HEN 26 BOROUGH OF HENDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH for the year 1949 A. FAIRCRIEVE ADAMSON, M.D., D.P.H., Medical Officer of Health. BOROUGH OF HENDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH for the year 1949 A. FAIRCRIEVE ADAMSON, M.D,, D.P.H., Medical Officer of Health. COUNCIL of the BOROUGH 1949,1950 The Mayor: Alderman G. J. Pryke, J.P., F.I.A.C., A.M.I.S.E. The Deputy Mayor: Councillor J. H. Rodway, J.P. Aldermen: W R. Clemens, J.P., F.C.A. H. L. K. Johnson. J. J. Copestake, J.P. R. J. Knowles, M.M., M.W.M.A. A. W. Curton, F.R.S.A., M. Inst. B.E. A. A. Naar, M.B.E. J. L. Freedman, M.A., LL.B. G. J. Pryke, J.P., F.I.A.C., A.M.I.S.E. Councillors: L. Andrews. H. M. Matthews. S. E. Arridge, F.I.S.M.A. C. G. Monk, M.A. A. C. Brooke. S. J. Patmore, A.M.I.Mech.E., E. G. Burman, M.I.T.A. A.M.I.E.E., A.R.Ae.S. L. C. Chainey. A. Paul. A. J. Chown. J. L. Paul. D. A. Davis. J. H. Rodway, J.P. J. Griffiths. W. Rowley. J. Harley, T.D., A.I.B. S. E. Sharpe. R. Harrison. C. H. Sheill. L. A. Hills. D. F. Simons. D. J. James, O.B.E. A. V. Sully, M.C., F.C.A. E. M. D. Jones, F.C.A. S. R. C. Sumpter, F.B.A.A. W. R. Lawrence, M.A., LL.B. B. H. O. Turrall. (Cantab.). PUBLIC HEALTH COMMITTEE. Chairman: Alderman W. R. Clemens, J.P., F.C.A. Vice-Chairman: Councillor S. R. C. Sumpter, F.B.A.A. Aldermen: G. J. Pryke, J.P., F.I.A.C., A.M.LS.E. (Mayor). Vacancy. Councillors: A. C. Brooke. A. Paul. E. G. Burman, M.I.T.A. J. L. Paul. R. Harrison. C. H. Sheill. H. M. Matthews. B. H. O. Turrall. 2 ANNUAL REPORT of the Medical Officer of Health FOR THE YEAR 1949. July, 1950. To the Mayor, Aldermen and Councillors of the Borough of Hendon. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my nineteenth Annual Report on the health of the Borough of Hendon for the year 1949, this being presented in accordance with the requirements of the Ministry of Health. In submitting this Report 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. 3 GENERAL HEALTH CONDITIONS. VITAL STATISTICS: The Registrar General's estimate of the population on the 30th June, 1949, was as follows:— Civilian Population 157,130 Total Population 158,430 It is on the former figure that the vital statistics have been calculated. Birth Rate: The number of live births decreased from 2,292 in 1948 to 2,257 in 1949, giving a birth rate in 1949 of 14.36 per thousand live births, as compared with 14.65 for the previous year. The birth rate for the country generally was 17.9 for 1948 and 16.7 for the year under review. Death Rate: 1,522 deaths were registered, an increase on the previous year when the number was 1,406. Th crude death rate was 9.69, the corrected death rate having regard to the age and sex distribution of the population was 10.56 as compared with 11.7 for the country generally. Infantile Mortality: The infantile mortality rate, that being the number of deaths of infants under one year of age as related to the number of live births registered, was maintained at practically the same low figure as for the previous year, namely 22 per thousand live births as compared with 21. The rate for the country generally was 32 per thousand live births. The gradual diminution which has taken place in this rate, and which is illustrated in Table I. below, is largely the result of better living conditions and an increasing knowledge of parentcraft and infant care and in this latter connection no mean contribution has been made by the Local Authority under its Maternity and Child Welfare Scheme, which originated as far back as 1918, although in fact voluntary agencies had 4 carried out work in this field even before that date. I am glad to see that provision exists in the National Health Service Act, 1946, for the continuance of this work. It is particularly gratifying to be able to report that this low rate is being maintained despite the unsatisfactory housing conditions under which many members of the population and particularly the younger families are now living. TABLE I. Year Death rate of infants undei 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 1949 22 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 — 2 2 Diphtheria — — — Tuberculosis of respiratory system 39 12 51 Other forms of tuberculosis 1 2 3 Syphilitic disease 5 — 5 Influenza 4 9 13 Measles — 1 1 Acute poliomyelitis and polioencephalitis 4 2 6 Acute infectious encephalitis — — — Cancer of buccal cavity and oesophagus (M); uterus (F) 6 12 18 Cancer of stomach and duodenum 29 15 44 Cancer of breast — 26 26 Cancer of all other sites 110 81 191 Diabetes 3 12 15 Intra-cranial vascular lesions 67 89 156 Heart Diseases 223 231 454 Other diseases of circulatory system 35 48 83 Bronchitis 35 30 65 Pneumonia 30 46 76 Other respiratory diseases 11 10 21 Ulcer of stomach or duodenum 6 3 9 Diarrhoea under 2 years 4 2 6 Appendicitis 2 5 7 Other digestive diseases 14 21 35 Nephritis 15 14 29 Puerperal and post-abortive sepsis — 3 3 Other maternal causes — 2 2 Premature births 5 2 7 Congenital malformation, birth injury, infantile disease 23 9 32 6 Cause. Male. Female. Total. Suicide 9 12 21 Road traffic accidents 12 8 20 Other violent causes 11 13 24 All other causes 51 46 97 All causes—TOTAL 754 768 1522 TABLE III. CASES OF INFECTIOUS DISEASES OTHER THAN TUBERCULOSIS NOTIFIED DURING 1945, 1946, 1947, 1948 and 1949. Disease Total cases notified during Removed to Hospital, 1949. 