Middt Borough of Finchley & SCHOOL MEDICAL OFFICER together with THE ANNUAL REPORT OF THE CHIEF SANITARY INSPECTOR ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937 Members of the Public Health Committee Chairman: Councillor Jones, LL.B. The Mayor (Alderman A. T. Pike, O.B.E., J.P.). The Deputy Mayor (Councillor H. A. Rutt). Alderman Briant. Councillor Grocott. ,, Pulham, J.P. ,, Mrs. Legge. ,, Syrett. ,, Mrs. Murphy Councillor Grobel. ,, Steward. Staff of the Public Health Department. Medical Officer of Health: *A. A. Turner, m.c., m.d., ch.b., d.p.h. Assistant Medical Officer of Health: *Miss C. Russell, m.b., ch.b., d.p.h. Chief Sanitary Inspector : *E. J. Franklin, f.r.san.i., f.s.i.a. Assistant Sanitary Inspectors: J. Gray, cert.r.san.i. G. H. cockell, cert.r.san.i. w. H. nicholls, 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. *Miss F. Hughes. *Miss C. Hemming. Chief Clerk : W. L. N. Relleen. Clerks: Miss K. M. Nichol. Miss F. Taylor. A. Field. Miss M. Powley. *Salary contribution made under the Public Health Acts or by Excnequer grants. 2 To the Mayor, Aldermen and Councillors of the Borough of Finchley. May, 1938. I have the honour to submit my Annual Report for 1937 on the health of the Borough. The vital statistics are very favourable indeed. The maternal mortality rate—1.09 per 1,000 births— and the infantile mortality rate—40.22 per 1,000 births—are both very satisfactory. In the case of infectious diseases the position is equally good. The number of notified cases of diphtheria, namely 11, was by far the lowest ever recorded, while the total mortality from all the infectious diseases was represented by one death from whooping- cough. The death rate from tuberculosis, 0.37 per 1,000 of the population, is very low. The rise in the birth rate which has been evident over the past few years has been maintained and is the highest since 1928. The death rate also shows a tendency to increase but, as will be seen in the body of the report, I believe that both these rates are exaggerated because the population is underestimated. I wish to express my thanks to Dr. Russell, Mr. Franklin, and all the staff of the Public Health Department for their willing and loyal assistance throughout the year. I am, Your obedient servant, A. TURNER. 3 SOCIAL CONDITIONS. Area (in acres) 3,477 Population, 1937 (Registrar-General's Estimate) 64,525 Number of Inhabited Houses (end of 1937) 17,227 Rateable Value (1937) 835,568 Sum represented by a Penny Rate £3,380 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births: Total. Males. Females. Legitimate 856 439 417 Illegitimate 39 22 17 Birth rate, 13.84 per 1,000 estimated resident population. Total. Males. Females. Stillbirths 25 12 13 Rate, 27.17 per 1,000 total (live and still) births. Total. Males. Females. Deaths 704 322 382 Death rate, 10.84 per 1,000 estimated resident population. Deaths, from diseases and accidents of pregnancy and child birth:— From sepsis — From other causes 1 Death rate of Infants under one year of age:— All infants per 1,000 live births 40.22 Legitimate infants per 1,000 legitimate live births 32.71 Illegitimate infants per 1,000 illegitimate live births 205.13 Deaths from Cancer (all ages) 103 Deaths from Measles (all ages) 0 Deaths from Whooping-cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 7 4 POPULATION. The Registrar-General estimates that the population on the 30th June, 1937, was 64,525. This is an increase of only 415 over the previous year. It is true that a part of the Borough, with a population of approximately 600, was transferred to Friern Barnet on the 1st April, 1937; nevertheless, for a number of reasons, it would appear that the RegistrarGeneral's estimate is too low and that the real figure is not less than 66,500. In consequence of the alteration of boundaries during the year, the Registrar-General suggests a population of 64,676 for the purpose of calculating the birth and death rates and the incidence rates of infectious diseases. The natural increase, or the excess of births over deaths, was 191. BIRTHS. In 1937 the number of live births registered was 895, an increase of 62 over the previous year. The birth rate was 13.84 as compared with 12.99 in 1936 and 10.97 in 1933. If the estimated populations of the Registrar-General are correct there has been a definite and progressive increase in the birth rate over the past 4 years, but this is difficult to believe and I think it is likely that much of the increase is only apparent and that the population has been consistently underestimated. The birth rate for England and Wales was 14.9. In 1937 there were 39 illegitimate births as compared with 36 in 1936. Twenty-five stillbirths were registered in 1937, giving a rate of 27.17 per 1,000 of all births. 5 77 88 BIRTH AND DEATH RATES FOR THE PAST 25 YEARS. INFANTILE MORTALITY In 1937 there were 36 deaths of infants under the age of one year, giving an infantile mortality rate of 40.22 per 1,000 live births as compared with 43.21 for 1936. The rate for England and Wales was 58 and for London 60. Of the 36 deaths no fewer than 29 were of males and only 7 of females, although the sexes were nearly equally represented in the total births. Nineteen deaths occurred during the first four weeks of life and 14 during the first week. DEATHS. The number of deaths registered in 1937 was 704, which is 61 more than in 1936 and the highest number ever recorded. The crude death rate was 10.84 as compared with 10.03 1936, and the standardised rate was 10.62 as compared with 9.83 in 1936. The death rate for England and Wales was 12.4. The diseases which show an increased mortality over 1936 are influenza, cancer, heart disease, and diseases of the blood vessels. Fifty-nine per cent. of all the deaths occurred in persons over 65 years of age. As in the case of the birth rate I am of the opinion that much of the increase in the death rate over the past few years is only apparent, and is largely accounted for by underestimating the population. POOR LAW RELIEF. During the year 507 families were in receipt of outdoor relief, and the total amount expended on such relief was £10,144 11S. 7d. Seven hundred and fifty-four persons were admitted to the Wellhouse Hospital, and of these 170 were admitted to the Lving-in Ward. 9 11 12 INFANTILE MORTALITY RATES FOR THE PAST 25 YEARS. INFANTILE MORTALITY DURING THE YEAR 1937. 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 14 3 2 ... 19 9 6 1 1 36 11 13 12 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... ... • • • ... ... ... ... ... ... ... ... Measles ... ... ... ... • • • ... • • • ... ... ... ... ... ... Scarlet Fever ... ... ... ... • • • ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... 1 ... ... ... ... 1 1 ... ... Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 ... ... ... ... 1 ... 1 ... Laryngitis ... ... ... ... • • • ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... • • • ... 1 ... ... 1 ... ... 1 Pneumonia (all forms) 1 1 ... ... 2 2 1 ... 1 6 1 1 4 Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... • • • Enteritis ... ... ... ... ... 2 3 1 ... 16 ... 3 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 1 ... ... Atelectasis 'Congenital 2 ... ... ... 2 ... ... ... ... 2 ... 1 1 Malformations ... 1 ... ... 1 2 ... ... ... 3 ... 1 2 Premature Birth 6 1 1 ... 8 ... • • • ... ... 8 2 5 1 Atrophy, Debility and Marasmus ... ... 1 ... 1 1 ... ... ... 2 1 1 ... Other causes 3 ... ... ... 3 1 1 ... ... 15 3 ... 2 Totals 14 3 2 ... 19 9 6 1 1 36 11 13 12 13 CAUSES OF, AND ACES AT, DEATH DURINC THE YEAR. No. CAUSES OF DEATH. NET DEATHS AT THE SUBJOINED AGES OF "RESIDENTS" WHETHER OCCURRING WITHIN OR WITHOUT THE DISTRICT. Total Deaths whether of 'Residents' or ' NonResidents' in Institutions in the District. WARDS. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15 15 and under 25. 25 and under 45. 45 and under 65. 65 and Upwards. North Ward. East Ward. West Ward. All Causes Certified 702 Uncertified 2 1. Typhoid and paratyphoid fevers ... ... ... ... ... ... ... ... ... ... ... ... ... 2. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping cough 1 1 ... ... ... ... ... ... ... ... 1 ... ... 5. Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Influenza 22 ... ... ... ... ... 3 5 14 3 11 5 6 7. Encephalitis lethargica 1 ... ... ... ... ... ... ... 1 ... ... ... 1 8. Cerebro-spinal fever ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Tuberculosis of respiratory system 22 ... ... ... 1 5 10 5 1 ... 6 6 10 10. Other tuberculous diseases 2 ... ... 1 ... ... ... 1 ... ... 1 1 ... 11. Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... 12. General paralysis of the insane, tabes dorsalis ... ... ... ... ... ... ... ... ... ... ... ... ... 13. Cancer, malignant disease 103 ... ... ... ... ... 8 40 53 18 33 31 39 14. Diabetes 9 ... ... ... ... ... 1 ... 8 2 1 4 4 15. Cerebral haemorrhage, etc. 36 ... ... ... ... ... 1 8 27 6 11 12 13 16. Heart disease 214 ... ... ... ... 1 3 38 172 28 65 69 80 17. Aneurysm 2 ... ... ... ... ... 1 1 ... ... 1 ... 1 18. Other circulatory diseases 33 ... ... ... ... ... ... 6 27 1 10 11 12 19. Bronchitis 16 1 ... ... ... ... ... 1 14 1 5 6 5 20. Pneumonia (all forms) 55 6 2 ... ... 1 7 20 19 8 18 21 16 21. Other respiratory diseases 7 ... ... ... ... ... 1 2 4 2 3 3 1 22. Peptic ulcer 6 ... ... ... ... ... ... 3 3 4 2 2 2 23. Diarrhœa, etc. (under 2 years) 7 6 1 ... ... ... ... ... ... ... 2 4 1 24. Appendicitis 5 ... ... ... 1 ... 1 2 1 3 2 1 2 25. Cirrhosis of liver 2 ... ... ... ... ... ... 1 1 1 ... 1 1 26. Other diseases of liver, etc. 4 ... ... ... ... ... ... 1 3 ... ... 3 1 27. Other digestive diseases 17 ... ... ... ... ... 1 9 7 3 2 11 4 28. Acute and chronic nephritis 23 ... ... ... ... ... 2 8 13 4 8 9 6 29. Puerperal sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... 30. Other puerperal causes 1 ... ... ... ... ... 1 ... ... ... 1 ... ... 31. Congenital debility, premature birth, malformations, etc. 19 19 ... ... ... ... ... ... ... 3 5 9 5 32. Senility 9 ... ... ... ... ... ... ... 9 1 1 4 4 33. Suicide 8 ... ... ... ... ... 5 3 ... ... 1 2 5 34. Other violence 27 1 1 2 ... 2 2 3 14 19 7 11 9 35. Other defined causes 52 2 ... 1 ... 6 10 10 23 9 20 18 14 36. Causes ill-defined or unknown 1 ... ... ... ... ... ... ... 1 ... ... 1 ... TOTALS 704 36 4 4 5 16 57 167 415 116 217 245 242 15 16 VITAL STATISTICS FOR THE PAST TWENTY YEARS. Year. Total Births. Birth Hate. Total Deaths. Death Rate. Total Infant Deaths. Infantile mortality rate. Deaths from Measles. Deaths from Whooping Cough. Deaths from Diarrhoea, (under 2 years). 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 51.2 2 1 3 1928 760 14.3 511 9.6 28 36.8 10 7 2 1929 704 12.8 604 11.0 32 45.5 1 6 5 1930 748 13.3 557 9.9 38 50.8 5 1 7 1931 761 12.9 588 10.0 42 55.2 1 ... 6 1932 698 11.6 621 10.3 35 50.0 4 3 3 1933 671 10 97 592 9.7 27 40.2 ... 3 6 1934 712 11.54 658 10.67 42 59.0 1 13 4 1935 807 12.88 656 10.47 39 48.5 ... ... 17 1936 833 12.99 643 10.03 36 43.21 2 l 6 1937 895 13.84 704 10.84 36 40.22 ... 1 7 •7 GENERAL PROVISIONS 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:— "The total number of beds reserved for the sole use of the County Council at the close of 1937 is as follows:— Accommodation. Institution. Adults. Children. Type of case Male. Female. County Sanatorium, Harefield 150 150 60 Pulmonary—sanatorium. 4 4 10 do. observation. County Sanatorium, Clare Hall, South Mimms 132 66 - do. late sanatorium and hospital. Victoria Home, Margate - - 6 Non-pulmonary. In addition to the above, further beds for pulmonary cases, and beds for non-pulmonary cases are obtained, as and when required, at a large number of voluntary and municipal hospitals and sanatoria, not under the control of the County Council, and situated in various parts of the country." 2. Maternity.—There is a well-equipped lying-in ward in the Wellhouse Hospital, Barnet. One hundred and seventy Finchley cases were admitted to this ward in 1937. 3. Children.—A grant of £20 per annum is paid by the Local Authority to the Royal Northern Hospital, and in return the staff of the hospital see cases of difficulty referred to them by one or other of the Maternity and Child Welfare Centres. 4. Infectious Diseases.—Cases of the common infectious diseases are admitted to the Finchley, Hornsey, Wood Green and Friern Barnet Joint Isolation Hospital at Muswell Hill, N.10. The hospital contains 150 beds. 18 Cases of Puerperal Pyrexia are admitted to theNorth Western Hospital and Queen Charlotte's Isolation Hospital. Cases of Ophthalmia Neonatorum are admitted to St. Margaret's Hospital. 5. Smallpox.—The provision of hospital accommodation for cases of Smallpox is undertaken by the County Council, and by arrangement with the London County Council all cases are admitted to that authority's hospital at Joyce Green, Dartford. 6. Other Hospitals:—(a) The Finchley Memorial Hospital contains 72 beds and receives annually a grant of two hundred 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 belonging to the Hertfordshire County Council and admitting cases from this part of the County of Middlesex. During 1937, 754 Finchley cases were admitted to this hospital. Other Institutions. 1. Unmarried mothers:— A grant of ten guineas per annum is paid by the Council to the Hornsey Deanery Association in respect of unmarried mothers admitted to their institution. 2. Illegitimate Infants and Homeless Children:— Wright-Kingsford Home, 120 children. Nazareth House, N.2, 45 children. These Homes are in no way supported by the Local Authority. 19 Ambulance Facilities. (a) Infectious Cases.—Arrangements have been made by the Joint Hospital Committee with the London County Council for the conveyance of all cases of infectious disease from their homes to the Joint Isolation Hospital. (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 349 accidents and 490 private cases. Mortuary. During 1937, 75 bodies were received in the mortuary, 10 of these belonging to Friern Barnet. The new mortuary, on the North Circular Road, near the Fire Station, is nearing completion. This is a thoroughly modern building equipped with a a refrigerating plant to ensure that bodies are kept under the best possible conditions. There is an excellent post-mortem room, a viewing room constructed in the form of a small chapel, relatives' waiting room, and doctors' room. It is hoped that the new mortuary will, in future, be used as a temporary resting place for bodies which are so frequently retained in small crowded houses or flats under very unsatisfactory conditions. 