HEN 22 BOROUGH OF HEND0N ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER FOR THE YEAR 1 9 ^ 5. 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 1945. August, 1946. To the Mayor, Aldermen and Councillors of the Borough of Hendon. I have the honour to submit my Sixteenth Annual Report on the health of the Borough for the year 1945. In accordance with the instructions of the Ministry of Health, it has been prepared as an interim report. general health conditions. The health conditions generally remained good, the vital statistics concerning the life and well-being of the future generation being worthy of special mention. Three women died as a result of conditions concerned with pregnancy and child bearing, giving a maternity mortality rate of 1.3 per thousand births. The infantile mortality rate fell to the record low level of 29 per thousand live births, compared with 46 for the country generally and 54 for the County Boroughs and greet towns, including London. This rate reflects great credit on the mothers of the Borough, many of whom are living under very difficult housing conditions, on the Council's activities with regard to the untiring efforts which were made to maintain and extend the Maternity and Child Welfare Services during the war years and on the Doctors, Health Visitors, Midwives and others conccrned. The confidence of the public in these Services is reflected in the growing volume of attendances at the Health Centres, which will be seen in that section of the report which deals with Maternity and Child Welfare. The number of births registered was 2239 as compared with 2245 in the previous year, giving a birth rate of 16.25 per thousand of the population as compared with 16.1 for the country generally. The general death rate of the population was 10,01, that for the country generally being 11.4 and 13.5 for the county Boroughs and great towns including London. Table I shows the 2. downward trend in the infantile mortality rate since the beginning of the century. 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 1945 29 The following Table shows the causes of death during the yeari- TABLE II CAUSE MALE FEMALE TOTAL Typhoid and paratyphoid fevers — — — Cerebro-spinal fever 1 1 2 Scarlet fever - - - Whooping Cough - - - Diphtheria - 1 1 Tuberculosis of respiratory system 36 21 57 Other forms of tuberculosis 6 1 7 Syphilitic diseases 8 2 10 Influenza 3 3 6 Measles - 1 1 Acute poliomyelitis & polioencephalitis - - - Acute infectious encephalitis — - - Cancer of buccal cavity & oesophagus (M) uterus (F) 10 19 29 Cancer of stomach and duodenum 17 16 33 Cancer of breast 1 29 30 Cancer of all other sites 84 79 163 Diabetes 6 12 18 Intra-cranial vascular lesions 63 91 154 Heart disease 173 165 338 Other diseases of circulatory system 23 18 41 Bronchitis 35 25 60 Pneumonia 50 33 83 Other respiratory diseases 12 12 24 Ulcer of stomach or duodenum 15 4 19 Diarrhoea, under 2 years 3 2 5 Appendicitis 4 4 8 Other digestive diseases 18 17 35 Nephritis 19 15 34 Puerperal and post-abortive sepsis - - - Other maternal causes - 3 3 Premature birth 9 6 15 Congenital malformations, birth injury, infantile disease 19 7 26 Suicide 11 7 18 Road traffic accidents 11 2 13 Other violent causes 14 19 33 All other causes 62 51 113 TOTAL - all causes 713 666 1379 3. INFECTIOUS DISEASES. The following Table shows the number of notifications of the principal infectious diseases as compared with the two previous years:- TABLE III CASES OF INFECTIOUS DISEASES OTHER THAN TUBERCULOSIS NOTIFIED DURING 1943. 1944 & 1945. DISEASE TOTAL CASES NOTIFIED REMOVED TO HOSPITAL 1945 1943 1944 1945 Scarlet Fever 756 374 180 145 Diphtheria 31 17 20 19 Pneumonia 172 132 129 55 Acute Polionyelitis 1 2 4 2 Measles 1005 123 2013 94 Whooping Cough 212 530 162 12 Cerebro-spinal Fever 10 5 4 3 Typhoid or Enteric Fever 2 1 1 1 i It will be seen that there was a decrease in notifications of scarlet fever, but that conversely the notifications of measles was markedly increased. The latter disease tends to reach a peak biennially and the increase was therefore anticipated. This disease, while in the majority of children passing off with little or no untoward results, gives rise in a proportion of cases, particularly in the very young or the debilitated child, to unfortunate complications, such as pneumonia, diseases of the middle ear, etc. In view of this, endeavours were made to admit as many complicated cases as possible to the Isolation Hospital and medical practitioners in the district wore notified that arrangements would be made there for the treatment of such cases and also where the housing conditions precluded a child being satisfactorily nursed at home. The incidence of diphtheria remained low and in only 11 out of the 20 cases notified was the diagnosis confirmed. The campaign for diphtheria immunisation was continued energetically, and Table IV shows the number of cases of diphtheria, deaths from that disease, and the accumulated total of children immunised. 4. TABLE IV. Year No. of Cases of Diphtheria notified No. of Deaths from Diphtheria Accumulated total of immunised children 1935 138 9 27 1936 86 2 130 1937 121 7 381 1938 195 4 725 1939 150 3 1124 1941 70 3 1729 1941 58 1 5868 1942 38 2 11068 1943 31 2 15506 1944 17 - 16970 1945 20 1 19555 of these the diagnosis of diphtheria was confirmed in only 11 cases. In the case of the death from this disease, the child, aged 13/12 yrs., had not been immunised against diphtheria. A new factor in epidemiology has been introduced by the number of contacts of the more serious forms of infectious diseases returning to this country from abroad. The speed of fir travel makes this an everincreasing anxiety as there is no time for the incubation period to expire before the arrival of the contact in this country. A comprehensive scheme for supervision has therefore been established. Notification of contacts is received from the Sea and Air ports and the contacts are kept under supervision until the termination of the incubation period. Altogether 95 contacts of typhus fever were supervised and 43 contacts of smallpox. 5 TUBERCULOSIS. The following Table shows the notifications of Tuberculosis during the last five years TABLE V. YEAR NOTIFICATIONS Pulmonary Non-pulmonary Male Female Male Female 1941 68 50 9 21 1942 141 93 14 27 1943 100 74 19 18 1944 112 96 4 19 1945 101 70 15 15 I an indebted to Dr. A. S. Hall, the County Tuberculosis Medical Officer, for the following observations:- "Despite many difficulties, and in a statistical sense, the position as regards tuberculosis in Hendon in 1945 was more satisfactory than in any previous year since Hendon has attained its present level of population. Deaths still remain our most trustworthy indication of the prevalence of the disease and they numbered 57 in the year, giving a rate of 39 per 100,000 compared with a rate of 6l in 1944, This new level is very satisfactory end more in keeping with the social conditions of the district. As tuberculosis comes under control it is usually noted that the age at death rises and this is confirmed in Hendon where 30 of the deaths were over the age of 40 and 27 under. When the sexes are differentiated we find that men fared worse than women for 37 of them died as opposed to 20 women. Under 40, there were 13 men and 14 women, whereas over 40, there were 24 men and 6 women. In fact, the middle-aged man is becoming the chief problem in tuberculosis. There were no deaths in the age-group 10 - 20 and there was only one non-pulmonary death. Of the 57 deaths, 5 were only notified on death certificates and a further 6 were either notified a short while before death or were of persons resident in mental hospitals. The remaining 1+6 were on the Chest Clinic register for periods varying from 26 years to one month. The average time on the register was 4,2 years. Six deaths were of persons transferring into the district already suffering from tuberculosis. There was a total of 1035 