AC 439 (1) HENDON Middx Borough of Hendon. ANNUAL REPORT of the Medical Officer of Health and School Medical Officer for the year 1933 A, FAIRCRIEVE ADAMSON, M.D., D.P.H., Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation Hospital. HEN 10 Borough of Hendon ANNUAL REPORT of the Medical Officer of Health and School Medical Officer for the year 1933. A. FAIRCRIEVE ADAMSON, M.D., D.P.H., Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation Hospital. london: Hendon Printing Works Limited, 44, Victoria Road, Hendon, N.W, 4, 2 BOROUGH OF HENDON. Council of the Borough, 1933-34. The Mayor: Alderman C. C. Cartwright, M.B.E., J.P. The Deputy Mayor: Councillor Brook Flowers. Aldermen: Bannister, (Mrs.) S. J., L.L.A. Maughan, W. M. Cartwright, C. C., M.B.E., J.P. Reynolds, A. J. Connell, H. Shakespeare, W. H. N., Egan, S. H., J.P., F.R.I.B.A. M.C., A.F.C., J.P. Latham, C., J.P., F.L.A.A., L.C.C. Taylor, W., J.P. Councillors: Thomas, (Mrs.) M. Naar, A. A., M.B.E. Arter, E., M.C., M.I.A.E. Pinkney, C. Browne, B. S. Potter, H. G., J.P., K.S.I. Collins, F. J. Pugh, T. Clemens, W. R., F.C.A. Rice, F. C. Copestake, J. J. Richardson, G. R. Curton, A. W. Rodway, J. H. Flowers, B. Ross, W. J., F.A.I. Ford, A. S. F. Samuel, V. Gilpin, F. W. Scott, T. J. Holt, E., J.P. Sharpe, S. E. Johnson, H. L. K. Spreull, J. M., C.A. Lightfoot, P. Teare, R. A. B., M.B.E. Monro, B. J., J.P. Public Health and Medical Services Committee. Chairman: Councillor J. J. Copestake. Vice-Chairman: Councillor F. W. Gilpin. The Deputy Mayor: Councillor B. Flowers. Aldermen: Connell, H. Latham, C., J.P., F.L.A.A., L.C.C. Egan, S. H., J.P., F.R.I.B.A. Maughan, W. M. Councillors: Browne, B. S. Richardson, G. R. Ford, A. S. F. Scott, T. J. Thomas, (Mrs.) M. Co-opted Members. Mrs. B. H. Jfwitt. Rev. J. Goggin. Mrs. B. Monro, Rev. J. S. Poulton. 3 Public Health Officers. Medical Officer of Health, School Medical Officer, Medical Superintendent Isolation Hospital:— A. Fairgrieve Adamson, M.D., D.P.H. Assistant Medical Officers:— G. G. Stewart, M.R.C.S., L.R.C.P., D.P.H Ethel M. L. Leitch, M.B., Ch.B. W. F. T. McMath, M.D., M.R.C.P., D.P.H., resigned 31/3/33. E. A. Johnston, M.A., M.B., Ch.B., D.P.H., commenced 10/5/33. Obstetric Consultant:— *L. Phillips, F.R.C.S. Orthopaedic Surgeon:— H. J. Seddon, F.R.C.S. Consulting Aural Surgeon:— *Dan McKenzie, M.D., F.R.C.S. Ophthalmic Surgeon:— *J. G. Milner, F.R.C.S. Anaesthetist:— *G. Moriarty, M.B., Ch.B., M.D. Dental Officers:— *T. Wynne-Jones, L.D.S., R.C.S. R. M. Underwood, L.D.S., R.C.S. Senior Sanitary Inspector:— 1. S. J. Chapman. District Sanitary Inspectors:— 1.2. Geo. E. Luck. 1.2.4. F. H. Day. 1. A. H. Smith. 2.3. R. E. Young. 2.3. S. J. Mastebs. Chief Clerk:— C. C. Knudsen. Clerks:— Miss I. M. Waierhouse. J. J. Pinnock. Miss E. Stephens. E. D. Newson. Miss H. Wise. C. H. Machin. *Miss D. Burns, resigned 24/10/33. A. B. Reynolds. Miss B. Parker. E. Higham. *Miss K. A. Hick, commenced 23/10/33. R. Betteridge. 4 Matron, Isolation Hospital:— Miss F. Harvey. Health Visitors, School Nurses, Infant Life Protection Visitors:— 7.8.10. Mrs. M. E. Bascom. 5.8.10. Miss A. L. Wharton 8.9. Miss M. Stewart. 5.7.8.10. Miss M. Trickeit. 5.7.8. Miss F. Case. 5.7.8.10. Miss C. Hall 5.7.8.10. Miss L. F. Ray. 5.8.10. Miss D. Snow. 3.6.7.8.10. Miss M. Lake. 5.7.8.10. Miss P. Bennett 5.7.3.10. Miss D. V. Atkinson. 5.7.8. Miss I. Doull, Midwife:— 8. Mrs. M. Sherman. Masseuse:— *Miss Chapman. 1. Certificate of the Royal Sanitary Institute, 2. Meat Inspectors' Certificate. 3. Certificate San. Insp., Ex. Board. 4. Smoke Inspectors' Certificate. 5. General Training Certificate. 6. Sick Children's Training Certificate. 7. Health Visitors' Certificate. 8. C.M.B. Certificate. 9. San.Sc.Cert., Board of Education. 10. State Registered Nurse. * Part-time Officers. 6 INDEX. Page. Adoptive Acts 17 Ambulance 18 Area 8 Bacteriological Examinations 49 Bye-laws 17 Births and Birth Rate 10—12, 15 Closet Accommodation 23 Deaths and Death Rate 10—15 Deaths, Causes of 11—14 Deaths—Table shewing causes of 13 Disinfection 45 Employment of Children 85 Factory and Workshop Act 28 Foods 36—40 General Statistics 8—9 Health Centres 19—21 Health Services, Cost of 61 Health Visitors 4 Houses owned by Local Authority 31 Housing Conditions 29—35 ,, Schemes 33—34 Housing—Acts, Proceedings under, 29—32 ,, Closing Orders 31 ,, Demolition Orders 31 ,, Public Health Acts, Proceedings under 30—31 ,, Unfit Dwelling Houses 29—31 Illegitimate Children—Institutional Provision for 18 Infant Mortality 11—13, 15 ,, ,, Table of 14 Infectious Diseases—Table of Notifications 43—44 ,, ,, Deaths from 43—44 ,, ,, Small Pox 45 ,, ,, Diphtheria 45 ,, ,, Scarlet Fever 45 ,, ,, Puerperal Fever 45 ,, ,, Acute Poliomyelitis 43—44 ,, ,, Ophthalmia Neonatorum 46 ,, ,, Tuberculosis 47—48 ,, ,, Encephalitis Lethargica 43—44 ,, ,, Typhoid Fever 43—44 Cerebro Spinal Fever 43—44 6 Page. Inspection Work 23—28 Introduction 7 Isolation Hospital 50—61 Laboratory Facilities 16 Licences for Music, Dancing, etc. 28 Maternity and Child Welfare 18—21 Meat 37—40 Medical Inspection of Schools and School Children 63—98 Midwives 16 Milk—Assisted Supply of 21 Milk Supply 36 National Society for the Prevention of Cruelty to Children 84—85 Notifiable Diseases 41—49 Nursing Arrangements 16 Offensive Trades 27 Overcrowding 35 Population 8 Public Health Staff 3—4 Rate, amount of Id 9 Rateable Value 9 Refuse Collection and Disposal 23 Rent and Mortgage Interest Restriction Acts 35 Rivers and Streams 22 Sale of Food and Drugs Act 36—40 Sanitary Administration 22—28 Sanitary Circumstances of the District 22—23 Sanitary Inspection 23—28 Schools—Medical Inspection of Schools and Scholars 63—98 ,, Medical Inspection Returns 86—98 ,, Secondary 83 Sewerage and Drainage 22 Slaughterhouses 37 Smoke Abatement 27 Social Conditions 9—10 Unmarried Mothers—Institutional Provision for 18 Vaccination 46 Verminous Houses 27 Water Supply 22 Vital Statistics 9—15 Annual Report for the Year 1933 OF THE Medical Officer of Health. To the Mayor, Aldermen and Councillors of the Borough of Hendon. Ladies and Gentlemen, I have the honour to submit my annual report on the health of the district for the year 1933. The report follows the lines indicated in Circular 1346 of the Ministry of Health. 8 Statistics and Social Conditions of the Area. 1.—GENERAL STATISTICS. AREA—10,471 acres. POPULATION. TABLE 1. Estimated population 30th June. Census 1921. Estimate of Registrar Geueral. Estimate of Medical Officer of Health. For calculation of Birth Rate. For calculation of Death Kate. 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 1926 — 62,790 62,570 71,111 1927 1 66,370 66,060 75,747 1928 — 80,220 79,710 89,871 1929 — 83,540 83 190 101,671 1930 — 83,540 83,190 109,683 1931 Census 1931 115,682 114,370 113,980 1932 — 123,200 124,477 1933 — 127.600 129,698 The estimated population of the district at 30/6/33 was as follows :— 9 TABLE II. Ward. Persons. Burnt Oak 16,552 Central Hendon 14,096 Child's Hill 14,624 Garden Suburb 8,681 Golders Green 19,973 Mill Hill 20,798 Park 13,751 West Hendon 14,436 Edgware 6,787 Total 129,698 Number of inhabited houses 1/1/34—30,606. Total Rateable Value 1/4/34 £1,638,401 SUM REPRESENTED BY A PENNY RATE. Estimated Product of 1d. Rate £6,600 SOCIAL CONDITIONS, INCLUDING THE CHIEF OCCUPATIONS OF THE INHABITANTS AND THE INFLUENCE OF ANY PARTICULAR OCCUPATION ON PUBLIC HEALTH. It is difficult to add anything; to that said in previous years regarding the social conditions of the inhabitants, the area maintaining its position as largely residential and the type of house which came into rating during the year was mainly of the semi-detached type, the rateable value averaging approximately £30 0s. 0d. per annum. There is, however, in addition a considerable working class population in the area largely centred on the London County Council estate at Burnt Oak, where there are 4,000 houses and the Borough Council have provided 1,012 houses and flats for the occupation of the working classes. There are also considerable numbers of houses suitable for the working classes in the older portions of the Borough. The social conditions are on the whole remarkably good and it is only in the older property that action for the abatement of nuisances, overcrowding, etc., has had to be taken. 10 A feature well worthy of comment is the open spaces which have been acquired by the Council for the use of the inhabitants of the Borough and all sections of the community have an open space within reasonable distance of their residence. Altogether, excluding Golders Hill Park and the Hampstead Heath Extension which are controlled by the London County Council, the Hendon Borough Council maintain over 800 acres of open spaces. There has been no great increase to the industries of the area during the year, the majority of the workers of all classes finding their occupation in London. The total number of unemployed on the Register at the Hendon Labour Exchange (excluding Juveniles) at the end of the year was:—Males 1,321, Females 235 VITAL STATISTICS. The vital statistics for the area continue to compare very favourably with those for the country generally, and are an indication of a population living under good environmental conditions. The comparisons are set out in Table III., and your attention is drawn to the comparative figures shown in this table. VITAL STATISTICS. (Calculated on the Registrar General's estimated Population ol 127,600). Live Births.— Total. Male. Female Birth Rate per 1,000 of the estimated resident population. Legitimate 1601 832 769 Illegitimate 72 29 43 13.11 1673 861 812 Total. Male. Female. Rate per 1,000 total (live and still) births. Still Births 42 23 19 24 Total. Male. Female. Death Rate per 1,000 of the estimated resident population. Deaths 1013 493 520 7.93 11 Deaths from puerperal causes (Headings 29 and 30 of the Registrar Official's Short List):— Deaths. Rate per 1,000 total (live and still) births. No. 29—Puerperal Sepsis 2 1.16 No. 30—Other puerperal causes 1 0.58 Total 3 1.74 Death Rate of Infants under one year of age :— All infants per 1,000 live births 38 Legitimate infants per 1,000 legitimate live births 36 Illegitimate infants per 1,00 illegitimate live births ... 97 Death from Measles (all ages) Nil Deaths from Whooping Cough (all ages) ... 7 Deaths from Diarrhoea (under 2 years) 8 TABLE III. Birth-rates, Death-rates and Analysis of Mortality in the year, 1933. England and Wales, 118 County Boroughs and Great Towns, and 132 Smaller Towns. (Provisional figures. The rates for England and Wales and for London have been calculated on a population estimated to the middle of 1933, but those for the towns have been calculated on populations estimated to the middle of 1932. Rate per 1,000 population. Annual Death Rate per 1,000 Population. Rate per 1,000 live births. All causes Typhoid and Paratyphoid Fevers. | Smallpox. Measles, Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea & Enteritis (under 2 years). Total deaths under 1 year. Live Births Stillbirths England and Wales 14.4 0.62 12.3 0.01 0.00 0.05 0.02 0.05 0.06 0.57 0.54 7.1 64 118 County Boroughs and Great Towns (including London) 14.4 0.67 12.2 0.00 0.00 0.06 0.02 0.06 0.08 0.55 0.49 9.4 67 132 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931) 14.5 0.63 11.0 0.00 0.00 0.04 0.02 0.04 0.04 0.53 0.44 4.9 56 London 13.2 0.45 12.2 0.00 0.00 0.02 0.02 0.08 0.08 0.51 0.58 11.6 59 Hendon 13.11 0.32 7.93 0.00 0 00 0.00 0.00 0 05 0.03 0.35 0.49 4.78 38 The maternal mortality rates for England and Wales are as follows:— Puerperal Sepsis. Others. Total. per 1,000 Live Births 1.79 2.63 4.42 ,, ,, Total Births 1.71 2.52 4.23 The maternal mortality rates for Hendon are as follows:— per 1,000 Live Births 1.19 0.59 1.78 ,, ,, Total Births 1.16 0.58 1.74 The rates for Hendon in the above table have been calculated on a population estimated to the middle of 1933 by the Registrar General. 12 13 TABLE IV. CAUSES OF DEATH IN HENDON M.B., 1933. Cause of Death. M. F. All Causes 493 520 1. Typhoid and paratyphoid fevers — 1 2. Measles — — 3. Scarlet Fever — — 4. Whooping Cough 2 5 5. Diphtheria 3 1 6. Influenza 21 24 7. Encephalitis Lethargica — — 8. Cerebro-Spinal Fever 2 — 9. Tuberculosis of respiratory system 41 35 10. Other Tuberculous disease 11 3 11. Syphilis 6 — 12. General paralysis of the insane, tabes dorsalis 2 1 13. Cancer, malignant disease 81 80 14. Diabetes 1 15 15. Cerebral Hæmorrhage, etc. 11 28 16. Heart Disease 95 123 17. Aneurysm 1 1 18. Other circulatory diseases 16 12 19. Bronchitis 13 15 20. Pneumonia (all forms) 31 25 21. Other respiratory diseases 6 6 22. Peptic Ulcer 7 — 23. Diarrhœa, etc. (under 2 years) 6 2 24. Appendicitis 3 5 25. Cirrhosis of liver 3 1 26. Other diseases of liver, etc. 2 5 27. Other digestive diseases 10 23 28. Acute and Chronic Nephritis 12 13 29. Puerperal Sepsis — 2 30. Other puerperal causes — 1 31. Congenital debility, premature birth, malformations, etc. 20 17 32. Senility 7 9 33. Suicide 8 13 34. Other violence 26 16 35. Other defined diseases 46 38 36. Causes ill-defined or unknown — — Special causes (included in No. 35 above).— Small-pox — — Poliomyelitis — — Polioencephalitis — — Deaths of Infants under 1 year.— Total 34 31 Legitimate 29 29 Illegitimate 5 2 14 TABLE V. DISTRICT—HENDON (MIDDLESEX). INFANT MORTALITY DURING THE YEAR, 1933. 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 Mths. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under 1 Year. All causes Certified 23 5 2 1 31 11 13 7 3 65 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-Cough ... ... ... ... ... ... ... 1 1 2 Diphtheria ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... 1 ... ... ... 1 Convulsions 1 ... ... ... 1 ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 1 ... ... 1 Pneumonia ... ... ... ... 1 5 4 3 2 15 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... 1 ... 3 2 ... 6 Gastritis ... ... ... ... ... 1 ... ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... Injury at birth 4 ... ... ... 4 ... ... ... ... 4 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformation 4 ... 1 ... 5 1 ... 1 ... 7 Atrophy, Debility and Marasmus. including Premature Birth 12 4 ... ... 16 1 4 ... ... 21 Other causes 2 ... 1 ... 3 2 1 ... ... 6 Totals 23 5 2 1 31 11 13 7 3 65 15 The following are the Birth Rates, Death Rates and Infantile Mortality Rates of Hendon since 1900:— TABLE VI. 