HEN 18 BOROUGH OF HENDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER FOR THE YEAR 19 4 1. A. FAIRGRIEVS ADAMSQN, M.D., D.P.H., Medical Officer of Health, School Medical Officer end Medical Superintendent of the Isolation Hospital. . ANNUAL REPORT 0F THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1941. To The Mayor, Aldermen & Councillors of the Borough of Hendon. September, 1942. I have the honour to submit my Twelth Annual Report on the health conditions of the Borough for the year 194-1. It has been prepared in accordance with the instructions of the Minister of Health as an Interim Report and is consequently limited in scope and no picture is presented of the social services as a whole, which I am happy to say, however, have not been adversely affected by war-time conditions but have in fact been extended. GENERAL HEALTH CONDITIONS. Vital Statistics. The Birth rate showed little variation, being 11.65 per 1000 of the estimated population, compared with 12.08 in the previous year. The Death rate however showed a slight reduction from 12.41 to 11.2. There were 81 deaths of infants under the age of one year, giving an infantile mortality rate of 57 per 1000 live births, as compared with 59 for tho country generally and 71 for the County Boroughs and greater towns including London. The rate is appreciably higher than was usual in Hendon in the pre-war years, as shown in the following Table TABLE I INFANTILE MORTALITY RATE PER 1000 LIVE BIRTHS . 1934 1935 1936 1937 1938 43 50 44 45 38 An investigation into the cause of this increase in infantile deaths showed that the majority occurred within the first 4 weeks of life, a large proportion being attributed to congenital malformations, atrophy, debility and marasmus, including premature births, conditions which might reasonably be associated with the health of the mother during the period of gestation. 2. The next most common cause was associated with diseases of the respiratory system, namely Pnuemonia and Bronchitis. INFECTIOUS DISEASES. The following Table shows the numbers of notifications of the principal infectious diseases recoivcd during the years 1940 and 1941s- TABLE II CASES OF INFECTIOUS DISEASES OTHER THAN TUBERCULOSIS NOTIFIED DURING 1940 & 1941 DISEASE TOTAL CASES NOTIFIED REMOVED TO HOSPITAL 1940 1941 1941 Scarlet Fever 306 258 162 Diphtheria ; 70 58 58 Pneumonia 142 217 50 Acute Poliomyelitis - 2 2 Measles 680 887 16 Whooping Cough 70 707 14 Cerebral Spinal Fever 18 26 26 Typhoid or Enteric Fever 4 8 6 It will be seen that Measles and Whooping Cough were prevalent in 1941, but generally these diseases were mild in character. nevertheless 3 children died from Measles and 6 from Whooping Cough. Within the limits of available accommodation complicated cases were admitted to the Borough Isolation Hospital and a number to the Hospitals of other Authorities. The incidence of Scarlet Fever was again low and showed a diminution as compared with the previous year, but the most remarkable feature has been the continued low incidence of Diphtheria, only 58 cases being notified. A further noteworthy feature is that only 29 of these were in children under 15 years of age, an unusual age distribution in a disease which has always been regarded primarily as one of childhood. How far this has been influenced by immunisation is of course only a matter of surmise but during the year 1941, 3907 children were immunised as compared with 604 in the previous year and if one may be permitted to anticipate, the figures for immunisation for this year arc still higher and the incidence of the disease still remains very low. 3. The incidence of Cerebro-Spinal Fever, a disease liable to become prevalent under war time conditions, increased slightly, but it is worthy of note that of the 11 cases admitted to the Borough Isolation Hospital in only 2 was the original diagnosis ultimately confimed. The incidence of Enteric Fever, liable also to be a camp follower of War, remained low, TUBERCULOSIS. The following Table shows the notifications & deaths during the last four years from Pulmonary Tuberculosis TABLE PULMONARY TUBERCULOSIS Notifications Deaths Males Females Total Males Females Total 1938 103 92 195 36 22 58 1939 82 63 145 30 28 58 1940 83 65 148 31 25 56 1941 68 90 158 48 37 85 In comparing these figures it should be borne in mind that there has been, since the commencement of the war, a diminished population as compared with the year 1938. It will be seen that during the year 1941 there has been an increase in both tho notifications of and deaths from this disease. One singular feature is the reversal in the number of notifications as between males and females. Previously the notifications amongst males has been consistently higher but this has now been reversed, perhaps due to the absencc of many of the male population on healthy military service. The cause of the rise in the total figures is not known, but is an example in miniature of the figures for the country as a whole and a Special Committee of the Medical Research Council has been appointed to investigate this matter. SCABIES & VERMINOUS CONDITIONS. Scabies and certain forms of uncleanliness became prevalent during the year, the former particularly in young adults, so much so that it became necessary to utilise the gas pleansing sections of the 3 First Aid Posts for their treatment. 