HEN 16 LIBRARY BOROUGH OP HSNDON ANNUAL REPORT OFPTHE MEDICAL OFFICER OP HEALTH AND SCHOOL MEDICAL OFFICER FOR THE YEAR 19 3 9 A. FAIRGRIEVE ADAMSON, M.D., D.P.H., Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation Hospital. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1939. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Tenth Annual Report, which, in accordance with the wishes of the Ministry of Health, takes the form of an interim report. Arrangements are, however, being made for the careful preservation of all records so that at the termination of the war a report can be made dealing more fully with the period from the beginning of 1939 to the end of the last complete year, and in which separate statistics for each year will be given in order that the annual records may be, as far as practicable, continuous and complete. I would point out that no detailed review of the Public Health and Medical Services has been attempted in this Report and mention is only made of temporary departures from normal, occasioned by the outbreak of war. Every effort was made to reduce to a minimum any temporary dislocation and by the end of the year the serviced had been re-established. INFECTIOUS DISEASES. The incidence of the main notifiable infectious diseases remained low during the year, 258 cases of Scarlet Fever and 150 cases of Diphtheria being notified compared with 283 and 195 respectively in the previous year. There was a marked reduction in dysenteric infections notified, there being only 5 as compared with 66 for the year 1938. 5 cases of Cerebro-Spinal-Fever were notified, 2 of these occurring after the outbreak of war. The presence of this disease gives rise to anxiety as it appears to "be particularly associated with war and post war conditions this was markedly manifested in the latter years of the last war and in 2. the post war period, but while the incidence ox this disease has risen in the country generally there has been so far no approach to the high incidence which then prevailed, I am indebted to Dr. A. S. Hall, Tuberculosis Officer, for the following report on the operation of the service under his control:- "The new Chest Clinic, opened in the grounds of Redhill Hospital in 1938, has proved most suitable; it is cheerfully furnished and well equipped and most of the diagnostic follow up work is done by means of an X-ray screening set installed in the consulting room. The amount of work is steadily increasing, this being due, not to the increase of tuberculosis in the Borough, but to the increased use of the services of the Clinic by the practitioners in the district. 1939 was the first year during which the number of new patients attending the Clinic, who were found to be non-tuberculous, exceeded the number who were found to be tuberculous. This excess of nontuberculous over tuberculous patients attending the Clinic, increased very rapidly during the last quarter of 1939 and the first quarter of 1940, and I think this is largely due to the decrease in the diagnostic services usually provided in peace time by Harley Street and the various London Hospitals. On the outbreak of War, the County Sanatoria, and most of the London Hospitals either suspended or grossly curtailed their artificial pneumothorax treatment. Accordingly on September 5th, 1939 at Redhill Chest Clinic, an artificial pneumothorax clinic was started, and has continued on four afternoons a week ever since. This is, of course, a great advantage to patients in Hendon Borough as their treatment is now available near to their homes." LABORATORY FACILITIES. At the outbreak of war the normal laboratory facilities, which were provided by University College Hospital, were suspended and alternative arrangements were made, under the anergency Medical Services Scheme, with the Watford Peace Memorial Hospital, which is carrying out the greater portion of the bacteriological investigations. ISOLAT10N HOSPITAL. The Emergency Hospital Scheme was put into operation when the threat of war became imminent, and 4 of the 6 ward pavilions were immediately converted for the reception of casualties, the normal accommodation of these wards being increased from 84 to 170. This, of course, meant a reduction in the accommodation for infectious diseases and there now only remains for that purpose a ward of 20 beds and one of 16 cubicles. In view of this decrease in accommodation 3. the doctors in the area were asked to co-operate "by nursing suitable cases at home, and particularly the milder types of Scarlet Fever. Such co-operation has been carried out most loyally but it is only fair to state that the incidence of infectious disease during the war period of the year was abnormally low, and there are already indications that further isolation provision will have to be made, either by overflowing into the emergency section of the hospital, a procedure which I am reluctant to adopt, or by arranging with other infectious disease hospitals within the County and London County Council areas. The section of the Hospital adapted for the emergency hospital service consists of, apart from bed accommodation, a reception ward, 4 resuscitation ward, and two theatres, the latter established by the conversion of kitchen premises. In addition an up-to-date X-Ray plant has been installed. The necessary medical and surgical staff has been allocated by Sector Headquarters and additional nursing staff is being recruited from the Civil Nursing Reserve. Unfortunately owing to these changes, the excellent and constructive work being conducted by Dr. Joyce Wright in cross infections in the Scarlet Fever wards had to be abandoned at a time when its interest and value were maturing. This cessation one hopes will be measured only by the period of the emergency. MATERNITY AND .CHILD WELFARE. All the Centres continued to be well attended until the outbreak of war. As soon as war was declared the Health Centres at Central and West Hendon and Mill Kill were converted into First Aid Posts and the services transferred to temporary premises. As, however, the war did not develop on the lines anticipated, and, moreover, the public demand for these services was acute, the normal sessions were reestablished at all the Health Centres, so that the three mentioned now function in a dual