Hen 19 BOROUGH OP HENDON ANNUAL REPORT OP THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER FOR THE YEAR 19 4 2 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 194 2. October, 1943. To the Mayor, Aldormen & Councillors of the Borough of Hondon. I have tho honour to submit my Thirteenth Annual Report on the health conditions of the Borough for the year 1942. In accordance with the instructions of the Ministry of Health it has been prepared as an interim report, and reference has only been made to matters of particular interest. No detailed couments have, therefore, been made concerning the general activities of the Public Health Department, but these have been fully maintained during the year GENERAL HEALTH CONDITIONS. Vital Statistics. The health conditions continued to be satisfactory, as revealed by the vital statistics, and by the continued observation maintained through the Maternity and Child Welfare and School Medical Services. The year was remarkable for a sharp increase in the number of births, 2081 as compared with 1410 in 1941. On the other hand the death rate showed a reduction from 11.2 per 1000 of the estimated population to 9.82. The infantile mortality rate was 34 per 1000 live births as compared with 49 for the country generally and 59 for the County Boroughs and greater towns including London. This is the second lowest infantile mortality rate to be recordod in the Borough. Tho incidence of new cases of tuberculosis, however, to which reference will bo made later, showed a definite increase. INFECTIOUS DISEASES. The following Table shows the number of notifications of the principal infectious diseases as compared with the previous year- 4, TABLE I. CASES OP INFECTIOUS DISEASES OTHER THAN TUBERCULOSIS NOTIFIED DURING 1941 & 1942. DISEASE TOTALCASES 1941 NOTIFIED 1942 REMOVED TO HOSPITAL 1942 [[Scarlet Fever 258 508 242 Diphtheria 58 38 38 Pneumonia 217 180 68 Acute Poliomyelitis 2 2 2 Measles 887 1300 37 Whooping Cough 707 340 18 Cerebral Spinal Fever 26 9 8 Typhoid or Enteric Fever 8 5 4 It will be seen that Measles increased in prevalence and that Whooping Cough declined, although the cases of the former diseases were almost invariably of a mild character and only 2 deaths from Measles were recorded. Scarlet Fever increased, particularly in the latter months of the year and this increase has boon maintained, giving rise to certain administrative problems in the provision of hospital accommodation. The incidence of Diphtheria was still further reduced and has now reached a uniquely low level, 38 cases having been notified during the year, but the diagnosis of Diphtheria was confirmed in only 26 of these cases. The campaign for the immunisation of children against Diphtheria was intensified in a variety of ways; the propaganda at the Health Centres and. following up by Health Visitors being continuod,as was the publicity on the birthday cards which are sent to the children attending the Centre on their birthday anniversaries. In addition,a letter was sent to all the parents of children attending the Junior Departments of the public elementary schools, enclosing a leaflet of advice and a form for the acceptance of treatment. Great interest was taken by the Director of Education and the members of his staff in this last method of approach, the success of which was very largely due to their influence. Propaganda was also carried out in the local press and by the inclusion of films in the Ministry of Information's weekly displays. Central Authorities also provided valuable propaganda at local Cinemas and in the daily press and particularly by Broadcast talks by authoritative persons, such as the Chief Medical Officer of the Ministry of Health. From enquiries made, I am of the opinion that 3 these talks are the most effective method of stimulating interest. The following Table gives particulars of the number of children who have now been immunised:- T A B L eII IMMUNISATION AGAINST DIPHTHERIA No.of children immunised. Under 5 Over 5 Total 1.Total No. of children immunised during 1942. 2487 | 3381 5868 2.Total No. previously immunised 1670 3530 5200 4157 6911 11068 It is a gratifying fact that in this fourth year of War the incidence of pneumonia was actually reduced and that the incidence of Cerebral Spinal Fever and Typhoid Fever, both of which tend to become prevalent under war time conditions, remained low, TUBERCULOSIS The following Table shows the notifications of and deaths from Pulmonary Tuberculosis during the last four years:- TABLE III PULMONARY tuberculosis . Year Notifications Deaths Males Females Total Males Females Total 193S 82 63 145 30 28 58 1940 83 65 148 51 25 56 1941 68 90 158 48 37 85 1942 141 93 234 38 28 66 It will be seen that the notifications of new cases of this disease havo, so far as males are concerned, markedly increased. How far this may be due to improved methods of diagnosis and to greater numbers of the population being medically examined prior to entry into the various services, I am unable to say, but the fact nevertheless remains and makes the only adverse feature in an otherwise healthy record. VENEREAL DISEASES, The seheme for the diagnosis and treatment of these diseases is administered 4 by the Middlesex County Council and there is no method of knowing the local incidence, but there has been an increase