HEN 9 Urban District Council of hendon. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1925, TOGETHER WITH THE ANNUAL REPORT ON THE Medical Inspection of Schools. London: London Incorporated Press, Ltd.; The Hendon Printing Works, New Brent Street, Hendon, N.W. 4. Urban District Council of hendon. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1925, TOGETHER WITH THE ANNUAL REPORT ON THE Medical Inspection of Schools. London: London Incorporated Press, Ltd., The Hendon Printing Works, New Brent Street, Hendon, N.W. 4. Urban District Council of Hendon. Members of the Council, 1925. Mr. C. C. Cartwrigiit, J.P. (Chairman). Mr. W. Taylor (Vice-Chairman). *Mrs. S. J. Bannister. Mr. A. S. M. Bowers. Mr. W. R. Clemens. *Mr. S. H. Egan, J.P. *Capt. T. F. Fenn, M.C. *Mr. Brook Flowers. *Miss E. C. Growse. *Col. F. W. Hearn. Mr. C. W. Hill. *Mr. E. Holt, J.P. *Mr. A. Morsman. *Mr. A. A. Naar. Mr. A. J. Reynolds. *Mr. F. C. Rice. Mr. A. Roberts. Air. W. E. Simnett. Mr. J. H. Sturgess, J.P. Mr. R. A. B. Teare, M.B.E. *Mr. R. M. Weeks. Mr. R. J. Wise. * Members of the Public Health: and Joint Medical Services Committees. Co-opted Members of the Joint Medical Services Committee : Mrs. Burn. Miss Lievett. Mrs. Moylan-Jones. Mrs. Weeks. Public Health Department. Medical Officer of Health:- T. S. MclNTOSH, m.a., m.d., f.r c.p.e., 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. Clerks : — C. C. Knudsen Miss M. A. Winslade. Miss I. M. Waterhouse. (Senior). E. D. Nkwson. Health Visitors :— *Mrs. M. E. Bascom. *Mrs. O. A. Hunt. *Miss M. Lake. *Miss A. B. Reidie. *Miss M. Stewart. *Mise A. L. Wharton. * Employed by Council and Education Committee. Heads of Other Departments. H. Humphris, f.c.i.s. (Clerk to the Council). A. O. Knight, m.c , a.m.i c e. (Engineer and Surveyor). Geo. Hails, a.s.a.a., f.inst.m.t. (Treasurer and Accountant). J. Anderson (Secretary, Hendon Education Committee). INDEX. page Adoptive Acts 42 Ambulance 36 Area 7-9 Bye-laws and Regulations 42 Births and Birth Hate 13-19 Centres (Maternity and Child Welfare) 37 Cesspools 45 Clinics and Treatment Centres 37 Closet accommodation 45 Day Nurseries 92 Deaths and Death Rate 13-29 Deaths, Causes of 21-23 and 29-31 Deaths—Table shewing causes of and ages at 21-22 Disinfection 74 Employment of Children 112-113 factory and Workshops Act 53 Foods 64-70 General Statistics 7-8 Health Visitors 87-88 Hospitals 32-35 Housing Conditions 54-60 „ Schemes 56 Housing—Acts, Proceedings under 61-63 „ Closing Orders 62-63 „ Demolition Orders 62-63 „ Public Health Acts, Proceedings under 61-62 „ Unfit Dwelling Houses 61 Illegitimate Children—Institutional Provision for 35-36 Infant Mortality 24, 25 and 28 „ „ Table of 24 Infectious Diseases—Table of Notifications 77-82 „ „ Deaths from 29, 34, 77-82 „ „ Small Pox 74 „ „ Diphtheria 70-71 „ „ Scarlet Fever 70-71 „ „ Puerperal Fever 89 „ „ Acute Poliomyelitis 89 „ „ Ophthalmia Neonatorum 85, 89-90 „ „ Tuberculosis 83 „ „ Malaria 72 „ „ Dysentery 72 „ „ Trench Fever 72 „ „ Non-notifiable 75-76 Inspection Work 47-52 Introduction 5-6 Inquests 26 page Isolation Hospital 32-34 „ „ New 34 Laboratory Work 72-74 Maternity and Child Welfare 87-92 Meat 66-69 Medical Inspection of Schools and School Children 96-125 Midwives 41 Milk—Assisted Supply of 91-92 Milk Supply 64-66 Notifiable Diseases 70-85 Notification of Births 87 Nursing Arrangements 41 Overcrowding 57 Physical Features 10 Poor Relief 31 Population 7-8 Public Health Staff 39-40 Rainfall 11-12 „ Register of 12 Rate amount of 1d. 8 Rateable Value 7 Refuse Collection and Disposal 46 Rent, Increase of (Restrictions) Act 64 Rivers and Streams 43 Sale of Food & Drugs Act 69 Sanitary Administration 47-52 Sanitary Circumstances of the District 43-46 Sanitary Condition of Schools 52 Sanitary Inspection 47-50 Scavenging 46 School Hygiene 98-102 Schools—Sanitary condition of 52 „ Medical Inspection of Schools and Scholars 96-125 Senile Mortality 26 Sewerage and Drainage 44 Sickness and Invalidity, causes of 32 Slaughterhouses 67 Small Pox Hospital Accommodation 35 Social Conditions 11 Tents, Vans and Sheds 60 Unmarried Mothers—Institutional Provision for 35-36 Vaccination 86 Vital Statistics 13-31 Water Supply 43 Zymotic death rate 20 Annual Report for the Year 1925 of the Medical Officer of Health. Public Health Department, "Burroughs House," The Burroughs, Hendon, N.W. 4. March, 1926. To the Chairman and Members of the Urban District Council of Hendon. Ladies and Gentlemen, I have the honour to present my report for the year 1925. The Ministry of Health has called for a special survey report, this year, which besides being a report for the year 1925 should survey the Public Health and the work of the department during the past five years. That period practically coincides with the period during which I have held office. The compilation of such a report entails a great amount of time and labour and it has thrown a considerable strain on my clerical staff to prepare it, while carrying on the routine work of the department. In this rapidly growing district the volume of work to be done by the department keeps steadily increasing and is at times extremely difficult to cope with. In addition, new duties are frequently placed upon the department as a result of new Acts of Parliament and Departmental Regulations and there is little doubt that the question of additional staff will have to be considered before long. 6 The health of the district is exceedingly good and yet the calls on the Public Health Department are constant and heavy. I hope it is not too much to claim that the way in which these calls are met plays some part in maintaining the high .level of health of the district. The form of the report is prescribed in a schedule issued by the Ministry of Health. This has been closely followed but some additional matter has been interpolated, which I hope will be found interesting. The following features seem to be worthy of special mention:— The rapid growth of the population—see Tables I. and II. and the remarks on page 8 Vital Statistics—Table VIII., page 28. During the 5 years under review the following will be noticed:— The steady decline of the birth rate. The very low and practically stationary deathrate. The steady decline of the infant mortality rate and the exceedingly low figure recorded in 1925. I would also draw attention to the progress made with regard to the New Isolation Hospital. 7 1.—GENERAL STATISTICS. AREA—8,382 acres. POPULATION. TABLE 1. Estimated population 30th June. Census population 19th June, 1921. Estimate of Registrar General. Estimate of Medical Officer of Health. For calculation of Birth Rate. For calculation of Death Rate. 1921 56,013 55,500 55,500 56,045 1922 — 55,930 55,930 57,507 1923 — 56,690 56,690 60,495 1924 — 57,760 57,530 64,444 1925 — 59,330 59,150 66,922 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.— £ s. d. Assessable Value for General District Rate as at 1st October, 1925, including Government Property 760,243 6 0 Rateable Value of Parish for Poor Rate purposes, as at 1st October, 1925 (including Government Property) 793,845 0 0 8 SUM REPRESENTED BY A PENNY RATE.— £ s. d. General District Rate (amount of levy of a penny rate for the half-year commencing October, 1925) (excluding Government Contribution) 3,145 10 6 Poor Rate (amount of levy of a penny rate for the half-year commencing October, 1925) (excluding Government Contribution) 3,260 3 9 The method of estimating the population has been fully explained in previous annual reports, in which are also stated my reasons for believing that it is substantially accurate notwithstanding the large discrepancy between my estimate and that of the Registrar General. In 1921 the Census population was 56,013 and the number of local government electors in the Autumn register was 22,595. In 1925 the number of local government electors on the Autumn register was 26,968. Assuming that the number of electors bore the same proportion to the population in 1925 as it did in 1921, the population in 1925 would be 66,853, whereas my estimate is 66,922. It will be observed that the two figures approximate fairly closely. My estimate is based on the number of occupied houses in the district and is to a great extent explained by the following table:— 9 TABLE II.—Table of Acreage, Dwellings and Population. District. Area, (land and inland water) Acres. 1921 Census. 30th June, 1925 Total population. Private families and dwellings. New structurally separate Dwellings taken into occupation since Census 1921. Estimated No. of dwellings shewn in column 7 which were vacant at 30th June, 1925. Estimated No. of structurallysepar atedwellings occupied by private families at 30th June, 1925. Estimated increase of population since Census 1921. Estimated population at 30th June 1925 Population in private families. Structurally separate dwellings occupied by private families. Persons per dwelling (from cols. 4 & 5) cols. 1 2 3 4 5 6 7 8 9 10 11 Hendon U.D. 8382 56013 52571 11028 4.76 2744 134 13638 10909 66922 Wards. Mill Hill 3180 6118 4571 1096 4.17 350 17 1429 1392 7510 West Hendon 1556 9384 8478 1306 6.49 25 1 1330 100 9484 Central Hendon 1654 11878 11370 2320 4.90 969 48 3241 3850 15728 Golders Green 960 10494 10262 2455 4.18 718 35 3138 2855 13349 Garden Suburb 464 7518 7309 1952 3.74 176 8 2120 702 8220 Child's Hill 568 10621 10581 1899 5.57 506 25 2380 2010 12631 io PHYSICAL FEATURES.— The district is widespread having an area of 8,382 acres and being- slightly over 6 miles long in the largest diameter, from North-west to South-east and about 3½ miles across at its widest portion. It is a long irregular area lying almost entirely on the North-east side of the Edgware Road and is bounded On the North by Elstree and Totteridge, On the East by Finch-ley, On the South-east and South by Hampstead, and on the West by Willesden, Kingsbury and Edgware. It is divided into the following wards:— Mill Hill. West Hendon. Central Hendon. Golders Green. Garden Suburb. Child's Hill (including a portion of Cricklewood), The old village of Hendon is the nucleus of the district and as recently as the early years of this Century Golders Green and Garden Suburb districts were quite undeveloped, the district at that time consisting of several quite separate aggregations of population. Now the houses are almost continuous over a large portion of the district and development of the undeveloped portions, is proceeding rapidly. The ground undulates considerably and the altitude ranges from 130 feet above sea level at the Welsh Harp to 463 feet at the Northern Boundary, the latter figure being 23 feet above the highest point of Hampstead Heath. The subsoil is almost entirely London clay. My predecessor records that "deposits of river gravel are found near the Brent showing that it was once a very large river bed. Some interesting specimens of fossil shells were excavated during the progress of some sewerage works in 1871 at Burgess Hill." 11 The natural drainage channels of the district are the Silk Stream on the West side and the River Brent whose tributaries form a great part of the Eastern boundary, the River Brent crossing the district in a South-Westerly direction and discharging, as does also the Silk Stream, into the Welsh Harp reservoir. Throughout practically the whole of the district the configuration of the ground provides satisfactory natural drainage. SOCIAL CONDITIONS.— A considerable portion of the district, especially in Mill Hill, is still rural in character. It is essentially a residential district, but there is a considerable number of factories, especially in the neighbourhood of Edgware Road and there is a very considerable working class population. The figures of the 192,1 Census appeared to indicate that fully half the population belonged to the artisan and labouring classes. There is no one predominant occupation in the district. Many are employed in factories of various kinds; a large number are employed in connection with the railways, omnibuses and other forms of transport and communication ; and those engaged in clerical and professional occupations form a large element in the population. There are no industries in the district having a special bearing on the Public Health. CLIMATE. 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 25.85 inches. Greatest rainfall, July 22nd 1.58 „ Wettest month, July 3.70 „ Driest month, June 09 „ Total number of rain days 178. Total number of dry days 187. 12 TABLE III. REGISTER OF RAINFALL. 1925. 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 top of Rain Gauge above ground—1ft. 2ins. Height of top of Rain Gauge above sea level—200ft. Date Jan. Feb. Mar. April M ay June July Aug. Sept. Oct. Nov. Dec. Date in. in. in. in. in. in. in. in. in. in. in. in. 1 .43 .00 .20 .00 .05 .00 .00 .04 .09 .00 .31 .00 1 2 .20 .01 .00 .21 .00 .00 .01 .01 .06 .00 .58 .00 2 3 .00 .00 .00 .00 .29 .00 .00 .02 .00 .00 .00 .00 3 4 .05 .00 .00 .00 .15 .00 .00 .22 .05 .02 .06 .00 4 5 .00 .31 .00 .27 .05 .00 .00 .01 .18 .00 .01 .00 5 6 .00 .04 .00 .20 .13 .00 .28 .00 .00 .00 .42 .00 6 7 .00 .11 .00 .00 .05 .00 .01 .00 .02 .01 .02 .09 7 8 .10 .01 .02 .07 .02 .00 .00 .02 .03 .00 .00 .08 8 9 .00 .01 .00 .04 .01 .00 .00 .06 .08 .00 .05 .00 9 10 .00 .00 .04 .00 .29 .00 .00 016 .09 .00 .05 .00 10 11 .00 .06 .01 .00 .00 .00 .00 .10 .02 .00 .04 .00 11 12 .00 .65 .00 .00 .00 .00 .00 .17 .00 .15 .00 .00 12 13 .00 .52 .10 .06 .00 .00 .00 .00 .00 .02 .00 .00 13 14 .18 .02 .03 .16 .00 .00 .00 .00 .00 .00 .00 .01 14 15 .23 .00 .00 .02 .00 .00 .00 .00 .00 .22 .00 .00 15 16 .01 .08 .00 .01 .00 .00 .00 .00 .19 .08 .00 .00 16 17 .00 .00 .00 .01 .06 .00 .02 .00 .00 .07 .00 .00 17 18 .00 .03 .00 .00 .13 .00 .13 .00 .04 .00 .00 .00 18 19 .00 .00 .00 .00 .00 .00 .00 .03 .41 .74 .00 .28 19 20 .00 .00 .07 .00 .01 .00 .15 .05 .56 .26 .00 .18 20 21 .00 .01 .02 .00 .00 .00 .26 .17 .10 .68 .00 .32 21 22 .00 .00 .04 .18 .08 .00 1.58 .08 .45 .51 .00 .34 22 23 .00 .15 .02 .02 .15 .00 .18 .76 .05 .21 .00 .01 23 24 .00 .26 .04 .00 .18 .09 .00 .02 .00 .10 .11 .08 24 25 .02 .57 .00 .06 .00 .00 .11 .00 .25 .03 .00 .04 25 26 .01 .20 .00 .02 .02 .00 .14 .25 .03 .15 .00 .10 26 27 .22 .10 .00 .00 .14 .00 .40 .00 .00 .01 .15 .02 27 28 .20 .00 .00 .08 .00 .00 .00 .00 .01 .00 .00 .11 28 29 .08 — .00 .11 .13 .00 .04 .00 .00 .00 .10 .25 29 30 .00 — .00 .36 .14 .00 .38 .00 .00 .04 .04 .28 30 31 .15 — .05 — .05 — .01 .00 — .00 — .08 31 Total 1.88 3.14 .64 1.88 2.13 .09 3.70 2.17 2.71 3.30 1.94 2.27 Total for year 25.85 in. No. of rain days 13 18 12 17 20 1 15 17 19 17 13 16 178 13 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 880 447 433 Illegitimate 42 18 24 Totals 922 465 457 Birth Rate ... 