HEN 7 Urban District Council of Bendon. ANNUAL REPORT — OF THE - Medical Officer of Health FOR THE YEAR 1923, TOGETHER WITH THE ANNUAL REPORT ON THE Medical Inspection of Schools. £onbon: London Incorporated Press, Ltd., The Hendon Printing Works, New Brent Street, Hendon, N.W. 4. INDEX. page. Adoptive Acts 59 Ambulance 57 Area 8-10 Bye-laws and Regulations 59 Births and Birth Rates 15-18 Centres (Maternity and Child Welfare) 49-52 Clinics and Treatment Centres 48 Bay Nurseries 53, 54 Deaths and Death Rate 15-31 Deaths—Causes of 19 Deaths—Table shewing causes of and ages at 21, 22 Disinfection 66 Factory and Workshop Act 71 Foods 64 General Statistics 8 Health Services, Outlay on 6 Health Visitors 49 Hospitals 54-56 Housing—Acts, Proceedings under 68 „ Closing Orders 68 „ Demolition Orders 68 „ Public Health Acts, Proceedings under 68 „ Unfit Dwelling Houses 68 Illegitimate Children—Institutional provision for 56 Infant Mortality 25, 26 „ „ Table of 25 Infectious Diseases—Table of Notifications 33-38 „ „ Relation between housing conditions and incidence of 39-42 „ „ Deaths from 33-38 „ „ Small Pox 33-38 „ „ Cholera 33-38 „ „ Diphtheria 33-38 „ „Erysipelas 33-38 „ „ Scarlet Fever 33-38 „ „ Tyhpus Fever 33-38 „ „ Typhoid (Enteric) Fever 33-38 „ „ Relapsing Fever 33-38 „ „ Continued Fever 33-38 „ „ Puerperal Fever 33-38 page. Infectious Diseases— „ „ Plague 33-38 „ „ Cerebro Spinal Fever 33-38 „ „ Acute Poliomyelitis 33-38 „ „ Ophthalmia Neonatorum 44 „ „ Tuberculosis 33-38 „ „ Encephalitis Lethargica 33-38 „ „ Polio-Encephalitia 33-38 „ „ Influenzal Pneumonia 33-38 „ „ Malaria 33-38 „ „ Dysentery 33-38 „ „ Trench Fever 33-38 Inspection Work 60-65 Introduction 5-7 Inquests 24 Isolation Hospital 54-55 Laboratory Work 58 Maternity and Child Welfare 49-52 Meat 64 Medical Inspection of Schools and School Children 73-95 Midwives 47 Milk—Assisted Supply of 52, 53 Milk Supply 62, 63 Notifiable Diseases 32-44 Notification of Births 49 Nursing arrangements 47 Poor Relief 57 Population 8-13 Public Health Staff 67 Rainfall 13 „ Register of 14 Rent, Increase of (Restrictions) Act 65, 66 Sale of Food and Drugs Act 64 Sanitary Administration 60-67 Sanitary Condition of Schools 78 Sanitary Inspection 60-61 Senile Mortality 24 Sickness and Invalidity, causes of 46 Slaughterhouses 63 Small Pox Accommodation 55-56 Unmarried Mothers—Institutional Provision for 56 Vaccination 44, 45 Vital Statistics 15 Urban District Council of Hendon. Member of the Council, 1923. Mr. A. Roberts, J.P. (Chairman). *Mr. C. W. Hill (Vice-Chaiirman). *Mrs. S. J. Bannister. * Rev. W. S. Macgowan, M.A.,LL.D. Mr. C. C. Cartwright. *Miss M. C. Matheson. Mr. D. L. Donald. Mr. A. J. Reynolds. Mr. S. H. Egan. *Mr. F. C. 1?ice. *Capt. T. F. Fenn, M.C. Mr. A. B. Soar. Mr. Brook Flowers. Mr. .T. H. Sturgf.ss, J.P. *Miss E. C. Growse. Mr. W. Taylor. Mr. W. L. Glanville. *Mr. R. M. Weeks. *Col. F. W. Hearn. Mr. A. E. Winny. *Mr. E. Holt. Mr. R. J. Wise. * Members of the Public Health and Maternity and Child Welfare Committees. Co-opted Members of the Maternity and Child Welfare Committee. Miss Flack Mis. Weeks Mrs Parry Mis. Woolley. Public Health Department. Medical Officer of Health :— T. S. MclNTOSH, m.a., m d., m.r c.p ed., d p h Assistant Medical Officer :— Ethel M. L. Leitch, m.b., ch b. Sanitary Inspectors :— S. J. Chapman (Senior). Geo. E. Luck. A H Smith. Health Visitors :— Mrs. M. E. Bascom. Mrs. O. A. Hunt. Clerks :— C. C. Knudsen (Senior). J. H. Jones. Heads of Other Departments. H. Humphkis, f.c.i.s. (Cleik to the Council). A. O. Knight, m.c, a.m.i ce. (Engineer and Surveyor). Geo. Hails, a.s.a.a., f inst.m.t. (Treasurer and Accountant). J. Anderson (Secretary, Hendon Education Committee). Annual Report for the Year 1923 of the Medical Officer of Health. Public Health Department, " Burroughs House," Hendon, N.W. 4. March, 1924. To the Chairman and Members ok the Urban District Council of Hendon. Ladies and Gentlemen, I have the honour to submit to vou my report for the year, 1923. It has been said that that country is happy which has no history and the aphorism applies equally to Public Health Departments. The year 1923 has been on the whole an uneventful year in the matter of Public Health. Whether this is to be ascribed to good luck or efficiency is not for me to say. The Birth Rate, 15.29, is the lowest recorded except in the exceptional year 191S when it was 12.09. The Corrected Death Rate, 7.8, is the lowest yet recorded, the rate for 1922 being 9.00 and for 1921 (the lowest previous rate) 7.9. The Infant Mortality Rate, 46, is a very low rate and only 1 above that of 1922 which is the lowest recorded. 6 The number of Infectious Diseases notified was much smaller than in either of the two preceding years. During the year, I reported to you on the subject of co-ordination and extension of the Child Welfare and School Medical services and a scheme is in course of preparation which I believe will greatly increase the usefulness of these services. I think it is not always realised how comparatively inexpensive Health Services are and the following extract from a report by the Accountant is of interest in that connection. STATEMENT OF OUTLAY ON HEALTH SERVICES, 1922-23, per AUDITED ACCOUNTS. Cost to Rates. Rate in £. Nuisance abatement, Sanitation, Administration, Notifications, Fees £ s. d. for Tests, etc. 2060 14 6½ 892 Maintenance and upkeep of Burroughs House 163 8 0 .071 Sanitary Van and Infectious Disease Ambulance 222 18 7 .097 Isolation Hospital 3450 14 2 1.494 Middlesex Joint Smallpox Hospital Board 578 11 6 .250 Maternity and Child Welfare Centre £1,355 7s. 7½ 677 13 10½ .293 School Medical Services £829 13s. 7d 414 16 9 .179 Mortuary 17 9 3 .008 Total £ 7586 6 8 3.284 Special Non-recurring Outlay in 1922-23. Purchase of Daimler Ambulance £883. 8s. 0d. Isolation Hospital extensions £1723 6s. 9d. 7 Whatever may be thought of Public Health Services it cannot be said that they are very costly when, taken all together, they only account for about 3¼d. out of a total rate of 8/7. I think it may justly be claimed that Public Health Work gives a remarkably good return for the comparatively small amount of money spent. It is perhaps unfortunate that the return is not always immediate and obvious. If a large sum of money is spent on road-making there results at least a certain number of yards of good smooth road which all can see. But for the Public Health Committee's modest outlay there is nothing quite so tangible to show. Success in Public Health Work means greater freedom from disease; and the absence of disease does not force itself on our notice in the same way that its presence does. Moreover, although valuable immediate results are obtained perhaps the most valuable of all are the results which are not immediate. As I have endeavoured to indicate here and there throughout the report, the full effect of some of the Public Health Work that is being done to-day will only be apparent many years hence. The writer and readers of this report will not be there to claim the credit and we can only hope that generations yet unborn will rise and call us blessed, inasmuch as we have sown the seed and they are enjoying the fruit. I have the honour to be, Ladies and Gentlemen, Your obedient servant, T. S. McINTOSH, Medical Officer of Health. 8 1.—GENERAL STATISTICS. AREA—8,382 acres. POPULATION. TABLE 1. Census population 19th June, 1921. Estimated population Estimate of Registrar General. 30th June. Estimate of Medical Officer of Health. 1921 56,013 55,500 56,045 1922 — 55,930 57,507 1923 — 56,690 60,495 Number of structurally separate dwellings (1921)— Occupied 11,028 Vacant on Census night 569 Total 11,597 Number of families or separate occupiers (1921) 13,260 Rateable value as at 1st October, 1923 £631,446 10s. Od. £ s. d. Sum represented by a penny rate for half-year commencing 1st October, 1923 :— General District Rate purposes 2474 0 0 Poor Rate purposes 2587 19 2 The discrepancy between the Registrar General's estimate of the population and mine is becoming progressively greater year by year, but he is manifestly very much underestimating the population of this district. 9 His estimate for 1923 is only 760 above his estimate for 1922. The natural increase of population (excess of births over deaths) in 1922 was 486 and in 1923 was 476. The Registrar General's estimate of the increase of population between the middle of 1922 and the middle of 1923 is therefore less than 300 above the annual natural increase and so allows very little for increase by immigration, whereas, everyone acquainted with the district knows that the annual increase by immigration is very large. Between 1st July, 1922, and 30th June, 1923, 687 new dwellings were taken into occupation. My own estimate of the population is fully explained in the following Table and notes. 10 TABLE II.—Table of Acreage, Dwellings and Population. 2 District. Area, (land and inland water). Acres. 1921 Census. 30th June, 1921. Estimate. 30th June, 1922. Estimate. Total population. Private families and dwellings. Structurally separate dwellings occupied by private families. Increase since 1921 Census. Total population. Increase since 1921 Census. Structurally separate dwellings occupied by private families. Increase since 30th June, 1921. Total population. Increase since 30th June, 1921. Population in private families. Structurally separate dwellings occupied by private families. Persons per dwelling (from cols. d & e) cols, a b c d e f g h i j k 1 m n Hendon U.D. 8382 56013 52571 11028 4 76 11036 8 56045 32 11344 308 57507 1462 Wards. Mill Hill 3180 6118 4571 1006 4.17 1097 1 6122 4 1104 7 6151 29 West Hendon 1556 9384 8478 1306 649 1306 9384 - 1306 9384 — Central Hendon 1654 11878 11370 2320 4.90 2321 1 11882 4 2386 65 12200 318 Golders Green 960 10494 10262 2455 4 18 2459 4 10510 16 2572 113 10982 472 Garden Suburb 464 7518 73°9 1952 3.74 1953 1 7521 3 1976 23 7607 86 Child's Hill 568 10621 10581 1899 5. 57 1900 1 10626 5 2000 100 11183 557 11 TABLE II. (Continued). 30th JUNE, 1923. District. New structurally separate dwellings taken into occupation since 30 / 6 / 22. Estimated number of structurally separate dwellings occupied by private families at 30/6/23. Estimated increase of population since 30/6/22. Estimated population at 30/6/23. Hendon Urban District 687 11,982 2,988 60,495 WARDS.