1945. 1946. 1947. 1948. 1949. Scarlet Fever 180 199 152 241 265 137 Diphtheria 20 33 10 8 10 8 Pneumonia 129 139 128 139 159 41 Acute Poliomyelitis 4 16 18 5 29 26 Acute Polioencephalitis — — — — 3 3 Measles 2013 558 973 1289 1195 36 Whooping Cough 162 367 394 516 329 14 Cerebro Spinal Fever 4 8 10 2 5 5 Typhoid or Enteric Fever 1 — 3 3 — — Erysipelas — — — 38 23 7 Dysentery — — — 27 7 4 7 INFECTIOUS DISEASES: There is little to comment upon on the incidence of infectious diseases as compared with that of the previous year, but special reference should be made to the following: Diphtheria: It will be seen that 10 cases of this disease were notified but in only 4 of these was the diagnosis ultimately confirmed. 3 of these were adults who, as far as is known, had not been immunised, and one, a child aged 7 years, was admitted from Edgware General Hospital. The residence of this child was outside the Borough and while there is reason to believe that the child had at some time been immunised, the actual date of immunisation was not known. Immunisation against Diphtheria: The duty of making arrangements for immunisation against diphtheria of persons living in the area has been transferred to the Local Health Authority, namely, the Middlesex County Council, under Section 26 of the National Health Service Act, 1946. The scheme previously in force by which children under 5 years of age were immunised by the medical staff at the Health Centres was continued as was the scheme for primary and re-inforcing injections amongst school children. Section 26 (3) of the Act states:— "In making arrangements under this section a local health authority shall give every medical practitioner providing general medical services in their area under Part IV. of this Act an opportunity to provide services under this section." This has been done, and the scheme has now been extended to include immunisation by general practitioners. 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:— 8 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 1949 10* — 28376 * of these the diagnosis was confirmed in 8 cases in 1946, 8 cases in 1947, and 4 cases in 1949. Poliomyelitis and Polioencephalitis: The increased incidence of this group of diseases which has been evident for a number of years, again repeated itself, particularly during the summer months. Altogether, 32 eases were notified, but in addition 5 others who had been admitted to hospitals diagnosed as suffering from other conditions, were finally diagnosed as suffering from poliomyelitis or polioencephalitis. The cases were distributed throughout the Borough and no evidence of contact with other known cases could be established, excepting that in a private day nursery five children were attacked all within a period of 14 days. The original case in this instance was a boy who had been absent from the nursery for 4 days suffering from a febrile condition 9 and who was re-admitted to the nursery before the occurrence of the first definite case. In view of later developments, he was ultimately diagnosed as having suffered from a mild attack of poliomyelitis. Severity of Cases: The following gives an indication of the severity of attack in the cases of poliomyelitis and polioencephalitis which occurred during the year:— Died 4 Severe 5 Moderate 8 Mild 3 No subsequent paralysis 17 In this latter group, the diagnosis was in the majority of cases arrived at because of the characteristic changes which occurred in the cerebro-spinal fluid and no subsequent paralysis developed. The usual administrative measures were taken in an endeavour to reduce the number of cases. These were, briefly, as follows (1) Notices to the General Practitioners in the Borough advising them that the disease had re-appeared. (2) Advice to parents at Health Centres and through the agency of the local press. (3) The postponement of operative procedure for tonsils and adenoids at local hospitals and the cessation of all but emergency dental extractions at the local Health Centres. (4) The isolation of cases, the exclusion from school and the supervision of all contacts. The heightened incidence of the disease gradually subsided with the advent of the cooler weather, and the last case was notified on 6th December, 1949. 