B0R0UGH 0F HEND0N ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER FOR THE YEAR 1 9 4 4. A. FAIRGRIEVE ADAMSON, M.D. , D.P.H., Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation Hospital. ANNUAL REPORT 0F THE MEDICAL OFFICER 0F HEALTH FOR THE YEAR 1944. July, 1945. To the Mayor, Aldermen and Councillors of the Borough of Hendon. I have the honour to submit my Fifteenth Annual Report on the health conditions of the Borough for the year 1944. It is issued as an interim report and only a very brief reference is made to the services now being operated, but new developments are described more fully. GENERAL HEALTH CONDITIONS. Vital Statistics. The health conditions generally remained good in so far as they could be judged by vital statistics and by observations made in the maternity and child welfare, and school medical services. The Registrar General's figure for the estimated population at the 30th June was 132,360. The number of births increased slightly, there being 2245 as compared with 2,223 in the previous year, giving a birth rate of 16.96 per 1,000 population. Despite the slight increase, the birth rate remains comparatively low, the rate for the country generally being 17,6 and for the County Boroughs and great towns including London, 20.3. While the increase is material as compared with the lowest figure recorded which was 12.09 in 1918, nevertheless the trend has been downwards as at the beginning of the century the birth rate in Hendon was 27.5 and in 1890 was 36.7. 2. The infantile mortality rate, namely 32 per 1,000 live births was equal to the lowest ever recorded in the Borough and compared with 46 for the country generally and 52 for the County Boroughs snd great towns including London. This rate is the most delicate of all vital statistics in reflecting the sociological circumstances of an area, inevitably being high in places where bad housing conditions, overcrowding, and maternal ignorance ore prevalent. It is, therefore, gratifying to be able to record the low level at which this rate is being maintained. In this connection, the downward trend which is illustrated in the following Table will be of interest. TABLE I. Year. Death rate of infants under one year of age per 1000 live births. 1900 133 1910 80 1920 47 . 1930 50 1940 54 1941 57 1942 34 1943 39 1944 \ 32 The general death rate of the population was 10.18 as compared with 11.6 for the country generally end 13.7 for the County Boroughs and great towns including London. As against these generally favourable vital statistics, there must be placed the facts that notifications of new cases of pulmonary Tuberculosis increased from 174 to 208. In only one year of the war, namely in 1942, was this figure exceeded, when 234 new cases were notified. 3. The following Table shows the causes of death during the year:- TABLE II. CAUSE MALE FEMALE TOTAL Typhoid and paratyphoid fevers - - - Cerebro-spinal fever 1 2 3 Scarlet fever - - - Whooping Cough 1 - 1 Diphtheria - - Tuberculosis of respiratory system 41 34 75 Other forms of tuberculosis 4 2 6 Syphilitic diseases 5 1 6 / Influenza 1 5 6 Measles - - - Acute poliomyelitis and polioencephalitis - - - Acute infectious encephalitis - - - Cancer of buccal cavity and oesophagus (M) uterus (f) 5 13 18 Cancer of stomach and duodenum 18 13 31 Cancer of breast - 19 19 Cancer of all other sites 95 71 166 Diabetes 2 5 7 Intra-cronial vascular lesions 64 77 141 Heart disease 164 165 329 Other diseases of circulatory system 26 18 44 Bronchitis 36 23 59 Pneumonia 41 31 72 Other respiratory diseases 12 10 22 Ulcer of stomach or duodenum 16 2 18 Diarrhoea, under 2 years. 9 4 13 Appendicitis 5 3 8 Other digestive diseases 19 12 31 Nephritis 18 11 29 Puerperal and post-abortive sepsis - 2 2 Other maternal causes - 2 2 Premature birth 9 8 17 Congential malformations, birth injury, infantile disease 16 8 24 Suicide 7 9 16 Road traffic accidents 14 7 21 Other violent causes 30 33 63 A11 other causes 48 50 98 TOTAL - all causes 707 640 1347 4 INFECTIOUS DISEASES. The following Table shows the number of notifications of the principal infectious diseases as compared with the previous year:- TABLE III. CASES OF INFECTIOUS DISEASES OTHER THAN TUBERCULOSIS NOTIFIED DURING 1943 & 1944. DISEASE TOTAL CASES 1943 notified 1944 REMOVED TO hospital 19 44 Scarlet Fever 758 374 256 Diphtheria 31 17 17 Pneumonia 172 132 66 Acute Poliomyelitis 1 2 1 Measles 1005 123 7 Whooping Cough 212 530 18 Cerebro-spinal. Fever 10 5 5 Typhoid or Enteric Fever 2 1 3. The situation as regards the main notifiable diseases, particularly that of cerebrospinal fever end typhoid or enteric fever continue!, to be satisfactory, Scarlet Fever showed a narked diminution as did the number of cases of measles. Conversely, whooping cough was much more prevalent, A small outbreak of a virulent type of smallpox occurred in Middlesex but was soon under control and finally eliminated, Altogether 34 contacts of cases were kept under observation in Hendon and a number of suspected cases were seen in consultation with local medical practitioners, but no case actually occurred in the Borough, The campaign for Diphtheria Immunisation has been continued intensively since 1941, and I think it is a fair assumption that immunisation has played a large part in the low level of the incidence of Diphtheria which now obtains. 5. The following Table shows the number of cases of Diphtheria, death from that disease, end the accumulated total of children immunised;- TABLE IV. Year No. of Cases of Diphtheria Notified. No. of Deaths from Diphtheria. Accumulated total of inmiunised children. 1929 156 7 - 1930 192 7 - 1931 193 8 - 1932 143 7 - 1933 157 4 - 1934 158 3 - 1935 138 9 27 1936 86 2 130 1937 121 7 381 1938 195 4 725 1939 150 3 1124 1940 70 3 1729 1941 58 1 5868 1942 38 2 11068 1943 31 2 15506 1944 17 - 16970 of these the diagnosis of diphtheria was confirmed in only 9 cases. 