capacity of Health Centre and First Aid Post. The Child Welfare Centre on the Woodside Park Estate had to be abandoned as the premises were no longer available but an additional weekly session was established in the Holders Hill Road at St. Mary Magdalen Church, where a considerable number of children from the 4. Woodside Park; area continued to attend. In spite of the temporary dislocation due to the war the total attendances of 53,000 were the highest recorded with the exception of the year 1938. ANTE-NATALSUPERVISION. There was a marked increase in the volume of this work, the number of expectant mothers who attended being 4,196 as against 3,192 in the previous year, a contributory factor being the arrangement made with Redhill County Hospital by which mothers who had been accepted for confinement at that hospital were supervised ante-natally at their local health centres. The amount of domiciliary midwifery carried out by the Council's Midwives also increased, 263 mothers being attended, and a total of 164 by the Watling District Nursing Association under arrangements made with this Authority, in pursuance of Section I of the Midwives Act, 1936. HEALTHVISITORS. At the outbreak of war 9 Health Visitors were temporarily transferred to A.R.P. duties, mainly in connection with the establishment and supervision of First Aid Posts and Mobile Units. This for a period brought home visitation almost to a standstill but these Health Visitors were gradually returned to duty and at the end of the year only 3 still remained in the A.R.P. service and steps were being taken for their early return to their normal duties. SANITARY SERVICES. These were, and still are, adversely affected by the outbreak of war. One Sanitary Inspector was seconded for A.R.P. duties, and for the remaining portion of the year 3 others were employed almost whole time in that service. This meant that practically the whole of the routine inspections and supervision had to be abandoned, and only the more urgent sanitary matters were dealt with. By the end of the year, however, steps were being taken to release, as far as possible, those Sanitary Inspectors who had been absorbed into the A.R.P. services and to provide a temporary Sanitary Inspector in place of the one seconded. The following were the main developments during the year:- FOOD. The Food and Drugs Act, 1938. This Act came into force on the first day of October, 1939, and two classes of Authorities - the 'Local Authority' and the 'Food and Drugs Authority' - are concerned in working the provisions of the Act. Prior to this Act coming into force the administration of the earlier Food and Drugs Acts, in Hendon, was undertaken by the Middlesex County Council, but under the new Act the Minister of Health had authority to confer such power upon any non-county borough which had a population at the last census of "between 20,000 and 40,000. Hendon Council decided to apply to the Minister for such power and although application was made the administration of that part of the Act concerning the 'Food and Drugs Authority' remains with the County Council. The result is that Hendon now administers that part of the Act designed for the 'Local Authority' which deals principally with unsound food, precautions against contamination of food, food poisoning, provision as to milk and dairies, other kinds of foods, markets, slaughterhouses and cold-air stores. SLAUGHTERHOUSES. The Food and Drugs Act prescribes that from the 1st October, 1939, all slaughterhouses shall be licensed by the Local Authority where such are suitable for the purpose. Before this there were five registered and three licensed premises in the district, the latter only being subject to annual licensing. It is understood that the intention of three occupiers is not to apply for licensing or renewal of licensing of their premises. ARMY BILLETING. Close contact was maintained between the Military Authorities and the Public Health Department during a period of billeting in privately occupied dwelling houses in Mill Hill and Edgware. Disinfection of sleeping quarters, bedding, clothing and equipment was done after cases of illness, especially chicken-pox; and disinfestation after verminous complaints. 5. 6. STAFF CHANGES. The principle staff changes were as follows:Dr. S. L. Wright, Assistant Medical Officers, was appointed Deputy Medical Officer to the Borough of Wembley, and left the services of the Council on the 11th July, 1939. This change was particularly unfortunate occurring as it did so near to the outbreak of war, as Dr. Wright had been devoting much of his time to the organisation of the the Casualty Services. Dr. J. A. Livingston was transferred from the Watling Health Centre to undertake the duties previously carried out by Dr. Wright. He was later promoted Deputy Medical Officer of Health. Dr. K. M. Bodkin was appointed Assistant Medical Officer, and took up duty on 23rd October, 1939. Miss F. Keegan, Deputy Matron at the Isolation Hospital was called up for military nursing service. Miss B. Williams, Health Visitor and School Nurse, was called up for Army duty. Mr. G. Gale and Mr. G. Phipps, of the clerical staff, also joined His Majesty's Forces. Mr. F. H. Day, Sanitary Inspector, was seconded to the A.R.P. Service. AIR RAID PRECAUTIONS. While this can hardly be regarded as a public health activity, your Public Health Department have become responsible for the organisation and maintenance of efficiency of the Casualty Services, with inevitable repercussions as far as the staff of the Department is concerned. For a short time before and for some time after the outbreak of war many of the senior members of my Department worked almost continuously day and night and this devotion to duty made it possible to build up rapidly the comprehensive service which now exists. Many of the pioneers of this work have now resumed to varying extents their normal duties in the Department but it is comforting to know that their knowledge and experience are still available if and when the time comes for this service to be put into operation. I should like to take this opportunity of thanking all those officers who have and still are giving so unsparingly of their services. 