in the country generally. The Council have, at tho request of the Middlesex County Council,co-operated in a publicity campaign designed to focus attention on tho dangerous nature of those diseases and on tho necessity for seeking early treatment. scabies and verminous conditions. These conditions continued to be prevalent and the facilities provided for their treatment at the Health Centres, particularly those which have been adapted as First Aid Posts, wore therefore continued. The increased incidence of Scabies is undoubtedly real, but many more cases have come to light because of the propaganda carried out by the Department through Local Practitioners, Welfare Officers of Factories, Health Centre, etc. The following Table shows particulars of the cases dealt with:- table iv. Scabies cases dealt with. Verminous conditions dealt with. West Hendon 258 51 Childs Hill 25 123 Mill Hill 450 38 Watling 268 74 Central Hendon 224 25 1225 311 " I should like again to record my appreciation of the work of the Civil Defence personnel stationed at the First Aid Posts who havo rendered valuable assistance in the treatment of those conditions and in the various activities which arc conducted at the Health Centres. MATERNITY & CHILD The Maternity and Child Welfare services showed a satisfactory development and continued to be widely utilised. 49,960 attendances were made by children under five years of ago at 3 Health Centres, this being an increase of 1715 as compared with the year 1941 When. one considers tho difficulties which mothers now experience in attending with their children the figures are particularly satisfactory. The care of Expoctant Nursing Mothers. The number of births showed a marked increase, being 2081 as compared with 1410 in the previous year. This was reflected in the Department by an increased 6. attendance of expectant mothers for ante-natal supervision and it became necessary to hold two additional ante-natal sessions per week. It is gratifying to record that a steadily increasing proportion of women arc availing themselves of these services. The following Table gives details of attendances of children under fivo years of age and ante-natal mothers at the Health Centres, as compared with the year 1941:- TABLE V. 1941 1942 No.of Child Welfare Sessions 909 925 Total No. of Attendances 48245 49960 No.of now members admitted 2074 2316 No. of Ante-natal sessions 331 431 No. of cases who attended for the first time 1189 1619 No.of attendances 5253 7464 As the increase in the number of births appeared likely to be maintained, the Council approved the appointment of two additional Midwives, bringing the number of Domiciliary Midwivos employed to a total of 8 in 1943. The following Table gives particulars of the casos attended under the Council's Domiciliary Midwifery Scheme:- TABLE VI DOMICILIARY CONFINEMENTS ATTENDED BY MOTIVES. 1941 1942  (a) Employed by the Council: as Midwives 239 348 as Maternity Nurses 70 100 (b) Employed by Voluntary associations: Under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 as Midwives 138 160 as Maternity Nurses 7 9 454 617 6. This increase in the numbers of births also created great difficulties in providing Hospital accommodation for certain cases. Those women referred to Hospital on medical grounds and on really bad environmental conditions, were admitted but there was a considerable number to whom neither of these considerations applied, but who nevertheless, for a variety of reasons, e.g. the breaking up of family life due to the war, could with advantage have been admitted to Hospital. In on endeavour to cope with this situation,arrangements were made for the admission of women to Ashridge Hospital, Berkhamsted, Herts. and for a limited number to Queen Charlotte's Hospital in London. The greater number of women, however, were admitted to the Middlesex County Council's Maternity accommodation at Redhill County Hospital or to the annex at Bushey. I should like to thank the Obstetric Surgeon at Redhill County Hospital for his continued co-operation in the supervision of difficult ante-natal cases and the prompt attention which he and his flying squad renders in difficult domiciliary labours. The Scheme wheroey women who were accepted for admission to County Hospitals for their confinements, were ante-natally supervised at the Health Centres, continuod to work satisfactorily. HOI/IB HELPS. One of the greatest difficulties encountered in the domiciliary midwifery services was the provision of adequate help in the home during the confinement. In an endeavour to moot this situation the following Scheme for the Provision of Homo Helps was approved:- SCHEME FOR THE PROVISION OF HOME HELPS, IN THE BOROUGH 0F HEND0N. "The scheme provides for attendance of Home Helps in cases where a Midwife has been engaged and the patient is unable to arrange privately for a Home Help, and is as follows:- 1. A panel of women recommended as Homo Helps to be prepared, this panel to bo available at each Health Centre and at the Public Health Department. 2. The Homo Help when employed shall bo paid at the rate of 10/0d per day, there being no retaining fee, this Authority to be responsible for 7/6d. of this payment and the mother for the remaining 2/6d. 3. The supervision of Homo Helps to be undertaken by the Midwife in attendance on the ease. 4. The duties for women on this panel are appended. 