20 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, Essex Park, N.3 Do. Do. Bourchier House, Oak Lane, N.2 Do. Do. (b) Ante-natal Clinic Do. Do. Do. (c) Day Nursery Do. Two large rooms Do. School Clinics (a) Minor Ailments Do. Waiting room and treatment room Do. Summerside School Waiting room and treatment room Do. (b) Dental Clinic Bourchier House, Oak Lane, N.2 Waiting room, 2 treatment rooms and recovery room Do. (c) Ophthalmic Clinic Martin School Waiting room and retinoscopy room Do. (d) X-Ray Clinic University College Hospital (e) Tonsils and Adenoids Clinic Finchley Memorial Hospital Tuberculosis Dispensary Chester Villa 655, High Ruad, N.12 ... Middlesex County Council Venereal Disease Clinic Royal Northern Hospital, Holloway Road, N.7 ... Do. 2 I 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. During the year 9 midwives notified their intention of practising within the area, and they attended 88 cases in the capacity of midwife and 61 cases as maternity nurse. Two Municipal midwives are employed by the Council. Legislation in Force. Details were set out in the report for 1934 and it is not considered necessary to repeat them. 22 SANITARY CIRCUMSTANCES OF THE AREA. Water. The Borough is supplied with water from three sources. By far the greater part is supplied by the Barnet District Gas and Water Company, and two small areas by the Colne Valley Water Company and the Metropolitan Water Board respectively. The water of the Barnet Company is derived from deep wells in the chalk. The wells are at New Barnet, East Barnet, Potters Bar, Tyttenhanger, Roestock, Northaw, Hatfield and North Mimms. The water is chlorinated at each of the pumping stations except Northaw and East Barnet where there is a heavy overlay of clay on top of the chalk and where the liability to pollution is extremely remote. The bulk of the water is examined bacteriologically every day and detailed examinations are made at each pumping station once a week. Of 529 samples taken in 1936, 96.4 per cent. contained no B. Coli in 100 c.c. Each month a copy of a report of a bacteriological examination carried out by an independent bacteriologist is sent by the Company to the Medical Officer of Health. Once every three months a sample is taken by this Department and submitted to bacteriological examination, and the following is a typical report:— No. of Bacteria per c.c. On Agar in 3 days at 200 C. 1 1 day at 370 C. o 2 days at 370 C. 1 Bacillus Coli Absent in 100 c.c. Bacillus Welchii Absent in 100 c.c. 23 The Colne Valley Water Company supplies the part of the Borough transferred from Hendon as the result of adjustment of boundaries—namely, the Finchley Golf Course. This Company's water is also derived from deep wells in the chalk and is chlorinated and partially softened before distribution. The purity of the supply is ensured by constant sampling for bacteriological and chemical examination. In 1936 of 506 samples of chlorinated and softened water examined bacteriologically, 97.2 per cent. showed the absence of B. Coli in 100 c.c. The Metropolitan Water Board supplies certain parts on the Eastern and Southern boundaries of the Borough— namely:— 1-31 and 2-42, Cherry Tree Road. 65-81, Summerlee Avenue. Gardener's Cottage, Stable, Chauffeur's Lodge and 4 garages with rooms over, attached to "The Firs," Hampstead Heath. "Heath End House,'' Hampstead Heath. The Spaniards Public House. West Lodge to Kenwood Farm, Hampstead Lane. "Spaniards Field," Wildwood Rise. Removal off House and Trade Refuse. House refuse is collected weekly, and in the summer months a bi-weekly collection is made from a certain number of flats. Trade refuse is collected on payment. The contract for refuse removal changed hands during the year and a new type of rear loading van is employed. All the refuse is incinerated. 24 Schools. The sanitary condition of the Council Schools is satisfactory, and there has been a definite improvement in certain non-provided schools, but in some the sanitary accommodation and facilities for washing still leave much to be desired. Drinking water direct from the main should be provided in all schools, but unfortunately this is not the case at present. Swimming Baths and Pools. A description of the bathing facilities was given in the report for 1935. During the year a new filtration plant of adequate capacity was installed at the Squires Lane indoor bath and this has brought about a very marked improvement in the condition of the water. THE PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Diphtheria. In 1937, only n cases of diphtheria were notified as compared with 28 in 1936 and 29 in 1935. For some years the incidence of the disease has been low, but in 1937 the number of cases was the lowest since reliable records have been kept. There were no deaths. Nine cases were removed to hospital, and two mild cases in good class houses were kept at home. Immunisation against Diphtheria. During the year immunisation of the children in the junior elementary schools was continued and practically completed so that every child with the exception of the latest entrants has had the opportunity of protection. Approximately 75% of these children have now been immunised. Five hundred and sixteen children received the full 25 course of three injections of T.A.F. The Schick Test was applied to 506 children who had previously been immunised, and of the 474 of these who were subsequently examined, 470 were negative and 4 positive. Thus 99.2% had been successfully immunised. No immunised child contracted diphtheria in 1937. I wish once more to record my appreciation of the valuable co-operation of the head teachers in making- this scheme a success. The following table shows the number of children dealt with during 1937 :— DIPHTHERIA IMMUNISATION. Ages Number of Children who received Result 1 injection. 2 injections 3 injections Schick tested Negative Positive Absent 1 1 ... ... 1 ... ... 1 2 3 6 23 10 8 ... 2 3 3 10 22 9 7 ... 2 4 1 6 22 16 14 1 1 5 4 7 79 75 71 1 3 6 3 5 66 49 48 ... 1 7 1 5 51 50 48 1 1 8 ... 1 47 50 45 1 4 9 ... 2 36 97 92 ... 5 10 2 2 81 105 99 ... 6 11 1 1 69 31 29 ... 2 12 1 ... 11 9 7 ... 2 13 ... ... 9 4 2 ... 2 Totals 20 45 516 506 470 4 32 26 INCIDENCE OF DIPHTHERIA FOR THE PAST 25 YEARS. 27 28 Scarlet Fever. There was an increase in the number of cases of scarlet fever in 1937 over the previous year, the figures being 146 as compared with 91. The disease was mild in character and there were no deaths. One hundred and eighteen cases were removed to hospital. Enteric Fever. Two cases of paratyphoid B. were notified during the year. One was removed to hospital and one nursed at home, and both recovered. In neither case was the source of infection discovered. . Pneumonia. The number of notifications received was 56, and the number of deaths 77, which include 22 deaths from influenzal pneumonia. Measles. Measles was not prevalent in 1937. Three cases were treated in the Isolation Hospital. There were no deaths. Whooping Cough. Whooping Cough was fairly prevalent in 1937, but the disease was fairly mild in character. There was one death. Influenza. The epidemic of Influenza which started at the end of 1936 continued throughout the early months of 1937 and a large number of the population were affected. There were 22 deaths. Poliomyelitis. Four cases of acute anterior poliomyelitis were notified in 1937 and all the patients were children, their ages being 2 years, 4 years, 11 years and 13 years. All the cases were comparatively mild. One was nursed at home and made a 29 complete recovery, two were admitted to the Isolation Hospital and later transferred to other hospitals for orthopaedic treatment, while the fourth was admitted to the Hospital for Paralysis and Epilepsy, Maida Yale. No source of infection was discovered and no connection could be traced between the individual cases. Dysentery. Two cases of dysentery were notified. One case was of the Shiga variety and the disease appeared to have been contracted in Germany, while the other was Sonne. Diarrhoea was prevalent in the Borough in the autumn but in the great majority of cases a doctor was not called in as the condition was not severe and cleared up in two or three days. Nevertheless, I have little doubt that Sonne Dysentery was the cause in many instances. Erysipelas. Fifteen cases of erysipelas were notified in 1937 and 6 of these cases were removed to the Isolation Hospital. There were no deaths. Smallpox. No case of smallpox was notfied in 1937. Vaccinations. No vaccinations were performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. Isolation Hospital. The Isolation Hospital is owned jointly by Finchley, Hornsey, Wood Green and Friern Barnet. It is situated at Coppetts Road, N.10, and contains 150 beds. The accommodation has proved adequate for the needs of the constituent Authorities and at no time during the year has any difficulty been met in getting patients admitted. By arrangement with the London County Council patients are conveyed to hospital by their ambulances, a scheme which works exceedingly well. 30 NCIDENCE OF SCARLET FEVER FOR THE PAST 25 YEARS. 31 32 Bacteriological Work. The bacteriological work for the district is carried out at the Joint Isolation Hospital, and during 1937 following specimens were dealt with:— Positive. Negative. Total. Diphtheria 19 269 288 Pulmonary Tuberculosis 10 90 100 Enteric Fever — 3 3 Other Specimens — 17 17 408 The following table shows the conditions as to overcrowding of the households invaded by Diphtheria and Scarlet Fever during 1937:— 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 age. Cases under 15 years of age. Susceptibles (including those attacked) under 15 years of age. Diphtheria: Home Cases 2 4 ... ... ... ... Hosp. Cases 2 6 5 12 ... ... Scarlet Fever: Home Cases 16 25 5 9 ... ... Hosp. Cases 30 57 58 142 3 13 TOTALS 50 92 68 163 3 13 (These figures do not include six cases which occurred in institutions.) 33 Health Education. Two hundred and fifty copies of "Better Health" have been distributed monthly at the Infant Welfare Centres and they are greatly appreciated. The Council took part in the National Campaign to encourage the wider use of the Health Services. Large posters were exhibited on hoardings, small posters were placed on the Council's boards and distributed to shops throughout the Borough, and many thousands of folders were distributed through the medium of the schools, welfare centres, and many local organisations. I regret to say that the tangible results produced by these efforts at health propaganda were somewhat meagre. 34 NOTIFIABLE DISEASES DURING THE YEAR 1937. 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 2 ... 2 2 2 ... 2 ... ... ... 11 2 8 1 9 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever Cases Notified ... 2 3 6 15 75 21 7 10 6 1 ... 146 69 30 47 118 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (Influenzal) Cases Notified ... ... ... ... ... 1 ... ... 4 ... 5 4 14 5 6 3 1 Deaths ... ... ... ... ... ... ... ... 2 1 5 14 22 11 5 6 ... Pneumonia (Other forms) Cases Notified 4 2 2 ... 3 2 1 ... 2 5 9 12 42 12 15 15 3 Deaths 6 2 ... ... ... ... ... ... 1 7 20 19 55 18 21 16 ... Erysipelas Cases Notified ... ... ... ... ... ... ... 1 4 3 5 2 15 4 9 2 6 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever Cases Notified ... ... ... ... ... ... ... 1 1 ... ... ... 2 ... ... 2 1 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever Cases Notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia Cases Notified ... ... ... ... ... ... ... ... 3 ... ... ... 3 1 ... 2 1 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis Cases Notified ... ... 1 ... 1 ... 2 ... ... ... ... ... 4 1 2 1 3 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica Cases Notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... Cerebro-Spinal Fever Cases Notified ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum Cases Notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria Cases Notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Smallpox Cases Notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery Cases Notified ... ... ... ... ... 1 ... ... 1 ... ... 2 ... 1 1 ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TOTALS Cases Notified 4 5 8 6 21 81 26 9 28 14 20 18 240 95 71 74 142 Deaths 6 2 ... ... ... ... ... ... 3 8 25 34 78 29 26 23 ... 35 36 Tuberculosis. During the year 60 new cases of pulmonary tuberculosis were notified comprising 26 males and 34 females. Five non-pulmonary cases were notified comprising 3 males and 2 females. There were 22 deaths from pulmonary tuberculosis as compared with 26 in 1936, and 2 from non-pulmonary tuberculosis, the same as in 1936. This gives a total of 24 deaths from all forms of tuberculosis, 14 males and 10 females. The death rate for the disease is 0.37 per 1,000 of the population. In 29.2% 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 non-tubercular 119 examined for first Diagnosed as tubercular 43 time during 1937 Undiagnosed and under observation 3 Number of tubercular cases transferred into district 6 Number of cases suffering from tuberculosis examined at the dispensary during 1937 184 Number of cases under observation at the dispensary, etc., on 31/12/37 133 37 TUBERCULOSIS DURING THE YEAR 1937. Age-periods New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year ... ... ... ... ... ... ... ... 1 to 5 years ... ... ... ... ... ... 1 ... 5 to 15 years 1 2 1 1 ... 1 ... ... 15 to 25 years 2 13 2 1 3 2 ... ... 25 to 35 years 10 14 ... ... ... 2 ... ... 35 to 45 years 3 3 1 1 5 3 ... ... 45 to 55 years 6 1 ... 1 3 ... ... ... 55 to 65 years 2 1 ... ... 1 1 ... ... 65 & upwards 2 ... ... ... 1 ... ... 1 Total 26 34 4 4 13 9 1 1 North 6 11 1 ... 5 1 1 ... Wards: East 12 14 ... 2 4 2 • • • 1 West 8 9 3 2 4 6 ... ... Removed to Hospital or Sanatorium 27 22 3 2 ... ... ... ... 