other plots is about to be undertaken by the owners. 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 61 Bakehouses 22 Dining Rooms 27 Slaughterhouses 8 52 Fried Fish Shops 7 Shops re Food Supplies 166 Factories, Workshops and Workplaces 289 Public House Conveniences 25 Places of Public Entertainment 25 Factory and Workshops Act, 1901 and 1907. The total number of Factories, Workshops and Workplaces on the register is 289. The businesses carried on at the respective premises are as follows :— Bakehouses 22 Dressmakers and Milliners 23 Bootmakers 41 Tailors 11 Laundries 12 Motor and Cycle Engineers 46 Restaurant Kitchens 27 Other Trades 107 289 These premises have been visited from time to time, and as a result of action taken by the department the following works Rave been carried out :— W.C. apartments provided or reconstructed ... ... 2 Urinal provided ... ... ... ... • New W.C. Pans provided ... ... ... ... 5 W.C.'s cleansed ... ... ... ... ... 23 Joints between flush pipes and w.c. pans repaired ... 4 Flushing Cisterns provided ... ... ... ■■■ 2 Flushing Cisterns repaired ... ... ... 5 New Sinks provided ... ... ... ... ... 2 Drains unstopped ... . ... ... 8 Manhole Covers provided ... . . .. ••• 2 Roofs repaired ... ... ... ... ... ■ 3 53 New Ventilation Shaft provided 1 Fresh air inlet shafts repaired 9 Yards cleansed or repaired 7 Eaves Gutterings and Rainwater Pipes repaired 2 Floors repaired and/or cleansed 9 Dustbins provided 16 Workshops cleansed 45 Accumulations of refuse removed 7 Miscellaneous 20 Rag Flock Acts, 1911 and 1928. A small quantity of rag flock is used in the district. The supply of this material is obtained from manufacturers who guarantee that it complies with the requirements of the above Acts. Rag Flock is not manufactured or sold in the district. Offensive Trades. The only trade under this heading which is carried on in Finchley is that of a fish fryer, this business being established at seven premises. Steps have been taken by periodical visits to secure reasonable compliance with the bye-laws. An application to establish the business of a fish fryer at 22, Princes Parade, Ballards Lane, N.3, was refused. Public Health (Meat) Regulations, 1924. Inspection of Meat in Slaughterhouses and in Shops. The Public Health (Meat) Regulations, 1924, which came into operation on the 1st April, 1925, are intended to secure more adequate inspection of animals slaughtered for human consumption and to improve the handling, transport and distribution of meat. It is not lawful for a person to slaughter an animal for sale for human consumption unless he has, not less than three hours before the time of slaughtering delivered to the Local Authority a notice (which may be given orally) of the intended slaughter. Written notice may, however, be 54 given stating the fixed times on fixed days when slaughtering is regularly carried out. If the time of slaughter falls between 7 p.m. on one day and 7 a.m. on the next day the removal of the carcase must not take place before 7 a.m. The Local Authority are not empowered to regulate the hours of slaughter and some traders find it convenient to carry out a large proportion of their slaughtering during the late afternoon and at night and quite frequently during the week-end. This has necessitated a large amount of inspection outside the usual office hours. The total number of visits paid to the eight slaughterhouses in the district was 1617. The number of carcases inspected after slaughter during the year is as follows:—Bovines, 600; Calves, 140; Swine, 3.593; Sheep, 8,737. The following is a list of the diseased or unsound meat which was detected by your inspectors and subsequently destroyed:— Tuberculosis. Bovines.— Carcases and Offal 4 Heads and Tongues 27 Sets of Lungs 25 Livers 7 Mesenteries 19 Skirts 3 Swine.— Carcases and Offal 22 Side of Pork 1 Heads 163 Plucks 26 Mesenteries 164 Spleens 31 Sets of Lungs 7 Livers 1 Stomachs 2 55 Conditions Other Than Tuberculosis. Bovines— Livers: 15 Abscesses, 57 Flukes 72 Sets of Lungs: 2 Abscesses, 1 Congestion 3 Mesenteries, Penta stomes 6 Trimmings 161bs. Other Organs 5 Swine.— Carcases and Offal 2 Head 1 Side of Pork 1 Plucks: 9 Congestion, 1 Cysts10 Sets of Lungs: 121 Congestion, 17 Pleurisy, 2 Parasites 140 Livers: Cirrhosis 119 Mesentery: Cysts 1 Kidneys: 3 Inflammation, 3 Cysts 6 Hearts: Pericarditis 32 Leg of Pork 1 Trimmings 12lbs. Other Organs 21 Sheep.— Carcases and Offal 7 Plucks: 1 Abscess, 3 Parasites, 2 Inflammation 6 Lungs: 10 Congestion, 3 Parasites 13 Livers: 103 Flukes, 3 Abscesses, 3 Cysts 109 Mesenteries: Cysts 3 Trimmings 16lbs. Other Organs 3 Miscellaneous- Rabbits 2 Preserved Eggs 8olbs. Tin of Cherries 1 56 The number of private slaughterhouses in use in Finchley at the dates mentioned hereunder was as follows:— Type of Slaughterhouse. 1920. 