notified persons at the end of the year, giving a rate of 707.6 per 100,000, a high rate, but an index rather of the persistence with which the disease is sought out than of the gravity of the problem in the district. Turning to the treatment of the living patients it must be confessed that the situation is very serious for the wait before in-patient treatment can be commenced has at no time been less than 3 months, and has been steadily increasing. This wait is a great test of the patients' morale and it has been remarkable to observe how well they have borne it. The initial period of rest with minor preliminary collapse measures have been undertaken in the patients' homes in a large proportion of cases with consider- 6. able success so that when the sanatorium vacancy arrived active therapy could be started at once. The length of the waiting list is almost entirely due to the shortage of nursing and domestic staff. All the year, not only were beds empty but whole wards were closed on that account. It is difficult to foresee how this problem will ever be met and it may well be that more and more treatment will have to be undertaken in the patients' homes. The paradox will be observed, however, of declining facilities for treatment accompanied by a declining death rate. The Government allowances supplemented by the grants of the County Council have proved very useful and one wonders what our patients used to do before this assistance was available. All the more anxiety is felt therefore at the prospect of its discontinuance under the new insurance act," SCABIES AND VERMIN. The disbandment of the Civil Defence Services necessitated alterations in the scheme for the treatment of these conditions. Treatment is carried out at the 5 permanent Health Centres and 2 full-time Clinic Attendants were appointed to undertake this amongst other duties. In addition, arrangements were made for the gas cleansing premises at the Isolation Hospital to be adapted for the treatment of adult males. It should be noted that the figures for treatment of scabies do not reflect accurately the incidenco of the disease, as included in this figure are the home contacts, in which prophylactic treatment is given as a routine procedure. TABlE VI. YEAR No, of Cases of Scabies dealt with. No. of Verminous conditions dealt with. 1943 1256 591 1944 1074 996 1945 1352 711 7. maternity and child WELFARE. HEALTH VISITING. Staff. The number of Health Visitors employed by the Council is 17. Approximately one half of their tine is devoted to the care of expectant and nursing mothers and the welfare of children under 5 years of age, the rest being devoted to the work of the School Health Services. Infant Welfare. The visiting of infants in their own hones and the education of their mothers in infant nurture should be the miainspring of the Maternity and Child Welfare effort. During the year the Health Visitors paid the following number of visits:- To expectant mothers First Visits Total Visits 985 1371 To Children under 1 year. First Visits Total Visits 1830 5563 To Children between ages of 1 & 5 years Total Visits 6266 TOTAL 13200 maternity & child welfare centres. The number of Maternity and Child Welfare Centres remains the saue as last year, viz, 11, Five are carried on. in ad hoc premises, at Central Hendon, Child's Hill, Mill Hill, Watling and West Hendon. Of the remaining six, five are held in Church premises rented for the purpose - Broadfields, Colindale, Edgware, Holders Hill and Temple Fortune, while the Woodside Park Centre is held at Frith Manor School. During the year it was found necessary to establish an additional session per week at the . ill Hill Centre. 8. The Table below indicates the days and times on which the Maternity and Child Welfare Centres are held:- TABLE VII DISTRICT PLACE OF MEETING DAY TIME DOCTOR OR HEALTH VISITOR PRESENT[/#/##] Central Hendon Health Centre, The Burroughs, Hendon, N.W.4. Monday Friday Friday 2 p.m; 9.30 a.m. 2 p.m. Doctor and Health Visitor -do-do- Child's Hill Health Centre, Garth Road, Hendon Way, N.W.2. Wednesday Thursday 2 p.m. 2 p.m. Doctor and Health Visitor -do- Mill Hill Health Centre, Hartley Avenue, Mill Hill, N.W.7. Monday Tuesday Wednesday Friday 2 p.m. 2 p.m. 2 p.m. 2 p.m. Doctor and Health Visitor Health Visitor Doctor and Health Visitor -do- Watling Health Centre, Cressingham Road, Burnt Oak. Tuesday Wednesday 2 p.m. 2 p.m. Doctor and Health Visitor -do- West Hendon Health Centre, 215, The Broadway, Hendon, N.W.9. Tuesday Friday 2 p.m. 2 p.m. Doctor and Health Visitor -do- Broadfields St. Andrews Church Hall, Lynford Gardens, Edgware. Tuesday Thursday 2 p.m. 2 p.m. Doctor and Health Visitor -do- Colindale Hyde Congregational Church Hall, Colin Close, N.W.9. Thursday 2 p.m. Doctor and Health Visitor Edgware Edgware Parish Church Hall, Station Road, Edgware. Monday Friday 2 p.m. 2 p.m. Doctor and Health Visitor -do- Holders Hill St. Mary Magdalen Church, Holders Hill Road, N.W.4. Monday 2 p.m. Doctor and Health Visitor Temple Fortune Gospel Hall, Bridge Lane, N.W.11. Monday Tuesday Tuesday 2 p.m. 9.30 a.m. 2 p.m. Health Visitor Doctor and Health Visitor -do- Woodside Park Frith Manor School, Lullington Garth, N. 12. Tuesday 2 p.m. Doctor and Health Visitor 9. The numbers of attendances at the Maternity and Child Welfare Centres during 1945 may be compared with preceding years:- TABLE VIII 1939 1940 1941 1942 1943 1944 1945 No. of Maternity and Child Welfare sessions held 911 952 909 925 934 1016 1033 No. of new members admitted 1923 2276 2074 2316 2298 2252 2442 Total No. of attendances 53009 50763 48245 49960 54962 49334 55282 The average attendances at the Child 'Welfare sessions during the five years immediately preceding the out-break of war was 46,600. It is gratifying to see therefore from the foregoing Table, despite the difficulties attendant upon war-time conditions, that the numbers attending each year exceeded the pre-war average. Maternal Care. Ante-natal Clinics. The ante-natal clinics are held in the five permanent Health Centres. Each session is attended by an Assistant Medical Officer, a Health Visitor and the Midwife of the area. At Watling Health Centre the Midwives of the Watling District Nursing Association attend. Owing to increasing numbers it was found necessary to establish an extra session per week at Child's Hill, The ante-natal programme is shown below:- table IX District No. of sessions per week. day A.M. or P.M. Central Hendon 2 Wednesday Wednesday a.m. p.m. Child's Hill 3 Tuesday Friday Friday a.m. a.m. p.m. Mill Hill 2 Tuesday Thursday a.m. a.m. Watling 2 Thursday Friday a.m. a.m. West Hendon 2 Tuesday Friday a.m. a.m. 10. The attendances during 1945 were a record, both as regards the number of patients seen and the total number of attendances made by them. TABLE X 1942 1943 1944 1945 No. of Ante-natal Sessions held 431 503 517 509 No. of Expectant Mothers seen 1619 1597 1498 1702 No. of attendances 7464 8721 8944 9109 Average No. seen per session 17 17 17 18 Average No. of attendances made by each patient 4.61 5.46 5.97 5.35 Provision for Confinement. Very complete provision is made by the Council. For domiciliary confinement a Municipal Midwife can be booked, either to take charge of the patient as a midwifery case or to assist the doctor if he is engaged for the confinement. (In the Watling area the watling District Nursing Association provides the service under arrangements made between the Association and the Council). Midwifery Staff. The number of Municipal Midwives employed by the Council remaining unchanged - 8. There were no changes in staff during the year. Gas and Air Analgesia is given by six of the Municipal Midwives. Owing to the restrictions placed by Central Midwives Board Rules upon the administration, the number of cases delivered with the aid of Gas and Air Analgesia is limited. However the figure is increasing - 31 cases in 1945 compared with 15 in 1944. Home Helps. In cases where adequate domestic