4. The continued high incidence of these conditions throughout the country resulted in the formulation by the Minister of Health of the Scabies Order, 1941, which extended the powers of Medical Officers of Health in the examination of suspected cases, in their treatment should the diagnosis be confirmed and in the supervision and examination of contacts. I should like here to take an opportunity of thanking the members of the Civil Defence personnel stationed at the First Aid Posts who have co-operated whole-heartedly not only in this work but in many other activities of the social services, ANTE-NATAL SUPERVISION OF EXPECTANT MOTHERS. There has been a considerable increase in the number of women attending the Ante-natal Clinics in the Borough for supervision during their pregnancy. > Last year 1189 women attended compared with 716 in 1958. It will be appreciated that this work requires a high degree of care and professional aptitude and it has been most ably carried out by the Assistant Medical Officers concerned. I should like to take this opportunity of expressing my thanks to the Obstetric Specialist at the Redhill County Hospital, who has co-operated whole-heartedly throughout and has always been prepared to give of his expert knowledge in oases of difficulty or doubt. MIDWIVES ACTS The number of domicilliary confinements attended by Midwives is shown in the following Table. Six full time Midwives are employed by the Council, 5 being allocated to districts and the sixth being available for relief duty. The arrangements entered into with the watling District Nursing Association under Section 1 of the Midwives Acts, 1936; continues to prove satisfactory. Each Midwife attends at the Ante-natal sessions appropriate to her area, and in this way has an opportunity of seeing her cases in consultation with one of the Council's Assistant Medical Officers. 5. TABLE IV. DOMICILLIARY CONFTIEMENTS ATTENDED BY MIDWIVES. 1940 1941 (a) Employed by Hendon Borough Council as Midwives 221 239 as Maternity Nurses 84 305 70 309 (b) Employed by Watling District Nursing Association as Midwives 126 138 as Maternity Nurses 16 142 7 145 (c) Employed by kill Hill District Nursing Association as Midwives 6 . as Maternity Nurses | 37 43 35 35 (d) In private practice as Midwives 3 7 as Maternity Nurses 40 43 12 19 533 508 DAY NURSERIES, A programme for the establishment of War Time Day Nurseries was connenood as a result of a joint Circular from the Ministry of Health and the Board of Education urging that such facilities should be provided to permit of women entering essential industries. A Special Committee was formed to ascertain the needs and to dccido a policy to provide such Day Nurseries as were considered necessary, subject, of course, to the approval of the appropriate Government Departments, By the end of the year work was proceeding for the establishment of Day Nurseries at Addington House, Orange Hill Road, Burnt Oak: Hyde School, N.W.9; and 2, Hocroft Road, Child's Hill. The demand, however, was of such magnitude that it became evident that no one solution to the problem would be sufficient. A Daily Minders Scheme was therefore inaugurated on a voluntary basis and later in the year an official Daily Guardians Scheme was formulated by the Ministry of Health, Hendon being scheduled as an area in which this Scheme should operate. At the same time the Education Committee made a valuable contribution by admitting as many children as possible under five years of age to public elementary schools. 