— Mill Hill 38 1,140 150 6,301 West Hendon 1 1,307 6 9,390 Central Hendon 227 2,599 1,045 13,245 Golders Green 234 2,788 904 11,886 Garden Suburb 45 2,018 158 7,765 Child's Hill 142 2,130 725 11,908 12 The above Table gives the estimated population at the middle of each year since the date of the Census. In arriving at the estimate for 1923, I have used the same method as in 1922, based on the assumption that the average number of persons per dwelling in each ward has remained the same as it was at the date of the Census. I have, however, introduced a slight modification in order to make allowance for any of the new dwellings which may have fallen vacant after being occupied. It is practically impossible to discover the actual number of dwellings vacant on any particular date and this can therefore only be estimated. The 1921 Census showed that there were then in the Urban District of Hendon 11,028 structurally separate dwellings occupied by private families and 569 vacant (total 11,597). The figures for vacant dwellings were not given for the various wards. Between the date of the census and 30th June, 1923, 1,003 new dwellings were taken into occupation in the Hendon Urban District. Assuming that the proportion of vacant dwellings remained the same the number of vacant dwellings among the 1,003 new dwellings would be 49 as shown by the following proportion sum :— 11597 569. 1003 49. These 49 vacant dwellings were distributed over the various wards in the proportion of the number of new houses taken into occupation in each ward. Deducting the appropriate figure from the number of new dwellings taken into occupation in each ward we get the estimated number of occupied dwellings in each ward to be added to the actual number shewn by the census. Taking Mill Hill for example:— 1 he number of new dwellings taken into occupation since the census was 46. The proportion of 49 which fell to be deducted from Mill Hill's new dwellings was 2, giving a nett addition of 44. The number of persons per dwelling in Mill Hill at the census was 4.17. 44 x 4.17 = 183 = the increase in the population of Mill Hill since the census. 13 The estimated population for the whole district is obtained by adding the estimated populations of the various wards. On the whole, I think that the method of estimating the population on the basis of the number of occupied dwellings is the one most likely to give accurate results for this district. It is interesting to compare the increase in the number of electors with the estimated increase of the population. The Accountant has kindly supplied me with the figures relating to the electorate. In 1921 the census population was 56,013 and the number of local government electors on the autumn register was 22,595. In 1923 the number of local government electors on the autumn register was 24,204. Assuming that the number of electors bore the same proportion to the population in 1923 as it did in 1921, the population in 1923 would be 60,001. My estimate (see Table II.) is 60,495. It will be noticed that the two figures approximate fairly closely. The following particulars have been extracted from the Register of rainfall compiled by Mr. J. Burgess, Headmaster of the Bell Lane School, and kindly furnished to me by him:— Total rainfall 29.29 inches. Greatest rainfall July 9th 3.01 „ Wettest month, October 5.44 „ Driest month, June .47 „ Total number of rain days 185. Total number of dry days 180. CLIMATE. 14 TABLE III. REGISTER OF RAINFALL. 1923. Kept at Hendon Central School in the County of Middlesex, by J. Burgess, Esq. Time of observation—9 a.m. Nearest Railway Station—Midland. Diameter of Rain Gauge—5 inches. Height of ton of Rain Gaugre above ground—lft. Height of top of Rain Gauge above sea level—200ft. Date Jan. Feb Mar. April May June July Aug. Sept. Oct. Nov. Dec. Date in. in. in. in. in. in. in. in. in. in. in. in. 1 .14 .04 .15 .00 .0l .00 .00 .00 .05 .02 .10 .23 1 2 .l6 .15 .03 .00 .03 .00 .00 .00 .00 .12 .01 .01 2 3 .00 .00 .00 .00 .00 .00 .00 .00 .09 .80 .05 .07 3 4 .00 .00 .00 .05 .00 .04 .00 .00 .09 .00 .00 .07 4 5 .35 .00 .00 .00 .00 .08 .00 .00 .00 .13 .19 .01 5 6 .32 ..05 .05 .05 .00 .05 .00 .00 .00 .01 .00 .00 6 7 .02 .76 .49 .00 .06 .00 .00 .00 .00 .28 .00 .18 7 8 .03 .25 .05 .00 .00 .00 .00 .00 .00 .32 .45 .00 8 9 .07 .02 .03 .00 01 .00 3.01 .00 .00 .02 .07 .05 9 10 .00 .09 .00 .32 .01 .00 .11I .00 00 .5 .00 .00 10 11 .03 .02 .00 .20 .04 .00 .00 .00 .00 .45 .00 .02 11 12 .00 .43 75 .31 .08 .08 .00 .00 .00 .54 .00 .00 12 13 .00 .15 .16 .03 .02 .00 .00 .00 .00 .00 .48 .00 13 14 .00 .05 .04 .08 .01 .00 .00 .05 .19 .07 .00 .00 14 15 .02 .01 .06 .01 .20 .10 .03 .00 .05 .00 .19 .00 15 l6 .00 .05 .00 .00 .00 .00 .00 .02 .00 .00 .11 .00 16 17 .03 .35 .00 .00 .01 .00 .00 .05 .10 .00 .00 .00 17 18 .03 .14 .00 .00 .00 .05 .06 .04 .14 .08 .00 .00 18 19 .15 .02 .00 .00 .04 .02 .04 .02 .11 .87 .00 .05 19 20 .00 .12 .18 .00 .08 .01 .00 .00 .25 .04 .00 .00 20 21 .04 .12 .01 .00 .07 .00 '00 .00 .00 .15 .00 .12 21 22 .00 .25 .01 .00 .01 .00 .00 .00 .10 .11 .00 .00 22 23 .00 .09 .10 .00 .20 .00 .04 .48 .07 .27 .00 .00 23 24 .00 .04 .00 .00 .01 .00 .00 .07 .23 .01 .00 .40 24 25 .00 .17 .16 .73 .05 .04 .14 .04 .06 .49 .00 .52 25 26 .00 .16 .01 .35 .00 .00 .00 .05 .00 .14 .00 .30 26 27 .00 .04 .09 .06 .17 .00 .00 .23 .00 .10 .00 .09 27 28 .01 .19 .00 .01 .65 .00 .08 .06 .00 .00 .02 .34 28 29 .12 - .35 .00 .19 .00 .05 .43 .00 .00 .00 .00 29 30 .00 - .00 .00 .00 .00 .24 .00 .00 .017 .00 .00 30 31 .00 - .05 — .02 — .21 .00 - .00 — .00 31 Total 1.52 3.76 2.72 2.20 1.97 .47 4-.01 1.'54 1.53 5.44 1.-67 2.46 Total for year '29*29 in. No of rain ays 15 25 18 12 22 9 11 12 13 23 10 15 185 15 2.—VITAL STATISTICS. STATISTICS BASED ON THE REGISTRAR GENERAL'S FIGURES. The following are the statistics prescribed by the Ministry of Health. They are based on the Registrar General's figures:— Births. Total. Male. Female. Legitimate 894 476 418 Illegitimate 31 14 17 Total 925 490 435 Birth Rate, 16.31. Deaths, 449. Death Rate, 7.92. Number of women dying in or in consequence of childbirth From Sepsis 1 Other causes 3 Deaths of legitimate infants under one year of age per 1,000 legitimate births 42 Deaths of illegitimate infants under one year of age per 1,000 illegitimate births 161 Total deaths of infants under one year of age per 1,000 total births 46 Deaths from Measles (all ages) 4 Deaths from Whooping Cough (all ages) 7 Deaths from Diarrhoea (under 2 years of age) 1 TABLE IV. Birth Rate, Death Rate, and Analysis of Mortality during the Year 1923. Birth Rate per 1,000 total population. Annual Death Rate per 1,000 Population. Rate per 1,000 births. All causes Enteric Fever. Smallpox. Measles, Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea & Enteritis (under 2 years). Total deaths under 1 year. *England and Wales 19.7 11.6 0.01 0.00 0.14 0.03 0.10 0 07 0.22 0 44 7 7 69 *105 County Boroughs and Great Towns (including London) (Igai adjusted populations over 50,000) 20.4 11.6 0.01 0.00 0.15 0.03 0.12 0.09 0.22 0.40 9.9 72 *157 Smaller Towns (1921 adjusted populations 20,000-50,000) 19.8 10.6 0.01 0.00 0.19 0.02 0.10 0.06 0.21 0.38 6.4 69 *London 20.2 11.2 0.01 0 00 0.08 0.02 0.09 0.13 0.17 0.45 10.2 60 †Hendon 16 31 7.92 0.00 0.00 0.07 0.01 0.12 0.08 0.15 0.40 0 03 46 * Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1923, while those for the towns have been calculated on populations estimated to the middle of 1922. The mortality rates refer to the whole population as regards England and Wales, but only to civilians as regards London and the groups of towns. † For the purposes of this Table the population of Hendon has been taken as 56,690 (which is the Registrar General's estimate for the middle of 1923). 16 17 STATISTICS BASED ON THE MEDICAL OFFICER OF HEALTH'S FIGURES. The following are fuller details of the Vital Statistics for the year. They are based on the Medical Officer of Health's estimate of population and on the office records and differ slightly in some respects from the Registrar General's figures. Births (Population 60,495). Number of births registered 840 Number belonging to other districts 31 809 Births occurring in other districts and belonging to Hendon 116 Nett births belonging to the district 925 Birth Rate 15.29 Birth Rate (England and Wales) 19.7 The births occurring in the district were distributed as follows:— Males 435 Females 374 The excess of births over deaths is:— 476 DISTRIBUTION IN DISTRICTS. District. Births. Mill Hill 75 West Hendon 161 Central Hendon 187 Golders Green 140 Garden Suburb 51 Child's Hill 195 Inward transfers 116 18 31 illegitimate births belonging to the district were registered:— Mill Hill Nil. West Hendon 3 Central Hendon Nil. Golders Green 3 Garden Suburb 2 Child's Hill 5 Inward transfers 18 DEATHS AND DEATH RATE. (Population—60,495). Deaths registered in the district 657 Deaths of non-residents 308 349 Deaths of residents registered in other districts 98 Nett number belonging to the district 447 Males 232 Females 215 Recorded Death Rate 7.38 Corrected Death Rate (Correction factor 1911 census) 7.8 37 per cent. of the deaths of residents were of persons over the age of 65 years. The number of deaths in each locality is set out in the table below :— 19 Mill Hill 45 West Hendon 75 Central Hendon 98 Golders Green 75 Garden Suburb 51 Child's Hill 103 CAUSES OF DEATH. A table has been prepared which shows the causes of and ages at death (see next page). The Zymotic Death Rate for the year is .31, the causes of death on which the rate is based are:— Small-pox Nil. Measles 4 Scarlet Fever 1 Diphtheria 5 Whooping Cough 7 Diarrhoea (under 2 years) 2 Enteric Fever Nil. Total 19 21—22 TABLE V.—Causes of, and Ages at, Death during Year 1923. 21—22 Name of District—HENDON (URBAN) 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 "Non-Residents' 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 year 65 and upwards All causes Certified 449 43 10 10 12 16 67 123 168 327 Uncertified ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ...... ... ... ... ... Measles 4 ... 2 1 1 ... ... ... ... 1 Scarlet Fever 1 ... ... ... ... ... 1 ... ... 1 Whooping-Cough 7 ... 2 2 ... ... ... ... ... ... Diphtheria 5 ... ... 4 ... ... ... 1 ... 4 Influenza 9 ... l ... ... 1 3 2 2 1 Encephalitis Lethargica 2 ... ... ... ... 1 ... 1 ... ... Meningococcal meningitis 1 ... ... ... ... ... 1 ... ... ... Pulmonary Tuberculosis 30 ... ... ... 1 ... 19 5 1 212 Other tuberoulous diseases 4 ... ... ... ... ... 3 1 ... 1 Cancer, malignant disease 60 ... ... ... ... ... 7 27 26 21 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... Diabetes 8 ... 1 ... ... 1 ... 5 1 ... Cerebral Hæmorrhage 26 ... ... ... ... 1 1 9 15 5 Heart disease 67 ... ... ... ... 3 7 21 36 15 Arterio-sclerosis 4 ... ... ... ... ... ... 1 3 1 Bronchitis 24 4 ... ... ... ... ... 5 15 4 Pneumonia 25 4 ... l 4 ... 3 6 7 10 Other respiratory diseases 5 ... ... ... ... ... ... 2 3 2 Ulcer of stomach or duodenum 2 ... ... ... ... ... 1 1 ... ... Diarrhoea, etc. (under 2 years) 2 2 ... ... ... ... ... ... ... ... Appendicitis and typhlitis 2 ... ... ... 1 ... ... 1 ... ... Cirrhosis of liver 2 ... ... ... ... ... 1 1 ... ... Acute and chronic nephritis 15 ... ... ... ... ... 1 8 6 2 Puerperal sepsis 2 ... ... ... ... ... 2 ... ... ... Other accidents and diseases of pregnancy and parturition 2 ... ... ... ... ... 2 ... ... ... Congenital debility and malformation, premature birth 21 20 ... ... 1 ... ... ... ... 3 Suicide 6 ... ... ... ... ... 2 3 l 1 Other deaths from violence 17 ... 2 ... 