1925 to 1928 Registered Nil Nil Licensed 10 8 Totals 10 8 Steps have been taken to ensure the observance of the byelaws in force in the district with respect to slaughterhouses 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 lime washing of the premises at certain intervals and the prevention of cruelty. There are 40 butchers' shops in the district. Two new shops were opened and three closed during the year. The meat purveyors' premises have been visited from time to time, and in addition to the inspection of food stufts, the sanitary condition and fitness of the premises have been dealt with by your inspectors All the butchers' shops are provided with glass fronts. There are no meat stalls in the district, but certain persons engage in hawking meat. It has been necessary to devote special attention to the premises occupied by these purveyors and to insist upon compliance with the regulations in regard to the proper storage and handling of meat. Dairies, Cowsheds and Milkshops. At the end of the year there were 25 dairies, cowsheds and milkshops in the district, and in addition 13 purveyors of milk whose premises are not in Finchley are registered for the purpose of retailing milk within the district. The usual inspection at regular intervals of all dairy premises has been maintained, and the provisions of the Milk and Dairies Order, 1926, with respect to the cleanliness of dairies and cowsheds, the protection of milk against 57 infection and contamination, and the conveyance and distribution of milk have been generally well observed. Special attention has been given to cleanliness in all operations connected with the production and handling of milk, including the grooming of the cows. Practically all the dairymen in the district now deliver milk to their customers in bottles, and in this connection it has become the practice of roundsmen and others to leave empty bottles on the public footpath, in passages, and on plots of vacant land. In these places the bottles become contaminated by dogs, dust, etc., and although the bottles are of course washed before being again used as milk containers, it is nevertheless an objectionable practice, which has increased considerably during the year under review. The matter was considered by the Public Health Committee, and an appropriate communication was sent to the dairymen in the district, but the practice continues as heretofore. One large dairy firm in the district has installed a large plant for the handling and delivery of milk in paper containers instead of bottles, and it is expected that this system will be put into operation at an early date. In another large dairy a new and improved plant has been installed for the storage of milk in large glass-lined tanks prior to being treated and bottled. The veterinary inspection of the cows kept in the district is carried out by the Middlesex County Council. The Milk (Special Designations) Order, 1923. During the year 1928, 17 licences were granted by the Council to dealers to sell designated milk as follows:— "Certified," 7; "Grade A (Tuberculin Tested)," 5; "Grade A," 3; and " Pasteurised," 2. At the request of the Ministry of Health, sixteen samples of "Certified" milk were obtained and delivered in London for bacteriological examination. Four samples of "Pasteurised" milk were also taken on behalf of the Council. The following is a summary of the Bacteriologists' reports upon these samples:— 58 No. of Sample. Bacteria per c.c. Presence of Bacillus Coli in 48 hours. Remarks. CERTIFIED MILK. l 760 Absent. This sample conformed to the bacterial standards required of Certified Milk. 2 2730 Absent. | This sample passed the bacterial standards required of Certified Milk. 3 2020 Absent. This sample of milk passed the bacterial standards required of Certified Milk. 4 1140 Absent. This sample passed the bacterial standards required of Certified Milk. 5 50750 Present in 0.1 c.c. This sample failed to pass the bacterial standards required of Certified Milk. 6 760 Absent. This sample conformed to the bacterial requirements of Certified Milk. 7 15950 Absent. This sample passed the bacterial standards quired of Certified Milk. 8 42000 Present in 0.1 c.c. This sample failed to pass the bacterial standard's required of Certified Milk. 9 28250 Present in 0.1 c.c. This sample failed to pass the bacterial standards required of Certified Milk. 10 18250 Absent. This sample satisfied the bacterial requirements required of Certified Milk. 11 8670 Absent. This sample readily passed the bacterial standards required of Certified Milk. 12 1720 Absent. A good sample of Certified Milk 13 1030 Absent. A very good sample of Certified Milk. 14 4430 Absent. This sample easily passed the bacterial standards required of Certified Milk. 15 1320 Absent. This sample passed the bacterial standards required of Certified Milk 16 1580 Absent. This sample satisfied the bacterial requirements of Certified Milk. 59 No. of Sample. Bacteria per e.c. Presence of Bacillus Coli in 48 hours. Remarks. PASTEURISED MILK. 17 6500 This sample of milk passed the bacterid standard required of Pasteurised Milk. 18 3500 This sample of milk passed the bacterial standard required of Pasteurised Milk. 19 9800 This milk easily passed the bacterial standard required of Pasteurised Milk. 20 10700 This milk readily satisfied the bacterial requirements of Pasteurised Milk Ice Cream Premises. The number of ice cream premises on the register is 61. The premises were visited during the summer months. Since several firms have undertaken the manufacture of ice cream on a large scale and carry on a wholesale trade in this commodity, the making of ice cream by several small retailers on premises which were not really suitable for the purpose has been discontinued. 