BOROUGH OF HORNSEY. ANNUAL REPORT FOR THE YEAR 1922 on the HEALTH AND SANITARY CIRCUMSTANCES OF THE BOROUGH together with A RECORD OF THE WORK of THE SCHOOL MEDICAL SERVICE IN THE BOROUGH by A. T. Nankiveil, M.D. (Lond.), D.P.H. (Camb.) Gold Medallist iu State Medicine of the University of London ; Bachelor of Surgery of the University of London ; Licentiate of the Royal College of Physicians; Member of the Royal College of Surgeons ; Medical Officer of Health and School Medical Officer to the Borough of Hornsey ; Fellow of the Royal Society of Medicine and Fellow of the Society of Medical Officers of Health, etc. Formerly Temporary Captain, R.A.M.C. ; Medical Officer of Health, etc., of Poole, and Demonstrator of Public Health and Lecturer in Epidemiology at King B College in the University of London, STAFF OF PUBLIC HEALTH AND SCHOOL MEDICAL SERVICES. Medical Officer of Health Assistant Medical Officer of Health Assistant for Maternity and Child Welfare Purposes Senior Sanitary Inspector Sanitary Inspectors Chief Clerk Assistant Clerks Matron of Isolation Hospital School Nurses Clerk at School Clinic Health Visitors Mortuary Keeper Disinfectors A. T. Nankivell, M.D., D.P.H. J 11. Prior, M.D., D.P.H. Flora Shepherd, M.B. Wm. Thorpe Henry Eastwood W. S. Parsons James Goodman Harold L. Burt Wm. Gilroy Arthur C. Arnold Joseph B. Harrild George E. Dorrell Miss Irene Webb ,, Eva Hubbard ,, L. M. Oliver ,, M. Anscombe ,, M. Ockleston ,, A. Glover „ J. T. Macpherson ,, E. Bell Charles F. Catlin Wm. H. Lewis Wm. Rutter PREFACE. To the Mayor, Aldermen and Councillors of the Borough of Hornsey. Gentlemen, In accordance with the order of the Ministry of Health, I have the honour of presenting to you my second Report on the Health of the Borough of Hornsey. This Report is written on the lines advocated by the Ministry of Health. The past year has been' one of economy and of consolidation in our work. We have embarked on no fresh schemes; but, on the other hand, we have made the very best use of the resources at our disposal. The high level of the Public Health in the Borough has for long been the pride of the Burgesses, and it is pleasant to be able to record in this Report that this excellence in health and in sanitary circumstances has been well maintained. To be penurious where health was concerned would be indeed a bankrupt policy; but that it is possible to have a high standard of public health without spendthrift extravagance is amply shown by the conditions that exist in our Borough to-day. I should like to take this opportunity of thanking the Members of the Town Council for their support during the last twelve months, and of expressing my appreciation of the help afforded to me by the Heads of the other Borough Departments and by the various members of my staff. I am, Gentlemen, Your obedient Servant, A. T. NANKIVELL. January, 1923. 4 GENERAL CONSIDERATIONS. The Borough of Hornsey is 2,874 acres in area, and is situated to the north of the County of London. On the southeast the Borough is bounded by the Metropolitan Borough of Stoke Nevvington, on the south by that of Islington, on the south-west by that of St. Pancras, and on the west by the Metropolitan Borough of Hampstead and the Urban District of Finchley; on the north the Borough is bounded by the Urban District of Friern Barnet, and on the east by the Urban District of Wood Green and the Urban District of Tottenham. The centre of the Borough is about five miles north of Charing Cross, and there are rail, tube, tram and 'bus services between the Borough and the Metropolis. Hornsey is very largely a " dormitory town." Many of its inhabitants spend their days at work in the City and return home in the evenings. Speaking generally, the Borough consists of good house-property, which is occupied by the well-to-do classes; there is not much poor house-property, and there are no slum areas, although there are certain districts and roads in the Borough which would rapidly degenerate were it not for the constant efforts of the Health Department to keep these houses reasonably fit for human habitation. The Assessable Value of the Borough is £690,808, and a penny rate produced about £2,821 during the past year. There are no large factories in the district, no offensive trades are conducted, and there are no common lodging-houses and no dwellers in tents and vans. The climate of Hornsey is bracing, and the air is clean and fresh. The town lies above the smoke of London, and frequently when the City and West End are shrouded in a pall of smoke the sky can be seen blue over Hornsey. There are no flat and low-lying areas in the Borough, and, as the ground is generally undulating or hilly, the district is well drained and dry, although the sub-soil is a heavy clay. The Borough is fortunate in possessing many lovely open spaces, such as the Highgate Woods and the Queen's Woods: these undoubtedly add to the amenities and health of the Borough. — 5 — VITAL STATISTICS. Tables of figures showing the chief features of the vital statistics of the Borough of Hornsey will be found at the end of this Report. These tables of statistical matter, although they are not always interesting in the reading, are to be considered as comparable to an annual balance-sheet. They show the work done by the Health Department during the year, and enable us to contrast the conditions of to-day with those of previous years. Population.—The population of the Borough, estimated by the Registrar-General's method, was 88,007 in 1922. As I pointed out in my last Report, the taking of the Census in Midsummer, 1921, decreased our population figure, as many of our inhabitants were away in the country or at the seaside. The estimate of the present-day population, given above, which is worked out from the Census figures, is probably therefore an under-estimation. We shall not be able to arrive with accuracy at the figure of our ordinary population until the census is taken at a time when people are at home and not on holidays. Age and Sex Distribution (See Tables M. and N.).