2 2 2 4 5 2 Other defined diseases 96 10 2 2 2 3 11 19 47 41 Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... Totals 449 43 10 10 12 16 67 123 168 327 23 URBAN DISTRICT OF HENDON Comparative view of 10 of the principal causes of Death during the year 1923. 24 SENILE MORTALITY. 167 Deaths of residents over 65 years of age were registered, a percentage of 37 of the total deaths of residents. INQUESTS. The following table shows the cause to which Deaths were attributed by Coroner's Juries :— Natural Causes. Accidents and Misadventures. Fatty degeneration of heart 5 Dislocated atlas through fall 1 Tuberculosis of lungs, kidney, etc. 1 Injuries through breaking of steel bond of Diphtheria 1 excavator 1 Cerebral haemorrhage Run over 6 Fell out of boat—fatty degeneration of heart, failed to reach shore Valvular heart disease 1 1 Myocardial degeneration 1 Pneumonia 1 Squeezed between two motor buses 1 Chronic alcoholism 1 Injuries caused by fire 1 Inattention at birth Strangled by strap placed in cot to keep child in 1 Hydrocephalus, epileptic fit 1 Drowning 1 Heat exhaustion 1 Spirit of Salts poisoning 1 Meningitis following scalds Arterio sclerosis 1 1 Atheroma of coronary arteries 1 Fractured skull through fall 1 Suicides. Revolver bullet wounds 2 Drowning 2 Coal gas poisoning 4 25 TABLE VI. DISTRICT—HENDON (MIDDLESEX). INFANT MORTALITY DURING THE YEAR, 1923. Nett deaths from stated causes at various ages under one year. Causes of Death. Under 1 Wees. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 months 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under 1 Year. All causes Certified. 16 6 4 1 27 8 3 3 2 43 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-Cough ... ... ... ... ... 1 ... 2 ... 3 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ...... ... Other Tuberculous diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... 1 1 ... 1 1 4 Pneumonia (all forms) ... ... 1 ... 1 3 ... ... ... 4 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... 1 ... 1 ... ... ... ... 1 Gastritis ... ... ... ... ... ... 1 ... ... 1 Syphilis ... ... ... ... ... ... 1 ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 2 1 ... ... 3 ... ... ... ... 3 Atelectasis ... 1 ... ... 1 ... ... ... ... 1 Congenital malformations 1 1 ... ... 2 3 ... ... ... 5 Premature birth 8 1 1 ... 10 ... ... ... ... 10 Atrophy, Debility and Marasmus 1 1 ... ... 2 ... 1 ... ... 3 Other causes 4 1 1 ... 6 ... ... ... 1 7 Totals 16 6 4 1 27 8 3 3 2 43 Nett births in the Legitimate 894 year Illegitimate ... 31 Nett Deaths in the J Legitimate infants 38 year Illegitimate infants 5 26 URBAN DISTRICT OF HENDON. Chart shewing Infant Mortality Rate per 1,000 births for Hendon compared with the Rate for England & Wales. Thin lines indicate England & Wales. THICK lines indicate HENDON. 27 The following table gives a comparison of the Vital Statistics and the incidence of and deaths from certain diseases, in the various Wards. Some of the rates are calculated on such low figures that not very much importance can be attached to them—notably the Infant Mortality Rate and the Death Rates from the specified diseases. 28 TABLE VII. Ward. Birth Rate. Death Rate. Infantile Mortality Rate per 1,000 births, Infectious diseases notified per 1,000 population. Deaths from certain diseases per 1,000 population. Deaths per 1,000 births. Scarlet Fever. Diphtheria. Pulmonary Tuberculosis. Scarlet Fever. Diphtheria. Pulmonary Tuberculosis Measles. Whooping Cough. Diarrhoea under 2 years. Mill Hill 13.64 7.14 23 2.22 0.63 1.26 - - 0.31 - - - West Hendon 19.59 8.09 81 .95 2.66 1.38 - 0.10 0.63 - 0.31 5.43 Central Hendon 16.15 7.47 37 1.13 3 69 1.05 - 0.15 0.37 0.15 0 15 - Golders Green 13.46 6.30 43 0.84 1.26 0.75 - 0.08 0.42 0.08 0.08 6.25 Garden Suburb 7 46 6.56 17 0.25 1.80 - - - 0.25 0.12 - - Child's Hill 18 72 8 64 44 1.34 1.00 1.34 0.08 0.08 0.83 - 0 08 - 29 A reference to Table IV. shews that the Death Rate and Infantile Mortality Rate of Hendon again compare very favourably with those of England and Wales as a whole and with those of London, the 105 Great Towns (of which Hendon is one) and the 155 Smaller Towns. The following are the Birth Rates, Corrected Death Rates and Infantile Mortality Rates of Hendon for the last 10 years:- TABLE VIII. Year. Birth Rate. Corrected Death Rate. Infautile Mortality Rate. 1914 24.12 8.96 56 1915 21.23 10.44 73 1916 19.33 10.16 67 1917 15.97 9.72 74 1918 12.09 11.67 54 1919 15.69 9.07 73 1920 19.78 8.24 47 1921 17.9 7.9 61 1922 17.45 9.00 45 1923 15.29 7.8 46 The number of deaths from acute infectious diseases is again very low. Only one death occurred from Scarlet Fever. This took place in the Isolation Hospital. There were 5 deaths from Diphtheria, representing a case mortality of just over 4 per cent. Four of these deaths took place in the Isolation Hospital out of 92 cases admitted, giving again a case mortality of just over 4 per cent. for cases admitted to the hospital. 4 per cent. is regarded as a low case mortality for Diphtheria. Heart Disease is again the most important single cause of death, giving rise to 67 deaths or over 1 /7th of the total deaths. This is not a cause of mortality against which direct measures of prevention can be taken. It is not a single disease but a group of diseases brought about by many causes. 30 It is significant that more than half the deaths from heart disease occurred after the age of 65. In many of these cases the heart disease was probably only part of a more or less general degenerative process incidental to old age. Of the cases of heart disease occurring in early or middle life probably the most important cause is acute rheumatism. One of the contributory causes of acute rheumatism is damp dwellings. Therefore the sanitary supervision of dwellings may be said to be a measure of prevention directed against heart disease. Again it is held by some that an unhealthy condition of the nose and throat is an important cause of rheumatism both acute and chronic and I think that there is a great deal to be said for this view. Accordingly, there is good reason to believe that the treatment of adenoids and enlarged tonsils provided by the school medical service is also a preventive of heart disease. This is a very good example of the way in which the various branches of the Council's health work are linked together. Child Welfare work and School Medical work are no less a part of the system of Preventive medicine than are Sanitary inspection and the isolation of cases of infectious disease. Each is working in its own way towards the same end and all are parts of one system. It also affords an indication that the immediate results obtained from Public Health work are by no means the whole of the benefit conferred on the community. The full effect must be looked for many years after the work is carried out. Cancer comes next in the list wth 59 deaths as against 66 in 1922. 7 of these deaths occurred under the age of 45, 27 between the ages of 45 and 65 and 25 over the age of 65. Progress is undoubtedly being made in the study of this disease, which encourages the hope that its causes will be discovered and possibly the way to its prevention indicated. Pulmonary Tuberculosis caused 30 deaths. This is 3 more than in 1922, but on the whole the death-rate from 31 this disease is undoubtedly declining. Here again there is good reason to believe that work which we are doing now is contributing to reduce the amount of disease years hence. The early treatment of certain minor ailments in children may be expected to save some of these children from developing Tuberculosis in later life. Pneumonia and Bronchitis together caused 49 deaths; that is 63 per cent. more than Pulmonary Tuberculosis. While these diseases cannot at present be said to be preventable 1 believe that some of the deaths might be prevented if ample hospital accommodation were available. 32 3.—NOTIFIABLE DISEASES DURING THE YEAR. The following Table gives particulars of the occurrence of notifiable diseases during the year. 33-38 TABLE IX. Cases of Infectious Diseases notified during the year 1923. Name of District—HENDON (URBAN) MIDDLESEX. Notifiable Diseases. Number of cases notified ami died. At ages—years. Total oases notified in each locality of the district. Total cases removed to. Under one year of age. 1 and under 2. 2 and under 3. 3 and under 4, 4 and under 5. 5 and under 10. 10 and under 15. 15 and under >0. 20 and under 35. 35 and under 45. 45 and under 65 65 and upwards. Total at all ages. Mill Hill. West Hendon. Central Hendon. Golders Green. Garden Suburb. Child's Hill and Oricklewood. Hendon Isolation Hospital. Other Hospitals. Small-pox Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria or Membranous Croup Cases notified 1 3 7 13 7 41 20 7 16 3 1 ... 119 4 25 49 15 14 12 92 5 Deaths ... ... 1 2 1 ... ... ... ... ... 1 ... 5 ... 1 2 1 ... 1 ... ... Erysipelas Cases notified ... ... ... ... ... ... ... 2 1 ... 4 4 11 6 1 2 ... ... 2 ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever Cases notified ... ... 3 5 1 30 12 4 9 2 ... ... 66 14 ... 15 10 2 16 39 5 Deaths ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... Typhus Fever Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhoid (Enteric) Fever Cases notified ... ... ... ... ... 1 ... ... 3 ... ... ... 4 1 ... 1 ... 1 1 ... 2 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever Cases notified ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 ... 1 Deaths ... ... ... ... ... ... ... ... 1 1 ... ... 2 ... ... ... ... ... 2 ... ... Plague Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro Spinal Fever Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Cases notified ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Poliomyelitis Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Ophthalmia Cases notified 3 ... ... ... ... ... ... ... ... ... ... ... 3 ... ... 1 ... ... 2 ... 1 Neonatorum Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis:- (a) Pulmonary- Male Cases notified ... ... ... ... ... 2 ... l 12 7 5 ... 27 5 6 10 1 ... 5 ... 13 Deaths ... ... ... ... ... ... 1 ... 5 3 5 1 15 2 3 4 1 1 4 ... ... Female Cases notified ... ... ... ... ... ... 1 5 21 5 1 ... 33 3 7 4 8 ... 11 ... 13 Deaths ... ... ... ... ... ... ... 1 11 3 ... ... 15 ... 3 1 4 1 6 ... ... (b) Non-pulmonary- Male Cases notified ... ... ... ... ... 1 1 ... 1 1 1 ... 5 ... 1 1 ... 2 1 ... 3 Deaths ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... ... ... ... 1 1 ... ... Female Cases notified ... ... ... ... 1 4 ... 2 5 1 ... ... 13 3 1 7 ... ... 2 ... 9 Deaths ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... ... ... 1 ... 1 ... ... Acute Encephalitis Cases notified ... ... 1 ... ... ... ... 1 1 ... 1 1 5 ... ... 1 1 1 2 ... 3 Lethargica Deaths ... ... ... ... ... ... ... 1 ... ... 1 ... 2 ... ... ... 1 ... 1 ... ... Acute Polio- Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Primary and Acute Influenzal Pneumonia Cases notified ... 1 l 1 1 1 1 1 10 4 8 ... 29 7 9 5 2 ... 6 ... ... Deaths from all forms of Pneumonia 4 ... ... l ... 