15.54 Deaths 551 Death Rate 9.31 Number of women dying in or in consequence of childbirth from Sepsis 1 other causes 1 Deaths of legitimate infants under one year of age per 1,000 legitimate births 35 Deaths of illegitimate infants under one year of age per 1,000 illegitimate births 119 Total deaths of infants under one year of age per 1,000 total births 39 Deaths from Measles (all ages) Nil. Deaths from Whooping Cough (all ages) 4 Deaths from Diarrhoea (under 2 years) 3 15—16 TABLE IV. 15—16 Birth Rate, Death Rate, and Analysis of Mortality during the Year 1925. Birth Rate per 1,000 population. Annual Death Rate per 1,000 Population. Rate per 1,000 births. Percentage of Total Deaths. All causes Enteric Fever. Smallpox. Measles, Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Causes of Death certified by Regd. Medical practitioners. Inquest Cases. Uncertified causes of Death. Diarrhoea & Enteritis (under 2 years). Total deaths under 1 year. *England and Wales 18.3 12.2 0.01 0.00 0.13 0.03 0.15 0.07 0.32 0.47 8.4 75 92.1 6.9 1.0 *105 County Boroughs and Great Towns (including London)... 18.8 12.2 0.01 0.00 0.17 0.03 0.18 0.09 0.30 0.43 10.8 79 92.1 7.3 0.6 *157 Smaller Towns (1921 adjusted populations 20,000-50,000) 18.3 11.2 0.01 0.00 0.15 0.02 0.14 0.06 0.31 0.38 7.6 74 93.0 5 9 1.1 *London 18.0 11.7 0.01 0.00 0.08 0.02 0.19 0.11 0.23 0 46 10.6 67 91.1 8.9 0.0 †Hendon 15.54 9.33 0.05 0.00 0.00 0.01 0.06 0.05 0.20 0.67 2.1 39 91.9 8.1 0.0 * Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1925, while those for the towns have been calculated on populations estimated to the middle of 1924. 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. Birth Rate-59,330 † For the purposes of this Table the population of Hendon has been taken as Barth Rate—59,150 (which the trar General's estimate for the middle of 1925). 17 Table IV., with the exception of the Hendon figures, is supplied by the Registrar General. I have added the Hendon figures for comparison and for this purpose have used the Registrar General's estimate of the population. This makes the various rates (with the exception of the rate per 1,000 births) higher than those calculated on my estimate of the population. It will be seen that the Hendon Birth Rate is low and that the other rates, almost without exception, compare very favourably with those of England and Wales, London and the groups of large and small towns. 18 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 66,922). Number of Births registered 831 N umber belonging to other districts 42 789 Births occurring in other districts, and belonging to Hendon 133 922 Birth Rate 13.77 Birth Rate (England and Wales) 18.3 The Births occurring in the district were distributed as follows:— Males 400 Females 389 The excess of Births over Deaths is:— 370 DISTRIBUTION IN DISTRICTS. District. Births. Mill Hill 79 West Hendon 133 Central Hendon 190 Golders Green 143 Garden Suburb 57 Child's Hill 187 *Inward Transfers 133 922 * i.e., children born outside the district, whose parents' ordinary residence is in the district. The number is supplied by the Registrar-General, but not the Ward to which the births belong. 19 42 illegitimate births belonging to the district were registered:— Mill Hill 1 West Hendon 7 Central Hendon 2 Golders Green 7 Garden Suburb 4 Child's Hill 3 *Inward Transfers 18 42 * See note under Distribution of Births in Districts. DEATHS AND DEATH RATE. (Population, 66,922). Deaths registered in the District 711 Deaths of Non-residents 299 412 Deaths of residents registered in other districts 140 Net number belonging to the District 552 Males 271 Females 281 Recorded Death Rate 8.24 Corrected Death Rate 8.38 (Correction factor, 1921 Census, 1.017). 41 per cent. of the deaths of residents were of persons over 65 years of age. 20 The number of deaths in each locality is set out in the table below:— Mill Hill 67 West Hendon 79 Central Hendon 135 Golders Green 93 Garden Suburb 63 Child's Hill 115 The Zymotic Death Rate for the year is 0.19; the causes of death on which the rate is based are:— Small-pox — Measles — Scarlet Fever 1 Diphtheria 3 Whooping Cough 4 Diarrhoea (under 2 years) 2 Enteric Fever 3 Total 13 CAUSES OF DEATH. The following* table shows the causes of and ages at death:— 21—22 TABLE V.—Causes of, and ages at, Death during Year 1925. Name or 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 i year. i and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years 65 and upwards All causes j Certified 552 36 9 9 6 25 70 168 229 339 Uncertified ... ... ... ... ... ... ... ... ... ... Enteric Fever 3 ... ... ... ... ... 3 ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever 1 ... 1 ... ... ... ... ... ... 1 Whooping-Cough 4 2 1 1 ... ... ... ... ... 1 Diphtheria 3 ... ... 1 2 ... ... ... ... 3 Influenza 12 1 ... 1 ... ... 1 4 5 1 Encephalitis Lethargica 1 ... ... ... ... ... ... 1 ... 1 Meningoccocal meningitis 1 ... ... ... ... ... 1 ... ... ... Pulmonary Tuberculosis 29 ... ... ... ... 6 12 9 2 195 Other tuberculous diseases 7 ... ... 1 1 3 ... 1 1 3 Cancer, malignant disease 78 ... ... ... 1 1 6 37 33 24 Rheumatic Fever 2 ... ... ... ... ... 2 ... ... ... Diabetes 5 ... ... ... ... ... 1 2 2 ... Cerebral Hæmorrhage 34 ... ... ... ... ... 2 14 18 17 Heart disease 87 ... ... ... 1 1 6 30 49 24 Arterio-sclerosis 19 ... ... ... ... ... 1 4 14 2 Bronchitis 30 3 1 ... ... ... 1 3 22 5 Pneumonia 38 2 4 2 ... 1 9 9 11 8 Other respiratory diseases 5 ... ... ... ... 1 2 ... 2 ... Ulcer of stomach or duodenum 6 ... ... ... ... ... 2 2 2 4 Diarrhœa, etc. (under 2 years) 2 2 ... ... ... ... ... ... ... 1 Appendicitis and typhlitis 6 ... ... ... ... 1 2 3 ... 3 Cirrhosis of liver. 4 ... ... ... ... ... ... 3 1 1 Acute and chronic nephritis 15 ... ... ... ... ... ... 8 7 4 Puerperal sepsis ... ... ... ... ... ... ... ... ... ... Other accidents and diseases of pregnancy and parturition 1 ... ... ... ... ... 1 ... ... 1 Congenital debility and malformation, premature birth 15 15 ... ... ... ... ... ... 3 Suicide 16 ... ... ... ... 1 7 7 1 ... Other deaths from violence 24 4 ... 1 ... 3 3 6 7 4 Other defined diseases 102 7 1 2 1 7 7 25 52 32 Causes ill-defined or unknown 2 ... 1 ... ... ... 1 ... ... ... Totals 552 36 9 9 6 25 70 168 229 339 23 • URBAN DISTRICT OF HENDON • Comparative view of 10 of the principal causes of Death during the year 1925 24 TABLE VI. DISTRICT—HENDON (MIDDLESEX). INFANT MORTALITY DURING THE YEAR, 1925. Nett deaths from stated causes at various ages under one year. Causes of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 months 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under 1 Year. All causes ( Certified. 10 2 1 ... 13 10 9 2 2 36 ( Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-Cough ... ... ... ... ... 1 1 ... ... 2 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 1 ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 2 1 ... ... 3 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... 2 Diarrhoea ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... 1 1 ... ... 2 Gastritis ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... 1 2 ... ... 3 Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Congenital malformations ... ... ... ... ... 2 ... ... ... 2 Atrophy, Debility and Marasmus, including Premature Birth 6 1 1 ... 8 1 3 ... ... 12 Other causes 1 1 ... ... 2 I 1 2 ... 6 Totals 10 2 1 ... 13 10 9 2 2 36 Nett births in the Legitimate 880 year Illegitimate 42 Nett Deaths in the Legitimate Infants 31 year Illegitimate Infants 5 25 URBAN DISTRICT COUNCIL OF HEND0N • Chart shewing INFANT MORTALITY RATE per 1000 births for mendon compared with the rate for England and Wales Thin Lines indicate England and Wales Thick Lines indicate HENDON 26 SENILE MORTALITY. 229 deaths of residents over 65 years of age were registered, a percentage of 41 of the total deaths of residents. INQUESTS. Natural Causes 29 Accidents and Misadventures 18 Open Verdicts 2 Suicides 11 The following table gives a comparison of the vital statistics and the incidence of and deaths from certain diseases in the various Wards. The infant mortality rates are calculated on such low figures that not very much importance can be attached to them. TABLE VII. Ward. Birth Rate. Death Rate. Infantile Mortality Rate per 1,000 births. Number of Infectious diseases notified. Number of deaths from certain diseases Scarlet Fever. Diphtheria. Pulmonary Tuberculosis. Scarlet Fever. Diphtheria. Pulmonary Tuberculosis. Measles. Whooping Cough Mill Hill 12 25 8.92 21 16 6 3 2 1 West Hendon 16.34 8.32 45 21 23 17 — 2 7 — 1 Central Hendon 14.11 8 58 67 46 50 17 — 1 7 — 1 Golders Green 12.51 6.96 23 23 19 10 1 — 5 — 1 Garden Suburb 8.15 7.66 29 12 9 2 — — 2 — Child's Hill 17.33 9.10 27 16 7 12 — — 6 — — 27 28 The following are the Birth Rates, Death Rates and Infantile Mortality Rates of Hendon since 1900:— TABLE VIII. Year. Birth Rate. Death Rate. Infantile Mortality Rate. 1900 27.5 11.9 133 1901 27.4 10.6 117 1902 28.7 10.8 90 1903 28.7 10.2 102 1904 27.7 12.1 137 1905 27.7 11.7 115 1906 25.5 10.9 98 1907 24.4 10.3 88 1908 24.7 10.0 91 1909 22.9 8.2 70 1910 22.1 7.7 80 1911 24.66 10.29 93 1912 23.8 8.51 54 1913 24.64 10.44 85 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 1924 14.55 8.70 42 1925 13.77 8.38 39 THE INFANT MORTALITY RATE again constitutes a record. Only 36 infant deaths occurred, giving a rate of 39 per 1,000 births, When the Causes of and Age at death 29 (Table VI.) are examined it will be observed that 10, i.e. slightly over one-quarter, of the deaths occurred in the first week of life and that 16, or nearly half the deaths, were accounted for by Congenital malformations, Atelectasis and Premature birth and Wasting conditions. This indicates that something approximating half of the infants who died were defective from birth. It is evident, therefore, that the Mortality among infants born healthy is exceedingly low. Other rather striking facts are that there were only 2 deaths from Diarrhoea, Gastritis and Enteritis, and 5 from Bronchitis and Pneumonia. THE GENERAL DEATH RATE is again very low though not the lowest recorded. It is probable that we have reached about the low-water mark in death-rate, which obviously cannot fall indefinitely, however much health may improve. It is not unlikely that it may begin to rise. The combination of a low birth-rate and a low death-rate will eventually bring about a condition of things in which a larger proportion of the population will be in the older groups, in which deaths is, of course, most frequent. This tendency may possibly be counteracted in this district, however, by a constant immigration of people in young adult life. The number of deaths from Acute Infectious Disease is again very low. There were no deaths from Measles. Only 1 death from Scarlet Fever occurred, out of 134 cases notified. This death took place in the Isolation Hospital in which 97 cases were treated. There were 3 deaths from Diphtheria out of 114 cases notified, representing a case mortality of 2.63. These deaths all took place in the Isolation Hospital in which 96 cases were treated. A very striking feature of the death returns (see Table V. and the Chart shewing a comparison of 10 of the principal causes of death) is that deaths from Violence occupy 3rd place on the list, while Phthisis (Pulmonary Tuberculosis) takes 7th place. In the 2 previous years the positions were exactly reversed. 30 The deaths from Violence were accounted for as follows:— Suicide 16 Knocked down or run over by motor vehicle 6 Motor accidents 4 Other accidents 14 Total 40 During the year in question motor vehicles were more important as the cause of death than the group of Infectious Diseases, Scarlet Fever, Diphtheria, Measles and Whooping Cough. Pneumonia and Bronchitis are each more important, as causes of death, than Phthisis. Out of 87 deaths from Heart Disease 49 were over the age of 65 and 30 between 45 and 65. Many of these cases were probably not so much a local disease of the heart as a general decay in which the heart and arteries participated. Of the 78 deaths from Cancer on the other hand only 33 or considerably less than half occurred over the age of 65, while a further 37 occurred between 45 and 65 and 8 below the age of 45. The deaths from Cancer for the last five years have been as follows:— 1921 56 (Population 56,045). 1922 66 (Population, 57,507). 1923 60 (Population, 60,495). 1924 83 (Population, 64,444). 1925 78 (Population, 66,922). Although the deaths are lower in 1925 than in 1924 a pretty definite upward trend is shewn even in that short period and making allowance for the growth of population. 31 There has been a good deal of discussion as to whether the increase in deaths from Cancer which have been steadily going on for many years is a real increase¬or is due to improved diagnosis. Both the Registrar General and the Chief Medical Officer of the Ministry of Health have expressed their opinion that it is a real increase and this opinion is supported by strong evidence. I think it may be definitely said that the causes of this increase are unknown. Much research is being carried on as to causation, treatment and prevention of cancer, and there are indications that important advances in our knowledge with regard to cancer will probably be made in the near future. What appears to be a really valuable contribution to the elucidation of its nature and causation has been published during the year, and this district has the honour of containing the laboratory in which the researches were carried on—namely, The Medical Research Institute at Mill Hill. POOR RELIEF. The following particulars have been kindly supplied to me by the Clerk to the Hendon Board of Guardians:— Parish of Hendon. 1924. 1925. 1. The average weekly number of inmates in Redhill Institution 134 129 2. The number of persons, in receipt of Outdoor Relief (ordinary) 521 489 3. The number of persons in receipt of Outdoor Relief (Unemployed.) 239 293 4. Average weekly number in receipt of Outdoor Relief (ordinary) 284 295 5. Average weekly number in receipt of Outdoor Relief (unemployed) 80 49 6. The amount of Outdoor Relief (ordinary) approximately £4358 £5407 7. The amount of Outdoor Relief (unemployed) £497 £431 32 CAUSES OF SICKNESS. There has been no specially noteworthy cause of sickness during the past five years. Winter and Spring have been associated with considerable prevalence of influenza and catarrhal conditions but there has been no serious epidemic of influenza of the severe type of 1918 and 1919. 