assistance cannot be found by the patient the services of a Municipal Home Help can be engaged. Fifteen are employed, ten on a full-time and five on a part-time basis. During the year home help was provided in 208 cases. When it is realised that without this help most of these patients would have been compelled to occupy beds in Institutions, it will be clear that the Home Help Service plays a vital part in relieving the strain on 11. the hard-pressed hospitals end utilising the Municipal Midwifery Service to the maximum degree possible. Above all, the hone help enables the mother to stay at home for her confinement when she wishes to do so and thus contributes to the happiness and comfort of mother and baby and the whole family. Many expressions of appreciation of this service have been received. Hospital Confinement. During recent years the hospitel maternity units have been working under great pressure and the applications for hospital confinement have now to be sifted and restricted in order that the most needful cases may gain admission. These are cases in which some complication is known or expected, and those in which the home conditions render domiciliary confinement undesirable. The bulk of the hospital maternity work for the area is dealt with at the Middlesex County Council Hospitals - Redhill end Bushey. The Borough Council has arrangements with two other hospitals for admission of necessary maternity cases, viz. Queen Charlotte's end Ashridge. Hendon mothers are also eligible for inclusion in the official evacuation scheme, by which expectant mothers from the London area are taken to distant emergency maternity homes in varoous parts of the country. All these arrangements may be described as official. Meny Hendon mothers prefer however to make their own private plans, either with hospitals or nursing homes. The following Table shows the comparative figures for domiciliary confinement, hospitals end nursing homes: - TABLE XI Domiciliary Attended by Municipal Midwives 356 584 " " Watling District Nursing Association 138 Others 90 Hospitals Redhill and Bushey 790 1183 Queen Charlotte's 18 Ashridge 49 Evacuation 19 Other Hospitals (private arrangements) 307 Nursing Homes 484 Hendon Nursing Homes 158 Nursing Homes outside the area 326 12. Post Natal Care is designed to ensure that the mother's health returns to the highest possible level after confinement. This is covered in a large measure by the Maternity and Child Welfare Centres, but in addition every mother should have a special medical examination about six weeks after her delivery. Mothers who enter hospitals or nursing-homes and those attended at home by their own doctors are covered accordingly. Patients delivered at home without a doctor may attend the Borough Clinics, where they are seen during ante-natal sessions. Unfortunately only a small proportion of these patients do attend for post-natal examination. Doubtless many conditions which require attention go untreated in the mothers who fail to attend for post-natal examination, and further efforts are required to educate the mothers about the importance of this examination. CARE OF PREMATURE INFANTS. The scheme established under Ministry of Health Circular 20/44 has worked smoothly, and more attention is now being devoted to the babies whose birth weight is 5½ lbs. or less. The total number of premature babies notified during 1945 was 81, of whom 75 were born in hospital and only 6 at home. This disparity is largely explained by the fact that prematurity is often the result of some complication of pregnancy for which the mother has been admitted to hospital. None of the 6 babies born at home were transferred to hospital but were nursed entirely in their homes. One died during the first 24 hours. The other five were alive at the end of one month. Of the 75 born in hospital 6 died during the first 24 hours and 15 subsequently before the end of the first month. 54 were alive at the end of the first month, CHILD LIFE PROTECTION. 38 foster mothers were on the Register at the end of the year, with 52 children in their care. 1 foster child died during the year. ADOPTION OF CHILDREN. During 1945, 32 persons fave notice of thoir intention to adopt in respect of 32 children. Careful visiting of these cases is carried out by the Health Visitors and the results are generally satisfactory. 13. 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 under the supervision of a trained Physiotherapist. The class was put into operation on the 3rd January, 1945 at the Central Hendon Health Centre and by the end of the year 103 women had attended. As this activity was, and still is, experimental in nature, a questionnaire was devised end sent to whoever was in charge of the mother during her confinement, and at the end of the year 26 reports had been received. The confinements mainly took place in hospital, particularly Redhill County Hospital, The questionnaire was framed to give en indication of the nature and duration of the labour, but from the replies received no definite conclusions could be drawn regarding the benefits or otherwise of these exercises. The numbers dealt with ere, however, too small on which to base a definite conclusion. There is, I believe, a psychological benefit insofar as the mothers, particularly those having first babies, meet others in a similar condition and view their approaching confinement with decreased apprehension. It is therefore proposed to continue the Class for a further period in the hope that a more definite conclusion will emerge from the increased numbers. 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 ere 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 pro-school age. 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. During the year the number of new cases referred for this treatment was 63 and the number of attendances made for treatment was 200. 14. DAY NURSERES. The number of Day Nurseries and the provision for children remained the same as in the previous year. Certain developments of preventive medicine and social service are beyond criticism, others are not so universally accepted as being beneficial to the public health. Amongst the provisions which have given rise to the most acute controversy is the desirability or otherwise of providing day nurseries, particularly for the very young. Critics quote the risk of infection which occurs from the congregation of numbers of very young children; the psychological effect of withdrawing the very young child from its mother for a long period each day and the fact that young children are taken to and from the nurseries in the cold and darkness of a winter morning and evening. These criticisms are well founded, but regard must be had to other considerations, e.g. a. the continuing needs for women in industry b. the financial position of some of the homes c. the opportunity which the child enjoys in forming good habits in cleanliness and social mixing d. the opportunity of regular medical supervision. It is probable that the ultimate ideal to be aimed at is the provision of nursery schools for children over two years of age, thus leaving the young child in his natural environment. Training of Student Nurses. As well as providing a homo for the young child during the day the Nursery has been of great assistance in providing a training ground for women who want to make child care their career. The Nurseries are staffed by a Matron, S.R.N., a Deputy Matron, Nursery-trained, several Nurses also Nursery-trained, and Probationers, or Student Nurses. All the Nurseries have been passed by the National Society of Children's Nurseries as training schools for their examination and they are open to the National Society of Children's Nurseries Inspector at any time. These Inspectors, as well as giving advice about the Nursery, advise about the training of the students in up-to-date methods. Mr. Walls, Principal of the Hendon Technical College has been of groat assistance in 15. providing the essential classes for the students at the College. So far twelve students have entered of whom ten have been successful and have gained the National Society of Children's Nurseries Diploma, Of these, a few hnve left for other ports, some have married and some are continuing to work ft the Nurseries as qualified Nursery Nurses. It is hoped to extend this work now that the War is over. It is also hoped to bring the mother more into the Nursery so that she may see for herself how her child is cared for and perhaps have a few lessons in child management by observation. The greatest need is for trained Nursery Teachers as there are approximately 335 children over the age of 2 years on the rolls at the eight Day Nurseries and there is only one certificated Nursery School Teacher acting as a Supervisor of the torching which is carried out by Wardens. The following Table gives particulars of the Nurseries:- TABLE XII Address of Nursery Date of Opening Accommodation Under 2 years Over 2 years Total Addington House, Orange Hill Road, Burnt Oak. 2.2.42. 