6. HEALTH VISITORS, No detailed record is given here of the work of the Health Visitors but it will suffice to say that this has increased materially during the year, and apart from their health visiting they are engaged in various activities carried out at the Health Centres. VOLUNTARY WORKERS. It is gratifying to record that the voluntary workers who help so materially at the child Welfare sessions, continued to do so despite many other calls upon their time resulting from war-time conditions. The assistance which they give is of primary importance and it is not an exaggeration to say that some of the heavier sessions could not be successfully carried out without them, HENDON EMERGENCY & ISOLATION HOSPITAL, The year 1941 saw the Hospital again functioning in a dual capacity, with the bed allocation as between infectious diseases and E.M.S. patients approximately the same as in the previous year. Cubicle space continued to bo limited, with the result that special cases had occasionally to be transferred' elsewhere, but all diphtheria and scarlet fever cases for which admission was requested were accommodated. By comparison with the figures for 1940, the total number of cases of infectious disease admitted during the year shows an increase of approximately 50 per cent. This increase, however, is more apparent than real, v/hen it is remembered that during 1940 large numbers of the child population were temporarily evacuated and have since returned. Despite the increase in the admissions of infectious disease, only three deaths occurred during the period under review — two from diphtheria and one from cerebro-spinal meningitis. Apart from scarlet fever and diphtheria, the remaining cases comprised a wide variety of pathological conditions. The group labelled "Tonsillitis" were largely cases notified as scarlet fever or diphtheria which, subsequent to admission, were proved by bacteriological investigation to be suffering from some other form of tonsillitis. Children suffering from measles made up the next largest group of admissions, the majority of children contracting this disease are nursed at home, so that the number of measles admissions is no criterion of the prevalence of the disease. Both Measles and Whooping Cough are on occasions very serious 7. diseases of childhood and it is a matter of regret that the public generally does not realise the mortality and morbidity for which these diseases are responsible. The question as to whether they should not be more generally regarded as diseases warranting admission to Hospital, appears to be worthy of consideration but every effort is now made to provide hospital treatment for the complicated and more serious cases. The remaining cases admitted to Hospital were spread over a variety of conditions, none of which appeared in any numbers worthy of mention. Diseases of which one is always apprehensive under war-time conditions - for instance, crrebro-spinal fever and typhoid fever - were fortunately very few. Five cases notified as enturic fever were received, and of these the diagnosis cf paratyphoid fever (b) was confirmed by bacteriological investigation in four cases. These patients all made an uninterrupted and uneventful recovery. Eleven cases were admitted with a diagnosis cf cerebro-spinal fever, but the diagnosis was confirmed in only two instances. Unfortunately one child died as a result of this disease. The following Tables show the allocation of beds in the hospital and give a picture of the work of the infectious diseases section:- TABLE V. ACCOMMODATION Block 1 (Diphtheria) 20 beds " 4. (Cubicles) 6 ,, " 5 (Scarket Fever) 26 ,, 52 Fever beds Block 2 (E.M.S.) 40 beds " 3 ,, 20 ,,, " 3 ,, 60 ,, 120 E.M.S. beds 172 8. TABLE VI. ADMISSIONS, DEATHS MB DISCHARGES of Infectious Disease, classified according to the disease notified on admission. Notified as Hospital 1.1.41. Admitted during year Died during year Discharged during year Remaining in Hospital 31.12.41. [Diphtheria or ? Diphtheria 14 68 2 73 7 Scarlet Fever or ? Scarlet Fever 20 167 - 177 10 Scarlet Fever & Chicken Pox - 1 - 1 - Whooping Cough 1 11 - 12 - Whooping Cough & Measles 1 3 - 3 1 Measles 4 12 - 14 2 Erysipelas 1 9 - 9 1 Enteric Fever 1 5 _ 6 - Encephalitis lethargica - 1 - 1 - Anterior Poliomyelitis - 2 - 1 1 Cerebro-spinal fever - 11 1 10 - Vincent's angina - 1 - 1 - Observation - 15 - 12 3 ; TOTALS 42 300 3 320 25 This figure includes tvro cases notified respectively as Meningitis and. ? Meningitis. TABLE VII. NUMBER OF CASES TREATED - COMPARISON WITH PREVIOUS TWO YEARS Notified as ADMISSIONS DEATHS 1939 1940 1941 1939 1940 1941 (Diphtheria or ? Diphtheria 144 53 68 3 5 2 Scarlet Fever or ? Scarlet Fever 207 127 167 - 7 - Erysipelas 10 5 9 - - — Measles 3 9 12 - - - 'whooping Cough 15 5 11 2 1 - Mumps 5 - - - - - lOther diseases 37 . 