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 at South Mimms, and to various other hospitals and Sanatoria under County Council arrangements. Cases of non-pulmonary Tuberculosis, both from this and other districts, are treated in the Hendon Cottage Hospital under arrangements made by the Middlesex County Council. (2) Maternity. There is no Maternity Hospital in the district. (Patients are frequently admitted to Queen Charlotte's Lying-in Hospital in Marylebone, or to Cedar Lawn Lying-in Home in Hampstead, and to St. Mary's Hospital, Hampstead, but not under official arrangements). (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. 33 The following shows the number of patients treated in each year since the hospital was first opened:— TABLE IX. Year. Number of patients. Year. Number of patients. 1890 4 1908 83 1891 23 1909 175 1892 23 1910 125 1893 70 1911 100 1894 66 1912 129 1895 51 1913 102 1896 60 1914 219 1897 23 1915 118 1898 86 1916 62 1S99 74 1917 92 1900 41 1918 79 1901 83 1919 118 1902 55 1920 199 1903 80 1921 176 1904 83 1922 209 1905 74 1923 131 1906 92 1924 127 1907 53 1925 211 The diseases treated were:— Scarlet Fever 2620 Diphtheria 810 Enteric Fever 47 Small Pox 10 Erysipelas 8 Measles 1 During the year 102 cases of Scarlet Fever and 109 cases of Diphtheria were removed to the Hendon Isolation Hospital. 34 DEATHS IN HOSPITAL. The following Table shows the Case Mortality Rates for the last 5 years:— HENDON ISOLATION HOSPITAL. TABLE X. Scarlet Fever. 1921. 1922. 1923. 1924. 1925. Cases removed to Hospital 90 37 39 66 102 Total deaths in Hospital — 2 1 1 1 Case Mortality — 5.40% 2.56% 1.51% .98% Diphtheria. Cases removed to Hospital 86 172 92 59 109 Total deaths in Hospital 6 2 4 2 3 Case Mortality 6.97% 1.16% 4.34% 3.38% 2.75% The plans of the proposed new Isolation Hospital have been under discussion with the Ministry of Health during the year and have been reduced so as to provide 60 beds instead of 80, in order to meet the views of the Ministry. The Ministry have now intimated their intention of holding a local inquiry. It is to be hoped that the Ministry's sanction will be forthcoming almost immediately in order that the building may commence. The position is. becoming very serious. The population is now about 67,000 and at the present rate of growth it may be expected to be 80,000 in 5 years. In addition the London County Council intend to erect over 4,000 houses in the district during the same period, so that the population will almost certainly reach 100,000 within a very few years of the hospital being completed. With our present population and without anything of the nature of an epidemic, there were as many as 42 patients in the hospital shortly before the end of the year. It is therefore obvious that a hospital of 60 beds will be far from giving a large margin of safety when the London County Council houses are occupied. If the hospital cannot be erected in time to meet 35 the needs of this large addition to the population, and if even a moderate epidemic should occur the situation will be a very serious one indeed. It is therefore of the utmost importance that building should be begun at the earliest possible moment and proceed as rapidly as possible. (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 Hendon Urban District Council is one of the constituent authorities. Hendon is entitled to one representative on the Board for every 25,000 of the population. Mr. Councillor R. M. Weeks and Mr. Councillor Brook Flowers were the Council's representatives. 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 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 52 beds for general medical and surgical cases. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS AND 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. 36 The Mothers' 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 married or unmarried. 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. AMBULANCE FACILITIES. The Council maintains two 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. 37 TABLE XI. 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 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. Mill Hill Maternity and Child Welfare Centre. Wesleyan Sunday School, The Ridgeway Mill Hill. do. do. 5. Temple Fortune Maternity and Child Welfare Centre. The Mission Hall, Hendon Park Row. do. do. 6. School Clinic. Burroughs House, Hendon. Examination and minor treatsment rooms. Hendon Education Committee 7. 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 8. Burgess Day Nursery. 1, Devonshire Place, Child's Hill. Cottage with accommodation for 14 children. Maintained by endowment. 9. Tuberculosis Dispensary. The Broadway. West Hendon. Consultation rooms. Middlesex County Council 10. 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. 39-40 PUBLIC HEALTH STAFF. 39 4 TABLE XII. 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. F.R.C.P.E., 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 Whole 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. Bascom C.M.B. Dip. of National Health Society Maternity and Child Welfare Grant School Nurse Whole time. „ O. A. Hunt C.M.B. H.V. Cert. of Battersea Poly. San. Ins. Cert. „ „ Whole time. „ M. Lake C.M.B., H.V. M. & C.W. cert. of R.S.I., S.I. Cert., S.I. Ex. Bd. „ „ Whole time. „ M. E. Stewart C.M.B., H.V. San. Sc. Certs. Bd. Ed. „ „ Whole time. „ A. L. Wharton C.M.B. „ „ Whole time. „ A. B. Reidie C.M.B., H.V., and S.N. Cert. of R.S.I. „ „ Whole time. Midwife M. Sherman C.M.B. „ Nil Whole time. Veterinary Surgeon E. R. Sherren M.R.C.V.S. Nil Nil Part time. 41 SUMMARY OF NURSING ARRANGEMENTS, 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 asi 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 is £1 10s. 0d. The following are the particulars of the work of the Council's Midwife during the year:— Number of Confinements attended 90 Number of Antenatal Visits 336 Number of ordinary working visits 1659 Number of late visits (i.e., visits paid after the normal period of 10 days) 69 The total number of Midwives registered for practice in the district and resident in the district during the year was 15. 42 CHEMICAL WORK. NIL. 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 Public Health Act, 1925 1/3/26 Parts II., III., IV. and V. Bye-Laws. Slaughterhouses 26/2/1881 Nuisances 26/2/1881 Common Lodging Houses 26/2/1881 Tents, Vans and Sheds (by M.C.C.) 26/10/1893 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.) 1906 43 SANITARY CIRCUMSTANCES OF THE DISTRICT. WATER SUPPLY. The water supply of the district is derived from the Mains of two Companies, viz., The Colne Valley Water Company, which furnishes the supply of water to the North, NorthWestern and Western area, and The Metropolitan Water Board which supplies the remaining portion of the District. The source of the Colne Valley Company's Supply is from deep wells sunk in the Chalk at Bushey and Eastbury, and that of the Metropolitan Water Board the River Thames at Staines. Both supplies are constant and plentiful and of good quality. In recent years the practice of chlorination has been adopted in the case of both supplies and the waters may be regarded as thoroughly safe drinking waters. Every house in the District is furnished with a supply of water and each Company requires the provision of a storage cistern in dwellings, and these, in nearly every instance are of galvanised iron, and provided with close fitting covers. In all recently built houses a "draw-off tap" is fitted on the rising main for the special supply of drinking water. In the course of Inspection special attention is given to the Storage Cistern to ensure cleanliness and proper coverings. RIVERS AND STREAMS. The Rivers and Streams which include the River Brent, Silk Stream, and Dollis and Mutton Brooks, flow from North to South on the North-Eastern and North-Western sides of the District, and form the natural drainage of the District, having their confluence at the Welsh Harp Reservoir, which feeds the Regents Canal. Any pollution detected by the discharge into these Streams of any offensive effluent from cesspool overflows, or drains, etc., is prevented. Throughout the year no complaints as to pollution have been received from the Middlesex County Council, or the Rivers Convervancy Authorities. 44 SEWERAGE AND DRAINAGE. The district is well provided for in the matter of drainage and sewerage, all the houses with very few exceptions being connected to the public sewers. The Sewage is dealt with at the Council's Sewage Works on each side of the River Brent. The works have been very considerably extended and improved during the last five years and I am indebted to the Council's Engineer and Surveyor, Mr. A. O. Knight, for the following description "In the years 1913 and 1914 the Council laid down and submitted to the Ministry of Health a complete Scheme of Sewage Disposal for the District based upon the principle of treating all the sewage in the watershed on the South of the River Brent on that side of the river, and the whole of the sewage in the watershed on the North of the River Brent on the north side of the river. There were therefore to be two entirely separate sewage disposal works. The Ministry of Health approved the Scheme in general outline and confirmed an Order to enable the Council to acquire the necessary land. The Council then took in hand the construction of the sewage disposal works on the south side of the Brent and a contract was placed in 1914 and the work commenced. The outbreak of the War stopped these works and it was not until the year 1921 that it was possible to re-commence the same. These works comprise Screening Chambers, Sedimentation Tanks, and Percolating Filters with automatic distributors and the necessary Humus tanks, etc., were duly completed and have been in operation for several years past with entire success. As soon as the foregoing works were completed the Council took in hand the new works required on the north side of the Brent. The general principles of the Scheme were the same as those on the south side but the works were somewhat larger in capacity. These works were completed in June of last year and have since been working successfully. The sludge from the new works on the north of the Brent is pumped across the valley to the land which the Council own on the south side and thus all sludge treatment is concentrated at one portion of the works. 45 At the present moment the Council possess modern sewage disposal works on both sides of the river capable of purifying the whole of the sewage. It must however be borne in mind that the district is developing very rapidly and the time will come in the future when the Council may have to extend these works to provide further facilities for the purification of the steadily growing dry weather flow which is received at these works. In designing the two Schemes outlined above, this possibility has been borne in mind and extensions can be made to the existing works without superseding any of the work already carried out." CESSPOOLS. With very few exceptions all premises and dwellings are connected with the public sewer. Some houses not situate within a hundred feet of a public sewer are furnished with a cesspool. There are 61 cesspools in the district affording means of drainage for 58 houses and premises. The emptying of 51 of these cesspools is performed by the Council's Contractor, the work being carried out at night and is supervised by the Sanitary Inspector. The remaining cesspools are emptied at the cost of the owners or occupiers of the property. CLOSET ACCOMMODATION. All the premises and dwelling houses in the district with the exception of a very small number situate in the most rural portion are furnished with water closets. A very large proportion of the water closets are of "pedestal wash-down type" and very few Long hopper basins " are in use and these are replaced when found defective by modern type basins of L.C.C. pattern. The closets are furnished with flushing cisterns, and supplied with a constant service of water. Nearly every house has a separate water closet and the major portion two or more. 46 SCAVENGING. The removal of house refuse is undertaken by the Council with the exception of the Mill Hill portion of the district where the work is done by a Contractor. Portable metal dust receptacles are in general use for the reception of dust pending its removal, which takes place once per week. A special charge is made for the removal of trade refuseor other accumulations. The question of refuse disposal has come in for a great deal of consideration by the Council during the last five years. It has been recognised that the present method of disposal, namely, by means of a dust shoot in the neighbourhood of the Welsh Harp was not satisfactory, but the high cost of more satisfactory methods has led to postponement of the adoption of another system. It has finally been decided to deal with the refuse by means of a Refuse Plant of modern type. Application has been made to the Ministry of Health for sanction for the raising of the necessary loan and a Public Local Inquiry has been held. It is hoped that the Ministry's sanction will be received shortly so that this important work may be put in hand as soon as possible. 47 SANITARY INSPECTION OF THE AREA. 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 2418 Re-inspections after order or notice 2103 Complaints received and investigated 480 Visits paid to infected houses 585 Rooms disinfected 464 Drains smoke or water tested 164 Drains uncovered for examination 51 Nuisances discovered and dealt with 2060 The following list shows the work carried out as the result of interviews, the sending of letters and service of notices. DRAINS AND SANITARY FITTINGS. DRAINS.— Main drains relaid 14 Main drains repaired 12 Branch drains relaid and constructed 166 Branch drains repaired 44 New gullies 69 Gullies unstopped, provided with grids and cement work around repaired 43 Manholes built 10 Manholes repaired 14 Manhole covers, provided 12 48 Intercepting traps fixed 3 Intercepting trap caps resealed 14 Fresh air inlets provided and repaired 22 New soil pipes 3 Soil pipes repaired 7 New drain ventilators 6 Ventilating pipes repaired — Drains unstopped and cleansed 41 Premises connected to sewer 1 Cesspools emptied 49 WATER CLOSETS.— New basins 38 New flushing cisterns 23 Flushing cisterns repaired 35 Seats removed and repaired 15 W.C. unstopped and cleansed 29 Floors paved and repaired 5 Compartments cleansed 38 Compartments repaired 11 SINKS.