7. DUTIES OF THE HOME HELP. 1. On being summoned to a case to notify the Public Health Departrnent as soon as possible of her commencement of duty. 2. To commence duty on the instruction of the Midwife and to attend each day thereafter for a period of 14 days (this period may be varied in accordance with the directions of the Medical Officer of Health). generally 3. The Home Help to be/responsible for the domestic arrangements of the household between 8 a.m. and 6 p.m. on weekdays and 9 a.m. to 1 p.m. on Sundays. 4. To do the washing, cooking and such general duties as the mother would normally do, this to include the removal and washing of soiled linen from the patient's room. 5. Not to interfere with the work of the Doctor or Midwife. 6. To attend punctually each day and not to leave without giving due notice. 7. To obey the instructions of the Midwife with regard to the Mother and baby. 8. To report immediately to the Midwife any contact with infectious disease. 9. To notify the Midwife if for any reason she is unable to continue her duties. 10. The Home Help must provide her own meals." The Home Help scheme has been of the utmost value to women in their confinement. Difficulties have, of course, arisen in obtaining the right type of woman for this work,in view of the competing claims of other forms of employment. It is probable that the future development of this service will be by the appointment of a number of women,in a full time capacity»who can be used in any part of the distric and in other activities of the Department during the waiting period between cases. CHILD LIFE PROTECTION. The Scheme for the supervision of foster children and foster mothers continue. The numbers of applications for foster mothers, however, far exceeded the supply, because of the many other forms of employment now open to women. WARTIME DAY MURSERIES. In order to give effect to the recommendations contained in a joint Circular of the Ministry of Health and the Board of Education, asking Authorities to provide facilities for the care of children under five years of age, to permit of the mothers entering essential war industries, a special Committee was appointed by the Council. Surveys were made in various parts of the district in order to ascertain the need for the establishment of these nurseries# various properties likely to be suitable for adaptation were then inspected and suitable sites selected for the erection of prefabricated huts. The demand was such, however, that it soon became evident that further Nurseries would be required and accommodation at existing nurseries increased. 8 The following Table gives particulars of the Nurseries which have either been established or projected in the areas- Established Nurseries. Address of Nursery. Date. of Opening Original Accommodation Approved Extension Total Acoommodation Addington House, Orange Hill Road, Burnt Oak. 2. 2.42 31 34 65 2,Hocroft Road, N.W.2. 30. 3.42 40 10 50 Hyde School, Hendon,N.W.9. 11. 5.42 45 - 45 York Park, Hendon,N.W. 9. 31. 8.42 35 26 61 Claremont Road, N.W.2. 3.12.42 35 15 50 Approach Road, Edgware. 3 0. 4.43 35 - 35 Projected Nurseries. Proposed Accommodation. Dollis Day Nursery, Dole Street, Fall Hill,N.W.7. 55 Watling Avenue, Burnt Oak. 55 Hyde Cottage, Colindale, N.W.9. 80 In addition to the establishment of War Time Day Nurseries, other methods had to be found for the care of the children of women war workers and with this end in view the Education Authority admitted 753 children under five years of age to the public elementary schools, and have recently opened a special department at Broadfields. The Registered Daily Guardian's Scheme introduced by the Ministry of Labour, by which a contribution is made by that Ministry to women undertaking the care of children in their own homes has not met with any large response. The above very inadequately reflects the volume of work which was undertaken in the establishment of these Nurseries, both by the members of the Committee and by certain members of the staff, but their best tribute will probably be found in the health and happiness of the children. 9 sanitary inspections of the area. The following summary of the inspection work performed by the Sanitary Inspectors has been submitted to mo by Mr.G.E.Luck, Chief Sanitary Inspector. Inspections made 8144 Reinspections after order or notice 9093 Complaints received & investigated 1888 No-answer visits 1409 Nuisances discovered and dealt with 2909 Inspections of air raid shelters 908 Visits paid to infected houses 429 Infected rooms disinfected 445 Cesspools emptied 126 Choked drains cleared by Local Authority for the abatement of urgent nuisances 201 NOTICES SERVED. Informal or cautionary 921 Complied with 812 Outstanding 1942 109 statutory notices Applied for 65 Served, under Public Health Acts etc 16 Outstanding from 1941 2 Complied with 15 Outstanding 1942 3 DISINFESTATION Treatment of Verminous houses. The following houses were successfully treated:- Privately-owned 46 Council houses 7 Number of separate treatments given 168 Inspections were made of furniture and bedding and rooms in the occupation of tenants before their removal into Council houses and disinfestation was performed where necessary. Work of disinfestation is done by the Local Authority and where verminous conditions were discovered,these cases were followed up after removal. factories act, 1037. Number of inspections. 