50 cases of dysentery were notified. These in the main were of a mild character. In 35 cases of this disease which were treated at the Isolation Hospital the Sonne bacillus was the casual organism. This condition which consists of a general gastro-intestinal upset, is usually of short duration and the patient, unless debilitated or at the extremes of life, normally makes an uninterrupted recovery, but there is considerable ground for believing that this type of dysentery is much more prevalent than the actual notifications would suggest. 6. TUBERCULOSIS. The following Table shows the notifications of and deaths from Tuberculosis during the last four years:— TABLE V. YEAR NOTIFICATIONS DEATHS Pulmonary N on-Pulmonary Male 1 Female Male Female Male Female TOTAL 1941 68 90 9 21 48 37 85 1942 141 93 14 27 38 28 66 1943 100i 74 19 18 56 35 91 1944 112 96 4 19 . 46 34 80 I am indebted to Dr. A. S. Hall, the County Tuberculosis Medical Officer, for the following observations: - "The number of tuberculosis deaths in Hendon in 1944 was 80, which with a population of 132,000 gives a death rate of 60.5 per 100,000; This compares favourably with the national figure of 62 for 1943. Nevertheless, with the relatively good living conditions in Hendon one would have expected a better rate. If one takes the deaths by age groups, one finds that there was only one death under the age of 5. The figures for this group are sometimes supposed to be an indication of the degree in which infectious cases are kept under control. If that supposition be correct, then Hendon does very well, for in two of the last six years there have been no deaths in this group, and never more than two. The 5-15 group which is commonly the safest group, has only one death. The 15-20 group with two deaths is very good. After that the sexes differentiate, the females having a peak at 25-35, and the men a prolonged plateau from 35-65. This "plateau" is most interesting as it is a feature of the tuberculosis figures which is gaining increasing prominence; in fact the brunt of the attack by the tubercule bacillus now falls on the middle-aged and the elderly male, and not on the young female as is commonly supposed. Whereas in 1939, 42% of the tuberculosis deaths were in men, in 1944 the figure was 57.5. The implication of this on the requirements of the tuberculosis service is not quite clear, for the middle-aged man requires quite different treatment from the young adult. The incidence figures vary from year to year; in 1939 the figure was 3.8 per death, and in 1944 it was 3.2. In the intervening years it fell to 2.85 in 1941 and rose to 4.3 in 1942. A scheme for tuberculin testing of the elementary school children has been planned and approved, and will be undertaken shortly. In the examination of the contacts of the tuberculin positive children it is hoped that a valuable method of finding the open cases will be demonstrated. Propaganda meetings have been held for the public at Redhill Chest Clinic during the year, while in addition there have been lecturedemonstrations for general practitioners." 7. SCABIES AND VERMINOUS CONDITIONS. The Scheme for the treatment of these conditions remained substantially the same as in the previous year, and the great majority "fere treated by members of the Civil Defence personnel based at the First Aid Posts at West Hendon, Mill Hill and Central Hendon Health Centres. This was supplemented by the services of a part-time attendant for the Childs Hill and Watling Health Centres, where no Civil Defence personnel were available. It will be noticed that as compared with the previous year, the numbers of verminous conditions treated have increased, but this increase was more apparent than real, end was due to a concerted compaign to ensure that mothers and children being sent to reception areas were clean on leaving this district, and therefore very minor degrees of infestation have been included. The policy has been pursued of examining and treating all members of the family in which a case of scabies or any verminous condition has been discovered, and in the former condition prophylactic treatment is given to other members of the family, as it has been found from experience that only in this way can the incidence of these diseases be adequately controlled. The following Table shows the number of cases dealt with during the year:- TABLE VI. CENTRE CASES OF SCABIES DEALT WITH VERMINOUS CONDITIONS DEALT WITH 1943 i 1944 1943 1944 West Hendon 377 268 78 19 Childs Hill 47 45 152 156 Mill Hill 277 298 40 83 Watling 276 174 285 687 Central Hendon 279 289 36 51 TOTALS 1256 1074 591 996 8. MATERNITY AND CHILD WELFARE. These services arc operated for the care of children under five years of age, and for expectant and nursing mothers. The following Table, which shows the number of attendances at Ante-Natal and Child Welfare sessions as compared with the years 1942 and 1943, reflects the continued interest in, and advantage taken of these services by the mothers. The slight decrease which can be seen in the total number of attendances at the Child Welfare sessions coincided with the evacuation of aothers and children to safer areas, consequent upon increased enemy activity. Nunber attending the Maternity & Child Welfare Sessions at the Health Centres. TABLE VII. 1942 1943 1944 No. of Child Welfare Sessions 925 934 1016 Total No. of attendances 49960 54962 49334 No. of new members admitted 2316 2298 2252 No. of Ante-Natal Sessions 431 503 517 No. of cases who attended for the first time 1619 1597 1498 No. of attendances 7464 8721 8944 MIDWIFERY. The provisions made by the Council for domiciliary midwifery remained unchanged. The following Table gives particulars of these services;- TABLE VIII. DOMICILIARY CONFINEMENTS ATTENDED BY MIDWIVES. 