— New provided 11 New wastepipes 10 Wastepipes trapped 12 ,, repaired 5 ,, unstopped 3 BATHS AND LAVATORY BASINS.— New Provided 59 Wastepipes trapped 58 ,, repaired and unstopped 17 49 WATER SUPPLY.— Service pipes renewed and repaired 12 Taps taken off rising main 2 Drinking water cisterns covered 9 ,, ,, new provided — Supplies renewed to houses 5 EXTERNAL WORK ON HOUSES. ROOFS.— Repaired and made watertight 79 RAINWATER GUTTERING AND DOWNSPOUT1NG.— New gutters and downspouts 27 Repaired 44 Unstopped 13 Disconnected from drains 7 YARDS.— Repaved and drained 9 Repaired 10 Cleansed 6 DUSTBINS PROVIDED 60 INTERNAL WORK ON HOUSES. LIVING AND SLEEPING ROOMS.— Walls and ceilings of rooms stripped and cleansed 433 Plaster of walls and ceilings repaired 147 Window-frames repaired, eased, etc. 19 Sash cords renewed 48 Dampness in house walls remedied 22 50 Rooms ventilated (windows made to open) 1 Smoky chimney, flues remedied 6 Fire grates, kitcheners, coppers renewed and repaired 39 FLOORS.— Repaired (New plates, joists and boards) 24 Cleansed 24 Air space under ventilated 6 OTHER MATTERS. Back passageways cleansed 7 Ditches oleansed 5 Accumulation of refuse, manure, etc., removed 41 Nuisances from keeping of animals abated 1 Nuisances from black smoke 3 Gipsy Vans removed 8 Urinals cleansed and repaired 8 Miscellaneous 56 NOTICES SERVED. Informal or Cautionary 608 Outstanding from 1924 69 677 Complied with 640 Outstanding, 1925 37 51 STATUTORY NOTICES. Applied for 73 Served under the Public Health Acts, etc. 13 Outstanding from 1924 Nil. Complied with 12 Outstanding 1 Served under the Infectious Diseases (Prevention) Act 19 Complied with 19 As in previous years the small number of Statutory Notices which it was found necessary to serve speaks well for the successful manner in which the owners have been induced to carry out the requirements dermanded of them without involving need for statutory action. SUMMONSES. The following proceedings were taken for non-compliance with Statutory Notices: Result of Proceedings. Under Section 91 of The Public Health Act, 1875.— Nuisances at two dwelling houses Abatement order granted. Penalty 40/—£5 5s. costs. Under Section 46.— A filthy and unwholesome room. (Certificate by Medical Officer of Health) Work executed by Sanitary Authority. Under The Housing and Town Planning Acts, 1909. Section 17.— Failure of Tenants to vacate two cottages after Closing Orders became operative Orders made by Magistrates for Cottages to be vacated. 52 SMOKE ABATEMENT. Only a few complaints have been received with regard to smoke nuisances. The nuisances were of a minor character and intermittent, due largely at the time to the use of unsuitable fuel. After cautions were administered the nuisances were abated. At one Laundry the nuisance was due to insufficient boiler capacity and an additional boiler was provided. PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BYE-LAWS OR REGULATIONS. There are no Common Lodging Houses or Offensive Trades in the District. No Bye-laws with regard to Houses let in Lodgings have been adopted. Slaughterhouses, and Dairies, Cowsheds and Milkshops are dealt with under the Food Section of this Report. SCHOOLS. Generally speaking the sanitary condition of the schools is very good. They are all supplied by the public water supply. During the last five years the sanitary accommodation in several of the public elementary schools has been improved and brought up to date. No action has been necessary on the part of the Sanitary Authority in connection with the schools beyond the exclusion of children suffering from notifiable infectious diseases and their contacts. This subject is more fully dealt with in my report to the Education Committee. 53 FACTORY AND WORKSHOPS ACT, 1901. The following is the number of Factories and Workshops as recorded on the Factory and Workshop Register, 1925:— Number of Factories (including Factory Laundries) 86 *Number of Factory Bakehouses 11 Total Factories 97 Number of Workshops and Workplaces (including Workshop Laundries) 122 Number of Workshops Bakehouses 9 Total 131 * One underground Factory Bakehouse. Number of inspections (Factories and Workshops) 177 Number of Notices served to1 remedy defects 28 Number of Notices complied with 28 Matters notified to H.M. Inspector 1 Matters notified by H.M. Inspector (remediable under the Public Health Acts) 8 List of Outworkers received 30 Nature of defects remedied at Factories and Workshops. Sanitary accommodation insufficient 5 unsuitable or defective 17 not separate for sexes — Want of cleanliness 5 Defective roof Nil. Improperly drained floor Nil. Want of ventilation Nil. Other nuisances 22 54 HOUSING. (I) GENERAL HOUSING CONDITIONS in the AREA (1) The general housing conditions in the area, speaking comparatively are very good. Fully half the houses have been erected during the last twenty years and a striking feature of the district is the very large proportion of modern houses of the villa type. The unsatisfactory houses in the district are relatively few and in no part of the district are there groups of houses exhibiting anything approaching the very bad housing conditions to be found in many of the large and small towns of England. There is a considerable number of houses that are far from satisfactory and that do not provide sufficient accommodation or convenience for the families who occupy them, but whether from the point of view of the proportion of houses which are unsatisfactory or of the degree of their unsatisfactoriness the standard of the district is high. (2) (a) Extent of shortage of houses. In this district it is essential to distinguish between two kinds of shortage; shortage of houses to meet the needs of those already resident in the district and shortage of houses to satisfy the demand of people who wish to move into' the district. The need for villas of six rooms and upwards is being met by private enterprise, but houses for the working classes have not been provided in recent years except by the Council. The Census figures of 1921 indicated that upwards of 500 working class houses were required at that time. Since then 282 houses have been provided by the Council and taken into occupation. It is doubtful however if the need has been appreciably reduced, since during that period many marriages have taken place resulting in the establishment of additional families and also the rooms vacated by those who have obtained Council houses have in many cases been re-occupied by immigrants. 55 The applications for Council houses cannot be taken as a reliable indication of the needs but there is some significance in the fact that a very considerable proportion of the applicants are not resident in the district. (b) Measures taken and contemplated to meet the shortage. The following table shews the housing schemes carried out and projected:— 56 TABLE XIII. HENDON HOUSING SCHEMES. Situation. No. 2 bedrooms, living room, bath. etc. 3 bedrooms, living room, bath, etc. FLATS. 3 bedrooms, living room, parlour, bath, etc. 4 bedrooms living room parlour, bath, etc. 2 bedrooms, living room, bath, etc. 3 bedrooms, living room, bath, etc. State assisted Childs Hill 37 — 23 — — 14 — Brent Hill 178 20 68 — — 68 22 Total 215 20 91 — — 82 22 Nonassisted Childs Hill (Pre war) 50 32 18 — — — — Bittacy Hill 52 — — 28 24 — — Kingsbury Road 52 — 44 8 — — — Brent Hill (in course of construction) 90 40 50 — — — — Total 244 72 112 36 24 — — Grand Total 459 92 203 36 24 82 22 50 additional houses are projected at Child's Hill. 57 (3) Important changes in population in the last 5 years. The population has increased from 56,045 to 66,922, the increase being mainly due to the building of villas for sale and the occupation of these villas by immigrants. The district contains a very large undeveloped and rapidly developing area and it seems almost certain that this development will continue on the same lines leading to an increase of the population of about 2,000 to 3,000 per annum. The opening of the Hendon extension of the Underground Railway in November, 1923, and the Edgware extension in August, 1924, gave a great fillip to this process. In addition, the London County Council in their Watling Estate Housing Scheme propose to build 2,000 houses in the district in the next two years and 4,200 in the next five years, the latter figure being equivalent, no doubt, to an additional 20,000 population. There is also the probability that new factories will be established in the district leading to an increase in the working class population if housing accommodation is available. (II) OVERCROWDING. (1) Extent. The Census figures of 1921 indicated that there were 531 families living under conditions of more than two persons per room. I do not think that the position has materially altered since then. The action of the Council in providing 282 houses has done something towards easing the situation but I doubt if it has done much more than prevent it from becoming worse than it was in 1921. Enquiries made by the Sanitary Inspector in 1923 indicated that the letting of 61 Council Houses to West Hendon families had reduced the number of cases of overcrowding in the houses vacated by these families by 20. But it is only too probable that some of this benefit has already been counteracted by further subletting and by increase in the size of families, 58 In the course of general inspection work throughout the district 88 cases of overcrowding were discovered during the year and reported to the Public Health Committee. These cases were all cases of overcrowding on the basis of a minimum allowance of 400' cubic feet for an adult and 200 for a child in a room used as a living and sleeping room and 300 cubic feet per adult and 150 per child in a room used for sleeping only. It has been found, however, that in Hendon the "2 persons per room" standard and the above cubic capacity standard give very similar results. (2) Causes. I know of no cause of overcrowding of any importance, except the shortage of housing accommodation. There is a constant demand for housing accommodation on the part of young men resident with their parents who wish to marry and set up house for themselves and of people who wish to move into the district. This demand has not been met in recent years by the building of houses by private enterprise, so far as working-class houses are concerned. The result has been a large amount of sub-letting of one or two rooms in a house, and consequent overcrowding in the portion occupied by the tenant or the sub-tenant or both. (3) Measures taken or contemplated for dealing with Overcrowding. See the Table given above showing the houses built or projected under the Council's schemes. (4) Principal cases of overcrowding during the year 1925, and the action taken. It has not been possible to take any action in the majority of cases of overcrowding discovered during the year. 23 cases have been abated through the granting of Council houses. 59 In all cases where a house has been vacated by a tenant to take up occupation of a Council house the owner of the house vacated has been asked to re-let the vacant tenement or house to a Hendon resident with a smaller family. Many owners have co-operated with the Council in this way. (III) FITNESS OF HOUSES. 1 (a) General standard of housing. Quite half of the houses in the district have been erected in comparatively recent years. After the opening of the Golders Green Tube Station in 1906 the district commenced to develop very rapidly and continued to do so until the outbreak of War in 1914. During the past 5 years great building development has again taken place, especially in connection with the extension of the Underground to Hendon and Edgware. The houses built during these periods were mainly of the villa type, varying in size, with Shopping Centres and Flats and consist of houses of modern plan with modern drainage, and good sanitary fittings including bathrooms. The older properties include a considerable number of tenement dwellings, some divided into' separate flats and others let off in flats without being divided, together with larger residences. These are in a reasonable state of repair, and very few have been allowed to get into a really bad state or into such a dilapidated condition as to be beyond repair, or to warrant closure. A very large proportion of houses are occupied by "Owner Occupiers" who are interested in keepin them in a reasonable state of repair, and these houses do not demand a large amount of inspection. 1 (b) General Character of defects found to exist in Unfit Houses:— There are no totally unfit houses, although some are very old, and from time to time one of these lapses into such a condition as not to be capable of repair. In the course of Inspection the defects 60 covered are such as would be expected to arise from time to time in older properties and are commonly:— Defective inside plastering, dirty walls and ceilings, defective guttering and downspouts, roofing, dustbins, broken sash cords, defective window framing, firegrates, coppers, flooring, etc., the occurrence of stoppages in drains and defects arising in drains by settlements, etc., together with dampness in house walls. 1 (c) How far the defects are due to neglect of Owners or Tenants:— Generally speaking the owners of property endeavour to maintain their houses in a state of repair and on the receipt of an Informal Notice comply with its requirements. Moreover certain defects which could only be legally dealt with by the service of Statutory Notices under Section 3 of The Housing Act, 1925, are frequently remedied as a result of their inclusion on the Informal Notice issued. In the case of houses let in tenements, especially when sub-letting has occurred, the tenants are apt not to exercise proper care in preserving, clean and intact, the plastering of walls, to neglect the cleansing of yards, and the proper use of water closets and dust receptacles, and also at times indulge in keeping fowls in the yards, not in the most cleanly condition. In some cases the Bedding and Rooms are permitted to become verminous and dirty. The owners of such tenements are therefore more frequently called upon to effect cleansing work and repairs than would be involved with more careful tenants. BYE-LAWS RELATING TO TENTS, VANS & SHEDS. The Council adopted Bye-Laws under Section 9 of the Housing of the Working Classes Act and submitted them for approval to the Ministry of Health but approval has not been received. There is a considerable number of caravans constantly in the district and it would be an advantage to have Bye-Laws to control them. 61 HOUSING. Number of new houses erected during the year: — (a) Total (including numbers given separately under (b) )+(c) 986 (b) With State assistance under the Housing Acts: (i) By the Local Authority Nil. (ii) By Other Bodies or Persons 2 (c) By Local Authority without State assistance 56 1. UNFIT DWELLING HOUSES. Inspection.