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. Execution of Work in Owners' Default. As certain statutory notices had not been complied with, the Council executed works in the owners' default as follows:— (1) Execution of repairs at two dwelling-houses under the Housing Act, 1925. 60 (2) Relaying of part of a combined drain situated under a dwelling-house. As admittance to the dwellinghouse was refused, despite the fact that the owner and occupier had been fined or ordered to pay costs on several occasions after a Magistrate's Order had been obtained, tunnelling under the, house was resorted to and the drain was relaid in a satisfactory manner. Legal Proceedings. Legal proceedings were taken under Section 23 of the Finchley Urban District Council Act, 1908, in one ase against an owner in respect of a dwelling-house without a supply of water. The water supply had been cut off owing to failure to pay the water rate. The before-mentioned section provides as follows:— "The owner of any dwelling-house which is not provided with a proper and sufficient water supply who shall occupy or allow to be occupied such dwelling-house shall be liable to a penalty not exceeding five pounds, and to a daily penalty not exceeding twenty shillings unless the dwelling-house was erected before the passing of this Act and such supply is not available" The magistrates dismissed the case on the ground that the owner had provided the means of supply, that is the pipes, fittings, etc. The Shops Acts. The Shops (Hours of Closing) Act, 1928, which came into force on the 3rd August, 1928, repeals the Acts of 1920 and 1921, and makes permanent provision for the general closing of shops (with certain exceptions) not later than 9 p.m. on one day in the week, referred to in the Act as " the late day," and not later than 8 p.m. on any other day of the week. Saturday is fixed as the late day, but power is 61 now given to the Local Authoritv to prescribe by Order some other day as the late day. The New Act is to be construed (except where the context otherwise requires) as one with the Shops Acts, 1912 and 1913, and is enforceable by the Local Authority. Two hundred and forty shops were visited during the year, and special attention was given to compliance with the provisions of the Acts relating to the following matters:— (1) Cleanliness and adequacy of sanitary dation. (2) Provision of seats for female shop assistants. (3) Provision and fixing of prescribed notices, re (a) Form I. respecting the week-day on which assistants are not employed after 1.30 p.m. (b) Form IV. in regard to "mixed shops" being closed for the sale of non-exempted goods. (c) Form under Section 11. respecting employment of young persons. (4) The allowance of proper intervals for meals. (5) Closing of shops at the prescribed hours, ing 1 p.m. on Thursdays to comply with the Order made by the Council fixing the weekly half-holiday. A number of infringements have been dealt with, but, in each case, a caution to the offender was sufficient to secure compliance with the Acts. Storage of Petroleum. The Petroleum (Consolidation) Act, 1928, came into force on the 4th August, 1928, and brings within the compass of a single statute all existing provisions with respect to the storage and safe keeping of petroleum spirit. Petroleum spirit is defined as Petroleum, which when tested in a prescribed manner, gives off an inflammable vapour at a temperature less than 730 Fahrenheit. 62 Petroleum spirit can only be kept in pursuance of a licence granted by the local authority with the following exceptions, namely:—(I) When kept in separate vessels, each containing not more than one pint, and the maximum amount does not exceed three gallons; (2) when kept for use on motor vehicles in accordance with the regulations made by the Secretary of State, and the quantity kept in each place of storage does not exceed 60 gallons. Carbide of Calcium, to which the Petroleum Act applies, may also be kept without a licence, provided the amount does not exceed 281bs., and certain prescribed conditions are complied with. The number of premises licensed by the Council for the keeping of petroleum spirit has steadily increased during the last ten