HEN 25 Borough of Hendon ANNUAL REPORT of the Medical Officer of Health AND School Medical Officer for the year 1948 A. FAIRGRIEVE 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 1948 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, 1948/1949. The Mayor: Councillor J. H. Eodway, J.P. The Deputy Mayor: Alderman A. W. Curton, F.R.S.A., M.Inst.B.E. Aldermen: W E. Clemens, J.P., F.C.A. H. G. Potter, J.P., F.E.I.C.S. J. J. Copestake, J.P. A. J. Reynolds, J.P., A. W. Curton, F.R.S.A., 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. 8. E. Arridge, F.I.S.M.A. R. J. Knowles, M.M., M.W.M.A. A. C. Brooke. W. R. Lawrence, M.A., LL.B. E. G. Burman. (Cantab.). L. C. Chainey. G. J. Pryke, F.I.A.C., A.M.I.8.E. C. R. D. Cope, B.E.M. J. H. Rodway, J.P. G. C. V. Coppen. P. G. Rouse. D. A. Davis. W. Rowley. J. L. Freedman, M.A., LL.B. S. E. Sharpe. E. J. Greenslade. C. H. Sheill. J. Griffiths. L. S. Suggate, B.Sc., A.K.C., W. F. Hughes. F.R.G.S. D. J. James, M.B.E. A. V. Sully, M.C., F.C.A. H. L. k. Johnson. S. R. C. Sumpter, F.B.A.A. R. H. Taylor. PUBLIC HEALTH AND MEDICAL SERVICES COMMITTEE. Chairman: Alderman W. R. ctiemfins, J.P., F.C.A. Aldermen: J. J. Copestake, J.P. G. R. Richardson, J.P. Councillors : E. G. Bukman. W. R. Lawrence, M.A., LL.B. L. C. Chainey. (Cantab.). C. R. D. Cope, B.E.M. G. J. Pryke, F.I.A.C., A.M.I.S.E G. C. V. Coppen. P. G. Rouse. D. J. James, M.B.E. 8. R, C. Sumpter, F.B.A.A. 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 1948. August, 1949. To the Mayor, Aldermen and Councillors of the Borough of Hendon. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my eighteenth Annual Report on the health of the Borough of Hendon for the year 1948. GENERAL HEALTH CONDITIONS. VITAL STATISTICS: The Registrar General's estimate of the population of the Borough in June, 1948, was 156,400, as compared with 158,670, for the previous year, and 115,682, at the last census in 1931. The number of live births decreased from 2,671, in 1947, to 2,292 in 1948, giving a birth rate in 1948 of 14.65 per thousand population as compared with 16.83, for 1947. The birth rate for the Country generally was 20.5 in 1947 and 17.9 in 1948. The number of deaths registered was 1,406 as compared with l,522 in the previous year, giving a death rate of 8.9 per thousand as compared with 10.8 for the country generally. The infantile mortality rate, that being the number of deaths of infants per thousand live births, was the lowest figure yet recorded, namely, 21 as compared with 34 for the country generally. The causes of the high infantile mortality which prevailed for many years, namely, parental ignorance 4 and lack of care, have been almost entirely eliminated, the deaths now taking place being largely concerned with prematurity and congenital defects. These in turn have been reduced by more intensive ante-natal care of the expectant mother and by the operation of the scheme in force for the preservation of the lives of premature infants. The following Table shows the decline in infantile mortality since the beginning of the century:— TABLE 1. Year Death rate of infants under 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 1947 27 1948 21 The following Table shows the causes of death during the year:— TABLE II. CAUSES OF DEATH. Cause. Male. Female. Total. Typhoid and paratyphoid fevers — — — Cerebro-spinal fever — — — Scarlet fever — — — 5 Cause. Male. Female. Total. Whooping Cough 1 1 2 Diphtheria 1 — 1 Tuberculosis of respiratory system 26 13 39 Other forms of Tuberculosis 2 3 5 Syphilitic diseases 1 4 5 Influenza — 2 2 Measles — ' — — Acute poliomyelitis and polioencephalitis — — — Acute infectious encephalitis 1 2 3 Cancer of buccal cavity and œsophagus (M); uterus (P) 9 6 15 Cancer of stomach and duodenum 22 20 42 Cancer of breast — 44 44 Cancer of all other sites 106 92 198 Diabetes 1 6 7 Intra-cranial vascular lesions 42 93 135 Heart Disease 198 186 384 Other diseases of circulatory system 35 43 78 Bronchitis 45 25 70 Pneumonia 16 28 44 Other respiratory diseases 8 12 20 Ulcer of stomach or duodenum 19 4 23 Diarrhœa under 2 years 1 3 4 Appendicitis 3 4 7 Other digestive diseases 7 13 20 Nephritis 19 9 28 Puerperal and post-abortive sepsis — 2 2 Other maternal causes — 4 4 Premature birth 4 6 10 Congenital malformations, birth injury, infantile disease 10 21 31 Suicide 12 9 21 Road traffic accidents 5 5 10 Other violent causes 22 18 40 All other causes 62 50 112 TOTAL—all causes 678 728 1406 6 TABLE III. CASES OF INFECTIOUS DISEASES OTHER THAN TUBERCULOSIS NOTIFIED DURING 1944, 1945, 1946 1947 and 1948. Disease Total cases notified during Removed to Hospital, 1948. 1944. 1945. 1946. 1947. 1948. Scarlet Fever 374 180 199 152 241 153 Diphtheria 17 20 33 10 8 8 Pneumonia 132 129 139 128 139 34 Acute Poliomyelitis 2 4 16 18 5 4 Measles 123 2013 558 973 1289 73 Whooping Cough 530 162 367 394 516 47 Cerebro Spinal Fever 5 4 8 10 2 2 Typhoid or Enteric Fever 1 1 3 3 3 Erysipelas — — — — 38 17 Dysentery — — — — 27 15 INFECTIOUS DISEASES: The foregoing Table shows that there was a rise in the incidence of Scarlet Fever, Measles and Whooping Cough, as compared with the incidence in the previous years. It will be seen also that 8 cases of Diphtheria were notified, but in none of these was the diagnosis ultimately confirmed. This may appear to be at variance with Table II showing the causes of death, as in that table one death is attributed to this disease. 