HEN 20 5 BOROUGH OF HENDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER FOR THE YEAR 19 4 3 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 1943. August, 1944. To the Mayor, Aldermen and Councillors of the Borough of Hendon, I have the honour to submit my Fourteenth Annual Report on the health conditions of the Borough for the year 1943. 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 comments have, therefore, bean made concerning the general activities of the Public Health Department, but these have been fully maintained and where necessary extended. The year has been one of great legislative activity, affecting Local Government, the two most important measures being the Education Bill and the Government White Paper on a National Health Service, the latter issued in the early part of 1944. The general effect of these proposals is to make the major Authorities, namely the County and County Borough Councils, responsible for health and education. While it is undoubtedly true that Local Government boundaries are in need of revision, the proposals bear hardly on areas which have shown their willingness and ability to establish and maintain first class social services. Fortunately, wide powers of delegation are contained in both measures and their operational success will depend largely on the sense of local responsibility which is fostered, and that again will depend on how wide an interpretation is given to the powers of delegation. GENERAL HEALTH CONDITIONS. Vital Statistics. I am glad to report that the health conditions continued to be satisfactory, ??? revealed by vital statistics and by the continued observation maintained through the Maternity and Child Welfare and School Medical Services. The number of births which had already reached a high level, namely 2,081 in 1942, increased to 2,223. The infantile mortality maintained a low level, namely 39 per thousand live births, as compared with 34 in the previous year, and with 49 for the country generally and 58 for the County Boroughs and greater towns including London. 2. The following Table shows the causes of death during the year;- TABLE I CAUSE MALE . FEMALE TOTAL Typhoid and paratyphoid fevers — — — Cerebro-spinal fever 1 — 1 Scarlet fever — 1 1 Whooping Cough 1 1 2 Diphtheria 1 1 2 Tuberculosis of respiratory system 49 24 73 Other forms of tuberculosis — 9 9 Syphilitic diseases 8 2 10 Influenza 13 15 28 Measles — — — Acute poliomyelitis and polioencephalitis — — — Acute infectious encephalitis — 2 2 Cancer of buccal cavity and oesophagus (M) uterus (P) 5 18 23 Cancer of stomach and duodenum 18 18 36 Cancer of breast — 23 23 Cancer of all other sites 89 76 165 Diabetes 5 6 11 Intra-cranial vascular lesions 54 83 137 Heart disease 183 178 361 Other diseases of circulatory system 20 23 43 Bronchitis 35 24 59 Pneumonia 42 41 83 Other respiratory diseases 11 9 20 Ulcer of stomach or duodenum 8 3 11 Diarrhoea, under 2 years 5 8 Appendicitis — 6 6 Other digestive diseases 15 22 37 Nephritis 21 15 36 Puerperal and post-abortive sepsis — — — Other maternal causes — 4 4 Premature birth 12 10 22 Congenital malformations, birth injury, infantile disease 13 15 28 Suicide — 7 7 Road traffic accidents 5 2 7 Other violent causes 17 14 31 All other causes 58 38 96 TOTAL - All causes 689 698 1387 3. INFECTIOUS DISEASES. The following Table shows the number of notifications of the principal infectious diseases as compared with the previous year:- TABLE II. CASES OP INFECTIOUS DISEASES OTHER THAN TUBERCULOSIS NOTIFIED DURING 1942 AND 1943 DISEASE TOTAL CASES NOTIFIED REMOVED TO HOSPITAL 1943 1942 1943 Scarlet Fever 308 758 562 Diphtheria 38 31 31 Pneumonia 180 172 65 Acute Poliomyelitis 2 1 1 Measles 1300 1005 39 Whooping Cough 340 212 14 Cerebro-spinal Fever 9 10 10 Typhoid or Enteric Fever 5 2 2 A mild type of Scarlet Fever was prevalent throughout the year, 758 cases being notified of which 5.62 were removed to Hospital. The incidence of Diphtheria was still further rcduced, 31 oases being notified, but of these only 17 proved to be true Diphtheria, I am glad to report that the incidence of acute poliomyelitis, cerebro-spinal fever, and diseases of the typhoid group all liable to increase in war, remained at a low level. The campaign for Diphtheria Immunisation was continued and 4438 children were immunised. The following Table gives particulars of the number of children who have now been immunised:- table iii IMMUNISATION -AGAINST DIPHTHERIA. No. of Children Immunised Under 5 Over 5 total 1. Total No, of children immunised during 1943 1795 2643 4438 2, Total No. previously immunised 4157 -6911 11068 totals 5952 9554 15506 4. The percentage of child population immunised is estimated to be as follows:- Under 5 years of age 58% Over 5 years and under 15 years 77% TUBERCULOSIS. The following Table shows the notifications of and deaths from Pulmonary Tuberculosis during the last four years:- TABLE IV YEAR NOTIFICATIONS DEATHS Males Females Total Males Females Total 1940 83 65 148 31 25 56 1941 68 90 158 48 37 85 1942 141 93 234 38 28 66 1943 100 74 174 57 27 84 Attention is drawn to the fact that in the year 1942 the incidence of this disease had shown a definite increase. It will "be seen that this has no longer been maintained and that the notifications of new cases, both male and female have decreased, but as could be expected from the previous high incidence the death rate from this disease