331 Notices served to remedy defects. 47 Notices complied with. 39 Matters notified by H.M.Inspector of Factories. 15 List of Outworkers received. 21 Outworkers premises inspected. 181 10, Nature of defects remedied at Factories:- Sanitary Accommodation. Insufficient 1 Unsuitable or defective 43 Not separate for sexes Improperly ventilated or unventilated 24 Want of cleanliness 68 Inadequate ventilation 7 Ineffective drainage of floors Inadequate lighting 5 Other offences 29 WATER SWIMMING POOLS, At the Council's swimming pools the water is treated by modern purification and filtration plant. Tests for chlorine content are triads daily. A privately owned swimming pool is fitted with filtration and purification plants and tests for chlorine content are also made daily. report on the examination of a sample of the pool water taken for bacteriological examination showed the water to be highly satisfactory# HOUSING. Individual unfit houses. No demolition order was made by the Local Authority and no house was found to be in a state so dangerous ,or injurious to health,as to be unfit for human habitation. Inspection of dwelling-houses during the Year:- Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts.) 1178 Number of inspections made for the purpose. 3774 Number of dwelling-houses found not to bo in all respects reasonably fit for human habitation. 837 Remedy of defects without service of Formal Notices: Number of dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers. 708 Proceedings under Public Health Acts:- Number of dwelling-houses in respect of which notices were served requiring defects to be remedied. 16 Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By Owner 15 (b) By Local Authority in default of Owners. 11. INSPECTION AND SUPERVISION OF FOOD. 1728 inspections were mads at premises where food intended for sale for human consumption was prepared, stored or sold. Milk Supply. Number of registered dairymen and purveyors of milk 13 Number of registered premises 32 Number of cowkeopers 7 Number of forms where milk is bottled on the premises 4 174 spocial visits have been made to secure cleanliness of dairies and dairy farms and for protecting milk against contamination. There is one pasteurising establishment in the district and during the year, 52 samples of bottled pasteurised milk taken immediately after machine capping were submitted for bacteriological examination. One of the samples failed to comply with the requirements of the Milk(Special Designations) Order, 1936 and 1938, the bacteria exceeding 100,000 per millilitre, although all samples gave satisfactory results on the phosphatase test - a test devised to indicate that pasteurised milk has been adequately heated. Twenty-four samples of raw bulk milk were taken from rail tanks, and 27 milk bottles immediately after cleansing in the bottle washing machines. The total number of milk samples taken for examination was 219 Tuberculin Tested Milk 23, Accredited Milk 5, Pasteurised Milk 144, and NonDesignated Milk 47. The 144 pasteurised milks satisfied the phosphatase test, although in addition to the one sample mentioned above, in five samples taken from another dairy the bacterial count exceeded the prescribed standard. The dairy concerned was in an adjacent district, and representations were made to that Local Authority. Of the 23 Tuberculin Tested and the 5 Accredited Milks, one sample of the latter and 8 of the former failed to conform to the prescribed tests. These milks were not bottled in establishments in Hendon and copies of reports on their examination were forwarded to the appropriate licensing authorities. SLAUGHTERHOUSES. Pour slaughterhouses arc licensod for the slaughter of animals intended for human consumption. 12 The Livestock (Restriction on Slaughtering) Order, 1940 made under the Defence (General) Regulations, 1939, prohibit the slaughtering of animals for human consumption,except under the terms and conditions of a license granted by, or under, the authority of the Minister of Pood. None of the four slaughterhouses is licensed by the Ministry of Pood and general slaughtering has temporarily ceased. Slaughter of Animals Acts,1953. Pour slaughtermen were licensed as fit and proper persons to slaughter or stun animals. FOOD CONDEMNATION. The following foodstuffs were examined and condemned as unfit for human consumption:- Butchers Meat. Bacon. Chickens. Pish. 24½ stones Beef 4½- lbs. 28 lbs. 391 stones (Skate wings, witches,herrings, sprats,cod,whiting, coalfish). 5¼ stones Mutton 2 stones Pork Fruit. Other Poods. Canned Poods. 936 lbs. (currants,prunes, dates,oranges). 2058 eggs 578 tins Fruit 466 lbs.Cereals 455 tins Vegetables 421 lbs.Cheeso. 434 tins Meat,and prepared meat meals 21 lbs.Chocolate 14 lbs.Cooking Pat 343 tins Milk 11 lbs.Sugar 138 tins Fish 12 jars Pickles 170 tins Soup 11 tins Spaghetti Total quantity of Canned Poods condemned 2179 tins Total weight of Other Poods condemned 3 tons 9½ cwts. Informal action taken in connection with Pood Shops and Stores. 65 Notices were served on occupiers of shops and stores for infringements of tho Pood and Drugs Act, 1938 where proper precautions were not being taken against contamination of food. The principal matters dealt with were:- Sanitary Accommodation: Defective sanitary conveniences. 