1942 1943 1944 (a) Employed by Council; as Midwives 348 336 281 as Maternity Nurses 100 118 113 (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 160 156 152 as Maternity Nurses 9 17 8 617 627 554 9. PROVISION OF ACCOMODATION FOR INSTITUTIONAL MIDWIFERY. The following Table shows the hospitals to which midwifery cases were admitted under official arrangements:— TABLE IX. HOSPITAL CASES ADMITTED Ashridge 39 Queen Charlottes 15 City of London 4 Redhill County 689 GAS AND AIR ANALGESIA. Authority was given by the Council for this facility to be made available throughout the midwifery services of the Borough, Three midwives had already been trained and recognised as competent to administer gas and air analgesia, and arrangements were made for others to be trained at the Central Middlesex Hospital, Unfortunately, that course of instruction had to be abandoned due to enemy action, but arrangenents have again been nade with the sane hospital. It is a rule of the Central Midwives' Board that a second person shall be present when gas and air analgesia is being adninistered, and to neet this need the British Red Cross Socicty and the Order of St. John were approached, and with the usual willing co-operation to be expected, nanes of members were subnitted who were willing to attend at confinements. These members were given instructions in the principles of procedure, and in the use of the apparatus, and while 30 far, not many calls have been nade on then, as gas and air analgesia was adninistered in only fifteen cases, it is likely that with the larger number of nidwives trained in the procedure, the numbers will materially increase, HOME HELPS. In order to relieve the difficulties of a mother with young children during the times of her incapacity, the H0.-10 Help Scheme was inaugurated in 1942, and has been steadily extended. Apart from obtaining the services of as many suitable women as possible on a part time basis, authority was given by the Council for the employment of five full tine Home Helps, later extended to as 10. many as was found necessary. At the end of the year 4 full time and 5 part time Home Helps were being employed. It will be appreciated that it is difficult to obtain the services of suitable women for this type of work, nevertheless, a valuable contribution was nade in helping to relieve domestic difficulties, end Home Helps were provided in 14.6 cases. CHILD LIFE PROTECTION. The scheme for the supervision of foster children continues to work satisfactorily, and no modification has been found necessary. The following Table gives the position at the end of the year»- TABLE X. No. of children on register. No. who died, 1 1 No. of children on whom inquests were held during year. 44 I 1 1 nil CARE OF PREMATURE INFANTS. In accordance with the provisions of Ministry of Health Circular 20/44, the following arrangements have been made with regard to the care of premature infants. 1. A letter has been forwarded to all medical practitioners, midwives and nursing homes asking that they will indicate on the notification of birth card, the weight at birth of any baby who is 5½- lbs. or less. 2. The provision of a premature baby outfit on loan containing: Electric blanket Stone hot water bottle Mucous catheter Feeding bottle 1 Tin milk. 3. The services of a Home Help where necessary. 4. The services of a consulting paediatrician and hospital provision at the Central Middlesex Hospital, when in the opinion of the consultant the removal of the child to hospital is indicated. CARE OF ILLEGITIMATE CHILDREN. Ministry of Health Circular 2866. This Circular drew the attention of Welfare Authorities to the increase of illegitimacy. It was appreciated that this was probably of a temporary nature, and largely consequent upon war-time conditions. The 11. problem was being more acutely felt by the County Council, as the majority of births were teking place in the hospitals maintained by that Authority. There was, however, a local problem in the rehabilitation of the mother. The cases to be dealt with fell into three classes, (a) those in which the girl is able to return home to her parents with her baby, (b) those in which adoption of the child is advisable on account of the extreme youth of the mother, or of the fact that she is a married woman, and (c) those for which there is need of shelter to which the mother, after confinement, may go with her baby and stay for a time in an atmosphere of security, until with sympathy and help she is able to re-establish herself, and make a permanent home for herself and child. The matter was felt to be one in which adequate provision could only be made on a wider basis than that of the individual local authority, and for this purpose the County Council decided to establish hostels and to provide a Social Worker with special experience in this work, whose services would be available to any of the participating authorities. The Borough Council agreed to participate in this scheme. EXERCISES FOR EXPECTANT MOTHERS. In view of the growing volume of evidence to the effect that training in relaxation combined with exercises is of value in promoting easier labour in selected cases, the Council decided to establish a weekly class for this purpose. The class did not commence until the 3rd January, 1945. With a view to ascertaining the result of these exercises, special enquiries are being made as to the nature and duration of the confinement in each case. PSYCHOLOGICAL TREATMENT. In view of the increase in the number of psychological difficulties found amongst school children, and of the fact that the earlier such problems are tackled, the better are likely to be the results, it was decided in collaboration with the National Council for Mental 'Health to undertake the treatment of these conditions in children of pre-school age, and for this purpose arrangements were made for the attendance of a psychologist to whom children in need of treatment were referred from the Child Welfare sessions. 12. DAY NURSERIES. The programme for the erection of a new nursery, and the extension of existing nurseries was continued, and the following Table gives particulars of the nurseries which have now been established:- TABLE XI. Address of Nursery Date of Opening Total Accommodation Addington House, Orange Hill Road, Burnt Oak. 2.2.42. 63 2, Hocroft Road, child's Hill, N.W.2. 30.3.42. 50 Hyde School, Hendon, N..W.9. 11.5.42. 45 York Park, West Hendon, N.W. 9. 31.8.42. 60 Claremont Road, Cricklewood, N.W.2. 3.12.42. 50 Approach Road, Edgware. 30.4.43. 35 Hyde Cottage, Hendon, N.W.9. 