still remained high, I am indebted to Dr, A. S. Hall, the County Tuberculosis Medical Officer, for the following observations:- "The position with regard to tuberculosis cannot be regarded with complacency for although the death roll is not as high as was feared it might become, yet it by no means approaches the level which might have been expected if the pre-war decline had continued. The figures for deaths are interesting for it will be seen that the increase is almost entirely due to deaths amongst men, the figure for women being down to the pre-war level. This contrasts with experience in the last war when the chief rise in mortality was amongst young women. No explanation of the change can be suggested at present, but it may be noted that the national figures confirm the Hendon experience. Notification figures as opposed to deaths do not reflect the amount of tuberculosis in the district with any great degree of accuracy and too much attention should not be paid to their yearly variation. Mass radiography and the increased interest in the disease play a great part in swelling the figures." INFLUENZA. Influenza, fortunately of a mild type, was prevalent in the latter months of the year and as difficulty in nursing those cases not admitted to hospital was anticipated, a scheme was formed in co-operation with the British Red Cross Society and St, John's Ambulance Brigade, for nursing in the home 5. and with the Women's Voluntary Service for domestic help and shopping. All medical practitioners in the area were notified of the facilities which had been arranged. The type of the disease, while giving rise to a serious degree of prostration was not of long duration nor was pneumonia, which is the most common sequel of influenza, unduly prevalent. scabies and verminous conditions The campaign against these conditions was continued energetically during the year. It was not found necessary to invoice the provisions of the Scabies Order, willing co-operation "being obtained in the majority of cases, but in a certain number there was reluctance on the part of other members of the family to submit themselves to examination. It was found, however, that a follow-up letter calling attention to the family nature of these conditions and to the provisions of the Order was sufficient to ensure attendance. As in the previous year the cleansing was carried out in the Health Centres mainly by the Civil Defence personnel to whom I am indebted for this and their co-operation in the health services generally. In the campaign against these conditions and for the information of members of the local medical profession, a film dealing with the diagnosis and treatment of scabies was shown at Brent Modern School, Ministry of Health Circular 2831 contained recommendations for dealing with head lice and suggested that Health Visitors should pay special attention to the subject not only at the Clinics but during their visits to the homes, and also that suitable combs should be provided for sale or on loan. The circular also advocated the use of "lethane" as an effective method of vermin destruction. Instructions were given to the Health Visitors along these lines but the majority of the recommendations contained in the Circular had, as a result of experience, been in operation in this district for some time. 6. The following Table shows the number of cases dealt with during the years:- TABLE V CENTRE CASES OP SCABIES DEALT WITH VERMINOUS CONDITIONS DEALT WITH West Hendon 377 78 Child's Hill 47 152 Mill Hill 277 40 Watling 276 285 Central Hendon 279 36 Totals 1256 591 . MATERNITY AND CHILD WELFARE. The Maternity and Child Welfare Services continued to expand, 54,962 attendances being made by children at the Centres as compared with 49, 960 in the previous year. This is particularly satisfactory, and showed a sustained interest on the part of the mothers, when one considers the difficulties which they must now experience in attending with their children at the Centres. For the convenience of the mothers on the Broadfields Estate a child welfare session was established at St, Andrews Church Hall. The number of mothers who took advantage of those facilities soon necessitated two sessions weekly being held at these premises. The care of Expectant and Nursing Mothers. The number of births showed a slight increase as did the number of individual attendances of expectant mothers at the ante-natal clinics, but the total number under supervision fell slightly from 1619 in 1942 to 1593 in 1943. The following Table gives details of attendances of children under five years of age and ante-natal mothers at the Health Centre, as compared with the year 1942:- TABLE VI 1942 1943 No. of Child Welfare Sessions 925 934 Total No. of Attendances 49,960 54,962 No. of new members admitted 2,316 2,298 No. of ante-natal sessions 431 503 No. of cases who attended for the first time 1,619 1,597 No. of attendances 7,464 8,721 7. To meet the demand of the increasing birth rate an additional midwife was appointed, bringing the total number of Domiciliary Midwives employed in the Borough to 8, The following Table gives particulars of the cases attended under the Council's Domiciliary Midwifery Scheme:- TABLE VII DOMICILIARY CONFINEMENTS ATTENDED BY MIDWIVES. » 1942 1943 (a) Employed by the Council: as Midwives 348 336 as Maternity Nurses 100 118 (b) Employed by Voluntary Associations: Under arrangements male