27 Without water supply. 2 Defects in drainage systems. 19 Choked drains. 5 Improper storage of food. 8 Provision of washing facilities: Hot water, soap and towels. 7 Want of cleanliness in shops watercloset and stores. 124 Insufficient accommodation for storage of refuse. 9 Refrigerators: Interiors relined. 5 Interiors cleansed. 2 13 HENDON EMERGENCY HOSPITAL YEAR 1942. ACCOMMODATION. The accommodation for the isolation of infectious diseases, which for the first 10 months of the year remained at 52 beds, was extended towards the end of the year owing to the increase in the incidence of Scarlet Fever, by the transference from the E.M.S. section of, first one half of Block 2, and later, of the remainder of the block. Details of the changes effected in the accommodation are shown below TABLE VII 1.1.42 to 4.11. 42 5. 11. 42 to 22.12.42 23.12.42 to 31.12. 42 Block 1 (Diphtheria) 20 20 20 Block 2 (Scarlet Fever - 10 20 Block 4 (Cubicles) 6 6 6 Block 5 (Scarlet Fever) 26 26 26 52 62 72 Block 2 (E.M.S.) 40 20 — — Block 3 (E.M.S.) 20 20 20 Block 6 (E. M.S.) 60 60 60 172 162 152 I am glad to report that the low incidence of Diphtheria,permitted, of Block 1, normally maintained for the reception of that disease, being used for the nursing of complicated cases of Whooping Cough and Measles,when these diseases were prevalent. The increase in the incidence of infectious diseases was anticipated, as this had remained unusually low for a number of years, and application was made to the Ministry of Health for permission to re-build that portion of the cubicle block which had been damaged by enemy action. This was at first granted, but was later withdrawn on account of the situation, both as regards labour and material, although the medical need was freely admitted. A deputation from this Authority was received, by the Ministry in this connection. a sufficiency of cubicle accommodation permits the remaining portion of the hospital being used to bettor advantage, and is a vital necessity in the isolation of cross infections and for cases sent in with the "wrong diagnosis or for observation. Moreover, at the present time, due to a variety of reasons, isolation accommodation is being sought for conditions which would normally be nursed at home, and which cannot be admitted to the more general wards. 14 DENTAL TREATMENT. As a certain number of beds are always available in the E.M.S.portion of the hospital an arrangement was made with Sector Headquarters to admit ante-natal mothers whose dental sepsis was of such a degree that it could bo treated more adequately in hospital. Altogether 16 such cases woro admitted. MEDICAL PANEL. The Council approved a recommendation to establish a medical panel for resident members of the nursing and domestic staff. It was made clear to the staff that whether they joined the hospital panel or continued under the care of their own practitioner was purely optional. The recommendation was made because of the increasing shortage of general practitioners. It is a convenience to the staff and also to the hospital, permitting of minor conditions being treated more expeditiously with a consequent reduction in the periods of sickness. The Middlesex Insurance Committee wore approached and agreed to the formation of a limited panel and this is now in operation. The following tables give particulars of cases treated and admitted during the year:- TABL E. VIII TOTAL NUMBER OP CASES TREATED DURING 1942:The total number of cases treated during the year,including those admitted to the E.M.S. Section is shown below In Hospital 1.1.42. Admitted during year. Died during year. Discharged during 1 year. Remaining in Hosp. 31.12.42. (a)INFECTIOUS DISEASE BEDS Service Cases. 1 9 - 10 - Others 24 360 3 329 52 (b)DSNTAL CASES - 16 - 16 - (c)E.MS.BEDS Service Sick - 2 - 2 - Transferred E.M.S. Cases 14 182 19 161 16 TOTAL 39 569 22 518 68 FEVER CASES The admissions, deaths and discharges of patients treated in the fever section, classified according to the disease notified on admission, are shown as follows:- 15. TABLE IX NOTIFIED AS:- IN HOSPITAL 1.1. 42 ADMITTED DURING ' YEAR DIED DURING YEAR DISCHARGED DURING YEAR REMAINING IN HOSP. 31.12.42 Diphtheria or ? Diphtheria 7 44 1 41 9 Diphtheria Carrier - 2 - 2 - Scarlet Fever or? Scarlet fever 10 239 - 209 40 Scarlet Fever & Chicken Pox - 2 - 2 - Scarlet Fever & Whooping Cough - 1 - 1 - Whooping Cough - 11 - 11 - Whooping Cough & Measles 1 - - 1 - Chicken Pox - 4 - 4 - Rubella - 4 - 4 - Measles 2 26 - 28 - Measles & Meningitis - 2 1 1 - Post Measles Mastoiditis - 1 - 1 - Mumps - 9 - 9 - Erysipelas 1 2 - 3 - Meningitis - 3 1 2 - ? Poliomyelitis 1 2 - 2 1 Paratyphoid Fever - 2 - 2 - Dysentery - 1 - - 1 Scabies - 4 - 4 - Impetigo - 4 - 3 1 Observation 3 5 - 8 _ Admitted with Mother for Nursing Purpose - 1 - 1 - TOTAL i 25 369 3 339 52 number of cases treated as compared with the previous year. table x notified as:- admissions deaths discharges 1941 1942 1941 1942 1941 1942 diphtheria or ? Diphtheria 68 44 2 1 73 41 Scarlet Fever or ? Scarlet Fever 167 239 _ - 177 209 Erysipelas 9 2 - - 9 3 Measles 12 26 - - 14 28 Whooping Cough 11 11 - - 12 11 Mumps - 9 - - - 9 Other conditions 39 38 1 2 35 38 total 306 369 3 3 320 339 PINAL DIAGNOSIS. The final diagnosis arrived at in connection with the 342 completed cases is shown as follows:- 16. TABLE XI i Discharged. Died. Total. i Diphtheria < 27* . i 28 Diphthoria Carrier . 