HEN 3 Urban District Council of hendon. ANNUAL REPORT of F. W. ANDREW, M.R.C.S., L.R.C.P., MEDICAL OFFICER OF HEALTH, Fellow of the Incorporated Society of Medical Officers of Health. FOR THE YEAR 1913, together with the Annual Report on the Medical Inspection of Schools. Dendon: Warden & Co., Ltd, Printers, "Hendon and Finchley Times" Office. 1914. INDEX. page Acreage, Number of Houses, and Population 10 Bacteriological Examination 43 Baths and Wash-houses 62 Boundaries of Parish 8 Causes of Death 20 Causes of, and Ages at, Death (Table III.) 21 Cesspools, Water Closets and Privies 21 Cowsheds, Milkshops and Dairies 59 Deaths and Death-Rate 18 Disinfection 45 Disposal of House Refuse 51 Drainage Work 69 Epidemic Diarrhoea 26 Factory and Workshops Act 52 Food Inspection 61 Geology 8 Housing, Town Planning, etc., Act, 1909 57 Hampstead Garden Suburb 63 Infantile Mortality 24 Inquests 23 Infectious Diseases— Scarlet Fever 29 Diphtheria 32 Typhoid Fever 35 Erysipelas 36 Puerperal Fever 36 Acute Poliomyelitis 36 Cerebro Spinal Fever 37 Phthisis (Pulmonary Tuberculosis) 37 Measles 39 Inspection Work 65 Introduction 5 Isolation Hospital 40 Mortuary 26 Members and Officers of the Council 3 Medical Inspection of Schools 75—90 New Buildings 63 Population 12 Public Conveniences 62 Register of Rainfall 50 Rateable Value 12 Senile Mortality 23 Sewage Disposal 46 Sale of Food and Drugs Act 61 Sanitary Staff 70 Situation and Height Slaughterhouses Smoke Abatement 62 Summary of Work Done 66 The Housing of the Working Classes Act 57 Vaccination Vaccination Vital Statistics Vital Statistics of Separate Localities 15 Vital Statistics of Whole District 17 Water Supply 48 Urban District Council of Hendon. members of the Council, 1913. Mr. Councillor C. C. Cartwright, J.P. (Chairman). ,, ,, R. C. Townsend (Vice-Chairman). Miss M. E. Bunney, Mr. Councillor J. M. Lickfold, Mr. Councillor W. E. Candy, „ „ J. M. MgGrath, ,, „ A. S. Ford, „ „ H. E. Rider, „ „ T. F. Fenn, ,, „ A. B. Soab, „ „ F. W. Hearn, „ „ J. H. Stubgess, „ „ E. E. Gardner, „ „ W. Taylob, Mr. Councillor A. B. Teare. Clerk to the Council Henry Humphris, F.C.I.S. Engineer and Surveyor— S. Slater Grimley, M.I.C.E. Chief Sanitary Inspector— Shafto J. Chapman, M.S.I.A. Medical Officer of Health— F. W. Andrew, M.R.C.S., L.R.C.P. ANNUAL REPORT FOR 1913. TO THE CHAIRMAN AND MEMBERS OF THE URBAN DISTRICT COUNCIL OF HENDON. Ladies and Gentlemen,— I have the honour of presenting to you my twenty-fourth Annual Report upon the Health and Sanitary Condition of the District, for the year 1913. The Tables and Statistics furnished, and the matters specially reported upon, are in accordance with the requirements of the General Order of the Local Government Board, etc. As in previous years, a considerable increase has taken place in the population, due to the erection and occupation of new properties, although not so much activity has been displayed in the building trade as in the last few preceding years. Many new roads have been laid out on the Neeld Estate in anticipation of the extension of the Golders Green Tube Railway, and when a station is provided in the neighbourhood, no doubt this estate will be rapidly built upon. During the 12 months' period under review, 587 new dwellings have become occupied, increasing the population by 2,510 persons, and bringing the estimated population of the district to 45,194. 6 From a perusal of the Vital Statistics, it will be seen that the health of the residents has been satisfactorily maintained. There is an increase in the Death Rate over that of last year, the corrected Death Rate for this year being 11.03 per 1,000. The deaths from Zymotic Diseases exceed the number in the previous year, many deaths being due to Measles, and an increased number of deaths have occurred under one year of age from Premature Birth, and Pneumonia, and these circumstances, together with the growth of the inhabitants largely account for the higher Death Rate. The Infantile Mortality Rate, 85 per 1,000 of the children born, cannot be deemed unsatisfactory, although undoubtedly a much lower rate might be obtained if the necessity to keep milk intended for infants cool and scrupulously clean was more generally realised, and care taken to exclude by properly covered vessels contact with dust, flies, and foul air. Ninety-five additional Births were registered compared with last year, producing an increased Birth Rate, viz., 24.64 per 1,000. This is a satisfactory Rate compared with the country in general. Measles assumed an epidemic form in the early part of the year, and 22 deaths resulted from this disease. This disease was not made notifiable. On account of its lengthy incubative period and infectivity it is a source of administrative trouble to all concerned with the control and management of Schools, especially Infants' Departments. No doubt many parents do not realise the dangers arising from careless treatment of this highly Infectious Disease. The Notifiable Infectious Diseases (not including Pulmonary and Tubercular Diseases), averaged 3.6 per week. None of the diseases assumed epidemic form. There was a larger number of Diphtheria cases than in the preceding year, but the cases of Scarlet Fever were considerably less. 7 On reference to the details in my report full particulars will be found set out under the various headings and tabulated in the Tables and Summaries. The sanitary condition of a large number of dwellings in the District has been considerably and creditably improved, and a large number of nuisances abated. Systematic Inspection work has been proceeded with under the Housing (Inspection of District) Regulations. This continuous inspection work, resulting in the suppression and abatement of a large number of nuisances, and the improvement and repair of dwellings, has a direct bearing on the maintenance of the general health of the inhabitants of the District, and adds to the comfort and well being of the tenants. There is an apparent lack of Artizans' Dwellings in West Hendon and parts of Central Hendon. There are no empty flats or houses in these neighbourhoods, and much difficulty is experienced by the working people in obtaining suitable accommodation. In the last year or so, the increased motor traffic, and the erection of motor works, and garages, has brought into the district a large number of employees, many being of the artizan type. The tendency is to erect villa dwellings on the new estates, with a rental not within the reach of the artizan classes. This matter will, undoubtedly, need the consideration of my Council at an early date. Further advance has been made towards the erection of a permanent Isolation Hospital conjointly with Finchley, and in the meanwhile additional accommodation has been furnished at the existing temporary Isolation Hospital, in the shape of quarters for the nursing staff, which will greatly improve the present building pro tem, 8 A great many new streets have been made up providing sanitary carriage and footways, and the main arteries, which arc. continually being torn up by motor 'bus traffic, are about to be paved with durable materials. BOUNDARIES OF PARISH. The parish is bounded on the north by Edgware, Elstree, Chipping Barnet, Shenley, Totteridge, and Finchley; on the south and east by Hampstead; and on the south and west by Willesden, Kingsbury, and Little Stanmore. It measures about miles in length, by 4 miles in breadth. GEOLOGY. The natural subsoil is the London clay; deposits of river gravel are found near the Brent, shewing that it once was a very large river. Some very interesting specimens of fossil shells were excavated during the progress of some sewerage works in 1871 at Burgess Hill. SITUATION AND HEIGHT. Hendon proper is situated in the angle of ground formed by the junction of two streams—the Brent and the Silk—at the Welsh Harp, or Hendon Reservoir. The highest point in Central Hendon is 287 feet above the sea level. The highest point in the parish is at Barnet Gate, 463 feet above sea level, and 23 feet above the highest point of Hampstead Heath. The parish comprises the central village of Church End, Brent Street and The Burroughs, and the following nine districts—Mill Hill, Child's Hill, Golders Green, West Hendon and The Hyde, Burnt Oak, The Hale, Cricklewood, Temple Fortune (including Garden Suburb), and Page Street. 9 For statistical purposes I have divided the district into six divisions, viz.:—Mill Hill, Burnt Oak, Central Hendon, West Hendon, Golders Green, and Temple Fortune, and Child's Hill and Cricklewood. The following boundaries shew the areas of the districts:— No. 1.—Mill Hill. The whole of the district lying north of the Great Northern Railway. No. 2.—Burnt Oak. Bounded on the north by the Great Northern Railway, on the south-west by Edgware Road, on the south-east by a lino drawn parallel midway between Annesley Avenue and Colindale Avenue, and extending to Midland Railway on the north-east by Midland Railway. No. 3.—Central Hendon. Bounded on the north by the Great Northern Railway, on the west by the Midland Railway, extending from Great Northern Railway to Colin Deep Lane, on the south-west by Colin Deep Lame, Queen's Road, Park Road, continuing in a straight line to River Brent, and including property fronting on both sides of these roads on the east and south-east by the Dollis Brook and River Brent. No. 4.—West Hendon. Bounded on the north by a line drawn parallel midway between Annesley Avenue, Colindale Avenue, extending from Edgware Road to Midland Railway, including property fronting on both sides of Colindale Avenue; on the west by the parish boundary; on the south by Brent Reservoir and a portion of River Brent; on the east by a portion of the Central Hendon, western and south-western boundaries. 10 No. 5.—Golders Green and Temple Fortune. Bounded on the north, east, and south-east by the parish boundary, extending from Dollis Brook to North End Road; on the west by Dollis Brook from Decoy Bridge to Golders Green Road; on the south-west by Golders Green Road arid North End Road, including property fronting on both sides of these roads. No. 6.—Child's Hill and Cricklewood. Bounded on the north-west by the River Brent extending from Golders Green Road to Edgware Road on the southwest and south-east by the parish boundary ; on the north-east by Golders Green Road and North End Road, excluding property facing these roads. ACREAGE. The district covers 8,382 acres, and the density of the population is equal to about 5.30 persons per acre. Mill Hill equals 1.6 persons per acre, Hendon Ward 5.5 persons per acre, and Child's Hill Ward 10.7 persons per acre. TABLE OF ACREAGE.—Number of houses and Population. Localities. Acreage. Inhabited Houses. Population. Census, 1901. Census, 1811. Estimated June, 1913. Increase since June, 1912. Census, 1901. Census, 1911. Estimated June, 1913. Increase since June, 1912. Average No of persons per house. Hendon Ward Comprised of— 3383 1731 3791 4008 106 11524 17776 18747 475 ... Central Hendon ... 960 1505 1637 57 5739 6843 7442 259 4.54 West Hendon ... 628 1962 2013 36 4333 8783 9009 160 4.47 Burnt Oak ... 140 317 351 13 687 1395 1541 56 4.30 Institutions ... 3 7 7 ... 765 755 755 ... ... Child's Hill Ward Com prised of — 1999 1225 3915 5091 439 8262 16616 21480 1805 ... Child's Hilland Cricklewood ... 1169 2368 2716 124 7909 10439 11991 545 4.40 Golders Green and Temple Fortune ... 56 1547 2375 315 353 6177 9489 1260 4.00 Mill Hill Ward 3000 423 804 905 42 2664 4414 4967 230 5.49 Totals 8382 3379 8510 10004 587 22450 38806 45194 2510 ... 12 RATEABLE VALUE OF THE PARISH. This was £209,394 in 1908; £222,537 in 1909; £257,530 in 1910; £298,449 in 1911; £346,092 in 1912; and for 1913 (this year) £394,808. In 1894, when the first Council was elected, the rateable value was only £118,381. POPULATION. Population 45,194 Population (excluding Institutions) 44,439 The estimated population given, viz., 45,194, is to the middle of June, 1913. The population, excluding Institutions, i.e., persons in the Workhouse and Central London Sick Asylum, admitted from outside districts, is estimated to be 44,439. In estimating the population of the district to June, 1913, I find there has been a large increase in the growth of the population. 587 new houses have become occupied during this 12 months' period, making an increase of 2,510 persons. The following table shews the estimated increase during this 12 months' period in the number of occupied houses, and persons in each respective district:— District. Houses. Persons. Mill Hill 42 230 Burnt Oak 13 56 Central Hendon 57 259 West Hendon 36 160 Grolders Green and Temple Fortune 315 1260 Child's Hill and Cricklewood 124 545 Whole District 587 2510 Taking the average number of persons per house as shewn in the Population Table the estimated increase of persons is derived. 13 This increase, combined with the estimated population to June of last year, realises a total of 45,194 persons. Deducting from this figure the non-residents in Public Institutions in the district (which number 755), I find that it leaves a population of 44,439 persons belonging to Hendon District. VITAL STATISTICS. Births. Number of births registered 1085 Births registered but not belonging to district 10 1075 Births registered in other districts and belonging to Hendon 20 Net number of births belonging to district 1095 Birth-rate 24.64 per 1000 Birth-rate, England and Wales 23.9 per 1000 Of the 1,095 births belonging to the district, 577 were boys and 518 girls, producing a birth-rate of 24.64 per 1,000 of the population. Last year the births numbered 1,000 giving a birth-rate of 23.8 pear 1,000. There has been an increase of 95 births, as compared with last year. The excess of births over deaths is 631. The birth-rate must be considered a favourable one compared with that of the country generally. The following are the rates per 1,000 of the population for respective localities:— 14 Mill Hill 107 births, birth-rate 21.5 per 1,000 Burnt Oak 41 ,, ,, 26.6 ,, Central Hendon 164 ,, ,, 22.0 ,, West Hendon 265 ,, ,, 29.4 ,, Golders Green and Temple Fortune 185 ,, ,, 19.4 ,, Child's Hill and Cricklewood 313 ,, ,, 26.1 ,, Registered outside 20 1095 The greatest number of births occurred in West Hendon and Child's Hill, and the highest birth-rates are recorded for Burnt Oak and West Hendon. Ten illegitimates were born in public institutions in the district. In 300 instances a midwife was in attendance at birth. At all houses in which a birth occurred, a printed card of instructions was sent to the parent or guardian of the child entitled, "The Feeding and Care of Infants." The instructions fully explained the preparation and amount of food required at different months from birth onward, and also gave other important advice with respect to the clothing, cleanliness and care of infants. Thirty seven illegitimate children were born, viz.:— Mill Hill 1 Burnt Oak 1 Central Hendon 4 West Hendon 6 Golders Green and Temple Fortune 3 Child's Hill and Cricklewood 12 Outside the District 10 37 15—16 Vital Statistics of Separate Localities in 1913 and previous years, exclusive of Cleveland Street Asylum and non-residents in Workhouse. Names of Localities. Whole District. Hendon Ward. Child's Hill Ward. Mill Hill Ward. Year. Population estimated to middle of each year. Births Regittered. D'ths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. D'ths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. D'ths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. li'ths at all ages Deaths under 1 year. 1903 23,200 666 238 67 11,760 367 131 44 8,578 210 81 22 2,862 48 27 2 1904 24,449 679 297 96 12,668 404 160 57 8,847 238 113 34 2,934 42 24 5 1905 25,488 708 300 82 13,327 411 163 50 9,134 233 102 30 3 017 64 35 2 1906 27,546 703 302 72 14,832 396 173 43 9,506 239 96 28 3,208 68 33 1 1907 29,002 708 300 63 15,886 429 151 39 9,710 214 112 23 3,406 58 36 1 1908 31,784 787 319 72 17,383 464 176 39 10,745 246 105 26 3,656 77 38 7 1909 34,219 784 282 55 19,025 435 136 20 11,963 278 112 18 3 886 71 34 8 1910 37,749 833 293 70 19,431 316 128 34 14,685 328 127 33 4,126 76 38 3 1911 38,760 956 399 89 17,096 462 205 48 17,163 408 157 36 4,501 77 37 5 1912 41,929 1000 357 54 17.517 420 160 22 19 675 465 165 26 4,737 93 32 6 Average of Years 1903 to 1912. 