21.2.44. 78 Dole Street, Mill Hill, N.W.7. 20.3.44. 55 The new nursery in Watling Avenue was completed at the end of June, but this coincided with increased enemy activity and with the district being scheduled as an evacuation area, so that the numbers seeking admission did not justify the staffing and equipping of the nursery, and so far, the necessity for its opening has not arisen. Hocroft Nursery was closed in August, and the staff transferred either to other nurseries in the Borough or to a nursery in a reception area. It had not been re-opened by the end of the year. The nursery in Dole Street, Mill Hill was severely damaged in August as a result of enemy action. Fortunately this happened at night when the nursery was unoccupied. It was repaired and re-opened for the reception of children in November. Throught the year great difficulty has continued to be experienced in obtaining the services of suitable staff both nursing and domestic, for the nurseries. 13. In concluding the Maternity and Child Welfare Section of this Report, I should like to pay tribute to the personnel of the Rescue Service for their co-operation in providing toys and recreational equipment for the children at the Day Nurseries and to the voluntary workers who have given such valuable help both at the Health Centres and Day Nurseries. SCHOOL MEDICAL SERVICES. I am glad to report that the health of the children attending school was well maintained, the incidence of infectious diseases remained low, but there was a slight deterioration in the nutritional standard as compared with the previous year to which reference will be made later. As a result of official and unofficial evacuation, the number of children attending the Public Elementary Schools fell during the summer and autumn terms from 13404 to 7261. This had the inevitable effect of interfering with the arrangements made for routine medical examinations and treatment, particularly in those cases for whom treatment of a protracted character was being provided. MEDICAL EXAMINATION. The following gives a brief resumd of the scheme of medical examination now in operation;- Public Elementary Schools. Children under 5 years of age twice annually. Children from 5-14 years of age "Entrants" at approximately 5 years of age. "Intermediates" at approximately 8 years of age. "Leavers" at approximately 12 years of age. In addition a final examination is carried out during the last term at which a child attends school so that treatment may be provided before the child leaves the care of the school medical services, and advice given as to mental and physical fitness for particular occupations. Secondary and Technical Schools. In Secondary and Technical Schools, children are examined annually. 14. Special Examinations, Public Elementary, Secondary and Technical Schools. In addition to the foregoing, a large number of special examinations are carried out of children who are referred by the parent, teacher or health visitor because of some suspected defect. The following Table shows the total number of children examined;- TABLE XII Routine Medical Inspections. Special Inspections. Total. Public Elementary Schools 4164 4837 9001 Secondary and Technical Schools 1623 34 1657 TOTALS 5787 4871 10658 TREATMENT. The forms of treatment available for school children, and where applicable, for children under five years of age attending at the Child Welfare Centres, were extended by the establishment of an Aural Clinic for the treatment of defects of the ear, nose and throat, and by the appointment of a fourth full time dental officer, which amongst other advantages permitted of orthodontic treatment for the correction of dental irregularities being extended and made more complete, end of more care being given to the dental conditions of children under five years of age end of expectant and nursing mothers. The Chief Dental Officer reports that in all districts of the Borough the dental health of those entering school for the first time has improved. It is difficult to attribute this to one particular factor, but the following undoubtedly play a parts- 1. The continued restriction of luxury food-stuffs and confections. 2. The less fermentable character of the whole-meal loaf. 3. The educative work carried out by the health services for many years, with a consequent growing appreciation by the public of the value of dental health. 15. The following Table gives particulars of the number of attendances at the Health Centres for the various forms of treatment;- TABLE XIII. NUMBER OP ATTENDANCES OP CHILDREN FOR TREATMENT AT HEALTH CENTRES. CLINIC Public Elementary Schools. Secondary & Technical Sohools. Total 1943 1944 1943 1944 1943 1944 Minor Ailment 29108 21703 432 792 29540 22495 Dental 11486 11385 1416 1723 12902 13108 Ophthalmic 1823 1654 426 426 2249 2080 Speech 1032 1188 8 16 1040 1204 Orthoptic 1743 1504 154 134 1897 1638 Orthopaedic 2299 2672 425 251 2724 • 2923 NUTRITION. The following Tables show the nutritional standards of children inspected in the routine age groups, both in the Public Elementary and Secondary and Technical Schools;- TABLE XIV. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED ■JJPIN'i THE YEAR IN THE ROUTINE AGE GROUPS. PUBLIC ELEMENTARY SCHOOLS. Number of Children Inspected. A. B. C. D. (Excellent) (Normal) (Slightly sub-normal) (Bad) No. % No. % No. % No. % 1942. 947 18.90 3506 69.97 550 10.97 8 0.16 5011 1943. 982 18.50 3756 70.77 566 10.66 3 0.06 5307 1944. 868 20.85 2640 63.40 623 14.96 33 0.79 4164 16. TABLE XV. SECONDARY AND TECHNICAL SCHOOLS. Number of Children Inspected A. B. C. D. (Excellent) (Normal) (Slightly sub-normal) (Bad) No. % No. % No. * No. % 1942. 1338 393 29.37 884 66.07 60 4.49 1 0.07 1943. 1559 431 27.64 1019 65.36 107 6.87 2 0.13 1944. 