56 39 1 1 1 TOTALS 421 255 306 6 14 3 Included 5 killed, by enemy action 9. TABLE VIII. FINAL DIAGNOSIS Discharged Died Total Diphtheria 42 2 44 " (Bacteriological) 3 - 3 Scarlet Fever 169 - 169 Scarlet Fever & Chicken Pox 1 - 1 Post-scarlatinpl adenitis 1 — 1 " " rhinitis 1 - 1 Tonsilitis 25 — 25 Whooping Cough 12 - 12 Whooping Cough, Measles & Scarlet Fever 1 - 1 Measles 15 - 15 Measles & Whooping Cough 1 - 1 Paratyphoid Fever (B) 4 - 4 Dysentery 1 - 1 Mucous colitis 1 - 1 Catarrhal jaundice 1 - 1 Acute haemolytic jaundice 1 - 1 Cerebro-spinal fever 1 1 2 Meningismus 2 - 2 Cerebral tumour 1 - 1 Hydrocephalus 1 - 1 Erysipelas 8 - 8 Cellulitis of nose 1 - 1 Vincent's angina 5 - 3 Quinsy 2 - 2 Croup 1 - 1 Broncho-pneumonia 5 - 3 Bronchitis 2 - 2 Influenza 8 - 8 Monilia Albicans 1 - 1 Urticaria 1 — 1 Dermatitis 1 - 1 Teething 1 - 1 N.A.D. 4 - 4 320 3 323 * Concurrent infection on admission. STAFF. I should like to take this opportunity of paying a tribute to Miss Mothershaw, the late Matron, whose health unfortunately broke down and who ultimately was invalided from the service of the Council. I believe that her breakdown was very largely due to the strenuous and worrying time that she had right from the commencement of the war and which was greatly aggravated by the staffing and other difficulties consequent upon the introduction of the Emergency Medical Services Scheme. 10. During the year an increasing difficulty in obtaining Nurses and. Domestic Staff was experienced. This I may say was not local but was common to Hospitals throughout the country. As far as Nursing Staff is concerned many were absorbed in the services of the Crovm aid more were vranted for the staffing of the additional Hospital beds provided to meet the needs of potential casualties, air raid victims, etc. At the same time more lucrative and probably more congenial employment was opening up in industry. This situation has been referred to from time to time in the press and in my view is not likely to become less difficult as the war progresses. BUILD PIGS, With the exception of the cubicles and the gate lodge, the damage to buildings sustained by bombing in September 1940 was repaired, or temporarily repaired. Further extensive damage to glass and ceilings in the various buildings, which occurred as the result.of the unfortunate incident at West Hendon has since been repaired. The new nurses' sitting-room annexe was completed in November, 1941, and was subsequently formally opened by His Worship the Mayor. This building has proved a most useful acquisition for the nursing staff and has added considerably to the amenities of the hospital. EMERGENCY MEDICAL SERVICES SECTION. During the year the E,M.S, section dealt with both air raid casualties and patients transferred from other hospitals in the Sector - chiefly urological cases from St. Paul's Hospital., Endell Street, W.l. The total number of patients dealt with in the E.M.S. beds was as under:- TABLE IX In Hospital 1.1.41. Admitted during year Died during year Discharged during year Remaining in Hospital 31.12.41. Civilian air raid casualties 5 41 4 42 - Service casualties - 3 1 2 - Transferred E.M.S, cases 10 240 8 228 14 TOTALS L 15 284 15 272 14 11. AIR RAID CASUALTIES. Of the air raid casualties dealt with during the year, 75 per cent of the admissions were due to a single incident - that which occurred at West Hendon. This incident taxed to the uttermost the facilities of the Hospital, owing to the fact that this was the hospital nearest to the scene of the bombing, and within a few minutes over 30 cases, the majority of them seriously injured, were admitted. This necessitated all further casualties being re-directed to other hospitals. Extra medical assistance was drafted into the Hospital and the whole of the nursing staff - including the fever nurses - turned out to assist and worked continuously until all the cases admitted had been dealt with. TRANSFERRED CIVILIAN SICK. The flow of genito-urinary cases from St. Paul's Hospital has been maintained throughout the year. All cases admitted required operation of a rather serious nature which has necessitated a prolonged stay in hospital, This work, which is onerous and demands a high standard cf nursing, is an integral part of the Emergency Medical Services scheme, necessitated by war-time conditions. Many of the beds in the Central London Hospitals, to which these patients would normally have been admitted, are no longer available, either as the result of bombing or evacuation of the hospitals, or because of the appropriation of beds as a reserve for service or civilian casualties. HOUSING. Housing inspection has in the main been carried out as a result of complaints and from entry as a consequence of following up infectious diseases, verminous conditions, etc. The total number cf houses inspected for defects either under the Public Health or Housing Acts, was 970 and of that number 554 were found not to be in all respects fit for human habitation. By the end of the year the defects in 504 of these had been remedied. The situation regarding overcrowding is somewhat obscure in that there has been an unusual movement of population with consequent sub-letting, but much of this appears to be of a temporary character with a consequent alteration in the situation from time to time. 12. INSPECTION AND SUPERVISION OF FOOD. All neat now