7. SCHOOL MEDICAL SERVICES. Every effort was made to maintain these services at their full capacity and mention is, therefore, only made in the following paragraphs of any section of the services which underwent temporary modification. As has already been mentioned in an earlier section of this Report three of the Health Centres were converted into First Aid Posts and it was necessary to find temporary alternative accommodation for the conduct of the School Medical Services based on these Centres but at the beginning of December they were re-opened as Health Centres, and have since continued in a dual capacity. ROUTINE MEDICAL INSPECTION. The arrangements for the routine medical inspection were interrupted during the months of September and October as the schools were closed during that period. Home tuition classes were, however, organised and considerable numbers of children were referred by parents or teachers for special examination and the schools began gradually to re-open in November as air raid shelters reached completion. Routine medical inspection was then automatically re-commenced. NUTRITION. The outbreak of war gave rise to apprehension that the increasing cost of living would be reflected in a lowering of the nutritional standards of certain of the poorer children and a very careful watch was therefore maintained by doctors, health visitors and teachers for any signs that this was taking place. While it is not quite within the scope of this year's Report, this supervision was carried still further and a nutritional survey was completed in June, 1940, with the following results:- Number of children surveyed CLASSIFICATION B. Cl C2 D 10,781 9618 765 322 76 89.21% 7.10% 2.99% .70% KEY - B = normal C2 = sub-normal C]_ = slightly sub-normal D = bad. .. 8. As a result of this survey 368 children were recommended for a mid-day meal, the nutritional classification of these children being as follows B. C1 C2 D. Total 2 127 182 57 368 The recommendations were made on such considerations as nutritional standard, the distance the child had to travel to school, whether or not the mother was engaged in industry, etc., the economic factor was not considered in making the recommendations. It can be generally said that so far there is no evidence that a deterioration is taking place in the nutritional standards of the school child but the Council have, in view of the exceptional circumstances of the times, decided to inaugurate a scheme for the provision of meals in schools. DENTAL SERVICER. There was a temporary dislocation of these services at the outbreak of war, one full-time Dental Officer being for a period absorbed into the A.R.P. services until the 18th December, and one part-time Dental Officer, who normally conducted three sessions per week, enlisted as a Dental Surgeon in His Majesty's Forces. Further dislocation was due to the adaptation for A.R.P. services of the Central Hendon Health Centre, the dental surgery being used as part of the temporary cleansing arrangements. In consequence of this latter change, it became necessary to transfer the dental equipment from Central Hendon to West Henc on Centre so that the work normally carried out at the first named Centre could be continued. The same considerations applied to the dental surgery at the Mill Hill Health Centre and it was not possible to re-establish the services there until the 5th April, 194-0. The necessary additions have, however, now been completed at the Central Hendon Health Centre, thus releasing the dental surgery there for its normal purposes. The volume of dental work to be carried out justifies replacing the part-time Officer by a full time Officer, and as all dental surgeries are now available, this matter will receive the early ation of the Public Health and Medical Services Committee. Provision for the necessary staff has already been made in the 1940 estimates. VISUAL DEFECTS. The Ophthalmic sessions were continued throughout as while the routine medical inspections, from which cases are normally referred, were in abeyance for a period, there was a sufficient number of children on the waiting list to necessitate carrying on the normal number of sessions until routine medical inspections were resumed. It was not possible, however, to continue the orthoptic treatment of squint normally carried out at the Central Hendon Health Centre as it was not thought advisable to transfer the delicate instruments in use to temporary premises. These sessions were re-established, however, when the Health Centre reverted to its normal function. ORTHOPAEDIC TREATMENT. As far as remedial exercises and treatment sessions were concerned the services have been maintained at full capacity throughout. The number of Surgeon's sessions had to be reduced as your Orthopaedic Surgeon had duties to the Emergency Hospital Service which precluded his devoting the same time to the School Clinics. Mr. Seddon, however, issued a very useful guide concerning the method of selection of cases to be seen by him which has helped considerably in reducing the numbers referred. No difficulty has been experienced in having children admitted for in-patient hospital treatment. TREATMENT OF DEFECTIVE SPEECH. This has been abandoned temporarily but was resumed on the 24th October, 1939. SECONDARY SCHOOLS. In accordance with the arrangements made with the Middlesex County Council routine medical examination was continued in secondary schools and the treatment of visual and dental defects. At the commencement of the war there was a period when only limited numbers of children were being instructed but as shelter accommodation became available all the children were ultimately re-admitted. Arrangements were made for these services to be extended to the children in the junior day departments of the Hendon Technical Institute. 9. In conclusion I wish to thank the members of the Council for the facilities they continued to extend towards the maintenance and development of the Public Health Services, especially during a period when new problems created by the war were inevitably claiming priority, and also to the members of my staff who have successfully undertaken many and varied additional duties which have necessitated long and arduous hours of overtime. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, A. FAIRGRIEVE ADAMSON, Medical Officer of Health. 10.