HEN 23 Borough of Hendon. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1946 A. FAIRCRIEVE ADAMSON, M.D., D.P.H., Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation Hospital Borough of Hendon. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1946 A. FAIRCRIEVE ADAMSON, M.D., D.P.H., Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation Hospital 2 BOROUGH OF HENDON COUNCIL OF THE BOROUGH, 1946/1947. The Mayor: Alderman W. R. Clemens, J.P., F.C.A. The Deputy Mayor: Alderman A. W. Curton, J.P., M.Inst.B.E. A Idermen: W R. Clemens, J.P., F.C.A. H. G. Potter, J.P., F.S.I. J. J. Copestake, J.P. A. J. Reynolds, J.P., A. W. Curton, J.P., M.Inst.B.E. F. C. Rice. A. A. Naar, M.B.E. G. R. Richardson, J.P. R. A. B. Teare, M.B.E. Councillors: (Mrs.) E. A. Ashman. E. M. D. Jones, F.C.A. A. C. Brooke. H. L. K. Johnson. E. G. Burman. R. J. Knowles, M.M., M.W.M.A. E. J. Cox. L. Lewis. H. W. J. Connell, J.P. S. C. Lewis. C. R. D. Cope. P. Lightfoot. G. C. V. Coppen. G. J. Pryke, F.I.A.C., A.M.I.8.E. (Mrs.) P. D. Davis. J. H. Rodway. .1. L. Freedman, M.A., LL.B. P. G. Rouse. J. Griffiths. L. S. Suggate. E. J. Greenslade. S. R. C. Sumpter, F.B.A.A. W F. Hughes. C. H. Sheill. D. J. James, M.B.E. R. H. Taylor. P. B. Utton, M.P.S. PUBLIC HEALTH AND MEDICAL SERVICES COMMITTEE. Chairman: Alderman R. A. B. Teare, M.B.E. Aldermen: J. J. Copestake, J.P. G. R. Richardson, J.P. Councillors : (Mrs.) E. A. Ashman. H. L. K. Johnson. E. G. Burman. s. C. Lewis. C. R. D. Cope. G. J. Pryke, F.I.A.C., A.M.I.S.E. (Mrs.) P. D. Davis. P. B. Utton, M.P:S. D. J. James, M.B.E. Co-opted Members: Mrs. W. M. Maughan, J.P. Rev. I. Livingstone. Mrs, B, J, Monro, J.P, Rev, R, W, Townsend, A.K,C, 3 ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1946. July, 1947. To the Mayor, Aldermen and Councillors of the Borough of Hendon. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my seventeenth Annual Report on the health of the Borough of Hendon for the year 1946, which in accordance with the instructions contained in Ministry of Health Circular No. 13/47 has been prepared as an interim report. CENERAL HEALTH CONDITIONS VITAL STATISTICS: The Registrar General's estimate of the population of the Borough in mid 1946 was 153,820, as compared with 137,770 for the previous year and 115,682 at the last census in 1931. The number of births increased considerably, 2,651 live births being registered as compared with 2,239 for the previous year, giving a birth rate of 17.23 per thousand population. This rate is, however, comparatively low, compared with the rate for England and Wales which was 19.1 and for the 126 County Boroughs and great towns, 22.2. The number of deaths registered was 1481 as compared with 1,379 for the previous year, giving a death rate of 9.63 per thousand population, the death rate for England and Wales being 11.5 and 12,7 for the 126 County Boroughs and great towns, 4 I am pleased to report that the infantile mortality rate was again very low, being identical with that of the previous year, namely, .29 per thousand live births as compared with 43 for England and Wales, and 46 for the 126 County Boroughs and great towns, including London. As in previous years the largest contributory factors to the deaths of infants under 1 year of age were prematurity and congenital defects. These causes of death may be due to a large variety of factors, involving maternal health, heredity, blood grouping of parents, etc., and it is unlikely that an infantile mortality rate as low as has prevailed during the last two years will be materially reduced excepting in the light of further knowledge. It will be seen, however, in the section headed "Maternity and Child Welfare," that a scheme is in operation for the care of the premature infant. Three women died as a result of child birth, giving a maternal mortality rate of 1.1 per thousand births. The following Table shows the downward trend in the infantile mortality rate since the beginning of the century:— TABLE 1. Year. Death rate of infants unde one year of age per 1,000 live births. 1900 133 1910 80 1920 47 1930 50 1940 54 1941 57 1942 34 1943 39 1944 32 1945 29 1946 29 The following Table shows the causes of death during the year:— 5 TABLE II. CAUSES OF DEATH. Cause. Male. Female. Total. Typhoid and paratyphoid fevers — — — Cerebro-spinal fever — — — Scarlet fever — — — Whooping Cough — — — Diphtheria — — — Tuberculosis of respiratory system 35 28 63 Other forms of Tuberculosis 8 4 12 Syphilitic diseases 5 1 6 Influenza 6 11 17 Measles — 1 1 Acute poliomyelitis and polioencephalitis 2 1 3 Acute infectious encephalitis 1 2 3 Cancer of buccal cavity and oesophagus (M); uterus (F) 8 15 23 Cancer of stomach and duodenum 25 18 43 Cancer of breast — 35 35 Cancer of all other sites 102 84 18,6 Diabetes 2 8 10 Intra-cranial vascular lesions 56 97 153 Heart disease 205 199 404 Other diseases of circulatory system 30 28 58 Bronchitis 42 31 73 Pneumonia 33 31 64 Other respiratory diseases 13 6 19 Ulcer of stomach or duodenum 12 5 17 Diarrhoea under 2 years 3 2 5 Appendicitis 4 2 6 Other digestive diseases 17 21 38 Nephritis 11 18 29 Puerperal and post-abortive sepsis — 1 1 Other maternal causes — 2 2 Premature birth 9 10 19 Congenital malformations, birth injury, infantile disease 25 18 43 Suicide 9 9 18 6 Cause. Male. Female. Total. Road traffic accidents 5 7 12 Other violent causes 9 11 20 All other causes 49 49 98 TOTAL—all causes 726 755 1481 INFECTIOUS DISEASES: The following Table shows the number of notifications of the principal infectious diseases as compared with the previous two years:— TABLE III. CASES OF INFECTIOUS DISEASES OTHER THAN TUBERCULOSIS NOTIFIED DURING 1944, 1945 & 1946. Disease. Total cases notified. Removed to Hospital, 1946. 1944. 1945. 1946. Scarlet Rever 374 180 199 125 Diphtheria 17 20 33 33 Pneumonia 132 129 139 40 Acute Poliomyelitis 2 4 16 15 Measles 123 2013 558 76 Whooping Cough 330 162 367 30 Cerebro Spinal Fever 5 4 8 8 Typhoid or Enteric Fever 1 1 — — As was expected there was a decrease in the incidence of measles, off-set by an increased incidence of whooping cough. It will be seen that 33 cases of diphtheria were notified but in only 8 of these was the diagnosis of diphtheria ultimately confirmed. A note-worthy feature was the increase in the incidence of poliomyelitis (infantile paralysis), which became prevalent throughout the country generally. 16 cases were notified but a further case initially diagnosed as measles ultimately proved to be a case of infantile paralysis, making 7 a total of 17 in all. There was a concurrent increase in the incidence of cerebro-spinal fever, another disease affecting the central nervous system, 8 cases being notified. Infantile paralysis is seasonal in its incidence, occurring generally in late summer and early autumn and then tending to disappear. The scheme for the immunisation of children against diphtheria was actively pursued and Table IV shows the number of children who have so far been immunised. There is a tendency for the effectiveness of immunisation to wane, and evidence exists to suggest that its effectiveness may be largely lost in many instances after a period of 5 years. Fortunately, the immunity can be re-established by one reinforcing injection and a scheme is now in operation by which children entering school at five years of age, who are likely to meet massive infection for the first time, and those attaining ten years of age, are given a re-inforcing injection. It will be seen that by the end of the year 2,551 children had been so treated. 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 1940 70 3 1729 1941 58 1 5868 1942 38 2 11068 1943 31 2 15506 1944 17 — 16970 1945 20 1 19555 1946 33* — 21478 * of these the diagnosis of diphtheria was confirmed in only 8 cases. 8 RE-INFORCING INJECTIONS AGAINST DIPHTHERIA: Prior to 1st January, 1946. During Year, 1946. Total. 849 1702 2551 The supervision of smallpox and typhus fever contacts arriving in this country was continued, 209 smallpox and 64 typhus contacts being kept under supervision; no case of either disease occurred in the district. TUBERCULOSIS: The following Table shows the notifications of tuberculosis during the last, six years:— TABLE V. Notifications. Year. Pulmonary. N on-Pulmonary. Male. Female. Male. Female. 1941 68 90 9 21 1942 141 93 14 27 1943 100 74 19 18 1944 112 96 4 19 1945 101 70 15 15 1946 84 65 14 12 I am indebted to Dr. McCallum, the County Tuberculosis Officer for the following observations:— "The situation as regards tuberculosis in Hendon for the year 1946 cannot be considered quite so optimistically as in the previous year. This is mainly because of the steadily increasing difficulty of obtaining institutional treatment for cases of all types owing to the shortage of usable beds from lack of staff, both nursing and domestic. In addition the death rate is once more nearer the 1944 level. During the year there were in all 75 deaths, giving a rate of 49 per 100,000 as compared with -39 in 1945 and 61 in 1944. Of the total number of deaths 63 were due to pulmonary disease and the remainder to non-pulmonary disease. Male deaths again preponderated and were 43 compared with ,32 in females. Correlating deaths with 9 age groups, there were 43 deaths at ages over '35 years and 132 deaths at ages under .35 years, a tendency which was also noted last year. The total number of registered persons at the end of the year was 1,059, a rate of 688.46 per 100,000 and includes some 60 cases who have removed into the district from other areas. Of the total number of deaths 41 occurred in hospital, sanatorium, or other institutions, while 34 occurred at home. This again emphasises the lack of institutional accommodation, particularly hospital beds, for the nursing of advanced and terminal cases. The burden of their care falls on relatives and the district nurses, whose help is most valuable. The waiting period for admission has risen to at least six months which has lead to the provision of more home treatment during the waiting period, with in many cases most satisfactory results, as from time to time further treatment in sanatorium is found to be unnecessary when the vacancy occurs. The task of treating a patient in bed at home over a period of some months is intensified by the present shortage of housing and segregation of the sputum positive case is often difficult. Tuberculosis is a social disease and good home conditions without overcrowding and a good standard of living are essential factors in limiting its spread, and the ultimate solution of the tuberculosis problem. The present scheme of government allowances goes some way in helping a patient and his family maintain his standard of living while priority in rehousing is of the highest importance, and there should be little need to justify this even at the present time. On the brighter side the scheme for providing home helps is functioning satisfactorily and meets an urgent need, although there are generally fewer available than are required. Relatives will sometimes give up work and be employed as a home help in the patient's house. Both this scheme and the government allowances are administered through the clinic welfare officer who also 10 