7 This was, however, a case of an adult who contracted the disease while temporarily residing in another district. It is reasonable to assume that the continued low incidence of diphtheria is largely influenced by the high percentage of children within the Borough who have been immunised against this disease, as illustrated in the following Table:— 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 1947 10* — 23890 1948 8 1 26346 *of these the diagnosis was confirmed in 8 cases in 1946, and 8 cases in 1947. ANTERIOR POLIOMYELITIS: I am glad to report there was a lower incidence of anterior poliomyelitis (infantile paralysis) than in the preceding year; 5 cases were notified, and in 4 of those the diagnosis was 8 firmed. There was one death, that of an infant under one year of age. 6 suspected cases were kept under observation, but none of these developed the disease. GASTRO-INTESTINAL INFECTIONS: It will be seen that the number of gastro-intestinal infections, namely, Typhoid or Enteric Fever and Dysentery, is the highest recorded for the 5-year period under review. In so far as the cases of Typhoid or Enteric Fever were concerned, one was that of a nurse who contracted the disease while nursing a ease of Typhoid Fever in hospital, the second, that of a child who had recently arrived from Germany where she had presumably contracted the disease, and the third, that of a boy in which no definite contact could be traced, the only suspicious feature being that he had recently returned from a children's holiday camp where it is possible that he might have been in contact with the disease. The cases of Dysentery notified were either of the Salmonella or Sonne types of Dysentery, two of the commonest organisms associated with outbreaks of Food poisoning. These cases were generally speaking not connected either in time or place, excepting that 4 of the cases of Sonne Dysentery occurred at or about the same time in one of the Day Nurseries. In this connection a comprehensive investigation was made of other children and of the staff, but the primary source of infection was not ascertained. Three eases of the Salmonella type of infection occurred at about the same time in one household, but again the original source of infection was not discovered. TUBERCULOSIS: The following Table shows the notifications of tuberculosis during the last eight years:— 9 TABLE V. Year. Notifications. 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 1947 109 80 7 10 1948 84 86 13 10 I am indebted to the Tuberculosis Officer at the Edgware Chest Clinic for the following observations "The total number of patients on the Clinic register increased during the year 1948 from 1,531 to 1,561 after taking into account transfers into and out of the area, patients recovered and lost sight of and those who died. During the year the already long waiting time for admission to Sanatorium was increased, special difficulty being experienced in the case of children, where the waiting time was approximately seven months. Similar difficulty was found in arranging admission for orthopædic cases, also suffering from pulmonary tuberculosis. The long waiting period for admission to sanatorium threw a great strain on the housing problem, where patients with positive sputum were being nursed in close contact with children, in overcrowded conditions; but cooperation between the housing department and the clinic alleviated this unsatisfactory situation as far as possible. An increasing number of home helps were required during the year, and there was also a greater call on the District Nursing Service. 10 The extension to the clinic premises was completed in May, so that working conditions for the personnel of the clinic, and accommodation for the patients, was made more satisfactory. After 5th July, 1948, there was a considerable increase in the number of people availing themselves of the facilities for X-Ray of the chest, and as a result of this some strain was thrown on the clinic as the installation of the X-Ray apparatus had not been completed. As a result of greater co-operation with the General Practitioners in the district the Chest Physician was called to a considerable number of consultations in patients' homes." MATERNITY AND CHILD WELFARE. The National Health Service Act became effective on the 5th July, 1948. This resulted in the transfer of these services throughout the country to the major Local Authorities (County and County Borough Councils) who for this purpose have been designated as Local Health Authorities, and who from that date became responsible for the operation of all the Services contained in Part 3 of the National Health Service Act, 1946. These services were provided and controlled by the Borough and District Councils and consisted of these services concerned with the care of mothers and young children, midwifery, health visiting, day nurseries and the provision of domestic help. In addition, the scheme for immunisation against diphtheria became the responsibility of the Local Health Authority and there was added to this, vaccination against smallpox, which has now become permissive, the Vaccination Acts of 1867 to 1907 ceasing to have effect. To these services already mentioned there was added the duty of providing a home nursing service. This had, in the past, been provided by voluntary associations acting separately, with a resulting lack of co-ordination as between the various associations, although in Hendon a considerable 11 measure of co-ordination had been achieved, the Borough Council having been instrumental in forming the Central Committee of the Hendon District Nursing Associations and in affording financial assistance to that Committee. The Local Health Authorities have also the responsibility of providing Health Centres as envisaged in the Act, at which facilities will