10 Tuberculosis: The following Table shows the notifications of tuberculosis since 1941:— TABLE V. Year. Notifications. Pulmonary. Non-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 1949 112 81 16 10 I am indebted to Dr. Trenchard, 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 1949 from 1,561 to 1,669 after taking into account transfers into and out of the area and the removal of the names of patients who had recovered, or who had been 'lost sight of' or who died. During the year the difficulties over the admission of patients owing to a shortage of staffed beds for tuberculous patients continued for adult men, but improved for children and for orthopædic cases. Unfortunately, the difficulties over admission of adult women have increased and such cases may have to wait up to 10 months before admission. Some of the worst cases have been dealt with by a system of priority in admission, but, of course, such a procedure deteriorates still further the position of cases on the ordinary list. There is a general shortage of beds for tuberculosis throughout the hospital region even though some additional beds are now open. 11 In consequence of the long wait for admission many patients have had to be treated in their own homes, using bed rest, some collapse measures (e.g., artificial pneunothorax or pneumoperitoneum) and streptomycin injections or therapeutic measures. Much help has been given by the general practitioners in the area and also by the home nursing service. The home help service has often enabled the mother of a family to remain in bed at home so as to receive treatment. The Chest Clinic now has its own X-ray department and a great deal of work is undertaken in X-raying the chests of patients for general practitioners. In all 7,489 patients were X-rayed from March to December, 1949." Food Poisoning: 41 cases of food poisoning were notified spread throughout the year as follows:— 1st 2nd 3rd 4th Quarter. Quarter. Quarter. Quarter. Total. 2 29 10 41 Amongst these were two minor outbreaks, one in which 10 persons were affected, the causal agent being Ox Tongue and the organisms isolated being Staphylococci. A bacteriological investigation was carried out amongst the food handlers who prepared the food with negative results. The duration of the illness was short, an average of two days, and there were no fatal cases. In the second outbreak, the food suspected was fish; 4 persons were affected, the symptoms were mild and all the cases had recovered in two days Unfortunately, it was impossible to carry out any bacteriological investigations as the notifications of the occurrence of the disease were received too late to be of value and none of the suspected food was available for investigation. In addition to these, 27 single cases were notified but these were unconnected with other cases and the origin of the attack was a matter of conjecture, and in a number of cases 12 the patient had recovered before the notification was received, so that in only eight cases did bacteriological investigation yield positive results and in each of these the organisms isolated were of the Salmonella group of food poisoning organism. I would like at this stage to express my gratitude to the staff of the Central Public Health Laboratory at Colindale, who have co-operated whole-heartedly in these and other investigations of public health interest and whose work on behalf of the Public Health Department and the practitioners in the Borough is recorded in the following Table:— RECORD OF EXAMINATIONS. Throat/Nose Swabs. Faeces. Sputum. Pertussis. Milk. Ice Cream. Water. Miscellaneous. TOTAL. 973 141 134 45 143 56 40* 212 1744 * Swimming Pools 37 Domestic Supplies 3 NATIONAL ASSISTANCE ACT, 1948. SECTION 47: The Borough Council on the representation of the Medical Officer of Health, decided to make application for the removal to suitable premises of a person in need of care and attention and served on the person concerned a Notice to that effect. The case was that of a very old woman whose precise age was difficult to determine, but who was reputed to be nearly ninety years of age. Attention had been called to this case by her own Doctor, by neighbours and by members of the Public Health staff. On visiting it was found that the woman concerned was very weak physically, her speech was incomprehensible and she was 13 living under grossly insanitary conditions. She, however, indicated that she was not prepared to be removed. Endeavours were made to obtain care and attention for her through neighbours, but they had already done all that could be reasonably expected, and through a friend, who, however, was not living in the district and was unable to help, but assistance was given by the provision of a Home Help. No relatives could be found and under all the circumstances the Council came to the conclusion that no option was left but to take action under Section 47 of the National Assistance Act. Unfortunately, this woman committed suicide before the Court Order could be made and at the subsequent inquest the Coroner recorded a verdict that the person took her own life while the balance of her mind was disturbed and he also considered that the Council had acted in accordance with their duty and in the best interests of the deceased lady. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT. MIDDLESEX COUNTY COUNCIL ACT, 1944, SECTION 353—363: The Council continued to exercise its function as a licensing authority under the provision of the above-mentioned Act. A person requiring a licence or renewal of a licence under this part of the Act must make application in writing to the Local Authority giving certain information, such as age, nationality, technical qualifications and nature of the establishment and business to be conducted thereat. The Council considered the following number of applications:— Renewals of Licences 24 Licences Refused 2 SANITARY CIRCUMSTANCES OF THE AREA. HOUSING: 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:— 14 "The Council has continued to give earnest attention to the rehousing of families living under inadequate housing conditions. During the course of the past twelve months 324 families have been rehoused in Council Houses, but even so the number of housing applicants requiring alternative accommodation continues to increase, and the number still awaiting rehousing shows an increase over last year's figures. A feature of the past year has been the number of transfers arranged whereby families not fully occupying houses have been moved to smaller property thus making the larger type house available for the bigger families. The demand from evicted families still continues to be heavy, and although 64 such families have been offered emergency accommodation in Half-Way Houses during the year, it has been impossible to assist in very many cases. The following table sets out the number of housing applicants assisted during the year ending 31st December, 1949:— 1. Number of families rehoused into Permanent Accommodation:— (a) Pre-War Houses 56 (b) Post-War Houses 247 (c) Temporarv Bungalows 21 324 2. Transfers arranged to relieve overcrowdding on Council Estates 102 3. Number of families rehoused into Requisitioned Property 69 4. Number of homeless families given emergency accommodation in Half-Way Houses 64" 15 HOUSING: Individual Unfit Houses: Demolition Nil Unfit for human habitation 2 Inspection of dwelling-houses during 1949: Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1119 Number of inspections made for the purpose — 3324 Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 576 Remedy of defects without service of Formal Notices: Number of dwelling-houses rendered fit in consequence of informal action by the Local Authority 488 Proceedings under Public Health Acts: Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 155 Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By Owner 98 (b) By Local Authority in default of Owner Nil 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 7663 Reinspections after order or notice 10943 Complaints received and investigated 1605 Nuisances discovered and dealt with 3581 16 Visits paid to Infected houses 641 Infected rooms disinfected 521 Cesspools emptied 166 Notices Served: Informal or cautionary 980 Complied with 941 Outstanding 1949 39 Statutory Notices: Applied for 287 Served under Public Health Acts, etc. 202 Complied with 116 Outstanding 86 DISINFESTATION: Treatment of Verminous Houses. 40 houses were successfully treated. Privately owned 31 Council houses 9 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 209 Notices served to remedy defects 17 Notices complied with 14 Matters notified by H.M. Inspector of Factories 14 Lists of Outworkers received 57 Outworkers' premises inspected 89 17 Nature of defects remedied at Factories: Sanitary accommodation: Unsuitable or defective 4 Improperly ventilated or unventilated 5 Want of cleanliness 7 Inadequate lighting -3 Other offences 16 INSPECTION AND SUPERVISION OF FOOD: 1,607 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. 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. 18 Total quantity of Canned Foods condemned 4454 Total weight of Other Foods condemned:— 5 tons 18 cwts 42 lbs. Informal action taken in connection with Food Shops and Food Stores: 115 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 106 instances. The principal matters dealt with were:— Sanitary Accommodation: Defective sanitary conveniences 8 Defects in drainage system 3 Choked drains 3 Compartments cleansed 24 Provision of washing facilities: Provision of hot water supply 43 Refrigerators: Interiors cleansed 5 General: Insufficient accommodation for storage of refuse 13 Want of cleanliness 37 Other defects 118 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 85 special visits have been made to secure cleanliness of dairies and dairy farms and for protecting milk against contamination. 19 There is one pasteurising establishment in the district and during the past year 29 samples of pasteurised milk and 26 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. 14 samples of raw bulk milk were taken from rail tanks, and 106 milk bottles immediately after cleansing in the bottle washing machines. The total number of milk samples taken for examination was 124; Tuberculin Tested Milk 36, Pasteurised Milk 74, and Non-Designated Milk 14. All the Pasteurised Milk Samples satisfied the Methylene Blue and Phosphatase Tests. The total number of samples (including cleansed bottles) was 230. 