4 ... ... ... 3 6 7 25 4 5 3 5 3 5 ... ... Malaria Causes notified ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Trench Fever Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39-42 The following tables are designed to show the relation between housing conditions and the incidence of certain Infectious Diseases. The word "Tenement" is used to mean a suite of one or more rooms occupied by one "family unit" and may include the whole or only part of a house. "Family unit" means a group of persons living together as one family whether they are actually all members of the same family or not, e.g., It includes a lodger who lives with the family and does not merely hire a room from them. It also includes domestic servants living in. " Unprotected " person means a person not known to have previously suffered from the disease in question. The tables refer to private families only—cases occurring in institutions, hotels, etc., have been omitted. TABLE X. 1 room. 2 rooms. Tenements of 3 rooms. 4 rooms. 5 rooms. Over 5 rooms. Population (1921 census) living in tenements of various sizes 1077 2510 8688 8038 8882 23376 Cases of the following diseases occuring in these tenements:- Scarlet Fever ... 3 12 9 4 30 Diphtheria 6 5 21 19 16 48 SCARLET FEVER. Unprotected persons under 15 years of age living in in the invaded tenements ... 3 25 21 6 47 Number of cases occurring among these persons ... 2 11 7 3 21 Attack rate per 1,000 among these persons ... 666 440 333 500 446 DIPHTHERIA Unprotected persons under 15 years of age living in the invaded tenements 6 15 59 44 22 86 Number of cases occurring among these persons 5 5 16 18 13 33 Attack rate per 1,000 among these persons 833 333 271 409 590 383 Up to one person per room. Over one and up to 2 persons per room. 2 More than persons per room. Population (1921 census) living in tenements showing various conditions of density of occupation 34,136 14,832 3,603 Cases of the following diseases in families living under varying conditions of density, in 1923: — Scarlet Fever 30 24 4 Diphtheria 51 44 19 SCARLET FEVER. Unprotected persons under 15 years of age living in the invaded tenements in 1923 48 46 11 Number of cases occurring among these persons 22 19 3 Attack rate per 1,000 among these persons 458 413 272 DIPHTHERIA Unprotected persons under 15 years of age living in the invaded tenements in 1923 73 94 64 Number of cases occurring among these persons 35 39 16 Attack rate per 1,000 among these persons 479 414 250 The facts recorded by these tables may be of some interest but the numbers in the various columns are too small to allow of any deductions being drawn from them. MULTIPLE CASES.— Scarlet Fever. 2 families 2 cases each. 1 family 3 cases. Diphtheria. 8 families 2 cases each. 4 families 3 cases each. 1 family 4 cases. URBAN. DISTRICT OF HENDON • — 1923. — 43 44 INFECTIOUS DISEASES. The subject of Infectious Disease calls for very little comment this year. There was no epidemic of Scarlet Fever or Diphtheria. The number of cases of Scarlet Fever was striking-ly low and of Diphtheria moderate. TABLE XI. Disease Case rate per 1,000 living. Hendon. England and Wales. Small Pox 0.00 0.06 Scarlet Fever 1.09 2.23 Diphtheria 1.96 1.04 Enteric Fever 0.06 0.05 Puerperal Fever 0.01 0.06 Erysipelas 0.18 0.32 TABLE XII. OPHTHALMIA NEONATORUM. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 3 l 2 3 - - - The ratio of non-notified Tuberculosis deaths to total Tuberculosis Deaths is 4 to 34. Of these 4, 1 died outside the district. VACCINATION. The following Table, for which I am indebted to Mr. A. E. Taylor, Vaccination Officer, shows the particulars as regards vaccination:- 45 TABLE XIII. *Number of Births registered in 1922 883 Successfully vaccinated 546 Insusceptible of vaccination 3 Exemptions 218 Dead, unvaccinated 32 Postponements by Medical Certificates 10 Removal to other districts and cases not found 55 Number of births unaccounted for 19 Number at ail ages vaccinated during the year (Primary).— Born within district 616 Born out of district 105 *Figures for the number of children born in 1923 and vaccinated are not available as vaccination may be performed any time during the first 6 months of life. 46 4.—CAUSES OF SICKNESS. No specially noteworthy cause of sickness has come to my notice during the year. 47 5.—SUMMARY OF NURSINC ARRANCEMENTS, ETC. PROFESSIONAL NURSING IN THE HOME. (A)—General. The provision of home nursing is not undertaken by the County Council or the District Council. Voluntary Nursing Associations provide a district nurse in each of the following parts of the district:- Central Hendon, West Hendon, Child's Hill, Hampstead Garden Suburb, These Nursing Associations are quite independent of Public Authorities. (B)—For Infectious Diseases. No special provision is made, but complicated cases of Measles, Whooping Cough, etc., are dealt with by the district nurses as part of their general work. MIDWIVES. The Hendon Urban District Council employs a Midwife whose work lies mostly in West Hendon The fee charged for attendance on a confinement case during the year was £1 1s. Od. The following are the particulars of the work of the Council's Midwife during the year :— Number of confinements attended 78 Number of antenatal visits 480 Number of ordinary working visits 1332 Number of late visits (i-e., visits paid after the normal period of 10 days) 108 The total number of Midwives registered for practice in the district and resident in the district during the year was 12. 48 TABLE XIV. CLINICS AND TREATMENT CENTRES. Name Situation. Nature of Accommodation. By whom provided. 1. Central Hendon Maternity and Child Welfare Centre. Burroughs House, Hendon. Consultation and weighing rooms. Hendon Urban District Council P 2. West Hendon Maternity and Child Welfare Centre. The Broadway, West Hendon. do. do. 3. Child's Hill Maternity and Child Welfare Centre. Granville Hall, Granville Road, Child's Hill. do. do. 4. School Clinic. Hurroughy House, Hendon. Examination and minor treatment rooms. Heiidon Education Committee •5. West Hendon Day Nursery. The Broadway, West Hendon. Converted shop with dwelling over; accommodation for 24 children. Voluntary Committee subsidised by the Ministry of Health and the Hendon Urban District Council 6. Burgess Day Nursery. 1. Devonshire Place, Child's Hill. Cottage with accommodation for 14 children. Maintained by endowment. 7. Tuberculosis Dispensary. The Broadway, West Hendon. Consultation rooms. Middlesex County Council 8. Venereal Diseases.—There is no centre in the district for this purpose. Treatment for these diseases is provided at various London Hospitals under Middlesex County Council arrangements. 49 The following is a summary of the work done in connection with the Maternity and Child Welfare Scheme:- NUMBER ATTENDING THE CENTRES. TABLE XV. West Hendon Centre. Child 8 Hill Centre. Central Hendon Centre. Total attendances of children 3969 5171 2138 Average attendances per session 79 53 44 Examinations by Medical Officer 1853 3124 1322 New members admitted 135 192 83 under one year of age 114 139 64 over one year of age 21 53 19 Antenatal cases 102 124 21 Number of visits paid in connection with the work of the Centres 4632 Antenatal visits (included in above) 349 The work of the Health Visitors in connection with the Notification of Births was as follows:- Number of births notified 834 First visits 659 Re-visits 1319 METHOD OF FEEDING. Breast 503 Breast and Bottle 34 Bottle 105 The following note on the Child Welfare work by the Assistant Medical Officer may be of interest:- 50 "The increasing numbers in attendances at the Maternity and Child Welfare Clinics show that these Centres are fulfilling a much needed Public Service. "As there still seems some apprehension among the public as to the function of these clinics, I should like to state that the Centres are primarily for Instruction in Mothercraft and the Prevention of Disease. "It cannot be too strongly emphasised that a child who is really ill should not be brought to the Clinic. The proper place for a sick child is at home in bed with the home doctor in attendance. "There is considerable evidence that the mothers are beginning to understand the principles of Mothercraft; but much more education is required to overcome old fashioned prejudices, especially in the matter of fresh air in the homes, care of the teeth, giving of snacks and sweets at all times of the day and overfeeding. "We like the mothers to bring the babies at an early age: a month old is a suitable time. The babies are undressed and weighed and passed into the Doctor's room. There a thorough examination is made with minute enquiries into the diet and management, and the necessary advice given. Each new baby will probably be seen by the doctor in the following week and after that every fortnight until he or she is a year old. Again the baby is undressed for the examination and this time particular attention is paid to the bone development and condition of the legs, head and abdomen : for it is about this time that slight rickets is often first noticed. After a year less frequent examinations are made by the doctor, but the child should attend and be weighed at regular intervals. The mother's attendance often begins to fall off in the second year, it is therefore very important that the Health Visitor should have time to visit these babies regularly until school age. "During the consultation at the Clinic the Health Visitor has to be "everywhere at once." She receives the mothers and watches that no child suffering from infectious disease is admitted and no child with a contagious skin disease weighed. She tries to get at least a glimpse 51 of all babies undressed so that her trained eye may observe anything that should be brought to the doctor's notice. She decides which babies must see the doctor and herself advises in less important details those who cannot be seen. She watches that none is taken in before his or her turn. Her attention besides is often required by the voluntary helper dispensing milk foods and simple tonics or ointments. "If the numbers become too large in any one day, it is impossible for her to do all these things satisfactorily. By her knowledge of the homes of the mothers and the conditions in which they live, she can often give a clue for the reason of a child's lack of progress which is of value in the future treatment of the child. "At present there are 4 afternoons per week for consultation. One at Burroughs House, one at West Hendon and 2 at the Child's Hill Centre. The numbers at West Hendon have become so great that if the babies are to get proper attention, another day will be required for a consultation. There is no doubt that by the advice given at the Clinic and by the mothers' attention to details much illness is prevented, especially in the summer months, and many delicate ailing babies have grown into strong healthy children." I reported to you during the year on