with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 as Midwives 160 156 as Maternity Nurses 9 17 617 627 I should like here to mention the high standard of domiciliary midwifery maintained by the Council's Midwives and by those of the Watling District Nursing Association with whom arrangements were made under the provisions of the Midwives Act, 1936. The arrangements whereby women who are accepted for confinement at the Redhill County Hospital are supervised at the Borough Ante-natal Clinics continued to operate satisfactorily, and I am indebted to the Obstetric Surgeon of that hospital for seeing difficult cases found at the Centres, and for the prompt and effective use of the "Flying Squad" in domiciliary obstetric difficulties. It is gratifying to record that the maternal mortality rate continued to be low. Pour deaths were attributed to conditions associated with childbirth, giving a maternal mortality rate of 1.76 per thousand births. An analysis of the deaths however, showed that one, while occurring during confinement, was due to a condition not associated with pregnancy; one was duo to self-induced abortion, a third to a concealed pregnancy, no arrangement having been made by the mother for her confinement, and the fourth was duo to eclampsia — a true complication of pregnancy. 8. PROVISION OF ACCOMMODATION FOR INSTITUTIONAL MIDWIFERY. The following Table shows the Hospitals to which midwifery cases were admitted under official arrangements:- TABLE VIII HOSPITAL CASES ADMITTED Ashridge 29 Queen Charlotte's 10 City c. London 1 Redhill County 597 ??? to the increased high birth rate and the upset of family life consequent upon war-time conditions, the Council decided to explore the adequacy or otherwise of the provisions for institutional midwifery. A Sub-Committee of the Public Health and Medical Services Committee was formed to consider the master, and reported that in their view the existing provisions were inadequate. The Sub-Committee inspected a number of properties and eventually found one capable of being adapted to form a maternity unit of 20 beds with a capacity of approximately 400 confinements each year, and recommended that such a unit should be established. This recommendation was approved by the Council and was submitted to the Minister of Health with plans and estimates, The Minister, however, took the view that any additional institutional provision for midwifery should be provided by the County Council and linked up with their general hospital service. The matter was still under consideration at the end of the year. HOME HELPS. In the last year's Report a brief summary was given of the Home Help Scheme which has now been extended and amended in detail. The Home Helps have mainly worked as an ancillary to the domiciliary midwifery service and have provided a valuable social service particularly under existing conditions where the upset of family life has created unusual difficulties for the expectant mother. It is hoped that this scheme may be extended to cover incapacity from other causes in the mother with young children. The number of cases attended by Home Helps was 135. 9 laboratory facilities. The arrangements with the E.M.S. Laboratories at Watford were continued whereby bacteriological investigations of public health interest could bo undertaken for this Department or for Practitioners practising in the Borough. The Laboratory's Staff have been most helpful in a number of difficult cases, particularly those admitted to the Isolation Hospital, and I should like to take this opportunity of recording my appreciation of their continued willing co-operation. With the expanding knowledge of bacteriology these investigations become more and more important both to preventive end curative medicine and the post-war development should envisage laboratories capable of carrying out all investigations, situated so as to be sufficiently accessible to large centres of population with subsidiary laboratories of more limited activity, so that the Doctors making use of them may have opportunities of frequent consultation with the personnel of the Laboratories, ADOPTION OF CHILDREN REGULATIONS) ACT, 1939. This Act came into force on 1st June, 1943 and deals with the registration of Adoption Societies, the registration Authority being the Council of a County or County Borough. As far as this Authority is concerned, Section 7 of the Act places on Welfare Authorities a responsibility for the supervision of the child during the probationary period and until a Court Order is made for legal adoption. The powers of the Authority under the Act arc identical with those already in force for the well-being of foster children, ambulance services, The ambulances which had been accommodated at the Fire Stations and operated by the Fire Brigade, were transferred to this Authority, and arrangements were made for them to be manned by Civil Defence personnel, provision being made for the Ambulances to be accommodated at two of the Civil Defence Ambulance Stations, one in the North end one in the South. There was a steady increase in the demand for this service and to meet this demand two additional ambulances were acquired, making a total of It was found necessary to supplement this provision by using Civil Defence Ambulances, a total of 3285 cases being removed during the year. 10. provision of insulin. Ministry of Health Circular 2734 gave approval