—(1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 748 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 58 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 486 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 480 Action under Statutory Powers. (a) Proceedings under Section 3 of the Housing Act, 1925. 62 (1) Number of dwelling houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By Owners Nil. (b) By Local Authority in default of owners Nil. (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. (b) Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 12 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By Owners 11 (b) By Local Authority in default of owners Nil. (c) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders Nil. (2) Number of dwelling houses in respect of which Closing Orders were made Nil. (3) Number of dwelling houses in respect of which Closing Orders were determined, the 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, 63 TABLE.—Shewing Action Taken with regard to Untit Houses. TABLE XIIIa. Year. Representations by M.O.H. Declaration of intention to close house by Owner under Sec. a8, Housing, Town Planning, etc. Act, 1919. Closing Orders made or become operative after voluntary closure by Owner. Houses Closed. Demolition Order. Demolition. 1919 1 1 2 — — — 1920 — — — 1 — — 1921 1 — 1 1 2 — 1922 — — — 1 — 3 1923 1 — 1 1 — 1 1924 2 — 2 — — — 1925 — — — 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. 1, Hale Lodge Cottages, Deans Lane. 2, Hale Lodge Cottages, Deans Lane. At the end of the year there were two houses unfit for human habitation remaining on the books of the Public Health Department, Closing Orders were made in respect of these during 1924. Legal proceedings were instituted under the Housing, Town Planning Acts and in one instance the premises were vacated. In the remaining instance the premises have not been vacated. 64 INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920 and 1923. During the course of the year 6 applications for the issue of Certificates under Section 2 of the above Act were considered by the Public Health Committee after an inspection of the premises had been made and reports submitted thereon. 3 Certificates were granted. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. Dairies, Cowsheds and Milkshops. No. of Registered Retailers and Purveyors of Milk 24 No. of Registered Wholesalers and Producers 47 The Milk sold and delivered from 22 Dairy Premises is received from Central Dep6ts in adjoining Districts. The bottling, cleansing and sterilisation of the vessels employed is performed at these Depots where special mechanical plant is used for the purpose and at which the milk is handled under the most hygienic conditions and pasteurised. Therefore, no "Loose" or unbottled Milk is retailed from these dairies except in one or two cases where a counter pan is in use, and no cleansing of vessels at the premises is rendered necessary. There are 19 dairies at which the milk is cooled, strained and placed in bottles and capped ready for delivery, and at which all churns, vessels and utensils used in the conduct of the business are cleansed and sterilised at the dairy premises. No special plant is employed at these Dairies. At 4 Shops, milk is either supplied in refreshment form, or from a Counter Pan—the Counter Pans are provided with covers. Four Retailers purvey milk in the District from Milk Vehicles, their dairy premises being situate in adjoining districts. 65 There are 17 Cowkeepers occupying dairy farms who, throughout the year have stalled in their sheds an average of about 260 milch cows. The majority of the milk produced is sold wholesale. All the cows are habitually grazed for the greater part of the year. The cowsheds vary in point of construction, several being Farm Buildings specially adapted for the purpose of cowkeeping, and other buildings erected as Cowsheds. The sheds are inspected as frequently as possible and the attention of the occupiers called to any contravention of the Bye-Laws and especially to the need for scrupulous cleanliness in every way. At the Dairy Farms at which milk is sold by retail, separate buildings or compartments are provided for storing the milk and in these the cleansing of vessels is conducted. (i) The cows are inspected periodically by the Council's Veterinary Surgeon and during the course of the year two cases of Tuberculosis were discovered necessitating the destruction of the animals which were destroyed by request—no official action being necessary. (ii) 25 Licences and 2 Supplementary Licences have been granted to Retailers of Milk under the Milk (Special Designations) Order 1922 and 1923 to sell "Graded Milk." No plaint for the pasteurisation of milk is used in any dairy premises in the district, all graded milk being obtained from sources outside the district. (iii) No retailer of milk, or retailer holding special licences has been refused Registration, and no licence has been revoked for any reason. (iv) 8 Samples of Pasteurised Milk and 5 of Grade A Milk have been obtained for Bacteriological Examination. The summarised result of such examinations is as follows:— Pasteurised.—Total count varied between 1950 and 57,800 per cc. Bacillus coli found in 1/10cc in 7 out of 8 samples. 66 Grade A.—Total count varied from 7280 to 47450 per cc. Bacillus coli in 1/100 cc, absent in 3 samples, present in 1 of 3 tubes in another, and present in all 3 tubes in the 5th. (b) Meat. MEAT INSPECTION. (Public Health (Meat) Regulations, 1924). (1) The Occupiers of Private Slaughter Houses have arranged fixed days and times for Slaughtering. When Slaughtering is performed on any other occasion a Special Notice is sent to the Public Health Department. A Sanitary Inspector is in attendance at the Slaughter House during the slaughtering operations when the carcase and organs are examined. The services of a part time Veterinary Surgeon are available if required. The marking of Meat has not been adopted. There are no special means for the disposal of condemned diseased meat, but after condemnation, any carcase and organs are conveyed to the Sewage Farm and buried in quick lime. When simply an organ is found to be diseased, it is suitably destroyed on the slaughterhouse premises. When the Refuse Destructor is erected, it will afford ready means for the destruction of unsound food. (2) Stalls, Shops, Stores and Vehicles at which meat is sold are kept under constant inspection to ensure that the provisions of the Public Health (Meat) Regulations, 1924, are being observed as far as possible. 67 There are no stalls in the district but a few covered vehicles visit certain portions of the district for the purveying of meat. These are provided with covered tops, sides and backs, and are kept clean. There are 45 Butchers Shops in the district only two of which are without glass front panels. The practice of placing the meat on "Tit boards" outside the shops has, by request, been discontinued. No prosecutions have been instituted for breach of the Regulations, as in no instance could it be clearly shewn that any contamination of meat had taken place. Speaking generally, the Butchers endeavour to carry out as far as they reasonably can the spirit of the Regulations. (3) There are no Public Slaughter Houses in the District. Slaughter Houses. 1920. January, 1925. December 1925. Registered 6 6 6 Licensed 1 2 2 Total 7 8 8 The registered slaughter houses are very old buildings but are kept in a cleanly condition and in conformity with the Slaughter house Bye-laws. A very small amount of slaughtering is performed as most of the Meat Supplies are obtained by the Butchers from the London Meat Markets. At 2 slaughter houses, no slaughtering has been done throughout the year. The following table shews the number of animals slaughtered and examined by the Sanitary Inspectors at the slaughter houses:— 68 TABLE XIV. Slaughtered and examined. Condemned and destroyed. Cattle. Sheep. Pigs. Description. Cause. 15 2 Carcases Tuberculous 1 Porequarter „ 3 Lungs „ 2 Livers „ 1 Heart „ 1 Mesentery „ 7 Carcases were slaughtered under the Tuberculous Order 1925. 102 5 Lungs Parasitic 2 Lungs Congested 2 Plucks „ 1 Pluck Parasitic 1 Liver „ 194 7 Omentums Parasitic 4 Plucks „ 4 Plucks Congested 4 Livers Parasitic 1 Lung „ (c) Other Foods. The Butchers, Fish, Poultry and Provision Shops, and all premises at which foods are prepared or exposed for sale have been kept under strict observation. The sanitary conditions thereat have been maintained, and the foods exposed were found wholesome and sound. In no instance was it found necessary to seize any articles of food which were unfit for consumption. The following foodstuffs which were voluntarily submitted to the Inspectors for examination, were condemned as unfit for consumption and destroyed:— 69 Meat:— 22 stone 2 lbs. of Beef Tainted. Fish:— 6 stone 2 lbs. of Cod Decomposition. Fruit and Vegetables:— 1 Crate of Bananas Decayed. 1 Crate of Oranges Decayed. 14 Apples Fouled by Rats. Other Foods:— 1 pkt. Quaker Oats Fouled by Rats. 1 pkt. Grape Nuts do. 30 Pastries do. 4 pots of Chutney do. 30 pkts. of Chocolate do. 1 pot of Jam do. In all cases where articles of food were brought to the Public Health Department by purchasers who considered them of doubtful quality the shop from which they were purchased was forthwith visited and their Stores examined. SALE OF FOOD AND DRUGS ACTS. The Administrative body under these Acts is the Middlesex County Council, and their Inspectors have taken the following samples in the District for the year ended 31st December, 1925. The following Table shewing the articles purchased with the result of their analysis was kindly forwarded to me by Mr. R. Robinson, Chief Officer of the Public Control Department. 70 COUNTY COUNCIL OF MIDDLESEX. Urban District of Hendon. List of samples taken during the year ended 31st December, 1925. Article. Taken. Adulterated. Milk 198 5 Butter 2 — Apples 5 1 Arrowroot 1 — Cinnamon 1 — Cocoa 1 — Coffee 2 — Cornflower 4 — Dripping 2 — Prescriptions 5 — Whiskey 1 1 222 7 No prosecutions were instituted during the year. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Of the notifiable acute infectious diseases only Scarlet Fever and Diphtheria have been of importance during the last 5 years. The numbers notified have been as follows:— 1921. 1922. 1923. 1924. 1925. Scarlet Fever 139 228 119 72 114 Diphtheria 153 132 66 110 134 71 Scarlet Fever was very prevalent in 1921 and 1922, the incidence being spread over the whole period and no actual epidemic occurring. The incidence remained low until near the end of 1925 when a considerable rise occurred. It has been of a mild type throughout the period. There was an epidemic of Diphtheria, moderate in extent but very severe in type, at the end of 1921 and beginning of 1922 followed by a fairly Low incidence until near the end of 1925, when there was a marked increase in prevalence for a few weeks, although nothing that could be called an epidemic. Except for the short period in 1921-22 already mentioned, the disease has been moderate in type, the vast bulk of cases yielding promptly to treatment, and very severe cases being uncommon. Antitoxin is supplied free to Medical Practitioners both for prophylactic and therapeutic purposes and is freely made use of. It is only occasionally, when there is some difficulty or delay in diagnosis, that any patient fails to receive prompt treatment with antitoxin. The number of "return cases" of Scarlet Fever has been very low. Taking a "return case" as being one occurring within 28 days of the return of the presumed infecting case, the numbers have been as follows:— RETURN CASES. "Infecting case" treated in Hospital. "Infecting case" treated at home. Total cases notified. Total return cases. 1921 2 1 139 3 1922 3 — 228 3 1923 2 1 119 3 1924 2 — 72 2 1925 1 — 134 1 If the period chosen were 3 months instead of 28 days this would add 2 cases to 1921, 1 case in 1923, 2 cases in 1924, and 1 in 1925, 72 The following is the number of cases notified under the Regulations of 7th January, 1919:— 1921. 1922. 1923. 1924. 1925. Pneumonia 3 41 29 52 78 Malaria — — 1* 2* 2* Dysentery — — — — — Trench Fever — — — — — * Contracted abroad. Examination of Bacteriological & Pathological Specimens. The examinations are performed for the Council at certain Laboratories in London. Medical Practitioners are at liberty to send specimens and this is freely taken advantage of. The main bulk of the specimens consists of swabs for the detection of the Diphtheria bacillus and sputum for the bacillus of Tuberculosis. Agglutination tests and occasionally other forms of examination are also carried out. A summary of this work will be found below. 73  Total number. Positive. Negative Throat swabs for Diphtheria bacillus 909 221 688 Typhoid Fever, blood examinations 13 7 6 Tuberculosis, sputum examinations 58 11 47 Hairs 12 5 7 Urine 2 0 2 Foeces for Typhoid 2 0 2 Cerebro Spinal fluid for meningococci 1 0 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. The measures taken to control infectious diseases are, generally speaking, isolation, disinfection and supervision of contacts. Visits are paid to the home and enquiries made as to the health of other persons living in the house. When it appears to be called for, these contacts are examined by the Medical Officer of Health or the notifying practitioner is consulted. As a rule no action is taken as. regards contacts other than those living in the same house, but outside contacts are examined on occasion, when such action appears to be called for. Contacts attending school are excluded on the general lines of the memorandum of the Ministry of Health and the Board of Education, though the rules followed are not identical with those recommended in that memorandum. This is more fully dealt with in my report on the School Medical Service, 74 The Schick and Dick tests and the corresponding methods of immunisation have not been made use of. In my opinion knowledge regarding these measures has net yet reached the stage which would warrant their adoption in a routine or wholesale fashion in this district. I would make use of them in special circumstances which, seemed to call for their use but so far these circumstances do not appear to me to have arisen. No case of Small-pox occurred during the 5 year period and no vaccinations have been performed by the Medical Officer of Health under the Public Health (Small-Pox prevention) Regulations, 1917. DISINFECTION (1925). 