31,412 782 308 72 15,892 410 158 40 12,000 288 117 27 3,633 67 33 4 1913 44,439 1,095 464 94 17,992 470 207 42 21,480 498 218 48 4,967 107 39 4 The difference in columns under population compared with the population table is due to the fast that all persons in institutions and non-residents are excluded. 17 Table 1. Vital Statistics of Whole District during 1913 and Previous Years. Name of District, Hendon Urban, Middlesex. Year. Population estimated to middle of each year. Births Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. Under 1 Year of Age. At all Ages. Of Non-residents registered in the District. Of Residents not registered in the District . Number. Rate per 1,000 Nett Births. Number. Rate. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1908 31,784 787 24.7 409 12.6 90 33 72 91 319 10.0 1909 34,219 784 22.9 343 10.2 97 36 55 70 282 8.2 1910 37,749 833 22.1 336 8.9 82 39 70 80 293 7.7 1911 39,515 960 956 24.66 474 11.9 122 47 89 93 399 10.29 1912 42,684 993 1000 23.8 433 10.14 130 55 54 54 357 8.51 1913 45,194 1085 1095 24.64 531 11.74 133 66 94 85 464 10.44 Area of District in acres (land and inland water) 8,382. At Census of 1911. Total population at all ages 38,806 Number of inhabited houses 8,513 Average number of persons per house 4.5. 18 DEATHS AND DEATH-RATE. Number of deaths registered 531 Number of deaths of non-parishioners 133 — 398 Number of deaths of parishioners registered in other districts 66 Net number of deaths belonging to district 464 Gross death-rate 11.74 per 1,000 Recorded death-rate 10.44 per 1,000 Corrected death-rate 11.03 per 1,000 Death-rate, England and Wales 13.4 per 1,000 Of the 597 deaths registered for the year, 464 were of parishioners, 66 of which number died in hospitals or in institutions in outside districts. In Table III. these deaths a.re classified in districts and under the various causes of death. The 133 deaths of nonparishioners occurred in the Workhouse or Central London Sick Asylum, and these have been transferred to the several districts to which they belong. Last year the deaths of Parishioners numbered 358. Gross Death-Rate. 11.74 per 1,000. This rate is derived by taking all the deaths registered in the district, whether residents or non-residents, per 1,000 of the gross population. The number of deaths registered is 531, and the gross population 45,194 persons. Last year this rate was 10.14. Recorded Death-Rate 10.44 per 1,000. This Rate represents the actual number of deaths per 1,000 of residents belonging exclusively to Hendon, who died within or outside the district 19 All deaths of persons dying in the district and belonging to other districts, and all deaths of non-residents occurring in Public Institutions have been transferred to the various districts to which they belonged. The number of deaths of parishioners is 464 and the net population is 44,439. Last year this rate was 8.53 per 1,000. Corrected Death-Rate 11.03 per 1,000. The value of a Corrected Death-Rate is for purposes of comparison with other districts and the country generally, and is obtained by using a "Correction Factor" supplied by the Registrar General. The Corrected Death-Rate signifies the Death-Rate which would obtain in Hendon if the local age and sex distribution were the same as that of the country generally. The Corrected Death-Rate is rather higher than last year—last year it being 9.01. Coupled with this fact nearly 20 per cent. of the deaths were of persons who had reached the age of 70 years. The highest rates are obtained in West Hendon and Child's Hill and Cricklewood districts, and the lowest rates dn Mill Hill and Golders Green districts. The following shews the actual number of deaths which have occurred in each locality and the Death-Rate. Mill Hill 39 deaths, death-rate equals 7.8 per 1,000 Burnt Oak 16 ,, ,, 10.3 ,, Central Hendon 78 ,, ,, 10.4 ,, West Hendon 113 ,, ,, 12.5 ,, Golders Green and Temple Fortune 71 ,, ,, 7.4 ,, Child's Hill and Cricklewood 147 ,, ,, 12.2 ,, 20 CAUSES OF DEATH. On reference to Table III. it will be seen that a complete list of all the deaths of parishioners is set out. The Zymotic Death-Rate for the year equals 1.23 per 1,000. Last year this rate was .38 per 1,000. The deaths from diseases upon which the Zymotic DeathRate is calculated are as follows:— Smallpox 0 Scarlet Fever 2 Measles 22 Epidemic Diarrhoea 15 Diphtheria 6 Whooping Cough 8 Typhoid Fever 2 55 21—22 TABLE III.— CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1913. Name of District.—HENDON URBAN DISTRICT, MIDDLESEX, Causes of Death. Nett 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. All Ages. Under 1 year. 1 and under 2 years 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards All causes Certified 463 93 29 12 32 12 54 104 127 133 Uncertified 1 1 ... ... ... ... ... ... ... ... Enteric Fever 2 ... ... ... 1 ... 1 ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... Measles 22 5 8 5 4 ... ... ... ... 1 Scarlet Fever 2 ... ... 1 1 ... ... ... ... ... Whooping Cough 8 3 4 1 ... ... ... ... ... 1 Diphtheria and Croup 6 ... 1 ... 5 ... ... ... ... ... Influenza 5 ... ... ... ... ... ... 1 4 2 Erysipelas 1 ... ... ... ... 1 ... ... ... Phthisis (Pulmonary Tuberculosis) 29 2 1 1 3 4 11 7 ... 25 Tuberculous Meningitis 7 2 ... 1 3 ... 1 ... ... ... Other Tuberculous Diseases 3 1 1 ... 1 ... ... ... ... 1 Cancer, Malignant Disease 43 ... ... ... ... ... 3 30 9 13 Rheumatic Fever 2 ... ... ... 1 ... 1 ... ... ... Meningitis 2 ... ... 1 ... ... ... ... ... 1 Organic Heart Disease 35 ... ... ... 1 ... 6 13 15 11 Bronchitis 27 5 ... ... ... ... 1 4 17 9 Pneumonia (all forms) 35 10 7 ... 2 ... 4 6 6 4 Other diseases of respiratory organs 9 2 ... ... ... ... 2 1 4 2 Diarrhœa and Enteritis 15 8 7 ... ... ... ... ... ... 1 Appendicitis and Typhlitis 2 ... ... ... 1 1 ... ... ... 1 Cirrhosis of Liver 6 ... ... ... ... ... 1 5 ... 5 Alcoholism 1 ... ... ... ... ... 1 ... ... ... Nephritis and Blights Disease 9 ... ... ... ... ... 2 3 4 4 Puerperal Fever ... ... ... ... ... ... ... ... ... ... Other accidents and diseases of Pregnancy and Parturition ... ... ... ... ... ... ... ... ... ... Congenital debility and Malformation, including Premature Birth 45 45 ... ... ... ... ... ... ... 3 Violent Deaths, excluding Suicide. 15 ... ... 1 4 2 2 3 3 ... Suicides 3 ... ... ... ... ... 3 ... ... ... Other defined diseases 129 11 ... ... 5 4 14 30 65 49 Diseases ill-defined or unknown . 1 ... ... ... ... ... ... 1 ... ... Totals 464 94 29 12 32 12 54 104 127 133 SUBENTRIES included in above figures. Cerebro-spinal Meningitis ... ... ... ... ... ... ... ... ... ... Poliomyelitis 1 ... ... ... 1 ... ... ... ... ... Cerebral Diseases 24 ... ... ... ... ... 2 8 14 7 Senile Decay 34 ... ... ... ... ... ... ... 34 22 Pneumonia 22 1 5 1 2 ... 4 3 6 2 23 SENILE MORTALITY. Of the 462 deaths of residents in Hendon, 92 were persons over 70 years of age. The proportion of deaths occurring amongst those over 70 years of age to the total deaths was therefore 19.9 per cent. The deaths were due to the following causes:— Heart Disease 5 Decapitation 1 Burns 3 Pericarditis 1 Fatty degeneration of heart 3 Anaesthesia 1 Cancer 1 Suicide 3 Epileptic fit 1 Bronchitis 2 Gastro-enteritis 1 Want of attention at birth 2 Suffocation (drowning) 1 Cerebral hæmorrhage 1 Ruptured aortic aneurysm 2 Shock 1 Pyæmia 1 Convulsions 2 Peritonitis 1 Fracture of skull 2 Glioma of cerebrum 1 Pleurisy and Pneumonia 1 — Bronchitis and Pneumonia 1 Total 38 The following is a return of the number of persons dying over 70 years of age in the different localities:— Mill Hill 15 Burnt Oak 6 Central Hendon 16 West Hendon 17 Goldera Green and Temple Fortune ... 15 Child's Hill and Cricklewood 23 92 INQUESTS, 1913. — During the year 38 inquests were held in the district. Last year 31 were held. 24 INFANTILE MORTALITY. Deaths registered under one year of age, 94. Infantile Mortality Rate, 85 per 1,000. Infantile Mortality Rate, England and Wales, 109 per 1,000. The Infantile Mortality is greater than that of last year, but compares favourably with the previous eight years. Last year the rate was the lowest recorded for the past 23 years, and was exceptionally low. Ninety-four deaths were registered, as compared with 34 deaths last year. On Table 4 the causes of deaths are classified, and from it can be seen the nature of the diseases, etc.:—Premature Birth 23, Atrophy, Debility and Marasmus 16, Pneumonia 10, Diarrhoea, and Enteritis 8, Congenital Malformation 6, Measles 5, Bronchitis 5. The following table shews the actual number of deaths which have occurred in each locality, and the Mortality Rates:— INFANTILE MORTALITY. The following table gives the rates for the past ten years. Localities. 1904 19.05 1906 1907 1908 1909 1910 1911 1912 1913 Infantile Rate for whole parish 137 115 98 88 91 70 80 93 54 85 Hendon Ward 141 121 106 81 84 66 82 103 52 89 Child's Hill Ward 142 128 117 107 101 64 100 88 55 96 Mill Hill Ward 119 31 14 17 89 112 52 65 64 37 Table IV. 25 District—Hendon Uhban (Middlesex). Infant Mortality During the Year 1913. Nett Deaths from stated c uses at various ages under 1 year of age Causes of Death. Under 1 Week 1-2 Weeks 2 -3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4Weeks to3 months. 3-6 Months. 6-9 Months. 9 12 Months. Total Deaths under 1 Year. All Causes Certified 28 9 4 1 42 13 a 17 10 93 Uncertified ... ... 1 ... 1 ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... 1 1 2 ... 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whopping Cough ... ... ... ... ... ... ... 3 ... 3 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 1 1 ... 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... 1 2 ... 3 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... ... ... 2 ... ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 1 3 ... 5 Pneumonia (all forms) ... ... ... ... ... 1 1 4 4 10 Diarrhœa ... ... ... ... ... ... 1 ... 1 2 Enteritis ... 1 1 1 3 ... 3 ... ... 6 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 3 1 ... ... 4 1 ... 1 ... 6 Premature Birth 18 2 1 ... ... 2 ... ... ... 23 Atrophy,Debility and Maraamus 4 4 1 ... 9 6 ... ... 1 16 Other Causes 2 1 2 ... 5 1 ... 1 2 9 Totals 28 9 5 1 43 13 11 17 10 94 Nett Births in the year legitimate 1095. Illegitimate 27. Nett Deaths in the year Legitimate Infants 90. Illegitimate Infants 4. 26 The printed instructions sent to the parents of newlyborn infants, if properly and carefully followed, should do much to protect infant life, and no effort should be spared in this direction when no fewer than 110,000 infants under one year of age die in England and Wales every year largely for the want of proper feeding and nursing. EPIDEMIC DIARRHœA. Fifteen deaths, all under the age of two years, were notified from this cause occurring principally in the months of August and September. This does not represent any undue incidence of the disease. As I have reported in previous years, this complaint appears to be greatly influenced by the nature of the summer seasons, as when a hot dry summer is experienced it is very often accompanied by an epidemic of this disease. The summer of this year was not unduly tropical in comparison with 1911, when I reported 28 deaths from this cause. MORTUARY. The new Mortuary, opened at the end of last year, has afforded ample accommodation for the needs of the district, and its value has been much appreciated by medical men for post mortem purposes. The post mortem room, which is isolated from the other apartments, is provided with every convenience and facility in connection with its use. The building conforms with the requirements laid down by the Local Government Board. 27-28 Table II. Cases of Infectious Disease notified during: the year 1913. Name of District-Hkndon Urban (Middlesex.) Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Locality (e.g. Parish or Ward) of the District. Total Cases removed to Hospital. At all Ages. At Ages-Years. Mill Hill. Burnt Oak. Central tlendon. West Hendon. Golders Green and Temple Fortune. Child's Hill and Crickle wood. No Fixed Abode. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox - - - - - - - - - - - - - - - - Cholera (C) Plague (P) - - - - - - - - - - - - - - - - Diphtheria (including Membranous croup) 59 - 5 43 9 2 - 12 - 3 18 12 14 - 34 Erysipelas 17 - 1 - 3 11 2 - - 3 4 3 7 - 1 Scarlet Fever 98 - 27 56 12 3 - - 9 2 30 29 15 13 - 76 Typhus Fever - - - - - - - - - - - - - - - Enteric Fever 11 - 1 2 2 5 1 1 - 1 5 - 4 - 7 Relapsing Fever (R) Continued Fever (C) - - - - - - - - - - - - - - - - Puerperal Fever 1 - - - - 1 - - - - - - 1 - - - Cerebro-spinal Meningitis 1 - 1 - - - - - - - - - - 1 - - Poliomyelitis 1 - - - 1 - - - - - 1 - - - - - Pulmonary Tuberculosis 121 - - 9 21 57 28 6 4 20 8 21 13 55 - - Other forms of Tuberculosis 50 3 8 18 9 11 - 1 3 1 4 12 7 23 - - Totals 359 3 43 128 57 90 31 7 29 23 50 89 51 117 - 118 Isolation Honpital or Hospitals, Sanatoria, &c.-The Hendon Urban District Council'a Isolation Hospital, Renters Lane, Hendon, and various London Hospitals if the occasion should arise. There is no .Sanatorium in the district for the receptioo of persons suffering from phthisis. 29 INFECTIOUS DISEASES. SCARLET FEVER. 98 Cases notified. 75 Cases removed to Isolation Hospital. 1 Case removed into a London Hospital. 22 Cases isolated at home. The incidence of this disease has been considerably less this year than in the four previous years. In the month of April not a single case was notified, and I was able to report that the Scarlet Fever Wards were free of patients for 14 days, a circumstance which has not occurred for a period of 11 years. At the end of the first eight months of the year only 33 cases had occurred, the majority of the cases being notified in the last four months of the year. The cases were distributed over different parts of the District, and no special outbreak occurred. The following notifications were received each month:— January 5cases February 7,, March 1,, May 7 ,, June 4 ,, July 5 ,, August 4 „ September 15,, October 13 ,, November 19 ,, December 18 ,, 98 cases 30 The smallest number of cases were notified in March, 1; and the largest number in November, viz., 19. Of these 98 cases, 76 were removed into Hospital; two children died, producing a death-rate equal to .044 per 1,000 of the population, and a case rate of 2.2. From 1 to 5 years of age 27 cases occurred. ,, 5 to 15 ,, 56 ,, ,, 15 to 25 ,, 12 ,, ,, 25 to 45 ,, 3 ,, The cases occurred in the following localities:— Mill Hill 9 cases Burnt Oak 2 ,, Central Hendon 30 ,, West Hendon 29 „ Golders Green and Temple Fortune 15 ,, Child's Hill and wood 13 ,, No Schools or Classes have required closure on account of this disease. These 98 cases represent infection in 86 houses. Seventyfive cases were promptly removed into the Isolation Hospital, when proper isolation could not be provided in the dwelling. 