38 MATERNITY AND CHILD WELFARE. There has been no change in the number of sessions at the welfare centres, but the numbers have again shown a large increase over the previous year. The voluntary workers have continued to give much valuable service at the welfare centres which is greatly appreciated by everyone concerned. Infant Welfare Centres. The attendances of children at the centres in 1937 were 18,581 as compared with 17,004 in 1936. Children under one year of age made 10,226 attendances and children over one year 8,355. The number of examinations made by the doctor in attendance was 6,647. The average attendance per session was 52. There has been a good deal of overcrowding at the centres in the North and West Wards and this is partly due to the fact that there were 85 children on the registers who lived in the Borough of Hendon and who had no centre belonging to their own Council within a reasonable distance. It became necessary to ask the Hendon Council to make provision for their children. The Council also decided to increase the sessions at which a doctor attends from 3 per fortnight to 2 per week at each of these 2 centres. A part time Medical Officer has been appointed on this account and she has taken charge of the North Finchley Centre from the 1 st April, 1938. Ante-Natal Clinic. There has been another marked increase in the number of pregnant women attending during the year—395 as compared with 319 in 1936 and 234 in 1935. The total attendances were 1,482 as compared with 1,192 in 1936. The number of mothers attending was equal to 46.75% of the total notified births. At her first attendance each patient has a general medical examination and any abnormality which might complicate 39 her pregnancy is watched and if treatment is necessary she is sent to her own doctor or to hospital. A report of the examination is sent to the midwife when one is engaged. Instruction in the care of her own health and in preparation for her baby is given. Milk is supplied to necessitous cases and dental treatment is recommended and increasing advantage of it is being taken. When dentures are required they are obtained through the Voluntary Association, who also help with the cost when mothers cannot pay the full amount. The health visitors and the municipal midwives attend the clinic in turn and visit those patients who do not keep their appointments. A small number of patients return for a postnatal examination, but the majority of those attended by the municipal midwives will do so in future. Those confined in Wellhouse return there for examination. During the year 413 women attended the antenatal clinic of whom 395 were pregnant, 179 being first and 216 second or subsequent pregnancies. Fourteen were found not pregnant and 4 came because of sterility. The total attendances were 1,482. At the end of the year 110 had not been confined and 18 had left the district. As far as could be ascertained 227 had normal confinements. Eleven patients had instrumental deliveries, 7 breech, and there were 6 sets of twins. Eight pregnancies ended in stillbirths and 6 in miscarriages. Two mothers had serious organic heart disease. One was in hospital for several weeks before and after her confinement and the other had a premature baby which died. Midwives Act, 1936. The Local Supervising Authority is the County Council but the Town Council act as their agents in the provision of a domiciliary midwifery service in pursuance of the above Act. Two midwives have been appointed by the Town Council and they took up their duties in October, 1937. Owing to the fact that most mothers make arrangements for their confinements several months ahead, the midwives did not attend many cases before the end of the year. 40 Accommodation for Maternity Cases. According to the Registrar-General 920 children were born to Finch ley parents in 1937, but the Public Health Department had knowledge of only 844. The following table shows the places of birth of Finchley children for the past four years:— 1934 1935 1936 1937 Private homes in Finchley 356 324 322 334 Nursing Homes in Finchley 57 70 59 59 Wellhouse Hospital, Barnet 122 125 I25 136 North Middlesex County Hospital 3 9 60 73 London Hospitals 85 128 141 97 Nursing Homes outside Finchley 63 81 68 121 Private homes outside Finchley 2 2 20 24 688 739 795 844 It will be seen that the tendency for women to have their confinements away from home continues to increase, the percentage in 1934 being 48 and 60 in 1937. The Council have continued to bring to the notice of the Ministry of Health and the Middlesex County Council the urgency for the provision of adequate maternity accommodation readily accessible to Finchley women and it would appear that the position is realised by all concerned as the County Council have stated that they are anxious and willing to provide the necessary accommodation at the earliest possible date. For the present we can only hope that that date is not far distant. Maternal Mortality. In 1937 there was only one maternal death as compared with three in the previous year. The maternal mortality rate was 1.09 per 1,000 births, while the rate for England and Wales was 3.23. 41 The Supply of Milk for Mothers and Children. The supply of milk and accessory foods for children is organised by the Voluntary Association, and for that purpose the Association receives an annual grant of £75 from the Council. Milk for necessitous expectant and nursing mothers is provided by the Council free or at half price according to an income scale. Up to two pints a day may be given at the discretion of the Medical Officer. All the milk provided must be pasteurised. The number of mothers in receipt of milk showed a large increase over the previous year—98 free and 20 at half price —as compared with 58 free and 5 at half price in 1936. The cost to the Council was approximately £125. Puerperal Pyrexia and Puerperal Fever. In 1937 three cases of puerperal pyrexia were notified. One was removed to hospital and 2 nursed at home. All recovered. Ophthalmia Neonatorum. It is gratifying to be able to report that no case of ophthalmia neonatorum was notified in 1937. Home Visiting. During the year the health visitors made 4,857 visits in connection with Maternity and Child Welfare work, as compared with 4,811 in 1936. Dental Treatment. Expectant and nursing mothers who are in need of dental treatment are referred by the doctor 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. Periodical visits are made by the dentists to the Welfare Centres for the purpose of inspecting the teeth of the children in attendance. 42 The amount of work done by the dentists continues to increase, and the Council have decided to increase the number of weekly sessions from 2 to 3 from the 1st April, 1938. Mothers. Children. 1936 1937 1936 1937 Number inspected 118 176 313 289 Number treated 98 170 178 212 Number of attendances 462 626 393 451 Fillings 205 351 274 365 Extractions 571 823 294 473 Gas administrations 88 61 87 119 Other operations 33 82 81 83 Dentures supplied 36 47 — — Dentures repaired 7 6 — — Visits re dentures 106 142 — — Day Nursery. The number of attendances at the Day Nursery shows a slight increase on the previous year. 1937 1936 Children attending 68 82 Total attendances 6,586 6,405 Receipts from mothers £152.3.8 £159.12.6 Children Act, 1908. Part I, Children and Young Persons Act, 1932, and Public Health Act, 1936. Part VII. At the beginning of the year there were on the register 17 mothers receiving 37 children, while at the end of the year there were 20 mothers receiving 40 children. Practically all the children attend the Infant Welfare Centres, but frequent home visits are also paid by the Health Visitors. No case called for any special action by the Council. 43 The following report was submitted to the Maternity and Child Welfare Sub-Committee and approved by the Council in December, 1937:— In accordance with your instructions I have pleasure in reporting on certain aspects of the Council's Scheme for Maternity and Child Welfare. (1) Antenatal Clinic. The Antenatal Clinic is situated at Bourchier House, Oak Lane, N.2, and prior to 1932 one session was held per fortnight, in 1932 two sessions, in 1936 three sessions, and in 1937 this number was increased to two per week. The attendances in 1932 were 400 and in 1936 they numbered 1,192. The work is carried out by the Assistant Medical Officer and Health Visitors. No further extension is contemplated at present. (2) Health Visitors. There are three Health Visitors and School Nurses, each of whom is responsible for home visiting in her area, Infant Life Protection, attendance at the appropriate Infant Welfare Centre, and Antenatal Clinic, and School Medical Work. Three-fifths of their time is devoted to Maternity and Child Welfare and two-fifths to School Medical Work. (3) Infant Welfare Centres. There are three Infant Welfare Centres in the Borough, and there has been no increase in the number of sessions since 1932. (a) Congregational Hall, Nether Street, N.12. Open Thursday and Friday afternoons. Assistant Medical Officer attends every Friday and alternate Thursdays. (b) Wesleyan Schoolroom, Essex Park, N.3. Open Tuesday and Thursday afternoons. Assistant Medical Officer attends every Tuesday and alternate Thursdays. (c) Bourchier House, Oak Lane, N.2. Open Wednesday morning and afternoon and Friday afternoons. Assistant Medical Officer attends Wednesday morning and afternoon. The attendances at the three Infant Welfare Centres have increased from 12,073 in 1932 to 17,004 in 1936, and in consequence it has become increasingly difficult for the doctor and nurse to give the necessary amount of individual attention. The North and West Centres have been affected most and additional medical sessions are needed at both. On the 30th September last the numbers of children on the registers of the three Centres were as follows:— North Finchley 525, including 42 from Hendon and 33 from Friern Barnet. East Finchley 508. West Finchley 578, including 43 from Hendon. 44 (4) Dental Treatment. At present the School Dental Officers devote two sessions per week to the inspection and treatment of expectant and nursing mothers, and children under 5 years of age. Another session per week will be required in the next financial year. (5) Treatment by Artificial Sunlight. In the new Health Centre at Oak Lane it is proposed to establish a clinic for artificial sunlight treatment of children who would benefit by this form of therapy. Such treatment would occupy the time of a nurse for 2-3 half-days per week (6) Health Education. Owing to lack of staff too little has been done in the way of talks and demonstrations to the mothers at the Centres, a form of health education which I think is very valuable. This is suitable work for a Health Visitor. (7) Provision of a Centre in the Hampstead Garden Suburb. A fair number of mothers from the Hampstead Garden Suburb take their children to the Centre at Oak Lane. The distances from most parts of the Suburb to this Centre are very considerable and I am convinced that there is a need for a more accessible Centre, say in the vicinity of Ossulton Way. (8) Medical Staff. When the Assistant Medical Officer was appointed in 1932 she devoted two-thirds of her time to Maternity and Child Welfare and one-third to School Medical Work, but now she is actually giving four-fifths to the former and one-fifth to the latter. Also during the past year or two more time has been taken up by immunisation and the administration of anaesthetics at the Dental Clinics, with the result that we are finding it difficult to cope with the work. (9) Suggestions. I recommend that your Sub-Committee should give consideration to the following suggestions:- (i) That the Hendon Borough Council be requested to make provision, as soon as possible, for the Hendon children who are now attending the Finchley Centres. (ii) That as from the 1st April, 1938, a part-time Assistant Medical Officer be appointed for Maternity and Child Welfare work for 2 sessions per week at 1½ guineas per sessionthe cost for the next financial year would be £164. (iii) That as from the 1st April, 1938, an extra session be devoted to the dental treatment of Maternity and Child Welfare cases at an approximate cost of £85 per annum (a corresponding amount would be saved by the Education Committee). (iv) That immediate steps be taken for the provision of a small Infant Welfare Centre in the vicinity of Ossulton Way to serve the southern part of the Borough. (v) That as from the 1st October, 1938, an additional Health Visitor be appointed for Maternity and Child Welfare work only. The approximate cost in the next financial year would be £100. A. TURNER, Medical Officer of Health. 45 Housing Statistics for the Year 1937. Number of New Houses erected during the Year:— (a) Total (including numbers given separately under (b) (i.) By the Local Authority Nil (ii.) By other Local Authorities Nil (iii.) By other bodies and persons 360 (b) With State assistance under the Housing Acts :— (i.) By the Local Authority. (a) For the purpose of Part II of the Act of 1925 Nil (b) For the purpose of Part III of the Act of 1925 Nil (c) For other purposes Nil (ii.) By other bodies and persons Nil 1.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses spected for housing defects (under Public Health or Housing Acts) 1,522 (b) Number of inspections made for the Purpose 6,555 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 254 (b) Number of inspections made for the purpose 1,786 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 166 46 2.—Remedy of Defects during the Year without Service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 138 3.—Action under Statutory Powers during the Year:— A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:- (1) Number of dwelling-houses in respect of which notices were served requiring repairs 9 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By Owners 7 (b) By Local Authority in default of owners — B. Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 7 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By Owners 8 (b) By Local Authority in default of owners — C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 4 47 D. Proceedings under Section 12 of the Housing Act, 1936:- (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 4.—Housing Act, 1936 — Part IV — Overcrowding: (a) (i) Number of dwellings overcrowded at the end of the year 43 (ii) Number of families dwelling therein 43 (iii) Number of persons dwelling therein 316 (b) Number of new cases of overcrowding ported during the year 52 (c) (i) Number of cases of overcrowding lieved during the year 72 (ii) Number of persons concerned in such cases 475 (d) Particulars of any cases in which crowding was abated and again recurred — 5.