22 40 62 2, Hocroft Road, Child's Hill, N.W.2. 30.3.42. 20 30 50 Hyde School, Hendon, N.W.9 11.5.42. — 45 45 York Park, West Hendon, N.W.9. 31.8.42. 30 30 60 Clarement Road, Cricklewood, N.W.2. 3.12.42. 20 30 50 Approach Road, Edgware. 30.4.43. 12 25 37 Hyde Cottage, Hendon, N.W.9. 21.2.44. 20 45 65 Dole Street, Mill Hill, N.W.7. 20.3.44. 27 28 55 In concluding the Maternity and Child Welfare Section of the Report I should like to take this opportunity of thainking those Voluntary Workers who attended regularly at the Health Centres and the District Nursing Associations for their whole hearted co-operation in the care of the expectant and nursing mother and the young children of the family. 16. SCHOOL HEATLH SERVICES. I an glad to report that the health of the children attending school was well maintained. The incidence of infectious diseases remained low and the nutritional standard of the children was well maintained. As a result of the passing of the Education Act, 1944, the Middlesex County Council became the Local Education Authority as from 1st April, 1945. In the subsequent scheme of divisional administration the Borough of Hendon became an excepted district and the scheme as ultimately formulated leaves the conduct and co-ordination of the School Health Services very largely under the control of the Borough Council, The same medical, health visiting, administrative and clerical staff are engaged in the School Health Services as are engaged in the Maternity and Child Welfare Services, child life being regarded throughout as an entity, with the family as the unit. The advantages of this procedure need hardly be stressed, providing as it does economy in staff with a continuity of supervision. The following Table gives particulars of the number of children examined?- TABLE XIII Routine Medical Inspections, Special Inspections TOTAL 6273 6071 12344 I cannot stress too much the importance of these routine and special examinations, as they permit of a skilled observer correcting a defect before it has reached a stage in which treatment could not achieve as satisfactory a result. One feature of the special examinations worthy of note is the steadily increasing number of children referred for examination because they are suspected of being mentally handicapped. These children are generally referred by the Teachers because of their inability to maintain their educational position with other children of the same age. The numbers of children referred because of behaviour problems still increases. This may be partly due to the aftermath of the war, the disturbances of family life and to a keener appreciation of the abnormal both by parents and teachers. 17. The following forms of treatment are provided free of charge at the various Health Centres:- 1. Minor Ailment Sessions. Minor Ailment Sessions at which a Doctor attends and where many of the Special Examinations are conducted and a variety of conditions of varying degrees of severity treated. Health Visitors Sessions where treatment for the less serious conditions is undertaken, many new cases seen and where necessary referred to a Doctor's session for further investigation. 2. Orthopaedic Treatment. For the remedying of crippling defects. 3. Ophthalmic and Orthoptic Sessions. For the treatment of eye defects. 4. Speech Therapy. For the treatment of speech defects. 5. Dental and Orthodontic Sessions. (the latter being the correction of irregularities of the teeth). 6. Aural Sessions. For the treatment of car, nose and throat conditions. In addition, the following forms of treatment are provided by arrangement with outside Authorities:- a. With the Royal National Orthopaedic Hospital, Stenmore for the in-patient treatment of orthopaedic defects. b. With the Royal Westminster Ophthalmic Hospital for the in-patient treatment of eye defects. c. With Redhill County Hospital and the Hendon Cottage Hospital for the operative treatment of diseased tonsils and adenoids. d. With the Tavistock Child Guidance Clinic for psychological investigation and treatment. It is not proposed to deal with each of those forms of treatment in detail but only to comment where additions or variations have taken place. Orthopaedic. Experience of this work over a long period has clearly demonstrated the need for the appointment of a Teacher of Remedial Exercises to work in the Schools in conjunction with the Organisers of physical training and the Teachers. By thus observing deviations from the normal at the earliest stage and providing specialised forms of remedial exercises forthwith, Incipient defects can be corrected without the necessity of their being referred to the Orthopaedic Surgeon. 18. The Council approved such an appointment but it was not until recently that a suitably trained person became available for the work. Diseases of the Bar, Nose & Throat. All who have had experience in work amongst school children must be impressed by the volume of conditions which are encountered affecting the ear, nose and throat and requiring specialised forms of treatment. The treatment tends to be protracted in character and difficult to arrange. In view of these considerations the Council approved the appointment of an Aural Surgeon and Dr. F.P.M. Clrake commenced duty with this Authority at the beginning of the year. At the present time two sessions ore held weekly at the Health Centre, Central Hendon, the after-treatment for the convenience of the mothers and children being undertaken by the Health Visitors at the various other Health Centres. The aims of treatment can be briefly summarised as:- 1. The eradication of sepsis, particularly of sinus infections. 2. The treatment of acute and chronic ear conditions with a consequent improvement in hearing. 3. The conservative treatment of diseased conditions of the tonsils and adenoids which otherwise would have required operative interference. The results achieved have been outstandingly successful end the following Table shows the number of children treated during the year:- TABLE XIV ! Total number seen at the Ear, Nose and Throat Clinic 591 School children 516 Pre-school children 75 Ear cases 64 Nose and Throat cases 460 Miscellaneous cases 67 Number of cases treated by "Tonsil Suction" 94 Number of cases treated by "Proetz 'Displacement-Nasal' ". 