31 The Scarlet Fever cases occurred in the following streets: North Road, Burnt Oak 1 Alyth Gardens 1 Borthwick Road 1 Milton Road, Mill Hill 4 Algernon Road 3 Golders Green Road 3 Elm Terrace 1 Bellevue Terrace 3 Bellevue Road 2 Station Road 1 Temple Fortune Lane 1 First Avenue 2 Hayes Crescent 1 St. Andrew's Road 1 Erskine Hill 1 Crewys Road 2 Church Walk 1 Russell Road 2 Hampstead Way 1 Heading Street 4 Newton Cottages, Stratford Road 1 Burnt Oak 1 Mill Hill School 1 Ravenshurst Avenue 2 Montpelier Rise 2 York Road 6 Powis Gardens 1 Telford Road 2 Foster Place 1 Campian Terrace 1 Wilberforce Road 3 Brockenhurst Gardens 1 Alexandra Road 1 West Heath Avenue 1 Holders Hill 1 Argyle Road 1 Ridgeway, Golders Heath Close 1 Green 1 Second Avenue 3 Bridge Lane 2 Hogarth Hill 1 Stanley Road 2 Bell Lane 1 Church Terrace 2 Victoria Road 2 Woodcroft Avenue, Herbert Road 4 Mill Hill 1 Broadway, West Burroughs Gardens 1 Hendon 1 Dallas Road 1 Wellgarth Road 1 Cricklewood Broadway 1 Sunny Gardens 1 Rotherwick Road 1 Winterstoke Gardens 1 Elm Grove 1 Shakespeare Road, Mill Dartmouth Road 1 Hill 1 Beverley Gardens 1 Egerton Gardens 1 The Burroughs 1 Ravenstone Road 1 Claremont Road 1 32 DIPHTHERIA. 59 Cases notified. 27 Cases removed to Isolation Hospital. 7 Cases removed to London Hospitals. 4 Cases isolated in School Sanatoria. 21 Cases isolated at home. Fifty-nine cases of this disease have been notified during the year, compared with 37 cases last year, shewing an increase in the incidence of this disease. Notifications were received in the following months:— January 1 case February 1 ,, March 18 cases April 2 „ May 2 ,, June 2 ,, July 6 „ August 1 case September 4 cases. October 3 ,, November 7 ,, December 12 ,, Total 59 Of these 59 cases, 38 were removed from dwellings for isolation and treatment. Six cases proved fatal, producing a death-rate of 13, and a case rate of 1.3. From 1 to 5 years of age 5 cases occurred. „ 5 to 15 „ 43 ,, 15 to 25 ,, 9 „ „ 25 to 45 „ 2 „ 59 33 Tho cases occurred in the following localities:— Mill Hill 12 Burnt Oak — Central Hendon 3 West Hendon 18 Golders Green and Temple Fortune 12 Child's Hill and Cricklewood 14 59 No schools or classes required closure on account of this disease. These 59 cases represent infection in 50 houses. The increase in the number of Diphtheria cases notified was partly duo to a local outbreak in the Mill Hill District during the months of February and March. I personally investigated all these cases with the Medical Officer of the School and a Medical Specialist. All the throats of the boys and staff at the School were carefully examined, and all the scholars and inmates of the school buildings injected with Antitoxin. The conclusions arrived at for the outbreak were that some "carrier" case in the School had eluded detection and spread the disease. This was emphasised, as so many of the cases were so mild in character that the disease could only be diagnosed by Bacteriological Examination. At the School House in which the first case occurred many of the boys left for home, so that it was impossible to see all the boys. The preventative measures adopted quickly checked the further spread of the disease, and no further case occurred after March the 24th. All the school buildings and class rooms were thoroughly disinfected. 34 The other cases which occurred in the Mill Hill district could not in any way be definitely associated with the school cases. With regard to all other cases notified, very careful enquiries did not reveal a.ny special cause for the occurrence in the dwelling. In two separate families three cases occurred in each, and in two separate families two cases occurred in each. On inspection at three houses defects were found in the drains, and two were relaid and one was satisfactorily repaired; and at four houses other nuisances were detected and abated. The cases occurred in the following streets:— Ridgeway House Mill Hill 4 The Broadway, West Hendon 2 Asmuns Hill 1 Hendon Park Villas 1 Willifield Way 5 Thorverton Road, Cricklewood 1 The Ridgeway, Mill Hill 1 Granville Road 2 West Heath Avenue 1 Midland Brent Terrace 3 Highwood Hill, Mill Hill 3 Audley Road 1 Golders Green Road 1 Mill Hill School 2 Argyle Road 4 Winterstoke Gardens 1 Ravenstone Road 3 Pattison Road 2 Gratton Terrace 1 Burton Bank, Mill Hill 1 Golders Hill Terrace 1 Westcroft Farm, Cricklewood 1 Renters Farm 1 Asmuns Place 1 Bertram Road 1 Addison Way 1 Borthwick Road 1 Devonshire Place 1 Wroughton Avenue 1 Milton Road, West Hendon 4 Brent View Road 1 Stanley Road 1 Hampstead Way 1 Egerton Gardens 1 Algernon Road 2 35 TYPHOID FEVER. 11 Cases notified. Eleven cases of this disease have been notified, as compared with five last year. Seven of these cases were removed into London Hospitals for treatment, and two of these cases proved fatal. The localities in which the cases occurred were:— Mill Hill 1 West Hendon3 Central Hendon 3 Child's Hill and Cricklewood 4 11 The months :— June 1 September3 October3 November1 December4 11 In one case a man of 31 years of age had just returned from Belgium who had undoubtedly contracted the disease out of this country and returned to his house in a convalescent condition. One person notified was afterwards diagnosed as suffering from another disease. One boy had frequently bathed in the Welsh Harp Waters, and had very possibly swallowed sewage contaminated water. 36 In two cases shell fish had been eaten outside the district. Three cases occurred in one family, two of which proved fatal. Thorough investigations were made, but the outbreak could not satisfactorily be accounted for. The mother had been unwell some months previous, but Typhoid fever was not suspected to be the cause of her illness. I thought possibly the mother might be acting as a "carrier" case, and had a Widal test made with a positive result. I am inclined to think that this member of the family was the unconscious cause of these cases. The case of the mother is still under observation. ERYSIPELAS. 17 Cases notified. Seventeen cases of this disease have been notified this year. Necessary disinfection was performed. PUERPERAL FEVER. One case of Puerperal Fever has been notified. The case was nursed at home, and on recovery of the patient, the house and bedding was disinfected. A midwife attended at the confinement. ACUTE POLIOMYELITIS. One case was notified from a family in Central Hendon. The patient was taken into the Hampstead General Hospital for treatment. A death also occurred from this disease in a Gipsy Caravan in the district. 37 CEREBRO SPINAL FEVER. One case of this disease was notified, that of a child three years of age, and was removed to St. Mary's Hospital for treatment. The child had been ailing about five months. PULMONARY TUBERCULOSIS AND OTHER TUBERCULAR DISEASES. The deaths from Pulmonary Tuberculosis numbered 29, producing a Mortality Rate of .65 per 1,000. The deaths from Pulmonary Tuberculosis and other Tubercular Diseases numbered 32, producing a Mortality Rate of .72 per 1,000. On 1st February, 1913, the new Public Health (Tuberculosis) Regulations, 1912, framed by the Local Government Board, came into operation. This Order consolidated and amended the previous Orders made in 1908 and 1911. The new Regulations apply to Non-Pulmonary as well as to Pulmonary Tuberculosis, and made these diseases notifiable on prescribed forms A.B.C.D. Primary Notifications were notifiable on Form A, and Supplementary Notifications of old cases on Forms C and D, and School cases of Form B. Supplementary Notifications of old cases would be made when the patient entered or was discharged from a Sanatorium, Hospital, or Poor Law Institution. During the year I received 171 Primary Notifications and 43 Supplementary Notifications. Of the 171 Primary Cases notified, 121 were Pulmonary Tuberculosis, and 50 were other Tubercular Diseases. 74 were males, and 97 females. 38 At the end of the year 21 of the persons notified had died from the disease. The cases occurred in the following districts:— Pulmonary. Non-Pulmonary. Mill Hill 4 3 Burnt Oak (including 18 cases in Public Institutions) 20 1 Central Hendon 8 4 West Hendon 21 12 Golders Green and Temple Fortune 13 7 Child's Hill and Cricklewood 55 23 The ages were:— Pulmonary. Non-Pulmonary. Under 1 year of age — 3 1 and under 5 years of age — 8 5 and under 15 years of age 9 18 15 and under 25 years of age 21 9 25 and under 45 years of age 57 11 45 and under 65 years of age 28 - 65 and upwards 6 1 Disinfection of bedding and rooms was performed in all cases where a death occurred or where the sleeping room occupied by the patient was vacated for any other cause. I found that in a great number of oases patients could not occupy a separate room for sleeping, as they were not in a position to rent a house affording sufficient accommodation, but they were strongly advised to sleep in a separate bed, and to keep the room well ventilated night and day. Sputum jars were provided from the Sanitary Department in necessitous cases, and disinfectants supplied on application. 39 Any nuisances found on inspection in or around the dwelling were abated. The unit area for administrative action in the treatment on a comprehensive scale of persons suffering from Tuberculosis for Hendon under the provisions of the National Insurance Act, 1911, is the County of Middlesex, and Dr. C. W. F. Young, the County Medical Officer of Health, has kindly supplied me with the following particulars as to the treatment afforded patients in this district. Thirty-one cases of insured persons were recommended for treatment, and were visited by Dr. J. R. Dobson, Tuberculosis Officer. Four of these cases removed elsewhere, but sanatorium treatment was obtained in fifteen cases, and hospital treatment in five. In other cases in which assistance was needed domiciliary treatment was procured through the medical attendant in charge of the case. MEASLES. During the early part of February this disease became verv prevalent in Central Hendon and West Hendon districts, and I received over 80 notifications from teachers respecting children who were absent from their respective schools through the presence of this disease in their homes. The cases appeared to be almost entirely confined to the Infants' Departments, Bell Lane being the principal school affected, but there were also several cases in St. Mary's Roman Catholic School. In accordance with my recommendation, the Infante' Department of Bell Lane School was closed on the 10th Februarv, and St. Mary's Roman Catholic School for a week after the Easter vacation. I also requested the superintendents of the various Sunday Schools in these vicinities to close their Infants' classes and also to exclude children up to the age of nine years. This request was readily complied with. 40 In the early part of March the disease spread to West Hendon district, and principally affected Algernon Road and St. John'9 Schools. The Sunday Schools in this district were also closed, and I am very pleased to be able to report that by April the district was apparently free from any undue number of oases of this complaint. During the year 22 deaths from this disease were registered. At every house in which Measles occurred a printed leaflet was sent or delivered containing important advice to parents and guardians explaining the nature of the disease and the complications which may result from neglectful nursing, with advice as to isolation, disinfection, and how to protect other children from contracting the complaint. A Special notice with regard to exclusion of school children is added to the instructions. ISOLATION HOSPITAL. The first temporary Isolation Hospital was erected in 1889; it contained two wards, with nine beds, for the treatment of Scarlet Fever. The building also comprised a dispensary, a nurses' day room a.nd bedroom, with kitchen and scullery, two w.c.'s and bath. This building, with slight alterations and the addition of an Observation Ward with three beds, served the district until 1902. In this year an outbreak of Small Pox occurred, when an additional ward was added for 8 beds. During the greater part of 1902 all the wards were reserved for the treatment of Small Pox, and temporary provision was found for Scarlet Fever patients. Other additions were afterwards made, when an ambulance house, mortuary, laundry, and drying room, and an extra nurse's bedroom, were furnished, also certain enlargements were made to the kitchen, etc. 41 In 1909 a Diphtheria block was erected, containing two wards for 8 beds, with nurse's room, kitchen, lavatories, etc. The area of the present site of Hospital Grounds is about three-quarters of an acre. The present Hospital buildings, erected in December 1889, with the subsequent additions, have rendered admirable sea-vices to the district. This is fully demonstrated when it is seen that no fewer than 1755 patients have been treated thorein since it was first opened. Now that the population of the district has so vastly grown during the past few years the present Hospital accommodation does not adequately meet the demands of the district, and my Council conjointly with the Finchley Urban District Council has decided to erect a permanent Hospital. The question of finding and procuring the most suitable site for the new Hospital has occupied some considerable time, but a very suitable and oonveniently situated site has now been decided upon, and my Council are now awaiting the approval of such site by the Local Government Board. As some little time must necessarily elapse before the conjoint permanent Hospital will be erected and opened, my Council is now proceeding with the erection of temporary quarters for the nursing staff, which, is very urgently needed. 42 The following shews the number of patients which have been treated in the Hospital each year since it was first opened:— Brought forward 521 patients. 