deals with many difficulties and queries of the tuberculous patient. For those compelled to remain inactive for long periods, or who are not yet fit for full employment, occupational therapy classes are organised and the patient may take up leather work, or make rugs or toys. Creative work of this kind which is suited to the patient's capabilities has great therapeutic value in tuberculosis as in other chronic conditions and has in many cases provided remunerative full time work on completion of treatment. A further step will be the wider provision of workshops and factories for the tuberculous person." SCABIES AND VERMINOUS CONDITIONS: Treatment of these conditions continues to be carried out where necessary at the permanent Health Centres and the Isolation Hospital. In the treatment of scabies every endeavour is made to treat all members of the infected family irrespective of whether they are suffering from the disease at the time of inspection or not. The reason for this is that scabies is a disease of slow development and once it has been introduced into a household, the probabilities are that other apparently non-infected members of the family may be developing the disease. The following table shows the number of cases and contacts dealt with— TABLE VI. Scabies. Vermin. Cases. Contacts. Cases. Adults 277 159 37 Pre-School Children 66 38 5 School Children 180 84 579 Total 52'3 281 621 11 MATERNITY AND CHILD WELFARE The scheme in operation for the care of children under five years of age and for expectant and nursing mothers continues as in previous years and consists of health education in the home by the Health Visitors and medical supervision of the mothers and children at the various Health Centres. INFANT WELFARE: During the year the Health Visitors paid the following number of visits:— To expectant mothers:— First Visits 1063 Total Visits 1556 To Children under 1 year:— First Visits 2166 Total Visits 6312 To Children between ages of 1 and 5 years:— Total Visits 5228 TOTAL 13096 Infant Welfare Sessions continue to be held at the five permanent Health Centres but for the convenience of the mothers accompanying the children to these sessions, a number of subsidiary Centres are in use. It will be seen from Table VII that the number of attendances by children increased from 55,282 in 1945 to 61,203, an increase of approximately 6,000. This necessitated the establishment of additional sessions, a process which could with advantage be further extended when more medical and health visiting staff are available. The Child Welfare Services are closely integrated with the School Health Services being under the administrative control of the same Committee and the same Officers operating the Services throughout, The various forms 12 of specialised treatment which have been provided under the School Health Services scheme are also available for children under five years of age. It should be noted that the Council, having considered the implications of the Education Act, 1944, by which these specialised forms of treatment were made free to school children, decided that they should also be free to children within the Maternity and Child Welfare scheme. TABLE VII. No. of Maternity and Child Welfare sessions held. No. of new members admitted. Total No. of attendances. 1939 911 1923 53009 1940 952 2276 50763 1941 909 2074 48245 1942 925 2316 49960 1943 934 2298 54962 1944 1016 2252 49334 1945 1033 2442 55282 1946 1168 2630 61203 MATERNAL CARE: Ante-natal clinics are held in the five permanent Health Centres, each session being attended by one of the Departmental Medical Officers, a Health Visitor and the Midwife who will ultimately be attending the patient at her confinement. By arrangement with Middlesex County Council antenatal care of the mothers who are to be admitted to the Redhill County Hospital from this area for their confinements is also undertaken at the Health Centres. It will be seen from Table VIII that there has been an increasing number of attendances at the ante-natal sessions, necessitating the provision of further sessions to overtake the work, 13 TABLE VIII. 1942. 1943. 1944. 1945. 1946. No. of Ante-natal Sessions held 431 503 517 509 626 No. of Expectant Mothers seen 1619 1597 1498 1702 1926 No. of attendances 7464 8721 8944 9109 11574 Average No. seen per session 17 17 17 18 18 Average No. of attendances made by each patient 4.61 5.46 5.97 5,35 6.01 PROVISION FOR CONFINEMENT, DOMICILIARY: Confinements are undertaken in the home by the Council Midwifery staff and by arrangement with the; Midwives employed by the Watling District Nursing Association. The increasing number of mothers attending the ante-natal clinics was, of course, reflected in due course in the midwifery service. To meet the increased demand the Council approved the increase of the establishment of Midwives from 8 to 9 and, in the following year, to 10. The difficulties experienced in extending the Midwifery Service were largely concerned with finding suitable accommodation for the additional midwives and in this, the Housing Committee and their Officers have been very helpful. Transport of Midwives, particularly as gas and air analgesia is in more general use, necessitating the transport of somewhat cumbersome apparatus, has also presented many problems. These have been solved in a variety of ways; two of the Midwives providing their own cars and one car being provided by the Council for a Midwife, but the greatest provision has been made by the Transport Section of the Borough Engineer's Department, whose timely and continuous help greatly assisted in meeting the difficulties attendant on the increase which has taken place in the birth rate. 14 HOME HELPS: The scheme for the provision of Home Helps, which has been operating successfully for a number of years, has been of paramount importance in the Domiciliary Midwifery Service enabling the mother to have complete rest over the period of the confinement. Normally, the Home Help is allocated for a period of fourteen days, which is subject to extension if necessary. Twenty Home Helps were employed during last year, sixteen full-time and four on a part-time basis, and assistance was given to 357 mothers. It will be appreciated that without this help many of these mothers would inevitably have had to seek hospital provision for their confinements with a consequent aggravation of the present hospital situation. No service operated by this Department earns so many expressions of appreciation as does the Home Help scheme. HOSPITAL CONFINEMENTS: The provision for hospital confinement is a duty of the hospital Authority, namely, the Middlesex County Council, and for this area provision is made at Redhill County Hospital and the Annexe at Bushey. All hospitals in the County area dealing with midwifery have been working under great pressure and accordingly admission could only be arranged for first confinements, for medical reasons and in cases in which the housing conditions were entirely unsuitable. The hospital provision was supplemented by the Borough Council by arrangements being made with Queen Charlotte's and Ashridge Emergency Medical Service Hospital. A scheme is also in operation, under the segis of the London County Council, by which mothers can be evacuated to Hostels which had been established during the war but which have been continued to relieve the general shortage of maternity beds. The following Table shows the comparative figures for domiciliary, hospital and nursing home confinements:— 15 TABLE IX. 1945. 1946. Domiciliary:— Attended by Municipal Midwives 356 490 Attended by Watling District Nursing Association 138 206 Others 90 584 124 820 Hospitals:— Redhill and Bushey 790 831 Queen Charlotte's 18 22 Ashridge 49 15 Evacuation 19 50 Other Hospitals (private arrangements) 307 1183 233 1151 Nursing Homes:— Hendon Nursing Homes 158 172 Nursing Homes outside the area 326 484 487 659 PREMATURE INFANTS: The scheme established for the care of premature infants which is briefly as follows continues to work smoothly, prematurity being regarded as existing in any baby whose birth weight is 5½ lbs. or less. The Scheme provides for:— The Premature Baby Outfit, on loan, containing:— Electric Blanket. Stone Hot Water Bottle. Mucous Catheter. Feeding Bottle. 1 Tin of Milk. 16 The services of a consulting pediatrician and hospital provision at the Central Middlesex Hospital when in the opinion of the consultant the removal of the child to Hospital is indicated. The services of a Home Help. CHILD LIFE PROTECTION: The group of children for whom the Council have responsibility are:— (1) Children maintained for reward and dealt with under Part VII of the Public Health Act, 19.36. (2) Children dealt with under Section VII, Adoption of Children (Regulations) Act, 1939. All the Health Visitors are nominated as Child Life Protection Visitors, each Health Visitor being responsible for the care of the foster children in her area. The scheme operates under the general supervision of one of the Departmental Medical Officers who investigates and reports upon each new case before submission to the Council, and also scrutinises the Health Visitor's case records and visits in every instance in which further investigation would appear to be indicated. 22 foster-mothers gave notice of having in their care 36 children; one foster child died during the year. 58 persons gave notice of their intention to adopt 59 children. Observations should here be made on a Report of the Care of Children Committee (Curtis Report) which was appointed in March, 1945, by the Secretary of State for the Home Department, the Minister of Health and the Minister of Education jointly, with the following terms of reference:— "To inquire into existing methods of providing for children who from loss of parents or from any cause whatever are deprived of a normal home life with their own parents or relatives; and to consider what further measures should be taken to ensure that these children are brought up under conditions best calculated to compensate them for the lack of parental care." 17 The Committee made an exhaustive enquiry into all aspects of this very varied subject and made many recommendations for the improvement in the care of children, amongst the more important of these being:— (1) (a) That an existing or separate Department of State should be responsible for administering and co-ordinating of measures taken to safeguard the well-being of the homeless child. It is recommended that Local Authorities (County Councils and County Boroughs) either alone or in combination should appoint a Children's Committee with power to submit estimates direct to the Council. (b) That the Committee should appoint a Children's Officer responsible to them for the care of all homeless children under their control. (2) That the private arrangements now made directly between the parent of the child and the foster mother be brought under the full control of the Children's Committee and the Children's Officer. This would necessitate:— (a) an approved list of foster mothers. (b) the mother to consult the Children's Officer before placement and so place the child only with a foster mother on the approved