years, but the rate of increase has been greatly accelerated during the last five years, consequent upon the continued rapid development of motor transport. The actual quantity of petroleum spirit which may be kept on licensed premises has increased by nearly 82%, that is from 31,478 gallons in 1924 to 57,225 gallons in 1928. The amount of Carbide of Calcium which may be kept is 4,072lbs. Most of the petroleum spirit is now kept in bulk in underground storage tanks, and there are now installed in the district no less than 80 of these tanks to which are connected a similar number of petrol supply pumps of various types. There are no movable arms connected to these pumps which can be swung over the public footpath, and with three exceptions, provision is made for motor vehicles to stand on the licensees' private premises when obtaining a supply of petroleum spirit from a pump. Certain mixtures containing petroleum spirit, e.g., cellulose paint, rubber solution, etc., come within the Petroleum Act. Three premises are now licensed for the keeping of cellulose paint which is used for spraying motor car bodies, and two premises for the keeping of spirit or petroleum mixture used in the retreading of motor tyres. 63 During the year 1O5 applications for licences to keep petroleum spirit and 12 for carbide of calcium were received and reported upon and a licence was granted in each instance. Two applications for licences were withdrawn upon the applicants being informed that the Council were not likely to approve the proposed installations. The maximum fee for licences was formerly 5s., but the prescribed fee now varies from 5s. to £ 5, according to the quantity kept. The licence fees paid during 1928 amounted to £-50 9s. 9d. Every endeavour is made to assist intending applicants for licences, both by interviews at the office and at their respective premises, when alternative methods of storage are discussed with them and their advisers, who usually represent one of the large petroleum companies or pump manufacturers. These discussions serve a useful purpose, as they tend to avoid the delay occasioned by the submission of applications for licences in a form which would not be approved by the Council, and they assist in securing the best storage conditions. The construction of all new installations has been carefully supervised before permission has been given for petroleum spirit to be placed in them. The various licensed premises have been inspected from time to time, and a number of contraventions of the tions attached to the licences have been dealt with. Staff. The following changes in the Sanitary Staff have taken place:— In January, Mr. C. W. Newbery, the Senior Assistant Inspector, terminated his appointment after 13 years' service with the Council to take up the position of Chief Sanitary Inspector of the Urban District of Sutton and Cheam. Mr. T. J. Moore was promoted to the position of 64 Senior Assistant Inspector, and Mr. J. Gray, of Bexley Heath, was appointed to fill the vacancy of Assistant Inspector. At the end of December, 1928, Mr. J. Lawrence retired under the Superannuation Act. Mr. Lawrence had been in the service of the Council for about 44 years, and during the greater part of that period carried out the duties of disinfector. He was a most reliable and painstaking officer, and during the whole time he was connected with this department he carried out his somewhat unpleasant duties in a most exemplary manner. Mr. W. H. Evans, the assistant disinfector, was promoted to fill the post of disinfector, and Mr. E. C. F. Bolding was appointed assistant disinfector. It is with much pleasure that I take this opportunity to express my great appreciation of the invaluable help given by the Assistant Inspectors and the Clerical Staff, and to acknowledge gratefully the kind co-operation of Dr. Turner, the Medical Officer of Health, and my colleagues in other departments. I am, Mr. Chairman, Mrs. Timberlake and Gentlemen, Your obedient servant, E. J. FRANKLIN, Chief Sanitary Inspector. Public Health Department, 3, The Hawthorns, Regents Park Road N.3. April, 1929. 65 1 Finchley Urban District Council. REPORT OF THE School Medical Officer for the Year 1928. 67 Finchley Urban District Council. MEMBERS OF THE EDUCATION COMMITTEE. Chairman: Councillor D. A. A. Merry. Vice-Chairman: Councillor F. J. Grocott. Councillor L. W. Bennett. Mrs. E. V. Timberlake. Councillor R. Williams, M.A Councillor H. G. Sommerfield. Councillor Vyvyan Wells. Councillor E. Toyne. Co-opted Members: Mrs. A. S. Miall, Miss L. Davey, Rev. F. St. Clair Goldie, B.A. Ex-officio Members: County Councillor W. Newcome Wright, County Councillor T. W. Hicks, M.D. County Alderman F. Goodyear. Secretary to the Education Committee: J. Cogdale. 