1890 4 patients 1901 83 " 1891 23 " 1902 55 " 1892 23 " 1903 80 " 1893 70 " 1904 83 " 1894 66 " 1905 74 " 1895 51 " 1906 92 " 1896 60 " 1907 53 " 1897 23 " 1908 83 „ 1898 86 " 1909 175 " 1899 74 " 1910 125 " 1900 41 " 1911 100 " 1912 129 " 1913 102 " 521 1755 The diseases treated were: 1,667 Scarlet Fever; 74 Diphtheria; 10 Smallpox; and 4 Typhoid Fever. During the year 75 cases of Scarlet Fever were removed into the Infectious Diseases Hospital, and one case into The London Fever Hospital; 27 cases of Diphtheria were treated in the Diphtheria block; and seven were removed into London Hospitals. The Infectious Hospital is a temporary building comprising Scarlet Fever and Diphtheria block. The Diphtheria block affords accommodation for eight beds, and the block is quite detached and separate from the old building and Scarlet Fever Wards, but it is linked up with a covered way. 43 The old hospital building is used exclusively for Scarlet Fever patients. It has two wards, each containing four beds, and a small ward in which are three beds; also a large day ward for convalescents, in which in times of urgency six beds can be placed. I endeavour, however, to keep the Convalescent Ward exclusively for the use of convalescent patients, to avoid these patients mixing continuously with the acute cases. The entire accommodation at the Hospital is eight beds for Diphtheria cases, eleven beds for Scarlet Fever cases, or seventeen beds using the Convalescent Ward. BACTERIOLOGICAL EXAMINATION. During the year 61 bacteriological examinations in suspected cases of Diphtheria have been made, as against 45 last year. My Council undertake to pay for such examinations where the patients are not in a position to afford them. Diphtheria Antitoxin is also supplied to all Medical Practitioners resident in the district for use in necessitous oases. VACCINATION. I am indebted to Mr. Taylor, the Registrar, for my annual returns with regard to Vaccination for the year. The newly included figures in the Vaccination Table are for the year ended 31st December, 1913. Of the 1004 births on the Registrar's list, 583 were successfully vaccinatcd, 311 conscientious objection certificates were obtained, and 41 died unvaccinated; 49 removed to other districts, and three were postponed by medical certificates. As in previous years, the number unvaccinated continues to increase, forming an unprotected population in the event of an epidemic of Smallpox. The continuous freedom from any epidemic form of this disease has strengthened the prevailing idea that protective measures are unnecessary, which is a matter for much regret. 44 Table giving Vaccination Returns since the Year 1901. Year end ing 31st December. No. of Births registered during preceding twelvemonths. No. of these Births duly entered in Register. No. of these Births remaining unentered in Register. No. of these Births unaccounted for. No. at all ages Vaccinated during year. (Primary.) Successfully Vaccinated. Insusceptible of Vaccination. Had Smallpox. Conscientious objections. Dead Unvaccinated. Removal to other Districts and cases not found. Postponement by Medical Certificate. Born within District. Born out of District. 1901 609 475 4 - 25 50 41 6 8 651 48 1902 679 575 5 - 30 44 18 3 2 648 98 1903 666 563 7 - 35 39 16 4 2 588 34 1904 660 559 4 - 38 45 11 3 - 571 39 1905 681 566 4 - 48 47 13 3 - 590 46 1906 703 597 — - 49 47 25 3 2 594 47 1907 708 597 1 - 39 48 24 1 3 602 35 1908 716 563 4 - 79 36 24 2 8 518 29 1909 786 535 1 - 149 49 42 5 5 517 36 1910 798 520 5 - 188 44 27 8 6 554 52 1911 838 551 2 - 206 51 19 5 4 559 46 1912 960 547 3 - 284 57 38 15 16 575 37 1913 1004 583 5 - 311 41 49 3 12 634 50 45 DISINFECTION. Eight hundred and seventy-two visits have been paid to infected premises for purposes of disinfection, and in making enquiries and investigations into the possible source of the diseases. A large amount of disinfection work has been entailed and carried out throughout the year. Three hundred and eight rooms have been fumigated, as against 247 rooms last year. This increase in the amount of disinfection work is partly due to the additional disinfection work performed in connection with cases of Consumption, made notifiable by recent legislation, and by special disinfection work after deaths from Cancer, etc. In every instance the work has been most speedily and thoroughly done. The fumigation of rooms is performed by Formaldehyde Tablets being dissolved and va.pourised in special lamps after all the apertures in the room have been sealed up and closed. Many of the rooms, in addition to being fumigated, were sprayed wtith a solution of Formalin, and this was done in all cases where, for various reasons, they could not be satisfactorily sealed. At every house where an infectious disease occurred the clothing, bedding, and all woollen or other articles likely to retain infection were taken from the room occupied by the patient and conveyed to the disinfecting station, where thorough disinfection was performed by treatment in a reliable Washington Lyon's steam disinfecting apparatus. Four thousand nine hundred and three articles were disinfected, namely, 245 beds, 471 blankets, and 3,187 miscellaneous articles of clothing. During the year about 566 journeys were made removing patients in the ambulance, and collecting and returning clothing and bedding with the infectious van. 46 Apart from the infectious work, the horse and driver were engaged by the Public Health Department with the testing and examination of house drains, and conveyed the smoke machine and other appliances to premises where tests were made. I am pleased to record that only two complaints reached me respecting any damage having been sustained to bedding or other fabrics shewing that due care has been exercised by the officer in charge of this work. Ninety-four rooms wore specially cleansed on my certificate, under Section 5 of the Infectious Diseases (Prevention) Act, 1890, which necessitated the stripping and cleansing of the walls and ceilings of these rooms after the removal of patients into Hospital, or on recovery of home nursed cases. In all cases of an infectious nature' disinfectants have been supplied from the Public Health Department, on application, for use in sick rooms, for cleansing, and for flushing purposes. The disinfectants supplied have been fluid "Sanitas Okol," and fluid "Izal." A printed leaflet prepared by me, entitled "Precautions for preventing the spread of Infectious Diseases" has been sent to or left with the occupiers of the infected houses. SEWAGE DISPOSAL, The following is a description of the system of treatment adopted by the Council:— The Outfall Works are situated at Renters Lane, and with the exception of the Pumping Station, which is at Cool Oak Lane, all the sewage gravitates to the works. 47 The area occupied with the land now belonging to the Council by the works covers 72 acres. The process adopted is, first, precipitation in tanks, the sewage having previously passed through a screening chamber and detritus tank. To aid this precipitation Sulphate of Alumina is used. The clarified effluent then passes over the high level filters, of which there are six, covering an area of acres in all. The filters are under-drained and ventilated. The filtrate after passing through these is carried to the low level "Contact Beds," which cover an area of 12,040 superficial yards, are five feet deep, and consist from below upwards of clean broken bricks, coke clinker, and pea gravel, the underdrains are large perforated pipes, each line of pipes being ventilated. The liquid sludge is pumped on to certain portions of the land and dug in. In addition to the artificial filtering area mentioned, there a.re 18 acres of land which can be used for irrigation purposes. The quantity of sewage flowing daily to the works in dry weather amounts to about one and a half million gallons. The reconstruction of the high level filters has had much to do with the generally improved condition of the outfall works. The rapid increase in the population of the district has rendered it necessary for the Council to acquire additional land for the treatment of sewage. With this object an application for a Provisional Order was laid before the Local Government Board, and has since been sanctioned by that authority and confirmed by Parliament. 48 Plans and estimates for a scheme of sewage disposal for the South side of the River Brent have now been laid before the Local Government Board. The scheme comprises new settlement tanks, primary and secondary percolating filters, and all necessary humus and detritus chambers, etc. The works are designed to deal with three times the dry weather flow of an estimated population of 20,000 persons, and form the first portion of the extension of the works necessitated by the rapid development of the district. WATER SUPPLY. The district derives its water supply from two Companies, viz., the Colne Valley Water Company and the Metropolitan Water Board. Both Companies furnish a constant and plentiful supply. In the months of June and July I received complaints that an inadequate water supply was being furnished by the Metropolitan Water Board to several houses in Central Hendon. My Council brought this matter to the notice of the Metropolitan Water Board, who stated that an auxiliary pump was being fixed at their works, to give additional pressure which would secure a oonstant and plentiful supply. Nearly every house in the district is furnished with a supply of water by one of the above Companies, and there are only one or two draw wells in use. A sample of water obtained from a draw well was analysed and found to be unsafe for drinking purposes, and the well was closed, and a supply of water laid on from the Company's main. I had samples of the Company's water taken from draw-off taps at different periods of the year analysed, and the water was pronounced to be of good quality. 49 Attention has been paid to storage cisterns, and nine found to be improperly covered or in a dirty state were covered or cleansed; and 16 taps were fixed on the rising main where cisterns'were found to be improperly constructed or placed. These taps draw the drinking water direct from the main, and not from an intermediate storage cistern. Six houses were furnished with a sufficient and improved water supply; the supply being taken into the house and a tap fixed over the sink. RAINFALL, 1913. I am indebted to Mr. Butler, Headmaster of Bell Lane School, for the following table shewing the rainfall for the past year:— The total rainfall was 22.16 inches. The greatest rainfall, January 11th, viz., .77 inches. The wettest month was October, viz., 3.07 inches. The driest month was June, viz., .43 inches. Total number of days on which rain fell, 182 days. Total number of dry days, 183 days. In 1912. The total rainfall was 29.12 inches. The greatest rainfall 29th September. The wettest month was August, 5.0 inches. The driest month was April, viz., .08 inches. Total number of days on which rain fell, 205 days. Total number of dry days, 161 days. 50 REGISTER OF RAINFALL IN 1913. Kept at Central Hendon School, in the County of Middlesex, Height of top of gauge above sea level 220 ft , and above ground 1ft. 4 ins. Time of Observation 9 a m  January. February. March. April May June. July. A ugust September October. November. December. Date. 1 .02 .23 .07 .31 .00 .00 .00 .00 .20 .00 .10 08 1 2 .06 .12 .01 00 00 .00 .06 .00 .10 .00 .02 .01 2 3 01 .01 01 25 45 .00 00 .00 .00 .00 .00 .04 3 4 .22 .00 .01 .02 26 .00 .20 .01 00 .21 .03 .04 4 5 .11 00 00 00 .00 .02 .12 00 20 .00 .00 .03 5 6 .01 02 .05 .00 .08 .20 12 06 02 15 .01 08 6 7 .00 11 .00 .00 .04 03 .18 .00 .00 .39 .11 00 7 8 .00 05 .05 .01 .11 .17 00 .00 .00 .07 02 00 8 9 .00 .18 01 .01 .03 .00 .00 .00 .05 .00 .05 .05 9 10 02 00 .08 .10 .04 00 .15 .09 .00 .00 31 00 10 11 .77 .00 .00 .48 21 00 .00 .00 00 .43 09 00 11 12 .00 .01 .00 .00 .02 .00 00 .00 00 .00 .37 00 12 13 06 .01 .01 00 .00 .00 00 .00 .06 .00 .31 00 13 14 06 02 .10 .05 .12 .00 46 .00 .00 .16 11 .00 14 15 .16 .05 .21 .23 00 .00 19 01 .01 00 00 .00 15 16 .14 .01 .31 .17 00 .00 .00 .0 .29 .00 00 .00 16 17 03 .00 03 .05 00 .00 15 .00 00 .00 .04 .03 17 18 .01 .00 .08 08 .08 .00 .01 .26 .00 .00 .07 .00 18 19 .16 .00 .07 .07 .02 .00 .12 00 .29 .00 .00 .00 19 20 .09 .00 03 .05 .00 .00 00 .00 .00 .54 02 .00 20 21 02 .00 .19 13 00 .00 .03 .00 .00 .18 73 .00 21 22 .43 .00 .14 .01 00 .00 .00 05 20 .00 .01 .00 22 23 01 .00 00 .00 .00 .01 .00 .10 .02 00 00 .21 23 24 .00 00 .01 .01 .00 .00 .00 .06 .00 .00 .02 .00 24 25 .00 .01 00 .17 .00 .00 00 00 00 .00 .00 00 25 26 .00 .02 .21 .09 00 00 .01 .08 .00 .72 00 .18 26 27 00 .01 01 08 .01 .00 .00 .00 .00 .01 00 00 27 28 .19 .00 .18 .08 00 .00 .00 .00 .00 07 00 00 28 29 .06 _ .08 48 .58 .00 00 .05 .00 .02 .00 00 29 30 .31 - .00 .10 .00 .00 .00 .14 .00 .08 03 .00 30 31 01 — 04 — .00 — .00 41 — .04 — .00 31 Total 2 95 86 1.99 3.06 2 05 43 , 1.80, 1.31, 1.44 3 07 2.45 10 Total for Year 2216 182 No. of Rain Day s 23 15 24 23 14 5 13 11 11 14 19 10 51 DISPOSAL OF HOUSE REFUSE, There is at present no Dust Destructor in the district. My Council undertakes a weekly collection of house refuse with their own plant, excepting in the Mill Hill district, where the work is done by my Council's Contractor. Throughout the year only 31 complaints were received at the Sanitary Office with respect to the non-removal of dust on the day for collection. My Council has continued to receive applications from residents in the Golders Green district asking for the house refuse to be removed more frequently than once a week. These applications have been carefully considered, and at present a more frequent collection has not been decided upon. The dust collected is very largely delivered at the Railway Stations and deposited in railway trucks and conveyed to suitable shoots down the line. Unfortunately it has not been possible at all times for the dust collected to be disposed of in this way, and one or two dust shoots have been used in the district for short periods, which invariably gives rise to complaints. Until a Dust Destructor is established the entire abolition of dust shoots cannot be brought about. CESSPOOLS, WATER CLOSETS AND PRIVIES. During the year 35 applications have been received at the Sanitary Department for cesspools to be emptied at 29 houses which cannot be drained into the main sewer. The work of emptying the cesspools has been carried out by my Council's contractor, under the supervision of the Sanitary Inspector. In the process of emptying these cesspools 121 times, 107,074 gallons of liquid and solid matter have been removed. 52 The houses in the district are nearly all on the water carriage system; only a very few outlying houses, from about 20 to 30, have a dry earth closet. The water closets in the new houses are of the " Short Hopper" L.C.C. pattern, washdown type. In the older houses the "Long Hopper" and " Spiral Flush" type of closet basin is being removed, and a modern type substituted. FACTORY AND WORKSHOPS ACT. The following is a list of the Factories and Workshops as recorded on the Factories and Workshops Register:— Total number of Factories 31 Total number of Workshops 130 Total161 Factory Laundries 17 Other Factories 14 Total 31 Workshop Laundries 46 Other Workshops 63 Bakehouses 21 130 Two of the Bakehouses are underground, one of which is at present closed. 53 During the year notices to abate nuisances have been served under the Public Health Act, 1875, and Factory and Workshop Act, as follows 12 Foul w.c. pans. 11 Defective flushing cisterns. 15 Dirty walls and ceilings. 3 Choked w.c.'s. 2 Dilapidated w.c. apartments. 2 W.C. doors without fastenings. 2 Defective drains. 2 Defective w.c. pans. 1 Dustbin dilapidated. 1 Accommodation for sexes. 1 Defective rain-water pipe 13 Other nuisances. 65 Total. 54 1. INSPECTION. Including Inspections made by the Sanitary Inspectors Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries). 25 8 ... Workshops (Including Workshop Laundries) 153 12 ... Workplaces 3 ... ... Total 181 20 ... 