list. (c) references of the foster mothers being obtained from some responsible persons. (3) There is much evidence to show that the uncertainty of payments to foster mothers by the parent, guardian or relative tells against the continuance of a happy home for the child. The Report very strongly recommends that the "Birmingham Scheme" whereby the Local Authority guarantees payments to approved foster parents and recover the payments in whole or in part from the responsible parent or guardian, should be adopted by Local Authorities, 18 (4) Favourable consideration should be given by Local Authorities to the method of placing children in a home by arrangements being made with a woman who has a home but must work and maintain herself, by which she takes a number of children and is paid a living wage. The fact that the children would be brought up in the woman's own home would have considerable advantage over the present arrangements of "scattered homes." This method is particularly suitable for large families of brothers and sisters. (5) A considerable number of children are fostered without any notification to the Local Authority concerned. Suitable publicity might therefore be given to the legal requirements in such circumstances. (6) Children found by a Juvenile Court to be in need of care and protection should be accepted by the Local Authority without the option of refusal. There is little doubt that the recommendations of the Curtis Committee when carried out, either in whole or in part, will add greatly to the happiness of children deprived of a normal home life. It is to be hoped, however, that a method will be devised for utilising the wealth of knowledge of particular cases already possessed by local Officers dealing with this subject. EXERCISES FOR EXPECTANT MOTHERS: The class for expectant mothers was continued under the guidance of a trained physiotherapist. The purpose of the exercises is, briefly, to make child-bearing easier. It has been difficult to decide by a study of the duration of the various stages of labour or by other criteria just how far this is achieved, but there is no doubt whatever of the enthusiasm of the women who attend and the reduction, particularly in primipara, of their natural apprehension, and in this connection the following brief report from the physiotherapist is illuminating:— 19 "The Ante-Natal Classes have been held every Wednesday throughout the year 1946, except Victory Day and Christmas Day. There have been 83 new patients and 545 attendances. Many of the patients come a long distance but in spite of bad weather the majority have put in 14 to 16 attendances. The mothers enjoy the classes and say they feel much better for them. From letters received and official reports the patients do not fear their confinement and therefore are able to co-operate with the Doctor or Midwife with beneficial results both for the mother and baby." This service is still experimental to some extent but 1 am now of opinion that it serves a useful purpose and could with advantage be extended to selected post-natal mothers in whom the tone of the abdominal muscles has been markedly lowered by successive pregnancies. PSYCHOLOGICAL: The provision of psychological treatment for children under five years of age was continued, the children being referred by the Departmental Medical Officers from the Child Welfare Centres. The following report from the Psychotherapist in charge will be of interest. In addition to this more preventive type of treatment, cases in which a more deep-seated neurosis has developed are referred to the Tavistock Clinic for treatment:— "The object of this clinic is to help mothers with the handling of pre-school children with behaviour problems and emotional disturbances. During the year 1946, an average of five mothers was seen every Thursday afternoon. At least 50% of these cases were "feeding problems," that is to say, children who appear to have no appetite at all, refuse all attempts to feed them and either do not gain or actually lose weight. The remaining 50% include chiefly nocturnal enuresis cases, children with temper tantrums and those having difficulty with their toilet training. 20 Comparing this with 1945, I find that there has been an increase in enuresis cases, and this is very probably due to such environmental causes as the housing problem, and the return of fathers from abroad (often strangers to their children who have either never seen them or who were too young to remember them). In the latter case, the matter can generally be dealt with very satisfactorily and parents are as a rule very glad to be able to discuss the difficulties and strangeness of these longed for—but often unexpectedly difficult—family reunions. The housing problem presents something rather more difficult to tackle. However, one has at any rate been able to help the mother cope with the worries of overcrowding, and to give her some practical advice on how to counteract as far as possible the harm which this situation may have on a normal, lively, healthy child. The mothers have been extremely co-operative and have shown a lively interest in their children's mental development, and an enthusiasm to learn; and the results have been gratifying. In a very few cases some playtherapy was necessary, but the great majority of mothers have finally been able to handle their children's problems without the children having to have any treatment whatsoever. The number of interviews with each mother naturally varies very considerably; some mothers will only need three or four visits before their own anxieties (the usual cause of the child's emotional disturbance) begin to be relieved and, as a consequence, she is able to cope ably with her child's difficulties. Other mothers, however, may need regular visits for some months. This depends entirely on the psychological make-up of the mother. For example, the more obsessional type of mother, though often the most intelligent, may be the most difficult to help. To my mind, one of the most important things about this work is that it is prophylactic. I think that by tackling these behaviour problems in their early stages while the children are under five, we are preventing, in a 21 great measure, the need for perhaps lengthy and deep psychological treatment later on." DAY NURSERIES: The provision of Day Nurseries on the previous scale was continued and at the end of the year all the existing eight Day Nurseries were still in operation. The public demand for the service has steadily increased, particularly latterly, when there has been a drive by the government for the return of women to industry. The Day Nurseries have been kept busy and each has a waiting list. Each Nursery has been approved as a training school for Student Nurses, who can take the National Nursery Nurses' Diploma Examination at the end of two years. This training is run in conjunction with the Hendon Technical College, where the Students attend for lectures. The health of the children has been good, infectious disease has been much less than was anticipated and the common cold, with subsequent catarrh has been the most outstanding cause of illness. Two cases of infantile paralysis, one in a member of the Staff and one in a child in widely separated nurseries occurred, fortunately there were no further cases. Four of the Departmental Medical Officers undertake the medical supervision of the children in attendance each having two Nurseries allocated to her for this purpose. The medical care consists of periodical examinations, immunisation against diphtheria and the diagnosis of any doubtful case of infectious disease. In this connection, and so that the incidence of infectious disease may be reduced to as low a level as possible, each new entrant to the Nurseries is examined at one of the Health Centres before admission. The co-ordination of the staffing and the general conduct of the Nurseries is the responsibility of one of the Departmental Medical Officers. The following Table shows the position and accommodation at each Nursery:— 22 TABLE X. 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, ,30/ 3/42 20 ,30 50 Childs Hill, N.W. 2 Hyde School, 11/ 5/42 45 45 Hendon, N.W. 9 York Park, West 31/ 8/42 30 30 60 Hendon, N.W. 9 Claremont Road, 3/12/42 20 30 50 Cricklewood, N.W. 2 Approach Road, 30/ 4/43 12 25 37 Edgware Hyde Cottage, 21/ 2/44 20 45 65 Hendon, N.W. 9 Dole Street, 20/ 3/44 27 28 55 Mill Hill, N.W. 7 VOLUNTARY WORKERS: Before closing this brief Report on the Maternity and Child Welfare Services 1 should like to take the opportunity of thanking all the Voluntary Workers who attended so assiduously at the Child Welfare Sessions and whose work continues to be greatly appreciated by the mothers and by the members of the staff. SCHOOL HEALTH SERVICES. The scheme by which these Services are administered by the Divisional Executive as an Excepted Authority continues to work smoothly. The School Health Services are closely integrated with the Child Welfare Services, being under the administrative control of the same Committee and operated by the same Officers throughout. 23 Each school is based on one of the five permanent Health Centres, the Medical Officer of the Centre being responsible for periodic medical examinations in the schools and special examinations in the schools and at the Health Centres. Every endeavour is made to elicit the co-operation of the teachers and I am happy to say that this is without exception gladly forthcoming. In fact, the Borough pjducation Officer and his administrative and teaching staff form a valuable adjunct to these Services. The following table gives the present allocation of schools and specialised services to the various Health Centres:— TABLE XI. HEALTH CENTRES. School Health and Maternity and Child Welfare Services. Health Centre. Weekly Sessions. Schools. Central Hendon Minior Ailment 6 Hendon County Dental 11 Hendon Technical Ophthalmic 2 St. Mary's C.E. Orthoptic 4 St. Mary's B.C. Orthopaedic 4 Sunnyfields Speech 2 Bell Lane Ear, Nose & Throat 2 Henrietta Barnett Child Welfare 3 Ante-natal 2 Ante-natal 1 Exercises Diphtheria Immunisation, as necessary. Subsidiary Centre Holders Hill Child Welfare 1 Watling Minor Ailment 6 Annunciation Dental 11 Barnfield Ophthalmic 1 Burnt Oak Orthopaedic 3 Goldbeaters Speech 2 The Meads Child Welfare 3 Woodcroft Ante-natal 3 Orange Hill Diphtheria Immunisation, as necessary. St. James' R.C. 24 Health Centre. Weekly Sessions. Schools. Subsidiary Centre Edgware Child Welfare 1 Mill Hill Minor Ailment 6 Broadfields Dental 11 Deansbrook Orthopaedic 1 Dollis Child Welfare 4 Edgware Ante-natal 3 Frith Manor Psychological 1 St. Paul's C.E. Diphtheria Immunisation, as necessary. St. Vincent's E.C. Copthall County Subsidiary Centres Edgware Child Welfare 1 Broadfields Child Welfare 2 Frith Manor Child Welfare 1 Childs Hill Minor Ailment 6 All Saints' C.E. Dental 11 Childs Hill Speech 2 Clit'terhouse Child Welfare 4 Garden Suburb Ante-natal 3 St. Agnes' E.C. Diphtheria Immunisation, as necessary. Wessex Gardens Subsidiary Centre Temple Fortune Child Welfare 3 West Hen don Minor Ailment 6 Algernon Road Dental 11 Colindale Child Welfare 2 Hyde Ante-natal 3 St. John's C.E. Diphtheria Immunisation, as necessary. Brent Modern Subsidiary Centre Colindale Child Welfare 1 It will be seen from Table XI that a variety of specialised forms of treatment has been provided. These have been gradually evolved to meet the demand which follows particular defects being discovered either at periodic or special examinations. In addition to these specialised services provided at the Health Centres, the following forms of treatment are provided by arrangement with outside Authorities— 25 (a) With the Royal National Orthpoæic Hospital, Stanmore, for the in-patient treatment of orthopedic 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. MEDICAL INSPECTIONS: The inspections carried out in the schools of the Borough consisted of:— 1. Periodic Medical Inspections:— Entrants—all children admitted to school for the first time during the year. Intermediates—all children of approximately 8 years of age. Children of 12 years of age. Leavers—during the last term before leaving school. 