2 - 2 Scarlet Paver. 191 - 191 * Scarlet Fovcr & Chicken Pox.... 2 - 2 * Scarlet Fever & Measles 1 - 1 Moasles........................ 28 ! 28 * Measles & Meningitis- » 1 - 1 * Measles &. Whooping <~V". h. 1 - 1 Whooping Cough.,...... ,, 10 10 Chicken Pox 5 - 5 Mumps. , „ 9 - 9 Rubella 4 _ 4 Meningococcal Meningitis. 1 1 2 Chronic Meningococcal Infection 1 - 1 * Encephalitis, Ilea bios & Whooping Cough j 1 1 -interio Poliouyelitis 1 - 1 Paratyphoid Fever 3 1 - 1 Colitis. 1 - 1 Toxic Jaundice 1 - 1 Erysipelas . 1 - 1 Cellulitis 2 - 2 Laryngeal Obstruction 1 1 -Croup.................... ...... 1 - 1 Broncho. Pneumonia 1 ~ 1 Quinsy 1 1 Tonsillitis 26 26 * Tonsillitis & Scabies 1 1 Scabies 2 - 2 * Scabies & Impetigo............ • 4 _ 4 Impetigo....................... 1 1 Septic Spots................... 1 } Inflamation of Left Subraax. Gland 1 1 Influenza & Cvstitis. .••••••••* 1 1 Mastoidectomy following Measles 1 - * ' Phimo sis....................... 1 - 1 Und e rnourishment 1 _ 1 admitted v.'ith Mother for Nursing Purposes j _ 1 N.A.D ) 4 339 3 342 * Concurrent infection on admission# i 17. SCHOOL MEDICAL SERVICES. The health of the children attending the elementary schools was well maintained and compared favourably with that of pre-war years. Careful watch was kept over their nutritional standards and so far as the findings of medical inspections are concerned, it will be seen that there was little deviation from the previous year. TABLE XII CLASSIFICATION 0F THE NUTRITION OP CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Number of children inspected. A (Excellent) B (Normal) C (Slightly sub-normal) D (Bad) No. % No. No. No. % 1941 5463 938 17.17 3824 70.0 696 12.74 5 0.09 1942 5011 947 18.90 3506 69.97 550 10.97 8 0.16 It is difficult, however, to measure standards of positive health by statistics only, but I am convinced from my observations that the muscular tone, the posture and general bearing of the children reflect as high a standard of wellbeing as in any pre-war year. This is particularly so in the children from the poorer homos. Against this optimistic picture one disquieting fact emerges, viz., that considerably more children were referred for psychological examination because of problems of behaviour. This may not be altogether surprising in a war atmosphere and it is probable that a number of causes are operating to produce this result; the lack of parental control due in many instances to the father being in the Services and the mother in industry is, I believe, the most important single factor. The clothing of the children generally remained good, but thero was evidence that difficulty was being experienced in a small number of cases and this is not likely to improve in the immediate future. The Scheme for the provision of milk and meals in schools has played a largo part in maintaining and in many instances, improving the standard of nutrition, and it is likely that in the near future, meals will bo provided for all children whose parents wish them to participate. At the present time a considerable number of children are taking advantage of meals provided at the British Restaurants, and the subsidising and stabilisation of the prices of the more essential foodstuffs, has also been a valuable contribution. 18. In this connection, I asked the Assistant Medical Officers who are in daily personal contact with the mothers and children, for their observations on the general effect of the war on the physical and mental welfare of the children, with special reference to their nutrition and to the effect of the provision of school meals and milk Their observations were as follows:- "I feel sure that there is a general improvement .In the nutrition of the school child; but without milk and school meals it certainly would not have been so. On the other hand, we are certainly getting more "difficult or problem" children referred to us and in many cases the difficulties are attributed to lack of care or parental control." "The general health of the school children is quite asg:iod a 3 before the war, in some cases it is better for the following reasons:- 1. There is less unemployment. 2. Wages are higher. 3. School meals. 4. British Restaurants f 3ed. many of the children. 5. The provision of cheap milk for the children under 5 years of age has resulted in an improvement in the physical condition of entrants into the Public iHementary Schools. Against this there is a small number of children who are in a worse position than before the war, e.g. those vrtio were oomfortably off; father being in the army has reduced the family income mother strives to keep up the former standard on a smaller income and fails. Result - nervous tension and unhaypiness leading to debility. Skins:- Improvement in Scabies. Clothing:- Difficulty in getting sufficient cheap clothes for growing children." "The general impression of the health of the children for 1942 is as follows:- The pre-war level of nutrition is maintained, and in many cases is improved. The condition of the new born baby shows considerable improvement, especially in those cases where the pre-war income was small or fluctuating and where the ante-natal mother is now having vitamins and additional food during pregnancy. T^ere is a definite improvement in the poorer type of child who is now having regular school dinners. A great many children, however, continuo to suffer from lacic of appetite, fatigue and slack posture, duo to late bed times and unsatisfactory supervision at home. Associated with this lack of supervision in the home is the accompanying wastage of school and clinic time expended on "dirt diseases", scabies and impetigo, septic sores and. vermin. In some schools marked improvement has followed time spent by the teaching staff on matters of health and cleanliness." 