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 1926 13.12 7.17 37 1927 13.41 8.48 41 1928 13.85 7.27 32 1929 14.83 8.61 44 1930 13.87 7.86 50 1931 14.41 7.72 37 1932 13.70 8.40 51 1933 13.11 7.93 38 16 General Provision of Health Services in the Area. SUMMARY OF NURSINC ARRANGEMENTS, ETC. PROFESSIONAL NURSING IN THE HOME. (A)—General. The provisions for home nursing remain as in previous years excepting that a new association, viz.:—The Golders Green District Nursing Association has been established. This brings the total number of District Nursing Associations up to 8. (B)—For Infectious Diseases. No provision is made. MIDWIVES. The Hendon Borough 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 91 Number of Ante-natal visits 386 Number of ordinary working visits 1432 Number of late visits (i.e., visits paid after the normal period of 10 days) 203 The total number of Midwives registered for practice in the district and resident in the district during the year was 30. LABORATORY FACILITIES. No changes have been made in the arrangements described in my last Annual Report. Table XXL shows the use made of these facilities by medical practitioners in the area. 17 LIST OF ADOPTIVE ACTS. Baths and Washhouses Acts, 1846-1925. The Infectious Disease (Prevention) Act, 1890. Public Health Acts (Amendment) Act, 1890. Public Health Acts (Amendment) Act, 1907. Parts II. and III. Part IV.—Sections 52 to 67. Parts VI., VIII. and X. Public Health Act, 1925. Parts II., III., IV. and V. Public Libraries Acts, 1892-1919. Small Dwellings Acquisition Acts, 1899-1923. Local Government and Other Officers' Superannuation Act, 1922. Middlesex County Council Act, 1930. Section 53. BYELAWS Nuisances. Common Lodging Houses. Pleasure Grounds. Employment of Children. Regulation of Advertisements Act. Houses Let in Lodgings (under Housing Act). Tents, Vans and Sheds. Slaughterhouses. New Streets and Buildings and Drainage, etc. Street Trading. Smoke Abatement. School Attendance. Public Libraries. Means of Escape from Fire. Petrol Filling Stations, 18 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 Public Assistance Committee. AMBULANCE FACILITIES. The Council maintains 3 ambulances. 2 are in charge of the Public Health Department and are 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. CLINICS AND TREATMENT CENTRES. The clinics and treatment centres remain as last year with the exception of that of Mill Hill which was transferred from the Wesleyan Sunday School, The Ridgeway, to the Methodist Church Hall, Goodwyn Avenue. The change was made because of the greater accessibility of these latter premises for the majority of the mothers attending the centre. MATERNITY AND CHILD WELFARE. The services provided under the Maternity and Child Welfare Scheme remain as in the previous year excepting that the Council became responsible for the provision of Midwives for necessitous women confined in their own homes, in accordance with the provisions of Section 5 of the Local Government Act, 1929. The question of the adequacy or otherwise of the number of maternity beds available for the Borough was also carefully considered. It was found that the total number of births notified was 1,700 of which 211 took place in Redhill Hospital, 61 in nursing homes inside the Borough and 295 in nursing homes and similar institutions outside the Borough. Only a small proportion of these as far as could be ascertained sought institutional treatment because of bad medical or environmental conditions, a large majority seeking admission as a matter of personal preference. A meeting was held with neighbouring authorities to find out their position in this matter and to decide if action of any kind was necessary, and secondly, if so, was joint action preferable from an economical point of view. No definite conclusions were arrived at as most of the authorities were about either to lose or change their identity because of the re-arrangement of districts necessitated by Section 46 of the Local Government Act, 1929, 10 In the meantime, however, the County Council have put forward proposals for the enlargement of Redhill Hospital, and that enlargement provides for an additional 25 beds for maternity cases. CHILDREN ACT, 1908, AND CHILDREN AND YOUNG PERSONS ACT, 1932. There is nothing to add to that which was said in the previous year excepting that the Children Act of 1932 came into operation on the 1st January, 1933. This Act gives additional powers to the responsible authorities, raises the age of which a child is considered a foster child from 7 to 9 years, it lengthens the period in which the prospective foster parent must give notice of her intention to take a child, and it increases the conditions which may be regarded as unsuitable by the registering authority. TABLE VII. The number of persons receiving children for reward, on the Register at the end of the year, was 62. Number of children on the Register:— (i) at the end of the year 130 (ii) who died during the year 1 (iii) on whom inquests were held during the year Nil No proceedings under the Act were taken by the Local Authority during the year. MATERNAL MORTALITY. As in the past, investigations are made into each maternal death, and only three deaths of residents were attributable to this cause, but investigations were, of course, carried out into more deaths than the above-mentioned total as a number of deaths occurred in Redhill Hospital of women who had been admitted there for their confinement from other outside areas. MATERNITY CENTRES AND HOME VISITATION. It will be seen that there is a steady increase in the numbers attending the centres, the total having increased from 35,184 to 38,825, and visits paid by the Health Visitors to the homes have also increased. This is due to the services becoming better known and to the fact that the Borough is still developing rapidly. Over 1,000 houses came into rating during the year and the majority of these are occupied by young married people. This increase will render certain additions to the staff inevitable in the near future, 20 NUMBER ATTENDING THE CENTRES. TABLE VIII. Central Hendon Centre West Hendon Centre Child's Hill Centre Temple Fortune Centre Mill Hill Centre Watling Estate Centre Edgware Centre Total attendances of children 6572 5791 8005 2028 3321 10183 2925 Average attendances per session 66 56 56 39 65 50 57 Examinations by Medical Officer 2672 2140 3763 946 1575 3356 1236 New members admitted 223 233 291 68 149 404 184 Under 1 year of age 187 179 206 50 115 261 169 Over 1 year of age 36 54 85 18 34 143 15 Ante-natal cases 142 190 200 — — 155 — HOME VISITATION. First Visits. Total Visits. To expectant mothers 297 927 To infants under one 1674 7205 To children one to five 480 9801 METHOD OF FEEDING. Breast 1355 Breast and Bottle 111 Bottle 198 DENTAL TREATMENT. Dental treatment is provided for expectant mothers attending the antenatal clinics and for children under 5 years of age. During the year 122 mothers and 145 children under 5 years of age were treated. 21 TABLE IX. TABLE OF TOTAL ATTENDANCES SINCE 1922. Year. Centre. Edgware Watling Estate Central Hendon West Hendon Child's Hill Temple Fortune Mill Hill Total Population 1922 – – 1806 3114 4439 – – 9359 57507 1923 – – 2159 4071 5295 – – 11525 60495 1924 – – 2243 4595 5758 50 63 12709 64444 1925 – – 1948 5288 5935 376 384 13931 66922 1926 – – 2464 5984 5958 452 553 15411 71111 1927 – – 2871 5688 5492 418 672 15141 75747 1928 – 1618 3364 5748 5272 556 1078 17636 89871 1929 – 7941 3843 4820 5284 868 1626 24382 101671 1930 – 10233 5163 3611 4755 1937 2717 28416 109583 1931 – 10336 5915 4597 5155 1937 3064 31004 115682 1932 690 10948 6519 5387 6118 2391 3131 35184 124477 1933 2925 10183 6572 5791 8005 2028 3321 38825 129698 NUTRITION. There was an increased demand for free or assisted milk supply for necessitous mothers and infants under 5 years of age, the total amount distributed and the cost being as follows:— Free 42,322 pints. Half-price 121 pints. Total 42,443 pints. Total cost to Council £436 9s. 2d. ORTHOPÆDIC TREATMENT. The Council's Orthopaedic Scheme which is mainly concerned with children of school age is also available for children in the younger age groups and during the year 151 children under 5 years of age attended and made 584 attendances, particulars of which are set out in the school portion of this report. 22 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 provides the supply of water to the North, North-Western and Western area, and The Metropolitan Water Board, which supplies the remaining portion of the district. RIVERS AND STREAMS. In one instance complaints were received of pollution of a stream by sewage matter being discharged from a surface water drain. The source of pollution was traced to an adjoining district and, in conjunction with Middlesex County Council, steps were taken to prevent the same. I am indebted to Mr. A. O. Knight, the Borough Surveyor and Engineer, for the following notes on Sewage Disposal, Sewerage and Scavenging : SEWAGE DISPOSAL. The contract for re-constructing the filters on the South side of the River Brent has been completed and the works are operating in a satisfactory manner. In view of the scheme now in course of construction by the Middlesex County Council for dealing with the sewage of Hendon and other districts in the Brent Valley, no further extensions of the works are contemplated, although some difficulty is being experienced, having regard to the rapid growth of the population. MAIN SEWERAGE. The re-construction of the Cricklewood main outfall sewer has been completed and all the main outfall sewers belonging to the Corporation are now of a size sufficient to deal with the estimated increase in population for some years to come. SCAVENGING OF HIGHWAYS. No alteration has been made in this service except necessary extensions to deal with the increased mileage of roads, which at the end of the year, amounted to 112 miles. 23 REFUSE DISPOSAL. The working of the refuse disposal plant has continued to be satisfactory during the year. The total quantity of refuse dealt with for the year 1933 was 26,698 tons. ARRANGEMENTS FOR THE REMOVAL AND DISPOSAL OF HOUSE REFUSE. No alteration has been made during the year in respect of this service, but additional transport, etc., has been acquired to deal with the steady development of the district. EARTH CLOSETS, PRIVIES AND CESSPOOLS. There are no privies in the district and only 17 earth closets. The contents of these earth closets are disposed of by the occupier of the premises on agricultural land. The cesspools, 85 in number are emptied periodically by the Council's men and plant, a vacuum emptier being employed for this purpose. SANITARY INSPECTION OF THE AREA. 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 (15) of the Sanitary Officers' Order, 1926:— Inspections made 4140 Re-inspections after order or notice 7063 Complaints received and investigated 1241 Visits paid to infected houses 1104 Rooms disinfected 990 Drains smoke or water tested 516 Drains uncovered for examination 9 Nuisances discovered and dealt with 2835 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 33 Main drains repaired 41 Branch drains relaid and constructed 201 24 Branch drains repaired 81 New gullies 56 Gullies unstopped, provided with grids and cement work around repaired 54 Manholes built 43 Manholes repaired 51 Manhole covers and frames provided 119 Intercepting traps fixed 17 Intercepting trap caps resealed 16 Fresh-air inlets provided and repaired 19 New soilpipes 5 Soilpipes repaired 6 New drain ventilators 17 Ventilating pipes repaired 9 New stackpipes provided 29 Drains unstopped and cleansed 129 Cesspools emptied 110 Premises connected with sewer 1 WATER CLOSETS.— New provided 23 New basins 141 New flushing cisterns 42 Flushing cisterns repaired 21 Flushpipe joints repaired 11 New seats 73 Water closets unstopped and cleansed 11 Floors paved and repaired 21 Compartments cleansed 55 Compartments repaired 17 Compartments lighted and ventilated 16 SINKS.— New provided 86 New wastepipes 100 Wastepipes trapped 21 Wastepipes repaired 5 BATHS AND LAVATORY BASINS.— New provided 143 Wastepipes repaired and unstopped 3 New wastepipes provided 152 25 WATER SUPPLY.— Service pipes renewed and repaired 3 Taps taken off rising main 14 Drinking water cisterns covered, cleansed or repaired 2 Supplies renewed to houses 5 EXTERNAL WORK ON HOUSES. ROOFS.— Repaired and made watertight 107 RAINWATER GUTTERING AND DOWNSPOUTING.— New gutters and down spouts 41 Repaired 53 Unstopped 11 Disconnected from drains 3 YARDS.— Paved and drained 11 Repaved and drained 12 Repaired 36 Cleansed 8 DUSTBINS PROVIDED 118 INTERNAL WORK ON HOUSES. LIVING AND SLEEPING ROOMS.— Walls and ceilings of rooms stripped and cleansed 980 Plaster of walls and ceilings repaired 134 Window frames and sashes repaired, eased, etc. 115 Doors and frames renewed, repaired, eased, etc. 23 Sashcords renewed 150 Dampness in house walls remedied 114 Rooms ventilated (windows made to open, etc.) 6 Firegrates, Kitcheners, coppers renewed and repaired 104 Staircases renewed or repaired 14 FLOORS.— Repaired (new plates, joists and boards) 57 Air space under ventilated 10 2b OTHER MATTERS.— Back passageways cleansed 14 Ditches cleansed 5 Accumulations of refuse, manure, etc., removed 219 Nuisances from keeping- of animals abated 3 Gipsy vans, tents, etc., removed 8 Urinals cleansed and repaired 4 Verminous houses disinfected 51 Miscellaneous 471 NOTICES SERVED. Informal or cautionary 1,046 Outstanding from 1932 153 1,199 Complied with 1,033 Outstanding, 1933 166 STATUTORY NOTICES. Applied for 215 Served under the Public Health Acts, etc. 193 Outstanding from 1932 15 208 Complied with 203 Outstanding 5 Served under the Infectious Diseases (Prevention) Act 10 Complied with 9 SUMMONSES. A Summons was applied for in respect of non-compliance with a notice served under the Bye-laws with regard to "Houses-let-in-lodgings." The owner, however, executed the necessary works before the date of hearing, and the Summons was withdrawn. A Summons was applied for in respect of failure to supply information required by a notice served under Section 42 of the Housing Act, 1930 : the offender was convicted and fined £5 and ordered to pay £2 2s. Od. costs. 27 SMOKE ABATEMENT. No. of observations made on chimney shafts 97 No. of chimney shafts on which observations were made 11 No. of nuisances observed 5 No. of verbal notifications of nuisance given to occupiers (Public Health (Smoke Abatement) Act, 1926) 3 No. of written notifications sent to occupiers (Public Health (Smoke Abatement) Act, 1926) 3 It was not found necessary to take any Summary action to enforce the abatement of nuisances, as recommendations made regarding alteration to plant, stoking and fuel were adopted. VERMINOUS HOUSES. 