—Number of houses owned by the Local Authority as follows:— (1) Housing Act, 1890 160 (2) Housing Act, 1919 200 (3) Housing Act, 1923 54 (4) Housing Act, 1925, Part III 121 (5) Other houses owned and let (mainly for occupation of Council employees) 70 48 HOUSING. No houses or flats were erected by the Town Council during the year, but further progress was made with the scheme for the erection of flats on the Red Lion Hill site. It has been decided to proceed as quickly as possible with the erection of 101 flats on this site and 6 houses for large families on another site to meet the immediate needs of the Borough in relieving the outstanding cases of overcrowding and rehousing families displaced from clearance areas and individual unfit houses, and families displaced from houses on the Red Lion Hill site which wiil have to be demolished. At the time of writing this report, 36 flats are in course of erection. At the beginning of 1937 there were 63 overcrowded families and during the year 52 new cases were reported. Seventy-two cases of overcrowding were relieved and at the end of the year 43 cases were outstanding. FOOD. Meat and Other Foods. Under the Public Health (Meat) Regulations, 1924, 7,861 carcases were inspected, and a large amount of meat was condemned as unfit for the food of man. A full account of this work will be found in the report of the Chief Sanitary Inspector. MILK SUPPLY. Details of the inspection of dairies, cowsheds and milk shops, together with the bacteriological results of samples will be found in the report of the Chief Sanitary Inspector. 49 Sale of Food and Drugs Act. 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 3ist December, 1937. Article. Samples Taken. Adulterated. Milk 76 — Butter 5 1 Cream 7 — Sild 1 — Gin 1 — Hake 1 — Lemon Sole 1 — Lamb's Liver 3 1 Sheep's Liver 1 — Sausages 1 1 Whisky 3 — Vinegar 5 2 Totals 105 5 50 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. 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) 265 1 ... Workshops (including Workshop Laundries) 211 2 ... Workplaces (Other than Outworkers' Premises) 118 1 ... TOTALS 594 4 ... 51 2.—Defects Found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of offences in respect of whicn Prosecutions were instituted. Found. † Remedied Referred to H.M. Inspector. Nuisances under the Public Health Acts:* Want of Cleanliness 59 62 ... ... Want of Ventilation 2 2 ... ... Overcrowding ... ... ... Want of drainage of floors ... ... ... ... Other Nuisances 35 32 ... ... Sanitary accommodation insufficient 2 3 ... ... unsuitable or defective not separate 40 45 ... ... for sexes ... ... ... ... 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) ... ... ... ... TOTALS 138 144 ... ... *Including those specified in Sections 2, 3, 7, and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. •{•Including defects standing over from the previous year. 52 ANNUAL REPORT of the CHIEF SANITARY INSPECTOR FOR THE YEAR 1937 BOROUGH of FINCHLEY ANNUAL REPORT OF THE Chief Sanitary Inspector For the Year 1937 To the Mayor, Aldermen and Councillors of the Borough of Finchley. I have the honour to present to you my Thirty-sixth Annual Report dealing- with the work carried out by your Sanitary Inspectors during the Year 1937. The total number of inspections made during the year was 12,919. At 1,212 of the houses and other premises visited, defects or nuisances to the number of 3,787 were discovered, and at the end of the year 2,799 of these had been remedied or abated, the work in connection with 901 was in hand, and the remaining 87 were outstanding. In order to ascertain that the sanitary defects were being properly remedied, 1,437 visits were paid to the respective premises while the work was in progress. 54 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 254 Special Inspections 3201 Inspections of Houses-let-in-Lodgings 101 Re-Inspections 3610 Inspections of Works in Progress 1437 Inspections of Factories, Workshops and Workplaces (including Bakehouses and Restaurant kitchens) 623 Visits to Slaughterhouses 701 Inspections of Cowsheds, Dairies and Milkshops 149 Inspections of Ice Cream Premises 131 Inspections of Meat, Fish and other Food Shops 246 Inspections of Shops (Shops' Act) 1381 Visits re Infectious Disease 874 Miscellaneous 211 Total number of Inspections and Re-inspections 12,919 Total number of Houses inspected under :— (a) Public Health Acts 1080 (b) Housing Acts 442 1522 Total number of other premises visited 1302 Overcrowding Survey. Number of visits arising out of the original overcrowding survey, and visits to measure rooms for the purpose of furnishing landlords with information for entry in rent books 7457 55 Summary of Sanitary Improvements Carried Out. Drainage. Number of Houses and Premises re-drained 8 Repairs or amendments to existing drains 70 Drains or Gullies unstopped or cleansed 150 Length in yards of Stoneware Drains laid 645 Length in yards of Heavy Cast Iron Drains laid 103 Manholes provided 27 Manholes repaired 49 Intercepting Traps fixed 5 Fresh Air Inlets provided or repaired 42 New Gully Traps fixed 65 Gully Curbs provided or repaired 74 New Soil Pipes and Ventilating Shafts fixed 32 Soil Pipes and Ventilating Shafts repaired 17 Water Tests applied 277 Smoke Tests applied 59 Air Tests applied 29 Water Closets and Sanitary Fittings. New W.C. Basins fixed 12b W.C.'s unstopped, cleansed or repaired 88 New Flushing Boxes fitted to W.C.'s 44 Existing Flushing Boxes repaired 30 Joints between W.C.'s and Flush Pipes repaired 17 New W.C. Apartments provided 16 Ventilated Lobbies provided 6 Existing W.C. Apartments improved 7 Urinals provided 2 Urinals abolished — Urinals cleansed or repaired 7 Lavatory Basins provided 44 Baths provided 14 New Impervious Sinks provided 37 New Waste Pipes fixed 72 Waste Pipes trapped, repaired or unstopped 59 56 Miscellaneous. New Roofs constructed H 2 Roofs repaired 114 Eaves Guttering renewed, cleansed or repaired 59 Stack Pipes provided, repaired or unstopped 48 Stack Pipes disconnected from Drains 1 Damp Walls remedied 101 Walls repointed, repaired or underpinned 59 Chimney Stacks repaired 22 Ventilation under floors provided 18 Site of room concreted 1 Yards Paved 18 Paving of yards repaired 20 Mews Paved 2 Floors of Rooms relaid 3. Floors of Rooms repaired 61 Rooms cleansed, distempered or repapered 508 Means of Ventilation to Rooms provided — Windows repaired and/or made to open 179 New Windows provided 15 New Sash Cords provided 432 Window sills repaired or provided 38- Doors provided or repaired 29. Doorsteps provided or repaired 12 Artificial Lighting to Staircases provided 4 Natural Lighting to Staircases provided 1 Staircases repaired 20 Ventilated Food Stores provided 14 New Ranges and Stoves provided 26 Stoves and Ranges repaired 68 Coppers provided 1 Coppers repaired 21 WTorkrooms (including Bakehouses) cleanse 1 and repaired 36 Cisterns provided 11 Cisterns repaired, cleansed and covered 24 Water Supply provided 1 Water Service Pipes repaired 11 Movable Sanitary Dustbins provided 151 57 Offal Bins provided 4 Nuisances from the keeping of animals abated — Stables cleansed 4 Nuisances from Smoke abated 2 Accumulations of refuse removed 71 Accumulations of water removed 2 Manure Receptacles provided 3 Accumulations of manure removed 3 Miscellaneous 116 Conservancy System. Number of houses provided with pail closets 5 Notices Served. Informal Notices 444 Statutory Notices 27 Enquiries—Outstanding Sanitary Notices. 818 letters were received during the year from the Town Clerk enquiring whether or not there were any outstanding sanitary notices with respect to certain properties in the district. The necessary searches were made and the required information furnished. Disinfection. Number of rooms sprayed and fumigated after infectious disease 168 Verminous rooms sprayed and fumigated 70 Number of articles disinfected 6,470 Number of verminous premises dealt with 33 874 visits were made by your inspectors and disinfectors in connection with cases of infectious disease and the necessary investigations were made in order to furnish the Medical Officer of Health with the detailed information he required. 58 Eradication of Bugs. The number of houses found to be infested with bugs and dealt with during 1937 was as follows:— Council Houses 3 Other- Houses 24 The methods employed for freeing infested houses from bed bugs are the use of insecticides combined with fumigation with sulphur. In all cases where necessary wall and/or ceiling paper is stripped off and mouldings, skirtings, etc., are eased or removed. Movable articles, e.g., bedding, etc., are removed and subjected to steam disinfection. The houses occupied by persons about to remove to Council dwellings are examined by the Housing Manager or one of the Sanitary Inspectors and any infested articles therein are either disinfested or destroyed. The work of disinfestation is carried out by the Corporation's own staff. The houses which have been disinfested are revisited in order to ascertain whether or not further treatment is necessary, and the tenants are requested to co-operate with the department by keeping their houses in a cleanly state and reporting any reappearance of bugs. House-to-House Inspection. The inspections under this heading are those made in compliance with the Housing Consolidated Regulations, 1925 and 1932. The houses inspected during the year in the areas scheduled to be dealt with under these Regulations were as follows:— Ballards Lane, N.12 6 Bow Lane, N.12 2 Brownlow Road, N.3 29 Church Path, N.12 12 College Terrace, N.3 10 Coleridge Road, N.12 8 59 Dale Grove, N.12 2 Dollis Road, N.3. 5 Granville Road, N.12 5 Grove Road, N.12 30 Gruneisen Road, N.3 27 Hall Street, N.12 9 Hamilton Road, N.2 3 High Road, N.20 2 Hutton Grove, N.12 16 Oak Lane, N.2 6 Park Road, N.2 4 Percy Road, N.12 51 Squires Lane, N.3 12 Winifred Place, N.12 15 254 The 254 premises comprise 280 separately rated houses and tenements. As a result of these house-to-house inspections, no less than 1,854 defects or nuisances were discovered and dealt with, and these are enumerated in the appended summary:— Defective drains — Blocked drains 7 Defective and short ventilating shafts to drains 7 Dilapidated W.C. apartments 15 Insufficient W.C. accommodation — Light and ventilation to W.C. apartments insufficient — Defective and insanitary W.C. basins 6 Defective joints between flush pipes and W.C. basins 7 Defective Wr.C. seats 12 W.C. flushing boxes out of order 13 Defective manholes - Defective fresh air inlets to drains 7 Defective house roofs 60 Dirty and defective ceilings and walls of rooms 464 Defective brickwork and pointing to walls 48 Defective doors 35 Defective doorsteps 11 60 Defective stairs and handrails, etc., to staircases 16 Unsatisfactory lighting to staircase 4 Defective floors of rooms 48 Absence of sink — Insanitary stone troughs and/or defective sinks 5 Defective and untrapped waste pipes 15 Defective, absence of, or insufficient yard paving 15 Absence of, or defective eaves guttering and stack pipes 43 Nuisances from dampness 93. Absence of, or defective gratings to ventilation openings under floors 16 Absence of sufficient ventilation to rooms 3 Windows, defective or not made to open 187 Defective window sills 20 Dirty, defective or uncovered service water cisterns 20 Defective kitchen ranges 52 Defective stoves 39 Defective coppers 25 Defective chimneys 27 Defective chimney pots 5 Broken sash cords 432 Defective dustbins 21 Absence of, or defective gully curbs 21 Absence of, or unventilated food stores 5 Miscellaneous 46 An analysis of the house-to-house records for the year 1937 has been made, and the following statistical information compiled therefrom:— Dwelling Houses. Number of houses inspected 254 Number of Rooms. Living Rooms 601 Sleeping Rooms 779 Bed-living Rooms 50 1,430 61 Occupants. Number of Occupants, Adults 962 ,, Children 197 Average number of persons per house 4.563 ,, ,, room 810 ,, ,, bedrooms 1.398 Sub-Letting. Houses occupied by one family 167 ,, ,, two families 82 ,, three ,, 4 ,, „ four „ 1 Number of houses sub-let—87 or 34.252 per cent. Rents. Annual Rental of £16 or under — £16 to £26 13 £26 to £40 65 over £40 159 Owned by occupiers 17 254 Sanitation. Number of houses where defects were found 215 Number of houses found to be in some respect unfit for human habitation 106 Notices. Number of informal notices served 193 Number of statutory notices served 4 62 Unfit Dwelling-houses Closed or Demolished. 41, Station Road, N.3. An Appeal was lodged against a demolition order made by the Council in respect of the above house, and an undertaking was given by the appellant to make the same fit for human habitation. The necessary works were carried out, the house being thoroughly reconditioned and made tit. At a later hearing the Town Clerk raised no objection to the Appeal being allowed. No order was made as to costs. 1, 2, 3 and 5, Rustic Cottages, Dunger Place, N.12. The above houses were demolished in compliance with demolition orders made by the Council. 4 and 6, Rustic Cottages, Dunger Place, N.12. These cottages were demolished voluntarily by the . owner. 3, Freemans Cottages, Red Lion Hill, N.2. This house was reported as being unfit for human habitation and the tenant was found other accommodation in a house owned by the Council. An undertaking was given by the owners not to permit 3, Freemans Cottages to be used again for human habitation. OVERCROWDING. Housing Survey—Housing Act, 1936. On the completion of the overcrowding survey in February, 1936, the position with respect to overcrowded families in Finchley was as follows:— Number of families overcrowded:— (a) In privately owned houses 97 (b) In houses owned by the tion 29 — 126 By the end of 1936 the number of overcrowded families had been reduced to 63. At the time of the original survey 169 houses were found to be occupied to their full capacity. 63 These houses were re-visited during the year when the following changes were recorded:— Families moved to other premises 60 Number in family reduced 25 Number of houses occupied to capacity 56 Number of families who had obtained additional accommodation without removal 11 Number of families overcrowded 17 The net result, therefore, of this special visitation was to add 17 families to the overcrowded list. In addition to the above, 35 other cases of overcrowding, not previously reported, were discovered, making in all, 52 new cases for the year. The actual position at the end of 1937 was as follows :— Number of overcrowded families (1st Jan., 1937) 63 Number of new cases recorded during 1937 52 — 115 Number of families relieved during 1937 72 Number of cases outstanding at end of 1937 43 Entries in Rent Books. At the commencement of 1937, it was estimated that there were in the Borough about 4,000 houses respecting which no application had been received from the owners and others for information as to the permitted number of persons in relation to the houses for sleeping. It was therefore decided to visit all houses in the district which had not already been dealt with and which were known to be occupied by persons of the working class and to measure the rooms and issue certificates to the persons interested. This work was carried out with the assistance of two enumerators and was completed during the year. 64 It was necessary in only four instances to serve formal notice upon occupiers of intention to enter for the purposes of the Act. The necessary records have been compiled and filed for future routine use in the department. The total number of houses dealt with under this heading is as follows:— Number of houses visited 6,666 Number of rooms measured 40,660 Number of houses for which certificates have been issued 5.521 Number of separate families 8,368 Houses Let in Lodgings. The number of houses let in lodgings on the register remains the same as last year, namely 64. A new code of byelaws with respect to houses let in lodgings was confirmed by the Minister of Health, and came into operation on the 1st August, 1937. Steps are being taken to register and inspect a number of houses not previously dealt with under the byelaws and which have been found to be occupied by three or more families. The usual routine inspection of the registered houses let in lodgings has been carried out and action has been taken to ensure reasonable compliance with the byelaws. Common Lodging Houses. There are no common lodging houses in the district. Sanitary Conveniences. There are 26 conveniences attached to licensed houses within the district. 