1623 703 43.31 837 51.57 79 4.87 4 0.25 It will be seen that the number of children classified as being of excellent nutrition, has increased in both the Public Elementary and Secondary and Technical Schools, but as far as elementary schools are concerned, the percentage found to be slightly sub-normal and bad has also increased. The assessing of nutritional standards of children of the slightly sub-normal group is likely to vary with the personal views of the examining officer, but generally speaking a wide basis has been taken for this group and all children were included whose general standards of health were considered to be below normal. I am indebted to the Director of Education for the following notes of the main developments likely to affect the health of the children, which have taken place in the educational service during the year, and for his continued co-operation and that of his staff in the work of the school medical services. "Children under five years of age. During the year continued arrangenents have been made for the admission of children under 5 years of age to Infant Departments. On 1st October, 1944, there were 371 such children attending 22 departments. These figures are 50% less than the corresponding date in 1943, due to evacuation. The opening of Infants' Schools to children under 5 years has been found to be a valuable contribution to the release of women workers for work of national importance in the area, inasmuch as it enabled many mothers to take up such work who would have otherwise been unable to do so. 17. Garden Suburb School. The Infant children attending the Garden Suburb School have, since September, 1940, been housed under overcrowded conditions in the Senior Department owing to the destruction of the Infants' School by enemy action, A pre-fabricated hut containing three classrooms for 40 children each, has now been erected and brought into use. Provision of Meals. The two central kitchens which have been in existence at Algernon Road and Bell Lane Schools for the past four years provide about 3,600 meals daily. There are also kitchens at Orange Hill Central School and the R.C. School of the Annunciation which provide 300 and 200 meals daily respectively. The latest figures show that 20,84-9 meals were served during one week at thirty school canteens for children attending 46 school departments. Owing to the shortage of kitchens there are still two schools without canteen facilities. Due to the same cause there are long waiting lists of children requiring meals in all schools. On 21st June, 3351 children received ⅓ pint of milk and 5300 received 2/3rd pint of milk (Total 8641) under the Milk in Schools Scheme. The Ministry of Education have given instructions to the Ministry of Works to proceed with the erection of a Central Kitchen on the Clitterhouse School site to provide 1000 meals daily." CIVIL DEFENCE. The personnel of the Civil Defence continued to co-operate in a diversity of ways in the work of the Public Health Department. Those at First Aid Posts, all of which are based at Health Centres, continued to help at the various clinics, and in addition made themselves responsible for the cleansing of verminous conditions and in treatment of scabies, and when the need arose, they supplemented the staff at the Day Nurseries. The personnel at the Ambulance Depots provided transport to other nurseries for those children who normally attended at Dole Street and Hocroft Road Day Nurseries, these latter having been closed for a portion of the year. Their greatest contribution however, was in the operation of the Civil Defence ambulance service and some indication of the magnitude of that task con be gathered from the fact that 3689 journeys were made. It is not too much to say that with the increase of clinic services, and the variety of new duties imposed, that the home visitation by the health visitors would have fallen to a very low level had it not been for the help given by the Civil Defence Services. This co-operation by the Civil Defence personnel was rendered the more praiseworthy as it was carried out in a year of increased enemy activity, with many alert periods. 18. REGISTRATION OF NURSING HOMES. In accordancc with tho powers delegated by tho Middlesex County Council, the local authority continued to exercise the function of the registration and supervision of Nursing Homes. Regular visits are paid to each Nursing Home in the Borough, inspectior is carried out end in many \ instances constructive suggestions are made end acted upon for their improvement. At the present time all Nursing Homes in varying degrees are finding great difficulty in obtaining the services of an adequate nursing staff. One new Nursing Home was registered, and at the end of the year 10 were under supervision. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT. The Council continued to be responsible for the licensing and periodic supervision of these establishaents. STATISTICAL TABLES. The Board of Education Statistical Tables will be found at the end of this Report. SANITARY INSPECTIONS OF THE AREA. The following suaaary of the inspection work performed by the Sanitary Inspectors has been subaitted to no by Mr. G. E. Luck, Chief Sanitary Inspector - Inspections made 6713 Reinspections after order or notice 7209 Coaplaints received and investigated 1422 No-answer visits 1002 Nuisances discovered and dealt with 2467 Inspections of Air Raid Shelters 458 Visits paid to Infected Houses 585 Infected rooas disinfected 417 Cesspools emptied 104 Choked drains cleared by Local Authority for the abatement of urgent nuisances 235 NOTICES SERVED. Informal or cautionary 695 Complied with 552 Outstanding 1944 43 19. STATUTORY NOTICES. Applied for 87 Served under Public Health Acts, etc. 36 Outstanding from 1943 4 Complied with 39 Outstanding froa 1944 1 One summons applied for against Owner for non-compliance with Abateaent Notice. Order made for work to bo done in 28 days and two guineas costs awarded against Owner. DISINFESTATION. Treatment of verminous houses. The following houses were successfully treated:- Privately-owned 35 Council Houses 4 Inspections were made of furniture and bedding and rooms in the occupation of tenants before their removal into Council houses and disin- festation was performed where necessary. Work of disinfestation is done by the Local Authority and where verainous conditions were discovered, these cases were followed up after removal. FACTORIES ACT. 1937. Number of inspections 343 Notices served to remedy defects 33 Notices complied with 27 Matters notified by H.M. Inspector of Factories 28 Lists of Outworkers received 31 Outworkers premises inspected 36 Nature of defects rcaedied at Factories:- Sanitary Accommodation. Insufficient 3 Unsuitable or defective 12 Improperly ventilated or unventilated 11 Want of cleanliness 14- Inadequate ventilation 3 Inadequate lighting 5 Other offences 18 WATER. Swimming Pools. At the Council's swimming pools the water is treated by modern purification and filtration plant. These for chlorine content are made daily. 