be available not only for the services defined in Part 3 of the Act, but also for the provision of general medical, dental, specialist and pharmaceutical services. The Ambulance services have also been transferred to the County Council as the Local Health Authority. So far as Middlesex is concerned, the County Council in undertaking their responsibilities for the provision of these services, has divided the County into 10 areas mainly by the amalgamation of contiguous districts, e.g., Hendon and Finchley have combined to form one area. There has been formed for each Area an Area Committee on which the district Authorities concerned are represented, these Area Committees acting as sub-committees of the Health Committee of the County Council. The Area Committees are responsible for all functions mentioned above with the exception of the administration of the Ambulance Service which, by its nature, lends itself to central administration. The services under Part 3 of the Act which were previously administered by the Borough Council continue to operate as before, the change so far being one of administrative procedure. There are appended statistical Tables relating to these services for the period up to and including 4th July, 1948, upon which they were transferred to the County Council. During the period 1/1/48 to 4/7/48 the Health Visitors paid the following number of visits:— 12 To expectant mothers:— First Visits 564 Total Visits 803 To Children under 1 year:— First Visits 1239 Total Visits 4157 To Children between ages of 1 and 5 years:— Total Visits 5827 TOTAL 10787 TABLE VI. 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 1947 1293 2856 65577 1948 (Up to 4/7/48) 667 1452 32758 13 TABLE VII. 1942. 1943. 1944. 1945. 1946. 1947. 1948 (Up to 4/7/48). No. of Antenatal Sessions held 431 503 517 509 626 708 358 No. of Expectant Mothers seen 1619 1597 1498 1702 1926 1716 825 No. of attendances 7464 8721 8944 9109 11574 10849 5102 Average No. seen per session 17 17 17 18 18 15 14 Average No. of attendances made by each patient 4.61 5.46 5.97 5.35 6.01 6.32 6.18 TABLE VIII. 1947. 1948 (Up to 4/7/48). Domiciliary Confinements 883 259 Hospital Confinements 1240 646 Nursing Home Confinements 684 298 2807 1203 HOME HELPS: The Home Help service continued to be in great demand and from 1/1/48 to 4/7/48, 21 full-time and 8 part-time Home Helps were employed. The number of Home Helps available necessitated their being limited almost entirely to midwifery 14 eases but it was found possible to provide assistance in certain cases apart from the Midwifery scheme. Altogether 112 midwifery and 118 other cases were given assistance. The demand for this service is very great indeed and the service is only limited by the number of staff obtainable. I should add that judging from the expressions of gratitude which are received, that no service is more appreciated. DAY NURSERIES: The following Table shows the position and accommodation at each nursery:— TABLE IX. 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, Childs Hill, N.W. 2 30/ 3/42 20 30 50 Hyde School, Hendon, N.W. 9 11/ 5/42 — 45 45 York Park, Hendon, N.W. 9 31/ 8/42 30 30 60 Claremont Road, Cricklewood, N.W. 2 3/12/42 20 30 50 Approach Road, Edgware 30/ 4/43 10 25 35 Hyde Cottage, Hendon, N.W. 9 21/ 2/44 20 45 65 1, Milespit Hill, Mill Hill, N.W. 7 20/ 3/44 27 28 55 15 SCHOOL HEALTH SERVICES These services have been described in detail in previous reports, but certain changes in their administration have followed as a result of the operation of the National Health Service Act, 1946. In the original scheme of Divisional Administration of education, the Divisional Executive were responsible for the medical and dental inspection of pupils attending any school maintained by the County Council and for the ascertainment of which children in the Borough required special educational treatment. In addition, they were responsible for securing that pupils attending any school maintained by the County Council should have free medical treatment in accordance with the arrangements made by the County Council and approved by the Minister. As a result of the operation of the National Health Service Act it became inevitable that the treatment provided for school children at Health Centres should be co-ordinated with the Local Health Service provided under the National Health Service Act, treatment becoming therefore the concern of the Local Health Authority acting through the Area Health Committee and not of the Divisional Executive. All matters of periodic medical inspection, dental inspection, inspection of cleanliness, ascertainment of pupils requiring special educational treatment and all matters dealt with under Section 57 of the Education Act and the provision of child guidance services, other than specialist treatment, remaining with the Divisional Executive. PERIODIC MEDICAL AND OTHER INSPECTIONS: It will be seen from Table No. X that 6,098 children were inspected at periodic medical inspections and that a further 8,138 special inspections and re-inspections were made. The nutritional standard of the children examined at the periodic medical inspections is shown in the following Table with a comparison with that of the year 1947:— 16 TABLE X. Number of Pupils Inspected. A (Good). B (Fair). C (Poor). No. % No. % No. % 1947: 7072 3892 55.03 2739 38.73 441 6.24 1948: 6098 3028 49.65 2760 45.26 310 5.09 SCHOOL DENTAL SERVICE: I am indebted to the Area Dental Officer for the following report on the School Dental Service:— "The number of children on the register increased during the year from 15,497 to 16,242. Staffing problems