'These premises are inspected periodically. There are nine public conveniences in the district, including two in the Victoria Recreation Ground which are situated close to the public highway. Seven of these conveniences provide accommodation for both sexes and two accommodation for males only. 65 Complaints. Four hundred and fifty-eight complaints were received with reference to the following matters, viz.:— Blocked or defective drains . 56 Insanitary condition of mews and passages 3 Insanitary or defective condition of houses 137 Defective roofs 15 Non-removal of refuse 2 Verminous condition of houses 5 Nuisance from dampness 25 Nuisance from overcrowding 5 Nuisance from the keeping of animals 8 Nuisance from the burning of refuse 19 Accumulations of refuse or manure 40 Absence of, or defective dustbins 11 Smoke nuisance 9 Smells from public sewers 4 Premises infested with rats 36 Premises infested with insects 12 Shops Acts 13 Flooding 10 Noise 8 Other complaints 40 The complaints were investigated promptly, and in those cases in which the Council had power to intervene the necessary steps were taken to remove the cause of complaint. 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. The defects discovered as a result of these inspections were remedied, after notice had been given to the persons responsible. 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 27. 66 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 70 Factories, Workshops and Workplaces (including Bakehouses and Restaurant Kitchens) 410 Fried Fish Shops 8 Ice Cream Premises 108 Places of Public Entertainment 27 Public House Conveniences 26 Slaughterhouses 5 Shops re Food Supplies 249 903 Factory and Workshop Acts, 1901 and 1907. The total number of Factories, Workshops and Workplaces on the Register is 410. The trades carried on at the respective premises are .is follows:— Bakehouses 40 Boot Polish Manufacturer — Boot repairers 47 Builders' Workshops 22 Cycle Makers or Repairers 8 Farriers and Blacksmiths 5 Glass Blowers 1 General Engineers and Motor Engineers 62 Laundries 10 Monumental Masons 7 Motor Accessory Manufacturers 3 Prepared Meat Factories 2 Printers and Printers' Accessories 18 Restaurant Kitchens 67 67 Sheet Metal Workers 3 Sports Accessory manufacturers 2 Tailors and Dressmakers 28 Timber Merchants and Sawyers 15 Tyre Re-treading 2 Upholsterers 14 Watch and Clock Repairers 9 X-Ray Apparatus 1 Other Trades 44 410 These premises have been visited from time to time, and as a result of action taken by the department the following works have been carried out:— W.C. apartments provided or reconstructed 5 Ventilated lobby provided 2 W.C. apartments screened 1 New W. C. Pans provided 4 W.C.'s cleansed or repaired 27 Urinals provided 1 Urinals cleansed 1 Joints between flush pipes and W.C. pans repaired 6 Flushing Cisterns provided — Flushing Cisterns repaired 2 New Sinks provided 2 New Sink Waste Pipes provided 1 Drains unstopped or repaired 7 Fresh air inlet shafts repaired 1 Roofs repaired — Floors repaired and /or cleansed 4 Dustbins provided 10 Workshops cleansed 51 Accumulations of refuse removed 8 Smoke nuisance abated 4 Yards cleansed or repaired 3 Yards paved 2 Miscellaneous 37 68 Nuisances—Smoke and "Crit" Emission. During the year a number of complaints were received with respect to a nuisance arising from the emission of "grit" from a certain factory chimney. The chimney in question is connected to two large modern boilers fitted with mechanical stokers and with fans to create a forced draught. Subsequent to the receipt of the complaints the Company's engineers fitted a special type of damper control in the flues, and by careful adjustment of the fans and stoking equipment the nuisance was practically abated. Constant care in the management of the plant, however, is essential as efforts to avoid nuisance from "grit" by diminishing the draught in the flues has occasionally resulted in the emission of black smoke. Other factory chimneys in the district have been kept under observation from time to time and appropriate action has been taken in several instances with respect to nuisance arising from the emission of black smoke. 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. Rats and Mice Destruction Act, 1919. The above Act is administered by the Middlesex County Council. A number of complaints have been received in respect of premises alleged to be infested with rats. These complaints were immediately forwarded to Mr. A. Chudley, the Rats Destruction Officer for this district. 69 The Inspection of Meat. 'Ihe inspection of meat is mainly controlled by the provisions of the Public Health (Meat) Regulations, 1924. These regulations provide that any person intending to slaughter an animal for human consumption must notify the local authority three hours before the time of slaughtering. These notices may be given at any time as the local authority are not empowered to regulate the hours of slaughter. No less than 467 notifications of intention to slaughter animals were received. These notices are not infrequently delivered later than 5.0 p.m., and as there are no fixed times for slaughtering to take place it is a somewhat onerous duty to provide for the necessary inspection to be made on all occasions. A large proportion of meat inspection in the slaughterhouses is carried out before or after the usual office hours and on Sundays, and, with few exceptions, the carcases and organs of all animals slaughtered in the district have been inspected. Six certificates were issued to butchers at their request certifying that certain meat had been inspected and found to be unfit for the food of man and destroyed. 70 The total number of carcases of animals (including organs) inspected after slaughter during the year and the number and percentage found to be affected with disease are as follows:— Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 129 None 64 5,599 2,172 Number inspected 129 ... 60 5,502 2,170 All Diseases except Tuberculosis:— Whole carcases condemned None ... None 8 23 ' Carcases of which some part or organ was condemned 18 ... 1 154 218 Percentage of the number inspected affected with disease other than tuberculosis 13.953 ... 1.666 2.944 11.106 Tuberculosis only:— Whole carcases condemned 1 ... ... ... 2 Carcases of which some part or organ was condemned 10 ... ... ... 151 Percentage of the number inspected affected with tuberculosis 8.527 ... ... ... 7.051 71 Diseased, or Unsound Meat, etc., Destroyed The following is a list of the diseased or unsound meat and other food which was detected by your inspectors and subsequently destroyed:— Tuberculosis. Bovines. Carcase and Offal 1 Heads and Tongues 4 Sets of Lungs 14 Liver 1 Mesenteries 4 Forequarters 2 (342 lbs.) Heart 1 Swine. Carcases and Offal 2 Heads 87 Mesenteries 86 Plucks 14 Spleens 7 Leg 1 Conditions other than Tuberculosis. Bovines. Head and Tongue: Actinomycosis 1 Sets of Lungs: Parasites 4 Livers : 8A Flukes, 4 Abscesses, 1 Congestion 13½ Swine. Carcases and Offal : 22 Swine Fever, 1 Dropsy 23 Sets of Lungs : 18 Congestion, 3 Pleurisy 113 Pneumonia 134 Plucks: 10 Congestion, 1 Pneumonia 11 Kidney: Cysts . 1 Livers : 39 Cirrhosis, 1 Fatty Infiltration, 3 Necrosis 43 72 Mesenteries: Cysts 3 Hearts: 20 Pericarditis, 1 Pleurisy 21 Spleens : 1 Congestion, 1 Rupture, 1 Melanosis 3 Head : Injury 1 Forequarters : Bruising 19 lbs. Hindquarters: Peritonitis 58 lbs. Sheep. Carcases : 1 Pneumonia, 1 Fevered, 4 Emaciated, 2 Malformation 8 Lung's: 3 Abscesses, 15 Congestion, 14 Strongulus Rufescens, 31 Pneumonia, 1 Pleurisy 64 Livers : 8 Fatty Degeneration, 54 Parasites, 1 Congestion, 1 Cirrhosis, 7 Abscesses 71 Hearts: 3 Pericarditis, 1 Congestion 4 Plucks : 3 Congestion, 1 Strongulus Rufescens, 3 Pneumonia 7 Meat 16 lbs_ Slaughterhouses. The number of private slaughterhouses in Finchley is as follows : Type of Slaughterhouse— Registered Nil Licensed 5 The number of visits paid to the five slaughterhouses was 701. Most of these visits have been made for the purpose of inspecting the carcases and organs of animals slaughtered for human consumption. Attention has also been given to the condition, generally, of the slaughterhouses and steps have been taken to ensure compliance with the provisions of the byelaws with respect to these premises. 73 The Slaughter of Animals Act, 1933. Humane Slaughter of Animals. In accordance with the provisions of this Act all animals, including sheep, slaughtered in anslaughter house within the district must be stunned by means of a mechanically-operated instrument kept in proper repair. This method of slaughter continues to prove quite satisfactory. Licensed Slaughtermen. The Act also provides that no animal shall be slaughtered or stunned by any person who is not the holder of a licence granted by the local authority. The licences granted by the Town Council have to be renewed annually. The number of persons licensed under the Act during 1937 was 16. Butchers' Shops. There are 49 butchers' shops in the district. All the shops are provided with glass fronts. These premises have been visited periodically and the provisions of the Public Health (Meat) Regulations, which provide for the cleanliness of the premises, apparatus, utensils and vehicles, the precautions to be taken against the contamination of meat, the storage and removal of refuse, etc., have been, generally, well observed. Bakehouses. The number of bakehouses in the district is 40. During the year 2 new bakehouses were opened and 2 existing bakehouses closed. At 29 bakehouses motive power is used and the premises, therefore, constitute "factory bakehouses." The remaining 11 bakehouses are "workshops." The bakehouses have been visited by your inspectors and steps have been taken to cause them to be maintained in a proper sanitary condition. The periodical limewashing of these premises, as required by statute, has been carried out. 74 Dairies, Cowsheds and Milkshops. There are 70 dairies, cowsheds and milkshops in the district, and in addition 29 purveyors of milk whose premises are not in Finchley are registered for the purpose of retailing milk within the district. There were nine new registrations of milk purveyors during the year. The usual periodical inspection 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 infection and contamination, and the conveyance and distribution of milk have been generally well observed. The veterinary inspection of the cows kept in the district is carried out by the Middlesex County Council. The Milk (Special Designations) Order, 1936. Licences were granted by the Council in respect of designated milk for the year ended 31st December, 1937, as follows:— Dealers' Licences- to sell milk as "Tuberculin Tested" 9 .,, ,, ,, ,, ,, ,, "Accredited" 2 ,, ,, ,, ,, ,, ,, "Pasteurised" 14 Supplementary Licence to sell milk as "Tuberculin Tested" 1 ,, ,, ,, ,, ,, ,, "Pasteurised" 1 Licence in respect of establishment at which Tuberculin Tested Milk is bottled 1 Licences in respect of establishments in which the process of pasteurising milk is carried on 2 Five samples of "Tuberculin Tested," 1 sample of "Accredited" and 7 of "Pasteurised" milk were taken on behalf of the Council and submitted for bacteriological examination. These samples complied with the prescribed conditions. Ice Cream Premises. The number of ice cream premises on the register is 108. The premises were visited during the summer months. 75 Coffee Stalls. The number of coffee stalls in the district is 7. Six of these stalls are situated in the main roads. These stalls are visited at intervals and action is taken to secure the provision of a satisfactory water supply, suitable means of food storage, cleanliness of stalls and utensils and proper means for the storage and disposal of refuse. Offensive Trades—Fish Friers. The only offensive trade carried on in this district is that of a fish frier, this business being established at 8 premises. Steps have been taken by periodical visits to secure a reasonable compliance with the bye-laws. Applications were received for the Council's consent to establish the business of a fish fryer at: 134, Ballards Lane, N.3. 367, Ballards Lane, N.12. 4, Market Parade, Woodhouse Road, N.12. 