51 houses infested with bugs have been dealt with, 26 Council houses and 25 privately owned houses. In all cases (excepting 9 where Cyanide Gas was employed) spraying by an insecticide of the walls, floors, furniture, etc., at intervals of from 7 to 10 days has been performed, together with the stripping off of wall papers, the removal of skirting boards, and the use of a blow-lamp for burning out all holes and crevices. The tenants are also advised to pursue cleansing with soap and water, and disinfectants are supplied. In addition fumigation by sulphur is also employed in some cases. All bedding is removed and sterilized in the steam disinfector at the commencement of the work, and again when the house and furniture appear to be free from bugs. At 9 houses (with contents) Cyanide Gas was employed by a firm who conducted the fumigation, and after one treatment disinfestation appeared to have been effected. This form of fumigation is only employed in very obstinate cases, as, owing to the dangerous nature of the Gas, special arrangements have to be made for the tenant to vacate the house. OFFENSIVE TRADES. There are no offensive trades established in the district. There are 18 Fried Fish Shops, which have been visited frequently. These premises were duly registered under Section 123 of the Hendon Urban District Council Act, 1929. The majority of the premises are fitted with modern fish-frying apparatus, which reduces the possibility of nuisances arising from the same. 28 MUSIC, DANCING, STAGE PLAY AND CINEMATOGRAPH LICENCES. The 60 premises in the district licensed by the Middlesex County Council for public entertainments have been inspected in accordance with Circular 120 of the Ministry of Health (Public Health—Theatres, Music Halls, etc.— Sanitary Condition of). The sanitary conditions and conveniences thereat were found to be satisfactory and were reported upon to the Licensing Authority accordingly. FACTORY AND WORKSHOP ACT, 1901. The following is the number of Factories and Workshops as recorded on the Factory and Workshop Register, 1933:— Number of Factories (including Factory Laundries) 105 *Number of Factory Bakehouses 18 Total Factories 123 Number of Workshops and Workplaces (including Workshop Laundries) 161 Number of Wokshop Bakehouses 11 Total 172 * One Underground Factory Bakehouse. Number of Inspections (Factories and Workshops) 100 Number of Notices served to remedy defects 15 / . Outstanding, 1932 5 Number of Notices complied with 17 Matters notified to H.M. Inspector 1 Matters notified by H.M. Inspector (remediable under the Public Health Acts). 2 Lists of Outworkers received 76 Nature of defects remedied at Factories and Workshops.— insufficient 3 Sanitary accommodation. unsuitable or defective 6 not separate for sexes — Want of cleanliness 19 Overcrowding Improperly drained floor Want of ventilation , Other nuisances 8 29 Housing. Further progress has been made with the inspection of properties under Sections 17 and 19 of the Housing Act, 1930, with a view to having unfit houses demolished or put into a habitable state of repair. Demolition Orders were made in respect of 6 houses and one house was closed. A representation was made in respect of an unhealthy area in the Child's Hill District, which embraced 22 houses and 46 tenements. In connection therewith an enquiry was held by the Ministry of Health and the Council's application for a Compulsory Purchase Order was confirmed. House-to-house inspection work has been continued, and the notices served have been most satisfactorily complied with, resulting in the securing of a very large amount of sanitary improvements. The Ministry of Health approved a scheme, adopted by the Council, for the erection of 138 houses on the Reets Farm Site, a portion of these being for the use of tenants displaced from the Clearance Area referred to, and also tenants of individual houses dealt with under the Housing Act, 1930. 1.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 932 (b) Number of inspections made for the purpose 3,500 (2) (a) Number of dwelling-houses (included un- I der sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 132 (b) Number of inspections made for the purpose 947 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 9 30 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 382 2.—Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 267 Note.—Informal notices in respect of 69 336 houses not complied with in 1932, complied with in 1933. 69 3.—Action under Statutory Powers during the Year :— (a) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 2 (2) Number of dwelling-houses which were dered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (b) Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of ' which notices were served requiring defects to be remedied ... ... ... ... 14 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners . 9 Note.—Formal notices in respect of 10 20 houses not complied with in 1932, complied with in 1933. 1 (b) By Local Authority in default of Owners 1 31 (c) Proceedings under Sections 19 and 21 of the Housing- Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 5 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil (d) Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 4.—Number of houses owned by the Local Authority distinguishing those built in the last two years and held under (1) Part III. of the Housing Act, 1925, (2) Part II. of the Housing Act, 1925, and (3) other powers:— (1) Number of houses owned by Local 1,012 Authority (2) Number of houses built during the last two years (Housing Act, 1930) 45 (Flats) Number of New Houses erected during the Year:— (fl) Total (including numbers given separately under (b) ) 1,017 (i) By the Local Authority Nil (ii) By other Local Authorities Nil (iii) By other bodies and persons 1,017 (b) With State assistance under the Housing Acts:— (i) By the Local Authority:— (a) For the purpose of Part II. of the Act of 1925 Nil (b) For the purpose of Part III. of the Act of 1925 Nil (c) For other purposes (Housing Act, 1930)Nil (ii) By other bodies or persons , Nil 32 TABLE X. HOUSING (CONSOLIDATED) REGULATIONS, 1925 and 1932. The following Table gives particulars of the house-to-house inspection work completed during the year:— Street or Road Inspected No. of Houses or Flats No. of Rooms No of Tenements Notices Served Prelim- Statuinary tory Notices complied with Prelim- Statuinary tory Short Street, Hendon 3 12 4 3 — 3 — Foster Street, Hendon 21 103 30 20 — 19 — Cheshire Cottages, Hendon 4 8 4 4 — 4 — Russell Road, West Hendon 65 384 104 40 2 39 1 Station Villas, Mill Hill 11 66 15 10 — 10 — Saunders Cottages, Mill Hill 6 24 9 6 — 6 — Saunders Place, Mill Hill 8 36 10 8 — 7 — Murray Road, Mill Hill 14 52 14 14 — — — 132 685 190 105 2 88 1 In the case of die outstanding notices, the necessary work is in most cases in progress and nearing completion. 18 Preliminary Notices, outstanding from the year 1932, were complied with during 1933. 1 Statutory Notice, served in respect of premises inspected in 1932, was complied with. 33 HOUSES LET IN LODGINGS. Number of houses on Register at end of year 132 HENDON HOUSING SCHEMES. In connection w'th the Council's Housing Schemes, the following Table allows the progress which has been made and the various types of dwellings which have been erected, together with the Estates upon which they have been built. I am indebted to Mr. G. Hails, Treasurer and Accountant, for furnishing me with this Table:— 34 TABLE XI. HENDON HOUSING SCHEMES. Situation. No. of Houses & Flats Flats 2 bedrooms, 3 bedrooms, living room, living room, bath, etc. bath, etc. Houses 2 bedrooms, 3 bedrooms, living room, living room, bath, etc. batfi, etc. 3 bedrooms, living room, parlour, bath, etc. 4 bedrooms, living room, parlour, bath, etc. Child's Hill 37 — — — 23 14 — Brent Hill 178 — — 20 68 68 22 Total A. 215 — — 20 91 82 22 Child's Hill (pre-war) 50 — — 32 18 — — Bittacy Hill 52 28 24 — — — — Kingsbury Road—B. 52 8 — — 44 — — Brent Hill 90 — — 40 50 — — •Child's Hill 52 — — 40 12 — — The Hyde 156 — — 88 60 — 8 Clitterhouse Lane—C. 300 — — 92 200 — 8 Clitterhouse Road—D. 21 21 — — — — — Goldsmith Avenue—D. 24 24 — — — — — 797 81 24 292 384 — 16 Grand Total 1012 81 24 312 475 82 38 A. "Addison" Schemes—1919 Act—Council's share Id. in the £. B. Subsidies at £6 per house in respect of 52 houses. C. Subsidies at £4 per house in respect of 242 houses. D. Subsidies at £7 10s. Od. per flat. 35 OVERCROWDING. Cases discovered and dealt with 16 Cases outstanding from previous year 2 Cases abated:— By service of notices 4 By granting- of Council houses 2 By removal or voluntary re-arrangement of rooms 8 Total cases abated 14 In the remaining 4 cases, applications which have been made for Council houses await consideration. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS, 1920 to 1933. During the course of the year 1 application for a Certificate under the above Acts was considered by the Public Health Committee, and granted. The neccssary work was done without the issue of the Certificate. 36 Inspection and Supervision of Food. (a) MILK SUPPLY : Dairies, Cowsheds and Milkshops. No. of registered dairymen (including 13 cowkeepers, occupying 18 cowsheds) 87 The above comprise 98 separate premises. The majority of the milk produced at the Dairy Farms is sold wholesale, and no bottling is done at the premises. There are only a few dairies from which milk is sold by retail where bottling is performed on the premises, entailing the cleansing and sterilization of bottles and other vessels. The main milk supply used for local consumption is derived from the large Dairy Companies' central dep6ts, being delivered to the retail dairies in sealed and capped bottles ready for distribution. After use the bottles are collected and returned to these depots, where they are thoroughly cleansed, refilled and capped by modern dairy madhinery. The milk pasteurising depot of the Express Dairy Company at Cricklewood is equipped with all modern appliances and deals with approximately 13,000,000 gallons of milk annually. Samples are taken periodically from this dep6t. The following samples of Graded Milks were taken and submitted for bacteriological examination during the year:— Grade "A" Tuberculin Tested 1 Grade "A" 2 Grade "A" Pasteurised 1 Pasteurised Total 14 til Meat inspection. Public Health (Meat) Regulations, 1924. Slaughter Houses. January, December, 1920. 1933 1933. Registered 6 6 5 Licensed 2 4 4 8 10 9 There is no Public Slaughter House in the District. At 4 of the Slaughter Houses no slaughtering has been performed throughout the year. 121 recorded visits have been paid to the Slaughter Houses on the days fixed for the slaughter of animals or upon the receipt of notice from the occupiers on other occasions. Most of the meat supplies are obtained by the local butchers from the London Meat Markets, so that only a small number of animals is slaughtered at the private slaughter houses. The following table shows the number of animals slaughtered and examined. TABLE XII. Slaughtered and Examined. Condemned and Destroyed. Cattle. Sheep. Pigs. Description. Cause. 7 471 233 Nil. 3 Livers 1 liver 1 liver 1 head Cirrhosis. Milkspot. Abscess. Tuberculosis. 38 There are 83 butchers' shops in the District, to which 281 recorded visits have been paid. These and other premises within the scope of the (Public Health (Meat) Regulations, 1924, have been kept under constant observation. In the course of these inspections several notices have been served upon occupiers, calling their attention to breaches of the Regulations; such notices were conformed to, and further action was found unnecessary. OTHER FOODS. The following foodstuffs, which were voluntarily submitted to the Inspectors for examination, were condemned as unfit for consumption and destroyed:— Meat :— 120 Sheep's Kidneys—mouldy. 53 Frozen Kidneys (Sheep's)—unsound. 22 stones Beef—improperly bled. 15 lbs. Pigs' Kidneys—unsound. Fish :— 12 stones Cod Fillets—unsound. 6 boxes Kippers—unsound Ice Cream (Registration of Premises). 143 premises are now registered under Section 123 of the Hendon Urban District Council Act, 1929, for the sale and/or manufacture of Ice Cream. These premises are inspected periodically. FOOD AND DRUGS (ADULTERATION) ACT, 1928. 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 ending 31st December, 1933. The following Table, showing 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. 39 TABLE XIII. COUNTY COUNCIL OF MIDDLESEX. Borough of Hendon. List of samples taken during the year ended 31st December, 1933 Article. Taken. Adulterated. Milk 205 3 Hake 19 7 Lemon Soles 11 2 Sweets 1 — Meat 2 — Minced Beef 1 — Sausages 3 — 242 12 DISEASES OF ANIMALS ACTS, 1894—1927. Report of Mr. S. J. Chapman, Inspector under Diseases of Animals Act:— Foot and Mouth Disease. On the 11th January, Hendon was by an order issued by the Ministry of Agriculture and Fisheries, included in a "Controlled Area" whereby the movement of cattle, sheep, goats, pigs and deer, could only be effected subject to the issue of Licences by the Inspector of the Local Authority. 18 Licences were issued or countersigned in respect of 164 animals. On February 2nd, Hendon was. by an order, included in an " Infected Area." 27 Licences were issued or countersigned in respect of the removal of 123 animals. Tuberculosis (Tuberculosis Orders 1925 and 1931). Three cows, notified under the Tuberculosis Order, were examined and tested by Mr. E. R. Sherren, the Council's Veterinary Inspector, and were found to be suffering from Tuberculosis. Orders were issued for the slaughter of these animals and the post-mortem examination revealed that 40 two of the cows were suffering from advanced Tuberculosis and one from Tuberculosis not being advanced. The carcases and organs were condemned as unfit for human consumption and with the exception of one hind-quarter were destroyed by incineration at the Hendon Destructor Works. The one hind-quarter was salvaged and used for the feeding of Greyhounds. Compensation paid to owners £1910 0 Salvage obtained £410 0 Note.—Three-quarters of the amount paid in compensation is refunded by the Ministry of Agriculture and Fisheries. Swine Fever. (Regulation of Movement Order, 1922). One Licence was received in respect of 7 pigs which were inspected during isolation period. Rabies. (Rabies Order, 1919). On June 9th, a dog which had attacked and bitten school children and was killed by a police officer, was examined by the Council's Veterinary Inspector, who, on a post-mortem examination, declared that the dog was not suffering from Rabies. This diagnosis was confirmed by the Government Laboratory, to which certain specimens were sent by the Medical Officer of Health. Pending the result of examinations, the children bitten were kept under observation, but suffered no ill effects. 