the advisability of better co-ordination of the Child Welfare work with the work of the School Medical Service and of the need for expansion of the Child Welfare work in certain directions, particularly as regards supervision between 2 and 5 years of age. The establishment of a Centre at Mill Hill and the holding of an additional session per week at West Hendon were recommended. These matters were receiving your consideration at the end of the year. The number of deaths of infants under one year of age who have attended the Centres once or oftener was 4. Compared with the total number of new members under one year of age this gives an Infant Mortality Rate of 12.6 per 1,000, whereas the general Infant Mortality Rate for the district was 46. It would be unscientific to ascribe the whole of the above difference in mortality to the Child Welfare Centres, but the 52 fact remains that this comparison of the death rate among infants who attended the Centres, with the general Infant Mortality Rate, works out year after year very much in favour of the infants who attend the Centres and it is only reasonable to suppose that some of the credit belongs to the Centres. I repeat the following sentence from my last year's report as I consider it of great importance:- Above all, I consider that these Clinics are acting as educational centres and that the effect of their teaching will in time spread far beyond the individual mothers and children who attend." ASSISTED MILK SUPPLY TO NECESSITOUS MOTHERS AND INFANTS. The following is the income scale adopted for this purpose:- TABLE XVI. Number in family. Scale of income per head of family after deducting rent. For a supply of milk free of charge. For a supply of milk at half cost price. 1 10 0 12 0 2 9 0 10 0 3 8 0 9 0 4 7 0 8 0 5 6 0 7 0 6 5 6 6 6 7 5 0 6 0 8 or over 5 0 6 0 The father, mother and children and other dependants living at home should be reckoned as members of the family. Children who are living at home but earning wages should be treated as lodgers and not as members of the family. The amount paid by the lodgers less 10/- per week, should be counted as income. Any case outside the scale will be specially considered on its merits by the Committee. 53 Milk was supplied as follows:- Number of families in receipt of milk at 1st Jan., 1923:- free 17 Half-price 1 Number of families supplied during 1923:- Free 48 Half-price 6 Number of families in receipt of milk at 31st Dec., 1923:- Free 12 Half-price 2 Total amount of milk supplied:— Free 7241 pints. Half-price 428 ,, Total 7669 ,, Total cost to the Council £97 15s. 0d. These figures include 42 pints (cost 14/-) supplied free to a Kingsbury resident, the cost of which would be re-paid by the County Council. DAY NURSERIES. These institutions perform a useful function in providing a place where young children can be left under proper care by mothers who for one reason or another are obliged to go out to work. The Burgess Day Nursery is self supporting, its income being derived from endowment and subscriptions from neighbours. It accommodates 14 children. Children are received up to 5 years of age and a few older children attend for meals only. It is open from 8 a.m. to 5.30 p.m. The West Hendon Day Nursery receives a grant of £250 per annum from Hendon Urban District Council. A charge of 1/- per head per day is made but in necessitous cases this 54 is reduced to 8d. The remainder of the necessary income is provided partly by voluntary contributions and partly by a grant from the Ministry of Health. It is open daily (except Saturdays and Sundays) from 7.30 a.m. to 7 p.m. There is accommodation for 24 children. HOSPITALS PROVIDED OR SUBSIDISED BY THE LOCAL AUTHORITY OR BY THE COUNTY COUNCIL. (1) Tuberculosis. Treatment of Tuberculosis is in the hands of the Middlesex County Council who possess a County Sanatorium at Harefield. Patients are also sent to Clare Hall Sanatorium, South Mimms, and to various other hospitals and Sanatoria under County Council arrangements. (2) Maternity. There is no maternity hospital in the district. (Patients are frequently admitted to Queen Charlotte's Lying-in Hospital in Marylebone, and to Cedar Lawn Lying-in Home, in Hampstead). (3) Children. There is no children's hospital in the district. (Children over 5 years of age are admitted to the Hendon Cottage Hospital which is a purely voluntary hospital, and children of all ages to the London Children's Hospitals). (4) Fever. The Hendon Urban District Council provides an Isolation Hospital. A scheme for the provision of a new Isolation Hospital is at present under consideration. The following shows the number of patients treated in the hospital each year since it was first opened:- 55 TABLE XVII. Year. Number of patients. Year. Number of patients. 1890 4 1907 53 1891 23 1908 83 1892 23 1909 175 1893 70 1910 125 1894 66 1911 100 1895 51 1912 129 1896 60 1913 102 1897 23 1914 219 1898 86 1915 118 1899 74 1916 62 1900 41 1917 92 1901 83 1918 79 1902 55 1919 118 1903 80 1920 199 1904 83 1921 176 1905 74 1922 209 1906 92 1923 131 The diseases treated were:- Scarlet Fever 2,452 Diphtheria 642 Enteric Fever 47 Small Pox 10 Erysipelas 6 Measles 1 During the year 39 cases of Scarlet Fever were removed to the Hendon Isolation Hospital and 92 cases of Diphtheria. (5) Small Pox. Accommodation for Small Pox is provided at Clare Hall, South Mimms, by the Middlesex Districts Joint Small Pox Hospital Board of which the Hen-Jon Urban District Council is one of the constituent authorities. Hendon is entitled to one representative on the Board for every 25,000 of 56 the population. The Chairman of the Public Health Committee and the Chairman of the Finance Committee are Hendon's representatives at present. The Small Pox Hospital is at present in use as a Sanatorium for Tuberculous cases. The Board have made arrangements whereby any case of Small Pox, which might arise, would be at once accommodated in other hospitals and the Clare Hall Hospital would be emptied for Small Pox cases if necessary. (6) Other Hospitals. There are no other hospitals provided or subsidised by the Local Authority or the County Council. The Hendon Cottage Hospital, which is a voluntary one, has an accommodation of 40 beds for general medical and surgical cases. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS & HOMELESS CHILDREN IN THE DISTRICT. There is no special provision of this nature available for the district apart from that made by the Guardians. St. Helena's Hospital Home and House of Rest, Thorverton Road, Cricklewood Lane, N.W., is situated in the district. It has an accommodation of 12 beds and admits unmarried mothers with their infants. It is associated with the London Diocesan Council for Preventive, Rescue and Penitentiary work and admits cases coming under the supervision of that organisation. The Mother's Rest Home at 110, Erskine Hill, Garden Suburb, is a small cottage with accommodation for 3 mothers and babies. They are admitted for a fortnight's rest after confinement and may be either unmarried or married. The cases come mostly from various parts of London. The Hampstead Guardians maintain a cottage home, in this district, for destitute children for whom they are responsible. The address is Homesfield, Erskine Hill, Garden Suburb, It provides accommodation for 26 children. 57 AMBULANCE FACILITIES. The Council maintains 2 ambulances. One is in charge of the Public Health Department and is used exclusively for infectious diseases. The other ambulance is kept at the Fire Station and is available at all times for accidents and other non-infectious cases, a charge being made for its use. POOR RELIEF. The following particulars have been kindly supplied to me by Mr. F. J. Seabrook, Clerk to the Hendon Board of Guardians:— TABLE XVIII. Parish of Hendon. 1922. 1923. 1. The average number of inmates in Redhill Institution 134 128 2. The number of persons in receipt of Outdoor Relief (ordinary) 151 259 3. The number of persons in receipt of Outdoor Relief (unemployed) 91 130 4. Average weekly number in receipt of Outdoor Relief (ordinary) 130 243 5. Average weekly number in receipt of Outdoor Relief (unemployed) 73 113 6. The amount of Outdoor Relief (ordinary) approximately £2980 £1935 7. The amount of Outdoor Relief (unemployed) £3833 £1222 58 6.—LABORATORY WORK. Examinations of throat swabs, sputum and blood (Widal test) are undertaken. Specimens are sent by the Medical Officer of Health and Private Practitioners in the district to London Laboratories which undertake the examinations for the Council. The following is a summary of the work done:— TABLE XIX. Total number. Positive. Negative. Throat swabs for Diphtheria bacillus 536 131 405 Typhoid Fever, blood examinations ... ... ... 5 — 5 Tuberculosis, sputum examinations ... ... ... 50 6 44 Milk 2 — — Hairs 16 11 5 Blood: culture ... ... 1 — — TABLE XIX. Total number. Positive. Negative. Throat swabs for Diphtheria bacillus 536 131 405 Typhoid Fever, blood examinations 5 5 Tuberculosis, sputum examinations 50 6 44 Milk 2 — — Hairs 16 11 5 Blood culture 1 — — Antidiphtheritic serum is supplied free of charge to Medical Practitioners practising in the district. It is obtainable at the Public Health Department and from certain Chemists and (at any time, day or night) at the Isolation Hospital and the Fire Station. 