2. The special inspection of children referred by the Head Teachers, School Nurses, School Attendance Officers or parents. 3. Annual inspection of physically and mentally defective children. 4. The periodical re-inspection of children whose general condition was below normal. 5. The annual inspection of children attending Secondary Schools. 6. The inspection of children for employment certificates and their annual re-inspection. GENERAL CONDITION OF PUPILS: It will be seen from the following Table that 7,670 pupils have been examined at periodic examinations, and that the standard of nutrition was almost identical with that of the 26 previous year. The pupils examined were a cross-section of the school population so that the findings can be regarded as significant. TABLE XII. Classification of the Nutrition of Pupils inspected during the years 1945 and 1946 in the Routine Age Croups. Number of Pupils Inspected. A. (Excellent). B. (Normal). C. (Slightly sub-normal). D. (Bad). No. % No. % No. % No. % 1945. 6273 1660 26.46 3965 63.21 630 10.04 18 .29 1946. 7670 1'886 24.59 4964 64.72 794 10.35 26 .34 The schemes for the provision of milk and meals in schools have in my opinion contributed very largely to the maintenance of nutritional standards. All children are now in receipt of at least one-third of a pint of milk daily, which can be increased on medical recommendations, and 6,584 children were in receipt of meals at the end of the year. When a dietary is restricted because of economic or other factors, first-class (animal) proteins, a sufficiency of which is essential to optimum development, is likely to suffer the first and greatest reduction. In view of this, and despite the satisfactory nutritional standard prevailing, it behoves those concerned with child health to maintain a careful watch over the general condition and nutritional standards of the children for whom they are responsible. OPHTHALMIC TREATMENT: The eye-sight of each child is examined at periodic medical inspections and those suffering from any defect, however slight, are referred for further examination and treatment to the Ophthalmic Surgeon. If, as a result of his examination, glasses are considered necessary these can be obtained free of charge under the Council's scheme, which 27 provides for the attendance of an optician at each session, who makes and fits the glasses in accordance with the prescription of the Ophthalmic Surgeon. A certain number requiring operative treatment, particularly cases of severe degrees of squint, are encountered each year, and these are referred to the Royal Westminster Ophthalmic Hospital, where your Ophthalmic Surgeon is a member of the Honorary Staff. As an ancillary to the ophthalmic service, an orthoptic scheme has been in operation since 19136. This scheme was first introduced because of the evidence which had accumulated that many children, particularly those suffering from squint, might, by operation or otherwise, achieve a perfect aesthetic result, but had not in fact at the same time achieved binocular vision as the defective eye had not played its proper part for a protracted period, and had thus become functionally inadequate. There are other visual defects for which orthoptic treatment is of value but its main usefulness is in the treatment of squint and for its encouragement of the defective eye to assume its proper function. AURAL CLINIC: This Clinic was established in 1945 to provide treatment for affections of the ear, nose and throat discovered amongst children, particularly those of school age, and also so that expert guidance might be obtained on the many cases referred for operative treatment of tonsils and adenoids. As the Clinic is a comparatively recent development, it has not so far been reported upon fully. It has, however, now been established sufficiently long to permit of an assessment of its value, and I am indebted to Dr. F. P. M. Clarke, who is in charge of the Clinic, for the following report:— "A new clinic in connection with the school medical service for the treatment of diseases of the ear, nose and throat was established for Hendon Borough children in January, 1945. The scheme of the clinic embraces the examination and treatment of affections of the ear, nose and throat, as far as is possible in an out-patient clinic, for all school and pre-school children within the Borough. 28 The inclusion of the pre-school age group, including those from the nurseries and maternity and child welfare centres is very important and the results obtained justify and strongly commend this arrangement. Systematic attention to the pre-school age groups yields a return in terms of lower incidence of certain defects at the school entrant age, which compares favourably with the percentage of corrections subsequently attained. The organisation of the scheme of the clinic consists of a Central Clinic at the Town Hall clinic premises where one regular session per week is held (with occasional supplementary sessions when the numbers on the waiting list require them). This clinic is fully equipped for the most up-to-date recognised methods in diagnosis and treatment of ear, nose and throat diseases in children as far as out-patient treatment can be carried out. All children found with any affections of the ear, nose and throat during school inspections, minor ailment clinics, pre-school clinics, nurseries, etc., are referred here in the first instance for detailed examination and prescribed treatment by the visiting surgeon. Supplementary treatment clinics have been established at the permanent Health Centres at Watling, West Hendon, Garth Road and Hartley Avenue. These are also equipped so as to enable health visiting staff to carry out certain of the treatments advised. All those cases which require special forms of treatment are necessarily retained for this purpose at the Central Clinic, Town Hall. These treatments require particular apparatus and technique, drugs, etc., and are carried out by the surgeon and the sister in charge of the clinic who has special knowledge and training in this work. This allocation of 'treatments' to the various local Health Centres greatly facilitates the regular attendance of the patients and consequently more efficient results. It saves a considerable loss of school time, and expense in travelling. At regular intervals during the course of treatment, the patients are referred back to the surgeon at the chief 29 Centre for further examination, observation as to progress, or modification of treatment as may be indicated. One regular session a week is held at the Central Clinic attended by the visiting surgeon and, on an average, one supplementary session a month is added to cope with the numbers referred for examination. Treatments prescribed after examination, except those retained for special treatment at the Central Clinic, are carried out at the various 'treatment centres' during two sessions per week. In the first year (1945), 591 new cases were seen and in the second year (1946), 733. Of the 591 new cases in 1945, 64 were suffering from affections of the ear, and of the 733 new cases in 1946, there were only 58 cases of ear affections. These figures shew an appreciable reduction in 1946 in the relative proportion of ear conditions to the totals. Particular attention is paid to the treatment of acute ear discharge (otorrhcea). It is vitally important to prevent these acute cases from becoming chronic when successful treatment is much more difficult and the hearing is usually seriously affected. In the case of acute ear discharge, it is insisted wherever possible, that the child attend the clinic for special treatment. It has been found that 10% Albucid or Penicillin combined with 'suction' is the most rapid and efficient form of treatment. The old practice of giving the parent 'ear drops' to instill in the child's ear daily, is rarely successful. I wish here to emphasise the importance of 'suction.' Its principle is to keep the opening in the ear drum patent, thus allowing the middle ear to discharge freely and to relieve stasis. When the external and middle ear are emptied by suction, a vacuum is produced which brings forward any pus that is posterior to the middle ear. In this way the pus has little chance of becoming stagnant in the ear and its various tracts. It is also valuable in efficiently filling the middle ear with the antiseptic medium used. 30 For cases of chronic otorrhœa (chronic 'running' ears), which are now very few, zinc ionisation is regularly employed with satisfactory results. The greater proportion of children seen were those with affections of the nose and throat. Nasal catarrh, rhinitis and 'mouth breathing' form the largest number of these cases. Sinus infection was also found in a relatively considerable number. All these cases were treated at the clinics during the year. Diastolisation, a French method of intra nasal massage, has been used here extensively for nasal catarrh, rhinitis, mouth breathing, deafness, etc., and the results have been remarkably good. For the 'sinus' Proetz 'nasal displacement' method is employed; this is a comparatively recent and valuable method of diagnosing and treating sinus infections. A conservative line has been adopted in regard to the operation for the removal of tonsils. I have found that a very large number of children who have had tonsils removed for one reason or another, have derived little or no benefit from the operation and indeed, frequently, the condition sought to be improved by the operation is aggravated. 