for insulin to be provided either free of cost or at reduced prices to persons suffering from diabetes for whom there was no provision either by way of Public Assistance or National Health Insurance Acts. At the sane tine the Education Act, 1921, was so amended as to allow Local Education Authorities to provide insulin froc of charge or at reduced rates to all persons and young children attending certain specified typos of schools or educational institutions, this provision to continue for the duration of the war. WAR-TIME DAY NURSERIES. The programme for the erection of new and the extension of existing nurseries was continued, and the following Table gives particulars of the Nurseries which have been either established or projected in the area:- TABLE IX. Established Nurseries, Address of Nursery Date of Opening. Original Accommodation, Approved Extension. Total Accommodation, Addington House, Orange Hill Road, Burnt Oak, 2.2.42. 31 32 . 63 2, Hocroft Road, Child's Hill. 30.3.42. 40 10 50 Hyde School, Hendon, N.W.9. 11.5.42. 45 — 45 York Park, West Hendon, N.W.9. 31.8.42. 35 20 55 Claremont Road, Criclclcwood, N.W.2. 3.12.42. 35 12 47 Approach Road, Edgware, 30.4.43. 35 — 35 Hyde Cottage, Hendon, N.W.9. 21.2.44. 80 — 80 Dole Street, Mill Hill, N.W.7: 20.3.44. 55 — 55 Projected Nurseries Proposed Accommodation, Watling Avenue, Burnt Oak, 50 11. I am indebted to Dr, J. Helen Garrow for the following observations on the health conditions of the children cared for at these Nurseries:- "The children on the whole put on weight, improved in firmness of muscle and became more energetic. Babies under one year have done particularly well. This is very much to the credit of the Matrons and nurserytrained nurses, who have been meticulous in their attention to these babies. Also to the fact that a small baby is always kept warm, bathed in a warm atmosphere and has warm clothes put on. His mother also as long as he is a baby realises that warmth is 'life' to him. Unfortunately, by the time this baby "gets on his foot", ho is allowed to stand and sit on cold floors without shoes or stockings, and possibly only a very brief frock and vest. He gets a cold in the head and nasal catarrh and bronchitis follows. This state of things is so general that it is accepted as unavoidable both in the small children and the infant class at school. Nasal catarrh and bronchitis are the chief cause of illness in the nurseries. Pour steps have been taken to improve this condition:- 1. Increase in heat in the Nurseries, 2. Warmer clothing for the children. 3. More toys of the movable type to promote activity. 4. Explaining the plan to the parents to enlist their co-operation in always keeping the child well wrapped up on the journey to and from the Nursery, as well as at home. The improvement in the childrens' condition in the summer months is most marked, with the drier atmosphere and warmer days the nasal catarrh practically disappears. There have been no epidemics of infectious illness in any of the six Nurseries. Each Nursery has had some cases of measles, whooping cough, mumps, scarlet fever and conjunctivitis# Prom time to time an occasional case of impetigo or scabies appeared which was promptly dealt with. There has been no gastro-enteritis in any of the Nurseries." SANITARY INSPECTIONS OF THE AREA. The following summary of the inspection work performed by the Sanitary Inspectors has been submitted to me by Mr. G, E. Luck, Chief Sanitary Inspector Inspections made 7384 Reinspections after order or notice 8742 Complaints received and investigated 1701 No-answer visits 1528 Nuisances discovered and dealt with 2462 Inspections of Air Raid Shelters 555 Visits paid to infected houses 950 Infected rooms disinfected 1079 Cesspools emptied 123 Choked drains cleared by Local Authority for the abatement of urgent nuisances 209 12. NOTICES SERVED. Informal or cautionary 421 Complied with 398 Outstanding 1943 23 STATUTORY NOTICES. Applied for 67 Served under Public Health Acts, etc. 27 Outstanding from 1942 3 Complied with 26 Outstanding 1943 4 DISINFESTATIQN. Treatment of Verminous houses. The following houses were successfully treated:- Privately-owned 50 Council houses 3 Inspections wore Dade 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, 1937. Number of inspections 211 Notices served to remedy defects 29 Notices complied with 26 Matters notified by H.M. Inspector of Factories 24 Lists of Outworkers received 30 Outworkers premises inspected 29 Nature of defects remedied at Factories:Sanitary Accomodation. Insufficient 8 Unsuitable or defective 10 Improperly ventilated or unventilated 23 Want of Cleanliness 16 Inadequate ventilation 6 Inadequate lighting 5 Other offences 15 WATER, Swinging Pools. At the Council's swimming pools the water is treated by modern purification and filtration plant. Tests for chlorine content are made daily. 13. 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 he unfit for human habitation. Inspection of dwelling-houses during the years:- Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts.) 1999 Number of inspections made for the purpose. 4890 Number of dwelling-houses found not to be in all respects reasonably fit for human habitation. 691 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 642 Proceedings under Public Health Acts:- Number of dwelling-houses in respect of which notices were served requiring defects to be remedied. 