2. DEFECTS FOUND Particulars. Number of Detects. No. of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts* — Want of cleanliness 9 9 ... ... Want of ventilation 1 1 ... ... Overcrowding ... ... ... ... Want of drainage of floors 1 1 ... ... Other nuisances 27 27 ... ... Sanitary accommodation insufficient ... ... ... ... unsuitable or defective 20 20 ... ... not separate for sexes 1 ... ... ... Offences under the Factory and Workshop Act- Illegal occupation of underground bakehouse (S 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 6 6 ... ... Other offences— (Excluding offences relating to out-work which are included in part 3 of this Report). ... ... ... ... Total 65 64 ... ... The defects found, and which are not shewn as remedied, are now in hand. 55 A. HOME WORK. Nature of Work. Outworkers' Lists. Section 107. Number of Inspections of Outworkers' Premises. Outwork in unwholesome Premises, Section 108. Lists received from Employers. Numbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Outworkers forwarded to other districts Instances Notices served. Prosecutions. Twice in the Year. Once in the Year. Lists. Outworkers Lists. Outworkers. Wearing Apparel— Making, &c ... ... ... ... 25 ... 47 ... ... ... Total ... ... ... ... 25 ... 47 ... ... ... 56 4.—REGISTERED WORKSHOPS. Workshops on the Register (s 131)at the end of 1913 Number. Workshop Laundries 46 Bootmakers' Workshops 19 Other Workshops 44 Bakehouses 21 Total number of Workshops on Register 130 5.—OTHER MATTERS. Class Number Matters notified to H.M. Inspector of Factories : — 3 Failure to affix Abstract of the Factory and Workshop Acts (S. 133.) 1 Action taken in matters referred by H.M. In Notified by H.M. Inspector spector as remediable 3 Reports (of action taken) Health Acts, but not sent to H.M. Inspector under the Factory Acts (S. 5) 3 Other ... _ Underground Bakehouses (S. 101) : — Certificates granted during the year — In use at the end of the year 2 57 HOUSING, TOWN PLANNING, Etc., ACT, 1909, and HOUSING OF THE WORKING CLASSES ACTS. One hundred and eighty-seven houses have been inspected under the Housing (Inspection of District) Regulations, 1911. The inspection of these properties resulted in the discovery of a large number of sanitary defects and nuisances. The nature of the defects noted were:—Dirty and defective walls and ceilings, defective water closet basins, traps and flushing cisterns, unpaved yards, lack of proper ventilation under floors, damp conditions, leaky roofs, defective gutterings and downspouts, improperly placed and covered drinking water cisterns, the absence of proper dust receptacles, leaky sinks and waste pipes, leaky and defective drains, and other general dilapidations. Notices were served with respect to these nuisances and defects, and at the end of the year nearly all the notices served were complied with and the nuisances and defects remedied. Only one of these houses was closed. The defects found at the other houses were such as to constitute nuisances and discomfort, and were remedied under the provisions of the Public Health Acts. I record the following particulars required by Article 5 of the Housing (Inspection of District) Regulations, 1911, to be included in my report:— Number of dwelling houses inspected 187 Number of houses considered on inspection to be in such a condition as to be unfit for human habitation 1 58 Number of houses closed and demolished without orders Nil. Number of houses closed and demolished following Closing Orders 1 Number of representations made to the local authority with a view to the making of Closing Orders 1 Number of Closing Orders made 1 Number of dwelling houses where defects were remedied without service of Closing Orders Number of houses which, after making of Closing Orders, were put in a fit state Nil. Details of the nuisances and defects dealt with are included in the summary of work done by the Inspector of Nuisances throughout the year, which he has submitted to me, and which I have included in my report, as required by Article 20 (16) of the General Order of the Local Government; Board. There are two back to back houses in the district. Throughout the year 4 cases of overcrowding were discovered, and the usual notices were issued which secured the abatement of the nuisance. With regard to the erection of Artizans' Dwellings. Last year a Local Government Board Inquiry was held at the Council Offices to consider the suitability of the proposed site. The site was approved and a building scheme has since been prepared which has met with the approval of the Local Government Board, and tenders accepted by my Council for the erection of 52 cottages, but owing to the increased cost of building materials, the Contractor failed to sign the Contract, and new tenders are being obtained. 59 COWSHEDS, MILKSHOPS AND DAIRIES. Number of Registered Cowkeepers and Dairymen 22 Number of Registered Dairymen and Milksellers 32 One additional farm building has been converted into a cowshed, and after the requirements with regard to lighting, ventilation, drainage, etc., under the Cowsheds and Milkshops Regulations were carried out, the keeper was registered. Six cowsheds are at present disused. Two new dairy premises have been registered. Four milksellers have given up and removed. There are about 347 milch cows stalled in the cowsheds, but this number fluctuates at different periods of the year. The majority of the cows are habitually grazed. In the past two or three years many cowsheds have been disused, and the number of cows kept in the district has greatly decreased. The cowsheds and dairies have been inspected very frequently throughout the year by the Sanitary Inspectors, and the cows examined at intervals by Mr. E. R. Sherren, M.R.C.V.S., the Council's Veterinary Surgeon. Mr. Sherren reports: "I have examined the cows in your district, which numbers about 347. Only two have I had to report to the County Inspector, Mr. Sidney Villar, the milk from which was not being used. In many of the cowsheds the cows looked absolutely as they should do, but I was glad to find not any of them 'bad'." Any cows viewed with suspicion or exhibiting any sign of disease have been reported to the County Authorities under the Tuberculosis Order, 1913, and have been satisfactorily dealt with by Mr. Sidney Villar, the County Veterinary Surgeon. 60 In the course of inspection 18 sanitary defects or contraventions of byelaws were observed at cowsheds, dairies and milkshops, which were forthwith remedied by the occupiers upon the receipt of a written or verbal notice. The sheds were specially limewashed during the months of May and October and have also been limewashed from time to time as required to maintain proper cleanliness. There is still need for more frequent cleansing of floors and for the removal of dung from yards and premises. The attention of some of the cowkeepers has been called to the necessity of keeping the udders and hind quarters of the cows in a more cleanly state, as there is room for much improvement in this direction. I am glad to say there are many well constructed and well kept dairies in the district efficiently equipped, and possessing recent appliances for maintaining a pure and wholesome milk supply. There is need for the long-promised Milk Bill to strengthen the existing Regulations governing milk supplies and stores which should specially enable Local Authorities to refuse the registration of premises unsuited for the storage of milk and for dairy purposes. SLAUGHTER HOUSES. There are 9 slaughter houses on the register, 8 being registered slaughter houses and one a licensed slaughter house. The slaughter houses have been inspected frequently, and as far as possible at times of slaughtering. The Central London Meat Market being so near at hand has the effect of reducing to a comparatively small number the head of cattle and sheep killed in the district. 61 It has not been found necessary to seize any carcase or meat inspected in the slaughter houses. Four cows on being slaughtered were found to be suffering from Tuberculosis, two were totally destroyed, one forequarter with viscera was destroyed, and the viscera of one in which a lesion was confined to the lungs was destroyed. These cows, which exhibited signs of the disease, were specially slaughtered for post mortem examination. FOOD INSPECTION. The various butchers' shops, and other places where food is sold, or in preparation for sale for human consumption, have been inspected very frequently during the year. No food-stuffs examined (exposed for sale) were found to be so unwholesome as to be unfit for food, but generally the fruit, fish and butchers' meat examined throughout the year were found to be in a healthy and saleable condition. The Sanitary Inspector was called in by a tradesman to examine one trunk of whiting, and after the fish was surrendered and destroyed a certificate as to its condition and destruction was granted. SALE OF FOOD AND DRUGS ACT. The work under the Sale of Food and Drugs Acts is carried out by the Officers of the Middlesex County Council. I am informed that the following samples were taken in the district, and submitted for analysis during the year ending December, 1913:— Samples taken. Adulterated. Butter 26 — Milk 84 14 Drugs 6 — Cream 4 1 Total 120 15 62 SMOKE ABATEMENT. Only one or two complaints have been made respecting the emission of black smoke from chimney shafts. I am pleased to report there has been little or no cause for complaint. The complaints received were investigated, and the occupiers of the laundries seen respecting the issue of black smoke, and in one instance a new and improved form of boiler was fixed. PUBLIC CONVENIENCES. As I have mentioned in my previous reports, there are one or two busy centres in the district where the provision of a public convenience would be of great benefit to the district. My Council has provided an above-ground convenience in Cricklewood Lane, near its junction with Edgware Road, one of the busiest points in the district, and a stopping-place for trams and motor 'buses. There are other busy points in the district where a convenience is needed. PUBLIC BATHS. My Council has still under consideration the question of providing a public swimming bath. The suggested site is adjoining the Public Council Offices, and my Council has issued an advertisement inviting Competitors to take part in a Competition, the competitive designs to be sent in early in March. All the new houses erected during the past few years are furnished with a bath in the dwelling. In the older cottage property this convenience is absent. The proposed bath and public hall would be a great asset to the district. 63 NEW BUILDINGS. There has been a slight decrease in the building operations during the past year, and in the Golders Green district, Child's Hill Ward, the greater proportion of the houses have been erected. Six hundred and sixty-one housee have been completed for occupation, and 528 are in course of erection. At the close of last year 679 dwellings were completed, and 602 were in course of erection. The houses were distributed over the district as follows:— Child's Hill Ward (including the Garden Suburb) 514 Central Hendon Ward 92 Mill Hill Ward 55 661 The total number of applications before the Council were 305, embracing the proposed erection of 825 dwelling-houses. Twenty plans were submitted for laying out new roads. The work of supervision entailed by these operations was most carefully and thoroughly carried out in the Engineer and Surveyor's Department. As in previous years, the sanitary fittings, drainage and structures were carefully inspected by the Building Inspectors before being passed, and the drainage and sanitary work was of the most modern type. HAMPSTEAD GARDEN SUBURB. The rate of progress of building on this estate for the past six years may be judged from the following figures:— In January, 1908, there were 80 houses on the estate In December, 1908, there were 390 houses on the estate In December, 1909, there were 550 houses on the estate In December, 1910, there were 850 houses on the estate In December, 1911, there were 1050 houses on the estate In December, 1912, there were 1134 houses on the estate 64 At the present time there are 1145 single houses, of which 1130 are occupied, and the rest are either completed or in course of erection. In addition to these, there are 237 occupied flats, and 55 being erected, beside the following buildings:— The Institute, Central Square.—The property of the Trust, is used as an educational centre for the estate, opened in March, 1909, and considerably enlarged since. Associated Homes for Ladies, Waterlow Court.—Opened in July, 1909. This building is composed of 50 flats with common dining rooms, sitting rooms, etc. Co-partnership Homes, in the Orchard.—These were opened in October, 1909, comprising 54 flats, occupied by old people and widows. The Club House, Willifield Green.—Containing billiard room, men's and women's club rooms, lecture hall, etc. Opened in March, 1910, and enlarged since. Shops and Flats, etc., Finohley Road.—The first block of nine shops and fourteen flats was completed in 1910, and a second block of six shops and twelve flats over was completed last year. The block of 16 flats, known as Temple Fortune Court, has now been completed and occupied. The Church of St. Jude, opened in May, 1911, has had a spire added during the past year. The Free Church, Central Square, was completed and opened in October, 1911. The Friends' Meeting House has been erected in the Central Square and is now in use. A block of Garages and Flats, and two blocks of cottages for accommodating the staff have been built by the Trust. 65 VITAL STATISTICS. Estimated population 4733 Number of births registered 98 Birth rate 20.7 per 1000 Number of deaths registered 31 Death rate 6.54 per 1000 Infantile mortality; 40 Senile mortality (deaths over 70 years of age) 12.9 % on deaths at all ages. The Death Rate is rather higher than last year, although much lower than the general death rate of the whole district. The Birth Rate remains practically the same, but lower than that of the whole district. INFECTIOUS DISEASES. Seven oases of Scarlet Fever were notified, occurring in separate houses. Last year 21 cases were notified. Nine cases of Diphtheria occurred, against one case during 1912. Seven of these cases occurred at one school. One case proved fatal. INSPECTION WORK. By Article 20' (16) of the General Order of the Local Government Board, 1911, "The Inspector of Nuisances shall as soon as possible after the 31st day of December in each year, furnish the Medical Officer of Health with a tabular statement containing the following particulars:— (a) The number and nature of the inspections made by him during the year. (b) The number of notices served during the year, tinguishing Statutory from informal notices. (c) The result of the service of such notices." 