20. 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 dwellinghouses during the year:- Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts.) 1587 Number of inspections made for the purpose. 3025 Number of dwelling-houses found not to be in all respects reasonably fit for human habitation. 485 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 450 Proceedings under Public Health Acts;- Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 35 Number of dwelling-houses in which defects were remedied after service of formal notices;- (a) By Owner 34 (b) By Local Authority in default of Owners INSPECTION AND SUPERVISION OF FOOD. 1382 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 6 Number of farms where milk is bottled on the premises 4 168 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 87 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 - 1941, the bacteria exceeding 100,000 per 21. millilitre, although all samples gave satisfactory results on the phosphatase test - a test devised to indicate that pasteurised milk has been adequately heated. Eighteen samples of raw bulk ailk were taken froa rail tanks, and thirty-six milk bottles immediately after cleansing in the bottle washing machines. During the year this pasteurising establishaent has been enlarged and two additional "High Temperature Short Tiae" Pasteurising Units caae into operation. The total nuaber of ailk samples taken for examination was 216; Tuberculin Tested milk 14, Pasteurised ailk 184, and non-Designated milk 31. The 184 pasteurised milks satisfied the phosphatase Test. Three samples exceeded the bacterial count prescribed by the Order and in the case of one Tuberculin Tested (Pasteurised) milk the saaple failed to satisfy the Phosphatase Test. SLAUGHTERHOUSES. Three Slaughterhouses are licensed for the slaughter of animals intended for human consumption. The livestock (Restrictions 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 Food. None of the three slaughterhouses is licensed by the Ministry of Food and general slaughtering has temporarily ceased. SLAUGHTER oF ANIMALS ACT. 1933. Three slaughtermen were licensed as fit and proper persons to slaughter or stun animals. 22. FOOD CONDEMNATION. The following foodstuffs were examined and condemned as unfit for human consumption;- Butchers Meat. Fish. Beef 392½ lbs. 467 stones 6½ lbs. Veal 36 lbs. (Cod, Chidlings, Coalfish, Coley, Dabs, Dogfish, Gurnet, Hake, Haddocks, Herrings, Kippers, Lobsters, Mackerel, Megrimes, Nurses, Pilchards, Ray, Roe, Salmon, Skate, Witches.) Pork 198 lbs. 2 oz. Ham 79¾ lbs. Liver 15 lbs. Tripe 95 lbs. Rabbits 80 Sausages 1202 lbs. Lamb 2½ lbs. Cow-heel 40 lbs. Bacon. Poultry. 92½ lbs. Chickens 44 Turkeys 1 Fruit end Vegetables. Other Foods. Potatoes 10 cwt. Eggs 1880 Apple Rings 23 lbs. Cheese 34½ lbs. Orenges 304 lbs. Cooking Fats 184 lbs. Cherries 56 lbs. Cereals 445 packets (assorted) Peas 26 lbs. Figs 2 cwts. Flour l80½ lbs. Dates 149½ lbs. Sweets 21 lbs. 2oz. (assorted) Sultanas 50 lbs. Raisins 50 lbs. Jam 76 Jars Pickles 244 bottles Paste 7 Jars Canned Foods. Fruit l bottle Sauces 37 bottles Meat 407 tins Coffee 2 bottles Fish 701 tins Fruit Cordia 3 bottles Milk 16o tins Dried Eggs 6 packets Fruit 77 tins Household Dried Soup 193 tins Milk 15 tins Jam & Marmalade 192 tins Soup Powder 167 packets Vegetables 251 tins Cocoa 12 tins Sugar 14 lbs. Biscuits 22 tins Spaghetti 108 lbs. Total quantity of canned foods condemned 2030 tins Total weight of other foods condemned 5 tons 2 cwts Informal action taken in conncction with Food Shops and Stores. 95 Notices were served on occupiers of Shops end Stores for infringements of the Food and Drugs Act, 1938, where proper precautions were not being taken against contamination of food. 23. The principal matters dealt with were- Sanitary Accommodation. Defective sanitary conveniences 3 Without proper water supply 4 Defects in drainage system 11 Choked drains 12 Other defects 22 Provision of washing facilities. Hot water soap and towels 4 Refrigerators. Interiors cleansed 2 Insufficient food storage accomodation 1 Want of cleanliness 60 Insufficient accomodation for storage of refuse 10 Other defects 25 RATS AND MICE (DESTRUCTION) ACT, 1919. Infestation Order, 1943. At a Meeting of the Middlesex County Council held on 27th January, it was resolved that the powers and duties of the County Council under the above-mentioned Act be, and are hereby, delegated, on and from the 1st April, 1944, to the several Boroughs and District Councils throughout the County as regards their respective Boroughs or Districts, in accordance with the relevant provisions of that Act. Temporary arrangements for Councils to act as agents of the County in the discharge of its functions were authorised on end from the 1st February, until the delegation took effect. A Foreman Rat-Catcher was appointed, and he commenced his duties on 1st February; and during the intervening period, until delegation, 355 visits were paid by him, and advice given to occupiers of infested premises. From 1st April to 31st December, 1597 visits were paid; and of this number 429 were at premises whore fees for treatment by the Local Authority were received. HOUSING-. It will be seen that many visits have been paid by the Sanitary Inspectors arising from complaints concerning unsatisfactory housing conditions. 