59 LIST OF ADOPTIVE ACTS, BYE-LAWS AND LOCAL REGULATIONS RELATING TO THE PUBLIC HEALTH IN FORCE IN THE DISTRICT. Date of adoption. The Infectious Disease (Prevention) Act, 1890. Whole Act 17/11/90 Public Health Acts (Amendment) Act, 1890 Parts II. and III. 1/12/90 Public Health Acts (Amendment) Act, 1907 Part II., Sec. 15-17 19-21 23-33 9/7/10 Part III., Sec. 34-47 49-50 9/7/10 Part IV., Sec. 52-57 60-65 and 67 9/7/10 Part VI., Sec. 76 and 77 9/7/10 Part X., Sec. 95 9/7/10 Bye-Laws. Slaughterhouses 26/2/1881 Nuisances 26/2/1881 Common Lodging Houses 26/2/1881 Tents, Vans and Sheds (by M.C.C.) Drainage of existing buildings 6/11/07 and 6/9/09 New Streets and Buildings 4/11/07 and 28/9/14 Regulations. Dairies, Cowsheds and Milkshops 13/4/08 Ice Cream Regulations (by M.C.C.) 60 SANITARY ADMINISTRATION. INSPECTION OF THE DISTRICT. The following summary of the inspection work performed by the Sanitary Inspectors has been submitted to me by Mr. S. J. Chapman, Chief Sanitary Inspector, in accordance with Article 19 (12) of the Sanitary Officers Order, 1922. Inspections made 2017 Nuisances discovered and dealt with 2409 Re-inspections after order or notice 2371 Complaints received and investigated 411 Visits paid to infected houses 251 Rooms disinfected 347 Drains, smoke and water tests applied 149 ,, uncovered for examination 52 ,, taken up and reconstructed 65 ,, unstopped 49 ,, provided with intercepting traps 24 ,, manholes provided to 45 ,, manholes repaired or covered 28 ,, manholes F.A.I, repaired or provided 28 Yards, re-paved or paving repaired 31 ,, cleansed 26 Common passages paved and drained 4 Dustbins provided 86 Water storage cisterns repaired or covered 21 Rooms stripped and cleansed 532 ,, plastering of walls and ceilings repaired 177 Roofs of houses repaired 101 Floors of houses repaired, cleansed, etc. 53 ,, ,, air spaces under ventilated 15 Window frames repaired and sash lines renewed 92 Dampness in house walls remedied 60 Accumulations of refuse and manure removed 38 Animals, fowls, etc., nuisances from, abated 4 Nuisances from overflowing cesspools removed 39 61 Water supply provided to houses, or a supply laid on over sink Nil. Water service pipes, etc., repaired 16 Taps taken off rising main for drinking purposes 4 Water closets, repaired and apartments cleansed 69 ,, new pans provided to 68 ,, unstopped and cleansed 21 ,, provided with efficient flushing cisterns or flushing cisterns repaired 67 ,, flush pipes repaired 24 Soil pipes and ventilating pipes reconstructed or repaired 27 Sinks removed and new provided 34 ,, waste pipes repaired, renewed and trapped 57 ,, waste pipes unstopped 4 Rain water pipes unstopped, repaired or renewed 76 ,, disconnected from drain 28 Eaves gutters repaired, cleansed or renewed 53 Defective traps replaced or new stoneware gullies fixed 63 Gullies unstopped, provided with grids, and cement work around same repaired 26 Rooms ventilated (windows made to open) 1 Cases of overcrowding abated 23 Ditches cleansed 2 Smoky chimney flues remedied 10 Fire grates, kitcheners, etc., repaired 35 Premises connected with sewer 2 Miscellaneous nuisances abated 133 NOTICES SERVED. Informal or Cautionary 626 Outstanding from 1922 89 715 Complied with 612 Outstanding 103 62 STATUTORY NOTICES. Under the Public Health Acts, etc. 32 Under the Infectious Diseases (Prevention) Act 24 Outstanding from 1922 2 58 Complied with 56 Outstanding 2 SUMMONSES. It was not found necessary to take proceedings for noncompliance with any Statutory Notices under the Public Health Acts. A Closing Order made in respect of a dwelling house under the Housing and Town Planning, etc., Act, 1909, was not obeyed, the occupier failing to comply with the Notice served upon him to quit the premises. A complaint was laid before the Magistrates and a summons granted. On the case being heard, the Magistrates made an Order for the Occupier to quit the dwelling. The Order was obeyed and the dwelling house was pulled down and demolished. It is gratifying to be able to record the small number of Statutory Notices which it was found necessary to serve and the avoidance of legal proceedings, in successfully dealing with the large amount of sanitary improvements effected during the year. In addition to the defects specially enumerated, many others have been removed as a result of verbal recommendations by the Sanitary Inspectors. MILK SUPPLY. Dairies, Cowsheds and Milkshops. Number of Registered Wholesale Milk Traders and Producers 25 Number of Cowsheds 19 Number of Registered Retail Purveyors of Milk 40 Number of Dairy Premises and Milk Shops 47 Number of Registered Purveyors of Milk whose premises are outside the district 3 63 To comply satisfactorily with the Milk and Dairies Amendment Act, 1922, Section 2 (3), re-registration of all persons engaged in the milk trade has been effected and new registers have been compiled, one of Wholesalers and Producers and one of Retail Dairymen and Purveyors. During the year one cowshed has been closed (premises unsatisfactory), one new shed has been erected and occupied and one new dairy has been opened. The milk sold and delivered from 19 dairy premises is received from Central Depots, bottled and capped with a disc, ready for distribution so that no cleansing of bottles or vessels is carried out on these dairy premises. All empty bottles are collected and conveyed to the Central Depot where they are cleansed, sterilized and refilled. 11 Retailers of Milk hold Licences, issued by the Sanitary Authority, to sell "Graded Milk" under the Milk Special Designations Orders, 1922 and 1923. The dairy premises have been very frequently inspected and found kept in a very cleanly condition. It is hoped the adoption of bottles in place of milk cans (which is now almost general) will assist in the production of a cleaner milk supply. The cowsheds have been inspected as frequently as possible. There has been an average of 320 milch cows stalled in the sheds, most of which are habitually grazed. The Council's Veterinary Surgeon has examined the cows quarterly and has reported favourably upon their condition. NUMBER AND CONDITION OF SLAUGHTER HOUSES. Registered or Licensed. Registered Slaughter Houses 7 Licensed Slaughter Houses 2 Very little slaughtering has taken place on these premises, as most of the meat sold by the butchers in the district comes from the London Meat Market. Visits have been paid to the Slaughter Houses as frequently as possible at the time of killing, and to ensure the same being kept in conformity with the Bye-Laws. 64 INSPECTION OF PLACES WHERE FOOD IS PREPARED. Constant observation has been kept on all shops and stalls in the district where food is sold and prepared for sale. In no instance was any unsound food deposited or exposed for sale. The following articles were examined and condemned as unsound, having been voluntarily offered for inspection, and were subsequently surrendered and destroyed:— 18 stones, 3 lbs. Beef (hind quarter). Bruised. 7 tins Toffee. Mildewed. 1 tin Chocolate. Mildewed. 54 boxes of Assorted Confectionery. Mildewed. 92 tins of Sweets. Mildewed. 22 7-lb. jars of Jam. Fermented. 48 tins of Salmon. Tins blown. 48 tins of Sardines. Tins blown. Restaurant kitchens and a manufactory where potatoes are prepared for sale as "Crisps" have been visited from time to time. SALE OF FOODS AND DRUGS ACTS. The Administrative body under these Acts is the Middlesex County Council and their Inspectors have taken for analysis 220 Samples of Food. The following table showing the Articles purchased with the result of their analysis was kindly supplied by Mr. R. Robinson, Chief Officer of the Public Control Department. 65 Article. Taken. Adulterated. Milk 173 5 Milk, separated 3 — Cream 8 1 Cream, preserved 6 — Butter 2 — Ale 10 — Baking Powder 2 — Coffee 2 — Lard 4 — Liquid Paraffin 1 — Oxide of Zinc 1 — Rice 3 — Sugar 2 — Tartaric Acid 2 — Vinegar 1 — 220 6 Number of Prosecutions 2 Number of Convictions 2 Fines and Costs imposed £31 1s. 0d. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920 and 1923. During the course of the year 16 applications were made for the inspection of houses under the provisions of the above Acts, on the grounds that "they were not in all respects reasonably fit for human habitation or were otherwise not in a reasonable state of repair,'' 66 A report upon the condition of each house was considered by the Public Health Committee and Certificates were ordered to be issued in each instance. It was, however, only found necessary to issue 8 Certificates, as the owners, on being informed of the Committee's decision, proceeded forthwith to execute the needed repairs. DISINFECTION. 347 Infected rooms disinfected by spraying with a solution of Formalin or by the vaporising of Formaldehyde Tablets. 24 Infected rooms cleansed, viz., wall papers stripped from walls and ceilings whitewashed, in compliance with notices served under the Infectious Diseases (Prevention) Act, 1890. 4349 Mattresses, articles of bedding, clothing, etc., disinfected at Disinfection Station by steam in a Washington-Lyons apparatus. All articles disinfected, collected and returned by the Sanitary Authority by a motor van. 67 8.-PUBLIC HEALTH STAFF. TABLE XX. Office. Name. Diplomas, etc. Contribution to salary. Other offices held. Whole or part time. Medical Officer of Health T. S. Mcintosh M.A., M.D. M.R.C.P. Ed., D.P.H. Under P. H. Acts and M. & C.W. Grant School Medical Officer Whole time. Assistant Medical Officer Ethel M. L. Leitch M.B., Ch.B. Maternity and Child Welfare Grant Asst. School Medical Officer Part time. Senior Sanitary Inspector S. J. Chapman Cert. R. San. I. Under Public Health Acts Nil Whole time. Sanitary Inspector G. E. Luck Cert. R. San. I. Ditto (Meat and Foods) Nil Nil Whole time. „ „ A. H. Smith Cert. R. San. I. Nil Nil Whole time. Health Visitor M. E. Basoom C.M.B. Dip. of National Health Society Maternity and Child Welfare Grant Nil Whole time. „ O. A. Hunt C.M.B. H.V. Cert. of Battersea Poly. San. Ins. Cert. S.I. Ex. Bd. „ Nil Whole time. Midwife M. Sherman C.M.B. „ Nil Whole time. Veterinary Surgeon J. E. Overed M.R.C.V.S. Nil Similar Office under Finchley U.D.C. Part time. 68 9.—HOUSING. Number of new houses erected during the year:— (a) Total 625 (b) As part of a municipal housing scheme 20 1. UNFIT DWELLING HOUSES. Inspection.—(1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 948 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 109 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 540 2. REMEDY OF DEFECTS WITHOUT SERVICE OF FORMAL NOTICES. Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their Officers 493 Action under Statutory Powers. (a) Proceedings under Section 28 of the Housing, Town Planning Act, 1919 (1) Number of dwelling houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling houses which were rendered fit:— (a) By Owners Nil. (b) By Local Authority in default of owners Nil. 69 (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. (b) Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 24 (2) Number of dwelling houses in which defects were remedied:— (a) By Owners 22 (b) By Local Authority in default of owners Nil. (c) Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act., 1909. (1) Number of representations made with a view to the making of Closing Orders 1 (2) Number of dwelling houses in respect of which Closing Orders were made 1 (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil. (4) Number of dwelling houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling houses demolished in pursuance of Demolition Orders Nil. (The dwelling house in respect of which the Closing Order was made was demolished without a Demolition Order being made). 70 TABLE.—Shewing Action Taken with regard to Unfit Houses. TABLE XXI. Year. Representations by M.O.H. Declaration of intention to close house by Owner under Sec. 28, Housing, Town Planning, etc., Act, 1919. Closing Orders made or become operative after voluntary closure by Owner. Houses Closed. Demolition Orders. Demolition. 1919 1 1 2 — — — 1920 — — — 1 — — 1921 1 — 1 1 2 — 1922 — — — 1 — 3 1923 1 — 1 1 — 1 The above Table refers to the following dwelling houses:— No. 1, Hendon Park Villas, Finchley Road. No. 2, Hendon Park Villas, Finchley Road. Burroughs Farm, Queen's Road. Heriot Cottage, Brent Street. At the end of the year there were no houses unfit for human habitation remaining on the books of the Public Health Deportment. 71 10.