66 The following statistical returns have been compiled by your Chief Inspector, Mr. S. J. Chapman, and submitted to me, shewing the work done by the staff in the Public Health Department. From a perusal of the annexed table it will be seen that a very large number of sanitary defects have been successfully dealt with during the year. The inspections and re-visits made to premises were 2,978, and the number of defects dealt with 2,031. Two hundred and eighty-four complaints were received by letter or verbally, and were investigated; 681 preliminary notices, letters or cautionary notices, were prepared and issued by the Sanitary Inspectors, and 143 Statutory notices under the direction of my Council. In no instance was it found necessary to take legal proceedings :— SUMMARY OF THE WORK DONE. Inspections made 1317 Re-inspections after order or notice 1661 Gipsy vans removed from the district 37 Visits paid to infected houses 872 Rooms disinfected 308 Drains, smoke and water tests applied 204 „ opened for examination 69 ,, taken up and reconstructed 53 ,, repaired 36 ,, unstopped and cleansed 65 ,, provided with intercepting traps 20 ,, manholes provided to 80 67 Drains, manholes oleansed 9 ,, manholes repaired and covered 20 ,, manholes, F.A.I., repaired 31 ,, drain interceptors repaired 9 Undradned houses drained — Yards paving repaired 21 ,, paved 46 ,, cleansed 6 Dustbins provided 96 Ashpits abolished and bins provided — Cistern® repaired and covered 9 Rooms cleansed and limewashed 352 ,, plastering of walls and ceilings repaired 298 Roofs of houses repaired 29 Floors of houses repaired or relaid 23 ,, ,, cleansed 21 ,, ,, air spaces under ventilated 21 drained — Dampness of house walls remedied 34 Accumulations of refuse removed 9 Accumulations of manure removed 4 Animals, fowls, etc., nuisances from, abated 2 Overcrowding, number of cases abated 4 Nuisances from ballast burning, rubbish, etc., dealt with 1 Privies abolished 2 Cesspools abolished Nuisances from overflowing cesspools removed 5 Overflow pipes removed from cesspools 2 68 Water supply provided to houses or a supply laid on over sink 6 Taps taken off rising main 16 Stables paved or paving made good 1 Dung cage provided 2 Drains removed from inside premises 2 Water Closets repaired 18 ,, ,, new pans provided to 117 ,, ,, unstopped and cleansed 14 „ ,, apartments cleansed and repaired 29 ,, ,, floors repaired 15 ,, ,, provided with efficient flushing cisterns or flushing cisterns repaired 65 ,, ,, apartments ventilated or lighted 2 ,, ,, provided 2 Soil pipes repaired 4 Soil pipes reconstructed 29 Ventilating shafts repaired 41 ,, ,, provided 4 „ ,, reconstructed 6 Defective sinks abolished and new provided 26 Waste pipes, sink waste pipes disconnected from drain 1 ,, ,, trapped with lead traps 16 ,, ,, provided to sinks 26 ,, ,, repaired 7 „ ,, unstopped 3 Rain-water pipes disconnected from drain 38 ,, ,, repaired 10 ,, „ provided 16 69 Eaves guttering provided 17 Eaves guttering repaired and cleansed 17 Defective traps replaced or new stoneware gullies fixed 141 Gullies unstopped 5 ,, cement work around repaired 3 ,, provided with grids 6 Rooms ventilated (windows made to open) 7 Ditches cleansed 8 Builders' privies abolished 2 New earth closets provided 2 Miscellaneous nuisances abated 62 DRAINAGE WORK. Two hundred and four tests have been applied to house drains and soil pipes by smoke and water to ascertain their condition, or in connection with the testing of drains after being relaid or repaired. The ground was opened for examination of drains under Section 41 of the Public Health Act, 1875, at 11 houses by the Council's workmen, and the owners on receipt of a preliminary notice caused the drains to be exposed for examination at 58 houses. Tn all cases where the ground was opened and the drains exposed for examination, defects were found, and in many instances the pipes were found to be broken, improperly jointed, leaky or otherwise defective, and the traps, junctions, and connections in various ways unsatisfactory. As a result of these examinations the drains at 53 houses were entirely re-laid on a good bed of concrete, with proper means of access, and on an approved system, and in the remaining 16 instances the drains were partially relaid or amended or repaired and left sound. 70 In connection with the drainage work described, 78 manholes were built and provided, 20 interceptors were fixed, 32 soil pipes and ventilating shafts were reconstructed, and in all cases the closet pans and traps and gullies, together with other sanitary fittings, were renewed. Forty-four houses were drained by a single drain, and nine by combined systems. Seven new drains passed under the houses, and these were laid with iron pipes. Twelve main drains were relaid with iron pipes, and all others and the branch drains with glazed stoneware pipes. Two drains wore repaired by a patent process and left watertight. SANITARY STAFF. I have again pleasure in placing on record that the work throughout the year has been carried out conscientiously and well by the Sanitary Staff. Many important new duties have been added to the Department in the past two or three years, and with the steady growth of the district it has been difficult at times to keep abreast of the work. All sanitary orders issued have been complied with, without instituting legal proceedings. I have found your Inspector, Mr. S. J. Chapman, and Mr. G. E. Luck, the Assistant Inspector, ever ready and anxious to further my wishes in every way, and zealous in the performance of their of times difficult and unpleasant duties. A complete change of staff ha® occurred at the Isolation Hospital during the year. 71 The new matron, Miss M. Stevens, and the nursing staff are well trained, and I have found them anxious to perform their duties conscientiously and well, and to assist me in every way with the hospital work, although oftimes working under difficulties in the present temporary hospital. In conclusion, I beg to be allowed to thank the Chairman and Members of the Public Health Committee, and my Council, for the support they have accorded me at all times, which has so materially contributed to the efficient working of the Public Health Department. I am, Gentlemen, Yours obediently, F. W. ANDREW, m.r.c.s., l.r.c.p., Medical Officer of Health. 73 Education Committee, 1913. Colonel F. W. Hearn (Chairman). The Rev. J. S. Poulton (Vice-Chairman). Mrs. A. Smart. Mr. George Sneath, J.P. Dr. E. B. Jones. The Very Rev. Canon Carter. The Rev. R. A. J. M. Waldram. Miss Councillor Bunney. Mr. Councillor W. E. Candy. Mr. Councillor C. C. Cartwright, J.P. Mr. Councillor A. S. Ford. Mr. Councillor A. B. Soar. Mr. Councillor J. M. McGrath. Mr. Councillor J. M. Lickfold. Mr. Councillor J. H. Sturgess. F. W. Andrew, M.R.C.S., L.R.C.P., Supervising School Medical Officer. H. W. Ogle-Skan, M.R.C.S., L.R.C.P., School Medical Officer. James Anderson, Secretary, to the Committee. 75 Petition education Committe SIXTH ANNUAL REPORT ON THE Medical inspection ot Children (YEAR ENDED 31st DECEMBER, 1913). Ladies and Gentlemen,— I have pleasure in submitting to you the Sixth Annual Report on the Medical Inspection of the Schools under your authority, and in doing so I would like to point out that the year's work is remarkable not only because of the very great increase in the number of children examined but also by reason of the increase in the number of children who were specially examined, either at the Schools or at the Council Offices, because of defects found at the first examination. The close attention to these cases has, in my opinion, resulted in many of the children being saved a considerable amount of suffering because of their more rapid recovery to health, whilst the fact that they returned earlier to School must have been of benefit to them educationally. 76 The following is a list of the Schools, together with the number of the children on the books at the 31st December:— SCHOOL. CHILDREN ON ROLLS. 1912. 1913. 1 St. Paul's C.E. 190 209 2 St. Vincent's R.C. 187 177 3 Bell Lane Council 837 696 4 St. Mary's C.E. 383 397 5 St. Mary's R.C. 129 127 6 Algernon Road Council 859 884 7 St. John's C.E. 248 233 8 The Hyde Council 764 786 9 Burnt Oak Council 237 246 10 Garden Suburb Council 186 599 11 All Saints' C.E. 417 426 12 Child's Hill Council 973 975 13 St. Agnes' R.C 117 111 14 St. Peter's C.E 46 44 5573 5910 The increase in the number of children on the rolls was 337, as compared, with 137 on the previous year. At the present time, with the exception of St. Peter's School, there are few vacant places in the Child's Hill district, but when the Wessex Gardens School, which is planned for over a thousand children, is built, it is hoped that some of the pressure on the Child's Hill Schools will be relieved. It must not be forgotten that the rapid development of the district, as evidenced by the number of plans passed by the District Council at almost every meeting, must result in a material increase in the school population. 77 The Mill Hill Schools are practically full, but the Committee have arranged for a school for 600 children to be built at Hale Grove Gardens, and when that is erected the needs of the Mill Hill district will probably be met, at least for a few years. In Central Hendon the new County School for 300 scholars, which is to be opened in September, will, of course, result in a small number of children being transferred from the Elementary Schools all over the district, and it will also if necessary meet the requirements of children who now attend private schools, or schools outside the district. The total accommodation in the Hendon Schools at the close of the year was 7,077. CONDITION OF SCHOOLS. The Provided Schools continue to be maintained in a highly efficient manner, and I think it would be difficult to find any schools in the Country where the children work under better or healthier conditions. The Schools are well equipped in every way. The rooms are spacious and well lighted, the desks are the best available and are so arranged that the children work in the best possible light, whilst there is ample room for free movement. Anyone visiting the Schools is bound to notice the cleanly appearance of the rooms. One could only wish that the healthy conditions under which the children live during the school hours prevailed in all the homes in the District. The Non-Provided Schools also continue to be well maintained. Two of these—St. Vincent's R.C. and St. Agnes' R.C.-—are comparatively new buildings and may be placed in the same class as the Non-Provided Schools. As regards three other Schools I understand that the Board of Education have recently asked that alterations 78 be made with respect to the accommodation, etc., and the Managers have, through the Education Committee placed their proposals before the Board. I have not examined the plans very carefully, but the Secretary to the Committee informs me that if the alterations proposed are sanctioned and carried out they will very materially improve the conditions of the buildings to the increased educational advantage of the District. There is nothing to add to the previous reports as to the Sanitary conditions. The Lavatories and Latrines continue to be well and carefully kept. The caretakers are careful to see that Disinfectants are frequently used, and that the flushing arrangements are in good order, and I understand that the Head Teachers make a careful inspection of the outside offices at least once a week. During the year under review the Managers of St. Mary's R.C. School had the drains overhauled and spent a considerable sum in improving same. It is satisfactory to be able to report that with the exception of a slight difficulty with regard to the flushing of one of the Schools—and which was only of a temporary character—no complaint reached the sanitary authority. If the proposals in connection with the three Schools before mentioned arc carried out their Lavatory and Latrine accommodation will be brought quite up-to-date. The lighting and heating of the Schools continue to be very satisfactory. At one of the Provided Schools an alteration was made to the artificial lighting which seems to have produced better results. ARRANGEMENTS FOR INSPECTION. The arrangements for the past year have been the same as those of previous years:—(1) Children entering School for the first time; (2) Children whose seventh birthday fell during 1913; (3) children whose tenth birthday occurred during 1913; and (4) children who were thirteen years of age 79 during 1913, and who would be likely to leave School by the end of the year or shortly after. It will be remembered that when Medical Inspection was first introduced the Board of Education indicated that ultimately they would require that all children should be examined four times during their School career and the Committee decided to adopt the suggestion and agreed that such arrangements should be carried out from the beginning. In a recent circular the Board indicate what they will regard as minimum requirements in 1915. From this it will be seen that as regards Medical Inspection the Committee are doing more than is actually required at present. Schedule " A" is extremely interesting as showing the number of children who received special attention on account of defects found and who were examined and reexamined in order to ascertain whether the treatment advised had been carried out. The total number as shown by the special cards known as "B" cards worked out at about 11 per cent. of the children on the rolls. 137 children who were absent for various causes, and who were not being attended by any Doctor were brought by their parents to the Council Offices, and instructions were given to them as to the treatment to be pursued. Exclusion Certificates and what are known as Clearance Certificates are now given by Dr. Skan and myself in all cases that are necessary. The attendance of the parents at the inspections continues to be very encouraging, and it is gratifying to find that in most oases they appreciate what is being done for their children. No fewer than 1937 parents were present last year and one can only hope that the brief conversations which Dr. Skan and I had with many of them will be of some use in assisting the parents to a knowledge of their responsibilities in the upbringing of the children. 