'Enlarged tonsils' is not a local disease, per se, just confined to the tonsils, but usually the sequel to a descending infection from the nasal accessory sinuses. The tonsils function as a protective trap to prevent free spread of infection into the general system. They also serve in children, the purpose of producing an autogenous immunity and resistance to bacteriological infections. The complete extirpation of organs of such importance is a serious consideration, and the removal of tonsils alone, without adequate attention to the factors involved in the production of this condition, is meaningless and unscientific. A very thorough examination is made of each case of 'suspected' tonsils and adenoids, both throat and nose, and a careful account is taken of any present or previous throat or nasal defect. Mere enlargement alone, unless so gross as to cause obstruction, is not taken as an 31 tion for operation. A definite pathological 'History' and condition must be present, which is not likely to yield to conservative treatment, before operation is advised. In the conservative treatment of unhealthy tonsils, Peters 'Tonsil Suction' method is employed in the great majority of cases with a high proportion of satisfactory results. I must stress here, however, the importance of treating at the same time any nasal disease that is present. It is in the recognition of the presence of intercurrent nasal disease, with diseased tonsils and the correlated treatment of each, that success depends. The regular attendance of the patients for the various treatments during the year has been very good. A certain number fail to attend as required, but in our experience the attendance at Hendon is very satisfactory. The administrative and nursing staffs have been exceedingly helpful and it is, of course, upon the close co-operation of all concerned that the success of such a clinic as this depends." ORTHOPAEDIC SCHEME: This Scheme is concerned with the prevention of crippling defects and their treatment. Many of the defects found by the Medical Officers at the periodical medical inspections are of a minor character, such as round shoulders, the result of slack musculature, and faulty posture, and the work in the schools of the physical training instructors is of particular value in counteracting the defects at an early stage. Their work has been supplemented by the appointment of a special teacher for remedial exercises, who works in close co-operation with the Medical Officers, the Orthopaedic Surgeon and the Physiotherapist. Children suffering from more serious orthopaedic defects are referred to the Orthopaedic Surgeon who holds a session each month at the Health Centres at Central Ilendon and at Watling. In addition, a trained Physiotherapist is in attendance at the present time for eight sessions each week. She carries out the treatment prescribed by the Surgeon, who sees the children periodically so 32 that lie may be satisfied as to what progress they are making. Children suffering from still more serious defects and requiring operative treatment are admitted to the Royal National Orthopedic Hospital Annexe, at Stanmore. I am indebted to Mr. David Trevor, M.S., F.R.C.S., your Orthopaedic Surgeon, for the following notes on this service:— "The Orthopaedic Clinics for School Children have been held throughout the year on the 2nd Monday of the month at the Health Centre, The Burroughs, and on the 4th Monday of the month at Cressingham Road, Watling Estate; these clinics have been well attended. The work done at the Clinic consists largely of diagnosis of early orthopaedic conditions and their treatment. Many of these conditions have been cured by simple means, thereby avoiding prolonged treatment and the possibility of operation which would be necessary if the condition had been allowed to progress before the child was referred to the Orthopaedic Clinic by the School Medical Officers. Children with more advanced conditions and disabilities have received operative treatment when necessary at the Orthopaedic Hospital at Stanmore, and arrangements were made for their subsequent treatment at the Clinics immediately upon their discharge from the Orthopaedic Hospital, thereby losing no time in the all important post-operative care. This close liaison between the Orthopaedic Clinic and the Hospital at Stanmore is beneficial for the welfare of school children. This was well exemplified last summer, when several children were admitted from the Borough of Hendon to the Orthopaedic Hospital suffering from infantile paralysis. After their in-patient treatment at the Hospital was concluded they continued the very important physiotherapy treatment at the 'Clinics under the supervision of the Orthopaedic Surgeon and the watchful eye of Physiotherapist, Mrs. Yorke. These children made remarkable recoveries, which in no small part was due to the very excellent physiotherapy treatment provided at these Clinics." 33 Physical Education. I am indebted to the Organisers of Physical Education for the following report:— Physical Education, like all other branches of Education, suffered severely during the war years, but in spite of the many disrupting causes, changes of staff through war service, overcrowding in schools, air raids and the commandeering of playing fields, a fair standard of work has been maintained. Unfortunately, it is apparent that facilities for Physical Education in the Secondary Modern Schools will not improve for some time to come, for as a result of the raising of the school leaving age, the present inadequate playground accommodation is to be further limited by the building of huts for classrooms, and school halls will continue to be used as classrooms and dining rooms. During the year, the Essex Agility Apparatus was introduced into some of the Primary Schools. This is proving to be most valuable, for as well as satisfying the children's natural desire for climbing and balancing, it is fostering muscular development, courage and body control. This year a Remedial Gymnast was appointed to visit the schools in the Borough to undertake the treatment of minor postural defects in the children. This method of medical treatment is proving satisfactory, as well as saving the time previously spent by the children travelling to and from the clinic. Organised Games and Playing Fields. Under the present difficult conditions existing in the halls and playgrounds, it is vital that the maximum use should be made of the playing fields, and it is hoped, therefore, that the Cressingham Road Playing Field, which has now been derequisitioned, will be available for use for organised games next year. This and other open spaces were requisitioned during the war, and in 34 quence, certain private sports clubs have responded to requests to co-operate by permitting some schools to enjoy the privilege of using their playing fields. This has added materially to the standard of play in their games, and a greater interest is shown, not only by the teams, but by all the children. Through the co-operation of the Borough Surveyor and his staff, greater facilities have been given for organised games for school children on the Council's Playing Fields. Nevertheless, there is a lack of adequate changing accommodation and washing facilities for large numbers of children in these playing fields, but it is hoped that these conditions will be gradually improved. Swimming. The swimming season proved to be very disappointing this year, owing to the poor weather. As the Borough possesses two open air baths and no indoor baths, the season is short and the attendance for swimming instruction is very irregular during inclement weather. The need for at least one indoor bath is very great, and it is hoped that it will not be very long before one is built. If this is impracticable, it may be that one of the open air baths could be adapted by being enclosed by moveable side screens and roof, as is now being considered in another part of the County. Training Courses and Demonstrations. Early in the year, a training course for teachers in Primary Schools in the use of small apparatus in the Physical Training lesson was held, and was well attended. Demonstrations of activities on the Essex Agility Apparatus were given by classes of children to Head Teachers and all assistant teachers in Hendon. Demonstrations were also given to assist teachers in the use of heavy portable apparatus in Senior and Secondary Modern Schools. 35 Local Youth Committee. The Organisers are members of the Local Youth Committee and serve on various sub-committees and in close collaboration with the Youth Officer, they have promoted courses for leaders in Physical Training, Ballroom Dancing, Netball and Football. In addition, special classes have been arranged in Keep-Pit, Swimming and Athletics. TREATMENT OP DEFECTIVE SPEECH: The sessions devoted to speech therapy continue to be well attended and the results achieved are highly satisfactory when it is considered that in the majority of cases attendance must be spread over a long period and that the ultimate cure of the condition depends largely upon the co-operation given by the child being treated. In this connection sympathetic teachers and parents are of the greatest value and the teachers especially have been throughout most helpful and interested. The following report has been prepared by the Council's speech therapist:— "Speech Therapy sessions are held in the Hendon, Childs Hill and Watling Health Centres, and in October a temporary centre was held in Garden Suburb Infant School where there were very many speech defectives, particularly from the nearby Waifs and Strays Home. These Centres have been visited regularly by speech therapy students, health workers, student teachers and nursery nurses. There are over 200 children with speech disorders in the Borough. Each child has been seen in school by the therapist and the work has been planned so that cases in greatest need of help attended the Centres first, with preference given to juniors and seniors who have not outgrown the difficulty, and to stammerers in particular. In time, it is hoped that only infants will need treatment. The later treatment commences, the more difficult it is to effect a cure. 36 During the year, the following children received treatment:— Hendon. Childs Hill. Watling. Stammerers 17 10 24 Cleft Palates 4 5 1 Speech defects 11 27 15 32 42 40 = 114 Discharged: Speech corrected, but case followed up for year 7 22 15= 44 Left (i.e., School, District or suspended) 6 4 3 = 13 These children were recommended by the teachers, and seen by the speech therapist in school. They were then referred for a medical and dental examination, and their parents interviewed by the therapist. They attend once or twice weekly and attendance is usually very good. The homes are visited by the therapist to discuss the progress noticed, to see, if possible, other members of the family, and to gain a better picture of the child's environment. 46 Home Visits were paid this year. Co-operation with the schools is essential, and 44 school visits were paid to discuss the speech and behaviour notice in class. The teachers often give valuable information. A lecture on the 'Work in the Speech Therapy Centre' was given to the Head Teachers on May 1st. Preventive work is also undertaken: many young children lose their defects without attending for treatment if they are receiving the right handling at home, and many parents are coming to the Centres for advice. 