—FACTORY and WORKSHOPS ACT, 1901. The following is the number of Factories and Workshops as recorded on the Factory and Workshop Register, 1923:— Number of Factories (including Factory Laundries) 76 *Number of Factory Bakehouses 11 Total Factories 87 Number of Workshops and Workplaces (including Workshop Laundries) 106 Number of Workshops Bakehouses 10 Total 116 *One underground Factory Bakehouse. Number of inspections (Factories and Workshops) 105 Number of Notices served to remedy defects 18 Number of Notices complied with 17 Matters notified to H.M. Inspector 3 Matters notified by H.M. Inspector (remediable under the Public Health Acts) 3 List of Outworkers received 32 Nature of defects remedied at Factories and Workshops Sanitary accommodation insufficient 3 unsuitable or defective 8 not separate for sexes — Want of cleanliness 9 Defective roof — Improperly drained floor — Want of ventilation — Other nuisances 14 ANNUAL REPORT OF THE WORK OF The School Medical Service IN RELATION TO Public Elementary Schools FOR THE YEAR 1923. 74 HENDON EDUCATION COMMITTEE. Members oj the Committee: COUNCILLORS. CO-OPTED MEMBERS. Colonel F. W. Hearn Mr. A. R. Bailey, M.A. (Chairman). Major N. G. Brett James, M.A. Mr. C. C. Cartwright B.Litt. (Vice-Chairman). Rev. C. E. de R. Copinger. Mrs. S. J. Bannister. Miss F. M. Levett. Mr. S. H. Egan. Mrs. l. Moylan-Jones. Capt. T. F. Fenn, M.C. Rev. J. S. Poulton. Mr. Brook Flowers. Rev. Father Walton. Miss E. C. Growse. Mr. E. Holt. Mr. F. C. Rice. Mr. J. H. Sturgess, J.P. Mr. W. Taylor. Mr. R. M. Weeks. Mr. A. E. Winny. Mr. R. J. Wise. Secretary to the Committee: Mr. James Anderson. Medical Officers: Dr. T. S. McIntosh. Dr. Ethel M. L. Leitch School Nurses: Miss E. Murdoch. Miss A. L. Wharton 75 SCHOOLS. Provided. Number of children on Rolls. Algernon Road 959 Bell Lane 488 Burnt Oak 235 Child's Hill 746 Colindale Temporary 48 Garden Suburb 574 The Hyde 730 Wessex Gardens 486 4266 Non-provided. All Saints' C.E. 314 St. Agnes' R.C. 114 St. John's C.E. 151 St. Mary's C.E. 425 S. Mary's R.C. 115 St. Paul's C.E. 172 St. Vincent's R.C. 134 1425 Total 5691 76 HENDON EDUCATION COMMITTEE. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE YEAR 1923. To the Chairman and Members of the Hendon Education Committee. "Burroughs House, Hendon, N.W. 4. 1st March, "1924. Ladies and Gentlemen, I have the honour to present the following report on the work of the School Medical Service for 1923. I think it may be regarded as a very satisfactory report. The health of the school children in Hendon Urban District is undoubtedly good. The number showing serious defects is small. The number of cases of serious vermin infestation is very small indeed and I think we may hope with some confidence that even the lesser degree, which is still fairly common, and shows itself by the presence of a comparatively small number of nits in the hair, will, as a result of the process of education which is going on and which the School Medical Service is materially assisting, gradually diminish almost to vanishing point. The number of cases of infectious skin diseases also keeps low which is another sign of increasing cleanliness and selfrespect. Although the health record is good I do not think that we have reached the stage at which we can say that no further progress is possible or desirable. On the contrary I think we should be encouraged to further efforts whereby I believe that we can still further improve the standard of health. It seems to me that there are two things to be specially remembered. One is that though the proportion of children in Hendon who require the good offices of the School Medical Service is small as compared with many districts, the in-dividuals 77 who comprise that small proportion are just as much in need of help as they would be if they were more numerous. Another thing is that in Public Health work it is necessary to take long views. The full benefit of Public Health measures is not always immediately apparent. For example, we are now reaping the benefit, in lessened incidence of Typhoid Fever and infantile diarrhœa, of an improvement in general sanitary conditions effected many years ago. These diseases did not disappear as soon as the process of improvement was instituted. But after some years of improved conditions they began steadily to decline and that decline has continued. So it will be, we hope, with the more recent developments of Public Health work such as the Institution of the School Medical Service. More or less trifling complaints in childhood may be the cause of serious illness in later life and it is hoped that as a result of our attention to the health of the school children of the present day the adults of the next generation will be much more free not only from fatal and disabling diseases such as Heart Disease and Tuberculosis, but also from such diseases as chronic rheumatism which, though not so serious, yet cause a great amount of suffering and disability in the later years of life. Another point which I should like to emphasise is one which is of special interest to an Education Committee, namely the educational aspect of the work. The gradual education of the Public in the importance of attention to health and in the means of maintaining health, which is undoubtedly taking place, is probably of even more value than the benefits conferred on the individual children. I think it may be claimed that the School Medical Service is playing an important part in this process. I have the honour to be, Ladies and Gentlemen, Your obedient servant, t. s. Mcintosh, School Medical Officer. 78 SCHOOL HYGIENE. The sanitary accommodation at Algernon Road, Bell Lane, and Child's Hill Council Schools required attention during the year. At Algernon Road school the Infant Boys' urinal and closet accommodation were reconstructed and improved. The drinking water supply was also amended. At Bell Lane school the older of the water closets were replaced by a new and more satisfactory pattern and the alterations of the drainage necessary to suit the new installation were carried out. The Senior Boys' urinal was also largely reconstructed. The drinking water supply was also improved, the fountains being supplied direct from the rising main. At Child's Hill school the Senior Boys' latrine was enlarged, more urinal accommodation provided and the system of closets amended and put into good working order. MEDICAL INSPECTION. (a) Age groups of the children inspected: All children are inspected on first admission to school. The bulk of these are, of course, children entering the Infant Departments, at about the age of 5. They are again examined between the ages of 8 and 9, and finally after attaining the age of 12. The total number of children included in the Routine Inspections was 1,775. (b) The Board of Education Schedule of Medical Inspection is adopted. (c) Steps taken to secure the early ascertainment of crippling defects. 79 Children suspected to be suffering from defects of any kind are referred to the Medical Officers by teachers, school nurses, attendance officers, members of the Education Committee or any other person interested in the children, also by charitable organisations. In many cases parents also seek the advice of the Medical Officer with regard to their children. In these ways serious defects of any kind come under observation early and are not left to be discovered only when the child happens to be due for Routine Medical Inspection. Children brought to notice by these various means are what are called "Specials," i.e., children first brought under observation by other means than by Routine Medical Inspection; 291 "special cases" were dealt with and 1,112 re-examinations made. FINDINGS OF MEDICAL INSPECTION. (a) Uncleanliness. At the Medical Inspections only 13 cases were found. The Nurses by their systematic examination of children in the schools discovered 541 cases. Most of these were moderate cases shewing only nits in the hair and the great majority were in girls. 59 cases were excluded from school. All these excluded cases were cleansed at home and re-admitted to school without the necessity of taking legal proceedings. Of the total 541 cases, 123 were completely remedied and 396 improved, leaving 22 cases not improved by the end of the year. (b) Minor Ailments. This includes such skin diseases as Ringworm, Scabies and Impetigo and mild inflammation of the eye and ear. These are dealt with under their respective headings below. (c) Tonsils and Adenoids. 75 cases were referred for treatment, 34 were operated on at the Cottage Hospital and 17 elsewhere. The arrangement with the Cottage Hospital continued to work satisfactorily and the results of the operations were good. The following shows the 80 amounts paid in fees to the Hospital and recovered from the parents:— £ s. d. Cost to the Committee—34 operations at 10s. 6d. 17 17 0 Amount remitted—on account of poverty 10 6 Amount recovered 14 14 0 Amount outstanding at the 31st December, 1923 212 6 (d) Tuberculosis. 2 cases of Tubercular glands of the neck were referred for treatment. Both recovered. 3 cases were suspected to have Pulmonary Tuberculosis. In one case the Tuberculosis Officer decided that the child was not suffering from Tuberculosis. The other 2 have not been decided and are being kept under observation. (e) Skin Diseases. (1) Ringworm. The number of cases of Ringworm was slightly lower than in 1922. There were 57 cases of Ringworm of the Head as against 62 in 1922, and 31 cases of Ringworm of the body as against 37 in 1922. Of these cases 9 (all Ringworm of the scalp) still remained under treatment at the end of the year; the remainder were cured. (2) Scabies. Only 7 cases were discovered during the year as against 17 in 1922 and 54 in 1921. All these cases were cured at the School Clinic. (3) Impetigo. 84 cases were discovered as compared with 76 in 1922. These were all cured, 73 at the School Clinic and 11 elsewhere, 81 (4) Other Skin Diseases. 4 cases came under observation. 3 were treated at the School Clinic and 1 by private arrangement. (f) External Eye Disease. 20 cases were referred for treatment. 18 were cured. There was only one severe case among them, which is under treatment at a London Hospital. (g) Defective Vision. 122 cases were referred for treatment, 95 obtained suitable glasses, 3 received other forms of treatment and in 4 cases treatment was found to be unnecessary. (h) Ear Disease and Defective Hearing. 12 cases of ear disease were referred for treatment and 11 were treated and cured. 3 cases of deafness were referred for treatment and 2 were cured, none of the cases was severe. (i) Dental Defects. 109 cases were referred for treatment and 52 received treatment. The number referred for treatment represents only a small proportion of the children who had dental defects since only bad cases, or those showing special symptoms, were referred, and of these only about 50 per cent. received treatment. At your request, I reported during the year on a scheme for the provision of Dental Treatment and this matter was under your consideration at the end of the year. (j) Crippling Defects. 