caused some dislocation to the work—Mr. K. Leney, L.D.S., not taking up his appointment in place of Dr. Kerpel until June. An additional Dental Officer, Miss F. Power, B.D.S., took up her duties at the beginning of the year and increased the number of Dental Officers to six from April onwards. This increase in staff has not resulted in an increase in the number of Routine Dental Inspections in school, and was not sufficient to maintain the level of Routine Dental Inspections in school carried out in 1947. The reason for this slight drop in numbers is accounted for by the accumulation of actual treatment due to the delay in the replacement of Dr. Kerpel, and a considerable amount of minor ailments amongst the Dental Staff. The condition of the children's teeth found at Routine Dental Inspection appears to be similar to that found for some years. The number of unsaveable teeth showed little noticeable difference from last year. The big majority of parents are now only too ready to avail themselves of the services offered for their children and in the case of Secondary Schools many scholars make their 17 own arrangments with the clinics for more frequent inspections. The provision of a complete Dental Service is based upon annual inspection for every pupil followed by prompt treatment and this depends upon the adequate staffing of the Dental Service which appears to be approaching a crisis in the country as a whole due to the implication of the National Health Service Act, for its effect upon recruitment and School Dental Services. It is gratifying to note that in Hendon the Dental Officers had remained loyal to the Service to the end of the year." ASCERTAINMENT OF HANDICAPPED PUPILS: An increased number of children suspected of being mentally or physically handicapped or mal-adjusted were referred for special examinations to ascertain whether their degree of handicap is of such a nature as to require special educational treatment. The Tavistock Clinic which has been absorbed by the North-West Metropolitan Regional Hospital Board continues to undertake treatment of mal-ad.justed children and during the year 74 children were referred for examination and treatment. Unfortunately there is a long waiting list with an inevitable delay in obtaining appointments. UNCLEANLINESS—VERMINOUS CONDITIONS: Ministry of Education Table V gives the number of children who were examined in the schools, the number of children who were found to be infested with vermin, and the number of individual pupils in respect of whom cleansing notices were issued under Section 54 (2) of the Education Act. These latter notices are only served in cases liable to persistent or repeated infestation, as in the vast majority of cases the degree of infestation is slight, and the co-operation of the parent is elicited by assistance and advice. 18 I am indebted to the Borough Education Officer for the following notes of the main developments likely to affect the health of the children, which have taken place in the educational service during the year and for his continued co-operation and that of his staff in the work of the School Health Services:— "PHYSICAL EDUCATION: During 1948, the situation in schools has not improved with regard to accommodation and general facilities. In fact the facilities for physical education are fewer than ever, owing to the erection of classrooms in playgrounds. In April the distribution of Organisers of Physical Education in the County was re-organised and instead of two organisers being responsible for the physical education in Hendon, the areas of Hendon, Willesden and Wembley were combined. By this arrangement the work of the organisers was trebled, consequently the amount of time available for visiting the schools and helping the teachers was less than one-third of the time previously available. Not only has this reduced the number of visits of organisers to the schools but the consequent loss of contact with the teachers and their difficulties is much to be regretted, the personal contact having proved invaluable in previous years. With the frequent changes of staff and the appointment of emergency teachers to the Borough, the assistance given by organisers should have been increased rather than diminished, but under present conditions this is impossible, not only by the increased area for which the organisers are responsible, but by a great increase in the amount of office work due to centralisation. The work of the Remedial Gymnast is proving most valuable; so much so that a request has been made for the appointment of a further Remedial Gymnast to visit the schools which are not covered at present. SWIMMING: The swimming this summer again proved disappointing as the weather was very inclement. Again the need 19 for some indoor facilities for teaching swimming was emphasised. The organisers have been fortunate in being able to arrange swimming at the Hampstead Baths. In order to have swimming instruction throughout the year, transport was provided for a limited number of schools as an experiment. Here the children have regular weekly instruction by qualified instructors and the advantage of this to the children cannot be over emphasised, and the number of children who have learnt to swim has been more than doubled by these facilities. ORGANISED GAMES: The difficult conditions existing in the lack of halls and playgrounds increases the need for greater facilities for organised games. Unfortunately Cressingham Road is still not available as the Ministry have not sanctioned the erection of a suitable fence for this field. Meantime this leads to overcrowding on the Public