41 Prevalence of, and Control over, Infectious and other Diseases. Table XIV. shows the incidence of notifiable infectious diseases occurring in the Borough during the year. The incidence of Diphtheria remained comparatively low showing only a very slight increase over the preceding year. IScarlet Fever, however, had a high incidence especially during the months of November and December ; this was concurrent with an increased incidence throughout the country generally. The higher incidence mainly affected the school children. The control of infectious diseases in the schools follows closely on the lines of the Board of Education's Memorandum on the Closure of and Exclusion from 'School that is to say that all cases of notifiable infectious diseases in the schools are excluded and examined by your school medical staff before re-admission, all contacts are also excluded for varying periods, depending on whether the case has been removed to hospital and on the incubation period of the particular disease. Periodic visits were paid to the schools by your School Medical Officers while the incidence of Scarlet Fever was high so that any missed or suspicious cases could be dealt with, this procedure was also adopted when the first case of Diphtheria occurred in any department. The result of this was that a number of children were found in school who had symptoms of having recently suffered from Scarlet Fever and others who were highly suspicious were also found, these were excluded from school and certain of the more definite were admitted to hospital, thus preventing further contact of the healthy children with these cases, and it is hoped, minimising the incidence of the disease. As regards the non-notifiable infectious diseases, a system is in force by which the Head Teacher of the Schools affected notify the Public Health Department weekly of any cases excluded on account of the occurrence of Measles, Mumps, Whooping Cough and Chickenpox, here again the exclusion of contacts follows the lines indicated in the Board's Memorandum. It has not been found necessary to close any school or department because of the incidence of infectious disease. 42 In March, 1933, I submitted a report on tlhe question of the admission of complicated cases of Measles and Whooping Cough to your hospital, suggesting therein that as far as possible, these cases should be admitted and in times of epidemic it might even be found advisable to keep the milder cases of Scarlet Fever at home and give preference to the complicated cases of these diseases. This report was approved by the Council but the high incidence of Scarlet Fever and the low incidence of Measles and Whooping Cough during the year rendered any general action along these lines unnecessary, although isolated cases of complicated Measles and Whooping Cough were admitted. The procedure of Schick Testing and if necessary immunising the nursing staff in the Isolation Hospital, was continued. 7 cases of Enteric Fever were notified, these were not connected witih each other and occurred at varying periods during the year, in no case could the infecting agent be traced. 43-44 TABLE XIV. 43-44 Cases of Infectious Diseases notified during the year 1933. Name of District— HENDON (BOROUGH) MIDDLESEX. Notifiable Diseases. Number of cases notified and died. At ages—years. Total cases notified in each locality of the district. Total cases removed to. 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. Burnt Oak. West Hendon Central hendon. Park. Holders Greeii. Harden Suburb Child's Hill. Edgware. Hendon Isolation Hospital. Other Hospital". Scarlet Fever Cases notified 442 1 9 23 19 31 189 90 24 40 14 2 ... 81 84 58 33 74 69 4 22 17 345 27 Deaths Nil. Diphtheria Cases notified 157 2 6 7 12 6 61 28 10 15 8 2 ... 40 51 18 8 6 15 3 9 7 140 ...9 Deaths 4 ...... 1 ... 2 ... 1 ... ... ... ... 2 1 ... 1 ... ... ... Pneumonia Cases notified 132 1 2 1 1 1 13 5 6 27 22 36 17 19 29 17 10 14 21 "2 i4 '6 ... ... Deaths 56 l1 2 ... ... ... ... ... ... 7 6 9 21 10 9 5 9 6 8 2 5 2 ... ... Pulmonary Cases notified 117 ... ... 1 ... ... ... 2 12 53 27 21 1 15 23 22 18 8 14 2 9 6 ... ... Tuberculosis Deaths 76 ... ... ... ... ... ... ... 3 33 14 24 2 21 14 7 7 4 8 3 5 7 ... ... Other Forms Cases notified 33 ... 2 i 1 ... 8 2 3 13 1 1 1 7 6 5 2 2 7 1 2 1 ... ... Tuberculosis Deaths 14 ... 2 ... ... ... 3 2 1 2 2 2 ... 1 3 1 3 1 2 ... 1 2 ... ... Typhoid or Cases notified 7 ... ... ... ... ... 1 ... ... 2 2 2 ... ... 1 ... 1 ... 2 1 1 1 2 "4 Enteric Fever Deaths 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Erysipelas Cases notified 58 44 "2 ... 22 ... 1 44 "i *8 10 24 2 "7 9 "8 12 "3 "6 1 8 4 24 is Deaths Nil. ... Puerperal Fever Cases notified 18 ... ... ... ... ... ... ... ... 12 4 2 ... 1 7 3 1 3 2 ... ... 1 ... 18 Deaths 2 ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... Puerperal Pyrexia Cases notified 45 ... ... ... ... ... ... ... 2 33 5 ... ... 2 27 "4 1 2 3 ... 3 3 ... 42 Deaths Nil. Ophthalmia Cases notified 4 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... 1 ... ... 1 Neonatorum Deaths Nil. ... Encephalitis Cases notified 1 ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ...... ... ... ... Lethargica Deaths Nil. ... Acute Cases notified 4 ... 1 ... ... ... 2 ... 1 ... ... ... ... ... ... 3 ... ... ... ... ... I ... 3 Poliomyelitis Deaths Nil. ... ... Food Poisoning Cases notified 3 ... ... ... ... ... ... ... 1 1 ... 1 ... 1 ... ... ... ... 1 ... ... 1 2 ... Deaths Nil. ... ... Cerebro Spinal Cases notified 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 2 Fever Deaths 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... Small-pox Cases notified 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... l ... V Deaths Nil. 45 TABLE XV. Disease. Case rate per 1,000 population. Hendon England and Wales Small Pox 0.00 0.02 Scarlet Fever 3.46 3.21 Diphtheria 1.23 1.18 Enteric Fever 0.05 004 Puerperal Fever 0.14 0 05 Puerperal Pyrexia 0.35 0,14 Erysipelas 0.45 0.45 The following are the number of cases of Diphtheria and Scarlet Fever notified during the last five years:— TABLE XVI. Disease. 1929. 1930. 1931. 1932. 1933. Scarlet Fever 304 347 265 217 442 Diphtheria 156 192 193 143 157 •Disinfection of the clothing, bedding and premises is done after removal of each case of practically all notifiable diseases, and the following statement shews the work carried out during the year:— 990 infected rooms and places disinfected by spraying with a solution of Formalin, or by vaporising of Formaldehyde Tablets. 162 infected rooms were cleansed by stripping of wallpapers from walls and washing of ceilings; 153 as the result of informal notices and 9 in compliance with notices served under the Infectious Disease Prevention Act, 1890. The disinfection of bedding, etc., was done at the Disinfection Station by steam in a u Thresh "apparatus; all articles were returned after disinfection in a covered van. 593 Library Books were collected from infected houses, 57 were destroyed and 536 disinfected and returned to houses or libraries from which issued. 46 VACCINATION. The Vaccination Acts are administered by the Middlesex County Council. I am indebted to Mr. A. E. Taylor for the table of vaccination which follows:— TABLE XVII. Number of births registered 1624 Successfully vaccinated 970 Insusceptible of vaccination 9 Exemptions 309 Dead, unvaccinated 68 Postponements by Medical Certificates 31 Removed to other districts, and cases not found 210 Number of birth? unaccounted for ... ...; 27 Number at all ages vaccinated during the year (Primary) Born within district 883 Born out of district 193 OPHTHALMIA NEONATORUM. Arrangements have been made with the London County Council for the admission of children suffering from this disease to be admitted to St. Margaret's Hospital, where the severity of the symptoms render hospital treatment a necessity. The following table shows the particulars of the cases which occurred TABLE XVIII. Cases of Ophthalmia Neonatorum. Treated. Vision Unimpaired. Vision Impaired. 1 Total Blindness. Deaths. Notified. At Home. 111 Hospital. 4 3 l 4 | — — 47 tuberculosis. The control of Tuberculosis is divided between the County Council and this Authority. The County Council are responsible for the sanatorium treatment and diagnosis. With regard to the latter they have established a Tuberculosis Clinic at The Broadway, West Hendon, at which their Specialist Officer attends on Friday mornings. The duties of this Authority are mainly the arrangements for bacteriological examinations of specimens, disinfection of premises and the visiting of cases who have ceased from one cause or another to avail themselves of the facilities provided by the County Council. The following is a table of the new cases and mortality during the year 1933 00 TABLE XIX. TUBERCULOSIS. NEW CASES AND MORTALITY DUiRING 1933. NEW CASES. DEATHS. Age Periods. Pulmonary. N on-pulmonary. Pulmonary. Non-pulmonary. M. F. M. F. M. F. M. F. 0—1 — — — — — — — — 1—5 — 1 5 — — 2 — 5—10 1 1 6 2 — — 2 i 1 10—15 1 1 3 3 — — 1 1 15—20 4 11 1 3 1 2 1 — 20—25 6 13 2 8 3 8 1 — 25—35 20 25 4 5 10 12 1 — 35—45 19 15 — 1 8 6 1 1 45—55 11 4 1 — 13 5 1 — 55—65 7 2 — — 5 1 i — 65 and upwards 1 — 1 1 1 — — Totals 70 73 23 22 41 35 11 3 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths is 14.90. 49 BACTERIOLOGICAL EXAMINATIONS. The Council have made an arrangement with the University College Hospital for the investigation and reporting upon pathological and bacteriological specimens forwarded by the practitioners in the area. This provision is largely used, as the table which follows very clearly shows:— TABLE XX. Total Number. Positive. Negative. Throat swabs for Diphtheria Bacillus 1161 89 1072 Typhoid Fever, Blood Examinations (agglutination), Paratyphoid, etc. 21 9 12 Tuberculosis, Sputum 198 15 183 Hairs — — — Urine for Typhoid, Paratyphoid, etc. 10 1 9 Fceces for Typhoid, Paratyphoid, etc. 14 I 13 Cerebro Spinal fluid for Meningococci, etc. 1 — 1 Virulence tests 111 25 86 Swabs for Haemolytic Streptococci 43 12 31 Swabs for infecting organisms 2 — 2 Blood cultural examination 6 — 6 Pus for Tubercle Bacilli 2 — 2 Pleural effusion for Tubercle Bacilli, etc. 1 — 1 Urine for Tubercle Bacilli 1 — 1 Glauber Salts for special chemical examination 1 50 ISOLATION HOSPITAL. The building of the new ward of 26 beds with the necessary additions to the administrative quarters was commenced in January, 1934, and it is hoped that it will be ready for occupation by July. The ward will be one consisting- of 26 beds built on the lines of the one recently added, the only difference being- that french windows are provided throughout the ward instead of at the end only as was done in the last ward to be built. The necessary additions to the administrative block consist of 11 bedrooms, one bathroom, 2 water-closets and two basins. SECTION 63, LOCAL GOVERNMENT ACT, 1929. The County Scheme made under this section was received in August and was on the lines foreshadowed in my last two annual reports, viz. :—that the County should be divided into four areas and that the hospitals in these areas should be acquired by joint hospital boards or committees and enlarged or abandoned, depending on their present condition and capabilities of expansion. This scheme was opposed by this Council and the following letter was sent to the Ministry of Health on the 3rd October, 1933 " The Hendon Borough Council have given most careful consideration to the Scheme for the provision of adequate hospital accommodation for the treatment of Infectious Disease, other than smallpox, within the County of Middlesex, which has been submitted to the Minister of Health by the Middlesex County Council in accordance with the provisions of (Section 63 of the Local Government Act, 1929, and I am directed to submit the following representations thereon to the Minister, the effect of which was communicated to the County Council prior to the submission of the scheme to the Minister. While fully realising the necessity for the provision of adequate hospital accommodation for the treatment of infectious disease within the County, a matter which has engaged their serious attention for some time past, they cannot agree that the proposals of the County Council will achieve that end in the most efficient and economical manner, 51 They feel that the attention of the County Council should be directed towards making available for the use of the inhabitants of the County existing and future accommodation provided or to be provided by urban sanitary authorities which have already proved their capacity adequately to administer the public health powers conferred upon them by Parliament. To divest those authorities of their functions in relation to the treatment of infectious disease-, and transfer such functions to Joint Boards would not be in the best interests of local government. The result would be to create an unnecessary multiplicity of ' ad hoc ' bodies and to produce an undesirable increase in financial burdens. Such a procedure would have the added disadvantage of taking away from those authorities most familiar with such matters the administration of important public health powers and bestowing such powers upon new authorities with no direct electoral representation and financial responsibility. The Hendon Isolation Hospital, which is a most up to date institution and will shortly provide 120 beds, is adequate to meet the needs of the Borough and can readily be extended to cover the requirements of a considerably larger area. Sufficient land has been acquired and the layout so arranged that the Hospital is capable of extension to accommodate 300 to 350 beds. By the adoption of double stories, this number could readily be increased to 450. One of the methods of co-operation set out in Memorandum L.G.A. 40 is by contract for the reception of patients from other areas. In the opinion of the Hendon Council this is the method which should be adopted and they have already indicated to the County Council their willingness to enter into an agreement on terms to be arranged with the Urban Districts of Wealdstone and Harrow and the Rural District of Hendon for the reception of cases of infectious disease and in case of need, so far as is practicable and subject to mutual arrangements, patients from other districts in Middlesex. This course would avoid the creation of an entirely new authority and leave the control of the hospital in the hands of those responsible for its erection and successful development up to the present time, while rendering its accommodation available for those areas where sufficient provision has not yet been made. The advantages from the financial point of view are apparent. It is fully realised that the ultimate population of the proposed Hospital Area No. 2 may render necessary at a later date the erection of a further Isolation Hospital. In view of the pending amalgamation of the Urban Districts of Harrow and Wealdstone and the Rural 52 trict of Hendon it is felt that this new Urban District, with an area of 12,423 acres would form a suitable unit of sufficient size to function successfully and economically as an authority for Isolation Hospital purposes and could well administer a hospital centrally situate and convenient of access to patients from all parts of the greater Harrow area. Such a hospital should, it is felt, be erected and maintained by the greater Harrow Urban District Council, which would be fully competent to carry out its functions wihout the intervention of a new authority—a joint board. Willesden, Wembley and Kingsbury (with an area of 10,778 acres) could most appropriately be catered for by the existing Willesden Hospital extended to meet future requirements. This would leave the Hendon Isolation Hospital available primarily for patients from the Borough, which has an acreage of 10,471. There would then be in the proposed Area No. 2 three urban sanitary authorities carrying out the functions entrusted to them by statute and providing isolation hospital accommodation for areas similar in size. Reciprocal arrangements would be entered into by these authorities for the reception of patients from other areas, as and when necessary. Such a scheme as that outlined above would in the opinion of the Hendon Borough Council have the advantage of avoiding, as far as practicable, any undesirable increase in the number of authorities operating in the respective districts, would prove most convenient from the point of view of the patients, and would ensure the greatest degree of efficiency and economy. The Council understand that the Willesden Council has asked the Minister of Health to receive a deputation to discuss the matter. In the event of the Minister agreeing to the proposal I am directed to ask that he will, at the same time, consent to receive a deputation from this Authority." This was followed up by a deputation from Willesden and Hendon, the latter consisting of the then Deputy Mayor, Alderman C. C. Cartwright, M.B.E., J.P., Councillor J. J. Copestake, Chairman of the Public Health and Medical Services Committee, and Councillor A. S. F. Ford, there the objections were reiterated and amplified but so far the decision of the Ministry has not been received. 