52 19. DENTAL SERVICES. These services continue to be in ever increasing demand, dental disease being the commonest single defect found amongst the children. The number of dental staff employed did not permit of much orthodontic work being undertaken (correction of deformities of the jaw and teeth) but the appointment of an additional Dental Officer permitted of more of this work be ins undertaken and it has now become a flourishing branch of the dental services with a marked aesthetic and a consequent physiological improvement in the children treated. The results of this treatment have to be seen to be believed. I am indebted to Mr. K. C. B. Webster, the Chief Dental Officer, for the following report on the Dental Services:- "The year was notable by reason of the transfer of the dental staff to the Middlesex County Council under the provisions of the Education Act, 1944. The scheme of divisional administration, however, enables the local unit to remain as an integral part of the Hendon health services without disturbances to the organisation built up over a number of years. The staff consisted of four full-time Dental Officers and one part-time Dental Officer in the latter part of the year, and four full-time and one part-time Dental Attendants, 7/ith the school registers giving attendances of approximately 13,500 children, this provided an allocation of a full-time Dental Officer to every 3,000 children, with 1,500 for the part-time Officer. The ending of the war and the return of evacuees, many of whom received little treatment during absence from the Borough, caused some disturbance to the routine Cental inspections in the schools. The principal factors, however, which continue to mitigate against annual inspection and treat, lent for every school child arej- (a) The hi; h acce^tancc rate, which was approxioately 70$ for the year, V/ith tooth-consciousness at this level it is doubtful if a Dental Officer can undertake the complete dental care of more than 2,000 children, which foreshadows an eventual establishment of seven full-time Dental Officers, provided the school population remains at a level of about 14,000 in 1946, The question of any expansion of the service is now closely bound up with the problem of accomodation as the five existing Dental Surgeries were occupied at the end of the year, (b) The increasing number of parents and older children who apply for inspection at the Clinics without waiting for routine inspection at school, a healthy attitude which is actively encouraged, (c) The increasing demand for orthodontic treatment, (d) The increased attendance in the Maternity and Child Welfare group, partly due to the rise in the birth rate. The state of dental health in the schools has been steadily improving for a number of years and it is now unusual to see badly neglected mouths. 20. Greater interest is being shown in dental treatment in the Maternity and Child Welfare eases. The following Table gives a comparison between 1938 & 1945:- TABLE XV Expectant & Nursing Mothers Pre-school children 1938 1945 1938 1945 Attendances for treatment 1491 2495 960 536 Fillings and other conservative treatment 376 801 269 295 Extractions 1033 851 939 203 Dentures constructed Nil 129 Proa the foregoing there is evidence of a greater interest in the preservation of the teeth in the mothers, end considerably less Cross dental disease among the toddlers, as indicated by the extraction figures. The improved state of dental health in both Schools and Welfare Centres is partly due to dietetic factors to which reference was rja.de in the report for 1944, but still mainly due to the education and treatment carried out in the Centres. The orthodontic scheme continues to develop rapidly, over 500 children being under treatment during the year, for whom 269 appliances were constructed, mostly of the removable type. During the period of development of this scheme, each Dental Officer has carried out orthodontic treatment, a central clinic having been conducted by the Chief Dental Officer for consultative purposes. There is much to commend the actual practice of a certain amount of orthodontic treatment by every Dental Surgeon engaged in children's dentistry, but the present dimensions of the scheme are interfering with routine dental inspections and treatment and the appointment of an orthodontic surgeon to take over the bulk of this work is now receiving consideration. There appears to have been an increase in the incidence of malocclusion of recent years, mostly of the type associated with thumb or finger sucking. Such habits are usually associated with unresolved anxiety in parly childhood and the increase may well bo due to the domestic stresses and disturbances occurring in so many families at the present time, X-ray facilities continue to be provided by arrangement with the Hendon Cottage Hospital, the number referred reaching the new high level of 198. The Emergency Medical Services Pathological service carried out 4 histological investigations during the ycer. Penicillin was mrdo available for a number of cases of Vincent's stomatitis bjr arrrnc ement with the Isolation Hospital, ' School and Maternity dentrl treatment was a difficult problem twenty years ago due to the fear end mistrust still lingering in the minds of the public as r legacy of conditions prior to the passing of the Dentists let, 1921. In a comparatively short space of time, de land for treatment in this Borough has far outstripped supply end the great majority of children have come to look upon periodic visits to the dentist es pert end parcel of their educational environment. Herein lie the seeds of a development that may eventurlly lead to a far better standard of dental health for the populace as a whole." 21. I am indebted to the Borough Education Officer 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 end that of his staff in the work of the School Health Services. "Children under 5 years of are. During the year continued arrangements have been uade for the admission of children under five years of age to Infant Deportments. On 28th September, 1945, there, were 594 such children attending 26 Departments. These figures represent an increase of approximately 60% above that prevailing at the corresponding dote for 1944 owing to the return of evacuees. The opening of Infant Departments to children under five years has been found to bo a valuable contribution to the release of women workers for work of National I .iportancc in the area, inasmuch as it enabled many mothers to take up such work who would have otherwise been unable so to do. Provision of Meals. The two central kitchens which have been in existence at Algernon Road ond Bell Lane Schools for the past four years provide about 3800 meals daily. There are also kitchens at Orange Hill Secondary School and the R.C. School of the Annunciation which provide 350 and 200 meals daily respectively. The latest figures show that 29,060 meals were served during one week at 34 school canteens for children attending 50 Primary, Secondary Modern, Secondary C-raomar and Lccondary Technical School Departments. Owing to the shortage of kitchens there are still two schools without canteen facilities. Due to the same cause there are Ion, waiting lists of children requiring meals in all schools. A central kitchen to provide 1000 meals daily is being erected by the Ministry of Works on the Clitterhouse School site and authority has been given for the erection of another central kitchen to provide 2000 meals daily at Abbots Road, Burnt Oak. It is also anticipated that Schemes will shortly be prepared for combined kitchens and dining rooms for 500 meals daily to be erected at several schools in the Borough. On 17th October, 1945, 4215 children received ; rd pint of milk ond 5546 received 2/3rds. pint of milk (total 9,76l) under the Milk in Schools Scheme," STATISTICAL TABLES. The Ministry of Education Statistical Tables will be found at the end of this Report. 22. SANITARY INSPECTIONS CP 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 Inspectors:- Inspections made 6607 Reinspections after order or notice 7089 Complaints received end investigated 2752 No-answer visits 1265 Nuisances discovered and dealt with 2533 Inspections of Air Raid Shelters 51 Visits paid to Infected Houses 692 Infected rooms disinfected 427 Cesspools emptied 118 Choked drains cleared by Local Authority for the abatement of urgent nuisances 239 NOTICES SERVED. Informal or cautionary 588 Complied with 475 Outstanding 1945 113 STATUTORY NOTICES. Applied for 150 Served under Public Health Acts, etc. 60 Outstanding from 1944 1 Complied with 52 Outstanding from 1945 9 Ons summons was applied for against an Owner for non-compliance with an Abatement Notice. The maximum penalty of £5 was imposed for failing to comply with a Nuisance Order made by the Court. Defendant was ordered to pay £2. 