19, "The physical and mental welfare of the children I see at the clinics has not deteriorated because of the war. On the whole, it may be said to have improved slightly, There is, however, a greater tendency to minor ailments, (i.e. septic spots, impetigo, catarrhal colds, etc.) which is probably the outcome of the children recoiving less care and supervision, at home due to so many mothers being engaged in war industry. There is no doubt as to the value of school meals and milk. The children invariably improve and put on weight. It is particularly to school meals that the improvement is due and, the extension of this valuable measure to all children is very desirable. It is sometimes conspicuous that the mal-nourished children of the improvident or very poor homos, who need this extra nourishment most, are deprived of it through the carelessness or lack of co-operation on the part of their mothers. This accounts to some extent, for the families of very undernourished children one still meets with in various parts of the Borough. In many of those instances, the mother too is in a poor state of health, and because of this, probably lacks the initiative and energy to avail herself of the facilities provided by the local authority.'' The services for the examination and the treatment of the children attending both the elementary and secondary schools have continued, to full capacity. The scheme for the inspection and treatment of children attending secondary and technical schools by this Department, on behalf of the Middlesex County Council, was continued, and during the year was extended to include tho treatment of Orthopaedic and Orthodontic defects, and minor ailments. Tho various forms of treatment therefore, which have been provided for the children attending the elementary schools are now available to the secondary school children, and while it is not possible to deal with them in detail in a report of this nature, the appended Tables will give some indication of the volume of work which was undertaken:- TABLE XIII • Routine Medical Inspections Special Inspections Total Public Elementary Schools 5,011 6,668 11,679 (Secondary Schools 1,338 9 1,347 6,349 6,677 13,026 20.. TABLE.XIV Number of attendances of Children for Treatment at Health Centres Public Elementary Schools Secondary Schools Total Minor Ailments 26,320 26,520 Dental 11,195 2152 13,347 Ophthalmic 2,198 401 2,599 Speech 1,313 40 1,353 Orthoptic 2,253 134 2,392 Orthopaedic 3,411 195 3,606 SECONDLY SCHOOLS An,analysis was also made of the nutritional standard of tho children attending the Secondary Schools, with the following results:- Table XV. No. of Children Inspected A (Excollent) B (Normal) C (Slightly sub-normal) D (Bad) No. % No. % No. %| No. %[#/##] 1941 1306 392 30,02 847 64.8 5 67 5.13 - - 1942 1338 L , ... 393 29. 37 884 66.07 60 4.49 1 < 0.07 The Dental services, however, as far as the school children wore concerned, were not so well maintained as in the previous year, despite the fact that arrangements were made for numbers of the Secondary School children to be treated at evening sessions. The falling off in this work was mainly due to an increase in the Maternity and Child Welfare Services, particularly in the dental work for expectant mothers, the numbers of women attending having markedly increased. At least one further full time Dental Officer could have been usefully employed. The number of Orthopaedic Surgeon's sessions had to be reduced from 2 to 1 per month, owing to the Surgical personnel being no longer available. To reduce congestion, at the sessions, a scheme was instituted whereby suitable cases were referred directly by the Assistant Medical Officers to the Orthopaedic Nurse for treatment, only those who failed to respond, or who had defects demanding the attention of the Orthopaedic Surgeon, being referred to him,although as far as possible, all cases under treatment were seen by the Orthopaedic Surgeon at regular intervals. In addition, a scheme was evolved with the assistance of the Physical Training Instructors, whereby children who had developed minor postural defccts were referred directly to the Instructors, so that the child could have the benefit of 21. graduated exorcises specially designed to correct his condition. I am indebted to the Director of Education for the following notes of the main developments likely to affect the health of children, which had taken place in the educational services during the year, and should like to tender my thanks to the Director and his staff for their continued co-operation. "1. CHILDREN UNDER 5 YEAR OF AGE. In accordance with the suggestions contained in Board of Education Circular 1573, arrangements have been made for the admission of children undor 5 years of age to Elementary Infant Departments. On 1st October there were 753 such children attending 25 departments. The opening of Infant Schools to children under five is a valuable contribution to the release of women for industry. 