supplied in the Borough comes from a distributing centre at North Finchloy and excepting for speoial licences issued to Fig Clubs, no local slaughtering is now taking place, Nevertheless, a careful supervision has been maintained on food supplies ganerally and considerable quantities of meat, fish, conned and other foods had to be condemned. In addition, careful examination was made of all food damaged by enemy action with the result that quantities were found unfit for human consumption and had to be withdrawn from sale. Particular attention has been given in order to secure cleanliness of dairies and dairy farms and for protecting milk against contamination. The largest pasteurisation plant in the County is situate in this Borough and is licenced and supervised by this Authority. Constant sampling is undertaken by the firm concerned in a Laboratory attached to the premises and the records of the results are inspected by Offioers of this Authority. In addition, samples are taken for examination as to their Baotoriological oontent and their reaction to the phosphatase test, this latter indicates whether or not the milk has been adequately pasteurised. Altogether a high standard was maintained, few samples failing to comply with the requirements of the Milk (Special Designations) Order. It should, however, be stated that a number of complaints were received of milk being distributed in dirty bottles. This was in the main due to labour difficulties, the blackout, and by bottles being used by oonsumers to contain matters such as oil, which the oleansing process failed to remove. Repeated representations were made to the Dealer concerned and every effort is being made to improve these conditions. WATER SUPPLIES. In my last Report I indicated briefly the additional precautions being taken by the Metropolitan Water Board and the Colne Valley Water Company to ensure the purity of the water supplies, under conditions in which water mains might reasonably be expected to suffer damage. The results of samples which are sent to me periodically have been very satisfactory throughout. Samples were also taken from two private wells in the district and from swimming baths, These, in all cases, proved satisfactory. 13. SCHOOL MEDICAL SERVICES. I am glad, to report that it was found possible to maintain the Medical and Dental examinations and treatments of the children in the Public Elementary and Secondary Schools to full capacity. The change in medical personnel and the difficulties of obtaining staff made it appear at one time that these services might have to be in some respects curtailed raid this was foreshadowed at a later date in a Circular from the Board of Education suggesting a limitation of inspections. Fortunately so far this has not been found necessary and I trust that the services mil be continued in their entirety, as a more complete survey can be maintained of the health conditions of the children and much of the subsequent treatment arises from these periodical medical inspections. It is not proposed in a report of this nature to endeavour to deal particularly with each of the services provided for the care of school children but the following Table mil I believe give some indication of the volume of work which vjas undertaken:- TABLE X Routine Medical Inspections Special Inspections Total  Public Elementary Schools 5463 5967 11430 Secondary Schools 1306 5 1311 6769 5972 12741 TABLE XI Number of Attendances of Children for Treatment at Health Centres Minor Ailments 24054 Dental 13939 Ophthalmic 2286 Orthoptic 1945 Speech 1420 Orthopaedic 3472 14. It can safely be said that the health of the school child remained good during the year, excepting for an increased incidence of Measles and Whooping Cough, which for a period adversely affected the attendances, particularly in the Junior Departments of the Schools. The incidence of infectious diseases otherwise was singularly low. In view of the increased prevalence of verminous conditions and soabics throughout the population as a whole, the school children were kept under constant supervision and it will be seen that a total of 35,336 examinations of children in School were made by the School Nurses and 826 individual children were found to be unclean compared with 684 in 1940, and 967 in 1938 the last pre-war year. Continued and careful observation was maintained of the nutritional standard of the children attending the public elementary schools, as some apprehension was felt that the limitations of foodstuffs over a protracted period and an increasing cost of living, with which the income of the lower wage earner might not keep pace, could result in numbers of children not having sufficient or properly balanced diets. In this connection Table XII, giving the