68 Finchley Urban District Council. SCHOOL MEDICAL STAFF. School Medical Officer: A. A. Turner, M.C., M.D., D.P.H. Ophthalmic Surgeon: J. S. Boden, M.B., B.S. School Dentist: R. S. Matthew, L.D.S., R.C.S., Edin. School Nurses and Health Visitors: Miss J. Hull, C.M.B. Miss W. B. Hudson, C.M.B. Miss S. Hacking, C.M.B. Clinic Nurse: Miss J. Sharpe. Clerk: Miss J. A. K. Dinning. 69 FINCHLEY SCHOOLS. ELEMENTARY SCHOOLS. School. Department. Accommodation. Average attendance 1928. Long Lane Mixed 720 323 Long Lane Infants 382 199 Albert Street Senior Mixed 594 392 Albert Street Junior Mixed 410 312 Squires Lane Boys 300 225 Squires Lane Girls 300 230 Squires Lane Infants 390 282 North Road Senior Mixed 500 243 North Road junior Mixed 500 307 St. Mary's Mixed 354 238 St. Mary's Infants 180 143 St. John's Mixed and Infants 324 247 Christ Church Mixed 429 386 Holy Trinity Mixed 248 160 Holy Trinity Infants 184 107 5815 3794 SECONDARY SCHOOLS. On Roll. County School Boys and Girls 390 Christ's College Boys 420 Woodhouse Boys and Girls 290 1100 70 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 for the year 1928. There has been no new extension of the scheme during the year, but the work carried out continues to increase in all branches. The number of children examined and the number treated at the various clinics are higher than in any previous year. The cleanliness of the children continues to improve, and for the first time no child required to be dealt with at the Cleansing Station, while for the third successive year no case of ringworm of the scalp was discovered. The incidence of certain infectious diseases has been rather heavy, there having been fairly wide-spread epidemics of measles, whooping-cough and chicken-pox, which greatly affected the school attendance. Five hundred copies of "Better Health" have been distributed among the senior schools every month, and the Head Teachers speak very highly of the Educational value of this publication. I have to thank Mr. Cogdale, the Head Teachers and the Staff generally for their willing co-operation in all matters connected with the School Medical Service. I am, Mr. Chairman, Ladies and Gentlemen, Your Obedient Servant, A. TURNER, School Medical Officer. 71 THE SCHOOL MEDICAL SERVICE IN RELATION TO THE PUBLIC ELEMENTARY 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 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 II a. and IIb. at the end of the Report. (a) Uncleanliness. That the cleanliness of the children continues to improve is shown by the following figures:— Discovered at routine medical inspection:— VERMINOUS HEADS. 1922 1923 1924 1925 170 (11.5%) 136 (10.4%) 167 (10.5%) 100 (8.8%) 1926 1927 1928 101(6.8%) 98 (7.7%) 95 (6.2%) DIRTY BODIES. 1922 1923 1924 1925 184 (12.4%) 159 (12.2%) 172 (10.8%) 87 (7.7%) 1926 1927 1928 31 (2.1%) 10 (.78%) 11 (.72%) 72 During 1928 the School Nurses made 19,494 examinations of children and 491 individual children were found to be unclean. No children required to be cleansed at the Council's Cleansing Station during the year, as compared with five during the previous year. (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 89 or 5.8% were found to be suffering from enlarged tonsils and adenoids. Operation was advised in 48 of these cases and in 55 other cases discovered as a result of special examinations. Seventy children were operated on during the year under the Education Authority's scheme, and 14 children received private treatment. (d) Tuberculosis. Two cases of suspected pulmonary tuberculosis, and one case of tuberculosis of bones and joints, were discovered at routine inspections; while six cases of non-pulmonary tuberculosis were found at special examinations. (e) Skin Disease. Five cases of impetigo, two of scabies and three of other skin diseases were found at routine inspections; while, at special inspections, twelve cases of impetigo, one case of scabies, and fortv of other skin diseases were discovered. (f) External Eye Disease. Four cases of blepharitis and one of conjunctivitis were found at routine inspections, and at special inspections one case of blepharitis, and seven of conjunctivitis. 73 (g) Vision. Seventy-one or 4.7% of the children at routine inspections were found to be suffering from some fairly serious defect of vision, and a total of 178 children were referred from various sources for refraction by the School Oculist. (h) Ear Disease and Hearing. As a result of routine and special examinations, 26 cases of discharging ears and 8 cases of deafness were referred for treatment. (i) Crippling Defects. One case of spinal curvature and 9 cases of other forms of deformities were discovered at routine and special examinations. (j) Dental Defects. Seven hundred and twenty-six or 47.6% of the children were found to be suffering from dental decay, 6.5% having four or more teeth decayed, and 41.1% having less than four. Infectious Diseases. Infectious diseases were fairly prevalent. In the early months there was a severe epidemic of measles, and scattered throughout the year there was a considerable outbreak of chicken-pox and whooping-cough. It was not necessary to close any school or department of a school on account of infectious disease. Individual children are excluded under Article 53b or Article 57, according to the nature of the complaint from which they are suffering. 