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. WATER SUPPLY: The Borough has a dual source of supply:— 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. 20 1. The Metropolitan Water Board supplied 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 ehlorination 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. 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 algæ in the water. 21 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. No. of Samples taken from West Hendon Swimming Pool 14 No. of Samples taken from Mill Hill Swimming Pool 16 RATS AND MICE (DESTRUCTION) ACT, 1919; INFESTATION ORDER. 1943: 855 complaints of 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 3565 Number of separate premises where treatment was given 1018 Number of dead rodents picked up during or after treatment:— Rats 1254 Mice 175 Estimated number of rats destroyed 11286 Estimated number of mice destroyed 2100 Total number of visits made by operators:— (a) Treatment 5151 (b) Advice 435 SCHOOL HEALTH SERVICES These services continued to function on the same lines as in previous years, but their administration has been modified in certain respects. The principal modification consisted of the transfer of treatment of school children from the Hendon Divisional Executive to the Area Committee. 22 The purpose of this change, which dated from the 5th July, 1948, was to co-ordinate the treatment of school children with the services provided under the National Health Service Act, which operated from the date. No description is therefore given of these services, but they remain substantially as has been described in previous reports. The Divisional Executive remains responsible for medical and dental inspection, cleanliness surveys, the ascertainment of pupils requiring special educational treatment, matters falling within Section 57 of the Education Act, which deals with children who are ineducable or require supervision after leaving a special school, and for the provision of the child guidance service. STATISTICAL TABLES: The following statistical tables relate to those portions of the School Health Services which are the concern of the Hendon Divisional Executive:— TABLE 1. A.—PERIODIC MEDICAL INSPECTIONS: Number of Inspections in the prescribed Groups:— Entrants 2169 Second Age Group 1611 Third Age Group 1693 Total 5473 Number of other Periodic Inspections 1832 Grand Total 7305 B.—OTHER INSPECTIONS: Number of Special Inspections 1818 Number of Re-Inspections 5295 Total 8113 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. For defective vision (excluding squint). For any of the other conditions recorded in Table IIA. Total individual pupils. (1). (2). (3). (4). Entrants 28 288 302 Second Age Group 94 108 197 Third Age Group 111 73 179 Total (prescribed groups) 233 469 678 Other Periodic Inspections 127 138 251 Grand Total 360 607 929 TABLE II. A.—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION. Defect or Disease. Periodic Inspections. Special Inspections. No. of defects. No. of defects. l. 2. l. 2. Skin 9 5 320 — Eyes—a. Vision 360 233 113 14 b. Squint 57 18 26 — c. Other 18 6 145 2 Ears—a. Hearing 17 17 6 — b. Otitis-Media 17 7 22 — c. Other 5 1 75 — Nose and Throat 242 195 184 12 Speech 25 25 18 5 Cervical Glands 27 77 18 7 Heart and Circulation 14 32 1 2 Lungs 2 61 4 — Developmental— a. Hernia 1 4 — — b. Other — 11 — — Orthopaedic— a. Posture 56 99 18 1 b. Flat Foot 46 102 13 3 c. Other 77 77 72 6 Nervous System— a. Epilepsy — — — 1 b. Other 4 12 4 2 Psychological— a. Development 5 5 9 — b. Stability 14 85 29 11 Other 6 24 520 3 1. Requiring treatment. 2. Requiring to be kept under observation but not requiring treatment. 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 2169 997 45.97 1018 46.93 154 7.10 Second Age Group 1611 701 43.51 785 48.73 125 7.76 Third Age Group 1693 934 55.17 699 41.29 60 3.54 Other Periodic Inspections 1832 804 43.89 919 50.16 109 5.95 Total 7305 3436 47.04 3421 46.83 448 6.13 TABLE III. DENTAL INSPECTION AND TREATMENT. Number of pupils inspected by the Authority's Dental Officers:— (a) Periodic age groups 5395 (b) Specials 4372 (c) TOTAL (Periodic and Specials) 9767 Number found to require treatment:— (a) Periodic age groups 3347 (b) Specials 3181 (c) TOTAL (Periodic and Specials) 6528 26 TABLE IV. DENTAL INSPECTION AND TREATMENT. Age-Groups. Number Inspected. Number found to require treatment. 4 53 24 5 408 158 6 674 355 7 654 372 8 406 285 9 415 284 10 470 312 11 537 340 12 577 397 13 506 346 14 397 282 15 223 152 16+ 75 40 Total 5395 3347 TABLE V. INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorised persons 33542 (ii) Total number of individual pupils found to be infested 512 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 1 iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) Nil 27 TABLE VI. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. (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 99 (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 25 (4) Number of cases in which certificates to take part in entertainments were withheld Nil ASCERTAINMENT OF HANDICAPPED PUPILS: It is the duty of every Local Education Authority to ascertain what children in their area require special educational treatment and in this connection the following Table shows the position at 31st December, 1949:— 29 TABLE VII. HANDICAPPED PUPILS. Category. In Special Day Schools. In Special Residential Schools. In Maintained Primary and Secondary Schools. In Independent Schools. Not at School. Total as at 31/12/1949. B. G. B. G. B. G. B. G. B. G. B. G. Blind Pupils — — 2 2 — — — — — 2 2 4 Partially-Sighted Pupils 1 — 3 2 2 — — — 1 — 7 2 Deaf Pupils 2 3 6 1 — — — — — 1 8 5 Partially Deaf Pupils 2 2 — 2 — — — — — 1 2 5 Delicate Pupils — — — 6 12 19 — — — — 12 25 Diabetic Pupils — — — 2 — — — — — — — 2 Educationally Sub-normal Pupils 18 22 7 2 29 10 1 1 3 3 58 38 Epileptic Pupils — — 1 — 2 2 1 — — 2 4 4 Maladjusted Pupils — — 9 3 12 4 — — — — 21 7 Physically Handicapped Pupils 3 2 7 3 5 2 — — 2 2 17 9 Pupils with Speech Defects — — — — 56 26 — — — — 56 26 Pupils with Multiple Defects — — 1 — 1 1 — — — 1 2 2 TOTALS 26 29 36 23 119 64 2 1 6 12 189 129 CHILD GUIDANCE: The arrangements by which seriously handicapped children are referred to the Tavistock Clinic for examination and treatment continued. Unfortunately the number referred from this and other areas exceeded the facilities available and a waiting list accumulated. Endeavours were made to overcome this difficulty by referring the children to other Child Guidance Clinics, but without much success as there the same conditions prevailed. It will be appreciated that in the majority of cases prolonged treatment is required not only of the child but indirectly of the parents so that a change of attitude on their part may be encouraged. Child guidance cannot hope to be successful without the co-operation of the parents and in the more serious cases a change of environment by admission to a special residential school may hold out the only prospect of cure or improvement. The mal-adjusted child is inevitably an unhappy child who does not fit into the community in which he lives and whose mental conflicts find expression in a multitude of ways from delinquency and antisocial behaviour which have wide repercussions, to physical manifestations peculiar to the individual child. 55 cases were referred for psychological treatment during the year under review. Section 57 (3) of the Education Act, 1944, places on the Local Education Authority the duty of reporting to the Local Authority for the purposes of the Mental Deficiency Act, 1913, the case of any child who has been found incapable of receiving education at school. Fourteen days' notice must be given to the parent of the intention of issuing such a report and the parent may, within that period, refer the question as to whether such a report may be issued, to the Minister of Education in which case a report shall not be issued excepting by the direction of the Minister. During the year 3 children were considered to be ineducable, but the parents of the children in question did not appeal to the Minister. Section 57 (5) places a duty on the Local Education Authority to notify to the Local Education Authority for the purposes of the Mental Deficiency Act, 1913, any child suffering from a disability of mind of such a nature or to such an 30 extent that he will in their opinion require supervision after leaving school. In this connection the majority of the mentally handicapped children from the Hendon Divisional Executive area are admitted to a special school administered by the Finchley Divisional Executive, who therefore become responsible for notifications under Sction 57 (5). During the year 4 reports were made by the Finchley Divisional Executive on behalf of Hendon children. 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: The year 1949 has not shown any improvement with regard to accommodation and general facilities. Space for indoor work is still severely limited owing to the high school population and the necessity, in many cases, of halls being used as classrooms or dining rooms. The appointment of Emergency Trained Teachers has increased the Physical Training Staff and most schools are numerically well supplied with teachers of the subject. The Area Organisers have arranged courses for Women and Men in Primary School Physical Education; Secondary School Physical Education, Dancing and Athletics. Demonstrations of Essex Agility Apparatus work were given and Assistant Teachers and Head Teachers from Primary Schools attended. The valuable work of the Remedial Gymnast still continues but the request for the appointment of a further Remedial Gymnast has not yet been approved. SWIMMING: The swimming instruction at open air pools was most successful as the weather in the summer term was exceptionally good, and the increase in transport facilities allowed schools to send more parties for tuition. The 31 indoor instruction at Hampstead Baths which has now become a regular all year round activity, has produced large numbers of good swimmers. Examinations for the Middlesex Swimming Tests were held throughout the year and the number of certificates awarded was a good advance on previous years. The standard of swimming in schools has appreciably improved since the introduction of these graded tests. ORGANISED GAMES: The majority of school games continued to be played on Public Parks and Recreation Grounds and the Borough Engineer and Surveyor and his staff have been most helpful in allocating pitches, providing special markings and maintaining grounds. Cressingham Road Field is now fenced in, seeding has been done and it is hoped to have full use of this field by the Spring of 1952. 