results found at Routine Medical Inspections over the last four years will bo of interest and I think it can be reasonably concluded that no deterioration in the nutritional standard of the child population has so far taken place as a result of the war, and my own personal observations confirm this. The vast experiment in scientific feeding being undertaken by the Minister of Food and his technical advisors is proving eminently successful. The percentage of children returned as being slightly sub-nourished is that most liable to wide variation, as these children are all border line cases and whether they arc classed as normal or slightly sub-normal depends on the view of the examining doctor who, moreover, is often influenced by such factors as the home environment, the family income, whether or not the mother is at work, etc., as when the child is classed as slightly sub-nourished he obtains priority in school feeding and obtains accessory foodstuffs free of charge if tlx family income is within the Council's economic scale. In an endeavour to put a. check upon the figures of all the Medical Officers who carried out the examinations, the results of one Doctor's findings were analysed, as she had worked for a long period in the same schools and it could be assumed 15. that her standard of what should be regarded as normal or slightly sub-normal had not materially varied. These results arc shown in Table XIII and it will be seen that they approximate to those returned by the Assistant School Medical Officers as a whole. TABLE XII No. of Children Inspected A (Excellent) B (Normal) C Slightly sub-normal) D (Bad) No. % No. % No. % No. % 1938 4510 294 6.52 3687 81.75 483 10.71 46 1.02 l939 2798 203 7.26 2226 79.56 514 11.22 . 55 1.96 1940 4675 582 12.45 2881 61.63 1156 24.73 56 1.19 1941 5463 938 17.17 3824 70.00 696 12.74 5 0.09 TABLE XIII #]No. of Children Inspected A Excellent) B (Normal) C (Slightly sub-normal) D (Bad) No. % No.. % No. % No. % 1938 1426 139 9.75 1125 78.89 152 10.66 10 0.70 1939 1077 142 13.18 816 75.77 115 10.68 4 0.37 1940 1710 299 17.48 1020 59.65 381 22.28 10 0.59 l941 1384 311 22.47 893 64.52 178 12.86 2 0.15 The Scheme for the provision of milk in schools was continued and in the case of children found to be suffering from sub-nutrition was supplemented by the provision of cod liver oil and other foods of a high vitamin and protein content. During the year a scheme was inaugurated for the provision of a hot mid-day meal for children attending the public elementary schools and this, if extensively used, will I feel certain make a very valuable contribution towards the physical well being of the children. 16. I am indebted to the Director of Education for the following resume of the position as it was at the end of 1941 but the Council will be aware that this provision has been considerably extended since that date. SCHOOL CANTEENS. "Following an interview by the Director of Education with the Board of Education which took place early in 1940, a scheme for the establishment of school meals was drawn up and implemented as soon as it was possible to obtain the necessary equipment. A medical survey was made in the schools, and the children requiring meals classified under the following headings (a) Under-nourished. (b) Other reasons, i.e. distances children had to travel to and from school, mother at work, etc. (c) Economic reasons (not malnourished.) While the medical survey was being made, a Central kitchen was being equipped at Algernon Road Council School to cook 1,000 meals. After six months' preparation, the first meals were served on the 4th June, 1941. Meals cooked in the Central Kitchen were sent in insulated containers to the schools. Centres were opened first in districts where there was most need for them. In some cases, children from two or three surrounding schools go to one dining hall. The demand for meals became very great as shown:- Algernon Road and Childs Hill School Canteens wore opened on the 4th June, 1941. Meals Served Week-ending 2799 7.6.41. 3173 14.6.41. 3420 21.6.41. 3609 28.6.41. • • Other Centres Opened. Week-ending. School. Weekly Total of all Centres. 5.7.41. Woodcroft 3981 6.9.41. Goldbeaters 4406 27.9.41. Bell Lane 4772 11.10.41. St. Mary's C.???. 5510 22.11.41. Deansbrook 6515 6.12.41. Edgware 6904 20.12.41. ALL CENTRES FULL 7556 In addition to centres mentioned above, school canteens have been running at Orange Hill Central School and Annunciation R.C. School for the whole year, catering for 250 and 200 respectively each day. For each of these schools, cooking is done on the premises. Figures are included in the total figures given above. It has been found that during the school holidays, when meals were continued, attendances dropped to one third of the normal number. 