53 It will be seen that the work of the Hospital has increased very considerably, during the year 561 patients being admitted as against 364 in the previous year. This increase was mainly due to the higher incidence of Scarlet Fever which prevailed not only in Hendon but throughout the country generally. CASES TREATED DURING YEAR, 1933. On January 1st, 1933, there were 47 patients in hospital. During the year 561 cases were admitted, thus the total number of patients treated in the hospital at any time during 1933 was 608. There were 504 discharges and 7 deaths during the year, leaving on December 31st, 1933, 97 patients in hospital. The above facts, classified according to the notified disease on admission are shewn in the following table :— TABLE XXI. Cases Notified as :— In Hospital beginning of year. Admitted during year. Died during year. Discharged during year. Remaining in Hospital at end of year. Diphtheria 19 129 3 114 31 Observation Diphtheria 3 20 — 21 2 Diphtheria Carrier 1 1 — 1 1 Scarlet Fever 20 325 — 290 55 Observation Scarlet Fever 1 21 — 20 2 Erysipelas 1 25 — 23 3 Typhoid Fever — 1 — 1 — Observation Typhoid Fever — 3 — 3 — Observation Paratyphoid — 2 — 2 — Measles — 7 — 7 — Whooping Cough — 10 3 7 — Mumps — 1 1 — — Vincent's Angina — 1 — 1 — Otorrhœa — 1 — — 1 Diphtheria and Scarlet Fever 1 — — 1 — Diphtheria and Whooping Cough – 1 – 1 – Scarlet Fever and Chicken Pox 1 3 — 3 1 Septic foot — *1 — 1 — Knee injury — *1 — 1 — Observation — 8 — 7 1 Totals 47 561 7 504 97 * Members of Hospital Staff, 84 TABLE XXII. The numbers of admissions, deaths and discharges during the year, compared with those of the two preceding years, are shewn below:— Cases Notified as :— 1931 Admissions. 1932. 1933. 1931. Deaths. 1932. 1933. 1931 Discharges. 1932. 1933. Diphtheria 149 122 129 5 6 3 143 129 114 Observation Diphtheria 6 9 20 — — — 3 9 21 Scarlet Fever 194 163 325 1 2 — 212 161 290 Observation Scarlet Fever 10 12 21 1 1 — 6 13 20 Erysipelas 5 14 25 1 1 — 4 12 23 Measles 2 24 7 — 4 — 1 21 7 Whooping Cough 2 5 10 — 1 3 2 4 7 Mumps 1 — 1 — — 1 1 — — Cerebro-spinal Meningitis 1 — — 1 — — — — — Other Diseases 10 15 23 — — — 10 12 22 380 364 561 9 15 7 382 361 504 55 FINAL DIAGNOSIS.- The final diagnosis arrived at in connection with the 511 completed cases was as follows :— Scarlet Fever 290 Diphtheria 127 K.L.B. Rhinorrhœa 1 Follicular Tonsillitis 14 Streptococcal Throat 3 Peritonsillar Abscess 2 Quinsy 1 Septic Throat 1 Vincent's Angina 1 Measles 7 Rubella 2 Whooping Cough 8 Cellulitis of Face and Septicaemia 1 Erysipelas 21 Typhoid Fever 1 Paratyphoid Fever 3 Food Poisoning (Bacillus Aertrycke) 2 Constipation 1 Erythema Nodosum 1 Arthritis 1 Pharyngitis 1 Catarrhal Laryngitis 1 Common Cold 1 Otitis Media and Drug Rash 1 Septic Foot (member of Staff) 1 Knee injury 1 No observed disease 2 *Mixed Infections :— Diphtheria and Scarlet Fever 6 Diphtheria and Whooping Cough 2 Scarlet Fever and Chicken Pox 4 Scarlet Fever and Whooping Cough 1 Scarlet Fever and Influenza 1 Whooping Cough and Erysipelas 1 15 511 * Both present on admission. 56 DIPHTHERIA.— 1931. 1932. 1933. Cases discharged or died, notified Diphtheria 148 135 139 Cases found to be suffering from Diphtheria on admission 117 127 135 Deaths from Diphtheria 5 6 3 Case Mortality Rate (corrected) approx. 4.3% 4.7% 2.2% Of the three deaths from Diphtheria, two were due to the laryngeal type of disease, tracheotomy being necessary in both cases. The other case died from haemorrhage and cardiac failure. Double Infections.— Six cases of Diphtheria were found to be suffering also from Scarlet Fever on admission; two cases of Diphtheria had concurrent Whooping Cough, one of these developing Scarlet Fever whilst in hospital. Complications.— Following are the complications met with among the completed cases of Diphtheria :— Cardiac paresis 1 Bradycardia 3 Cardiac irregularity 9 Haemorrhage and cardiac failure 1 Extra systoles 4 Mitral stenosis 1 Palatal Paresis 4 Ocular Paresis 2 Nephritis 1 Otitis 2 Adenitis 5 Haematuria 1 Rhinorrhœa 1 Peritonsillar abscess 2 Tonsillitis 1 Conjunctivitis 1 Cellulitis of face 1 Furunculosis 1 Septic finger 2 Septic knee 1 Serum Reactions :— Urticaria 8 Erythema 3 57 Average Stay In Hospital of Cases notified as Diphtheria was 63.5, an increase of 4 days as compared with the average of 59.5 days for all diphtheria cases from 1930 to 1933 inclusive. Type of Disease.— The type of disease during the year has been of moderate severity, but in the latter months a number of particularly severe cases were admitted. SCARLET FEVER.— 1931. 1932. 1933. Cases discharged or died, notified Scarlet Fever 213 163 310 Cases found to be suffering from Scarlet Fever on admission 206 166 302 Deaths from Scarlet Fever 1 2 — Case Mortality Rate (corrected) approx. 0.5% 1.2% Nil. Double Infections.— Twelve cases were found, on admission, to be suffering from the following diseases in addition to Scarlet Fever :— Concurrent Diphtheria 6 ,, Chicken Pox 4 ,, Whooping Cough 1 ,, Influenza 1 Complications.— The following complications were met with among the 310 completed cases of Scarlet Fever :— Arthritis 1 Albuminuria (marked) 1 Nephritis 3 Adenitis (marked) 53 Otitis 23 Mastoiditis 5 Rhinitis 22 Rheumatism 5 Scarlatinal relapse 2 Vaginal Discharge 5 58 *Diabetes 1 *Empyema 1 Stomatitis 1 Bronchitis 1 Chorea 1 *Fractured olecranon 1 *Fractured femur 1 *Scalds 1 *Ringworm 1 Peritonsillar abscess 1 Nasal polypi 1 Cellulitis 1 *Ulcer of leg 1 Stye 2 Boils 2 Furunculosis 1 Septic Finger 6 Serum Reactions :— Urticaria 6 Erythema 1 7 Present on admission. Average Stay in Hospital of cases notified as Scarlet Fever was 34.9 days, representing a decrease of 4.3 days as compared with the average of 39.2 days for all Scarlet Fever cases during the period 1930 to 1933 inclusive. Type of Disease.— The type of disease has been of ordinary severity. The number of cases treated during 1933 is double that of the previous year, due to increased incidence in the latter half of the year. Complications of the Ear, Nose and Throat have been more frequent, operation being required in 17 cases. Return Cases.— 13 return cases of Scarlet Fever occurred during the year. ERYSIPELAS.— 25 cases notified as Erysipelas were admitted during the year; a further case was in hospital at the commencement of the period. 23 of these patients were discharged during the year, leaving 3 in hospital at 31st December, 1933; these have since made satisfactory recoveries. The diagnosis was confirmed in respect of 21 of the 23 completed cases; the other two were found to be suffering from Erythema Nodosum and Arthritis respectively. 59 One case of Erysipelas had concurrent Tubercular Laryngitis on admission. The average stay in hospital of the completed cases of Erysipelas was 27.8 days. WHOOPING COUGH.— 10 cases notified as Whooping Cough were admitted during the year. Of the 9 patients who were found to have Whooping Cough on admission, one was also suffering from Erysipelas, whilst another had concurrent Diphtheria. This latter patient later contracted Scarlet Fever. Three deaths from Whooping Cough occurred; all three cases were complicated by broncho-pneumonia, two of them in addition suffering from Empyema and Erysipelas respectively. MEASLES.— 7 cases were notified. All made satisfactory recoveries, the diagnosis being confirmed in every case. ENTERIC FEVER.— 6 cases of suspected Enteric Fever were admitted. All made satisfactory recoveries, the final diagnosis being :— Typhoid Fever 1 Paratyphoid Fever 2 Food Poisoning 2 Constipation 1 VINCENT'S ANGINA.— One case of this disease was admitted and made a satisfactory recovery after 19 days in hospital. DIPHTHERIA AND WHOOPING COUGH.— One case was notified as co-existant Diphtheria and Whooping Cough. The diagnosis was confirmed and the patient made a satisfactory recovery. SCARLET FEVER AND CHICKEN POX.— Three cases were admitted notified as suffering from concurrent Scarlet Fever and Chicken Pox. All made satisfactory recoveries, the diagnosis being confirmed in every case. 60 DIPHTHERIA AND SCARLET FEVER.— One case, notified as concurrent Diphtheria and Scarlet Fever, was discharged during 1933, having been admitted in the previous year. The patient was suffering from Diphtheria only. MUMPS.— One case, which was admitted notified as Mumps, died from Cellulitis of face and Septicaemia. CROSS INFECTION.— One case of Erysipelas developed Scarlet Fever. One case of Diphtheria and Whooping Cough developed Scarlet Fever. LABORATORY WORK.— During the year, 1,339 cultures were examined for the diphtheria bacillus, 2 smears were examined bacteriologically, and 8 chemical examinations of urine were carried out. SCHICK TESTS.— 28 Schick tests were performed, 15 proving positive and 13 negative. Of these, 9 were immunised against Diphtheria. DICK TESTS.— 5 Dick tests were carried out, all proving negative. GENERAL SURGEON.— During the year, Mr. Trevor Jones operated on two cases, the first being an aspiration of the chest and the second a tracheotomy. He also saw a third patient in consultation. ORTHOPÆDIC SURGEON.— Mr. Turner was called in in consultation to a case of Scarlet Fever complicated by a fractured femur. RADIOLOGIST.— The services of a radiologist were obtained and two X-ray photographs of the chest taken in the case of a patient admitted with Typhoid Fever and suspected of having Pulmonary Tuberculosis. 61 Aural surgeon.— During the year, Dr. Dan McKenzie was called for the following consultations and operations :— Examinations (including post-operative examinations) 23 Operations.— Mastoidectomy 7 Double Mastoidectomy 3 Paracentesis of drum 3 Wilde's incision 1 Removal of:— Adenoids 1 Tonsils 1 Tonsils and Adenoids 1 17 INFECTIOUS ILLNESS AMONGST STAFF.— One member of the nursing staff contracted Diphtheria and another contracted Scarlet Fever. CONSULTATIONS. The practice of seeing doubtful cases of infections at the request of Medical Practitioners in the area was continued and during the year 67 such consultations were made. COSTS OF THE HEALTH SERVICES'. 1 am indebted to the Borough Treasurer for the following summary of the costs of health services for the financial year ended 31/3/33 :— TABLE XXIII. Total Cost. Grant in Aid. Nett Cost to Rates. Rate in £. pence. £ s. d. £ s. d. £ s. d. Nuisance abatement, sanitation and general cost of Health Department 3853 9 8 – – – 3853 9 8 .7 Isolation Hospital 15536 14 7 — — — 15536 14 7 2.7 Maternity and Child Welfare Services 5422 8 6 2300 0 0 3122 8 6 .5 School Medical Services 7638 0 11 3819 0 5 3819 0 6 .7 62 In conclusion 1 should like to thank the members of the Council, especially the Chairman and members of the Public Health Committee for their continued interest and help in all matters affecting the public health. I desire also to place on record my appreciation of my staff who have carried through the growing volume of work efficiently and successfully. I should like also to extend my thanks to the voluntary workers without whose help it would be difficult to adequately deal with the numbers now attending the centres. I have the honour to be, Ladies and Gentlemen, Your obedient servant, A. FAIRCRIEVE ADAMSON, Medical Officer of Health. SCHOOL MEDICAL SERVICES. 64 HENDON EDUCATION COMMITTEE. Members of the Committee : CHAIRMAN : Alderman W. M. Maughan. VICE-CHAIRMAN : Alderman (Mrs.) IS. J. Bannister, L.L.A. THE MAYOR: Alderman C. C. Cartwright, M.B.E., J.P. THE DEPUTY MAYOR: Councillor B. Flowers. ALDERMEN: S. H. Egan, J.P., F.R.I.B.A., C. Latham, J.P., F.L.A.A , L.C.C. W. H. N. Shakespeare, M.C., A.F.C., J.P. COUNCILLORS : E. Arter, M.C., M.I.A.E., B. J. Monro, J.P., J. J. Copestake, C. Pinkney, A. W. Curton, G. R. Richardson, A. S. F. Ford, W. J. Ross, F.A.I., P. Lightfoot, S. E. Sharpe, (Mrs.) M. Thomas. CO-OPTED MEMBERS. Major N. G. Brett James, The Rev. J. Goggin, M.A., B.Litt., F.S.A., The rev. j. Livingstone, The Rev. C, E. de R. Copinger, The Rev. J. S. Poulton. 65 STAFF. School Medical Officer : A. Fairgrieve Adamson, M.D., D.P.H. Assistant School Medical Officers : Ethel M. L. Leitch, M.B., Ch.B. G. G. Stewart, M.R.C.S., L.R.C.P., D.P.H. W. F. T. McMath, M.D., M.R.C.P., D.P.H., resigned, 31/3/33. E. A. Johnston, M.A., M.B., Ch.B., D.P.H., commenced, 10/5/33. Ophthalmic Surgeon (part-time) : J. G. Milner, F.R.C.S. Orthopcedic Surgeon (part-time) : H. J. Seddon, F.R.C.S. Dental Officers : T. Wynne-Jones (part-time), L.D.S., R.C.S. R. M. Underwood, L.D.S., R.C.S. Anesthetist (part-time) : G. Moriarty, M.B., Ch.B., M.D. Chief Clerk : C. C. Knudsen. Clerks : C. H. Machin. A. B. Reynolds. Miss D. Burns, resigned, 27/10/33. E. F. Higham. Miss K. A. Hick, commenced, 23/10/33. R. Betteridge. Health Visitors : *Mrs. M. E. Bascom. *Miss M. Trickett. *Miss M. Lake. *Miss D. V. Atkinson. *Miss L. F. Ray. *Miss D. Snow. *Miss M. C. E. Stewart. *Miss C. Hall. *Miss A. L. Wharton. *Miss P. Bennett. *Miss F. Case. *Miss I. Doull. Masseuse (part-time) : Miss Chapman. * Employed by Council and Education Committee 66 SCHOOLS. No of Children on rolls, 31/12/33. Provided. — Algernon Road 884 Bell Lane 461 Burnt Oak 324 Child's Hill 930 Colindale 332 Garden Suburb 586 The Hyde 979 Wessex Gardens 986 Barnfield 1336 Woodcroft 1453 Goldbeaters 1248 Meads 752 Deansbrook 519 Edgware 524 Orange Hill Central 674 11988 Non-Provided.