26 Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) by Owner 25 (b) by Local Authority in default of Owners — inspection and supervision of food. 1273 inspections were made 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 cowkeepers 7 Number of farms where milk is bottled on the premises 4 108 special 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 past year, 56 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, 19361941, the bacteria exceeding 100,000 per millilitre,, although all samples gave 14. 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 twenty—four milk bottles immediately after cleansing in the bottles washing machines. During the year this pasteurising establishment converted their existing original plant into a "High Temperature Short Tine" pasteurising unit and several improvements as a result of special tests carried out by the Department over a period of 3 months wore made to ensure that the requirements of the Milk (Special Designations) Order 1936 to 1941 were being fulfilled. In addition to the talcing of weekly samples 9 special samples from various points in the milk pipe-line were found on examination to be satisfactory; a licence was subsequently granted. The total number of milk samples taken for examination was 162: Tuberculin-Tested milk 5, Pasteurised milk 115, and non-Designated milk 42, The 115 pasteurised milks satisfied the Phosphatase Test, although in addition to the one sample mentioned above, in two 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 five Tuberculin-Tested, one sample failed to conform to the proscribed test. This milk was not bottled in on establishment in Hendon and a copy of the report on its examination was forwarded to the appropriate licensing Authority, SLAUGHTERHOUSES. Three Slaughterhouses are licensed for the slaughter of animals intended for human consumption. The livestock (Restriction on Slaughtering) Order 1940, made under the Defence (General) Regulations 1939, prohibits the slaughtering of animals for human consumption except under the terms and conditions of a licence granted by, or under the authority of, the Minister of Pood. None of the three slaughterhouses is licensed by the Ministry of Food and general slaughtering has temporarily ceased. 15. SLAUGHTER OF ANIMALS ACT 1933. Pour slaughtermen were licensed as fit and proper persons to slaughter or stun animals. POOD CONDENSATION. The following foodstuffs were examined and condemned as unfit for human consumption: - Butchers Meat, Bacon, Poultry, Fish. 23 Calves Heads 125 lbs. 52¼ lbs. 497 stones. 110¼ lbs. Rabbit (Chickens and Ducks) (Herrings, Haddocks Skate, Wings, Dogfish Catfish, Coalfish, Whiting, Cod, and Megrims.) 106 lbs, Cowheel 9 lbs. Pork Sausage, Fruit and Vegetables, Other Poods. Canned Foods. 20 cwt. Potatoes 228¼ lbs. Cheese 475 tins Fruit 70 lbs. Pigs 92 lbs. Chocolate 512 " Vegetables 25 lbs. Prunes & Confectionery 525 " Meat 56 lbs. Biscuits 1807 " Milk 10¾ lbs. Tea 389 " Fish 8¾ lbs. Cooking Fats 65 " Soup 96 lbs. Jam, Marmalade, etc, (in jars) 69 " Jam & Marmalade 902 Eggs (484 bags Cereals (in- (181 pkts, cluding Flour. 169 jars Pickles & Sauces 168 Meat Pies Total quantity of canned foods condemned 3842 tins Total weight of other foods condemned 4 tons 9½ cwts. Informal action taken in connection with Food Shops and Stores, 47 Notices were served on occupiers of Shops and Stores for infringements of the Pood and Drugs Act, 1938, where proper precautions were not being taken against contamination of food. The principal matters dealt with wore:Sanitary accomodation; Defective sanitary conveniences 4 Without proper water supply 4 Defects in drainage system 3 Choked drains 6 Other defects 19 Provision of washing facilities; Hot water, soap & towels 2 Want of cleanliness 27 Insufficient accommodation for storage of refuse 9 Refrigerators. Interiors relined 1 Interiors cleansed 1 16. Rats and Mice (Destruction) Act, 1919. Infestation Order, 1943. In exercise of the powers conferred upon him by Regulations of the Defence (General) Regulations, 1939, the Minister of Pood made an Order - The Infestation Order 1943, dated 6th May, 1943, which, in effect, required every Local Authority in England and Wales to whom directions shall be given by the Minister under the Order to perform in its area certain functions. Those functions included, the making of comprehensive reports to the Minister with respect to the extent to which land in its area is subject to infestation by rats and mice, end to the measure which the Local Authority have taken or propose to take to remedy rat infestation. The remedying of such infestation of land in the area of the Local Authority, and, the enforcement when so required by the Minister of any directions in relation to the remedying of such infestation given by the Minister to any occupier, undertaker or other person in that area, The Minister had in view the delegation of powers - those powers at present are the responsibility of the County Councils and Port Sanitary Authorities from the County Councils to the Local Authorities, and in October launched a Publicity Campaign by newspaper advertisements, poster displays, distribution of leaflets, and the reporting to Local Authorities of the presence, at any place, of rats and mice. At the end of the period covered by this report, no directions by the Minister to perform in Hendon the functions under this Order had been