Parks & Recreation Grounds which through the co-operation of the Borough Engineer and Surveyor and his staff are so generously placed at the disposal of the schools. The question of adequate changing and washing accommodation is still a vital one, and it is hoped that proper facilities will be available in the near future. TRAINING COURSES: Training Courses for Teachers and Leaders have been arranged throughout the year, but having to cover Area No. 4 of Middlesex administration, these courses are not always so conveniently situated for Hendon as one would wish. LOCAL YOUTH COMMITTEE: Since the re-organisation of the administration for the County of Middlesex it has been impossible for the organisers to keep in such close contact as they would have liked with all phases of Youth work in Hendon, but they act as advisors to the Local Youth Committee and are available when required. 20 CHILDREN UNDER 5 YEARS OF AGE: As the influence of the recent increase in the birth rate makes itself felt by the number of children reaching compulsory school age less space is, and will be, available in the infant schools for children below school age. Unfortunately, therefore, until new buildings are provided to accommodate the infants it has been increasingly necessary to limit the admission of the under fives although the demand for places had been as heavy as hitherto. Whereas in 1945 there were 594 such children in attendance at 26 schools, there were only 490 children under five years of age in 24 schools at the corresponding time in 1948. Of these only 51 were between the age of 3 and 4 and were located in four schools. At the same time, some 290 children were on the registers of the nursery schools associated with the seven day nurseries. ATTENDANCE: Throughout the year attendance was well maintained at approximately 90% each week. Only during certain weeks in the spring term, when weather conditions and illness are likely to cause a falling off in attendance, was there any noticeable drop in the school averages. A few, Algernon Road, Wessex Gardens, Sunnyfields and the Garden Suburb Infants' Schools fell below 75% for some four or five weeks during the year but otherwise the school attendance gave no indication of general ill-health other difficulties. SCHOOLS MEALS AND MILK: Since the last report, further extensions have been made in the School Meals Service although it is not yet possible to provide a meal for all children who require it. The central kitchens which provide the largest number of meals have been over-producing throughout the year but even so waiting lists have to be made at some schools. Only one school is now without school meals. 21 The milk in schools scheme operates in all schools and is very satisfactory. School meals and milk have been made available in the long holidays although relatively few children take advantage of the facilities. With regard to the number of meals served, a census taken on 20th October, 1948, showed that 8,754, representing over 55% of the children in school that day, took the meal. Of these 4,880 or 48.6% were children attending primary schools, 3,615 or 64.6% in secondary schools and 259 or 100% of the nursery school population that day. There were 14,991 children taking milk on the above day, or 95.4% of those in attendance and the corresponding figures for primary schools were 9,592 or 95.6%, secondary schools 5,068 or 90.5% and 259 or 100% in the nursery schools. In addition, 196 breakfasts and 259 teas were served in the nursery schools." STATISTICAL TABLES: The Ministry of Education Statistical Tables for the year 1948 are appended. 22 MINISTRY OF EDUCATION. MEDICAL INSPECTION RETURNS. Year ended 31st December, 1948. TABLE 1. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. (Including Special Schools.) A.—PERIODIC MEDICAL INSPECTIONS: Number of Inspections in the prescribed Groups:— Entrants 1739 Second Age Group 1674 Third Age Group 898 Total 4311 Number of other Periodic Inspections 1787 Grand Total 6098 B.—OTHER INSPECTIONS: Number of Special Inspections 2575 Number of Re-Inspections 5563 Total 8138 23 c.—PUPILS FOUND TO REQUIRE TREATMENT: Number of Individual Pupils found at Periodic Medical Inspection to Require Treatment (excluding Dental Diseases and Infestation with Vermin). Group. (1). For defective vision(excluding squint). (2). For any of the other conditions recorded in Table IIA. (3). * Total individual pupils. (4). Entrants 25 213 222 Second Age Group 143 134 259 Third Age Group 61 66 122 Total (prescribed groups 229 413 603 Other Periodic Inspection 138 148 271 Grand Total 367 561 874 24 TABLE II. A.—RETURN OP DEFECTS FOUND BY MEDICAL INSPECTION. In the year ended 31st December, 1948. Periodic Inspections. No. of defects. Special Inspections. No. of defects. Defect Code No. Defect or Disease. Requiring treatment Requiring to be kept under observation, but not requiring treatment. Requiring treatment. Requiring to be kept under observation but no*. requirinB treatment. (1). (2). (3). (4). (5). 4. Skin 6 5 354 l 5. Eyes—a. Vision 367 201 153 18 b. Squint 20 14 24 1 e. Other 26 8 220 4 6. Ears—a. Hearing 15 5 20 3 b. Otitis Media 5 3 31 — c. Other 9 1 160 — 7. Nose or Throat 214 179 278 19 8. Speech 19 10 24 6 9. Cervical Glands 16 63 21 4 10. Heart and Circulation — 37 2 7 11. Lungs 7 32 14 4 12. Developmental— a. Hernia 2 5 — — b. Other — 7 — — 13. Orthopaedic— a. Posture 93 42 29 1 b. Flat foot 28 56 23 1 c. Other 65 55 69 5 14. Nervous System— a. Epilepsy 2 1 — — b. Other 3 18 6 2 15. Psychological— a. Development 5 1 4 2 b. Stability 13 22 39 4 16. Other 48 42 781 6 25 B.-CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS. Age Groups. Number of Pupils Inspected. A. (Good). B. (Fair). C. (Poor). No. % of col. 2. No. % of col. 2 No. % of col. 2. (1). (2). (3). (4). (5). (6). (7). (8). Entrants 1739 817 46.98 814 46.81 108 6.21 Second Age Group 1674 688 41.10 869 51.91 117 6.99 Third Age Group 898 505 56.24 375 41.76 18 2.00 Other Periodic Inspections 1787 1018 56.97 702 39.28 67 3.75 Total 6098 3028 49.65 2760 45.26 310 5.09 26 TABLE III. TREATMENT TABLES. GROUP I.—MINOR AILMENTS (excluding Uncleanliness, for which see Table V). (a) Number of Defects treated, or under treatment during the year. Skin- Ringworm—Scalp— (i) X-Ray treatment — (ii) Other treatment 2 Ringworm—Body 18 Scabies 74 Impetigo 120 Other skin diseases 649 Eye Disease (external and other, but excluding errors of refraction, squint and cases admitted to hospital) 550 Ear Defects (treatment for serious diseases of the ear (e.g., operative treatment in hospital) should not be recorded here but in the body of the School Medical Officer's Annual Report) 352 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 3887 Total 5652 (b) Total number of attendances at Authority's minor ailments clinics 25072* * Includes 3000 attendances at M.A.C. for E.N.T. treatments. 27 GROUP II.—DEFECTIVE VISION AND SQUINT (excluding Eye Disease treated as Minor Ailments—Group I.) No. of Defects dealt with. Errors of Refraction (including squint) 860 Other defect or disease of the eyes (excluding those recorded in Group I.) 37 Total 897 No. of Pupils for whom spectacles were: (a) Prescribed 681 (b) Obtained 447 GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Total number treated. Received operative treatment— (a) for adenoids and chronic tonsillitis — 49 (b) for other nose and throat conditions — Received other forms of treatment 548 Total 597 GROUP IV.—ORTHOPEDIC AND POSTURAL DEFECTS. (a) No. treated as in-patients in hospitals or hospital schools - — 18 (b) No. treated otherwise, e.g., in clinics or outpatients departments — - 369 28 GROUP V.—CHILD GUIDANCE TREATMENT AND SPEECH THERAPY. No. of pupils treated (a) under Child Guidance arrangements 49 (b) under Speech Therapy arrangements 71 TABLE IV. DENTAL INSPECTION AND TREATMENT. (1) Number of pupils inspected by the Authority's Dental Officers:— (a) Periodic age groups 6063 (b) Specials 3654 (c) TOTAL (Periodic and Specials) 9717 (2) Number found to require treatment 6825 (3) Number actually treated 5073 (4) Attendances made by pupils for treatment 21698 (5) Half-days devoted to:— (a) Inspection 67 (b) Treatment 2272* Total (a) and (b) 2339 (6) Fillings:— Permanent Teeth 8461 Temporary Teeth 1796 Total 10257 (7) Extractions:— Permanent Teeth 1576† Temporary Teeth 6232 Total 7808 29 (8) Administration of general anaesthetics for extraction 3125 (9) Other operations:— (a) Permanent Teeth 2736 (b) Temporary Teeth 658 Total (a) and (b) 3394 * Includes 413 Orthodontic. † Includes 617 Orthodontic. TABLE V. INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorised persons 23842 (ii) Total number of individual pupils found to be infested 452 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 4 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) Nil 30 EMPLOYMENT OP CHILDREN AND YOUNG PERSONS. MIDDLESEX (HENDON). (1) Number of children medically examined in order to ascertain whether they were physically fit'to undertake employment of a light nature outside school hours 105 (2) Number of instances in which the state of health was found to be such that certificates were withheld 1 (3) Number of children examined as to fitness to take part in entertainments 30 (4) Number of cases in which certificates to take part in entertainments were withheld EDUCATION ACT, 1944—SECTIONS 57 (3) and 57 (5). Cases notified under Section 57, Education Act, 1944:— Sub-section 3 15 Sub-section 5 — Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act, 1948 — MEDICAL EXAMINATION OF TEACHERS. (a) Number of Teachers examined as to fitness for appointment 17 (b) Number of Students examined as to fitness for first appointment 6 31 MIDDLESEX (HENDON) 1948. DENTAL INSPECTIONS. Age-Groups. Number Inspected. Number found to require treatment. Age 3 16 5 Age 4 31 13 Age 5 680 336 Age 6 467 263 Age 7 391 254 Age 8 444 290 Age 9 595 398 Age 10 523 367 Age 11 544 390 Age 12 457 318 Age 13 526 359 Age 14 579 388 Age 15 466 297 Age 16 plus Totals 344 6063 221 3899 SANITARY CIRCUMSTANCES OF THE AREA. HOUSING: The acute shortage of housing continues to present the most serious public health problem of the present time. To meet the situation every endeavour is being made to maintain existing property in as habitable condition as possible and to press forward with a building programme for the erection of new houses. In this connection I am indebted to the Housing Officer for the following observations and statistics relevant to the housing situation in the Borough during the year under review:— "The Council has continued to give earnest attention to the alleviating of the inadequate housing conditions prevailing amongst the large number of families who have 32 submitted housing applications to this Authority. Due to the progress made in the provision of new houses, the number of families rehoused during the past year shows a marked increase over the figures submitted in my last year's report. It will also be noted that the number of exchanges of tenancies arranged between Council tenants to ensure that available accommodation is put to the best use, shows an increase as compared with last year. As forecast in my report of last year, it has not been possible to maintain the progress attained in previous years in rehousing families into requisitioned properties, due to the curtailment of requisitioning powers, and the number of releases of such property which the Council have been obliged to effect." "HOUSING REPORT. STATISTICS. TABLE XI. For period 1st January, 1948, to 31st December, 1948. 