74 Exclusion of School Children on Account of Infectious Disease. Discase. 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: Until 28 days after discharge from hospital. All children in the family must be excluded until 10 days after disinfection of premises. (a) Hospital Cases (6) Home Cases Until 28 days after disinfection of premises. SMALLPOX Until Medical Officer of Health certifies that child may attend. All children in the family must be excluded until the 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. WHOOPING COUGH Until at least 5 weeks after commencement of illness, and so long as characteristic cough continues. No exclusions. 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. 75 Following up. There are four Nurses concerned with the School Medical Service—one spends her whole time in the various school clinics, while the other three devote half their time to school work and half to maternity and child welfare work. 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 1276 Visits to clinics 724 Home visits 981 2981 Number of examinations of children— heads, bodies, clothing, etc. 19,494 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. Nine hundred and seventy-four children received treatment at these clinics during the year, making 9,209 attendances, as compared with 943 children making 7,942 attendances in 1927. 76 (b) Tonsils and Adenoids. Seventy 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 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 Tubercul6sis Officer of the Middlesex County Council. (d) Skin Diseuse. The treatment of cases of skin disease is carried out at the Minor Ailments Clinics; 551 children were treated during the year. It is pleasing to be able to record that for the third year in succession, no case of ringworm of the scalp was referred for treatment. (e) External Eye Disease. Children suffering from external eye disease are treated at the Ophthalmic Clinic and the Minor Ailments Clinic; 53 children were treated during the year. (f) 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. During 1928, 182 children were referred for examination. 166 were submitted to refraction—spectacles were prescribed in 162 cases and 154 actually obtained spectacles. In 20 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. 77 (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 89 children were treated. (h) Dental Defects. In December, 1926, a whole time Dental Surgeon was appointed, and he took up his dyties on the 17th January, 1927. Ten sessions per week are devoted to the inspection and treatment of school children, and one session to the inspection and treatment of Maternity and Child Welfare cases. During 1928 a routine inspection was made of the whole of the school children, and a re-inspection was carried out in the schools where the acceptance of treatment was least satisfactory. At the routine inspection 3,805 children were inspected, and 2445 or 64.3 per cent. were found to require treatment. Of the 2,445 who required treatment, 1,628 or 66.5 per cent. actually received treatment. 560 children were re-inspected, and of these 171 received treatment. 482 Special Cases were seen by the Dentist at the request of parents or teachers, and 288 of these were treated. The work carried out by the Dentist during the year is set out in the following table Number of children inspected & re-inspected 4847 Number of children treated 2087 Number of attendances at Dental Clinic 3248 Number of fillings 1892 Number of extractions 2380 Number of other operations 1263 Number of general anaesthetics 545 78 The following table shows the percentage of the children in each school who were found to require treatment, and also the percentage of these children requiring treatment who actually accepted treatment at the Dental Clinic. (1) (2) (3) School. Percentage of children requiring treatment. Percentage of those in (2) who accepted treatment. Long Lane 77 52.6 St. John's 70 69.7 Christ Church 69.5 65.9 Holy Trinity 68.5 69.6 St. Mary's 67.5 73.7 Albert Street 66 64.7 Squires Lane 57 61.2 North Road 56 82.2 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 94 5 0 Operative Treatment of Tonsils and Adenoids 45 5 0 Treatment of Minor Ailments 7 1 9 £146 11 9 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 playgrounds 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. 79 The provision of a day open air school would be of great 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. 66 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. During the year, 16 children were sent to Parkstone, and without exception, their health was greatly improved. 