5 cases of spinal curvature were referred for treatment. All improved. (k) Heart Disease. Only 1 case of heart disease was found to require treatment. As usual a considerable number of chil- 82 dren with some heart abnormality were put down tor observation, but many of these children have probably quite healthy hearts. (1) Anæmia. 26 cases were referred for treatment. 14 showed definite improvement. None were serious cases. (m) Lungs (not including Tuberculosis). 5 cases were referred for treatment. 4 of these were cured and 1 improved. (n) Mental Defects. 3 cases of mental deficiency (Feeble-minded, educable) were reported to the Committee during the year. These children are still attending ordinary schools. One child who had previously been reported as feeble-minded and crippled was sent to an Institution by the County Council as no school could be found which would admit her. One imbecile and 2 idiots were notified to the County Council under the Mental Deficeincy Act, 1913. INFECTIOUS DISEASES. Following on 2 years of rather high prevalence, 1923 was a very fortunate year as regards infectious diseases. There was no epidemic of Scarlet Fever or Diphtheria; 18 cases of Scarlet Fever and 45 cases of Diphtheria occurred. They were fairly evenly distributed over the year and no school was specially affected. A considerable number of cases of Measles, Whooping Cough and Chicken Pox occurred in the Spring but there was no extensive epidemic and during the rest of the year the scholars were remarkably free from these diseases. FOLLOWING UP. When children are found to be suffering from defects their parents are informed, and advised to consult their own doctors. The school nurses visit the homes to see if this has 83 been done and to urge the parents to obtain treatment if they have not done so. 1,689 visits were paid by the school nurses. The defective children are re-examined in the schools and at the Clinic by the Medical Officers to ascertain the results of treatment. Children who require it are thus kept under continuous observation. During the year I reported to you recommending the better co-ordination of this work with the Maternity and Child Welfare work of the Council and also recommending an extension of the home visiting of school children, more particularly in the case of children reported as absent from school on account of Infectious Diseases and other illnesses. This matter was receiving your consideration at the end of the year. The School Clinic is held at Burroughs House on Saturday morning. Children who have been excluded are brought there to be re-examined by the Medical Officers with a view to being re-admitted when fit; other children are brought up by their parents for advice or are referred to the Medical Officer by Teachers, Nurses, Attendance Officers, etc. For certain minor ailments, such as Ringworm, Scabies and Impetigo, ointments are distributed with directions for treatment. 292 children attended the clinic and made S64 attendances. 144 cases were treated and cured at the Clinic and in addition a small number were under treatment at the end of the year, their treatment not having been completed by that time. PROVISION OF MEALS. The arrangement described in my report for 1922 was in operation for the greater part of the year, the small number of children considered to require this provision receiving meals at certain caterers'. I inspected and found the meals provided satisfactory. An improvement in the condition of the children fed was observed in most of the cases. The number of families for whom this provision was made was 16 and the number of children 38. 1,862 meals were provided at a cost of £62 Is. 4d., i.e., 8d. per meal. 84 EMPLOYMENT OF CHILDREN. Boys. Girls. Children examined and employment certificates granted 108 20 Re-examined and certificates continued 7 3 Certificates refused 3 1 Examined for employment under Entertainment rules, 1920 (Certificates granted) — 4 The statistical tables prescribed by the Board of Education will be found overleaf. 85 MEDICAL INSPECTION RETURNS, 1923. TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections. Entrants 613 Intermediates 493 Leavers 669 Total 1775 Number of other Routine Inspections Nil. B.—OTHER INSPECTIONS. Number of Special Inspections 291 Number of Re-Inspections 1112 Total 1303 86 TABLE II. A.—Return of Defects found by Medical Inspection in the year ended 31st December, 1923. Defect or Disease. Routine Inspections. Special Inspections No. of Defects. No. of Defects Requiring treatment. Requiring to be kept under observation but, not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment. (1) (2) (3) (4) (5) Malnutrition 14 26 Uncleanliness (See Table IV., Group V.) - - — — Skin Ringworm: - - - - Scalp — — 57 — Body 2 — 29 — Scabies — — 7 — Impetigo 3 — 81 — Other Diseases (non-Tubercular) 1 — 3 - Bye Blepharitis 3 12 6 — Conjunctivitis 3 2 3 — Keratitis - — 1 - Corneal Opacities — 1 - - Defective Vision (excluding Squint) 72 11 29 1 Squint 13 11 2 2 Other Conditions 5 6 6 1 Ear Defective Hearing 3 5 — — Otitis Media 6 8 3 2 Other Ear Diseases — 3 3 — Nose and Throat Enlarged Tonsils only 18 31 8 2 Adenoids only 6 4 6 — Enlarged Tonsils and Adenoids 27 4 10 — Other Conditions 2 '4 11 — Enlarged Cervical Glands (Non-Tubercular) 6 15 1 - 87 TABLE II. (continued). Defect or Disease. Routine Inspections. Special Inspections No. of Defects. No. of Defects. Requiring treatment. Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment. (1) (2) (3) (4) (5) Defective Speech - 1 - - Teeth—Dental Diseases (See Table IV., Group IV.) 105 - 4 - Heart and Circulation Heart Disease Organic 1 7 — — Functional — 116 — — Anaemia 18 8 8 1 Lungs Bronchitis — 3 5 — Other Non-Tubercular Disease - 1 - - Tuberculosis Pulmonary: Definite — — — — Suspected — — 3 — Non-Pulmonary: Glands — — 2 — Spine — — — — Hip — — — — Other Bones and Joints - - - — Skin — — — — Other Forms — — — — Nervous System Epilepsy — 3 — — Chorea — - 4 — Other Conditions — — 5 — Deformities Rickets — — Spinal Curvature 5 3 — l Other Forms - 2 1 — Other Defects and Diseases 5 8 12 — 88 TABLE II. (continued). B.—Number of individual children found at Routine Medical Inspection to require Treatment (excluding Uncleanliness and Dental Diseases). Group. Number of Children Percentage of Children found to require Treatment Inspected Found to require Treatment (1) (2) (3) (4) Code Groups:— Entrants 613 47 766 Intermediates 493 77 15.61 Leavers 669 72 10.75 Total (Code Groups) 1775 196 11.04 Other Routine Inspections — — — 89-92 TABLE III. Return of all Exceptional Children in the Area. Boys. Girls. Total. Blind (including partially blind) (i) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 1 - 1 Attending Public Elementary Schools - - - At other Institutions - - - At no School or Institution — — — (ii) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind - - - Attending Public Elementary Schools - - - At other Institutions - - - At no School or Institution - — — Deaf (including deaf and dumb and partially deaf). (i) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 2 1 3 Attending Public Elementary Schools - - - At other Institutions - - - At no School or Institution — — — (ii) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf - - - Attending Public Elementary Schools ... - — — At other Institutions - — - At no School or Institution - — — Mentally Defective. Feebleminded (cases not notifiable to the Local Control Authority). Attending Certified Schools for Mentally Defective Children 1 - 1 Attending Public Elementary Schools 2 3 5 At other Institutions — 1 1 At no School or Institution — — — Notified to the Local Control Authority during the year. Feebleminded - - - Imbeciles 1 — 1 Idiots 1 1 2 Epileptics. Suffering from severe epilepsy. Attending Certified Special Schools for Epileptios 1 - 1 In Institutions other than Certified Special Schools - - - Attending Public Elementary Schools — — — At no School or Institution — — — Suffering from epilepsy which is not severe. Attending Public Elementally Schools 1 2 3 At no School or Institution - - - Physically Defective. Infectious pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At other Institutions - - - At no School or Institution — — - Non-infectious but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools — — - At Certified Day Open Air Schools — — - At Public Elementary Schools — — - At other Institutions — — - At no School or Institution — — - Delicate children (e.g., pre-or latent tuberculosis, malnutrition, debility, anaemia, etc.) At Certified Residential Open Air Schools At Certified Day Open Air Schools - - - At Public Elementary Schools 4 2 6 At other Institutions — - — At no School or Institution — - - Aotive non-pulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board - - - At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Crippled Children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease. At Certified Hospital Schools - - - At Certified Residential Cripple Schools — — - At Certified Day Cripple Schools — — - At Public Elementary Schools 1 2 3 At other Institutions — — — At no School or Institution — — - 93 TABLE IV. Return of Defects treated during the year ended 31st December, 1923. TREATMENT TABLE. GROUP I.—MINOR AILMENTS (excluding Uncleanliness, for which see Group V). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Other wise. Total (1) (2) (3) (4) Skin: — Ringworm-Scalp 32 31 63 Ringworm-Body 23 13 36 Scabies 7 - 7 Impetigo 73 11 84 Other Skin Disease 3 1 4 Minor Eye Defects— (External and other, but excluding oases falling in Group II.). - 18 18 Minor Ear Defects — 11 11 Miscellaneous (e.g. minor injuries, bruises, sores, chilblains, etc.) 6 3 9 Total 144 88 232 94 TABLE IV. (continued). GROUP II.—DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments—Group I.). Defect of Disease. No. of Defects dealt with. Under Authority's Scheme. Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report). - 103 - 103 Other Defect or Disease of the Eyes (excluding those recorded in Group I.). — 2 — 2 Total — 105 - 105 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme Nil. (b) Otherwise 95 Total number of children who obtained or received spectacles (a) Under the Authority's Scheme . Nil. (b) Otherwise 95 95 TABLE IV. (continued). GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number Treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 34 17 5' 8 59 GROUP IV.—DENTAL DEFECTS. Dental Treatment not Provided. GROUP V.—UNCLEANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 6 (ii) Total number of examinations of children in the Schools by School Nurses 10152 (iii) Number of individual children found unclean 541 (iv) Number of children cleansed under arrangements made by the Local Education Authority Nil. (See reference in body of report). (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 Nil. (b) Under School Attendance Byelaws Nil.