24. As a result of these visits it was found that tho percentage of cases of statutory overcrowding was comparatively small but in many instances the housing conditions were unsatisfactory for a variety of reasons, e.g. the sharing of kitchen and other accommodation between families with consequent friction, children having to sleep in living rooms, insufficient accommodation for sex distribution, etc. Some improvement was effected in a nunber of cases by advice concerning re-allocation of existing accommodation and by -maintaining property in as satisfactory a state as possible under existing conditions, either by informal action or where necessary by the serving of statutory notices. In addition, and so that the maximum use might be made of existing housing accommodation, houses were requisitioned by the Council mainly under Defence Regulations, for persons rendered homeless by enemy action and a small number under powers conferred by Circular 2845 of the Ministry of Health. At the end of the year 937 requisitioned properties were held by the Council. Those measures are obviously only palliative and the housing situation will be rendered still more acute when demobilisation of the Armed Forces takes place. HENDON ISOLATION HOSPITAL. Bed accomodation was maintained throughout 1944 at 98 fever beds for the isolation and treatment of infectious diseases and 20 E.M.S. beds. The decline in the number of cases of infectious diseases reduced the numbers of admissions as compared with the previous year. This was mainly due to a reduction in tho incidence of scarlet fever and measles but on the other hand 38 cases of whooping cough were admitted as compared with six. In both measles and whooping cough accommodation is sought in a number of instances because of unsatisfactory home conditions but much more frequently because of complications, particularly broncho-pneumonia. This latter complication generally responds well to treatment but occasionally, as was the case in two out-district cases, the disease was so advanced as to cause the death of the patients shortly after admission. 25. The seriousness of both measles and whooping cough, particularly in very young children cannot be exaggerated. Tho advent of the "flying boob" and the "rocket" was attended by certain consequences. As a result of one incident three patients were admitted to the E.M.S. Ward, two ultimately recovering but one died on admission. Evacuation to reception areas reduced the number of children, with a consequent lowering of the incidence of infectious diseases in the Borough and on the 12th August the patients then in the hospital were transferred to the Sisters' Hospital, St. Albans, which continued to provide isolation hospital accommodation for the Eorough until the 18th September. The preliminary Training School, which was held at Clayponds Hospital, Ealing, and which received student nurses from the Hendon Isolation Hospital, was so badly damaged by enemy action as to be no longer capable of being used, and arrangements were, therefore, made for the teaching to be continued at the Hendon Isolation Hospital for our own students and subsequently this facility was extended to students from the Willlesden Municipal Hospital. TOTAL NUMBER OP CASES TREATED The total nuaber of patients treated in the Hospital during 1944 (including adaissions to the E.M.S. Section) is shown "below;- TABLE XVI In Hospital 1.1.44. Admitted during year Died during year Discharged during year. Reuaining in Hospital 31.12.44. (1) INFECTIOUS DISEASE BEDS. Service Cases 5 69 - 73 1 Others 72 416 4 471 13 (2) E.M.S. BEDS. Civilian Air Raid Casualties - 3 1 2 - TOTALS 77 488 5 546 14 26. FEVER CASES. The admissions, deaths end discharges of patients treated in the fever section, classified according to the disease notified on admission, are shown below. (Tentative diagnoses are included under the heading of the disease suspected.) TABLE XVII. Notified as i In Hospital 1.1.44. Admitted during year Died during year Discharged during year Remaining in Hosp. 31.12.44. Diphtheria 3 34 - 37 - Scarlet Fever 67 265 1 323 8 Scarlet Fever and Diphtheria - 1 - 1 - Scarlet Fever and Chicken Pox - 1 - 1 - Chicken Pox - 11 - 10 1 Chicken Pox and acute appendicitis 1 - _ 1 - Whooping Cough - 40 2 38 — Mumps - 4 - 4 - Measles - 11 - 10 1 Rubella - 30 - 30 - Rubella and acute appendicitis - 1 - 1 - Rubella and Meningitis - 1 - 1 _ Meningitis 3 4 - 7 - Erysipelas 1 17 - 18 - Erysipelas and Meningitis - 1 - 1 - Vincents Angina - 1 - 1 - Enteric Fever - 2 - 2 - Dysentery 2 34 - 34 2 Impetigo - 4 - 2 2 Scabies - 1 - 1 - Scabies and Impetigo _ 1 - 1 - Observation _ 18 1 17 - Admitted with mother for nursing purposes - 3 - . 3 - TOTALS 77 485 4 544 14 NOTE: The foregoing table of admissions includes the following cases which were transferred to the Sisters' Hospital, St. Albans within a day or two of admission:- 1 Diphtheria 1 Scarlet Fever 1 Whooping Cough 1 Erysipelas & Meningitis 2 Dysentery 1 Observation. 27. The admissions also include 35 out-district patients, 69 service cases, 1 case from Redhill Hospital and 9 members of staff treated in the infectious wards. Details of these are as under:- TABLE XVIII Notified as Service Cases Redhill Hospital Cases Out District Cases. Staff Diphtheria 9 - - - Scarlet Fever 14 - 2 4 Chicken Pox 4 _ 2 - Whooping Cough 1 1 6 1 Whooping Cough and Acute Appendicitis - - 1 - Measles 3 - 2 - Rubella 20 - 3 3 Rubella and Acute Appendicitis - - 1 - Rubella and Meningitis - - 1 - Erysipelas - — 5 - Mumps 1 - 1 - Dysentery 11 - 11 - Scabies and Impetigo 1 - - - Observation 5 — - 1 TOTALS 69 1 35 9 NUMBER CF CASES TREATED AS COMPARED WITH THE PREVIOUS TWO YEARS. TABLE XIX. Notified as ADMISSIONS DEATHS DISCHARGES 1942 1943 1944 1942 1943 1944 1942 1943 1944 Diphtheria 44 51 34 1 1 - 41 56 37 Scarlet Fever 239 56o 265 - - 1 209 533 323 Erysipelas 2 18 17 - - - 3 17 18 Measles 26 49 11 _ - - 28 49 10 Whooping Cough 11 6 40 - - 2 11 6 38 Mumps 9 8 4 - - - 9 8 4 Chicken Pox 4 3 11 - - - 4 2 11 Rubella 4 6 31 - - - 4 6 31 Dysentery 1 9 34 - - - - 8 34 Other Conditions 29 38 38 2 2 1 30 35 38 TOTALS 369 748 485 3 3 4 339 720 