— All Saints' C.E. 237 St. Agnes' R.C. 226 St. John's C.E. 132 St. Mary's C.E. 638 St. Mary's R.C. 124 St. Paul's C.E. 246 St. Vincent's R.C. 189 The Annunciation R.C. 555 2347 Total 14,335 67 HENDON EDUCATION COMMITTEE. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE YEAR 1933. To the Chairman and Members of the Education Committee. Ladies and Gentlemen, I have the honour to submit my report on the work of your School Medical Services for the year 1933. The report is in accordance with the suggestions contained in the Board of Education Form 6M (Schedule), dated January, 1934. CO-ORDINATION. The arrangements for the co-ordination of the work of the School Medical Services with that of other health services are as follows :— (a) The Public Health and Medical Services Committee have control of all health services and are responsible for the administration of legislature affecting public health. (b) The Medical Officer of Health is also the School Medical Officer. (c) His assistants also act as assistant school medical officers. (d) The specialist officers are engaged in both maternity and child fare and the school medical services. (e) The Health Visitors are also appointed to act as School Nurses. (f) The health centres are used for the dual purpose of maternity and child welfare and school medical work. When a child attains school age any medical history of importance is transferred from his maternity and child welfare record card to his school medical card, thus ensuring continuity throughout the years when he is under the care of this authority. The treatment provided for many conditions is also designed to be continuous, and children under 5 years of age may attend the orthopaedic, dental or ophthalmic centres and if necessary, the treatment is continued into their school life. 68 THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. SCHOOL HYGIENE.— The hygienic conditions of the public elementary schools in the area is generally very good, as many of them are of recent construction.. The following works of improvement have been carried out during the year :— Algernon Road School.—Additional lights installed. Wood block flooring relaid in five classrooms and hall of Senior Department. New window in one classroom of Infants' Department to give better lighting. Childs Hill Infants' School.—Additional lighting installed. Staffrooms re-decorated. Burnt Oak School.—Renewals carried out in children's lavatories. The Meads School.—Additional lights installed in both departments. Woodcroft Infants' School.—Platform provided for Assembly Hall. Montessori shelving fitted in one classroom. Various Schools.—Pin rails have been provided around the walls of classrooms for the purpose of displaying children's work. Garden Suburb Infants' School.—Installation of a centrifugal accelerator and alterations to radiators and connections to provide more adequate heating. Desks.—All small and obsolete desks have been removed and replaced by baby tables and chairs and up-to-date dual desks. Blackboards.—Reversible Swing Blackboards have been provided for new schools instead of separate blackboards and easels. Playgrounds.—A number of school playgrounds were topped and dressed during the Midsummer Holidays. Cleanliness of School Rooms.—The classrooms and halls of all schools have been swept daily with Dusmo Sweeping Powder. Drying of Children's Clothes.—In all new schools hot water pipes were installed for the purpose of drying children's clothes during inclement weather, 69 ADDITIONAL SCHOOL ACCOMMODATION. (A.) COLINDALE AREA.— A new school for 400 children with an age range of 5 to 11 years was opened in April, 1933. (B) OTHER AREAS.— Owing to overcrowded conditions obtaining at Deansbrook, Wessex Gardens, St. Mary's C.E., Algernon Road and the Hyde Schools, the Board of Education have approved the erection of new schools and extensions as follows :— Plans already approved by Board of Education :— (i) Deansbrook Junior Department.—Accommodation 400; age range 8—11 years. To be opened after Midsummer, 1934. (The existing building will be organised as an Infants' Department, accommodation 400, age range 5—8 years). (ii) Clitterhouse Junior and Infants' Diepartment.—Accommodation 400; age range 5—11 years. To be opened in May, 1934. (iii) Sunnyfields Infants' School.—Accommodation 300; age range 5—8 years. To be opened in January, 1934. (iv) St. Mary's C.E. School.—Alterations and extensions to this school were commenced in July. When completed the school will be re-organised into Senior Mixed and Junior Mixed Departments with accommodation of 280 and 309 respectively. To be opened in January 1934. (v) R.C. School of the Annunciation.—The erection of a new Central School has been approved to accommodate 320 children of 11+ on a site already acquired in Orange Hill Road. This school will contain a Science Room for 40 children and Domestic Science and Manual Instruction Rooms with accommodation for 20 children in each room. To be opened after Midsummer, 1934. The schools now being built are of a semi open air type a typical plan of which is shown on the opposite page. They are planned around a court with sliding fronts to the classrooms opening on to a corridor and facing the court. All windows open and cross ventilation is arranged up to ceiling level. Low pressure hot water radiant panel heating from the ceiling is now installed, previously high temperature electric panel heating was used, this proved effective but was costly. 70 The external and internal walls and partitions are constructed of 4 in. by 2 in. stud framing carried on brick piers, covered externally with an insulating board ½ in. thick, metal lathed, rendered in two coats and decorated with a waterproof paint. Internally all walls are pine panelled up to 4 ft. high to school rooms and 7 ft. high to staff rooms, above same and to ceilings 3/8 in. plaster or ½ in. insulating board is used. The flooring is hardwood strip laid on a ½ in. insulating board. Drinking fountains push valve operated with jet delivery are used throughout both inside school building and in the playgrounds, thus avoiding the necessity of many children using the same receptacle. Gardens and shrubberies are laid out around the playgrounds and in the central court the latter being tended by the children and the whole effect is very pleasing. MEDICAL INSPECTION. The scheme of inspection adopted in previous years has continued, each child being examined three times during his school life at routine medical examinations, at his entrance, at about the age of 8 years, and again about the age of 12 years. These routine inspections are carried out in the schools and in the more recently erected schools special accommodation is provided for this purpose. To examine the numbers necessary during the year without hurry, it is essential that the arrangements should run smoothly and without the willing co-operation of the teachers this would be impossible and I should like to take this opportunity of expressing my appreciation of their assistance. In addition many children were referred by the Health Visitors, Teachers, or parents for special examination because of some suspected or actual defect. These examinations are carried out at the various health centres. Altogether 4,921 routine examinations were made and 5,419 special inspections, in addition 3,550 re-inspections were made. FINDINGS OF MEDICAL INSPECTION. The children generally were found to be in good health and while the following paragraphs may tend to create an impression of there being a large number of children with departures from the normal standard of health, there must be kept in view the number of children examined and the total numbers on the school roll :— (A) MALNUTRITION.— A careful search has been made for all children suspected of being mal nourished, school teachers, attendance officers and health visitors being in- 71 structed to refer any child suspected of mal nourishment to the appropriate centre for examination and altogether during the year 200 children were found whose nutritional condition could be regarded as sub-normal. It is very difficult to be precise in this matter as there obviously can be no definite standard for groups of children, the height and weight standard in relation to age being fallacious. The only reasonable standard is the expert knowledge of the examining officer accustomed to seeing many children in a normal nutritional state and it is on that solely, that those referred were judged. (B) UNCLEANLINE'SIS.— The general standard of cleanliness throughout the schools is satisfactory and is improving. Periodical visits are paid by the school nurses to each school and all children are examined. Altogether 835 children fell below a reasonable average in this respect and in four cases it was necessary to have the children cleansed at one of the centres but in no case was it necessary to take proceedings against the parents, the desired standard being achieved by persuasion. (C) MINOR AILMENTS AND DISEASES OF THE SKIN : The treatment of minor ailments is generally carried out by nurses and includes such conditions as minor diseases of the skin, eyes, cuts, bruises, burns, etc. It is advisable to undertake such treatment early so that the risk of sepsis and other troubles may, as far as possible, be avoided and interference with the child's school life reduced to a minimum. A Medical Officer is present on certain days during the week as many children present themselves with conditions which are too serious to be safely dealt with by the school nurse in attendance. The following Table shows the number of attendances at the Minor Ailment Clinics during the year 1933 :— TABLE XXIV. CLINICS. 1933. Burroughs House, Hendon 1908 Child's Hill 3449 West Hendon 5784 Watling Estate 17786 Total 28927 72 (D) VISUAL DEFECTS.— During 1933, the number of new cases referred to the Ophthalmic Surgeon was 606. It was found that 367 of these required glasses, and by the end of the year 347 had obtained them. Several operations have been performed by the Ophthalmic Surgeon upon children from the clinics. The details of these are as follows :— Operations for squint 15 Operations for congenital cataract 1 Radium for growth of the retina 1 In addition, a number have been referred to hospital for inflammations, corneal ulcers, etc. One child was sent to the Radium Institute for treatment for a nævus of the eyelid, and is progressing favourably. With a few exceptions, the operations were performed at the Royal Westminster Ophthalmic Hospital, and to this hospital also were referred the cases of inflammation referred to above. In addition, some of the squint cases have had the advantage of training in the Orthoptic Department of the hospital. The attendances during the year were as follows :— ATTENDANCES AT EYE CLINICS—1933. Central Hendon.— School Medical Service Cases 1009 Maternity and Child Welfare Cases 58 Watling.— School Medical Service Cases 1203 Maternity and Child Welfare Cases 57 2327 Total School Medical Service Cases 2212 Total Maternity and Child Welfare Cases 115 2327 73 (E) NOSE AND THROAT DEFECTS.— The number of children suffering from defects of the nose and throat is shown in Table II. at the end of this report. The defects are very carefully assessed, such things being considered as the age of the child, interference with function, and whether or not the condition is prejudicial to health. It is only after this careful survey that a recommendation for operative treatment is made. The scheme for operative treatment remains as in previous years and during the year 225 children were operated upon for tonsils or adenoids or both. There is a difference of medical opinion as to the advisability or otherwise, of operative interference but of due care is taken in the selection of cases, the benefit to health, both physical and mental is often most marked. (F) EAR DISEASES AND DEFECTIVE HEARING.— During the year 9 children were discovered to be suffering from defective hearing but not of sufficiently serious a nature as to preclude their being educated at a public elementary school, this Authority also maintains at special schools 7 children whose degree of deafness is so serious as to totally preclude their being so educated. One of the most intractable defects with which one has to deal is ear disdharge. This is often allied to a septic condition of tonsils and adenoids and the removal of these sometimes effects a cure or a marked improvement but there are many cases in which the condition of the tonsils or adenoids does not justify operative interference and for such cases routine irrigation is carried out and some of the more severe, referred to one or other of the ear, nose and throat hospitals. On the whole the treatment of these conditions cannot be regarded as satisfactory and apart from the general lowering of health which a chronic discharge of any kind gives rise to, there is the prospect of certain of the children developing varying degrees of deafness in later life. (G) DENTAL DEFECTS.— All the children attending the public elementary schools are now included in your scheme of dental inspection and treatment. The ideal scheme is one where all children are examined at least once every year and acceptances of treatment obtained in all cases where it is necessary. 74 With your present dental staff of one full time and one part time dental officer, it was only found possible to examine 9,488 children in view of the fact that the acceptances of treatment have increased very markedly, as out of 4,470 children found to require treatment, over 3,000 were actually treated. This was mainly due to propaganda at the dental inspections and while in itself gratifying, it w ill undoubtedly require additional dental staff to cope with the numbers now on the school roll. The importance of the yearly dental inspection is that if too long a period is allowed to elapse between inspections a proportion of the work which has previously been carried out by your dental officer will be wasted, as dental treatment can never be said to be completed. This is especially so in the school period of life which is the formative period as regards dentition. At that time if dental caries becomes established it tends to progress with alarm-, ing rapidity. Provision has therefore been made in the estimates for the year 1934/35 for additional dental staff. (H) ORTHOPEDIC AND POSTURAL DEFECTS.