10, Friern Watch Parade, High Road, N.12. These applications were refused. Came Licences. Fourteen 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. THE SHOPS ACTS, 1912—1936. The duties under the Shops Acts have been greatly increased by new legislation, particularly by the provisions contained in the Shops Acts, 1934, and the Shops (Sunday Trading Restriction) Act, 1936. A special report upon the administration of the Shops Acts was submitted to the Public Health Committee in July and the Council, upon the recommendation of the Committee, appointed an additional inspector. With this addition to the staff, it has been possible to undertake systematic inspection under the Acts. 76 Employment of Young Persons and Welfare of Shop Assistants. The Shops Act, 1934, contains provisions for regulating the hours of employment of young persons under the age of 18 years and for securing improved arrangements for the health and comfort of shop workers generally, including the provision of sufficient sanitary conveniences, washing facilities, accommodation for taking meals, and the provision of suitable means of lighting, warming and ventilation. , Sunday Trading. The general effect of the Shops (Sunday Trading Restriction) Act, 1936, is:— (1) to require the closing of shops on Sundays, subject to a number of exceptions designed to meet the reasonable needs of the public ; (2) to provide for compensatory holidays during the week for persons employed on Sundays about the business of those shops which are permitted to open, subject to exemptions for certain classes of workers. Special provision is made to enable persons of the Jewish religion to carry on retail trade or business on Sunday up to 2 p.m. Two such persons have been formally registered by the Council and one trader was registered under the provisions of the Retail Meat Dealers Shops (Sunday Closing) Act, 1936 The administration of the Shops (Sunday Trading Retriction) Act has involved visits to certain shops on Sundays and, in some instances, the keeping under observation of shops suspected of keeping open contrary to the provisions of the Act. Systematic inspection has revealed that of the shops already dealt with no less than 25 per cent, can lawfully keep open on Sunday with respect to transactions permitted by the Act and 33 per cent, may keep open on the weekly halfholiday. Complaints. Six complaints were received in regard to the alleged serving of customers after the general closing hour and 77 seven complaints were in reference to the keeping open of nonexempted shops on Sunday. These complaints were promptly investigated and appropriate action taken in each case. Legal Proceedings. Legal Proceedings were taken in the following instances:— (1) The occupier of a shop was summoned for selling after the general closing hour. The defendant was fined £2 and ordered to pay £2 2s. costs. (2) The occupier of a shop and an assistant were summoned for selling after the general closing hour. The defendants were each fined £2 and the occupier of the shop was also ordered to pay £2 2s. costs. At the end of the year legal proceedings were being taken with respect to four other cases of infringements of the Acts. Generally. In addition to routine inspection during ordinary office hours the inspectors have devoted a great deal of time to the observation of certain shops after 8 p.m. in cases where the traders, after due warning, were suspected of serving customers after the general closing hour. The following is a brief summary of the matters dealt with under the Acts during the year:— Number of Shops on Register 981 Number of Shops closed 17 Number of new shops entered on Register 86 Changes in occupation of Shops 81 Number of inspections of shops 1,381 Failure to post up prescribed notices 480 Failure to keep prescribed registers 17 Young person employed for more than 48 hours per week 12 Means of heating provided 9 Washing accommodation provided 5 Additional sanitary conveniences provided 3 78 Storage of Petroleum. Petroleum Spirit is defined as Petroleum, which, when tested in a prescribed manner, gives off an inflammable vapour at a temperature less than 73 degrees Fahrenheit. Certain mixtures containing petroleum spirit, e.g., cellulose paint, rubber solution, etc., and also carbide of calcium come within the Petroleum Act. During the year applications for licences to keep petroleum spirit and carbide of calcium were received as follows:— Petroleum Spirit. No. of applications for licences 90 No. of applications granted 90 Quantity of petroleum spirit which may be kept in licensed stores 125,063 gallons Carbide of Calcium. No. of applications for licences 3 No. of applications granted 3 Quantity of carbide of calcium which may be kept in licensed stores 504 pounds Licence fees paid during 1937 £65.1.3 Nearly all the petroleum spirit is kept in bulk in underground storage tanks and there are now installed in the district no less than 176 of these tanks to which are connected 156 petrol supply pumps. Most of the hand-operated pumps have now been replaced by electrically operated pumps. The various licensed premises have been inspected from time to time, and a number of contraventions of the conditions attached to the licences have been dealt with. During the year a communication was received from the Home Office, directing the attention of the Council to the fact that certain serious accidents had occurred in connection with explosions in disused tanks which had previously been used for the storage of petroleum spirit. The Council adopted the suggestion that a special condition should be attached to the licences granted by them, requiring the 79 licencee to give notice of his intention to discontinue to use an underground tank and to take the necessary steps to render the same immune from danger of fire or explosion. It is satisfactory to note that it has been the practice of the department in the past to require all disused tanks to be dealt with as follows:—The residue of petroleum spirit is removed, the pipe lines disconnected and the tanks filled with sand or water and the connections sealed with screw plugs. The total number of disused storage tanks which have been dealt with in this manner is 15. staff. In October, the Council on the recommendation of the the Public Health Committee decided to appoint an additional inspector. Mr. J. Yates, one of the sanitary inspectors of the Thurrock Urban District Council, was selected to fill the post, and with this addition to the staff it will be possible to deal more effectively with the increased duties for which the department is now responsible. At the end of the year, Mr. G. H. Cockell, one of the assistant inspectors, resigned in order to take up the appointment of a sanitary inspector under the Borough of Surbiton, and steps were being taken to fill the vacant post. It is with much pleasure that I take this opportunity to express my great appreciation of the invaluable help given during the year by the assistant inspectors and the clerical staff, and I again gratefully acknowledge the kind co-operation of Dr. Turner, the Medical Officer of Health, and my colleagues in other departments. I am. Your obedient servant, E. J. FRANKLIN, Chief Sanitary Inspector. Public Health Department, 308, Regents Park Road, N.3. 80 ANNUAL REPORT of the SCHOOL MEDICAL OFFICER FOR THE YEAR 1937 BOROUGH OF FINCHLEY. * MEMBERS OF THE EDUCATION COMMITTEE. Chairman : Councillor F. J. Grocott. Vice-Chairman : Councillor W. L. Brooksbank. The Mayor. The Deputy Mayor. Councillor P. H. Burch. ,, W. C. Langlands ,, Major H. W. Steward ,, H. H. Wilmot Co-opted Members : Miss L. Davey, M.A., Mrs. A. S. Miall, B.A., Mr. D. A. A. Merry. Ex-oflicio Members : County Councillor J. Boggon, J.P. ,, ,, W. Newcome Wright, J.P. The Chairman of the Local Higher Education Committee (Alderman C. S. Syrett) . Director of Education H. L. Hume, LL.M. 82 BOROUGH OF FINCHLEY. * SCHOOL MEDICAL STAFF. School Medical Officer : A. A. Turner, M.C., M.D., D.P.H. Assistant School Medical Officer : C. Russell, M.B., Ch.B., D.P.H. Ophthalmic Surgeon : C. Lomas Harris, M.B., Ch.B. Radiologist : J. Rhynland Parry, M.B., Ch.B., D.M.R.E. School Dentist : C. R. Wilshaw, H.D.D. (Edin.), L.D.S. (Eng.). Assistant School Dentist : W. B. Priest, L.D.S. (Eng.). School \urses and Health Visitors : Miss J. Hull. Miss C. Hemming. Miss F. Hughes. Clinic Nurse : Miss J. R. Sharpe. Dental Attendants : Miss P. Parry. Miss E. G. sommerfield. Clerk : Miss D. Martin. 83 FINCHLEY SCHOOLS. ELEMENTARY SCHOOLS. School. Department. No. on roll. Average Attendance 1937 Alder Senior 326 293 Alder Infants 125 104 Northside Senior 238 208 Northside Junior 449 386 Manorside Senior 278 253 Manorside Junior 522 445 Martin Junior 443 377 Summerside Junior 508 457 St. Mary's Junior 482 399 St. John's Junior 273 237 Christ Church Senior 203 181 Holy Trinity Junior 295 247 Our Lady of Lourdes Mixed & Infants 275 234 4417 3821 SECONDARY SCHOOLS. On Roll. County School Boys & Girls 349 Christ's-College Boys 464 Woodhouse Boys & Girls 343 1156 84 To the Chairman and Members of the Education Committee of the Borough of Finchley. I have the honour to submit my report on the work of the School Medical Service for the year 1937. The health of the children has continued to be good although the prevalence of certain infectious diseases was somewhat higher than of recent years. Chicken Pox, Whooping Cough and Scarlet Fever all show an increase, but fortunately in the case of Diphtheria, the most serious of all the infectious diseases which affect the school child, only two cases were notified. Of the children submitted to routine inspection 8.98% were found to be in need of medical treatment and in about one half of these the condition requiring treatment was defective eyesight. The work at the various clinics continues to increase and there is ample evidence that the parents appreciate what is being done for their children. I am greatly indebted to the Director of Education and the Head Teachers for their help and co-operation and to all members of the School Medical Staff for their loyal and willing service throughout the year. I am, Your obedient Servant, A. A. TURNER, School Medical Officer. 85 CO-ORDINATION WITH OTHER HEALTH SERVICES. Close co-operation exists between the Public Health Department and the School Medical Service; the Medical Officer of Health is also School Medical Officer, while the Assistant School Medical Officer and the three School Nurses also carry out the Maternity and Child Welfare work in the Borough. The School Nurses know most of the children before they are admitted to school, and they are also acquainted with their home circumstances. Medical Inspection. Routine Medical Inspection is carried out on the elementary school premises and the three age groups laid down by the Board of Education are dealt with, namely :— Five year olds, eight year olds, and twelve year olds. All new admissions to the schools which do not fall into any of these groups are also examined. '4Special" children referred by parents, teachers or school nurses are examined in the schools or at the appropriate school clinic, while ''re-inspections" are dealt with in the same manner In 1937 the total number of medical inspections was 4,169 as compared with 4,226 in 1936. Findings of Medical Inspections. The number of defects, apart from dental defects and uncleanliness, found at routine medical inspection in the schools and at other inspections is set out in Table II. Of the 1,633 who were submitted to routine inspection 146 or 8.98% were found to be in need of medical treatment. (a) Malnutrition. 86 (b) Uncleanliness. Every effort is made to keep the standard of cleanliness as high as possible and it is now very rarely that one sees a child with vermin in its head. All children are examined by the School Nurses as soon as possible after the commencement of each term and the unsatisfactory ones are reviewed at frequent intervals. All new admissions are examined at the earliest possible moment. Every case of uncleanliness however slight is recorded. Until a very few years ago one frequently came across children whose bodies were covered with flea bites, but now such cases are never seen. The nurses paid an average of 68 visits to each school for uncleanliness inspections during the year; 16,171 inspections were made and 240 individual children were found not to comply with the rigid standard which is enforced. At routine medical inspection the heads of 51 or 3.12% of the children were found not to be entirely satisfactory while 3 or 0.18% had dirty bodies. (c) Minor Ailments and Skin Diseases. Few cases of minor ailments are found at routine inspection as these are sent to the school clinics by parents, teachers, and school nurses as soon as they are discovered. 87 The Board's classification of the nutrition of the children submitted to routine examination was used out the year and the following summary of the results clearly shows that very little malnutrition exists. No. of children inspected A B C D (Excellent) (Normal) (Slightly sub-normal) (Bad) 1633 No. % No. % No. % No. % 267 16.35 1254 76.79 112 6.86 — — One case of scabies, one case of impetigo and one of other skin disease were found at routine inspections, while at special inspections, I case of ringworm of the scalp, 3 cases of ringworm of the body, 32 cases of impetigo, 11 cases of scabies and 53 of other skin diseases were discovered. (d) Visual Defects and External Eye Disease. Sixty-six or 4.04% of the children at routine inspections were found to be suffering from some fairly serious defect of vision while 14 others were found at special inspections. A considerable number of children who had already been supplied with spectacles were referred to the School Oculist as a result of re-examination. In all 200 children were referred for refraction. One case of blepharitis and 2 cases of conjunctivitis were found at routine inspection and at special inspections 7 cases of blepharitis, 32 of conjunctivitis, and one case of corneal opacities. (e) Nose and Throat Defects. At routine medical inspection 20 children were found to be in need of surgical treatment for enlargement of the tonsils or adenoids, or both, while 28 were referred for observation. At special inspections 22 were referred for treatment and 40 for observation. (f) Ear Disease and Defective Hearing. As a result of routine and special examinations, 32 cases of discharging ears were referred for treatment. (g) Orthopcedic and Postural Defects. Five cases of deformities were referred for treatment, and 9 cases of deformities and 2 of spinal curvature were referred for observation. 