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. CHILDREN UNDER 5 YEARS OF AGE: As the influence of the increase in the birth rate makes itself felt by the number of children reaching compulsory school age less space has been available in the infant schools for children below school age. 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 has been as heavy as hitherto. Whereas in 1945 there were 594 such children in attendance at "26 schools, there were only 403 children under five years of age in 20 schools at the corresponding time in 1949. Of these only 24 were between the age of 3 and 4 32 and were located in four schools. At the same time, 296 children were on the registers of the nursery schools associated with the day nurseries. ATTENDANCE: Throughout the year attendance was well maintained at approximately 90% each week. Only during certain weeks in the Spring and Autumn Terms, when weather conditions and illness were likely to cause a falling off in attendance, was there any noticeable drop in the school averages. A few, Deansbrook, Wessex Gardens and the Meads Infants' Schools fell below 75% for some three or four weeks during the year but otherwise the school attendance gave no indication of general ill-health or other difficulties. SCHOOL MEALS AND MILK: Since the previous report, the number of meals served has shown a slight increase. This is due to the conversion of the Granville British Restaurant into a School Meals Centre, where approximately 400 meals daily are cooked and served on the premises to senior and junior pupils of Childs Hill and St. Agnes, R.C. Schools and all the children of All Saints' C.E. School who require dinners. Two new Kitchen Dining Rooms to produce 500 meals each are nearing completion at St. James' R.C. and Garden Suburb Schools, which will help towards the reduction in the waiting lists which still persist in some schools. Statistics compiled in respect of the 20th October, 1949, show that 9,036 meals were served on this day, representing 56% of the children in school. Of these 3,509 or 61% were in attendance at Secondary Schools and 5,427 or 51% were children attending Primary Schools. The Milk in Schools Scheme continues to operate in all schools, although there appears to be a slight decrease in the number of children who are taking the milk. On October 20th milk was taken by a total of 14,513 children, 33 that is 89% of those in attendance at school. Of these, 9,783 were Primary School children and 4,730 were Secondary School children." Supplement. CENERAL INFORMATION. HEALTH SERVICES PROVIDED BY THE LOCAL HEALTH AUTHORITY (MIDDLESEX COUNTY COUNCIL). The Services enumerated below, with the exception of the Home Nursing Service, were previously administered by the Borough Council, but were transferred to the Local Health Authority on 5th July, 1948, under the provisions of the National Health Service Act, 1946. MATERNITY AND CHILD WELFARE SERVICE: The following gives particulars of the various clinics held in Hendon:— Child Welfare Sessions: West Hendon Centre, 215, The Broadway, N.W.9: Tuesday, 2 p.m. to 4 p.m. Friday, 2 p.m. to 4 p.m. Childs Hill Centre, Garth Road, N.W.2: Tuesday, 2 p.m. to 4 p.m. Wednesday, 2 p.m. to 4 p.m. Thursday, 2 p.m. to 4 p.m. Friday, 2 p.m. to 4 p.m. Central Hendon Centre, rear of Public Library. N.W.4: Monday, 2 p.m. to 4 p.m. Friday, 10 a.m. to 12 noon. Friday, 2 p.m. to 4 p.m. Mill Hill Centre, Hartley Avenue, N.W.7: Monday, 2 p.m. to 4 p.m. Wednesday, 2 p.m. to 4 p.m. Thursday, 2 p.m. to 4 p.m. Friday, 2 p.m. to 4 p.m. 34 Temple Fortune Centre, Gospel Hall, Bridge Lane, N.W.ll: Tuesday, 10 a.m. to 12 noon. Tuesday, 2 p.m. to 4 p.m. Watling Centre, Cressingham Road, Burnt Oak: Monday, 2 p.m. to 4 p.m. Tuesday, 2 p.m. to 4 p.m. Wednesday, 2 p.m. to 4 p.m. Edgware Centre, Parish Church Hall, Station Road, Edgware: Monday, 2 p.m. to 4 p.m. Friday, .2 p.m. to 4 p.m. Broadfields Centre, St. Andrew's Church Hall, Lynford Gardens, Edgware. Tuesday, 2 p.m. to 4 p.m. Thursday, 2 p.m. to 4 p.m. Cofindale Centre, Congregational Church Hall, Colin Close, N.W.9: Thursday, 2 p.m. to 4 p.m. Holders Hill Centre, St. Mary Magdalen Church Hall, Holders Hill Road, N.W.4: Monday, 2 p.m. to 4 p.m. Woodside Park Centre, Frith Manor School, Lullington Garth, N.12: Tuesday, 2 p.m. to 4 p.m. Ante-Natal