17. The scheme now gives priority to:- (a) Medical cases. (b) Children having long distances to travel to and from school. (c) Children with parents on war work. The Central Kitchen is now supplying to capacity, and two further kitchens for supplying 1,500 and 1,000 meals daily respectively are in preparation. Great delay has been experienced owing to inability to get necessary equipment. The cost of the meals is 6d. per child daily. Those who cannot afford 6d. may apply for free meals or meals at a reduced rate. The Education Committee have drawn up a financial scale, which is applied to these cases." SECONDARY SCHOOLS. An analysis was also made of the nutritional standard of the children attending the Secondary Schools, with the following results:- TABLE XIV No. of Children Inspected A (Excellent) B (Normal) C (Slightly sub-normal) J D (Bad) No. % No. % No. % No. ... % 1941 1306 392 30.02 847 64.85 67 5.13 NIL STATISTICAL TABLE. The Board of education Statistical Tables are appended. It will be evident that the volume of work so briefly portrayed in this Report could only have been carried out by the loyal co-operation of the members of my staff, whose numbers were depleted, particularly in the administrative and clerical sections, by the calling up of members to His Majesty's Forces. In conclusion I would like to thank the Members of the Council for their continued encouragement and help, I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, A. FAIRGRIEVE ADAMSON, Medical Officer of Health. i •' 18. BOARD OF EDUCATION MEDICAL INSPECTION AND TREATMENT RETURNS YEAR ENDED 31st DECEMBER, 1941. TABLE I MEDICAL INSPECTIONS OP CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS A. ROUTINE MEDICAL INSPECTIONS: (1) No. of Inspections in the prescribed Groups: Entrants 1760 Second Age Group 2275 Third Age Group 1428 TOTAL 5463 (2) No. of other Routine Inspections Nil GRANT TOTAL 5463 B. OTHER INSPECTIONS. No. of Special Inspections and Re-Inspections: 5967 TABLE II CLASSIFICATION OF THE NUTRITION OF CHILDREN. INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS Number of Children Inspected A (Excellent) B (Normal) C (Slightly sub-nomal) D (Bad) No. % No. % No. % No. % 5463 938 17.17 3824 ' 70. 696 12.74 5 .09 TABLE III GROUP I.- TREATMENT OF MINOR AILMENTS (EXCLUDING UNCLEANLINESS) Total Number of Defects treated or under treatment during the year under the Authority's Scheme 4498 GROUP II.- TREATMENT OF DEFECTIVE VISION AND SQUINT. Under Authority's Scheme. ERRORS OF EEFR4CTICN (including squint) 584 Other defect or disease of the eyes (excluding those recorded in Group i) 4 Total 588 No. of Children for whom spectacles were (a) Prescribed 323 (b) Obtained 268 19. GROUP III.-TREATMENT OP DEFECTS OF NOSE AND THROAT. Received Operative Treatment 107 Received other forms of Treatment Nil Total number treated 107 TABLE IV DENTAL INSPECTION AND TREATMENT. (l) Number of children inspected by the Dentist (a) Routine Age-groups AGE 5 6 7 8 9 10 11 12 13 14 TOTAL Number 922 1040 1024 1159 1347 1376 1436 1266 1238 721 11529 (b) Specials 962 (c) TOTAL (Routine and Special) 12491 (2) Number found to require treatment 6987 (3) Number actually treated 4771 (4) Attendances made by children for treatment 11908 (5) Half-days devoted to:- Inspection 99 Treatment 1244 Total 1323 (6) Fillings:- Permanent Teeth 5584 Temporary Teeth 582 Total 6166 (7) Extractions:- Permanent Teeth 1736 Temporary Teeth 6105 Total 7841 (8) Administrations of general anaesthetics for extractions 2575 (9) Other operations:- Permanent Teeth 1102 Temporary Teeth 300 Total 1402 20, TABLE V VERMINOUS CONDITIONS (1) Average number of visits per school made during the year by the School Nurses or other authorised persons 14 (2) Total number of examinations of children in the Schools by School Nurses or other authorised persons 33336 (3) Number of individual children found unclean 826 (4) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 2 (5) Number of cases in which legal proceedings were token:- (a) Under the Education Act, 1921 2 (b) Under School Attendance Byelaws Nil TABLE VI BLIND AND DEAF CHILDREN Number of totally or almost totally blind and deaf children who are not at the present time receiving education suitable for their special needs. The return should relate to all such children including evacuees resident in the Authority's area. 1. At a Public Elementary School 2. At an Institution other than a Special School 3. At no School or Institution Blind Children - - 1 Deaf Children - - MENTALLY DEFECTIVE CHILDREN. Total number of children notified during the year ended 31st December, 1941, by the Local Education Authority to the Local Mental Deficiency Authority, under the Mental Deficiency (Notification of Children) Regulations, 1928. 7