given, HENDON EMERGENCY HOSPITAL. ACCOMMODATION The low rate of incidence of notifiable infectious disease which had been maintained throughout the war, no longer continued, as Scarlet Fever, fortunately in the main of a mild type, became prevalent. The accomodation which had been reduced to 72 beds was not entirely sufficient to deal with this situation and extra accommodation had to be provided by reducing the bed space normally allotted for the isolation of infectious diseases. It was also necessary for a 17. short period to ask Medical Practitioners, with the consent of parents, to nurse at home mild eases of Scarlet Fever in which the hone conditions were satisfactory. Representations were made to the Ministry of Health asking that Block 6 should be released from the Emergency Medical Services and be returned to its original purpose, namely, the reception of infectious diseases. This was approved and took effect from December. The return of this Block has been of the greatest value as before the war it had been specially adapted for barrier nursing, a form of nursing which permits of a selected variety of infectious diseases being nursed in the sane Ward, thus replacing to some extent the cubicle accomodation which had been reduced to 6 cubicles as a result of enemy action. There remained at the end of the year 20 E.M.S. beds in Block 3 available for the reception of air raid casualties. TOTAL NUMBER OF CASES TREATED. The total number of patients treated in the Hospital during 1943 (including admissions to the E.M.S. Section) is shown below:- TABLE X In Hospital 1.1.43. Admitted during year Died during year Discharged during year Remaining in Hospital 31.12.43. (a) INFECTIONS DISEASE BEDS. Service cases - 39 - 34 5 Others 52 709 3 686 72 (b) DENTAL CASES - 21 - 21 - (c) E.M.S. BEDS. Service (injured Home Guard) - 1 - 1 — Transferred E.M.S. Cases 16 170 11 175 - TOTALS 68 940 14 917 77 18, FEVER CASES. The admission, deaths and discharges of patients treated in the fever section, classified according to the disease notified on admission, were as under;- TABLE XI - Notified as Hospital 1.1.43. Admitted during year Died during year Discharged during year Remaining in Hosp. 31.12.43. Diphtheria or ? diphtheria 9 51 1 56 1 3 Diphtheria Carrier – 3 — 3 – Scarlet Fever or ? Scarlet Fever 40 560 – 533 67 Scarlet Fever and Chicken Pox – 2 – 2 – Scarlet Fever and Whooping Cough - 1 - 1 – Whooping Cough - 6 - 6 – Chicken Pox — 2 - 2 – Chicken Pox and acute appendicitis - 1 - – 1 Chicken pox and Measles – 1 – 1 – Measles – 49 – 49 - Rubella - 6 – 6 – Mumps – 8 – 8 – Erysipelas – 18 - 17 1 Meningitis – 4 - 1 3 Anterior poliomyelitis 1 1 – 2 - Enteric Fever — 7 – 7 – Dysentery 1 9 – 8 2 Impetigo 1 4 – 5 - Observation - 13 2 11 - Admitted with mother for nursing purposes – 2 – 2 – 52 748 3 720 77 NOTE: The foregoing Table of admissions includes the following three out-district cases which wore transferred to neighbouring hospitals within 24 hours of admission: - 1 ease of Diphtheria transferred to Wembley Isolation Hospital 1 " " " " " " Harrow " " " 1 " " Scarlet Fever " " Wembley " " 19. The admissions also include a further 26 out-district cases, 39 service cases, 1 case from Redhill Hospital (County's responsibility) and 5 members of staff treated in infectious wards. Details of these, which were all treated to completion, are as under:- TABLE XII Notified as Service Cases Redhill Hospital Cases OutDistrict Cases Staff Diphtheria or ? Diphtheria 10 - 2 -' Diphtheria Carrier 2 - - - Scarlet Fever or ? Scarlet Fever 5 - 2 1 Whooping Cough - - 1 - Chicken Pox 1 - 4 - Chicken Pox and Measles - — 1 - Measles 9 1 5 - Rubella 5 - - - Mumps 2 - 1 1 Erysipelas - - 5 - Meningitis 3 - 1 - Enteric Fever - - 2 - Dysentery 1 - 5 - Observation 1 - 1 [ 3 TOTAL 39 1 26 5 NUMBER OF CASES TREATED AS COMPARED WITH THE PREVIOUS TWO YEARS. TABLE XIII Notified as ADMISSIONS DEATHS DISCHARGES 1941 1942 1943 1941 1942 1943 1941 1942 1943[/##] Diphtheria or ? Diphtheria 68 44 51 2 1 1 73 41 56 Scarlet Fever or ? Scarlet Fever 167 239 560 – – – 177 209 533 Erysipelas 9 2 18 – – – 9 3 17 Measles 12 26 49 – – – 14 28 49 Whooping Cough 11 11 6 – – – 12 11 6 Mumps – 9 8 – – – – 9 8 Other conditions 39 38 56 1 2 2 35 38 51 TOTAL 306 369 748 3 3 3 320 339 720 Harrow case. 20. FINAL DIAGNOSIS. Of the 723 fever cases which were discharged or died during 1943, three out-district patients who were transferred to neighbouring hospitals within 24 hours of admission have been excluded from the Table of final diagnosis and from all subsequent figures in the report. The final diagnosis in respect of the remaining 720 completed cases was as follows:- TABLE XIV Discharged Died Total Diphtheria 23 1 24 Diphtheria Carrier 3 – 3 Scarlet Fever 520 – 520 Scarlet Fever and Chicken Pox 2 – 2 Scarlet Fever and Whooping Cough 2 – 2 Whooping Cough 7 – 7 Chicken Pox 4 – 4 Measles 48 – 48 Rubella 9 – 9 Rubella and catarrhal jaundice 1 – 1 Mumps 7 - 7 Septic parotitis 1 1 Cervical adenitis 1 - 1 ø Tubercular Meningitis 1 1 2 1 Sunstroke 1 – 1 Anterior poliomyelitis 1 – 1 Typhoid Fever 1 – 1 Paratyphoid Fever B. 1 - 1 Dysentery (Sonne) 6 - 6 Dysentery (b. Morgan) 1 - 1 1 Gastro enteritis 4 1 5 Erysipelas 13 – 13 Allergic rash and eczema following varicose ulcer 1 – 1 Reaction from Diphtheria Immunisation 2 - 2 Urticaria 2 - 2 Impetigo 5 – 5 Lobar Pneumonia 2 – 2 Broncho Penumonia 1 – 1 Influenza 3 – 3 Acute Laryngitis 1 - 1 Vincents Angina 1 - 1 Quinsy 2 - 2 Tonsillitis 30 – 30 Strept, Rhinorrhoea 1 – 1 Ulcerated stomatitis 2 – 2 Furunculosis (right ear) 1 – 1 Mastoiditis 1 - 1 Vulvo-vaginitis 1 - 1 Cold 1 – 1 Admitted with mother for nursing purposes 2 – 1 1 N.A.D. | 1 – 1 T0TAL 717 3 720 * Concurrent infection on admission. S Wembley District Case, ø The case of tubercular meningitis shown as discharged was one which was transferred to Hill End Hospital, St. Alban's and died there subsequently. 