37 Treatment was also given to three boys at Stanmore Hospital, and their teachers continue the exercises." DENTAL SERVICES: I am indebted to the Divisional Dental Officer for the following report on the Dental Services:— "The staff consisted of five full time dental officers, five dental attendants and five dental clinic clerks., a unit of a dental officer, attendant and clerk operating at each of the five health centres, each unit devoting approximately two sessions per week to the Maternity and Child Welfare services, one session per week to orthodontic treatment, one to extractions under general anaesthetics and seven sessions to the routine dental inspection and conservative treatment for the school health service. In the report for 1945 reference was made to the problem of accommodation, the five existing dental surgeries being occupied. Plans were therefore made for the adaptation of the Central Hendon Health Centre to provide an additional dental surgery and a mechanical laboratory, and also subsequently for the extension of the Mill Hill Health Centre to provide a second dental surgery there. Approval was obtained in 1946 for the appointment of a part time orthodontic surgeon and a dental technician, and the appointment of a sixth full time dental officer and attendant was included in the estimates for 1947, but unfortunately, the building adaptations were not commenced by the end of the year and no early solution of the problem of accommodation could be envisaged, and as a consequence some restriction in the treatment of orthodontic defects became nececssary in order to maintain routine dental inspection and treatment in the schools. As future development is primarily dependent upon accommodation and in view of the probable delay in settling health centre policy under the National Health Services Act, further expansion in the dental services would appear unlikely in the immediate future save for such improvisations as can be contrived in existing premises." 38 SCHOOL DENTAL SERVICE: The number of children on the school registers showed a marked increase in the course of the year, 13,668 children being on roll in February compared with over 15,000 by the end of the year. The allocation of approximately 3,000 children to each dental officer applying in 1945 was therefore again reverted to in the latter part of the year despite the increase of staff from four and a half to five full time dental officers. The raising of the school leaving age in 1948 will further increase the proportion of children to dental staff, and 1949 will mark the commencement of a phase showing the repercussions on the school population of recent increases in the birth-rate. The number of children receiving routine dental inspection in the schools, was approximately the same as in 1945, but the number of special inspections increased from 1,532 to 3,313. The schools receiving routine inspection in 1946 were, in the main, last inspected in 1944, and it is important to note that the ratio of permanent teeth extracted because of disease to permanent fillings performed was approximately 1 to 10 in both 1945 and 1946, an indication that the improved state of dental health in school children and the lessening in rapidity of dental decay is being maintained. Reference has been made to this improvement in reports since 1944 with suggestions as to the primary reasons, and a more detailed summary of conclusions should be possible at the end of 194(7. The number of fillings in permanent and temporary teeth showed an increase of approximately 2,000 over 1945, and the acceptance rate for treatment following routine dental inspections was 88%, denoting a steadily increasing demand on the part of parents for a conservative dental service for their children. Some amplification of Ministry of Education Table IV is desirable in a scheme of these dimensions and the following table provides evidence of the wide scope of treatment undertaken by the dental staff:— 39 TABLE XIII. Dressings 1,643 Inlays 5 Silver Nitrate applications to temporary teeth 571 Splints for injured teeth 10 Scalings 356 X - Ray investigations 196 Cleaning and Polishing 237 Advice only 2,021 Minor dental operations, e.g., Frænoplasties, , apicectomies,, etc. 67 Dentures constructed following accidents to teeth 20 ORTHODONTIC SCHEME. TABLE XIV. Attendances 3,740 Appliances fitted 442 New Cases 298 Cases completed 53 MATERNITY AND CHILD WELFARE—DENTAL SCHEME: The National Health Services Act, 1946, Part III, para. 22 (i) stated "it shall be the duty of every local health authority to make arrangements for the care, including in particular dental care, of expectant and nursing mothers, and of children who have not attained the age of five years and are not attending primary schools maintained by a local education authority." From the foregoing it may be assumed that the Act envisages in the future a scheme of dental care for expectant and nursing mothers and pre-school children on similarly systematic lines of routine inspection and early treatment as 40 has applied for many years in the dental services for school children. In the past, expectant women needing dental treatment have been referred to the dental officer by the medical officers conducting the ante-natal clinics, and similar arrangements have applied in the case of young children attending the welfare centres. During the year 1,926 expectant mothers were attending the Council's ante-natal clinics of whom 640 were inspected and treated by the dental officers and 4,639 young children over one year of age were attending the welfare centres but only 315 received dental inspection. The scheme cannot be considered complete until every expectant mother receives dental inspection shortly after her first attendance at the antenatal clinic, every nursing mother receives a dental inspection three months after her baby is born, every pre-school child is examined at least once a year from the age of 18 months onwards, all such inspections to be followed by facilities for prompt treatment. In the absence of routine dental inspection for these priority groups it remains a matter of conjecture to estimate the staff necessary to provide a complete scheme in the Borough. Five dental officers having devoted approximately two sessions per week to this work, the equivalent of one full time officer, and completed 656 cases provides, however, sufficient evidence for an increase in staff. Continuity in dental health education and in treatment remains the basis for the adequate control of dental disease and it is desirable that this be borne in mind when detailed arrangements ensue from the operation of the National Health Services Act in order to ensure that the same dental staff continue to act as dental advisers to expectant mothers and the young children and to school children. The existing scheme continues to make considerable headway as the appended table illustrates:— 41 TABLE XV. Expectant and Nursing Mothers. Pre-School Children. 1938. 1945. 1946. 1938. 1945. 1946. Attendances foxtreatment 1,491 2,495 3,210 960 536 862 Fillings and other conservative treatment 37,6 801 1,764 269 295 584 Extractions 1,033 851 1,540 939 203 331 Dentures constructed Nil 129 168 — — — 17 mothers and 10 pre-school children received X-Ray investigations. STATISTICAL TABLES: The Ministry of Education Statistical Tables are appended. MINISTRY OF EDUCATION. MEDICAL INSPECTION AND TREATMENT RETURNS Year ended 31st December, 1946. TABLE 1. MEDICAL INSPECTIONS OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. A. ROUTINE MEDICAL INSPECTIONS: (1) No. of Inspections:- Entrants 1532 Second Age Group 1868 Third Age Group 2062 TOTAL 5462 (2) No. of Other Routine Inspections 2208 GRAND TOTAL 7670 42 B. OTHER INSPECTIONS: No. of Special Inspections and He-inspections 7090 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. % 7670 1886 24.59 4964 64.72 794 10.35 20 .34 TABLE III. Croup 1. TREATMENT OF MINOR AILMENTS (Excluding uncleanliness). Total number of defects treated or under treatment during the year under the Authority's Scheme:— Scabies 180 Miscellaneous 4516 4696 Croup II. TREATMENT OF DEFECTIVE VISION AND SQUINT. Under Authority's Scheme. Errors of Refraction (including squint) 534 Other defect or disease of the eyes (excluding those recorded in Group I) 46 TOTAL 580 No. of pupils for whom spectacles were (a) Prescribed 456 (b) Obtained 418 43 Croup III. TREATMENT OF DEFECTS OF NOSE AND THROAT. tinker Authority's Scheme. Received operative treatment 35 Received other forms of treatment 502 Total number treated 537 TABLE IV. DENTAL INSPECTION AND TREATMENT. (1) Number of pupils inspected by the Dentist:— (a) Routine age groups 5254 (b) Specials 3313 (c) TOTAL (Routine and Specials) 8567 (2) Number found to require treatment 6367 (3) Number actually treated 5599 (4) Attendances made by pupils for treatment 19924 (5) Half-days devoted to:— Inspection 54 Treatment 1960 TOTAL 2014 (6) Fillings:— Permanent Teeth 6373 Temporary Teeth 2003 TOTAL 8376 44 (7) Extractions:— Permanent Teeth 1429* Temporary Teeth 5658 TOTAL 7087 (8) Administrations of general anaesthetics for extractions 2795 (9) Other Operations:— Permanent Teeth 2388 Temporary Teeth 571 TOTAL 2959 *Includes 805 Orthodontic. TABLE V. VERMINOUS CONDITIONS. (1) Total number of examinations of pupils in the Schools by School Nurses or other authorised persons 29623 (2) Number of individual pupils found unclean 579 45 HANDICAPPED PUPILS. (as at 20/1/47). Category. At Special Schools. At Maintained Schools. At Independent Schools. Not at School M. F. M. F. M. F. M. F. Blind Pupils 1 2 — — — — — — Partially Sighted Pupils 2 3 — — — — — — Deaf Pupils 9 4 — — — — — 1 Partially Deaf Pupils 3 — — — — — — Delicate Pupils 8 9 3 2 — — — — Diabetic Pupils — — — — — — — — Educationally Subnormal Pupils 24 17 11 3 1 1 2 2 Epileptic Pupils 1 2 — — — — — — Maladjusted Pupils 2 2 4 1 — — — — Physically Handicapped Pupils 2 3 — — — — — — Pupils Suffering from Speech Defects — — 40 12 — — — — Pupils Suffering from Multiple Disabilities 1 1 53 42 58 19 1 1 2 3 Total—Males 114: Females 65 SANITARY CIRCUMSTANCES OF THE AREA. HOUSING: The lack of adequate housing accommodation has received the continued attention of the Borough Council. The causes for the existing situation are too well-known to need recapitulation, but the situation here, as in the country generally, tends to become more acute as an increasing number of men 46 and women reach marriageable age. The only solution to the problem is, of course, the provision of a sufficient number of houses to meet the growing demand but that is a long-term policy and in the meantime some alleviation of the situation was found by the transfer of tenants on Council estates, the placing of families in "halfway houses" and in requisitioned properties and, at the same time, a building programme was formulated and is coming into effect. The following Table indicates the action taken during the year:— TABLE XVI. 1. Number of families rehoused in Requisitioned Property during the year 234 2. Number of families rehoused in permanent accommodation:— Relettings of Pre-war Council Houses 14 Post-war Houses (Prefabricated Bungalows) 94 Houses partially completed by private enterprise pre-war, acquired and completed post-war by Council 4 112 3. Number of homeless families given emergency accommodation in Half-way Houses 66 412 4. Number of transfers arranged on Corporation Estates to relieve overcrowding 40 At the same time every endeavour has been made by the Sanitary Section to maintain existing properties in a