2. 0 costs. DISINFESTATION. Treatment of verminous houses. The following houses were successfully treated:- Privately-owned 29 Council Houses 3 Inspections were made of furniture and bedding and rooms in the occupation of tenants before their removal into Council houses and disinfestation was performed where necessary. Work of disinfestation is done by the Local Authority and where verminous conditions were discovered, these cases were followed up after removal. 23. FACTORIES ACT, l937. Number of inspections 181 Notices served to remedy defects 28 Notices complied with 23 Matters notified by H. M. Inspector of Factories 12 Lists of Outworkers received 19 Outworkers premises inspected 20 Nature of defects remedied at Factories;- Sanitary accommodation. Insufficient 1 Unsuitable or defective 13 Improperly ventilated or unventilated 5 Want of cleanlinoss 37 Inadequate lighting 1 Other offences 11 WATER SUPPLY. The Borough has a dual source of water supply:- 1. The Metropolitan Water Board supplying en area bounded on the west by the London Midland and Scottish Railway, on the North by a line along the Mutton Brook to Bridge Lane and on the East by the London North Eastern Railway. The remaining Northern portion of the Borough is supplied by the Colne Valley Water Company. The Metropolitan Water Board supplies selected Thames water which has been subjected to purification by storage in which time it is freed of the bulk of organisms. It is filtered through rapid and then slow filters, attaining a degree of purity which compares favourably with the general supplies in Great Britain, but as a further safeguard, terminal chlorination is applied which ensures a first class water in every respect. Samples of waters and filter beds ere examined bactoriologically, chemically and for taste rnd other spcciel purposes on every working day. 2. The Colne Valley Water Company derives its supply from deep wells sunk into the chalk rnd before distribution to the consumers the water is under the constant supervision of a chemical and bactoriologica1 staff which carries out examinations in modern laboratories situated at the Works. A high standard of purity is maintained. SWIMMING BATHS. There are two swimming baths owned by the Local Authority and one privately owned. The purification and filtration plant at the Locel Authority's baths consists of filters of the horizontrl pressure type, together with centrifugal pumps, chlorination plant and cascede aerators. The total quantity of bath water can be passed through the filters in four hours, but during slack bathing periods this is extended to six hours. 24. After passing through the filters the water is injected with ammonia gas in solution and then passes over the cascade aerators and is finallyinjected with chlorine gas in solution "before passing into the bath. The use of ammonia and chlorine gas is for the destruction of harmful bacteria and prevention of the growth of algae in the water. In order to assist in the cleansing and efficient working of the filters, a coagulent and alkaline salt are introduced into the water between the pumps and filters, 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 dwellinrhouses during the years- Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts.) 1749 Number of inspections made for the purpose 3348 Number of dwelling-houses found not to be in all respects reasonably fit for human habitation. 480 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 463 Proceedings under Public Health Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 60 Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By Owner 42 (b) By Local Authority in default of Owners INSPECTION AND SUPERVISION OF FOOD. 1287 inspections were made at premises where food intended for sale for human consumption was prepared, stored or sold. 25. MILK SUPPLY. Number of registered dairymen and purveyors of milk 13 Number of rer istered premises 32 Number of cowkeepers 6 Number of faros where milk is bottled on the premises 4 186 special visits have been made to secure cleanliness of dairies and dairy farms and for protecting nilk against contamination. There is one pasteurising establishment in the district end during the past year 84 samples of bottled pasteurised milk taken immediately after machine capping were submitted for bacteriological examination. Two of the samples failed to comply with the requirements of the Milk (Special Designations) Order, 1936-1941, in one case the bacteria exceeding 100,000 per millilitre, and one sample gave unsatisfactory results on phosphatase test, - a test devised to indicate that milk has been adequately heated. Eighteen samples of raw bulk milk were taken from rail tanks, forty-six milk bottles immediately after cleansing in the bottle washing machines and eight bottles after hand washing. The total number of milk samples taken for examination was 194; Tuberculin Tested milk 12, Fasteurised nilk 158 and non-Designated milk 24. Of the pasteurised nilk 157 samples satisfied the Phosphatase Test, seven samples exceeded the bacterial count prescribed by the Order and one failed to satisfy the Phosphatase Test. SLAUGHTERHOUSES. Three Slauliterhouses 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 Pood and general slaughtering has temporarily ceased. 26. SLAUGHTER OF ANIMALS ACT, 1933. Three slaughtermen were licensed as fit and proper persons to slaughter or stun aninals. FOOD CONDEMNATION. The following foodstuffs were examined and condemned as unfit for human consumption:- Butchers Meat. Fish. Beef 209 lbs. 10 ozs. 413 stones 11½ lbs. Mutton 3 lbs, 3 ozs. (including Cod, Coalfish, Pork 70 lbs. Dogfish, Haddock, Hake, Lamb 15 lbs. Halibut, Herring, Plaice, Rabbits 271 lbs. 4 ozs. Ray, Skate, Tarsk, 'Teever, Liver 5 lbs. Whiting end Roe. Sausages 130 lbs. Ham 26 lbs. 12 ozs. Bacon. Poultry. 70 lbs. Chickens 59 lbs. Ducks 15½ 1bs. Eggs (2516) 2 cwt. 28 lbs. Fruit and Vegetables. Miscellaneous Articles. Oranges 10 cwts. 37 lbs. Flour 505 lbs. Carrots 2 cwts. Cooking Fats 156 lbs. 14ozs. Apples 1¾ cwts. Sweets 100 lbs, 2ozs. Raisins 105 lbs. Cheese 1 lbs. Dates 85 lbs. Jam 297 Jars Currants 56 lbs. Soup Powder 264 packets Sultanas 22 lbs. Biscuits 96 lbs. Lemons 15 lbs. Cereals 47 packets Prunes 5 lbs. Sugar 39¼ lbs. Dried Egg 36 packets Fish 33 jars Pickles 27 jars Salad dressing powder 25 packets Canned Foods. Paste 20 jars Cod Liver Oil & Malt 19 tins Milk 1509 tins Tea 14 lbs. Fish 1107 tins Sauce 9 bottles Vegetables 874 tins Salt 9 packets Meat 649 tins Mustard 7 tins Soup 214 tins Bi-carbonate of Soda 3 packets Jam 156 tins Fruit Cordial 2 bottles Fruit 90 tins Coffee Essence 2 bottles Junket 1 bottle Ryvita 1 packet Baking Powder 1 packet Health Salts 1 packet Total quantity of Canned Foods condemned 4599 Total weight of Other Foods condemned (not including; canned foods, and foods contained in jars, packets and bottles) 4 tons 4 cwts. 3½ stones. 27. Informal action telcen in connection with Food Shops and Pood Stores. 47 Notices were served on occupiers of Shops end Stores for infringements of the Food end Drugs Act, 1938, where proper precautions were not being taken against contamination of food, The principal matters dealt with were:- Sanitary Accommodation. Defective sanitary conveniences 10 Without proper water supply 1 Defects in drainage system 3 Choked drains 19 Other defects 41 Provision of washinr; facilities. Hot water soap and towels 1 Refrigerators. Interiors cleansed 2 Want of cleanliness' 19 Insufficient accommodation for storage of refuse 10 Other Defects 2 9 RATS AND MICE (DESTRUCTION) ACT. 1919. Infestation Order. 