1947. 1948. 1. Number of families rehoused into Permanent Accommodation:— (a) Pre-war Houses 36 61 (b) Post-war Houses 178 274 (c) Temporary Bungalows 16 20 230 355 2. Transfers arranged to relieve overcrowding on Council Estates 58 86 3. Number of families rehoused into Requisitioned Property 110 78 4. Number of homeless families given emergency accommodation in HalfWay Houses 113 73 " 33 TABLE XII. 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) 1288 Number of inspections made for the purpose Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 4071 887 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 656 Proceedings under Public Health Acts: Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 159 Number of dwelling-houses in which defects were remedied after service of formal notices (a) By Owner 123 (b) By Local Authority in default of Owner None 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:— 34 Inspections made 7326 Re-inspections after order or notice 12027 Complaints received and investigated 1729 Nuisances discovered and dealt with 2654 Visits paid to Infected Houses 535 Infected rooms disinfected 572 Cesspools emptied 160 Notices Served: Informal or cautionary 1018 Complied with 965 Outstanding 1948 53 Statutory Notices: Applied for 432 Served under Public Health Acts, etc. 198 Outstanding 1947 67 Complied with 175 Outstanding 1948 90 In 4 eases authority was given for legal proceedings to be taken for non-compliance with Abatement Notices. DISINFESTATION: Treatment of Verminous Houses. Thirty-eight houses were successfully treated. Privately-owned 32 Council houses 6 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. 35 FACTORIES ACT, 1937: Number of inspections 286 Notices served to remedy defects 29 Notices complied with 21 Matters notified by II.M. Inspector of Factories 9 Lists of Outworkers received 58 Outworkers' premises inspected 108 Nature of defects remedied at Factories: Sanitary accommodation: Unsuitable or defective 4 Improperly ventilated or unventilated 2 Want of cleanliness 4 Inadequate lighting 4 Other offences 18 WATER SUPPLY: The Borough has a dual source of 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 safe-guard, 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. 36 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. 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. This process has resulted in a high standard of purity being maintained. INSPECTION AND SUPERVISION OF FOOD: 1,974 inspections were made at premises where food intended for sale for human consumption was prepared, stored or sold. 37 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, bqth 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. 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 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 Food 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 human consumption and was destroyed by incineration. Total quantity of Canned Foods condemned 5161 Total weight of other Foods condemned 5 tons 14 cwts. Informal action taken in connection with Food Shops and Food Stores: 78 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 contamination of food. At the end of the year a remedy had been effected in 47 instances. \ 38 The principal matters dealt with were:— Sanitary Accommodation: Defective sanitary conveniences 12 Without proper water supply 1 Defects in drainage system 6 Choked drains 4 Compartment cleansed 12 Provision of washing facilities: Provision of hot water supply 18 Refrigerators: Interiors cleansed 3 General: Insufficient accommodation for refuse storage 2 Want of cleanliness 40 Other defects 76 MILK SUPPLY: Number of registered dairymen and purveyors of milk 11 Number of registered premises 32 Number of Cowkeepers 7 Number 'of farms where milk is bottled on the premises 3 141 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 51 samples of bottled pasteurised milk and 20 samples of bottled tuberculin tested (pasteurised) milk taken immediately after machine capping were submitted for bacteriological examination. All these samples complied with the requirements of the Milk (Special Designations) Orders, 1936—1946, 39 30 samples of raw bulk milk were taken from rail tanks, and 100 milk bottles immediately after cleansing in the bottle washing machines. The total number of milk samples taken for examination was 166, Tuberculin Tested Milk 32, Pasteurised Milk 86, and Non-Designated Milk 48. All the Pasteurised Milk samples satisfied the Methylene Blue and Phosphatase Tests. The total number of samples (including cleansed bottles) was 266. SLAUGHTERHOUSES: The Livestock (Restriction on Slaughtering) Order, 1940, made under the Defence (General) Regulations, 1939, 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. Neither of the two slaughterhouses in the district is licensed by the Ministry of Food and slaughtering has temporarily ceased. RATS AND MICE (DESTRUCTION) ACT, 1919; INFESTATION ORDER, 1943: 759 complaints of rat or mouse infestation were received in the Department. Th6 work generally was supervised by the District Sanitary Inspectors. 