544 * Out-district cases 28. FINAL DIAGNOSIS. Of the 548 fever cases which were discharged or died during 1944, 7 patients who were transferred to St. Alband Hospital 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 541 completed cases was as follows TABLE XX. Discharged Died Total Diphtheria 9 - 9 Scarlet Fever 291 * 1 292 Ø Scarlet Fever and Chicken Pox 5 — 5 Ø Scarlet Fever and Rubella 2 - 2 Ø Scarlet Fever end Scabies 2 - 2 Whooping Cough 37 + 2 39 Ø Measles and Whooping Cough 1 - 1 Measles 8 - 8 Rubella 42 - 42 Rubella and acute appendicitis 1 — 1 Chicken pox 11 - 11 Chicken Pox and acute appendicitis 1 - 1 (Mumps 3 - 3 Mastoiditis 2 - 2 cerebro-spinal Meningitis 1 _ 1 Encephelo-Myelitis following Rubella 1 - 1 Oedema face and neck following attempted strangulation 1 - 1 Ø Dysentery (b. Sonnei) Dysentery (b, Sonnei) and 27 - 27 Rubella 2 - 2 Enteritis 1 — 1 Gastritis and Pyrexia 1 - 1 Infective Hepatitis 2 - 2 Catarrhal Jaundice 1 - 1 Food Poisoning 2 - 2 Erysipelas 15 - 15 Cellulitis of leg 2 - 2 Sulphanilamide Rash 1 - 1 Eczema 1 — 1 Impetigo 4 — 4 Ø Scabies and Impetigo l - 1 Erythema Iris l - 1 Lobar Pneumonia 3 - 3 Acute Bronchitis 2 — 2 Influenza 4 - 4 Quinsy 1 - 1 Tonsillitis Toxaemia following Strept. 34 — 34 Tonsillitis 1 - 1 Strept. Stomatitis and Gingivitis Acute Streptococcal infection 1 - 1 following septic scratch Rheumatic Fever following 1 - 1 Scarlet Fever 1 - 1 Marasmus 1 1 2 Cold 1 — 1 Admitted with mother for nursing purposes 3 - 3 n.a.d. 5 - 5 TOTALS 537 4 541 Ø Concurrent infection on admission: + Out-district cases. * Died of rupture of congenital aortic aneurism. 29. DIPHTHERIA. 1942. 1943. 1944. 1. Cases discharged or died during the year notified as Diphtheria or ? Diphtheria 42 57 37 2. Cases found to be suffering from diphtheria on admission (excluding diphtheria carriers) 28 24 9 3. Deaths due to diphtheria 1 1 - 4. Case mortality rate (calculated on number of cases of clinical diphtheria.) 3.6% 4.2% - * The death of this Scarlet Fever patient was proved, by post-mortem examination, to have been due to the rupture of congenital aortic aneurism. Complications, The following complications were encountered among the completed cases of Scarlet Fever:- Adenitis 93 Otorrhoea 32 Mastoiditis 4 Rhinitis 11 Catarrhal Jaundice 1 Rheumatism 2 Tonsillitis 2 Alveolar abscess 1 Neck abscess 1 Eczema 2 Conjunctivitis 2 Blepharitis 1 Various Sepsis 22 Vaginal discharge 2 Serum reaction 21 Scarlatinal relapse 14 Complications. Among the 9 completed cases of diphtheria were:- Palatal paresis 1 Cervical Adenitis 2 Tachycardia 1 Rhinitis 1 SCARLET FEVER. 1942. 1943. 1944. 1. Cases discharged or died, notified as Scarlet Fever or ? Scarlet Fever 209 533 324 2. Cases found to be suffering from Scarlet Fever on admission (including dual infection) 194 524 301 3. Deaths due to Scarlet Fever - - 1 * 4. Case Mortality rate NIL NIL 0.3 30. AURAL AMD GENERAL SURGEON. Mr. Trevor Jones' visits during the year were as follows;- (a) Operations: Mastoidectomy 1 Appendicectomy 1 2 (b) Consultations 4 PHYSICIAN CONSULTANT. Dr. Stevenson was called in in consultation regarding six patients and made seven visits to the hospital during the year. POST MORTEM EXAMINATION. During 1944, one post mortem examination was carried out by Mr. T. Skene Keith. The patient, a boy of 11 years suffering from Scarlct Fever, had collapsed suddenly and died, end the investigation revealed a ruptured aortic aneurism. STAFF. In conclusion, I would again take this opportunity of recording my appreciation of the whole-hearted co-operation which has been forthconing from all members of my staff in successfully overtaking an exceptional volume of work under particularly difficult conditions. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, A. FAIRGRIEVE ADAMSON, Medical Officer of Health. MINISTRY OF EDUCATION. MEDICAL INSPECTION AND TREATMENT RETURNS YEAR ENDED 31ST DECEMBER, 1944. TABLE I MEDICAL INSPECTIONS CF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A. ROUTINE MEDICAL INSPECTIONS. (1) No. of Inspections: Entrants 1487 Second Age Group 1361 Third Age Group 1316 TOTAL 4164 (2) No. of other Routine Inspections — — GRAND TOTAL - 4164 B. OTHER INSPECTIONS: No. of Special Inspections and re-inspections 4837 TABLE II CLASSIFICATION OP THE NUTRITION ON 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. % 4164. 868 20.85 2640 63.40 623 14.96 33 .79 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 5788 GROUP II. - TREATMENT OF DEFECTIVE VISION AND SQUINT. Errors of Refraction (including squint) Other defect or disease of the eyes (excluding those recorded in Group I) 1008 12 Total 1020 No. of Children for whom spectacles were (a) Prescribed 270. (b) Obtained 247 GROUP III. - TREATMENT OF DEFECTS OF NOSE AND THROAT. Received Operative Treatment 113 Received other forms of Treatment Total number treated 113 TABLE IV. DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist (a) Routine Age groups 8369 (b) Specials 1014 (c) TOTAL (Routine and Specials) 9383 (2) Number found to require treatment 4635 (3) Number actually treated 3319 (4) Attendances made by children for treatment 11385 (5) Half-days devoted to:- Inspection Treatment 81 1766 1847 (6) Fillings:- Permanent Teeth Temporary Teeth 4097 1588 5685 (7) Extractions:- Permanent Teeth Temporary Teeth 987 3746 4733 (8) Administrations of general anaesthetics for extractions 1774 (9) Other Operations:- Permanent Teeth ) Temporary Teeth ) 2828 TABLE V. VERMINOUS CONDITIONS. (1) Average number of visits per school made during the year by the School Nurses or other authorised persons 18.5 (2) Total number of examinations of children in the Schools by School Nurses or other authorised persons 28327 (3) Number of individual children found unclean 848 (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 (b) Under School Attendance Byelaws Nil Nil TABLEVI. 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. At a Public Elementary School At an Institution other than a Special School. At no School or Institution Blind children Nil Nil Nil Deaf Children Nil Nil Nil '