reasonable state of repair, as will be seen from the following Table:— 47 TABLE XVII. Individual Unfit Houses:— No demolition order was made by the Local Authority and no house was found to be in a state so dangerous, or injurious to health, as to be unfit for human habitation. Inspection of dwelling-houses during the year:— Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1803 Number of inspections made for the purpose 5152 Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 731 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 644 Proceedings under Public Health Acts:— Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 101 Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By Owner 75 (b) By Local Authority in default of Owner — The following summary of the inspection work performed by the Sanitary Inspectors has been submitted to me by Mr. G. E. Luck, Chief Sanitary Inspector:— Inspections made 6957 Re-inspections after order or notice 8501 Complaints received and investigated 2123 Nuisances discovered and dealt with 2930 Visits paid to Infected Houses 1124 Infected rooms disinfected 476 Cesspools emptied 145 48 Notices Served:— Informal or cautionary 702 Complied with 486 Outstanding, 1946 216 Statutory Notices:— Applied for 167 Served under Public Health Acts, etc. 109 Outstanding from 1945 9 . Complied with 92 Outstanding from 1946 26 In 18 cases, authority was given for legal proceedings to be taken for non-compliance with Abatement Notices. DISINFESTATION: Treatment of Verminous Houses: The following houses were successfully treated:— Privately-owned 15 Council Houses 2 Inspections were made of furniture and bedding and rooms in the occupation of tenants before their removal into Council houses and disinfestation was performed where necessary. Work of disinfestation is done by the Local Authority and where verminous conditions were discovered, these cases were followed up after removal. FACTORIES ACT, 1937: Number of inspections 224 Notices served to remedy defects 42 Notices complied with 36 Matters notified by H.M. Inspector of Factories 38 Lists of Outworkers received 16 Outworkers' premises inspected 14 49 Nature of defects remedied at Factories:— Sanitary accommodation:— Insufficient 3 Unsuitable or defective 19 Improperly ventilated or unventilated 8 Want of cleanliness 28 Inadequate lighting 9 Overcrowding 1 Other offences 14 WATER SUPPLY: The Borough has a dual source of water supply:— 1. The Metropolitan Water Board supplying an 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 are examined bacteriologically, chemically and for taste and other special purposes on every working day. 2. The Colne Valley Water Company derives its supply from deep wells sunk into the chalk and before distribution to the consumers the water is under the constant supervision of a chemical and bacteriological staff which carries out examinations in modern laboratories situated at the Works. A high standard of purity is maintained. 50 SWIMMING BATHS: There are two swimming baths owned by the Local Authority and one privately owned. The purification and filtration plant at the Local Authority's baths consists of filters of the horizontal pressure type, together with centrifugal pumps, chlorination plant and cascade 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. After passing through the filters the water is injected with ammonia gas in solution and then passes over the cascade aerators and is finally injected 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. INSPECTION AND SUPERVISION OF FOOD: 1,213 inspections were made at premises where food intended for sale for human consumption was prepared, stored or sold. Constant attention was given to the inspection of premises, including street hawkers' premises, where food was offered or exposed for sale or had been deposited with or consigned to any person for the purpose of sale or of preparation for sale. As a precaution against contamination of food attention was given to the observance of cleanliness by persons employed in food stores, both in regard to the rooms and all articles, apparatus and utensils therein, and in regard to themselves and their clothing. Where necessary suitable washing basins and a sufficient supply of clean water, both hot and cold, soap and clean towels were provided. 51 For some considerable time an understanding has existed between the Public Health Department and the local food retailers whereby retailers notify us of any article of food about the quality of which they were in doubt and before such article was exposed for sale on their premises. By these means a large amount of food, unwholesome or unfit for food for human consumption, was withdrawn from sale. In each case a certificate of unfitness detailing the article was issued to the retailer who in turn forwarded it to his wholesaler, so that the replacement might be effected. A copy of such a note was sent to the Local Pood Control Officer for his guidance in the adjustment of food rations to those concerned. A considerable amount of food was condemned as being unfit for food for human consumption and was destroyed by incineration. Total quantity of Canned Poods condemned 5802 Total weight of Other Poods condemned (not including canned foods, and foods contained in jars, packets and bottles) 10 tons 2 cwts. 6 stones. Informal action taken in connection with Food Shops and Food Stores: 51 Notices were served on occupiers of Shops and Stores for infringements of the Food and Drugs Act, 1938, where proper precautions were not being taken against contaminiation of food. The principal matters dealt with were:— Sanitary Accommodation: Defective sanitary conveniences 11 Without proper water supply 1 Defects in drainage system - Choked drains 9 Compartments cleansed 4 Provision of washing facilities: Provision of hot water supply 11 52 Refrigerators: Interiors cleansed 1 General: Want of cleanliness 36 Other defects 25 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 4 112 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 98 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, in this case the sample failed to comply with Methylene Blue Test. Twenty samples of raw bulk milk were taken from rail tanks, fifty milk bottles immediately after cleansing in the bottle washing machines and two bottles after hand washing. The total number of milk samples taken for examination was 176, Tuberculin Tested milk 7, Pasteurised milk 149 and non-Designated milk 20. Of the pasteurised milk 145 samples satisfied the Methylene Blue and Phosphatase Tests, four samples failed to satisfy the Methylene Blue Test. SLAUGHTERHOUSES: Three Slaughterhouses are licensed for the slaughter of animals intended for human consumption. 53 The Livestock (Restriction on Slaughtering) Order, 1940, made under the Defence (General) Regulations, 19.39, prohibits the slaughter 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. RATS AND MICE (DESTRUCTION) ACT, 1919: INFESTATION ORDER, 1943: A Foreman Rat Catcher and an Assistant are employed in investigating complaints of rat or mouse infestation, treatment of infested premises where such is requested and giving advice to those occupiers who themselves wished to carry out treatment. Methods employed for the destruction of these vermin were the laying of poison baits in safe places, trapping and gassing. 755 complaints of either rat or mouse infestation were received in the Department. The work generally was supervised by the District Sanitary Inspectors. Summary of work performed during the Year: Number of treatments given where fees were paid 1538 Number of separate premises where treatment was given 327 Number of dead rodents picked up during or after treatment:— Rats 520 Mice 112 54 Estimated number of rats destroyed 240 Estimated number of mice destroyed 344 Total number of visits made by operators:— (a) Treatment 186 (b) Advice 19 2105 DISEASES OF ANIMALS ACTS, 1894—1937: Foot and Mouth Disease (Infected Areas Restriction) Order, 1938: Two outbreaks of Foot and Mouth Disease at Kings Cross, London, and Rickmansworth, Hertfordshire, 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 or within an Infected Area was by licence only. Three licences were issued. Swine Fever Order 1938: An outbreak of Swine Fever was confirmed by the Ministry. Notices defining the Infected Place were sent to the Ministry and other persons concerned. Six pigs died and the carcases were treated with disinfectant, slashed and buried on the farm at a depth of 8 feet. The piggery was disinfected. HENDON ISOLATION HOSPITAL. During 1946 the hospital reverted in full to its normal peace-time function of isolating and treating cases of infectious disease. As from 1st September, 1946, the ten beds, which had been held for E.M.S. purposes, were released for fevers, thereby restoring accommodation (with the exception of the 10 bombed cubicles) to the pre-war standard. Admissions, which totalled 812, showed an increase of 166 over the previous year's total of 646, cases admitted as ? Diphtheria being 89 as against 56 in the previous year and those admitted as Scarlet Fever rising from 154 to 206. 55 A feature of interest among the admissions was the number of cases of acute anterior poliomyelitis and of cerebrospinal meningitis, fuller details of which are given later in the report. During recent years, admissions have been accepted on a much wider basis than formerly was the case, and the hospital now caters for practically all diseases of a bacteriological nature. This widened scope has enabled hospital treatment to be afforded to a number of cases which have proved difficult to deal with satisfactorily at the Child Welfare clinics, particularly septic skin conditions, including scabies and impetigo. Another example of the increased facilities afforded by the hospital was the admission, during 1946, of cases of puerperal pyrexia and ophthalmia neonatorum. The rate of intake was materially affected by the agreement with the Wembley Corporation for the admission to the Hendon Isolation Hospital of all cases of infectious disease from the Wembley area. This arrangement came into full working in October, 1946, and resulted in a greater number of admissions during the closing months of the year, a trend which, influenced also by admissions from Service units and from the Harrow Urban District, has resulted in a high admission rate being continued into 1947. The patients treated included 231 out-district cases, 70 Service patients, and 27 from Redhill Hospital. Admissions from the Hendon area totalled 48.4, or 59.6 per cent. of the total. Nine deaths occurred during the year, and 783 patients were discharged, leaving 62 in hospital on the 31st December, 1946. A comparison of the admissions, deaths, and discharges with those of the two preceding years is shown below, and is followed (overleaf) by the table of admissions:— 56 NUMBER OF CASES TREATED—COMPARISON WITH PREVIOUS TWO YEARS. TABLE XVIII. Notified as:— Admissions. Deaths. Discharges. 1944. 1945. 1946. 1944. 1945. 1946. 1944. 1945. 