464 Infected rooms disinfected by spraying with a solution of formalin or by vapourising of Formaldehyde Tablets. 19 Infected rooms cleansed, viz.:—Wallpapers stripped from walls, and ceiliings whitewashed in compliance with notices served under the Infectious Diseases (Prevention) Act, 1890. Articles of bedding and clothing, etc., disinfected, viz.:— 516 beds and mattresses, 958 blankets, and 4,139 various other articles. The disinfection of clothing, bedding, etc., was performed at the disinfection station by steam in a Washington Lyons Apparatus. The collection and return of these articles was colnducted by the Sanitary Department with a covered motor van. NON-NOTIFIABLE ACUTE INFECTIOUS DISEASES. There have been considerable epidemics of Measles, Whooping Cough, Chicken Pox and Mumps during the last 5 years. 1921 was specially marked by Mumps, Chicken Pox and Whooping Cough. In 1922 none of the non-notifiable diseases was unduly prevalent, 75 In 1923 there were considerable epidemics of Measles, Whooping Cough and Chicken Pox in the Spring, the rest of the year being remarkably free. In 1924 the incidence was low. In 1925 there were extensive epidemics of Mumps and Measles, the former being chiefly in the 2nd and 3rd quarters and the latter especially in the 4th quarter. Mumps and Chicken Pox are of very little consequence except from the point of view of school attendance and the epidemics of Measles and Whooping Cough during the last 5 years have not been of a very serious type, judging from the deaths. Deaths from 1921. 1922. 1923. 1924. 1925. Measles Nil. 2 4 5 Nil. Whooping Cough 9 1 7 2 4 The school notifications and reports from the Health Visitors are the chief sources of information as to these diseases. Sufferers and infant school contacts are excluded from school and the homes are visited by the Council's Nursing Staff, who advise the mothers as to care of the children, seeking medical advice, and isolation so far as that is possible. The death rates from Influenza per 1,000 population were as follows:— 1921. 1922. 1923. 1924. 1925. 0.17 0.33 0.14 0.20 0.17 77- 82 TABLE XV. Cases of Infectious Diseases notified during the year 1925. Name of District—HENDON (URBAN) MIDDLESEX. Number of cases notified and died. At ages—years. Total oases notified in each locality of the district. Total cases removed to. Notifiable Diseases. Total at all ages. 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 20. 20 and under 35. 35 and under 45. 45 and under 65 65 and upwards. 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 Cases notified 114 ... 6 9 6 15 40 22 3 9 4 ... ... 6 23 50 19 9 ... 96 ... Membranous Croup Deaths 3 ... ... ... 1 ... 2 ... ... ... ... ... ... ... 2 1 ... ... ... ... ... Erysipelas Cases notified 22 1 ... ... ... ... ... ... ... 5 7 ... ... 6 7 5 1 1 2 ... 2 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever Cases notified 134 2 1 7 9 13 56 21 10 4 1 ... 16 21 46 23 1'2 16 97 5 Deaths 1 ... l ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Typhus Fever Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhoid (Enteric) Cases notified 12 ... ... ... ... ... ... 1 ... 8 2 1 ... 1 3 ... 3 4 1 ... 8 Fever Deaths 3 ... ... ... ... ... ... ... ... 2 1 ... ... ... 1 ... 2 ... ... ... ... Relapsing Fever Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ••• ... ... Continued Fever Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague Cases notified Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro Spinal Cases notified 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... Fever Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Cases notified 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Poliomyelitis Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Cases notified 6 6 ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 2 ... 2 Neonatorum Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... PliUvinnnT'Tr Oases notified 61 ... ... ... ... ... ... ... 10 26 16 7 1 3 17 17 10 2 12 ... 40 l u iino iiciTV Tuberculosis Deaths 29 ... ... ... ... ... ... ... 2 5 11 9 2 2 7 7 5 2 6 ... ... Non-pulmonary Cases notified 22 ... ... 1 ... 1 5 1 3 4 3 4 ... 6 4 4 2 1 5 ... 8 Tuberculosis Deaths 7 ... ... ... ... 1 ... 1 1 2 ... 1 1 ... ... 1 1 1 4 ... ... Acute Encephalitis Cases notified 4 ... ... ... ... ... ... ... 1 1 1 1 ... 1 1 2 ... ... ... ... 2 Lethargica Deaths 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... Acute Polio- Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Primary Oases notified 52 1 5 1 ... 1 8 1 3 10 10 9 3 9 21 1'2 5 1 4 ... 2 and Acute Deaths from 38 2 4 2 ... ... ... ... 1 ... 9 9 11 7 7 8 6 1 9 ... ... zal Pneumonia all forms of ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria Cases notified 2 ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 2 ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Trench Fever Cases notified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 83 TABLE XVI. TUBERCULOSIS. NEW CASES AND MORTALITY DURING 1925. NEW CASES. DEATHS. Age Periods. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M. F. M. F. M. F. M. F. 0—1 1—5 — — 2 — — — 1 — 5—10 — 1 3 2 — — — — 10—15 — — 1 - — — — 1 15—20 6 4 1 2 1 1 1 — 20—25 8 5 — 1 1 3 — 2 25—35 5 8 2 1 1 2 — — 35—45 7 9 1 2 6 3 — — 45—55 5 1 2 1 6 1 — — 55—65 — 1 — 1 2 1 1 — 65 and upwards — 1 — — 1 1 — 1 Totals 31 30 12 10 17 12 3 4 84 85 PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No action has been taken or required under these Regulations. PUBLIC HEALTH ACT, 1925, SECTION 62. No action taken. table xviii. OPHTHALMIA NEONATORUM. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 6 4 2 5† — — l* * Accidental death after complete recovery, † 1 case left district—result not known. table xvii. Disease. Case rate per 1,000 living. Hendon. England and Wales. Small Pox 0.00 0.14 Scarlet Fever 2.00 2.36 Diphtheria 1.70 1.23 Enteric Fever 0.17 0.07 Puerperal Fever 0.00 0.06 Erysipelas 0.32 0.39 86 VACCINATION. The following Table, for which I am indebted to Mr. A. E. Taylor, Vaccination Officer, shows the particulars as regards vaccination :— table xix. *Number of Births registered in 1924 825 Successfully vaccinated 526 Insusceptible of Vaccination 7 Exemptions 176 Dead, unvaccinated 22 Postponements by Medical Certificate 13 Removal to other districts and cases not found 68 Number of Births unaccounted for 13 Number at all ages vaccinated during the year (Primary).— Born within the district 598 Born out of the district 83 *Figures for the number of children born in 1925 and vaccinated are not available, as vaccination may be performed any time during the first six months of life. MATERNITY AND CHILD WELFARE. The following is a summary of the work done in connection with the Maternity and Child Welfare Scheme :— 87 NUMBER ATTENDING THE CENTRES. table xx. . Central Hendon Centre. West Hendon Centre. Child's Hill Centre. Temple Fortune Centre. Mill Hill Centre. Total attendances of children 1908 5236 5933 376 384 Average attendances per session 39 51 59 15 14 Examinations by Medical Officer 1259 2849 3006 305 333 New members admitted 96 180 187 36 48 Under 1 year of age 71 135 146 17 21 Over 1 year of age 25 45 41 19 27 Antenatal cases 40 52 2 Number of visits paid in, connection with the work of the Centres 6583 Antenatal Visits (included in above) 518 The work of the Health Visitors in connection with the Notification of Births was as follows:— Number of Births notified 826 First Visits 781 Re-visits 5334 METHOD OF FEEDING. Breast 590 Breast and Bottle 31 Bottle 81 88 Six Health Visitors are employed, approximately half their time being spent on Maternity and Child Welfare work, and a half on the work of the School Medical Service. Two sessions per week are held at Child's Hill and West Hendon Centres, one session at Central Hendon, and one session per fortnight at Mill Hill and Temple Fortune. There is a special antenatal session once a fortnight at Central Hendon and West Heindon alternately. An effort is made to keep in touch with all the children until they reach school age, whether they attend the Centres or not. Those who do not attend are visited periodically at home, but the supervision is, of course, much more complete in the case of the children who attend the Centres. A fair proportion continue to attend, at least occasionally, right up to school age. When, they go to school, their records are passed on to the School Medical Service and the coordination between the two services may be said to be complete. The Maternity and Child Welfare work has been greatly developed in the last 5' years, both in the direction of co-ordination with the School Medical Service and of extension of scope. At the beginning of 1921, the Council had 3 Child Welfare Centres at each of which one session per week was held. There were 2 Health Visitors and 2 School Nurses whose work was entirely separate, and although they cooperated to some extent, there was no definite co-ordination of the two services. It was not possible to attempt any effective supervision of children who did not attend the Centres, and there was comparatively little supervision of children between 1 and 5 years of age. Now there are 5 Centres, with a total of 6 sessions per week, and in addition two antenatal sessions per month. There is a total of 6 Health Visitors for the Materinity and Child Welfare and School Medical Services combined and the 2 services are completely co-ordinated, a serious attempt being made to keep all the children coming within the scope of the Services under supervision from birth until they leave school. The notifications of Puerperal Fever, Ophthalmia Neonatorum and Poliomyelitis are shown in the following Table:— 89  1921. 1922. 1923. 1924. 1925. Puerperal Fever 6 4 1 1 -- Ophthalmia Neonatorum 3 8 3 6 6 Poliomyelitis — 1 1 3 1 There has been no serious outbreak of epidemic diarrhoea since the hot dry summer of 1921 and even in that year it was much less serious than might have been expected—accounting for 12 deaths in all. Subsequent years have shewn a total of only 2 or 3 deaths. A great deal is done to combat this disease by advice given at the Child Welfare Centres and by home visiting and I think it is justifiable to claim that it was partly on this account th,at the mortality was not more serious in 1921. With regard to Measles and Whooping Cough, see the remarks on non-notifiable infectious disease earlier in the report. In the case of Ophthalmia Neonatorum, an agreement has now been entered into with the Metropolitan Asylums Board for the admission of such cases to Hospital when this is required. The following table gives the results in the cases of this disease during the last 5 years. 90 OPHTHALMIA NEONATORUM. table xxi. Year. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 1921 3 2 l 2 — — 1 1922 8 7 l 8 — — — 1923 3 1 2 3 — — — 1924 6 2 4 6 — — — 1925 6 4 2 5† — — 1§ * This was a case of a premature infant who was admitted to a London Hospital and died there. †One case left district—result not known. § Accidental death after complete recovery. The number of deaths of children under one year of age who had attended the Centres at least once was 6. Compared with the total number of new members under one year of age (547) this gives an Infant Mortality rate of 10.9 per 1,000, whereas the general Infant Mortality Rate was 39. 91 ASSISTED MILK SUPPLY TO NECESSITOUS MOTHERS AND INFANTS. table xxii. 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. s. d. s. d. 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 dependents 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. Milk wa-s supplied as follows:— Number of families in receipt of milk at 31st December, 1924 :— Free 14 Half-price Nil. 92 Number of families supplied during 1925:— Free 34 Half-price 2 Number of families in receipt of milk at 31st December 1925:— Free 6 Half-price Nil. Total amount of milk supplied:— Free 3304 pints. Half-price 42 pints. Total 3346 pints. Total cost to Council £41 2s. Id. 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 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. I have the honour to be, Ladies and Gentlemen, Your.obedient servant, t. s. Mcintosh, Medical Officer of Health. ANNUAL REPORT OF THE WORK OF The School Medical Service IN RELATION TO Public Elementary Schools FOR THE YEAR 1925. 94 hendon education committee. Members of the Committee: COUNCILLORS. Colonel F. W. Hearn (Chairman). Mr. C. C. Cartwright, J.P. (Vice-Chairman). Mrs. S. J. Bannister. Mr. S. H. Egan, J.P. Capt. T. F. Fenn, M.C. Mr. Brook Flowers. Miss E. C. Growse. Mr. E. Holt, J.P. Mr. F. C. Rice. Mr. J. H. Sturgess, J.P. Mr. W. Taylor. Mr. R. M. Weeks. Mr. A. S. M. Bowers. Mr. A. A. Naar. CO-OPTED MEMBERS. Mr. A. R. Bailey, M.A. Major N. G. Brett James, M.A. B.Litt. Rev. C. E. de R. Copinger. Miss F. M. Levett. Mrs. L. Moylan-Jones. Rev. J. S. Poulton. Rev Father Walton. Secretary to the Committee; Mr. James Anderson. Medical Officers: Dr. T. S. McIntosh. Dr. Ethel M. L. Leitch Health Visitors: *Mrs. M. E. Bascom. *Mrs. O. A. Hunt. *Miss M. Lake. *Miss A. B. Reidie. *Miss M. C. E. Stewart. *Miss A. L. Wharton. * Employed by Council and Education Committee, 95 SCHOOLS. Provided. Number of children on Rolls at 31/12/25. Algernon Road 949 Bell Lane 507 Burnt Oak 229 Child's Hill 730 Colindale Temporary 61 Garden Suburb 541 The Hyde 779 Wessex Gardens 511 4307 Non-provided. A1J Saints' C.E. 295 St. Agnes' R.C. 113 St. John's C.E. 155 St. Mary's C.E. 416 St. Mary's R.C. 110 St. Paul's C.E. 162 St. Vincent's R.C. 156 1407 Total 5714 96 HENDON EDUCATION COMMITTEE. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE YEAR 1925. To the Chairman and Members of the Hendon Education Committee. " Burroughs House," Hendon, N.W. 4. March, 1926. Ladies and Gentlemen, I have the honour to report on the work of the School Medical Service for the year 1925. There has been no very outstanding event during the year. The School Medical work does not, as a rule, afford opportunity for striking or spectacular effects. Its chief value lies in careful supervision of the individual children, whereby defects are discovered at an early stage when they are most capable of remedy, and in this way an effort is made (not without success, I believe) gradually to raise the level of health of the children. The new scheme of Co-ordination with the Child Welfare work is in operation, and the treatment of Dental and Visual defects is on the point of commencement. The question of Orthopaedic Treatment has been under consideration during the year, and the Committee have, in general terms, expressed themselves as in favour of it. Alternative schemes are at present under the consideration of a sub-committee. The report follows the lines laid down by the Board of Education in their " Schedule to Form 6 M," 97 STAFF— Medical Officers: Dr. T. S. Mcintosh. Dr. Ethel M. L. Leitch. Health Visitors: Mrs. M. E. Bascom. Mrs. O. A. Hunt. Miss M. Lake. . Miss A. B. Reidie. Miss M. C. Stewart. Milss A. L. Wharton. CO-ORDINATION With (a) Infant and Child Welfare..