1945. A Foreman Rat-Catcher and one Assistant are employed in investigating complaints of rat and mouse infestation, the giving of advice to occupiers of infested premises and treatment where such is sought. Treatment of infested premises is given where an occupier is willing to pay the Council's fee Cor this service. During the year, 789 complaints were received in the Department and were investigated. ".Then a complainant's premises were inspected others on both sides were visited to ensure that a local infestation v/as covered. Where treatment by the Council was not requested advice for the destruction of rats or mice was proffered. The number of treatments given where fees were paid was 1317. The estimated number of rats and mice destroyed was 4320 - rats 4200, mice 120 affecting 263 separate premises. The actual number of visits paid by the operatives was 2479 - for treatment 1580 and for advice 899. Methods employed for the destruction of these vermin were the laying of poison baits in safe places, trapping end gassing. The work generally was supervised by the District Sanitary Inspectors. 28. DISEASES OF ANIMALS ACTS. 1894 to 1937. Foot-and-Mouth Disease (Infected Areas Restrictions) Order of 1938. Two outbreaks of Foot-and-Mouth Disease occurring ot Paddington and Chalfont St. Giles respectively were confirmed "by the Ministry of Agriculture and Fisheries. Hendon was declared an Infected Area on each outbreak for the purpose of preventing the spreading of the disease. Movement of animals into an Infccted Area or within an Infected Area was by licence only. 44 licences were issued or countersigned for movement of animals into, within or without the district. Swine Fever Order of 1938. A suspected case of this disease was reported by the Ministry but not confirmed. Notices defining the infected place were sent to the Ministry and persons concerned. HENDON ISOLATION HOSPITAL. The number of patients admitted was 648 as compared with 485 in the previous year. The incidence of diphtheria remained low and admissions of scarlet fever cases fell to 154 as compared with 265 in the previous year. There was, however, an increase in certain other conditions chiefly measles (131 patients being admitted as compared with 11 in 1944) with dysentery and gastro-enteritis, mumps, pneumonia and impetigo and other skin conditions also showing a rising trend. The patients treated included 64 out-district cases, the majority of whom came from the Harrow Urban District, 95 service patients, and 6 from Redhill Hospital. Admission from the Hendon area totalled 481, or 74.5% of the total. As from 1st October, 1945, the beds allocated to the Emergency Medical Services were reduced from 20 to 10, but no patients were admitted during the year. Twelve deaths occurred and 606 patients were discharged, leaving 42 in hospital on 31.12.45. The admissions, deaths and discharges, classified according to the disease notified on admission, are shewn overleaf. (Tentative diagnoses are included under the heading of the suspected disease.) TABLE XVI Notified as In Hospital 1.1.45. Admitted during year. Died during year. Discharged during year. Remaining in Hospital 31.12.45. Diphtheria — 56 1 48 7 Diphtheria "carrier" - 2 - 2 - Scarlet Fever 8 154 - 149 13 Scarlet Fever & Measles - 1 - 1 - Scarlet Fever & Chicken Pox - 1 - 1 - Measles 1 131 2 129 1 Measles &. Acute Appendicitis - 1 - 1 - Measles & Meningitis - 2 - 2 - Measles & Whooping Cough - 3 - 3 - Whooping Cough - 18 - 15 3 Chicken Pox 1 22 - 22 1 Chicken Pox & Infantile eczema - 1 1 — - Mumps - 42 - 40 2 Rubella - 8 - 8 - Erysipelas - 23 1 20 2 Typhoid Fever - 4 - 4 - Paratyphoid Fever - 1 — 1 — Dysentery (incl. gastro-enteritis) 2 58 5 53 2 Marasmus - 1 - 1 — Glandular Fever - 1 - 1 — Infective Hepatitis - 8 — 7 1 Meningitis - 5 - 5 - Poliomyelitis - 5 - 5 - Malaria - 1 - 1 - Pneumonia - 20 1 13 6 Bronchitis — 2 — 2 - Vincent's Angina - 3 - 3 - Quinsy - 5 - 5 - Tonsillitis - 8 - 8 - Ulcerated stomatitis - 1 1 - Furunculosis - 3 - 3 - Otorrhoea - 3 - 3 - Adenitis of neck - 2 - 1 1 Dermatitis - 2 — 2 — Impetigo 2 24 - 25 1 Scabies - 7 - 6 1 Observation - 11 1. 9 1 Infants admitted with mothers for nursing purposes — 5 — 5 — Mother admitted to nurse infant — 1 — 1 — TOTALS 14 646 12 606 42 NUMBER OF CASES TREATED - COMPARISON WITH PREVIOUS TWO YEARS. TABLE XVII Notified as ADMISSIONS. DEATHS, DISCHARGES. 1943 1944 1945 1943 1944 1945 1943 1944 1945 Diphtheria 51 34 56 1 — 1 56 37 48 Scarlet Fever 560 265 154 - 1 - 533 323 149 Erysipelas 18 17 23 - - 1 17 18 20 Measles 49 11 131 - - 2 49 10 129 Whooping Cough 6 40 18 - 2 - 6 38 15 Mumps 8 4 42 - - - 8 4 40 Chicken Pox 3 11 22 - - - 2 11 22 Rubella 6 31 8 - - - 6 31 8 Dysentery & Gastro-enteritis 9 34 58 - - 5 8 34 53 Other conditions 38 33 134 2 1 3 35 38 122 TOTALS 748 485 646 3 4 12 720 544 606 30. FINAL DIAGNOSIS. Of the 618 cases which were discharged or died during 1945, one patient, who was transferred to the Wembley Isolation Hospital after 1 day's treatment, has been excluded from the Table of Pinal Diagnosis and from all subsequent figures in the Report. Pinal diagnosis in respect of the remainder was as follows: - TABLE XVIII Disease Discharged Died Total Diphtheria 7 1 8 Diphtheria "carrier" 1 - 1 Vincent's Angina 4 - 4 Scarlet Fever 144 - 144 Scarlet Fever & Measles 1 - 1 Scarlet Fever & Chicken Pox 1 — 1 Measles 124 2 126 Measles & Whooping Cough 3 - 3 Measles & Appendicitis 1 - 1 Chicken Pox 21 - 21 Rubella 9 - 9 Whooping Cough 14 - 14 Whooping Cough & Appendicitis 1 - 1 Mumps 37 - 37 Erysipelas 14 1 15 Anterior Poliomyelitis 3 - 3 Meningococcal Meningitis 1 - 1 Infective hepatitis 8 - 8 Dysentery (bacillary) 27 - 27 Gastro-enteritis 19 5 24 Malaria 2 - 2 Tonsillitis 50 - 50 Broncho-pneumonia 3 - 3 Broncho-pneumonia & Cerebral tumour - 1 1 Lobar pneumonia 4 - 4 Acute bronchitis 6 1 7 Influenza 4 - 4 Acute Appendicitis 1 - 1 Perforated gastric ulcer 1 - 1 Carcinoma of colon 1 - 1 Diabetic ulcer 1 - 1 Laryngeal spasm 1 - 1 Rhinorrhoea 1 - 1 Epistaxis 1 - 1 Cervical Adenitis 1 - 1 Infantile eczema & septicaemia - 1 1 Dermatitis 11 — 11 Impetigo 25 - 25 Scabies 6 - 6 Septic conditions 8 - 8 Sub-phrenic abscess 1 - 1 Brachial paresis 1 - 1 Psycho-neurosis 2 - 2 Tubercular arthritis of hip 1 - 1 Acute nephritis 2 - 2 Otitis media 3 — 3 Marasmus 5 - 5 Pyrexia of unknown origin 1 - 1 Infants admitted for nursing purposes 5 - 5 Mother admitted to nurse infant 1 — 1 N.A.D. 16 — 16 TOTALS 605 12 617 Concurrent infection on admission. 31. DIPHTHERIA. Of 56 cases sent into Hospital with a diagnosis of diphtheria or suspected diphtheria, the existence of true diphtheria was confirmed in only 8 instances. One of these - an infant of 15 months - suffering from the laryngeal form of the disease, died within an hour of admission after tracheotomy had been performed. The remaining 7 cases recovered and were discharged after average stay in Hospital of 52 days. One of them exhibited symptoms of laryngeal obstruction which subsided without resort to tracheotomy. Comparison of incidence and case mortality rate with that of the previous two years is shown below:- 1943. 1944. 1945. 1. Cases discharged or died, notified as diphtheria or ? diphtheria 57 37 56 2. Cases found to "be suffering from diphtheria on admission (excluding diphtheria "carriers".) 24 9 8 3. Deaths due to diphtheria 1 - 1 4. Case mortality rate (calculated on number of cases of true diphtheria) 4.2% — 12.5% SCARLET FEVER. The type of scarlet fever remained mild during 1945, with decreased incidence as compared with the previous year. 156 cases with a diagnosis of scarlet fever were admitted and 151 discharged, the diagnosis being confirmed in 146 ceses. Avcrrge duration of stay of the completed cases was 33.3 days. Comparison of incidence, etc., with that of the previous two years is shown below:- 1943. 1944. 1945. 