1946. Diphtheria 34 56 89 — 1 — 37 48 91 Scarlet fever 265 154 206 1 — — 323 149 189 Erysipelas 17 23 27 — 1 1 18 20 27 Measles 11 131 116 — 2 1 10 129 107 Whooping cough 40 18 47 2 — — 38 15 49 Mumps 4 42 27 — — — 4 40 29 Chicken pox 11 22 40 — — — 11 22 40 Rubella 31 8 7 — — — 31 8 7 Dysentery and gastro-enteritis 34 58 50 — 5 1 34 53 47 Other conditions 38 134 203 1 3 6 38 122 197 TOTALS 485 646 812 4 12 9 544 606 783 57 TABLE OF ADMISSIONS. (Cases are classified according to the disease notified on admission, tentative diagnoses being included under the heading of the suspected disease.) TABLE XIX. Notified as:— In Hospital 1/1/46. Admitted during year. Died during year. Discharged during year. Remaining in Hospital 31/12/46. Diphtheria 7 89 — 91 5 „ and Measles — 1 — 1 — „ "carrier" — 2 — 2 — Scarlet fever 13 206 — 189 30 „ „ and chicken pox - 3 — 3 - „ „ and mumps — 1 — 1 - Measles 1 116 1 107 9 Rubella - 7 — 7 — Whooping cough 3 47 — 49 1 „ „ and Measles — 2 — 2 — „ „ and Scarlet fever - 1 - 1 - Mumps 2 27 — 29 — Chicken pox 1 40 — 40 1 Cerebro - spinal meningitis — 23 3 19 1 Poliomyelitis — 27 2 23 2 Encephalitis — 3 — 3 — Paratyphoid fever — 10 — 9 1 Gastro-enteritis — 20 — 18 2 Diarrhœa and vomiting 2 3 — 4 1 Dysentery — 30 1 29 — Pneumonia 6 11 — 17 — Bronchitis — 5 — 5 — Influenza — 14 — 14 — Tonsillitis — 5 1 4 — Tonsillectomy — 1 — 1 — Laryngeal obstruction — 1 — 1 — Croup — 1 — 1 — Vincent's angina — 2 — 2 — Pemphigus — 2 — 2 — Erysipelas 2 27 1 27 1 Cellulitis — 1 — 1 — Scabies, impetigo and other septic skin conditions 2 26 - 28 - 59 TABLE XX. [# ##]Disease. Recovered. Died. Total. Diphtheria 20 - 20 „ "Carrier" 6 — 6 Scarlet fever 181 — 181 *„ „ and chicken pox 5 — 5 *„ „ and mumps 1 — 1 Measles 105 1 106 *„ and whooping cough 3 — 3 Whooping cough 45 — 45 *„ „ and scarlet fever 2 — 2 *„ „ and measles 3 — 3 Rubella 8 — 8 Acute anterior poliomyelitis 19 1 20 Polio-meningo-encephalitis 1 1 2 Lymphocytic meningo-encephalitis 4 — 4 Cerebro-spinal meningitis 4 — 4 Meningococcal meningitis 3 — 3 Tuberculous meningitis - 2 2 Influenzal meningitis 1 1 Meningismus 1 — 1 Erysipelas 22 1 23 Mumps 28 — 28 Chicken pox 40 — 40 Paratyphoid fever (B) 2 — 2 Dysentery (bacillary) 11 1 12 Gastro-enteritis 33 —. 33 Salmonella infection 4 — 4 Giardia lambliasis 5 — 5 Infective hepatitis 6 — 6 †Obstructive jaundice 1 — 1 Pneumonia 14 — 14 Bronchitis 7 — 7 Acute lymphatic leukæmia - 1 1 †Sub-arachnoid hæmorrhage 1 — 1 Osteomyelitis 2 — 2 Tonsillitis 70 — 70 Acute larvngeal œdema 1 — 1 Vincent's angina 3 — 3 Post-scarlatinal rhinitis 1 — 1 Malaria 2 — 2 Peurperal pyrexia 7 — 7 Ophthalmia 7 — 7 Pemphigus neonatorium 2 — 2 58 Notified as:— In Hospital 1/1/46. Admitted during year. Died during year. Discharged during year. Remaining in Hospital 31/12/46. Vaccinia - 1 - 1 - Conjunctivitis — 1 — 1 - Ophthalmia — 7 — 6 1 Adenitis 1 2 — 3 - Post-scarlatinal rhinorrhœa — 1 — 1 - Nasal discharge and pyrexia 1 — — 1 - Puerperal pyrexia — 7 — 6 1 Hysterectomy — 1 — 1 - Glandular fever — 4 — 2 2 Ludwig's angina — 2 — 2 — Infective Hepatitis 1 5 — 6 — Rheumatism — 1 — 1 — Malaria — 3 — 2 1 Pyrexia of unknown origin — 2 — 2 — Observation — 4 — 4 — Mothers admitted to nurse infants — 12 - 11 1 Infants admitted for nursing purposes — 5 — 4 1 TOTALS 42 812 9 783 62 FINAL DIAGNOSIS: The table overleaf shows the final diagnoses arrived at in connection with the 792 completed cases:- 60 Disease. Recovered. Died. Total. Adenitis 9 - 9 †„ (tuberculous) 1 — 1 Rheumatism 6 — 6 Debility 2 — 2 Malnutrition 1 — 1 Scabies and septic skin conditions 32 — 32 Influenza 17 — 17 Pyelitis 1 — 1 Otorrhœa 1 — 1 Vulvo-vaginitis 1 — 1 Neurosis 2 — 2 Catarrh 1 — 1 Vaccinia 1 — 1 Stomatitis 2 — 2 N.A.D. 12 — 12 Mothers admitted to nurse infants 10 — 10 Nursing infants admitted with mothers 4 — 4 TOTALS 783 9 792 *concurrent infection on admission. †transferred to other hospitals for further treatment. DIPHTHERIA: For some years past, as a result of the large-scale programme of immunisation, diphtheria cases have been greatly reduced in number, and the figures for 1946 show a continued low incidence. Of the 92 cases, admitted as diphtheria or ? diphtheria, which were treated to completion during the year, there were 20 instances of true diphtheria, including 3 of the laryngeal type. All recovered and were discharged after an average stay of 56.2 days. There were, in addition, six symptom-free diphtheria "carriers." Comparison of incidence and case mortality rate with that of the two preceding years is shown below:— 61 TABLE XXI. 1944. 1945. 1946. 1. Cases discharged or died, notified as diphtheria or ? diphtheria 37 56 92 2. Cases found to be suffering from diphtheria on admission (excluding "carriers ") 9 8 20 3. Deaths due to diphtheria — 1 — 4. Case mortality rate (calculated on number of cases of true diphtheria) Nil 12½% Nil SCARLET FEVER: Scarlet fever cases dealt with during 1946 show a slight increase in number over those for the previous year. This resulted from additional intake of out-district cases rather than from any generally increased incidence. The type of disease remained comparatively mild, the average stay of completed cases being 28.9 days. Including dual infections, 210 cases with a notification of scarlet fever or ? scarlet fever were admitted, and 193 discharged during the year, the diagnosis of scarlet fever being confirmed in 187 cases, in 6 of which the disease was allied with a second infective condition at the time of admission. Comparison of incidence, etc., with that of the preceding two years is shown below:— TABLE XXII. 1944. 1945. 1946. 1. Cases discharged or died, notified as scarlet fever or ? scarlet fever 324 151 193 2. Cases found to be suffering from scarlet fever on admission (including dual infections) 301 146 187 3. Deaths among scarlet fever cases *1 — — 4. Case mortality rate 0,3% Nil Nil *This death was due to aortic aneurysm. 63 Complications included six cases of broncho-pneumonia and five of bronchitis. POLIOMYELITIS: 27 cases were admitted with a notification of poliomyelitis. Seventeen of these from the Hendon district and 10 came from surrounding areas. Two of the patients died, one from Bulbar paralysis on the day of admission, and the other on the 38th day of treatment, death being proved by post mortem examination to be due to polio-encephalitis. Two patients remained in hospital at the end of the year, and an analysis of the 23 cases who recovered and were discharged during 1946 showed that the diagnosis of acute anterior poliomyelitis was confirmed in 16 instances. Three further cases of poliomyelitis were diagnosed one having been notified as measles and two others as encephalitis. Eleven out of the total of 19 recovered cases of poliomyelitis were, on discharge, transferred to orthopædic units for treatment of the residual paralysis. Of the remainder notified, two were found to be cases of virus encephalitis, and in five instances no diagnosis of virus infection was established. MENINGITIS: 23 cases with a definite or tentative diagnosis of this disease were admitted during 1946. Three deaths occurred; one was due to acute meningitis (Pfieffer's bacillus) in a girl, aged 2 years, from the Wembley District. The other two were due to tuberculous meningitis, the diagnosis in both instances being confirmed by post mortem examination. Of the remaining 20 cases, 19 were discharged during the year and one remained in hospital until January, 1947. Amongst the recovered cases, a diagnosis of cerebro-spinal meningitis was made in four instances (average stay 29.4 days) and that of meningococcal meningitis in three cases (average 23.3 days). The remaining 12 discharged cases included two which proved to be suffering from acute anterior poliomyelitis and have been dealt with under that heading, one of subarachnoid hæmorrhage which was transferred to Redhill Hospital within 24 hours of admission, and nine others in which the diagnosis was not confirmed. 62 Complications: The following complications were encountered among the 187 cases of scarlet fever completed during 1946:— Nephritis 2 Adenitis 10 Otitis media 9 Mastoiditis 2 Rhinitis 9 Rheumatism 2 Septic spots 11 Ringworm 1 Herpes 1 Conjunctivitis 1 Bronchitis 1 Myocarditis 1 MEASLES: 116 patients with a diagnosis of measles were admitted. One patient—an infant from the Harrow Urban District— died, on the 3rd day of treatment, of measles complicated by extensive broncho-pneumonia. The remainder recovered and were discharged during the year or early in 1947. Six cases of measles were found among patients notified as suffering from other conditions. In all, 105 confirmed cases of measles, and 3 of measles combined on admission with whooping cough, were discharged, the average stay of the completed cases being 20.2 days. Complications included 11 cases of bronchopneumonia, 5 of bronchitis, 3 of otitis media, 28 of rhinitis, 2 of adenitis, and one case suffering from ? appendicitis which was transferred to Redhill County Hospital for further investigation. WHOOPING COUGH: 50 cases of whooping cough, or whooping cough in conjunction with other conditions were admitted during 1946. All recovered and were discharged during the year, the average stay in hospital being 36.2 days. In 45 instances the diagnosis of whooping cough was confirmed, and there were, in addition, five cases of dual infection—two of whooping cough and scarlet fever and three of whooping cough and measles, 64 ERYSIPELAS: Two cases of this disease were in hospital on 1st January and 27 admissions were received during the year. One elderly patient (a male, aged 72 years, from the Harrow Urban District) died of cerebral hæmorrhage whilst under treatment for erysipelas. 27 patients were discharged and the remaining case went out early in 1947. The diagnosis of erysipelas was confirmed in 22 of the 27 cases discharged during the period, the average stay in hospital being 16.4 days. MUMPS: Two cases of mumps were in hospital at the beginning of the year and 27 admissions were received during 1946. All were discharged, the diagnosis of mumps being confirmed in 28 cases. Average stay of these patients was 22.8 days. OTHER DISEASES: A variety of other conditions, which are listed in detail in the tables of admissions and final diagnosis, were admitted. These included a number of cases of dysentery and gastroenteritis, one of which terminated fatally, a woman, aged 53 years, who died of acute dysentery on the 2nd day of treatment. A further death occurred—that of a patient from the Harrow Urban District admitted with a diagnosis of streptococcal tonsillitis. The cause of death in this case proved to be acute lymphatic leukæmia. The discrepancy between the figures given in this Section of the Report as compared with those in the Section dealing with Infectious Disease is due to the fact that patients were admitted to the Hospital from other Authorities. In conclusion I should like to take the opportunity of thanking the members of the Council for the interest they have taken in all matters affecting the public health, and also the members of my staff for the efficient and successful manner in which they have carried through a growing volume of work. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, A. FAIRCRIEVE ADAMSON, Medical Officer of Health. Hendon Printing Works Limited, 44, Victoria Road, Hendon, N.W. 4