80 EXTENT AND SCOPE OF INSPECTION. The Board of Education in a recent letter to the Committee commented on the small number of leavers who appeared to have been examined. As a matter of fact, however, very few cases had been missed, but it so happened that the Board's return was for the period ending 31st July, and many of the thirteen-year-old children were not examined until after that period. Arrangements have now been made so that these children will be examined earlier in the year. The number of children medically examined during the period, namely, 2,791, is the highest number ever examined in one year. In addition to this, a very large number (699 children) were specially examined, and the particulars of their defects noted on the "B" cards. Some of the latter children were examined more than once, and their progress carefully noted. Altogther these children necessitated 1,158 separate examinations. Many of the worst cases were seen by me at the Offices. These involved 324 examinations. From Schedule "A" it will be seen that 1,731 children (890 boys and 841 girls) were examined in the Senior Departments, whilst 1,060 children (563 boys and 497 girls) were examined in the Infants' Departments. Details and particulars of the inspection are to be found in Schedules "B" and "C." Of the total number examined, 1,005 or 35 per cent., were found to be without obvious defects. This is an increase of one per cent, on the previous year. I venture to think that a perusal of Schedule "F" will be very instructive, as it shows a comparison of the results since 1908. There is no doubt that the fact that the children are now subject to inspection has been noted by the parents, 81 and this has had a marked effect on the condition of the children. It will be noted that in the majority of cases there is a very distinct improvement shown under the various headings in 1913 as compared with 1908. As an example of this, the figures under the heading of Cleanliness and Condition of the Skin show a 2.8 per cent, improvement as compared with last year, and no less than 14.4 as compared with 1908. ANTHROPOMETRICAL FACTS. The figures in Schedules "D" and "E" which are appended to this report do not vary very much from those of the previous year, and it is satisfactory to know that the physique of the Hendon children is being well maintained. As regards the boys, the only notable changes are slight decreases in the height and weight of the children between 5 and 6, and 13 and 14, and increases between 6 and 7, 8 and 9, 10 and 11, and 11 and 12—that between 11 and 12 being somewhat pronounced. In the case of the girls, there are slight decreases between 4 and 5, 6 and 7, 8 and 9, 9 and 10, and 12 and 13, and increases between 5 and 6, 7 and 8, 10 and 11, and 11 and 12. Taking the children all round, the heights and weights are slightly above the standards as given by the Anthropometric Committee. HOME CIRCUMSTANCES, SOCIAL AND INDUSTRIAL CONDITIONS. The year that has just passed was a good one for trade an this district, and as far as I could see there was less unemployment than in the previous year. The unemployment question generally makes itself felt under the headings of Clothing and Nutrition, although strangely enough the figures under the head of Nutrition are slightly less than last year. 82 Home circumstances, unfortunately, in some parts of the District are such as necessitate a considerable number of mothers going out to work during the day, the children thus losing a good deal of the care and attention they need and would otherwise receive. This particularly is the case in Child's Hill, which contains many laundries and wash-houses, and it also applies to certain parts of the Central and West Hendon Districts. Cases are continually cropping up of parents who say that they cannot afford to get proper treatment for their children, and undoubtedly there are many instances where, owing to the head of the family being frequently out of work or only able to earn a bare living wage, the children do not receive proper medical treatment. During the year several cases have come to my notice where young children have been employed out of school hours, and wherever possible I have endeavoured to get the parents to see the harm this may do to the growing boy or girl. In some cases pressure has been brought to bear on the parents, and they have stopped the evil, although the few shillings the children have been able to earn have no doubt been a very welcome addition to a poor household. REMEDYING OF DEFECTS. The most important matter to my mind in connection with the Medical Inspection of Children is the remedying of defects when found, and a special effort has been made during the year to this end. A periodical inspection of all children who have been found to be suffering from a complaint requiring attention has been carried out at the Schools, and the progress noted on a special "B" card. In very many cases it is gratifying to record that the instructions given have been carried out, and the children have greatly improved in health. 83 A further important work which was inaugurated last year with considerable success was continued, namely, that of seeing all oases who wore kept from school with various Complaints. The Attendance Officers who had full knowledge of such cases were instructed to ask the parents to bring the children, who were not being attended by a medical man, to the Offices for the Medical Officer to examine. This was carefully carried out, and the cases were examined at intervals of a week, in some cases less, until they were well. I am glad to say that the parents valued the advice given, and owing to the constant exercise the children recovered more rapidly and were thus able to resume their school duties at an early date. A very large percentage of these cases was due to Impetigo and Ring-worm, and verminous condition of the head, which, owing to neglect, had reached alarming proportions. Up to the time of their seeing me many of the children had undergone no treatment, and were thus daily getting rapidly worse, thereby causing unnecessary suffering to the children. I regret to say that a great amount of ignorance is still displayed by parents in the treatment of simple ailments, and this shows the need for some elementary teaching in the upbringing of children. The ladies of the School Care Committee have been of considerable assistance in visiting cases and keeping them under observation after I have given instructions as to their treatment, but I am bound to say, as a medical man, that the services of a skilled Nurse are required in many cases. During the year children have been brought to me in a very bad state with Impetigo, and the mothers have admitted to me that all they have done has been to smear some ointment over the surface. One still hears of Ring-worm being treated with a mixture of ink and tobacco dust. It is also amazing to me to find how indifferent many parents seem to be in cases of nasal obstructions in 84 their children. Many of them do not seem to notice the defect, and even in cases where they have noticed something they have taken it that the children would grow out of it. A similar indifference waa found as regards eye-eight. INFECTIOUS DISEASES. The year 1913, as regards Infectious Diseases, was, if anything, worse than the previous year, and I am afraid when the attendance statistics are published by the Board of Education that Hendon may be deposed from its position at the top of the Committees in Middlesex. The Central Hendon Infants' School and St. Mary's R.C. School were both closed on account of Measles for short periods, but in nearly every district the attendance at the Schools was seriously affected by the absence of children on account of infectious diseases. The number of notifications sent in by the Head Teachers are given in Schedule G, but I am sorry to state that the figures given do not nearly represent the actual number of cases. Care was taken to exclude every case that appeared suspicious, but in some cases it was regrettable to find that the parents did not take the matter seriously. One still comes across oases of parents who have allowed children excluded from school on account of infectious disease in the home to take up little jobs, to the danger of the general public. When the matter is brought to their notice such parents usually plead ignorance', but it may be necessary at some future time to take steps against such offenders. PERSONAL HYGIENE. The conditions under this head continue to improve, and even in the schools attended by children from the poorer districts there is abundant evidence that the lessons in Hygiene are bearing fruit. There is no doubt that the personality of the Teacher is a great factor in this direction. It must not 85 be forgotton that many of the children come from poor homes where the conditions do not make for cleanliness, so that it is absolutely necessary that the missionary work should be begun at school. Lessons on the care of the teeth must, of course, in order to be effective, be supplemented by the use of the tooth-brush in the home, but I am afraid it is often neglected. We still seem to have a large number of mouth-breathers among the children, and wherever possible I have impressed upon the parents that such a condition is very probably the result of nasal obstruction of some sort. The careful teaching of physical exercises in the schools must have an effect on the children in improving their carriage and physique, and thereby inducing them to take a more wholesome view of life. As in previous years, I have pleasure in submitting the following comments on the various headings in Schedules B and C, which are appended to this report:— CLOTHING AND FOOTGEAR. The general appearance of the children in the various schools has been on the whole very satisfactory. Naturally one comes across individual cases of insufficient clothing and faulty footgear. In many of these cases the children come from poor homes, the parents not being in a position to obtain the necessary clothing. In a few cases the general untidy condition has been due to neglect of the parents to give the necessary attention required, particularly ae regards the mending of the clothes. Some parents also dress their children in an unsuitable manner without proper regard to the climatic conditions which prevail at the time. Every effort is made by the Teachers to see that the children come to school clean and properly clad, and special attention is given to see that the footgear is sufficient. Some of the schools have a fund whereby they are able to supply boots in necessitous eases, but it is pleasing to note that suoh funds have not been much called upon during the past year. 86 NUTRITION. Little change is noticeable under this heading in comparing the figures with recent years, but it is satisfactory to be able to report that taking the figures of the first two years, 1908 and 1909, there is a marked improvement. The general condition of the children points to the fact that parents recognise the importance of sending their children to school well fed, although there are, of course, a number of children who, on examination, have proved to be distinctly illnourished. Sometimes this is the result of unsuitable food, and in some cases I have no doubt conditions of poverty have produced this effect. Nothing is of greater importance than that children should be sent to school bodily fit to undergo their school training, and I sometimes think it as a matter of congratulation that so much good work is done when one knows the condition of some of the homes. If we are to accept the results with respect to heights and weights as evidence of the degree of nutrition of the children, then Hendon may be said to be slightly above the standard of the rest of the country. CLEANLINESS' AND CONDITIONS OF SKIN. Under this heading are included all conditions of verminous heads and bodies due to dirt. I am pleased to report that a continued improvement has taken place ever since the introduction of medical inspection. It is gratifying to know that children are being better looked after in this respect by the parents. Nothing can be more aggravating to parents with clean children to know that their children run the risk of sitting next to verminous children and thereby contracting diseases. The percentage of dirty children has dropped from 23 in 1908 to 8.6 in the year under review—a truly remarkable decrease. Bad cases of skin disease, due to dirt and carelessness, are unfortunately still to be found, but we are hoping that our interviews with the parents will, as time goes on, have beneficial results. 87 TEETH. The condition of the teeth is a problem which will have to be dealt with in a more drastic way in the near future. It is well known that septic conditions of the mouth due to decayed teeth are the cause of many conditions of ill-health. As a rule no notice is taken of this subject until attention is called to it by actual toothache, and often by this time the tooth is beyond all hope of repair. Until opportunities are given for treatment which will be within the reach of all to get, one cannot look for much improvement in this direction. A very considerable number of children were discovered with defective teeth, and when it lis borne in mind that all with four decayed are classed as "good" it will be seen that the number 335 children classed under "fair" and "bad" means that all these children had five or more decayed teeth. It is very difficult to get mothers to understand the importance of obtaining treatment, which necessarily means time and expense, and thus the conditions which in some cases are deplorable prevail during the whole of the child's school life. NOSE AND THROAT. There i9 a welcome decrease in the percentage under this head of 2.5 as compared with the previous year, but as I have previously pointed out there stall appears to be too much ignorance among the parents in regard to nose and throat defects, and the possible harm which may result to the children. I am bound to say, however, that when operations have been advised the parents have in nearly every case seen that they were carried out. It would perhaps be of advantage if the teachers reported every case of mouth breathing so that such children should be examined as soon as possible. If cases are allowed to pass for even three years much mischief may have been done. 88 DEFECTS IN VISION. The percentage of defects for 1913, is 1.7 more than in the previous year. In the case of these defects the question of the provision of glasses beooines somewhat acute and one is often met with the remark that it is difficult enough to provide food for the children let alone glasses. One is at a loss what to do in some cases, and in the event of glasses not being forthcoming there is only the Children's Act to be put in force. It would, in my opinion, be a real help if some sort of fund could be organised locally whereby parents could be supplied with glasses and pay for them by instalments. EARS AND HEARING. Some improvement is shown under this head, and the defects noticed do not call for very much comment. Considering the number of children examined, I think the Committee may take it that the hearing of Hendon children i« quite up to the average. SPEECH. Only 1.4 per cent, defects as regards speech were found, although cases of imperfect speech due to carelessness, etc., were not uncommon. Amongst the children examined at the Offices there were several who spoke in a very careless manner, and it was sometimes difficult to understand their answers. The chief faults seemed to be that they did not speak out well enough nor did they syllable their words properly. MENTAL. There is not much change under this head. The results for the last three years have not varied to any great extent. In several of the schools the backward or dull children are 89 taught in a separate class with, I am told, very good results. As regaxds such children a simple curriculum seems the only reasonable way out of the difficulty. No doubt the passing of the Mental Deficiency Act will have an important bearing on the education of some of these children in future. HEART. From comparison of the defects found during the last four years two per cent, may almost be considered the normal percentage. Only a very few oases were so bad as to call for special treatment, and these cases were duly notified to the Head Teachers. LUNGS. It is gratifying to note that out of the 2,791 children examined at the