— The School Medical Officer is also Medical Officer of Health and the Assistant School Medical Officer is Medical Officer to the Maternity and Child Welfare Centres. When children coming- within the scope of the Maternity and Child Welfare Service go to school, their records are carried over to the School Medical service, and there is no break in the continuity of supervision. To a great extent they are under the supervision of the same nurse and the same Medical Officer both before and during their school life. The co-ordination may thus be said to be complete. (b) Nursery Schools.— There are no Nursery Schools. (c) The care of debilitated Children under school age, {See under A). 98 SCHOOL HYGIENE. Speaking- generally, the standard in the Provided Schools is very high, these being good, buildings, wel,l situated, with, sufficient space around them and the equipment and sanitary arrangements good. The Non-Provided Schools do not reach such a high standard, but some of these may be said to attain a very satisfactory standard, and in the case of the less satisfactory ones, it is rather a matter of their being cramped and inconvenient, than of any conditions actually inimical to the health of the scholars being present. There is no doubt, however, that attendance at a well-planned, roomy, well-equipped school such as Wessex Gardens or Garden Suburb School, with pleasant surroundings, well-lighted corridors, excellent latrines and general air of freshness and hygiene, tends to have a better effect on the health of the scholars than attendance at the less satisfactory schools. It also gives them an objectlesson in hygiene which ought to have its effect in producing a desire for, and appreciation of a healthy environment, and in furthering the cultivation of hygienic habits. The following is a summary of the conditions existing, arranged under the various headings prescribed by the Board of Education. Buildings and Surroundings.— Provided Schools: Satisfactory in all cases—only 2 (Child's Hill and The Hyde) have 2 storeys of class-rooms, and these are well constructed, satisfactory schools. The rest have only one storey of class-rooms, in some cases arranged round a Hall of greater height. Garden Suburb and Wessex Gardens Schools are examples of a very good type of construction, the classrooms having windows on both sides (on one side over a central corridor) so allowing of cross-ventilation and excellent lighting. There is plenty of air-space around the school, in every case and sufficient playground accommodation. Hyde school has a large playing-field adjacent, 99 The Hyde School is the only school that has its own playing-field, but the Committee have a large playingfield at The Burroughs, which is used by several schools. There is an open-space close to St. Mary's C.E. School which is available for romping and informal games, though not suitable for cricket and football. Hendon Park is also available and has good cricket and football ground. It is within easy reach of Bell Lane School. The Committee rent a field at Cricklewood which is used by 4 schools in that neighbourhood. The Council has recently acquired a field of 8 acres between Wessex Gardens and the Child's Hill group of schools which will be available for them. The Mill Hill Park is open to the 2 schools at Mill Hill. In the Garden Suburb, negotiations for playingfield accommodation are in progress. On the Watling Estate, the site of the London County Council Housing Scheme, playing fields will be provided which will serve the schools to be erected on that estate, and also the Burnt Oak School. Thus the schools will before long be very well provided for in this respect. Non-provided Schools: The standard in these is lower and the variations greater. St. Mary's C.E. and St. Agnes' R.C. are on the whole, very satisfactory. They are attractive buildings with sufficient room both in and around them and an air of freshness about them. On the other hand, St. Mary's R.C. and St. John's C.E. are cramped, the latter hemmed in by other buildings and right on the street. They have insufficient playground accommodation. All Saints' School, although it has been much improved, is a rambling building, close to the street and other buildings, the arrangement of the building being such that the corridors are rather poorly lighted. The playground is rather small and on a slope. 100 St. Vincent's R.C. School is also rather cramped in accommodation, and has a small and steeply sloping playground which is not very suitable for games. Ventilation.— Four schools have the plenum system, others have ventilation by windows on one side of the classrooms, roof ventilators and ventilating shafts, while several have excellent cross-ventilation by means of windows on two sides of the classrooms. On the whole, the plenum system is the least satisfactory, but all the schools may be said to be well-ventilated. Lighting.— Provided Schools: Both natural and artificial satisfactory. I he artificial lighting is by electricity. Non-provided Schools: Natural lighting generally good; in the case of certain schools some of the rooms are scarcely sufficiently lighted. The artificial lighting is by gas and not very satisfactory. It appears to be little used and not very often required. Warming.— In the schools on the plenum system, there is difficulty in getting a sufficient temperature in certain of the rooms in cold weather. Those heated by radiators and hot-water pipes are satisfactory. In the case of 6 nonprovided schools, the classrooms are warmed by open fires or stoves only. In any but a small classroom this cannot be considered a satisfactory method of heating, since the heat is not sufficiently evenly distributed. Equipment and Sanitation.— In all the provided schools this is good and requires no special comment. In the non-provided schools it varies considerably. In some the class-rooms are 101 separated by partial or complete wood and glass partitions, and the accommodation altogether is rather cramped. In All Saints' School the cloakrooms are simply partitioned off the corridors and the corridors are rather dark. In St. Mary's R.C. School the cloakrooms are small and ill-lighted and the Infants' Cloakroom is a rather dilapidated shed in the playground. In St. Mary's C.E. School and St. Agnes' R.C. School the conditions are very good. Desks and Blackboards.— Satisfactory dual desks and suitable blackboards throughout the schools. Lavatory Basins.— Generally speaking, the provision is very good. In St. Paul's School the lavatory basins are in the latrines, which is not a desirable situation. In All Saints' Schooil there are two compartments each with one lavatory basin partitioned off the corridor, which can hardly be considered sufficient or satisfactory. Sanitary Conveniences.— These vary considerably in the different schools. In St. Mary's C.E. and St. John's Schools there are oldfashioned trough closets (the latter has 2 good pedestal closets in addition). This is not a good type of convenience, but they appear to be in good working order and cannot be called insanitary. In St. Mary's R.C. School the closets are of the old-fashioned boxed-in type and the woodwork and the latrines generally have a shabby unhygienic appearance, although I should not describe them as insanitary. In the other schools the conveniences are satisfactory, some, such as Garden Suburb and Wessex Gardens, being of a particularly good and up-to-date type. Water Supply.— The public supply is laid on to every school and is satisfactory. 102 Cleanliness of School-Rooms, Etc.— Satisfactory. Arrangements for Drying Clothes and Boots.— Generally speaking, no definite arrangements. In Schools with central heating, the cloakrooms are warmed to some extent. Clothes are dried at times at classroom fires, in boiler houise and so forth. Warming-up Supervision and Service of Meals.— In the case of St. Vincent's, St. Agnes' and St. Mary's R.C. Schools, where a considerable number of the children come from a distance and take their midday meal at school, arrangements are made for supervision and provision of hot drinks. In the case of the other schools, very few scholars take a meal at school, and generally speaking there are no definite arrangements made, but in some cases the children can get hot cocoa or milk, either by arrangement with the caretaker or at a cookery centre. Relation of General Arrangements of the School to the Health of the Children.— The arrangement of school hours and intervals appears to be satisfactory. There is nothing calling for special comment under this head. MEDICAL INSPECTION. (a) Age gioups 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. The Intermediate Group includes children of age 7 and 8 and the Leaver Group children of age 12 and 13. The total number of children included in the Routine Inspections was 2,139. 103 (b) The Board of Education Schedule of Medical Inspection is adopted. (c) Steps taken to secure the early ascertainment of crippling defects :— 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. 396 " Special Cases " were dealt with and 1,490 re-examinations made. FINDINGS OF MEDICAL INSPECTION. (a) Uncleanliness. At the Medical Inspections 106 cases were found. The Nurses by their systematic examination of children in the schools discovered 936 cases. Most of these were moderate cases shewing only nits in the hair and the great majority were in girls. 129 cases were excluded from school. Of the children who were excluded 2 were cleansed at the school clinic, the remainder were cleansed at home and re-admitted to school without the necessity of taking legal proceedings. Of the total 1,042 cases, 388 were completely remedied and 293 improved. (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. 104 (c) Tonsils and Adenoids. 136 cases were referred for treatment, 82 were operated on at the Cottage Hospital and 35 elsewhere while 2 received other forms of treatment. The arrangement with the Cottage Hospital continued to work satisfactorily and the results of the operations were good. The following shows the amounts paid in fees to the Hospital and recovered from the parents :— £ s. d. Cost to the Committee—*80 operations at 10s. 6d. 42 0 0 Amount remitted—on account of poverty Nil. Amount recovered 32 8 6 Amount outstanding at the 31st December, 1925 9 11 6 * In 2 other cases the fees were paid direct to the Hospital by the parents. (d) Tuberculosis. 1 case of Tubercular glands of the neck was referred for treatment. It was treated and improved. 2 bone and joint cases were treated, 1 improved and I cured. 1 case was suspected to have Pulmonary Tuberculosis. The diagnosis was confirmed and the case improved under treatment. (e) Skin Diseases. (1) Ringworm. There were 21 cases of Ringworm of the head, and 11 cases of Ringworm of the body. 21 of these cases received treatment at the clinic and the remainder privately. There were 13 cases still under treatment at the end of the year. 105 (2) Scabies. Only 4 cases were discovered during the year. 3 of these cases were cured at the School Clinic and 1 privately. (3) Impetigo. 94 cases were discovered. These were all cured, 89 at the School Clinic and 5 elsewhere. (4) Other Skin Diseases and Minor Injuries.— 59 cases came under observation. 29 were treated at the School Clinic and 7 by private arrangement. (f) External Eye Diseases. 15 cases were referred for treatment. Including cases brought forward from the previous year, 11 were treated at the School Clinic and 16 otherwise. (g) Defective Vision and Squint. 140 cases were referred for treatment, 123 obtained suitable glasses, 2 received other forms of treatment and in 5 cases treatment was found to be unnecessary. One case of squint was treated by operation. (h) Ear Disease and Defective Hearing. 15 cases of ear disease were referred for treatment. Including cases brought over from the previous year, 22 received treatment, 12 being cured and 10 improved. 6 cases of deafness were referred for treatment and 3 were cured. The remainder are still under observation. (i) Dental Defects. 101 cases were referred for treatment and 86 received treatment. The number referred for treatment represents only a small proportion of children who had dental defects, since only bad cases, or those shewing special symptoms, were referred. 106 (j) Crippling Defects. 15 cases of spinal curvature and other slight deformities were referred for treatment. Including those under treatment last year 21 were treated. 1 was cured, 19 improved. (k) Heart Disease. Only 1 case of heart disease (associated with Rheumatism) was found to require treatment. As usual a considerable number of children with some heart abnormality were put down for observation, but many of these children have probably quite healthy hearts. (1) anaemia. 18 cases were referred for treatment. 24 were treated during the year, 4 cured and 18 improved. (m) Lungs (not including Tuberculosis). 