2. PLAY CENTRES. Pour Play Centres have been established at the following schools:- Average daily number at present on roll. Childs Hill School 73 Clitterhouse School 47 Goldbeaters School 76 The Meads School 34 TOTAL 230 The total number of teas served during the week ended 2nd October was 967. 3. PROVISION OF MEALS. Two Central Kitchens have been established at Algernon Road and Bell Lane Schools which provide over 3,500 meals daily. In addition there arc kitchens at Orange Hill Central School and R.C. School of the Annunciation which provide 300 and 200 meals daily respectively. The latest figure shows that 20,339 meals were served during one week at 28 school canteens for children attending 46 school departments. Approximately 30% of children on the school rolls arc receiving meals daily. The Education Committee have forwarded a scheme to the Board of Education for increasing this figure to a ceiling of 10,000 meals a day which is 75% of the children on the school rolls. 4. CARE OF CHILDREN DURING HOLIDAYS. Six school centres were established in the area during the Summer Holidays at which 503 children promised to attend. The actual daily average attendance was 263, representing only l.9% of tho number of children on roll. During the period facilities were afforded for meals and milk to be provided at various schools. Unfortunately the demand for school meals dropped from over 20,000 a week to less than 3,400. Moreover, at the last count taken on the 6th October, 14,624 thirds of a pint ofmilk were consumed, whereas the average daily consumption during the Midsummer Holidays was 1,063 thirds of a pint. 5. WAR TIME DAY NURSERY. A War-time Day Nursery was opened at Broadfields Avenue Council School for children between the ages of 2 and 5 years whose mothers are engaged on war work. 22 15 children have so far been enrolled. Breakfasts, dinners and teas are provided, daily at this Nursery which is open from 7 a.m. to 6 p.m. (Mondays to Fridays) and from 7 a.m. to 1 p.m. on Saturdays." STATISTICAL TABLES. The Board of Education Statistical Tables are appended. I cannot conclude this brief record of a very busy year without paying tribute to the members of my staff, all of whom have co-operated loyally and efficiently in maintaining the existing services at their present high level, and in undertaking the new duties and responsibilities which have been placed upon the Public Health Department. I have the honour to be, Mr.Mayor, Ladies and Gentlemen, Your obedient servant, a.fairgrieve adamson, Medical Officer of "Health, BOARD OF EDUCATION MEDICAL INSPECTION AND TREATMENT RETURNS YEAR ENDED 31st DECEITS, 1942. TABLE I MEDICAL INSPECTIONS OF CHILDREN ATTEIDING PUBLIC ELELENTARY SCHOOLS. A. ROUTINE MEDICAL INSPECTIONS: (l) No. of Inspections: Entrants 1818 Second Age Group 1606 Third Age Group 1587 TOTAL 5011 (2) No. of other Routine Inspections — GRAND TOTAL 5011 B. OTHER INSPECTIONS: No. of Special Inspections and re-Inspections 6668 TABLE II CLASSIFICATION OP THE NUTRITION OP CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Number of Children Inspected A (Excellent) B (Normal) C | (Slightly sub-normal) D (Bad) No. I '0* >S No. 55 ! No. % 5011 947 18.9 3506 69.97 550 10. 97 8 0.16 TABLE III GROUP I. - TREaTMENT 0? MINOR AILMENTS (Excluding uncleanliness) Total Number of Defects treated or under treatment during the year under the authority's Scheme 6954 GROUP II. - TREATMENT OP DEFECTIVE VISION /J© SQUINT Errors of Refraction (including squint) 585 Other defect or disease of the eyes (excluding those recorded in Group I) 33 Total 618 No. of children for whom spectacles were (a) Prescribed 321 (b) Obtained 296 GROUP III. - TR..aTMENT OF DEFEATS OF NOSE AND THROAT. Received Operative Treatment 144 Received other forms of Treatment - Total number treated 144 TABLE IV. DENTAL INSPECTION AND TREATMENT (l) Number of children inspected by the Dentist (a) Routine age groups 8632 (b) Specials 805 (c) TOTAL (Routine & Special) 9437 (2) Number found to re qui rn treatment 5238 (3) dumber actually treated 3837 (4) Attendances made by children for treatment 11195 (5) Half-days devoted to:- Inspection 87 Treatment 1409 Total 1496 (6) Fillings:- Permanent Teeth 4804 Temporary Teeth 610 Total 5414 (7) Extractions:- Permanent Teeth 1175 Temporary Tooth 4535 Total 5710 (8) Administrations of general anaesthetics for extractions 1996 (9) Other Operations:- Permanent Teeth 1051 Temporary Tooth 356 1407 TABLE V. VERMIN0US CONDITIONS (l) average number of visits per schdol made during the year by the School Nurses or other authorised persons 22 (2) Total number of examinations of children in the Schools by School Nurses or other authorised persons 34557 (3) Number of individual children found unclean 857 (4) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 Nil (5) Number of cases in which legal proceedings were taken (a) Under the Education Act, 1921 Nil (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 othei than a Special School 3. At no School or Institution Blind Children - - 1 Deaf Children - - -