40 Summary of work performed during the Year: Number of treatments given 3215 Number of separate premises where treatment was given 1071 Number of dead rodents picked up during or after treatment:— Rats 1365 Mice 56 Estimated number of rats destroyed 12285 Estimated number of mice destroyed 672 Total number of visits made by operators:— (a) Treatment 3670 (b) Advice 288 3958 LABORATORY SERVICE. The arrangements made with the Central Public Health Laboratory at Colindale continued to operate in a highly satisfactory manner, and during the year the following investigations were carried out:— Record of Examinations. Throat/ Mis- Nose Faeces. Sputum. Pertussis. Milk lee Cream Water, eellan- Total. Swabs. eous. 716 505 81 78 175 48 — 134 1737 This service is proving of the utmost value not only to the Public Health Department but to the general practitioners in 41 the Borough, and the Officers of the service have been of the greatest assistance in carrying out investigations in outbreaks of infectious disease, particularly gastro-intestinal infections and in co-operating in methods of control. They have, in addition, carried out a controlled experiment in the Day Nurseries on immunisation against measles and whooping cough. HENDON ISOLATION HOSPITAL. By virtue of the National Health Service Act, 1946, all hospitals vested in Local Authorities were transferred to the Minister of Health. This included the Hendon Isolation Hospital which was transferred on the appointed day, namely, 5th July, 1948. The hospital services in England and Wales are now administered by Regional Hospital Boards, these are based on universities and medical schools, 4 of the Boards being associated with the University of London. The Hospital Boards in turn divided the regions for which they were responsible into smaller administrative units, under the control of Hospital Management Committees. It will be understood that a change of administration of this magnitude could not be effected until a considerable time had elapsed, and to overcome this gap the North-West Metropolitan Regional Hospital Board asked the Borough Council to be responsible for certain aspects of the administration of the Isolation Hospital until they in turn could become entirely responsible. This the Borough Council agreed to do, and an agency agreement was entered into and continued until the 28th February, 1949. The Hospital, of course, remains available for the" isolation and treatment of eases of infectious disease occurring within the Borough. The following figures show admissions to the Isolation Hospital from 1st January up to the 4th July, 1948, when the control of the hospital was transferred to the Regional Hospital Board. As the information given covers only part of the year, comparisons with previous years' statistics would be of little value, and have been omitted. 42 TABLE OF ADMISSIONS. (Cases are classified according to the disease notified on admission, tentative diagnoses being included under the heading of the suspected disease.) Notified as:— In Hospital 1/1/48. Admitted during year. Died during year. Discharged during year Remaining in Hospital 4/7/48. Diphtheria 2 31 2 25 6 Vincents Angina 1 2 — 3 — Scarlet Fever 17 195 — 175 37 Measles 7 93 1 98 1 Measles and Whooping Cough — 1 — 1 — Cholera — 1 — 1 — Glandular Fever — 2 — 2 — Rubella — 3 — 2 1 Whooping Cough 4 64 3 58 7 Abortion — 3 — 3 — Pneumonia 3 20 — 22 1 Mumps — 10 — 9 1 Chicken Pox 6 18 — 23 1 Cerebro - Spinal Meningitis 3 14 1 16 — Poliomyelitis 5 7 — 12 — Typhoid Fever — 3 1 1 1 Paratyphoid Fever — 2 — 1 1 Gastro-Enteritis, etc. 3 9 2 10 — Dysentery — 29 — 29 — Erysipelas 1 21 — 19 3 Puerperal Pyrexia 1 1 — 1 1 Nursing Mothers — 1 — 1 — Otorrheea — 3 — 3 — Infective Hepatitis 1 — — 1 — Observation 1 7 — 7 1 Nursing Infants 1 3 — 3 1 Pleurisy — 1 — 1 — Streptococcal Tonsillitis — 11 — 10 1 Skin Conditions — 2 — 2 — TOTALS 56 557 10 539 6 43 FINAL DIAGNOSIS. Disease. Recovered. Died. Total. Acute Anterior Poliomyelitis 6 6 Typhoid Fever - 1 1 Paratyphoid Fever 2 — 2 Dysentery (Bacillary) 21 — 21 Dysentery and Measles 1 — 1 Dysentery and Mumps 1 — 1 Dysentery and Chicken Pox 1 — 1 Gastro-Enteritis 10 1 11 Scarlet Fever 166 — 166 Scarlet Fever and Measles 2 — 2 Chicken Pox 23 — 23 Measles 104 1 105 Rubella 3 — 3 Whooping Cough 55 3 58 Whooping Cough and Dysentery 1 — 1 Diphtheria 1 1 2 Diphtheria Carrier 1 — 1 Croup 1 — 1 Erysipelas 16 — 16 Tonsillitis (Streptococcal) 22 — 22 Tonsillitis (Other Forms) 13 — 13 Strept. Throat and Acute Oedema of Larynx - 1 1 Meningitis 6 — 6 Meningitis Tuberculosis — 1 1 Virus Encephalitis 1 — 1 Acute Otitis Media 6 — 6 Bronchiolitis 1 — 1 Influenza, Bronchitis and Pneumonia 24 — 24 Skin Infection 4 — 4 Puerperal Pyrexia 1 — 1 Septic Abortion 3 — 3 Mumps 8 — 8 Glandular Fever 2 — 2 Infective Hepatitis 1 — 1 Food Poisoning 2 — 2 Endocarditis 1 — 1 Ulcerative Colitis 1 1 2 Stomatitis and Gingivitis 2 — 2 Migraine 1 — 1 Tuberculosis Pleural Effusion 1 — 1 Neuritis 2 — 2 44 In concluding this Report I would like to take the opportunity of thanking the Members of the Council for their continued interest in all matters affecting the public health. I wish also to thank the members of my staff for their loyal co-operation and devotion to duty during this year of transition—the most difficult in the history of the Department. It is only by the enthusiasm which they have displayed that the many administrative difficulties which have presented themselves are being overcome. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, A. FAIRCRIEVE ADAMSON, Medical Officer of Health. Disease. Recovered. Died. Total. Epilepsy 1 — 1 Cholera 1 — 1 Congenital Heart 1 — 1 Nursing Mothers 1 — 1 Nursing Infants 3 — 3 N.A.D. 13 — 13 P.U.O. 2 — 2 TOTALS 539 10 549 HENDON PRINTING WORKS LIMITED, 44, VICTORIA ROAD, LONDON, N.W. 4 (14419)