6 cases were referred for treatment and cured. school report. INFECTIOUS DISEASES. Scarlet Fever and Diphtheria did not occur to any serious extent among the scholars during the year. Mumps was very prevalent during the 2nd, 3rd and 4th quarters, and measles during the 4th quarter. The action taken to control these diseases has consisted of visits to the schools by myself and the nurses for the purpose of examining children in affected classes, visits by the nurses to homes in which cases have occurred and enquiries regarding children absent from suspicious or unknown causes, and the exclusion of children suffering from the diseases, and of certain of their contacts. In 1921, I reported to you as follows:— " In the case of the minor infectious diseases, Measles, Mumps, Chicken-Pox and Whooping Cough, 1 107 am of opinion that contacts attending senior departments need not be excluded. It cannot be questioned that the presence of these contacts in school might, on occasion, result in the infection of another scholar. But considering the whole question broadly and having in mind the extent to which contact takes place outside the school, I think on the whole that the amount of good done by the exclusion of senior contacts is not sufficient to compensate for the loss of attendance. Although there is always the possibility of a contact infecting another scholar in school, I do not believe that in actual experience this is an important factor in the spread of infectious disease. The case of infants is different. They are more liable to contract the diseases which are also much more dangerous to infants than to older children. I therefore recommend that all contacts attending infants' Departments should be excluded. With regard to the more serious Infectious Diseases, such as Diphtheria and Scarlet Fever, i propose to continue the present practice of excluding all contacts" After considering' this report you adopted the following Regulations :— 108 Disease. Exclusion of children suffering from the disease. Exclusion of contacts, i.e., Children living in the SAME HOUSE. Small Pox According to instructions sent in each case by the Medical Officer of Health. According to instructions sent in each case by the Medical Officer of Health. Cholera Diphtheria or Membranous Croup Scarlet Fever or Scarlatina Erysipelas Until the Medical Attendant or Medical Officer of Health certifies free from infection. Not to be excluded unless special instructions are received from Medical Officer of Health. Typhoid or Enteric Fever Measles Three weeks. Infants—3 weeks. Seniors—not excluded. Mumps Three weeks. Infants—4 weeks. Seniors—not excluded. Whooping Cough As long as cough continues, but not less than 6 weeks. Infants—3 weeks. Seniors—not excluded. Chicken-Pox Three weeks. Infants—3 weeks. Seniors—not excluded. Ringworm Impetigo (Sores) Until certificate received from Medical Attendant or School Medical Officer. Not to be excluded. Scabies (Itch) 109 In 1925, the Ministry of Health and Board of Education issued a Joint Memorandum on Closure of and Exclusion from School in which recommendations as to the exclusion of cases and contacts of infectious diseases are made. Although these differ in some respects from your regulations, I have not thought it necessary to advise you to alter the Regulations. The most important differences between the recommendations in the memorandum and your regulations are :— 1. In the case of Infant contacts of Whooping Cough, the exclusion period recommended in the memorandum is 6 weeks from the date of onset of the last case in the house. I consider this period unnecessarily long. 2. In the case of Measles and Chicken-Pox, the Memorandum recommends the exclusion of senior contacts who have not had the disease. This is logical and reasonable in theory but in practice I do not think it is passible to make arrangements for obtaining the information in all cases; moreover, the information when obtained is so often unreliable that I do not think it practicable to draw a distinction between those who have and those who have not had the disease; and as I explained in the report quoted above, I do not consider that the attendance of a few senior contacts, even if they have not had the disease, is a factor of much importance in the spread of the disease. Taking everything into consideration, I think that your Regulations are as satisfactory as such Regulation can be made, and that the recommendations in the Official Memorandum, where they differ from your regulations, would tend to increase the loss of attendance without a corresponding benefit. EOLLOWING 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 been done and to urge the parents to obtain treatment if they have not done so. 3,454 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 re- 110 suits of treatment. Children who require it are thus kept under continuous observation. The School Clinic is held at Burroughs House every 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. 470 children attended the Clinic and made 1,040 attendances.. 188 cases of minor ailments were treated. Practically all these cases may be regarded as complete cures. A few, however, had not completed their treatment at the end of the year. A Scheme for treatment of Dental and Visual defects at the Central Clinic and for daily treatment of minor ailments at 2 school clinics (Central Hendon and Child's Hill) has been adopted and will be put in operation early in 1926. Open-Air Education. Playground classes are held at many of the schools in Summer. Physical Training. There is no organiser of physical training, but physical training is carried on in all the Schools. The exercises are performed out-of-doors when the weather permits and facilities exist for indoor exercises in Halls, etc., when the weather is unsuitable. 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. The number of families for whom this provision was made was 3 and the number of children 8. 179 meals were provided at a cost of £5 19s. 4d., i.e., 8d, per meal, 1ll Co-operation of Parents. Parents are invited to attend the medical inspections and in a very large proportion of cases do so. They frequently express appreciation of the advice given. An encouraging' fact is that many parents voluntarily consult the Nurses and Medical Officers about their children. Co-operation of Teachers. Teachers frequently refer children to the Medical Officers for advice and assist by influencing the parents to take the advice given. Co-operation of School Attendance Officers. I am in constant communication with your Secretary and the Attendance Officers. Information is constantly passing between the two Departments. Children are frequently referred to the Nurses and Medical Officers by the Attendance Officers, and the assistance of the Attendance Officers is often of considerable value to the Medical department. There is close and helpful co-operation between your Secretary and myself. Co-operation of Voluntary Bodies. There is not a great deal of this, but cases are at times referred to the School Medical Officer by Hospitals and other Charitable Associations, and these are always given attention. Cases are, when necessary, referred to the Inspector of the National Society for the Prevention of Cruelty to Children by the School Medical Officer. Such cases are always promptly investigated by the Inspector and invariably with good results. Blind, Deaf, Defective and Epileptic Children. These cases usually come to notice through the medium of Head Teachers and Attendance Officers. Not infrequently they are brought to the notice of the Secretary by the parents before they have commenced school attendance. In these ways they are nearly always ascertained, even before they come up for routine medical examination. 112 One blind child, two deaf children, three feeble-minded and one epileptic are at special schools. The remainder are nearly all in attendance at the ordinary elementary schools. They are seen from time to time by the School Nurses and Medical Officers and so kept under supervision. Employment of Children and Young Persons. The following Table shews the work of Medical Inspection in connection with the granting of Employment Certificates :— 1925. EMPLOYMENT OF CHILDREN. Boys. Girls. Children examined and employment certificates granted 113 17 Re-examined and certificates continued 9 — Certificates refused 2 — Examined for employment under Entertainment rules, 1920 (Certificates granted) — 6 The employed children are carefully supervised and the Committee satisfied that the conditions are satisfactory and the regulations complied with. The following; shews the number of children employed at the end of the year :— 113 Boys. Girls. AGES. Boys. Girls. 12 13 12 13 yrs. yrs. yrs. yrs. Delivery of Newspapers. Mornings, Evenings and Sundays 45 2 17 28 2 Mornings and Sundays 81 14 26 55 7 7 Mornings and Evenings 7 3 2 5 1 2 Weekday mornings only 18 — 12 6 — — Evenings only 2 — — 2 — — Sundays and Evenings 1 — 1 — — — Sundays only 1 — — 1 — — Delivery of Milk. Weekdays and Sunday mornings 3 1 2 1 1 Saturdays and Sundays Errands. 3 — 3 — — — After School and Saturdays 34 1 13 21 — 1 Saturdays and Holidays 12 — 3 9 — — Golf Caddie Boys. After school and Saturdays 5 — — 5 — — Saturdays only 5 — 2 3 — — Delivery of Bread. Saturdays and Holidays only 11 — 6 5 — — Domestic Work. After school and Saturdays 2 1 _ 2 _ 1 230 22 87 143 9 13 Children working for two employers 6 — 4 2 — — Total Children Employed 224 22 83 141 9 13 114 The Juvenile Employment Committee pays strict attention to the placing of young persons between 14 and 18 in employments suitable for them. The School Medical records are available for consultations and the Medical Officer is consulted when necessary. The following extract from a report to the Juvenile Employment Committee for the 8 weeks ending 4th March, 1926, gives a good idea of the type of employment in which young persons are placed. ANALYSIS OF PLACINGS. Boys. Girls. Aircraft 1 Cashiers 2 Building 1 Clerical 10 Clerical 8 Domestic 1 Drawing- Office 1 Dressmaking 1 Electrical 5 Electrical 11 Engineering 5 Factory 4 Factory 1 Leather Work 6 Garage 1 Millinery 2 Leather 6 Packing 1 Messengers 2 Photographic Works 1 Shop Assistant 1 Shop Assistants 3 Motor Work 4 Telephone Operator 1 Optical Work 1 Porters 2 P.O. Messengers 2 Van Boy 1 42 43 The conditions of employment in this district are, generally speaking, very good. The Statistical tables prescribed by the Board of Education will be found overleaf. I have the honour to be, Ladies and Gentlemen, Your obedient servant, t. s. Mcintosh, School Medical Officer. 115 medical inspection returns, 1925. table 1. RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections. Entrants 1030 Intermediates 805 Leavers 304 Total 2139 Number of other Routine Inspections Nil. B.—OTHER INSPECTIONS. Number of Special Inspections 396 Number of Re-Inspections 1490 Total 1886 116 table 11. A.—Return of Defects found by Medical Inspection in the year ended 31st December, 1925. 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 8 36 2 — Uncleanliness {See Table IV., Group V.) — — — — Skin Ringworm : Scalp 2 — 19 — Body — — 11 — Scabies 2 — 2 — Impetigo 1 — 93 — Other Diseases (non-Tuberculou s) 4 3 55 — Eye Blepharitis 1 7 2 — Conjunctivitis 3 1 8 — Keratitis — — 1 — Corneal Opacities — 1 — — Defective Vision (excluding Squint) 78 44 46 1 Squint 11 26 5 1 Other Conditions 2 5 4 — Ear Defective Hearing 3 8 3 1 Otitis Media 5 12 8 1 Other Ear Diseases — 2 2 Nose and Throat Enlarged Tonsils only 36 74 26 2 Adenoids only Enlarged Tonsils 15 8 7 2 and Adenoids 27 15 25 1 Other Conditions 2 22 16 1 Enlarged Cervical Glands (non-Tuberculous) - 14 6 4 117 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 3 1 Teeth—Dental Diseases (See Table IV., Group IV.) 85 7 16 Heart and Circulation Heart Disease — Organic — 15 Functional . — 64 1 1 Ansemia 4 13 13 1 Lungs Bronchitis 1 14 5 Other Non-Tuberculous Disease 1 4 — Tuberculosis Pulmonary: Definite — — — — Suspected Non-Pulmonary: 1 1 — Glands 1 — — Spine —- — — — Hip — — — — Other Bones and Joints — — 2 — Skin — — — Other Forms — — — — Nervous System Epilepsy — 4 1 — Chorea — 3 3 — Other Conditions — 5 3 — Deformities Rickets — 1 1 — Spinal Curvature 3 7 4 Other Forms 3 6 4 — Other Defects and Diseases 7 6 37 1 118 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) Cade Groups : — Entrants 1030 7S 7.5 Intermediates 805 116 14.4 Leavers 304 3i 10.1 Total (Code Groups) 2139 225 10.5 Other Rourtine Inspections — — — 119—12-2 table III. Return of all Exceptional Children in the Area, 1925. Blind (including partially blind) (a) Suitable for training in a School or Class for the totally blind. Boys. Girls. Total. 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 1 1 2 Attending Public Elementary Schools - - - At other Institutions - — At no School or Institution 1 - 1 (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 2 3 Attending Public Elementary Schools 5 7 12 At other Institutions - - - At no School or Institution 1 — 1 Notified to the Local Control Authority during the year. Feebleminded - - - Imbeciles — — — Idiots — — — Epileptics. Suffering from severe epilepsy. Attending Certified Special Schools for Epileptics 1 - 1 In Institutions other than Certified Special Schools - - - Attending Public Elementary Schools - - - At no School or Institution — — — Suffering from epilepsy which is not severe. Attending Public Elementary Schools At no School or Institution 3 2 5 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, ansemia, etc.) At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - At Public Elementary Schools 13 20 33 At other Institutions - - - At no School or Institution — — — Active non-pulmonary tuberculosis. At Sanatoria or Hospital Schools approved - - by the Ministry of Health or the Board - - At Public Elementary Schools - - 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 13 18 31 At other Institutions - - - At no School or Institution 1 1 2 123 TABLE IV. Return of Defects treated during the year ended 31st December, 1925. TREATMENT TABLE. GROUP I.—MINOR AILMENTS (excluding Uncleanliness, for which see Group V). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otheivvise. Total. (1) (2) (3) (4) Skin : — Ringworm-Scalp 12 21 33 Ringworm-Body 9 3 12 Scabies 3 1 4 Impetigo 89 5 94 Other Skin Disease 29 7 36 Minor Eye Defects— (External and other, but excluding cases falling in Group II.). 11 16 27 Minor Ear Defects 2 11 13 Miscellaneous (e.g. minor injuries, bruises, sores, chilblains, etc.) 33 9 42 Total 188 73 261 124 TABLE IV. (continued). GROUP II.—DEFECTIVE VISION AND SQUINT (excluding) Minor Eye Defects treated as Minor Ailments—Group I.). Disease Defect 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). — 130 1 131 Other Defect or Disease of the Eyes (excluding those recorded in Group I.). — 2 — 2 Total — 132 1 133 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme Nil. (b) Otherwise 124 Total number of children who obtained or received spectacles (a) Under the Authority's Scheme Nil (b) Otherwise 123 125 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) 82 35 "7 2 119 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 9.8 (ii) Total number of examinations of children in the Schools by School Nurses 15172 (iii) Number of individual children found unclean 936 (iv) Number of children cleansed under arrangements made by the Local Education Authority 2 (v.) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 Nil. (b) Under School Attendance Byelaws Nil.