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 22,858 attendances were made by 1,513 children. 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. 80 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. 1924 1925 1926 1927 1928 62.2% 66% 71.7% 74.5% 72% 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. 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. 81 Co-operation of Voluntary Bodies. During the year the Children's Care Committee sent 67 children to Heme Bay for a period of one week, and in 20 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 brought up to date. Head Teachers and Attendance Officers and Health Visitors are requested to notify the School Medical Officer of all children whom they suspect to be physically or mentally defective, and all these children are examined and classified. The Education Committee are 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 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. Thirteen mentally defective children were in attendance at the Joint Special School situated within the area at the end of the year. (b) There is only one feeble-minded child not in attendance at the Special School, and this is supervised by the School Medical Officer and the Attendance Officers. The statutory cases are supervised by the Middlesex Countv 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, 82 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. 527 pupils were examined during the year. Continuation Schools, There are no Continuation Schools in the district. 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. Twenty-three children were examined during the year and all were found to be fit for employment. 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. 83 STATISTICAL TABLES for the Year 1928, 85 TABLE I. Return of Medical Inspections. A.—Routine Medical Inspections. Number of Code Group Inspections:— Entrants 615 Intermediates 370 Leavers 368 1353 Number of other Routine Inspections 171 R.—Other Inspections. Number of Special Inspections 1176 Number of Re-Inspections 363 Total 1539 TABLE II. A.—Return of Defects found by Medical Inspection in the year ended 31st December, 1928. 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 20 12 5 Uncleanliness - - - — (See Table IV, Group V.) Skin- Ringworm- Scalp — — Body — — Scabies 2 - — Impetigo 5 12 — Other Diseases (Non-Tuberculous) 3 - 40 — Eye- Blepharitis 4 — 1 — Conjunctivitis 1 7 — Keratitis — - — Corneal Opacitis — — Defective Vision (excluding squint) 71 22 5 — Squint 3 1 — Other conditions — 1 20 1 Ear- Defective Hearing 4 4 2 Otitis Media 4 3 22 — Other Ear Diseases 2 - 18 3 Nose and Throat- Enlarged Tonsils only 8 32 4 11 Adenoids only 3 3 6 1 Enlarged Tonsils and Adenoids 37 6 45 8 Other conditions 2 1 25 1 Enlarged Cervical Glands (NunTuberculous) 1 2 12 3 Defective Speech — — — 1 Teeth—Dental Diseases (See Table IV, Gruup IV.) - 1 — Heart and Circulation- Heart Disease : Organic — 4 — 3 Functional — 3 1 — Anaemia 4 6 17 — Lungs- Bronchitis — 7 6 - Other Non-Tuberculous Diseases — — 15 - Tuberculosis- Pulmonary: Definite — — Suspected — 2 — Non-Pulmonary: Glands — — 3 Spine — — — — Hip — — 1 — Other Bones and Joints — 1 - — Skin — — 1 — Other forms — — — 1 Nervous System— Epilepsy — — — — Chorea 1 1 2 1 Other conditions — — 7 1 Deformities- Rickets — — — — Spinal Curvature — 1 — — Other forms 1 4 4 — Other Defects and Diseases 6 4 154 8 87 TABLE II. B.—Number of Individual Children found at Routine Inspection to require Treatment (excluding Uncleanliness and Dental Diseases). Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. CODE GROUPS: Entrants 615 57 9.3 Intermediates 370 54 14.6 Leavers 368 49 13.3 TOTAL (Code Groups) 1353 160 11.8 Other Routine Inspections 171 21 12.3 88 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 3 3 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 1 2 3 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 — — — 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 — — — Menially Defective Feebleminded (cases notnotifiable to the Local Control Authority). Attending Certified Schools for Mentally Defective Children 9 4 13 Attending Public Elementary Schools — — — At other Institutions — 1 1 At no School or Institut on — 1 1 Notified to the Local Control Authority during the year. Feeble-minded — — — Imbeciles — — — Idiots - - - Epileptics Suffering from severe Epilepsy. Attending Certified Schools for Epileptics 1 — 1 In Institutions other than Certified Special Schools — — — Attending Public Elementary Schools — — — At no School or Institution — — — Suffering from Epilepsy which is not severe. Attending Public Elementary Schools 1 1 2 At no School or Institution - - - 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 1 — 1 At Certified Day Open-Air Schools — — — At Public Elementary Schools — — — At other Institutions — — — Physically Defective Delicate children (e.g., preor latent