Sessions: West Hendon Centre, 215, The Broadway, N.W.9: Tuesday, 9 a.m. to 12 noon. Wednesday, 2 p.m. to 4 p.m. Thursday, 9 a.m. to 12 noon. 35 Childs Hill Centre, Garth Road, N.W.2: Wednesday, 9 a.m. to 12 noon. Thursday, 9 a.m. to 12 noon. Friday, 9 a.m. to 12 noon. Central Hendon Centre, rear of Public Library, N.W.4: Wednesday, 9 a.m. to 12 noon. Wednesday, 2 p.m. to 4 p.m. Mill Hill Centre, Hartley Avenue, N.W.7: Tuesday, 10,30 a.m. to 12 noon. Thursday, 10.30 a.m. to 12 noon. Friday, 10.30 a.m. to 12 noon. Watling Centre, Cressingham Road, Burnt Oak: Thursday, 9 a.m. to 12 noon. Thursday, 2 p.m. to 4 p.m. Friday, 9 a.m. to 12 noon. DOMICILIARY MIDWIFERY SERVICE: Under the provisions of the National Health Service Act, an expectant mother is entitled to the services of a general practitioner obstetrician to attend her during pregnancy and the lying-in period and to be on call for her confinement in case of need. Alternatively, she may book a midwife who can attend either as a midwife or, if a doctor is also engaged, as a maternity nurse. The services of a midwife can be obtained through the Ante-natal Clinic which the mother attends, or if she does not attend a clinic, through the general practitioner obstetrician who has been engaged. The following gives the names and addresses of the midwives in TTendon:— 36 Name and Address. Telephone No. Area. Miss Lovell, 17, Woodland Way, N.W.7 Mill Hill 3040 Central Hendon and West Finchley. Mrs. Dyer, 30, Wordsworth Walk, N.W.ll Speedwell 0958 Hampstead Garden Suburb. Mrs. Jacobs, 55, Burnham Court, Brent St., N.W.4 Hendon 1361 West Hendon. Mrs. Noble, 18 Marlow Court, Colindeep Lane, N.W.9 Colindale 3224 Colindale. Miss Wiggs, 4, Chadbury Court, Watford Way, N.W.7 Hendon 3606 Mill Hill. Mrs. Lee, 25, Mowbray Road, Edgware Edgware 3355 Edgware. Miss Hobbs, 276, Crieklewood Lane, N.W.2 Gladstone 1358 Cricklewood. Miss Ditchburn, 276, Crieklewood Lane, N.W.2 Gladstone 1358 Childs Hill. Mrs. Betteridge, 51, Hillfield Avenue, N.W.9 Colindale 5357 Relief Duties. 37 HOME NURSING SERVICE: A free nursing service is available for all cases of illness which are being nursed at home. The service was previously established on a voluntary basis, operated by a number of District Nursing Associations and as far as Hendon was concerned, these were co-ordinated by the Central Committee for District Nursing Associations. The National Health Service Act, however, placed the responsibility for the administration and future development of the service on the Local Health Authority. The services of a Home Nurse can be obtained through the Doctor in attendance. The following gives the particulars of the full-time Home Nurses who were operating in Hendon during 1949:— Name and Address. Telephone No. Area. Miss Sennitt, 138, Whitchurch Lane, Edgware Edgware 1936 Edgware. Mrs. Elson, 1, Cloister Gardens, Edgware Mill Hill 2179 Edgware. Mrs. Savage, Chesdale, Powells Close, Canons Drive, Edgware Edgware 3575 Edgware. Miss Hartley, 32, Addison Way, N.W.11 Speedwell 8357 Hampstead Garden Suburb. Miss Brown, 131, Pennine Drive, N.W.2 Gladstone 2596 Golders Green and East Cricklewood. Miss Summers, 131, Pennine Drive, N.W.2 Gladstone 2596 Golders Green and East Cricklewood. 38 Name and Address. Telephone No. Area. Miss Jeremy, 33, Birkbeck Road, N.W.7 Mill Hill 1154 Mill Hill. Miss Perkins, Miss Bedforth, Miss Reid, Miss Rockey, Miss Maud, Nurses' Home, 1/3, Gervase Road, Burnt Oak Mill Hill 1836 Watling and district. Miss Hartshorn, 19, Mount Road, Hendon, N.W.4 Hendon 9188 West Hendon, Central Hendon and Colindale. Miss Smith, 19, Mount Road, Hendon, N.W.4 Hendon 9188 West Hendon, Central Hendon and Colindale. HOME HELP SERVICE: This service provides domestic help in the home in the event of the confinement or sickness of the mother, particularly where there are young children in the family. Help is also provided for households in which cases of tuberculosis are being nursed at home, and for aged persons. A charge is made for this service, but it is reduced or remitted in cases of financial hardship. Applications for this service should be made to the Area Health Office, Town Hall, Hendon, N.W.4. DAY NURSERY SERVICE: This service provides for the reception of children under five years of age into Day Nurseries. Admission is mainly restricted to the children of those women who are in employment, but temporary admission is also permitted for social 39 reasons, for example, during the confinement or illness of the mother, or of children suffering from psychological problems. The following gives particulars of the Day Nurseries in the Borough:— Address. Accommodation. Addington House, Orange Hill Road, Burnt Oak (Closed on account of structural defects.) 62 2, Hocroft Road, Childs Hill, N.W.2 50 Hyde School, The Hyde, N.W.9 45 York Park, Hendon. N.W.9 60 Claremont Road, Crieklewood, N.W.2 50 Approach Road, Edgware 35 Hyde Cottage, Hendon. N.W.9 65 1, Milespit Hill, Mill Hill, N.W.7 55 40 Hendon Printing Works Ltd., 42/44, Victoria Road, N.W.4 'Phone : HEN. 1004