21. DIPHTHERIA. 1941 1942 1943 1. Cases discharged or died during the year notified as Diphtheria or ? Diphtheria, 75 42 57 2. Cases found to be suffering from diphtheria on admission (excluding diphtheria carriers) 44 28 24 3. Deaths due to diphtheria 2 1 1 4. Case mortality rate (calculated on number of cases or clinical diphtheria) 4.6% 3.6% 4.2% Complications. The following complications were encountered among the completed cases of diphtheria:- Palatal Paresis 3 Tachycardia 3 Otorrhoea 1 Adenitis 4 Rhinitis 2 Peripheral Neuritis 1 SCARLET FEVER. 1941 1942 1943 1. Cases discharged or died, notified as Scarlet Fever or ? Scarlet Fever 177 209 533 2. Cases found to be suffering from Scarlet Fever on admission (including dual infections) 170 194 524 3. Deaths due to Scarlet Fever - - 4* Case Mortality rate NIL NIL NIL Complications. The following complications were encountered among the completed cases of Scarlet Fever:- Adenitis 217 Otorrhoea 41 Rhinitis 16 Serum Re-action 14 Rheumatism 2 Various Sepsis 50 Pneumonia 1 Bronchitis 6 Jaundice 2 Chronic catarrh 1 Conjunctivitis 2 Pyelitis 1 Vulva vaginitis 1 Thread worms 1 Laryngitis 1 22. SCHOOL MEDICAL SERVICES. I an glad to report that the health of the school children was well maintained. The incidence of infectious diseases, with the exception of Scarlet Fever to which reference has already been made, remaining low and the nutritional standard was almost identical with that of the previous year, as will be seen in the following comparative tables:- TABLE XV. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS PUBLIC ELEMENTART SCHOOLS. Number of children inspected A (Excellent) B (Normal) C (Slightly SubNormal) D (Bad) No. % No. % No. % No. % 1942. 5011 947 18.90 3506 69.97 550 10.97 8 0.16 1943 5307 982 18.50 3756 70.77 566 10.66 3 0.06 I am convinced that the Scheme for the provision of meals and milk in school has been the largest single factor contributing to the maintenance of this satisfactory nutritional standard. In a report of this scope no detailed description has been given of the medical and dental services which have been established for the inspection and treatment of the school child, comment being limited to points of particular interest, but these services have been fully maintained and in certain respects increased. The various forms of treatment which have been provided for the children attending the elementary schools are now available to the secondary school children, and the appended Tables will give some indication of the volume of work which was undertaken:- TABLE XVI. Routine Medical Inspections Special Inspections Total Public Elenentary Schools 5307 5079 10386 Secondary Schools 1559 15 1574 TOTALS 6866 5094 11960 23. TABLE XVII Number of attendances of children for Treatment at Health Centres Clinic Public Elementary Schools. Secondary Schools Total Minor Ailment 29,108 432 29,540 Dental 11,486 1,416 12,902 Ophthalmic 1,823 426 2,249 Speech 1,032 8 1,040 Orthoptic 1,743 154 1,897 Orthopaedic 2,299 425 2,724 SECONDARY SCHOOLS. T.1BLE XVIII An analysis was also na.de of the nutritional standard of the children attending the Secondary Schools, with the following results:- No, of children Inspected A (Excellent) B (Normal) c (Slightly Subnormal) D (Bad) No. % No. % No. % No. % 1942 1,338 393 29.37 884 66.07 60 4.49 1 0.07 1943 1,559 431 27.64 1019 65.36 107 6.87 2 0.13 As in the previous year there was an increase in the number of children referred "by the Teachers for mental grading and for psychological advice arising out of behaviour problems. Of these latter 38 were referred to the Tavistock Clinic for further assessment and advice. Long experience of the mal-adjusted child has convinced me that in a large majority of cases, home conditions predominate, the abnormality in many instances originating from the attitude of the parents, either towards each other or towards other children in the family as opposed to the child under consideration. How far war conditions are a contributary factor it is difficult to say, but they have, without doubt, a bearing 24. on the problem, although a growing appreciation of abnormality on the part of the Teacher is of importance. The Dental Scheme continued to provide a comprehensive service for expectant mothers, children attending the Child Welfare Centres, Elementary and Secondary Schools, The resignation of Mr, Motcalf in October, after ten years' service was a great loss, his educative experience and operative skill having done much to build up the confidence of parents and children in the value of systematic conservative treatment. The orthodontic scheme remains a popular side of the dental work and good results are being obtained both in improving mastication and in enhancing appearance. Close co-operation between Medical Officers, Speech Therapist and Dental staff is preserved in this work, as mal-occlusion is frequently associated with widely