— The scheme for the treatment of these defects remains as in previous years. Your Orthopaedic Surgeon attends at two sessions each month and the nurse provided by the Royal National Orthopaedic Hospital seven sessions each week. Arrangements have been made for in-patient treatment, where necessary, with the Royal National Orthopædic Hospital at Stanmore. Any necessary operative treatment is carried out there by your Orthopaedic Surgeon. The following statistics show the volume of work undertaken during the year :— 380 School Medical Services cases attended during the year 1933, and made 4,954 attendances. 151 Maternity and Child Welfare cases attended, and made 584 attendances. Total cases 531. Total attendances 5,538. 220 School Children attended for the first time. 92 Maternity and Child Welfare cases attended for the first time. 1,008 Examinations were made by the Orthopaedic Surgeon. 7 cases were sent to hospital. 531 cases received treatment or were kept under observation at the clinic. 75 TABLE XXV. Defects Treated Results of Treatment. Spastic Paralysis 9 3 under treatment. 6 under observation. Knock Knees 114 35 under treatment. 46 under observation. 14 cured and discharged. 19 ceased attending. Flat Feet 41 16 under treatment. 11 under observation. 7 cured and discharged. 7 ceased attending. Scoliosis 24 14 under treatment. 2 under observation. 6 cured and discharged. 2 ceased attending. Anterior Poliomyelitis 6 2 under treatment. 3 under observation. 1 cured and discharged. Kyphosis and Round Shoulders 213 104 under treatment. 16 under observation. 45 cured and discharged. 48 ceased attending. Fractures 8 2 under treatment. 4 under observation. 2 cured and discharged. Torticollis 1 1 under treatment. Bow Legs (O.C.T.) 34 5 under treatment. 15 under observation. 12 cured and discharged. 2 ceased attending. Congenital Equino Varus 5 2 under treatment. 3 under observation. Congenital Dislocation of Hip 2 1 under treatment. 1 ceased attending. Hammer Toes 2 1 under treatment. 1 under observation. 76 Defects Treated. Infantile Paralysis 10 Varieties of Club Foot 4 Miscellaneous 58 Results of TrEatmenT. 2 under treatment. 7 under observation. 1 cured and discharged. 2 under treatment. 1 under observation. 1 ceased attending. 17 under treatment. 22 under observation. 8 cured and discharged. 11 ceased attending. (I) HEART DISEASE, RHEUMATISM.— Rheumatic disease is the most common factor in the causation of diseases of the heart in children and altogether 33 children were discovered to have heart lesions of varying degrees of severity. Most of these are in attendance at the public elementary schools but are kept under periodical observation and their school curriculum modified especially as regards physical exercises, to suit their individual needs. A number of cases are referred for convalescent treatment from various (hospitals after acute rheumatic conditions of the heart. These cases are all examined by your School Medical Officers and if it is considered that convalescent treatment lin a special heart home will be likely to arrest the damage being done to the heart or bring about some improvement, they are represented to the Education Committee for their consideration. During th,e year 8 children were sent to heart homes under the care of this authority. In practically all cases an improvement of the heart condition is obtained and provided no further attacks of rheumatism supervene, there is every prospect of the children growing up useful, if not robust citizens. (J) TUBERCULOSIS,— The number of children found to be suffering from definite pulmonary or non-pulmonary tuberculosis is remarkably low and it is, I hope an indication of a general decrease of tuberculosis in the generation just growing to manhood. As in previous years, my thanks are due to Dr. Dobson, the County Tuberculosis Officer for this area for his co-operation and his reports on all doubtful cases found at inspections. (K) OTHER 1DEFECTS AND DISEASES.— These are set out in the various tables appended to this report but one special defect which is worthy of mention is that of defective speech. 77 The Director of Education co-operated with me in an enquiry into the incidence of this defect in the various schools and quite a number of children were found to have some defect or other of speech, mainly stammering. The whole question of defective speech, however, will be the subject of a report to the Education Committee, as a good deal can now be done for these children, and the handicap of a speech defect to a young person seeking employment needs no stressing. FOLLOWING UP. A notice is sent to all parents of children found to have defects, advising them to seek treatment and where this is provided by the local authority the parents are asked to sign a form authorising it and the treatment is then carried out at the appropriate health centre, but where the treatment indicated is of such a nature that it should be carried out by a private practitioner or at hospital, advice is given to that effect. The percentage of acceptances is very high and parents are realising more and more the importance of early treatment. There are, however, always a certain number who do not respond and these are followed up by the school nurses and efforts made to persuade the parents to avail themselves of the appropriate treatment. Altogether 7,155 visits were made to the homes of school children; these were not totally in connection with the following up of defects but also included visits paid in the following up of infectious diseases, etc. Re-examinations are also made by the School Medical Officers of all children found to have had defccts to ascertain progress and also to discover whether or not the appropriate treatment is being carried out, and if not, efforts are made to convince the parents of the necessity. ARRANGEMENTS FOR TREATMENT. These have been dealt with under the appropriate headings under the Findings of Medical Inspections. INFECTIOUS DISEASES. The following tables show the number of cases of infectious diseases occurring amongst the school children. The action taken to detect and prevent the spread of infectious diseases is shown on page ... of this report. 78 TABLE XXVI. NOTIFIABLE INFECTIOUS DISEASES. School. Disease. Scarlet Fever Diphtheria Smallpox Typhoid Erysipelas St. Mary's C.E. 11 - — 1 St. Mary's R.C. 2 — - — — Central Hendon 3 — - — — St. Paul's C.E. — - — — St. Vincent's R.C. 5 2 - — — St. John's C.E 1 1 - — — The Hyde 25 2 - — — Algernon Road 65 6 - — - All Saints' C.E. 3 1 - — — Child's Hill 12 1 - — — Garden Suburb 1 — - — — St. Agnes' R.C. 3 — - — - Wessex Gardens 19 9 - — - Woodcroft 15 14 - - — Barnfield 11 4 - — — Burnt Oak 2 — - — — Goldbeaters 16 11 - — — Meads 12 22 - — — Orange Hill 4 — - — — Edgware 4 — - — — Deansbrook 12 4 - — — Annunciation 7 1 - — — Colindale 2 4 - — — Total 235 82 - — 1 79 TABLE XXVII. NON-NOTIFIABLE INFECTIOUS DISEASES. School. Disease Measles Mumps Whooping Cough Chickenpox St. Mary's C.E. 1 1 1 - St. Mary's R.C. — — — — Central Hendon — 1 21 — Algernon Road — 9 35 35 The Hyde — 72 44 17 St. John's C.E. — — 19 — Colindale 1 22 — St. Paul's C.E. — - 1 St. Vincent's R.C. — - — St. Agnes' R.C. — — - — Child's Hill 3 2 21 — All Saints' C.E. — 1 — — Wessex Gardens 5 16 20 34 Garden Suburb — 1 3 — Meads 4 13 40 13 Orange Hill — — — 1 Deansbrook — 3 10 — Burnt Oak 19 30 — 11 Goldbeaters — 66 — 5 Woodcroft 33 16 30 13 Barnfield — — — — Annunciation — 1 — — Edgware - 11 1 — Total 66 243 267 130 80 The Council has allocated to the Juvenile Organisations Committee a permanent Camp Site at Mote Mount. Upon this site a hut 'has been erected which serves as a general Headquarters for Campers. During 1933, 749 boys and 57 girls from local organisations were in camp for week ends and holiday periods. PHYSICAL TRAINING. The system in force remains as in previous years and each child devotes approximately 60 minutes per week to physical training. The system followed is that contained in the syllabus of the Board of Education. There is no area organiser.of physical training in the district. The same facilities for sports are enjoyed by all the schools, and in July, 1933, teams representing the Hendon Schools' ISiports Association won the Middlesex County Schools Championship at the County Championship Meeting held on the Rugby Union Ground, Twickenham, and were awarded the Alderman Forrester Clayton Challenge Shield and Cup to be held for a period of one year. These trophies are competed for annually by teams representing Public Elementary Schools in the County of Middlesex. PROVISION OF MEALS. Certain Head Teachers have adopted a voluntary sdheme for the supply of milk to children in their schools. The milk is supplied in bottles containing one third of a pint and this is issued to the children during the morning session of each school day, at a cost to the parents of one penny per bottle, which is collected daily from the children concerned. Dairies deliver to the school each morning, the requisite number of bottles of fresh milk and this is distributed to approximately 1,000 children during playtime. The glass bottles are fitted with disc tops through which the children draw the milk by means of a straw. The empty bottles are collected by the dairies at mid-day so that there is, therefore, no labour entailed in the washing of the receptacles. The distribution of the milk is usually carried out by a monitor and the great advantage of the scheme is that the amount of clerical work to be done by Head Teachers is reduced to a minimum. The Education Committee in 1931, gave instructions that a careful watch was to be kept on the school population as regards the danger of any child suffering from sub-nutrition and it also decided to provide such Children with milk and cod liver oil, this to be free of dharge in necessitous cases. 81 During the year the Education Committee provided milk and cod liver oil for 124 children. This is done for a three monthly period, at the expiration of that time, the child is re-examined and if found necessary, the extra nourishment is continued. CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. I am pleased to report that the interest of the parents in the .School Medical Services is wlell maintained and as high a percentage as 70.3 attended at the routine medical inspections; in the Infants' Departments however and at special examinations the percentage was practically 100. This is very gratifying as much more good can be done in the giving of advice in the ways of life for the healthy, and in the early treatment of any defect found, if the parents are present. The teachers have also been most helpful both at the routine medical and dental inspections in facilitating the work and in referring special cases to your School Medical Officer for examination. The attendance officers are also constantly helpful to this department in referring dhronic absentees for examination and providing much useful information regarding environmental and other matters. I should also like to thank your Director of Education who is always prepared to give his advice on the question of the education of the physically or mentally defective child. BLIND, DEAF AND EPILEPTIC CHILDREN. These are generally ascertained at routine examinations or referred by parents, teachers, school nurses or attendance officers. A schedule of all children of school age in the area is kept by the attendance officers and enquiries are made as to what education is being provided, in this way a certain number of defective children are discovered but they are more generally ascertained at routine examinations or referred by parents, teachers and school nurses. When a child is suspected to be suffering from one or other of the defects, he is examined by one of the School Medical Officers. If possible hospital records, if they exist are examined and all efforts made to ascertain the precise degree of incapacity, if the child is blind a report from your Ophthalmic Surgeon is also asked for. In the case of mentally defectives, these are examined by the Stanford Revision Test and an assessment made of their mental calibre, should they be uneducable they are notified to the County Council. If they are educable they are either retained in a special class at a public elementary school or 82 if their deficiency is more marked are sent to the Special School for Mentally Defective Children at Finchley. At that school the children are seen periodically by one of your assistant medical officers of health and an annual report is submitted to your School Medical Officer. When a mentally defective child reaches the age of 16, the Director of Education consults the School Medical Officer as to the advisability of him being notified to the County Council for after-care. In the event of blind children leaving special schools, these are notified to the Blind Persons' Act Authority. An endeavour is made by your School Medical Officer, to see personally, all children whose defect is sufficiently severe to preclude their being educated in a public elementary school before recommendations for their specialised education are made to the Education Committee and in Table III. at the end of this report will be found a list of all exceptional children and the arrangements made for the provision of their education. RUSSELL COTES SCHOOL OF RECOVERY. The Education Committee maintain ten beds at the Russell Cotes School of Recovery for any children found to be debilitated and to require fresh air and an altered regime of life. In all cases the children benefited by their stay. The children are examined before admission and after their return, and in all cases it is found that they come back definitely improved in health. The Council also send children away from time to time to other convalescent schools. MENTALLY DEFECTIVE CHILDREN. As regards mentally defective children who are not sufficiently defective as to be completely uneducable, the same arrangements exist with Oak Lodge School at Finchley and there are at present attending there, 27 children from this area. 5 children were notified to the County Council as bi ing uneducable. There are in addition in the ordinary elementary schools, certain classes where slightly retarded children are given special educational facilities. NURSERY SCHOOLS. There are no nursery schools in the area but 166 children under the age of 5 years were in attendance at the public elementary schools on the 31st March, 1934, 83 SECONDARY SCHOOLS AND OTHER INSTITUTIONS OF HIGHER EDUCATION. I. MEDICAL INSPECTION.— There is one secondary school in the area with 463 pupils and arrangements have been entered into by which the routine medical inspections arranged by the Middlesex County Council are carried out by your School Medical Officers. The children are examined when they enter the school and at 12 and 15 years of age. II. FOLLOWING UP AND MEDICAL TREATMENT.