88 (h) Heart Disease and Rheumatism. Four cases of organic heart disease were found at routine inspection and one case at special inspections. (i) Tuberculosis. No case of tuberculosis was discovered during the year. (j) Other Defects and Diseases. These form a very miscellaneous group and in all 200 cases were referred for treatment from routine and special inspections. Following up. There are three Health Visitors and School Nurses who devote approximately two-fifths of their time to school work. There is a whole-time Clinic Nurse who does the minor ailments and supervises the Dental Clinic, and there is also a whole-time and a part-time Dental Attendant. Home visits are paid by the School Nurses in connection with the treatment of defects ; in connection with uncleanliness cases, and to arrange for children to go to special schools. The following is a summary of the work done by theSchool Nurses during the year:— Visits to schools 688 Visits to clinics 389 Home visits 387 1,464 Number of examinations of children— heads, bodies, clothing, etc. 16,171 89 Medical Treatment. (a) Minor Ailments. The Clinic at Bourchier House is open every morning from 8.30 a.m. and the clinic at Summerside School on Tuesday afternoons. On occasions the number of patients has been so large as to necessitate a second weekly session which has been held on Friday afternoons. One thousand, three hundred and forty children received treatment at these clinics during the year, making 9,417 attendances, as compared with 1,468 children making 9,705 attendances in 1936. (b) Tonsils and Adenoids. Twenty-four children were operated on for tonsils and adenoids at the Finchley Memorial Hospital. The arrangement whereby the children are detained in Hospital for two days following the operation is greatly appreciated by the parents, and it minimises the risk of hasmorrhage and sepsis which are apt to occur when children are taken home immediately after operation. (c) Tuberculosis. All cases of tuberculosis occurring among school children are referred to the Tuberculosis Officer of the Middlesex County Council. (d) Skin Disease. The treatment of cases of skin disease is carried out at the Minor Ailments Clinics ; 353 children were treated during the year. Ring-worm of the Scalp. One case of ringworm of the scalp was found in 1937 and it was submitted to treatment by X-Rays. (e) External Eye Disease. Children suffering from external eye disease are treated at the Ophthalmic Clinic and at the Minor Ailments Clinics; 125 children were treated during the year. 90 (f) Vision. The Ophthalmic Surgeon attends one session per week at the Clinic at the Martin School and examines all children suffering from defects of vision or other eye conditions referred to her. During 1937, 200 children were referred for examination ; 190 were submitted to refraction—spectacles were prescribed in 175 cases and 148 actually obtained spectacles. In 7 of these cases the parents were unable to pay the whole cost of the spectacles and the Children's Care Committee subscribed varying sums towards the purchase. (g) Ear Disease and Hearing. Children suffering from ear discharge and defective hearing are dealt with at the Minor Ailments Clinic at Bourchier House. During the year 101 children were treated. (h) Dental Defects. I am indebted to Mr. C. R. Wilshaw, the Senior Dental Officer for the following report on the year's work. DENTAL REPORT 1937. As particular interest is now being focussed on the School Dental Service as a gesture in the National Health Campaign, it is, perhaps, appropriate in this Report to set.out the aims and achievements of the Finchley School Dental Service. The object of the service is to eliminate oral sepsis in order to prevent its ill effects on the body as a whole, and to seek out cavities and repair all saveable teeth that sepsis may be prevented and the masticatory efficiency of the mouth maintained. The scheme includes the pupils of both elementary and secondary schools and the procedure adopted is as follows. Inspections are carried out annually at the schools and the parents of the elementary school children are invited by notices to be present. As may be expected it is the parents 91 of the younger children who most usually attend. The parents who attend are informed of the treatment required; if they wish their child to be treated by their private practitioner they are advised to make the necessary visit without delay, or, if they desire the treatment to be undertaken at the clinic, they are invited to sign the consent form. The details of treatment required are recorded at the time of inspection, and are indicated on the consent form that is sent to the parents of each child requiring treatment. Treatment appointments are sent to all who desire treatment at the clinic as soon as possible after the return of the consent form appropriately signed. Treatment is carried out at Bourchier House, Oak Lane, where the children attend by appointment at quarter hourly intervals. As far as is practicable all fillings are completed for the child before any necessary extractions are made. This course is adopted because experience has shown that in many cases where extractions have been made on the first visit, the child does not return to have the saveable teeth filled. Thus, the latter policy, lends itself to the loss of would-be saveable teeth. Treatment of a conservative nature is aimed at, greatest stress being laid on the permanent dentition, and every effort is made to discover defects at their earliest manifestation. This inevitably makes the number referred for treatment correspondingly high and in 1937 was 79% of those inspected. That such a policy is a sound one may be ascertained from the number of teeth that were saved. The ratio of extractions to fillings in permanent teeth in Finchley for the year under review is 1 :6.7, whereas the average ratio for all areas (1936 figures) is 1:2.1. The figures include extractions for irregularities. No regulation by appliance is undertaken at the clinic. Where, however, the irregularity is caused or threatened by overcrowding, the condition is relieved by extraction, and many good results are obtained in this way. There are, 92 nevertheless, a considerable number of irregular dentitions that can only be treated by appliance. Parents in these cases are advised to attend their private practitioner or, failing that, to- attend one of the Dental Hospitals. A number of these are unable to follow this advice because of the expense incurred by the frequent visits which the effective operation of an orthodontic appliance involves. Regrettable as this is, it would be unwise to attempt regulation by appliance at the clinic, for the time being, because the surgery time spent in so doing would be at the expense of the more essential and universally needed conservative work. Root canals are only treated at the clinic in Cases of incisor teeth—usually those devitalised by an accidental blow which fractures the tooth. These are preserved that the space and root may be retained in a healthy condition for subsequent crowning. The application of silver nitrate is not generally resorted to, but in selected shallow cavities, where the arrest of caries may reasonably be expected to occur, silver nitrate is used. General anajsthetics are administered by a School Medical Officer who attends for that purpose at special sessions. No extractions of any kind are performed without the use of either a general or local anaesthetic. Children whose parents have refused treatment in the past are allowed re-entry to the scheme at the next routine inspection providing they consent to all necessary treatment, and any teeth requiring fillings are filled before extractions are made, as in routine cases. Ideally no permanent teeth should be lost except those removed to relieve overcrowding, and temporary teeth should be retained until they are due to be replaced by their permanent successors. It is not reasonable to suppose that any school dental service will reach that ideal, because it depends on a long chain of eventualities the links of which are forged or flawed by divers persons at different times. Without straining the metaphorical chain too much, perhaps a little hammering on the weaker links might make the whole more efficient. 93 The comparative table, this year given on page 16, shows that the acceptance rate varies from school to school and from year to year. Where the percentage of treatment is high, credit is due mainly to the enthusiasm of the responsible teachers. It will be seen that the schools with senior pupils show lower acceptance rates. This may be due to the older children being more successful in "getting round" their parents in order to withhold consent. As these older children should be more amenable to reason, it is possible that a little stimulation might turn the balance. Perhaps an award for Oral Hygiene could be instituted, to be competed for and held each year by the school with the best dental record. After all this is just as important for physical well being as competing for any other team race, and it would serve to put a clean set of teeth on parity with a clean pair of heels. In assessing values it is not only the number that attend for treatment which must be taken into account, but the number found to be sound at dental inspection. The latter is very important because it includes those who are effectively helping themselves by the toothbrush habit. While complacency is to be avoided as it tends to stagnation, the outlook is not a gloomy one for there are only relatively few really outside the scheme. It must be remembered that the changes are being rung on the four columns. Children who require treatment this year may appear as sound next year and vice versa; and children who do not accept one year may do so the next and, again vice versa. It is an unfortunate fact that there are still parents who only consent to treatment when they feel the matter is urgent. One or even two small cavities requiring to be filled, which they cannot see, is not sufficient to induce them to bother. These parents tend to consent every other year. This is regrettable as it means that for their children an annual service is distended to a two-yearly one. The operation of filling becomes more tiresome for the child because there is more softened tooth substance to remove, as well as being less satisfactory as a repair because there is less sound tooth structure left to support the filling. This is particularly true of temporary and smaller permanent teeth. If parents 94 could be convinced of, and act in accordance with, the fact that they do not save their children discomfort by declining treatment at the early stage, or even merely postpone the evil day, but definitely accumulate and create more trouble for those whom they wish to protect, then the children would benefit enormously. The work of the dentists will always remain largely one of repair. Prevention of decay rests with the child—his eatables and his toothbrush, together with well directed and effective guidance in the home and school. In conclusion it is not a mere formal expression to add that the relatively satisfactory state of the Finchley School Dental Service is only made possible by the sympathetic cooperation of the teachers. The details of the year's work are set out below and on pages 17, 38 and 39. During the year 4,057 children were inspected, 3,712 as routines and 345 as specials. Of this total 3,205 of 79% were found to require treatment and of this number 2,219 or 67.36% were actually treated at the Clinic. The following table shows in comparative form for each school, the number of children with sound teeth, the number with unsound teeth, the numbers treated, and the percentage dentally sound, when treatment has been completed:— 95 ELEMENTARY SCHOOLS, 1937. School Number sound Number requiring treatment Percentage requiring treatment Number treated % of those req. treatment who were treated at the clinic % of school total dentally sound or rendered so by treatment Manorside 235 586 71.38 355 60.58 71.86 St. Mary's 106 322 75.23 233 72.36 79.42 Martin 93 327 77.86 308* 77.57 82.38 Holy Trinity 56 199 78.00 127 63.82 71.76 Alder 66 332 83.42 189 56.93 64.07 Summerside 93 329 77.96 260 79.03 83.65 St. Johns 37 229 86.09 164 71.62 75.56 Christ Church 42 160 79.21 91 56.88 65.84 Our Lady of Lourdes 35 196 84.85 127* 58.33 63.85 Northside 89 525 85.50 365 69.52 73.96 Totals 852 3205 79.00 2219* 67.36 74.22 * These figures include a number of treated cases held over from the previous year's inspection. The percentage given in the last two columns is corrected by calculation on a two year basis. 96 1936 1937 Number of children inspected and re-inspected 3353 4057 Number of children treated 1818 2219 Number of attendances at Dental Clinic 3359 3700 Number of fillings 3631 4001 Number of extractions 3394 3947 Number of other operations 324 330 Number of general anaesthetics 743 791 Parents' Contribution Towards Cost of Treatment Contributions for dental treatment are collected at the Dental Clinic when the child attends for treatment. The charge is 1/- for each child treated. At the Minor Ailments Clinic an endeavour is made to collect 3d. a week for each child attending, but treatment is never withheld on account of inability to pay. Contributions for the operative treatment of tonsils and adenoids are collected by the Education Department. 97 The sums recovered from parents in respect of dental and medical treatment are as follows:— 1936 1937 £ s. d. £ s. d. Dental Treatment 83 5 0 100 15 0 Operative Treatment of Tonsils and Adenoids 9 8 6 8 19 0 'Treatment of Minor Ailments 4 3 9 3 11 6 £96 17 3 £113 5 6 Infectious Diseases. The following list gives the number of cases which were brought to the notice of the School Medical Officer for the past three years. 1935 1936 1937 Chicken-pox 6 283 301 Diphtheria 12 15 2 Measles 3 255 116 Mumps 44 3 96 Scarlet Fever 49 28 72 Whooping Cough 38 15 137 152 599 724 There was a considerable increase in the cases of Whooping Cough, Mumps and Scarlet Fever over the previous year, but Diphtheria with only 2 cases, fell to almost vanishing point. There can be little doubt that this is largely due to the excellent response by parents to the Council's scheme for immunisation and to the part played bv head teachers in making the scheme a success. 98 Exclusion of School Children on Account of Infectious Disease. Disease PATIENTS Period of exclusion CONTACTS Period of exclusion SCARLET FEVER: (a) Hospital Cases Until 14 days after discharge from hospital. All children in the family must be excluded until 10 days after disinfection of premises. (b) Home Cases Until 14 days after disinfection of premises. DIPHTHERIA: (a) Hospital Cases Until 28 days after discharge from hospital. All children in the family must be excluded until 10 days after disinfection of premises. (b) Home Cases Until 28 days after disinfection 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. 