different origins. The staffing of the dental service generally gave rise to anxiety as the staff at one time was not sufficient to overtake the volume of treatment found necessary, particularly as this service has increased steadily in popularity, I am glad to say that despite the very marked shortage of dental staff available, this difficulty was eventually overcome by the appointment of a fourth Dental Officer, The volume of work also necessitated the re-establishment of the Dental Clinic at the Central Hendon Health Centre, I an indebted to the Director of Education for the following notes of the main developments likely to affect the health of children which have taken place in the educational servicc during the year, and to his continued co-opcration and that of his staff in the work of the school medical services, "Children under 5 years of ago. Arrangements have been made for the admission of children under five years of age to elementary infant departments. On 1st October, 1943, there were 753 such children attending 25 Departments, The opening of infants' schools to children under five is a valuable contribution to the release of women workers for munitions in the area, in so far as it enabled many mothers to take up war work who would otherwise not have been able so to do. 25. Play Centres. Four Play Centres arc held at the following schools;- Average daily number on roll at 1st October, 1943. Child's 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. Provision of Meels, The two central kitchens which have been in existence at Algernon Road and Bell Lane Schools for the past three years provide over 3,500 meals daily. In addition, there are kitchens at Orange Hill Central School and the R.C. School of the Annunciation which provide 300 and 200 meals daily respectively. The latest figure shows that 21,328 meals were served during one week at 30 school canteens for children attending 46 school departments. On 7th June, 3,177 children received 1/3rd pint of milk and 5,716 received 2/3rds pint of milk (total 8,893 children) under the Milk in Schools Scheme, The Board of Education has approved a scheme submitted by the Education Committee for the establishment of a 2,000 meals canteen, kitchen on the Watling Estate and a 1,000 meals central kitchen on the Clitterhouse School Playing Field. The Ministry of Works have been asked to erect and equip these kitchens. When the whole scheme is in full working operation it is estimated that a minimum of 6,000 meals a day will be provided. Wartime Day Nursery, The war-time day nursery at Broadfields Avenue Council School for children between the ages of two and five years whose mothers are engaged on war work was opened on 1st September, 1943, Breakfasts, dinners and teas are provided daily at this Nursery which is open from 7,00 a.m. to 6,00 p.m. - Monday to Friday - and 7,00 a,m, to 1.00 p.m. on Saturdays," STATISTICAL TABLES. The Board of Education Statistical Tables are appended. In conclusion, I wish to record my appreciation of the true team spirit which has been displayed by the members of my staff in successfully overtaking an exceptional volume of work during the year under review. 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 DECEMBER, 1943. TABLE I MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A. ROUTINE MEDICAL INSPECTIONS, (l) No. of Inspections: Entrants 1675 Second Age Group 1781 Third Age Group 1851 TOTAL 5307 (2) No. of other Routine Inspections — GRAND TOTAL 5307 B. OTHER INSPECTIONS: No. of Special Inspections and re-inspections 5079 TABLE II CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Number of Children Inspected A (Excellent) (Normal) 0 (Slightly sub-normal) D (Bad) No. % No, % No. % No. % 5307 902 18.50 3756 i70.77 566 10.67 3 .06 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 7124 GROUP II. - TREATMENT OF DEFECTIVE VISION AND SQUINT, Errors of Refraction (including squint) 575 Other defect or disease of the eyes (excluding those recorded in Group I) 5 Total 580 No, of children for whom spectacles were (a) Proscribed 340 (b) Obtained 292 GROUP III - TREATMENT OP DEFECTS OF NOSE AND THROAT. Received Operative Treatment 103 Received other forms of Treatment - Total number treated 103 TABLE IV DENTAL INSPECTION AND TREATMENT. (l) Number of children inspected by the Dentist (a) Routine age groups 8972 (b) Specials 942 (c) TOTAL (Routine & Special) 9914 (2) Number found to require treatment 4812 (3) Number actually treated 3675 (4) Attendances made by children for treatment 11486 (5) Half-days devoted to:- Inspection 75 Treatment 1343 1418 96) Fillings:- Permanent Teeth 4955 Temporary Teeth 1251 Total 6206 (7) Extractions:- Permanent Tooth 955 Temporary Teeth 4457 Total 5412 (8) Administrations of general anaesthetics for extractions 2063 (9) Other Operations:- Permanent Tooth ) 2465 Temporary Teeth ) TABLE V VERMINOUS CONDITIONS (l) Average number of visits per school made during the year by the School Nurses or other authorised persons 23 (2) Total nuttier of examinations of children in the Schools by School Nurses or other authorised persons 34903 (3) Number of individual children found unclean 840 (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 ANT) 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. At a Public Elementary School At an Institution other than a Special School At no School or Institution Blind Children – - - Deaf Children – – 1