— No provision has been made for treatment. Two years ago tentative suggestions were put forth for the dental and visual treatment of these defects to be carried out by the local authority but the proposals were not then proceeded with. They have, however, since been revived and it is hoped that in the near future this work will be undertaken. PARENTS' PAYMENTS. There has been no change in the arrangements for recovering the cost of treatment from parents. HEALTH EDUCATION. In all schools in the area a portion of time is devoted each week to the teaching of elementary physiology and hygiene, sometimes they are taken as separate subjects and sometimes as part of the science lessons. Apart from the constant health propaganda which is carried out at the various centres, during the year, the Dental Board of the United Kingdom provided a lecturer who spent a week in the area delivering lectures on dental hygiene to the school children. These lectures were very much appreciated and in many of the schools, essays were written by the school children on what they had heard. I had the pleasure of seeing a certain number of these essays and it was quite obvious that the lecturer had presented her subject matter in sudh a way as to be easily intelligible to the children and the lectures stimulated an increasing interest in the care of the teeth. 84 TABLE XXVIII. EMPLOYMENT OF CHILDREN. Boys. Girls. Children examined and employment certificates granted 128 11 Children re-examined and certificates granted 5 — Certificates granted provisionally 3 — Certificates refused 1 — Examined for employment under Entertainment Rules, 1920 (Certificates Granted) 1 9 The employed children are carefully supervised and the Committee satisfied that the conditions are satisfactory and the regulations complied with. An endeavour is made to examine all employed children once a year to ensure that the conditions of employment have no retrograde effect on the child's health. NATIONAL SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN. The Local Education Authority have found it to be advantageous to seek the assistance of the N.S.P.C.C. in connection with difficult cases of children of school age whose non-attendance at school was alleged to be due to neglect in the home. During the year ended 31st March, 1934, officers of this Society, at the direct request of the Authority, paid 31 visits to 7 families in respect of 16 children, the majority of whom were absent from school owing to the above cause. The intervention by the Society's Officers had beneficial results in each case and dispensed with the necessity for Police Court proceedings being taken by the Authority against the parents. In July, 1933, the Local Education Authority made a contribution to the Society of £5 5s. Od. for these services, 85 Particulars of the above cases for the year in question are as follows : TABLE XXIX. No. of children of school age in family. Ages of such children. . Nature of complaint. No. of visits made by Officers of N.S.P.C.C. 2 5i and 8 years Parental Neglect 3 3 6, 7 and 9 years do. 4 3 6, 8 and 10 years do. 12 3 6, 8 and 12 years do. 6 I 11 years do. 1 1 10 years do. 3 3 6, 8 and 12 years do. 2 Officers of the Local Education Authority and of the Society are in constant touch with one another and a considerable amount of help is received from the Society apart from the special visits mentioned. For example, the Society provides " surgical letters " in necessitous cases for Children requiring orthopEedic treatment and if necessary such children are taken direct to hospital in the Society's ambulance. The Society has also conveyed two cases to Convalescent Homes in the Country free of charge by their ambulance. STATISTICAL TABLES, The Statistical Tables prescribed by the Board of Education in respect of Secondary Schools and Public Elementary Schools are appended. In conclusion I desire to thank the Chairman and members of the Education Committee for their sympathetic consideration of all matters affecting the health of the school children and their continued support during the year. I have the honour to be, Ladies and Gentlemen, Your obedient servant, A. FAIRGRtEVE ADAMSON, School Medical Officer. 86 STATISTICAL TABLES. Public Elementary Schools. MEDICAL INSPECTION RETURNS. TABLE 1. RETURN OF MEDICAL INSPECTIONS, 1933. A.—ROUTINE MEDICAL INSPECTIONS. dumber of Inspections in the prescribed Groups.— Entrants 1850 Second Age Group 1639 Third Age Group 1432 Total 4921 Number of other Routine Inspections Nil B.—OTHER INSPECTIONS. Number of Special Inspections 5419 Number of Re-Inspections 3550 Total 8969 87 TABLE II. A.—Return of Defects found by Medical Inspection in the Year ended 31 December, 1933. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Delects Requiring treatment. Requiring to be kepi under observation but, not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiting treatment. , (1) (2) (3) (4) (5) Malnutrition 13 57 115 15 Skin Ringworm : - Scalp - 2 - Body. - — 19 — Scabies — — 51 1 Impetigo — — 179 Other Diseases (non-Tuberculous) 5 3 708 — Blepharitis 4 11 32 6 Eye Conjunctivitis 1 3 71 2 Keratitis — — - Corneal Opacities - - - Defective Vision (excluding Squint) 374 138 212 10 Squint 32 29 25 6 Other Conditions 2 7 96 4 Ear Defective Hearing - 5 2 2 Otitis Media 4 2 103 2 Other Ear Diseases - 5 100 - Nose and Throat Chronic Tonsillitis only 11 95 40 37 Adenoids only 4 19 13 9 Chronic Tonsillitis and Adenoids 59 81 163 66 Other Conditions 7 15 34 9 Enlarged Cervical. Glands (non-Tuberculous) - 20 1 10 88 TABLE II.—continued. Defect or Disease. Routine Inspections. Special Inspections. No. of Delects. 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 4 17 1 Heart and Circulation Heart Disease Organic 7 4 22 Functional - 64 1 39 Anaemia - 11 3 4 Lungs (Bronchitis 1 4 — 4 Other Non-Tuberculous Diseases 1 8 - 2 Tuberculosis Pulmonary: Definite - 2 - 1 Suspected - — — — Non-Pulmonary : Glands - - 2 Bones and Joints - 1 - Skin - — - — Other Forms - — — — Nervous System f Epilepsy - - 2 Chorea - - - — Other Conditions 1 7 2 5 Deformities Rickets - - — - Spinal Curvature 21 15 7 3 Other Forms 240 151 110 38 Other Defects Diseases (excluding Uncleanliness & Dental Diseases) 18 51 16 22 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) Prescribed Groups: — Entrants 1850 140 7.57 Second Age Group 1639 292 17.82 Third Age Group 1432 313 21.86 Total (Prescribed Groups) 4921 745 15.14 Other Routine Inspections — — - 89 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. PARTICULARS OF CHILDREN SUFFERING FROM MULTIPLE DEFECTS. 1 Male. Mentally defective, cripple at Oak Lodge Special School for Mentally Defective Children (Day), at Finchley. 2 Females. Two totally blind and mentally defective—one at the Ellen Terry National Homes, Reigate, and one at Court Grange, Abbots Kerswell, South Devon. BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 6 - - - 6 PARTIALLY BLIND CHILDREN. At Certified Schools for the Blind. At Certified Schools for the Partially Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 5 — — — — 5 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 4 — — — 4 PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 3 — — — — 3 90 TABLE III.—continued. MENTALLY DEFECTIVE CHILDREN. Feeble-Minded Children. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 27 27 EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 1 1* 2 0 Recommended for admission to Certified Special School, February, 1934. PHYSICALLY DEFECTIVE, CHILDREN. A. Tuberculous Children. I.—Children Suffering from Pulmonary Tuberculosis. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. _ 1 - 1 II.—Children Suffering from Non-Pulmonary Tuberculosis. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 1 — 2 3 B. Delicate Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 5 49 — 4 58 91 TABLE III.—continued. C. Crippled Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 2 3 2 7 D. Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 7 2 — 4 13 TABLE IV. Return of Defects treated during the Year ended 31st December, 1933. TREATMENT TABLE. GROUP 1.—MINOR AILMENTS (excluding Uncleanliness, for which see Groun VI.). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total (1) (2) (3) (4) Skin: — Ringworm-Scalp 4 2 6 Ringworm-Body 23 1 24 Scabies 51 1 25 Impetigo 553 4 557 Other Skin Disease 187 15 202 Minor Eye Defects— 177 7 184 (External and other, but excluding cases falling in Group II.). Minor Ear Defects 290 16 306 Miscellaneous (e.g. minor injuries, bruises, sores, chilblains, etc.) 2312 71 2383 Total 3597 117 3714 92 TABLE IV.—continued. GROUP II.—DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments—Group I.). No. of Defects dealt with. Disease or Defect. Under the Authority's Scheme. Submitted to refraction by piivate practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) 606 — — 606 Other Defect or Disease of the Eyes (excluding those recorded in Group I.). — — — — Total 606 — — 606 Total number of children for whom spectacles were prescribed.— (a) Under tJhe Authority's Scheme 367 (b) Otherwise — Total number of children who obtained or received spectacles.— (a) Under the Authority's Scheme 347 (b) Otherwise — 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 irom the Authority's Scheme. Total. 0) (2) (3) (4) (5) (i) (ii) (iii) (iv) (0 (ii) (in) (iv) (i) (ii) (iii) (iv) 31 16 164 — 5 — 9 — 36 16 173 — — 225 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. 93 TABLE IV.—continued. GROUP IV.— ORTHOPEDIC AND IPOSTURAL DEFECTS. Under the Authority's Scheme (1) Otherwise (2) Total number treated Residential treatment with education Residential treatment without education Non-Residential treatment at an orthopsedic clinic Residential treatment with education Residential treatment without education Non-Residential treatment at an orthopaedic clinic (i) (ii) (iii) (i) (ii) (iii) Number ot children treated. IO Nil 380 Nil Nil Nil 380 GROUP V.—DENTAL DEFECTS. (1) Number of Children who were : — (2) Half-days devoted to: (a) Inspected by the Dentist: Inspection 85 Treatment 582 Routine Age Groups : — Aged 5 ... 997 Total 667 „ 6 ... 854 (3) Attendances made by children for treatment „ 7 ... 1033 6140 „ 8 ... 864 (4) Fillings: — ,, 9 ... 859 Permanent teeth 1504 „ 10 ... 903 Temporary teeth 259 ,, 11 ... 869 Total '763 „ 12 ... 914 (5) Extractions:— „ 13 ... 726 Permanent teeth 1126 ,, 14 ... 59 Temporary teeth 5506 8J78 Total 6632 Specials 14118 (6) Administrations of general anaesthetics for extractions 2145 Grand Total 9486 (b) Found to require treatment 4470 (7) Other operations: — Permanent teeth (c) Actually treated 3069 Temporary teeth ) Total 253 GROUP VI. — UNCLEANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 20.78 (ii) Total number of examinations of children in the Schools by School Nurses 35,785 (iii) Number of individual children found unclean 835 (iv) Number of children cleansed under arrangements made by the Local Education Authority 4 (v) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 Nil. (b) Under School Attendance Byelaws Nil. 94 MENTAL DEFICIENCY (NOTIFICATION OF CHILDREN) REGULATIONS, 1928. Statement of the number of dhildren notified during the year ended 31st December, 1933, by the Local Education Authority to the Local Mental Deficiency Authority. Total number of children notified—6. Analysis of the above Total. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School: - - (a) Idiots (b) Imbeciles 3 2 (c) Others — - (ii) Children unable to be instructed in a Special Sdhool without detriment to the interests of other children : - - (a) Moral defectives (b) Others -- — 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 - 1 3. Feeble-minded children notified under Article 3, i.e., "special circumstances " cases ... - - 4. Children who in addition to being mentally defective were blind or deaf — — Grand Total 3 3 95 STATISTICAL TABLES. Secondary School. TABLE 1. Number of pupils inspected—1st January, 1933, to 31st December, 1933. A.—ROUTINE MEDICAL INSPECTION. (i) Cases in which a full examination has been made (see Paragraph 4, Circular 1153, Board of Education). Age 9 10 11 12 13 11 15 16 17 18 19 Total Boys — 1 36 14 5 — 1 4 — — — 61 Girls — 3 39 20 4 2 29 2 — — — 99 Total 4 75 34 9 2 30 6 160 (ii) Cases in which only partial examination has been made (see Paragraph 4, Circular 1153, Board of Education). NIL. Special Cases Re-Examinations (i.e., No. of pupils re-examined) Boys — 3 Girls 1 52 Total 1 55 96 TABLE II. A.—Return of Defects found by Medical Inspection in the year ended 31st December, 1933. Defect or Disease. / Routine Inspections. Special Inspections. No. of Defects. No. of Detects. Requiring treatment Requiring to be kept under observation but not requiring treatment Requiring j treatment Requiring to be kept under observation but not requiring treatment. (1) (2) (3) (4) (5) Malnutrition — .— - — Uneleanliness — — - — Skin Ringworm Scalp — — - — Body — — - — Scabies — — - — Impetigo - - Other Diseases (non-Tuberculous) — 3 — — Eye Blepharitis 1 1 - — Conjunctivitis - — - — Keratitis - — - — Corneal Opacities - — - — Corneal Ulcers - — - — Defective Vision (excluding Squint) 18 7 1 — Squint 1 2 - — Other Conditions — — - — Ear Defective Hearing - - - Otitis Media - 3 - - Other Ear Diseases - - - Nose and Throat Enlarged Tonsils only - 1 - - Adenoids only -- — - - Enlarged Tonsils and Adenoids . - _ - - Other Conditions - — - — Enlarged Cervical Glands (non- Tuberculous) - — — — 97 TABLE II.—continued. Defect or Disease. Routine Special Inspections. Inspections. No of Defects. No. of Defects. Requiring Requiring to be kept to be kept under under ing tion but ing tion but treatment. not requiring treatment treatment not requiring treatment. (1) (2) (31 (4) (5) Defective Speech — - Teeth—Dental Diseases 21 3 - - (See Table IV., Group IV.) - - - Heart and Circulation Heart Disease: - - - Organic - 2 - - Functional - 4 - - Antemia - 3 - 1 Lungs Bronchitis - - - - Other culous Diseases - - - - Tuberculosis Pulmonary : Definite - - - - Suspected - - - - Non-Pulmonary - - - - Glands - - - - Spine - - - - Hip - - - - Other hones and joints - - - - Skin - - - - Other Forms - - - - Nervous System Epilepsy - - - - Chorea - - - - Other Conditions - - - - Deformities Rickets - - - - Spinal Curvature 4 2 - - Other Forms 3 - - - Other Defects and Diseases (Muscular Rheumatism) - - - - ~ 4 - - 98 TABLE IV. Return of Defects treated during the year ended 31st December, 1933. TREATMENT TABLE. GROUP I.—MINOR AILMENTS (excluding L'ncleanliness). NIL. GROUP 11.-DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) — 13 — 13 Other Defect or Disease of the Eyes (excluding those recorded in Group 1) — — — — Total — 13 13 Total number of pupils for whom spectacles were prescribed ... 13 Total number of pupils who obtained or received spectacles ... 7 GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. NIL GROUlP IV.—DENTAL DEFECTS. Number of pupils who were :— (a) Found to require treatment 21 (b) Actually treated 6