schools only six were found to have lung trouble, and advice was given to both parents and teachers with reference to the children. RINGWORM. Under this heading we are dealing with one of the most troublesome of communicable diseases whioh attacks our elementary schools, and one which causes more interference with school work than any other on the list which already is full to overflowing. It is only fair to the parents that their children should be protected as far as possible from infection. For many years little heed was seriously taken of this troublesome disease, but it is only by adopting a system of complete supervision as far as possible that the spread of this complaint can be controlled. For this purpose I have continued my personal inspection of all such cases, and this inspection has been carried out weekly until the cases have been pronounced free and fit to attend school. I 90 Lave found from experience that left to themselves the parents do little to remedy the condition; and it is only by personally impressing upon the mothers the treatment to be adopted and continual supervision that a satisfactory result has been obtained. There is no doubt that the constant following up of these cases has resulted in the children returning to school months sooner than would otherwise be the case. During the year 55 cases have come under my personal ca.re, and I have little doubt there were others that escaped observation. On the other hand several oases were seen by the parents own medical adviser. I am sorry to say that the disease does not appear to show signs of abatement, but I am in hopes that with an additional effort on the part of the Teachers and School Medical Officers, and the help of the medical profession generally, the disease may soon be exterminated. I feel that to a very large extent the help of a School Nurse in finding out all such cases and bringing them to the notice of the School Medical Officers would do more than anything to eradicate this extremely troublesome disease. In conclusion, my thanks are again due to the Teachers, Attendance Officers and Secretary for their kind assistance during the year. I have the honour to be, Ladies and Gentlemen, Your obedient servant, F. W. ANDREW, m.r.c.s., l.r.c.p. suervising School Medical Officer. Schedule A.—Children medically examined during 1913. School Senior Departments Infants' Departments Total Parents Attended Special Blue Cards Nos. of Boys Girls Boys Girls Children Examined Separate Examinations Central Hendon 90 73 67 72 302 226 64 76 Child's Hill 105 98 85 84 372 220 71 86 West Hendon 90 75 117 91 373 279 63 103 The Hyde 90 72 82 77 321 201 84 135 Garden Suburb 169 175 107 71 522 428 52 97 Burnt Oak* 66 65 •• •• 131 73 23 34 St. Paul's* 64 58 •• •• 122 96 16 26 St. Vincent's R.C.* 45 31 •• •• 76 52 19 29 St. Mary's 58 61 36 32 177 132 51 93 St Mary's R.C.* 31 33 , 64 36 28 51 St. John's •• 44 30 34 108 92 26 28 All Saints' 44 33 26 28 131 38 41 45 St. Agnes' R.C.* 38 33 71 45 18 26 St. Peter's •• •• 13 8 21 19 5 5 Secretary's Office •• •• •• •• •• •• 562 834 137 324 Totals ... 890 841 563 497 2791 1937 69!) 1158 * Both Departments. Schedule B. SCHOOL. Defects. All Schools. Boys' Departments. No Examined 1453. Parents Present Examined No Defects Clothing N utrition Cleanliness of Skin Teeth Nose and Throat Eyes Ears Speech Mental Heart & Circulation Lungs Nervous System Tuberculosis Rickets deformities (Spinal Infectious or Contagious Others Good Fair Bad Good Fair Bad Good Fair Bad External Vision Not Tested Disease Hearing Bell Lane Mxd 52 90 32 82 7 1 82 8 0 2 81 9 .. 91 1 16 .. 2 .. 4 8 4 .. 3 .. .. 1 .. 6 Inf 61 67 17 64 2 1 57 9 1 2 49 17 1 26 2 5 52 8 2 .. .. 3 2 .. .. .. .. 1 .. Algernon Road Mxd 60 90 43 89 1 .. 81 9 .. 3 84 6 .. 17 3 18 1 4 .. 1 1 . .. .. .. .. .. .. .. Inf 92 117 32 110 6 1 89 24 4 11 91 25 1 49 3 7 56 2 .. .. 1 3 1 .. .. .. 1 1 2 Child's Hill Mxd 55 105 44 99 5 1 82 17 6 2 98 4 3 18 3 21 4 .. 3 1 1 1 .. 1 .. .. 2 3 1 Int 58 85 32 84 .. 1 65 17 3 .. 71 10 4 24 1 .. 85 .. 1 .. .. .. .. 1 .. 1 2 1 .. The Hyde Mxd 41 90 19 59 28 3 57 19 14 2 84 3 3 11 3 12 12 2 2 1 9 4 .. 2 .. .. 3 2 1 Inf 58 82 40 80 .. 2 69 11 2 6 77 2 3 19 2 .. 82 4 2 3 1 2 .. 1 .. 1 1 2 .. Garden Suburb Boys' 126 169 62 154 12 3 150 18 1 4 157 12 .. 42 2 37 4 6 3 5 1 6 .. 3 .. 1 1 .. 4 Inf 91 107 37 1< 6 1 .. 82 24 1 2 91 15 1 35 4 1 80 6 2 1 1 1 1 2 .. .. .. 2 4 Burnt Oak 35 66 31 66 .. .. 57 5 4 .. 57 6 3 13 1 8 32 1 1 1 4 1 .. 1 .. .. 1 .. .. St. Paul's 49 64 21 61 3 .. 53 9 2 .. 51 13 .. 17 5 6 24 2 2 2 1 .. .. .. .. .. .. .. 4 St. Vincent's 27 45 17 43 2 .. 40 5 .. 1 39 6 .. 15 .. 3 21 2 2 1 1 1 .. .. .. .. .. 1 1 St. Mary s Boys' 38 58 20 46 12 .. 53 5 .. 2 42 15 1 16 2 12 .7 4 2 .. 1 .. .. .. .. .. .. .. 3 Inf 31 36 13 31 5 .. 32 4 .. 1 31 5 .. 14 1 .. 35 4 1 .. .. .. .. .. .. .. .. .. 1 St. Mary's R.C. 16 31 7 22 6 3 24 7 .. 5 26 5 .. 10 2 3 15 .. .. 1 .. .. .. 1 .. .. .. 1 .. St. John's Inf 27 30 11 25 5 .. 22 7 1 .. 26 4 .. 6 2 .. 30 .. .. 1 .. .. .. .. .. .. .. .. 1 All Saints' Boys' 3 44 19 44 .. .. 35 5 4 .. 36 6 2 7 1 14 .. .. 1 .. .. .. .. .. .. .. .. .. .. Inf 13 26 12 25 .. 1 22 4 .. 3 26 .. .. 8 1 .. 26 2 .. .. .. 1 .. .. .. .. 1 3 1 Sf. Agnes R C. 23 38 15 37 1 .. 36 2 .. 9 32 6 .. 11 .. 2 16 1 .. 1 2 .. .. .. .. .. .. .. 1 St. peter s Inf 11 13 3 11 1 1 10 2 1 2 12 1 .. 5 1 4 5 .. .. .. .. .. .. 1 .. .. .. .. .. Totals 966 1453 527 1338 97 18 1198 211 44 57 1261 170 22 384 40 169 595 50 4 23 32 27 4 16 .. 3 13 17 30 Percentages of Total number examined 66 5 30.2 92 6.7 13 82.4 14 5 3 1 4 86.8 11 7 1.5 26.4 2.7 11.6 41 3 4 1.6 1.6 2.2 1.8 .3 1.1 .. .2 .9 1.2 2 Schedule C. SCHOOL. Defects. All Schools. Girls Department. no Examined 1338. Parents present. No examined. No defects. Clothing. Nutrition. Cleanliness of skin. Teeth. Nose and Throat. Eyes. Ears. Speech. Mental. Heart &. Circulation Lungs. Nervous System Tuberculosis. Rickets. Deformities (Spinal). Infectious or Contagious. Others. Good. Fair. Bad. Good. Fair. Bad. Good. Fair. Bad. External. Vision Not tested. Disease. Hearing. B???ll. Lane Mxd. 53 73 19 67 5 1 64 7 2 15 69 4 .. 14 1 26 1 2 1 2 2 4 ... ... ... .. 2 .. 1 Inf. 60 72 28 67 3 2 62 10 .. 10 63 9 .. 2 7 4 4 52 4 1 .. .. 1 ... ... ... 1 1 1 1 Algernon Road Mxd. 58 75 33 75 .. .. 65 8 2 5 69 6 ... 10 .. 19 .. 7 .. .. 5 4 ... ... ... .. .. .. .. Inf. 69 91 25 89 2 .. 76 14 1 14 80 10 1 33 2 6 50 ... 3 3 1 4 ... ... ... .. .. .. .. Child's Hill Mxd. 47 98 37 97 1 .. 80 13 5 11 86 9 3 17 4 2b 5 4 .. .. 2 1 ... ... ... .. 1 1 1 Inf. 60 84 45 84 .. .. 67 15 2 6 74 6 4 11 2 . 84 1 2 2 .. 1 1 ... .. .. 2 .. 1 The ???yde Mx 1. 46 72 15 42 30 .. 47 19 6 12 65 5 2 18 .. 10 3 .. .. .. 1 ... ... ... .. .. 2 1 1 Inf. 56 77 32 73 . 4 60 16 1 7 70 5 2 21 4 .. 77 1 1 1 . 1 ... ... .. .. 1 1 1 Garden Suburb Girls 149 175 63 174 .. 1 159 14 2 20 158 17 .. 38 4 44 6 7 1 3 3 5 ... ... .. .. 3 .. 1 Inf. 62 71 25 62 8 1 59 11 1 7 61 10 .. 20 3 5 59 2 .. 1 .. 5 ... ... .. .. .. .. 1 Burnt O???k . 38 65 26 64 1 .. 55 7 3 10 57 6 2 9 2 6 38 2 2 .. 1 1 ... 1 1 .. .. .. .. St. pauls 47 58 22 57 1 .. 50 8 .. 3 54 4 .. 18 2 8 18 2 .. 1 3 1 ... ... .. .. .. .. 2 St. Vmcents 25 31 13 30 1 .. 28 3 .. 4 24 7 .. V .. 2 13 2 .. .. .. 1 ... ... .. .. .. .. .. St. Mary's Gills 38 51 21 45 6 .. 50 1 .. 10 45 6 .. 14 .. 13 5 3 1 1 2 ... ... ... .. .. .. .. 1 luf. 26 32 9 27 5 .. 24 8 .. 4 29 3 .. 14 .. .. 31 .. .. .. .. ... ... ... .. .. .. .. .. Sr. Ma???ys R.C. 20 33 7 17 10 6 31 2 .. 12 30 3 .. 6 1 5 10 2 .. .. 1 1 ... ... .. . .. .. .. Sr. John's Girls 34 44 9 43 .. 1 29 10 5 2 38 4 2 il .. 6 16 2 . .. .. 1 ... ... .. .. .. .. .. Tnf. 31 34 16 31 2 1 25 6 3 4 31 1 2 V 1 .. .. .. .. .. .. ... ... ... .. .. .. .. .. All Saints' Girls 5 33 15 28 3 2 26 6 1 6 32 1 .. 3 .. 11 .. .. 1 1 1 ... ... ... .. .. 1 1 .. Inf. 17 28 4 28 .. .. 25 3 .. 15 23 2 3 4 2 .. 28 3 i .. .. ... ... ... .. 1 .. .. .. St. Agn??? s' 22 33 11 31 1 1 28 5 .. 6 29 4 .. 7 1 11 9 1 .. 2 1 ... 1 ... .. .. .. 1 .. Sr. Peter's In f. 8 8 3 8 .. .. 7 1 . 1 8 .. .. 3 .. 1 7 .. .. .. .. ... ... ... .. .. .. .. .. Totals 971 1338 478 1239 79 20 1117 187 34 184 1195 122 21 312 33 201 512 45 14 17 23 31 2 1 1 2 13 6 11 Percentages of total number examined. . 72.7 35.7 92.6 5.9 1.5 83.5 14 2.5 13 7 89.3 9.1 1.6 23.3 2.5 15 38 2 3.4 1 1.3 17 2 3 1 .07 .07 1 1 .4 .8 Schedule D.—All Schools. Ages HEIGHTS AND WEIGHTS. Boys' Departments 4—5 5—6 6-7 7—8 8-9 9—10 10—11 11—12 12—13 13—14 Height. Weight. Height. Weight. Height. Weight. Height. Weight. Height. Weight. Height. Weight. Height. Weight. Height. Weight. Height. Weight Height. Weight. ft. ins. st lbs. ft ins. st lbs. ft. ins. st lbs. ft ins. st lbs. ft. ins. st lbs. ft ins. st lbs. ft. ins. st . lbs. ft ins. st. . lbs. ft. ins. st lbs ft . ins. st . lbs. Central Hendon 3 4 2 10 3 7 3 0 3 9½ 3 5½ 3 10¾ 3 7 *4 2½ *3 ll½ 4 3 4 2 4 4¾ 4 8½ *4 2¼ *3 11½ 4 7¾ 5 6 4 9½ 5 12 Algernon Road 3 5¼ 2 11 3 6¼ 2 13 3 10½ 3 6 3 11¾ 3 8¾ 4 0¾ 3 10½ *4 3½ *4 8 4 5¼ 4 8½ — — 4 7 5 8 4 11½ 6 0 Child's Hill *3 7 *3 2 3 5 2 9¼ — — 3 9¼ 3 4½ — — — — 4 3½ 4 4¼ *4 3½ *4 6 — — 4 8¼ 5 7½ The Hyde 3 4 2 9¼ 3 6 2 13½ 3 9 3 4 3 9½ 3 3½ — — *4 3½ *4 5¼ 4 4 4 5 — — *4 6 *4 11¾ 4 9 5 6 Garden Suburb 3 4 2 9½ 3 6½ 2 13 3 7½ 3 3 3 11½ 3 9 4 1½ 3 13 4 3½ 4 4½ 4 5½ 4 10½ 4 6 4 12½ 4 7 5 4 4 9½ 5 11¼ Burnt Oak *3 4¼ *2 8¾ 3 5¾ 2 11¾ *3 10½ *3 10½ 3 10 3 4¾ — — *4 3 *4 6 4 4½ 4 11 *4 6¼ *4 9½ — — 4 9 5 13 St. Paul's 3 4 2 11 3 6½ 2 12 *3 9½ *3 2¼ 3 11 3 8 *4 2½ *4 5½ *4 3 *3 13¼ 4 4½ 4 10½ *4 7 *4 13½ *4 8 *5 11 4 11¾ 6 4¾ •St. Vincent's *3 2½ *2 9½ 3 6 2 11½ *3 10 *3 5¼ 3 11 3 9½ — — — — 4 4½ 4 11 — — — — *4 9¼ *6 5 St. Mary's 3 3 2 7¾ 3 6¼ 2 12¼ *3 9½ *3 6 3 10 3 4¼ 4 0 3 9½ *4 7 *4 2 4 3½ 4 6 *4 6 *4 13¼ — — 4 10¾ 6 0½ St. Mary's R.C. 3 2 2 11½ *3 8½ *3 3 *3 6¾ *3 6¼ *4 1 *3 10½ _ — — — *4 4 *4 8¼ *4 7½ *4 2 — — 4 8½ 5 2¼ St. John's 3 3½ 2 9½ 3 5¼ 2 10½ — — *3 5½ *2 9½ — — — — — — — — — — — All Saints' 3 1¼ 2 6¾ 3 5½ 3 0 *3 6½ *3 0 — — — — — — 4 4½ 4 7½ — — — — 4 10 5 12½ St. Agnes' 3 3¾ 2 12¾ 3 5¾ 2 13 *3 5 *2 9½ 3 10½ 3 9¼ *4 2 *3 11 — — 4 5½ 4 7½ *4 7 *4 13¼ *4 5 *4 9¾ 4 10 5 6 St. Peter's *3 4½ *2 11½ *3 5¼ *2 10½ *3 7 *3 1 4 1¼ 3 7½ — — — — — — — — — — — — Average all Schools 3 3½ 2 9½ 3 6 2 12½ 3 9 3 4 3 10½ 3 6¾ 4 1¼ 3 12 4 3¾ 4 4 4 4½ 4 7½ 4 5¾ 4 11 4 7 5 5 4 9½ 5 10½ Number Averaged 158 157 191 192 102 103 280 279 63 63 44 44 254 254 28 28 36 36 228 228 * Denotes not exceeding four averaged. Schedule E.-All Schools. AGES HEIGHTS AND WEIGHTS. Girls' Departments 4—5 5—6 6—7 7—8 8—9 9—10 10—11 11—12 12—13 13—14 Height. Weight. Height. Weight. Height. Weight. Height. Weight. Height. Weight. Height. Weight. Height. Weight. Height. Weight. Height. Weight Height. Weight. ft ins. st lbs. ft ins. st lbs. ft. ins. St. lbs. ft . ins. st lbs. ft. ins. st lbs. ft. ins. st lbs. ft. ins. st lbs. ft ins. st lbs. ft ins. st lbs ft . ins. st lbs. Central Hendon 3 3¾ 2 9 3 6 2 12¼ 3 8 3 1 *3 9½ *3 4½ *4 2¼ *3 12½ 4 2½ 4 l½ 4 4 4 5½ *4 l½ *3 12½ — — 4 11½ 6 4 Algernon Road 3 4 2 8½ 3 7½ 3 0½ 3 9¼ 3 1¾ 3 10½ 3 5 4 1¼ 3 9½ *4 3 *3 12 4 5½ 4 7 4 8 5 3¼ *4 6¾ *5 2¾ 5 0 6 2 Child's Hill *3 5 *2 10 3 5¼ 2 10½ *3 10 *3 3 3 9 3 4 *4 0 *3 10 *4 2¼ *4 2 4 3½ 4 2¾ *4 7 *4 11½ *4 11 *5 12 4 10 5 9 The Hyde 3 3¼ 2 8 3 5¼ 2 9½ 3 8 3 0 3 10¼ 3 3¾ — — *4 4 ♦4 5½ 4 3½ 4 1 *4 7 *4 11 *4 9¼ *5 3½ 4 9½ 5 5 Garden Suburb 3 3½ 2 7¾ 3 6½ 2 12¾ 3 8¼ 2 13½ 3 11¾ 3 8 4 0½ 3 11 4 3 4 5¾ 4 4½ 4 6 4 7½ 5 1 4 9½ 5 6 4 11 6 l½ Burnt Oak 3 3 2 8¼ 3 5¾ 2 12¼ *3 10 *3 2½ 3 10 3 7 *3 8½ *3 0½ *4 2½ *4 3¼ 4 4 4 8 .4 9¾ *5 4½ — — 4 11 6 4½ St. Paul's *3 2¾ *3 1½ 3 6 3 0 *3 6½ *2 10½ 3 10¾ 3 6¾ *4 0¼ *3 8¾ *4 2 *3 9 4 4 4 6¾ *4 11¼ *6 5 *4 2½ *3 7 4 11½ 6 6½ St. Vincent's *3 3¾ *2 9½ 3 5½ 2 12½ *3 5 *2 8 3 9 3 5¼ *3 9¼ *2 13 — — 4 4 4 8 — — — — *5 2¾ *6 13½ St. Mary's 3 3 2 8¼ 3 6 2 9½ *3 0½ *2 8¾ 3 10 3 4 *3 11½ *3 8 — — 4 4 4 7 — — — — 4 11 6 4¾ St. Mary's R.C. *3 3½ *2 8½ *3 6 *3 3 *3 5½ *3 3¼ *3 9½ *3 6¼ — — *4 4 *4 8½ 4 3¼ 4 7 *4 2 *4 4 *4 9½ *5 10 4 10½ 6 2¾ St. John's 3 3½ 2 7½ 3 5 2 10 — — 3 7½ 2 13¾ — — — — 4 3 4 0¼ — — — 5 0 6 0 All Saints' 3 0 2 5¾ 3 3¾ 2 10 3 4¾ 2 10 *3 10 *3 13½ — — 4 0 3 13½ 4 1½ 4 4 — — *4 8 *5 5 4 6¾ 5 9 St. Agnes *3 4¼ *2 13¼ *3 5¾ *2 12¾ *3 8¼ *3 6¾ *4 1¼ *3 12½ .4 0¾ *3 13¾ *4 7 *5 5 4 3 4 4½ *4 5 *4 3 *4 7 "5 5¾ 5 0 6 6 St. Peter's 3 4½ 2 10¼ *3 5 *2 9 *3 8½ *3 4½ — — — — — — — — — — — — — — Average All Schools 3 3¼ 2 8¼ 3 5¾ 2 11½ 3 7¾ 3 0½ 3 10 3 5 4 0½ 3 10 4 2¼ 4 2½ 4 4 4 5 4 7¼ 5 0½ 4 8½ 5 4¾ 4 10½ 6 0 Number Averaged 128 127 196 196 85 86 251 251 39 39 49 49 268 269 30 30 27 27 208 208 * Denotes not exceeding four averaged. Schedule F.—Comparison of Medical Inspection Results for the Last Six Years. year. No. on Roll. No. Examined. Parents Present. No. and prcent. with no defects. Clothing. Nutrition. C???anlines and Condition of Skin. Teeth. Nose aud Throat. External Eye Disease. Vision Defect. Ear Disease. Hearing. Speech. Mental. Heart and Circulation. Lung'. Nervous System. Tuberculosis. Rickets. Deformities (Spinal) Disease- Infectious or Contagious Disease. Other Disease or Defect. Good. Fair. Bad. Good. Fair. Gad. Good. Fair. Bad. 1908 Totals. % 4770 1557 ... 379 1404 127 26 1213 322 22 362 1080 318 159 430 94 137 79 42 51 48 42 6 53 15 37 37 18 31 ... ... ... 24 90 8 16 78 21 1 23 70 20 10 27 6 9 5 3 3 3 3 4 3 1 2 2 1 2 1909 Totals. % 4980 1831 ... 531 1653 156 22 1443 371 17 300 1230 489 112 53. 103 174 97 43 73 82 49 92 24 9 52 17 21 68 ... ... ... 29 90 9 1 79 20 1 16 67 27 6 29 6 10 5 2 4 4 3 5 1 .4 3 1 1 4 1910 Totals. % 5400 2073 1525 673 1782 260 31 1721 341 11 286 1752 276 45 491 114 280 134 40 45 78 44 5 8 4 18 37 18 71 ... ... ... 32.5 859 126 1.5 83 16.5 .5 13.8 845 13.3 2.2 23.6 5.5 13.5 6.4 19 2 1 3-7 2-1 •2 •4 ■2 •9 1-8 9 3-4 1911 Totals. % 5436 1981 1211 637 1721 ???07 55 1650 295 37 227 1661 257 63 571 69 223 93 40 22 41 42 8 14 4 6 31 24 24 ... ... 32 86.5 104 26 83 15 1.9 11.3 84 12.8 31 28.7 3.4 11.2 4.6 2 1 2 2 .4 .7 2 .3 1.5 1.2 1.2 1912 Totals. % 557.1 1878 1206 634 1691 155 32 1619 212 47 2 1 1574 253 51 517 66 218 98 30 30 37 45 3 1 4 4 25 27 16 .. ... ... 33.9 90 82 1.7 861 113 2.5 11.4 83.8 13.5 2.7 275 3.5 11.5 5.2 1.5 1.6 1.9 23 .3 5 2 .2 1.3 1.4 .9 1913 Totals. % 5910 2791 1937 1005 2577 176 38 2315 398 78 241 2456 292 43 696 73 370 95 38 40 55 58 6 17 1 5 26 23 41 ... ... ... 35 92.3 63 14 829 14.3 2.8 86 88 104 1.6 25 2.6 13.2 34 1.3 14 2 2.1 .2 .6 .04 .2 1 .8 1.5 SCHEDULE G—NOTIFICATIONS RECEIVED FROM HEAD TEACHERS DURING 1913. School Measles. Chicken Pox. Ringworm. Mumps. Whooping Cough. Scarlet Fever. Sore Throat. Sores. Diphtheria. Other Causes. Total The Hyde School 65 ... 4 2 2 1 ... 1 ... ... 75 St. Paul's School 11 2 ... ... 7 ... ... ... ... ... 20 Algernon Road School 141 11 18 3 3 12 ... 1 7 2 198 St. Mary's School 3 18 3 32 10 3 ... 7 . ... ... 76 Bell Lane School 69 41 2 58 1 11 ... ... 3 1 186 All Saints' School 27 2 16 ... 12 ... ... ... 1 10 68 Child's Hill School 15 25 1 1 16 ... ... ... ... 4 62 St. Vincent's School 25 1 1 ... 2 ... 2 ... ... 1 32 St. John's School 55 4 1 2 1 ... ... 7 2 1 73 Burnt Oak School 15 4 ... ... 2 4 ... ... ... 2 27 St. Agnes' R.C. School 14 ... 7 ... ... ... ... ... ... ... 21 St. Peter's School 14 1 2 ... 4 ... ... ... ... ... 21 Garden Suburb School 42 14 2 9 ... 1 ... 1 1 3 73 St. Mary's R.C. School 23 ... ... 2 3 ... ... ... ... ... 28 519 123 57 109 63 32 2 17 14 24 960