tuberculosis, malnutrition, debility, anaemia, etc.). At no School or Institution — — — At Certified Residential Open-Air Schools 8 9 17 At Certified Day Open-Air Schools — — — At Public Elementary Schools 42 27 69 At other Institutions — 1 1 At no School or Institution — — — Active non-pulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 2 1 3 At Public Elementary Schools — — — At other Institutions — — — At no School or Institution 1 — 1 Crippled Children (other than those with active tuberculous disease) e.g., children suffering from paralysis, etc., and including those with severe heart disease. At Certified Hospital Schools 1 - 1 At Certified Residential Cripple Schools 1 - 1 At Public Elementary Schools 12 5 17 At other Institutions — — — At no School or Institution 2 2 4 89 90 TABLE IV. Return of Defects treated during the year ended 31st December, 1928. Treatment Table. Group J.—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 - - - Ringworm—Body 1 — 1 Scabies 1 — 1 Impetigo 390 — 390 Other skin diseases 159 — 159 MINOR EYE DEFECTS— (External and other but excluding cases falling in Group II.) 49 49 MINOR EAR DEFECTS- 89 — 89 MISCELLANEOUS— (e.g., minor injuries, bruises, sores, chilblains, etc.) 285 - 285 TOTAL 974 — 974 91 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) 166 3 169 Other Defect or Disease of the eyes (excluding those recorded in Group I.) 4 - - 4 Total 170 3 — 173 Total number of children for whom spectacles were prescribed:— (a) Under the Authority's Scheme 162 (b) Otherwise 3 Total number of children who obtained or received spectacles:— (a) Under the Authority's Scheme 154 (b) Otherwise 2 GROUP III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatmen. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. Received other forms of Treatment. Total Number Treated. 70 14 84 — t84 92 TABLE IV. (continued). Group IV.—Dental Defects. (1) Number of children who were:— (a) Inspected by the Dentist: Aged: 5 185 3805 6 381 7 492 8 593 9 400 10 352 Routine Age Groups. 11 334 Total 12 399 13 394 14 275 15 — Specials 482 Grand Totals 4287 (b) Found to require treatment 2461 (c) Actually treated 1916 (d) Re-treated during the year as the result of periodical examination 171 (e) Re-inspected during the year 560 (2) Half-days devoted to Inspection 64 Total 417 Treatment 353 (3) Attendances made by children for treatment 3248 (4) Fillings Permanent teeth 935 Total 1892 Temporary teeth 957 (5) Extractions Permanent teeth 209 Total 2380 Temporary teeth 2171 (6) Administrations of general anaesthetics for tions 545 (7) Other operations Permanent teeth 603 Total 1263 Temporary teeth 660 93 Group V.—Uncleanliness and Verminous Conditions. (1) Average number of visits per school made during the year by the School Nurses 146 (2) Total number of examinations of children in the Schools by the School Nurses 9494 (3) Number of individual children found unclean 491 (4) Number of children cleansed under arrangements made by the Local Education Authority (5) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 (b) Under the School Attendance Bye-Laws 94 INDEX. Page. Report of the Medical Officer of Health 1 Natural and Social Conditions 4 Vital Statistics 4 General Provision of Health Services in the Area 6 Members of Public Health Committee and Staff, Public Health Department. 11 Professional Nursing in the Home 12 Legislation in Force 12 Sanitary Circumstances in the Area 14 Statistical Tables—Mortality, etc. 16 Housing 20 Food 23 Factories and Workshops 24 Infectious Disease 27 Statistical Tables—Infectious Disease 30 Tuberculosis 33 Maternity and Child Welfare 35 Report of the Chief Sanitary Inspector 39 Inspections 41 Notices Served . 41 Sanitary Improvements—summary 41 Infectious Disease and Disinfection 44 Complaints 50 Premises Periodically Inspected . 52 House-to-House Inspection 44 Overcrowding 49 Houses Unfit for Human Habitation 49 Factories and Workshops 53 Rent and Mortgage Interest Restriction Acts 49 Sanitary Conveniences 51 Places of Public Entertainment 51 Public Health (Meat) Regulations, 1924 54 Page. Dairies, Cowsheds and Milkshops 57 Milk (Special Designations) Order, 1923 58 Ice Cream Premises 60 Offensive Trades 54 Game Licences 60 Storage of Petroleum 62 Legal Proceedings 61 Execution of Works in Default 60 Staff 64 Report of School Medical Officer 67 School Medical Staff 69 School Medical Service in relation to the Public Elementary Schools 72 Medical Inspection 72 Infectious Diseases 74 Medical Treatment 76 Open-Air Education 79 Physical Training 80 Provision of Meals 80 School Baths 80 Co-operation of Parents, Teachers, School Attendance Officers and Voluntary Bodies 81 Blind, Deaf, Defective and Epileptic Children 82 Nursery, Secondary and Continuation Schools 83 Employment of Children and Young Persons 83 Special Enquiries and Miscellaneous 83 Statistical Tables 85 Warden & Co., Ltd , Printers, 11, Regents Parade, North Finchley, N.12.