1, Cases discharged or died, notified as Scarlet Fever or ? Scarlet Fever 533 324 151 2. Cases found to be suffering from Scarlet Fever on admission (including dual infections) 524 301 146 3. Deaths due to Scarlet Fever - 1 X - 4. Case mortality rate Nil 0.3% Nil. This case died of ruptured aortic aneurism, unconnected with Scarlet Fever, 32. SCARLET FEVER, (cont.) Complications. The following complications were encountered among the 146 cases of scarlet fever completed during 1945:- Adenitis 16 Otitis Media 6 Rhinitis 10 Nephritis 1 Rheumatism 2 Pneumonia 1 Tachycardia 2 Various sepsis 19 MEASLES, 137 cases with a diag osis of measles, or measles in conjunction with acute other conditions, were admitted. One, suffering from measles and/appendicitis, underwent an operation for removal of appendix and was discharged after 20 days' treatment. Three cases with concurrent measles and whooping cough on admission were treated and discharged after rn average stay of 32 days. Two cases sent in with a diagnosis of measles and meningitis proved to be suffering only from measles. Excluding dual infections, the diagnosis of measles was confirmed in 128 of the cases completed, of whom Wo died, "both having extonsive bronchopneumonia on admission. 126 recovered and were discharged after an average stay in hospital of 22.1 days. Complications among measles patients included 16 cases of bronchopneumonia, 1 of lobar pneumonia, 1 cr.su of mastoid disease for which a right radical mastoidectomy was performed, Mid 1 suffering from secondary anaemia requiring blood transfusion. Oxygon tent treatment was used in 11 instances. CHICKEN FOX. 22 cases were received with a diagnosis of Chicken Pox. One patient sent in as a case of chicken pox and infantile eczema proved not to be suffering from chicken pox, but died of infantile eczema and septicaeiiua on the first day after admission. A further case of chicken pox was found in a patient who had been sent in with a diagnosis of iieasles. Of the 23 patients discharged during the year, one was found to be suffering from pemphigus, and another from acute haemorrhagic nephritis. The latter developed chicken pox on the 24th dey of treatment. Average stay of the recovered cases of chicken pox was 22 days. 33. RUBELLA. 8 cases were received with a notification of rubella, the diagnosis "being confirmed in 7 instances, with 2 further cases occurring in patients sent in as "seerlet fever" and "measles". All were discharged during the year after an rverage stay of 11 days. MUMPS. 42 patients were received with a diagnosis of tumps, 40 being discharged during the year and 2 regaining in hospital until January, 1946. In 36 of the 40 completed cases the diagnosis was confirmed, a further case found among those sent in as Scarlet Fever bringing the total to 37. Average stay of these patients was 22,3 days. ERYSIPELAS. 23 cases with a notification of Erysipelas were admitted of which one, a male patient aged 84 years, died. Of the remainder, 20 were discharged during the year, leaving 2 in Hospital on 31.12.45. The diagnosis was confirmed in 15 of the completed cases, the average stay of the recovered 14 being 18.8 days, ANTERIOR POLIOMYELITIS. 5 ca ses were admitted with a notification of this disease. Three of these, in which the diagnosis was confirmed, were transferred, after the infectious period, to the Royrl National Orthopaedic Hospital, Stanmore, for treatment of the residual parelyr-:i Of the remaining two cases, one which was diagnosed as tubercular nrtiir: '.is of hip,was transferred to the Redhill County Hospital after 10 days' treatment. In the 5th case no recognisable malady was observed. TYPHOID & PARATYPHOID FEVER. 4 cases were admitted with a diagaosis of suspected typhoid fever but in each case the diagnosis was unconfirmed. A further patient, sent in from the Harrow Urban District with a diagnosis of Paratyphoid Fever, exhibited on arrival symptoms of acute appendicitis and operative treatment was imxdiately arranged. Appendicoctomy revealed a ruptured appendix abscess and peritonitis ensued. This patient was transferred to the Redhill County Hospital for further treatment after 9 days in the Isolation Hospital. 34. DYSENTERY. 27 cases in which the final diagnosis was bacillary dysentery were treated and discharged during the year after an average stay of 42.4 days. In 25 instances the causal organism was b, Sonnei, the other two "being due to b, Flexner infection, GASTRO-ENTERITIS. 24 cases of gastro-cnteritis in young children were dealt with and five deaths occurred anong these patients. In one of the fatal cases, the immediate cause of death was cardiac failure duo to congenital heart disease. Average stay of recoverod cases was 18,7 days, CONCLUSION. I would again teko this opportunity of recording my appreciation of the whole-hearted support which has "been forthcoming from all members of my staff. Despite the many added responsibilities of the war years and the depletion of staff by mombers being called to the Forces, the Council's Health Services have been maintained end expended, I would also wish to express my indebtedness to the Chairman of the Public Health and Medical Services Committee and all the members of the Council for their unfailing interest and support in all measures likely to benefit the public health, I have the honour to be, Mr, Mayor, Ladies and Gentlemen, Your obedient servant, A. FAIRGRIEVE ADAMSON, Medical Officer of Health, MINISTRY OP EDUCATION. MEDICAL INSPECTION AND TREATMENT RETURNS YEAR ENDED 31ST DECEMBER, 1945. TABLE I MEDICAL INSPECTIONS OP PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. • A. ROUTINE MEDICAL INSPECTIONS. (l) No. of Inspections: Entrants 1696 Second Age Croup 1325 Third Age Group 2722 TOTAL 5743 (2) No. of other Routine Inspections 530 GRAND TOTAL 6273 B. OTHER INSPECTIONS. No. of Special Inspections and Re-inspections. 6071 TABLE II CLASSIFICATION OF THE NUTRITION OF PUPILS INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Number of Pupils Inspected A (Excellent) B (Normal) C (Slightly sub-normal) D (Bad) No. % No. % No. % No. % 6273 1660 26.46 3965 63.21 630 10.04 18 .29 TABLE III GROUP I. - TREATMENT OP MINOR AILMENTS (Excluding uncleanliness) Total Number of Defects treated or under treatment during the year under the Authority's Scheme 4035 GROUP II. - TREATMENT OP DEFECTIVE VISION AND SQUINT. Under Authority's Scheme Errors of Refraction (including squint) 1055 Other defect or disease of the eyes (excluding those recorded in Group I.) 48 Total 1103 No. of pupils for whom spectacles were (a) Prescribed 478. (b) Obtained 446 GROUP III. - TREATMENT OF DEFECTS OF NOSE AND THROAT. Under Authority's Scheme Received operative treatment 24 Received other forms of Treatment 501 Total number treated 525 TABLE IV. DENTAL INSPECTION AND TREATMENT. (1) Number of pupils inspected by the Dentist (a) Routine age groups 5886 (b) Specials 1532 (c) TOTAL (Routine and Specials) 7418 (2) Number found to require treatment 4169 (3) Number actually treated 5453 (4) Attendances made by pupils for treatment 14146 (5) Half-days devoted to:- Inspection 56 Treatment 1775 TOTAL 1831 (6) Fillings:- Permanent Teeth 5111 Temporary Teeth 1386 TOTAL 6497 (7) Extractions:- Permanent Teeth 466 Orthodontic 534 Temporary Teeth 3513 TOTAL 4513 (8) Administrations of general anaesthetics for extractions:- 1810 (9) Other Operations:- Permanent Teeth 2148 Temporary Teeth 616 TOTAL 2764 TABLE V. VERMINOUS CONDITIONS. (l) Average number of visits made during the year by the School Nurses or other authorised persons 16.8 (2) Total number of examinations of pupils in the Schools by School Nurses or other authorised persons 24,437 (3) Number of individual pupils found unclean 747 TABLE VI. BLIND AMD HEAP PUPILS. Number of totally or almost totally blind and deaf pupils who are not at the present time being educated in a Special School. The return should relate to all such pupils including evacuees resident in the Authority's area. 1. At a Maintained Primary or Secondary school 2. At an Institution other than a Special School 3. At no School or Institution Blind Pupils - - — Deaf Pupils - 1 -