99 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. Four places, two for boys and two for girls, are reserved by the Education Committee at the Russell C6tes School of Recovery, Parkstone. During the year 33 children were sent to Parkstone, and without exception, their health was greatly improved. Two places are also reserved, during the winter months, at the Children's Hostel, Collinton Manor, Bexhill-on-Sea. Three boys and two girls were sent there for a period of six weeks, and one girl for a period of twelve weeks. Physical Training. I am indebted to the Director of Education for the following notes on physical training:— Developments in Physical Training have proceeded along the lines suggested by the Physical Training Organiser who has served the joint areas of Tottenham, Hornsey, Wood Green and Finchley since 1934. During the year under review, however, the post of man organiser has been vacant, but under a new scheme, shared by the Middlesex County Authority and the autonomous areas within the County, two organisers, one man and one woman, have recently been appointed to serve the Authority's area jointly with those of Hornsey and Wood Green. This scheme will be in full operation for the year 1938. Provision of Milk in Schools. The number of children having milk in school shows a small increase over last year, 2,585 as compared with 2,382. The value of the milk scheme is unquestioned and it is surprising that parents do not take greater advantage of it. In School the price of milk is 1½d. per pint, while the same milk at home costs something over 3d. per pint. 100 The following table shows the numbers receiving milk in each school department on the 1st October, 1937. School. Department Number of pupils on the register Number of pupils receiving milk % of pupils receiving milk Alder Senior 307 147 47 Alder Infants 130 96 74 Northside Senior 246 93 38 Northside Junior 472 269 57 Manorside Senior 291 157 54 Manorside Junior 536 271 51 Martin Junior 443 296 67 Summerside Junior 496 329 66 St. Mary's Junior 492 268 54 St. John's Junior 270 200 75 Christ Church Senior 233 100 43 Holy Trinity Junior 293 181 62 Our Lady of Lourdes Mixed 290 178 61 Totals 4,499 2,585 57 School Baths. The Council's baths in Squires Lane are available for the use of the chidren of all the elementary schools, and during the year 17,347 attendances were made by 1,560 children. Co-operation of Parents. During the year 66% of parents attended routine medical inspections. The attendance is very good in the case of younger children but it tends to fall off as the children grow older, and this is more marked in the case of boys. Many mothers cannot attend because they go out to work and there does not appear to be any means of avoiding this. Very few parents neglect to carry out the recommendations of the medical officers as regards medical treatment but unfortunately the same is not yet true in the case of dental treatment. The percentage of those in need of dental treatment who actually attended for treatment at the Dental Clinic shows a wide degree of variation throughout the schools, e.g., in the Alder, Christ Church and Our Lady of Lourdes, it was 101 as low as 56.93, 56.88, 58.33 respectively, while in Summerside it was as high as 79.03. Obviously these figures are influenced not only by the interest or lack of interest of parents but also by other factors which can be found inside the schools. 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. Co-operation of Voluntary Bodies. During the year the Children's Care Committee sent 19 boys and 20 girls to Bexhill for a period of two weeks. One boy was sent to Bournemouth for a similar period. In seven cases assistance was granted in the purchase of spectacles. One case was assisted in the purchase of surgical shoes, and an outfit was supplied to a boy to enable him to go to a holiday home. 102 Blind, Deaf, Defective and Epileptic Children. Every effort is made to ascertain children suffering from "special" defects and it is very unlikely that any are missed. Physically defective children are few, and so far it has not been found necessary to establish an Orthopaedic Clinic in the Borough, but arrangements have been made whereby the Education Committee assume responsibility for the maintenance in the Royal Orthopædic Hospital of any cripple child recommended for admission by the School Medical Officer. No difficulty has been experienced in placing blind, deaf and epileptic children in certified special schools. Eleven mentally defective children were in attendance at the Joint Special School situated within the area at the end of the year. The Education Authority has no other Special Schools. Nursery Schools. No nursery schools have been established in the district. Secondary Schools. The School Medical Officer conducts the medical inspection 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. Five hundred and forty-four pupils were examined during the year. Continuation Schools. There are no Continuation Schools in the district. 103 Employment of Children and Young Persons. (1) The children employed in Finchley are mostly engaged in the distribution of 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. Eighty-nine 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. 104 STATISTICAL TABLES for the Year 1937 TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups:— Entrants 600 Second Age Group 522 Third Age Group 352 Total 1474 Number of other Routine Inspections 159 Grand Total 1633 B.—OTHER INSPECTIONS. Number of Special Inspections 1835 Number of Re-Inspections 701 Total 2536 106 C.— CHILDREN FOUND TO REQUIRE TREATMENT. Number of individual children found at Routine Medical Inspection to require treatment (excluding defects in Nutrition, Uncleanliness and Dental Diseases). Group For defective vision (excluding squint) For all other conditions recorded in Table IIA Total (1) (2) (3) (4) Entrants 11 29 40 Second Age Group 31 36 67 Third Age Group 15 4 19 Total (Prescribed Groups) 57 69 126 Other Routine Inspections 9 11 20 Grand Total 66 80 146 107 TABLE II. A. Return of Defects found by Medical Inspections in the year ended 31st December, 1937. DEFECT OR DISEASE. Routine Inspections. No. of Defects. Special Inspections No. of Defects. Requiring treatment. Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment. (1) (2) (3) (4) (5) Skin— Ringworm:— .. Scalp .. .. 1 Body .. .. 3 .. Scabies 1 .. 11 .. Impetigo 1 .. 32 .. Other Diseases (Non-Tuberculous) 1 1 53 .. Eye— Blepharitis 1 .. 7 .. Conjunctivitis 2 .. 32 .. Keratitis .. .. .. .. Corneal Opacities .. .. 1 .. Defective Vision (excluding Squint) 66 32 14 1 Squint 7 .. 2 .. Other Conditions .. 1 18 1 Ear- Defective Hearing 1 2 .. 10 Otitis Media 3 2 29 .. Other Ear Diseases .. .. 39 4 Nose and Throat— Chronic Tonsillitis only 5 26 10 32 Adenoids only 1 1 .. 2 Chronic Tonsillitis and Adenoids 14 1 12 6 Other Conditions .. .. 33 9 Enlarged Cervical Glands (Non-Tuberculous) .. .. 2 7 Defective Speech .. .. .. .. Heart and Circulation— Heart Disease: Organic .. 4 .. 1 Functional .. .. .. .. Anaemia 8 .. 7 .. Lungs— Bronchitis 1 4 5 1 Other Non-Tuberculous Diseases 1 4 16 4 Tuberculosis— Pulmonary: Definite .. .. .. Suspected .. .. .. .. Non-Pulmonary: Glands .. .. .. .. Bones and Joints .. .. .. .. Skin .. .. .. .. Other forms .. .. .. .. Nervous System— Epilepsy 1 .. .. 3 Chorea .. .. 3 .. Other Conditions .. .. 4 .. Deformities— Rickets .. .. .. .. Spinal Curvature .. 2 .. .. Other forms 5 4 .. 5 Other Defects and Diseases— (Excluding Defects of Nutrition, Uncleanliness and Dental Diseases) 27 2 173 13 Totals 146 86 507 99 108 B. Classification of the Nutrition of Children inspected during the year in the routine age-groups. AGE-GROUPS Number of Children Inspected. A. [Excellent]. B [Normal] C. [Slightly subnormal]. D. [Bad]. No. % No. % No. % No. % Entrants 600 59 9.83 481 80.17 60 10 — — Second Age Group 522 70 13.41 413 79.12 39 7.47 — — Third AgeGroup 352 110 31.25 238 67.61 4 1.14 — — Other routine Inspections 159 28 17.61 122 76.73 9 5.66 — — TOTAL 1633 267 16.35 1254 76.79 112 6.86 — — 109 TABLE III. Return of all Exceptional Children in the Area. Blind Children. At Certified Schools for the Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — — Partially Sighted Children. At Certified Schools for the Blind. At Certified Schools for the Partially Sighted. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 1 — — — 1 Deaf Children. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 5 — — 1 6 Partially Deaf Children. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — — — Mentally Defective Children. Feeble Minded Children. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 11 — — — 11 Epileptic Children. Children suffering from Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — 1 1 Physically Defective Children. A. Tuberculous Children. i.—Children suffering from Pulmonary Tuberculosis (including pleura and intra-thoracic glands). At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — — ii.—Children suffering from Non-Pulmonary Tuberculosis (this category includes tuberculosis of all sites other than those shown in i. above). At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — 1 1 B. Delicate Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 6 19 — — 25 C. Crippled Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 2 — — 2 D. Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no school or Institution. Total. 2 — — — 2 Children suffering from Multiple Defects. Combination of defect At Certified Special Schools. At Public Elementary Schools. At other Institutions At no School or Institution Total. — — — — — — 111-114 TABLE IV. Return of Defects treated during the year ended 31st December, 1937. Treatment Table. Group I.—Minor Ailments (excluding uncleanliness, for which see Table VI). Disease or Defect Number of Defects treated, or under treatment during the year. Under the Authority's Scheme Otherwise Total (1) (2) (3) (4) SKIN Ringworm— Scalp (i) X-Ray Treatment ... 1 — 1 (ii) Other — — — Ringworm— Body 3 — 3 Scabies 11 — 11 Impetigo 282 — 282 Other skin disease 56 3 59 MINOR EYE DEFECTS— (External and other, but excluding cases falling in Group II.) 125 4 129 MINOR EAR DEFECTS— 101 2 103 MISCELLANEOUS— (e.g., minor injuries, bruises, sores, chilblains, etc.) 501 14 515 TOTAL 1080 23 1103 115 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 Otherwise Total (1) (2) (3) (4) Errors of Refraction (including Squint). (Operations for squint are recorded separately in the body of the Report.) 200 5 205 Other defect or disease of the eyes (excluding those recorded in Group I) 49 — 49 TOTAL 249 5 254 Number of Children for whom spectacles were (a) Prescribed 170 — 170 (b) Obtained 148 5 153 116 117 GROUP III.—Treatment of defects of Nose and Throat. NUMBER OP DEFECTS. Received Operative Treatment. Received other forms of treatment. Total number treated. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) (1) (2) (3) (4) (1) (2) (3) (4) (1) (2) (3) (4) 10 — 14 — 3 — 6 — 13 — 20 — — 33 (1) Tonsils only. (2) Adenoids only. (3) Tonsils and Adenoids. (4) Other defects of the nose and throat. 118 GROUP IV.—Orthopædic and Postural Defects. Under the Authority's Scheme. (1) Otherwise. (2) Total number treated. Residential treatment with education. Residential treatment without education. Nonresidential treatment at an orthopædic clinic. Residential treatment with education. Residential treatment without education. Nonresidential treatment at an orthopædic clinic. (1) (2) (3) (1) (2) (3) Number of children treated. — 2 — — — — 2 TABLE V—Dental Defects. Elementary Schools. (1) Number of Children who were: (7) Administration of general anæsthetics for extractions 791 (a) Inspected by the Dentist:— Aged:— 5 214 Total: 3712 6 488 7 391 (8) Extractions:— 8 436 Routine 9 427 On account of overcrowding Age 10 420 (a) Permanent 121 Groups. 11 427 On account of advanced decay 12 276 13 278 14 355 (b) Specials 345 (b) Permanent 360 GRAND TOTAL 4057 (c) Temporary 3468 (2) Found to require treatment 3205 Total 3828 (3) Actually treated 2219 (4) Half-days devoted to:— Inspection 56 Treatment 405 Total 461 (9) Other operations:— (a) Dressings 161 (5) Attendances made by children for treatment 3700 (b) Application of Silver Nitrate 88 (c) Scalings 78 (6) Fillings:— (d) Root treatment 3 Permanent teeth 3219 (e) Miscellaneous — Temporary teeth 782 Total 4001 Total 330 119 TABLE V—Dental Defects. Secondary Schools. (1) Number of Children who were: (7) Administrations of general anaesthetics for extractions 13 (a) Inspected by the Dentist:— Aged:— 11 82 Total: 1144 12 198 (8) Extractions:— 13 193 On account of overcrowding 14 210 Routine 15 201 (a) Permanent 25 Age 16 178 On account of advanced decay Groups. 17 57 18 25 19 — (b) Permanent 135 (b) Specials - GRAND TOTAL 1144 (c) Temporary 52 Total 212 (2) Found to require treatment 882 (3) Actually treated 398 (9) Other operations:— (4) Half-days devoted to:— Inspection 14 Treatment 118 Total 132 (a) Dressings 39 (b) Application of Silver Nitrate - (5) Attendances made by children for treatment 679 (6) Fillings:— (c) Scalings 53 Permanent teeth 1110 (d) Root treatment — Temporary teeth — Total 1110 Total 92 Table VI—Uncleanliness and Verminous Conditions. (1) Average number of visits per school made during the year by the School Nurses 68 (2) Total number of examinations of children in the Schools by the School Nurses 16171 (3) Number of individual children found unclean 240 (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 School Attendance Bye-Laws — 120 Index PAGE Report of the Medical Officer of Health 1 Members of the Public Health Committee and Staff of the Public Health Department 2 Social Conditions 4 Vital Statistics 4 Poor Law Relief 9 Statistical Tables—Mortality, etc. 13 General Provisions of Health Services in the Area 18 Clinics and Treatment Centres 21 Professional Nursing in the Home 22 Sanitary Circumstances of the Area 23 Infectious Diseases 25 Statistical Table—Infectious Diseases 35 Tuberculosis 37 Maternity and Child Welfare 39 Housing Statistics, etc. 46 Food 49 Factories and Workshops 51 Report of the Chief Sanitary Inspector 53 Inspections 55 Summary of Sanitary Improvements Carried Out 56 Notices Served 58 Disinfection 58 Eradication of Bugs 59 House-to-House Inspection 59 Unfit Dwelling-houses Closed or Demolished 63 Overcrowding 63 Houses Let in Lodgings 65 Sanitary Conveniences 65 Complaints 66 Places of Public Entertainment 66 Premises Periodically Inspected 67 Factory and Workshop Acts 67 The Inspection of Meat 70 Bakehouses 74 Dairies, Cowsheds and Milkshops 75 The Milk (Special Designations) Order, 1936 75 Ice Cream Premises 75 Coffee Stalls 76 Offensive Trades 76 Game Licences 76 The Shops Acts 76 Storage of Petroleum 79 Staff 80 Report of the School Medical Officer 81 Members of the Education Committee 82 School Medical Staff 83 Finchley Schools 84 Medical Inspection 86 Medical Treatment 90 Dental Report 91 Infectious Diseases 98 Open-Air Education 100 Physical Training 100 Provision of Milk in Schools 100 School Baths 101 Co-operation of Parents, etc. 101 Blind, Deaf, Defective, and Epileptic Children 103 Nursery, Secondary, and Continuation Schools 103 Employment of Children and Young Persons 104 Statistical Tables 105 FINCHLEY PRESS LTD. FINCHLEY N.2