—A most instructive series of figures will be found in Table M. at the end of this Report. This table shows the numbers of persons of different ages who were in Hornsey on the last three occasions when the census was taken, namely, in 1901, 1911 and 1921. From these census figures it will readily be seen that we have now a greater proportion than formerly of elderly people in the Borough. In 1901 only nine per cent, of the inhabitants were over fifty-five years of age; but in 1921 more than sixteen per cent, were over fifty-five. Although people suffer from sickness and mortality at earlier ages, it is from fifty-five and onwards that the amount of disease and death increases rapidly. The years above fifty-five may well be spoken of as " dangerous ages." Whereas in the year 1921 the death-rate per thousand of Hornsey inhabitants aged less than 45 was only 4'3, that of those from 45-65 was 12.3 per thousand living, and persons over 65 years of age had a death-rate of 72.5 per thousand. To-day we have in our Borough nearly eight thousand more elderly — 6 — people than we had twenty years ago, and it is significant that during 1922 there were thirty more deaths attributed to old age than in the previous year. The fact that we have so many elderly people in the Borough is in itself a tribute to the essential healthiness of Hornsey: if we had been in the past an insanitary town these people would not have lived to grow old. But this larger proportion of older people, taken in conjunction with the fact of a steadily-declining birth-rate over a period of years, must necessarily mean that the average age of our population is rising. A young population, with its normal low deathrate, is no longer being recruited; and, on account of the decreasing numbers of young people and the increasing numbers of old people, we must expect to see a gradual increase in our death-rate. Table N. clearly shows the influence of age on the death-rates of Hornsey and of England and Wales in 1921. The last census showed that there was a considerable excess of females over males in the Borough of Hornsey. Altogether there are 12,063 more women than men in the Borough. This excess is chiefly due to the number of domestic servants. Up to the age of fifteen years the numbers of boys and girls in the town are practically equal—9,317 boys and 9,235 girls: in every other age-group, however, the females are in excess. For example, between the ages of 25 and 35 there are 5,794 males and 8,830 females in Hornsey—fifty-two per cent, more women than men of those ages. The Birth-rate, that is to say, the number of births per thousand persons in the Borough, was 15'5 during the past year. This is a decrease over the rate of last year, and is far below the birth-rates of fifteen or twenty years ago. One reason for this decrease is to be found in the later age at which people marry; and another, and probably more important cause, is the voluntary limitation of families by those parents who do not desire to have children. The Death-rate of the Borough of Hornsey for the year under review was only 1T2 per thousand population. This is a very low rate, and attests to the absence of unusual causes of mortality. Such a low rate would not be possible had the Borough — 7 — been subjected to epidemics of Pneumonia, Summer Diarrhoea, Measles, Whooping Cough, Influenza or Small-pox. The deathrate of a district is not, however, the best means of deciding whether the sanitary circumstances are perfect or otherwise; for, as I have pointed out, the rate (apart from fatal epidemics) depends much upon the numbers of infants and of the aged in a district. Mortality falls heavily upon the two extremes of age; and the town with few babies and old people will have a much lower death-rate than another equally healthy in which there are many old persons or infants. If our present-day population and death-rate in Hornsey remained stationary the average age at death would be 90 years. Eightly to judge of the health of a district the infant mortality rate and such records of sickness as are available are more to be relied upon than the death-rate by itselL The Infant Mortality rate of the Borough during the past year was remarkably low, namely, 52 per thousand births. This is nearly the lowest rate on record, and one of which we may justly be proud. Summer diarrhoea was practically absent from Hornsey during 1922, and therefore the lives of many babies were spared. The frail body of a little child is a very delicate indication of insanitary conditions, and the infant mortality rate reflects very truly the hygienic condition of a town. There are three main causes of the death of children during their first year of life. Firstly, they suffer from the ill-health of the parents— they are " born tired " or diseased, and live for a few hours or days; secondly, they die from injuries received at birth; and, thirdly, they perish from diseases and infections that are acquired amid unhygienic surroundings. It is this third group of morbid conditions against which at present we are fighting most successfully; but in future we hope to reduce the ante-natal causes of death by being able to give more attention to mothers at our ante-natal clinics. The intermediate group, injury at birth, is not in this Borough a cause of much infant mortality. There will be found in the Appendix to this Report (Table G.) a diagram which shows the infant mortality rate over a number of years. From this it will readily be seen that the death-rate due to antenatal causes has remained fairly constant for many years, while — 8 — that due to post-natal causes has shown a decline. Much of the credit for the saving of many lives is due to the admirable work which has been done for some years past at the Council's Maternity Centres. If in future we hope still further to reduce our rate of infant mortality, it will be necessary to diminish the number of deaths from ante-natal causes. This can only be accomplished by undertaking more ante-natal work at our Centres, where the expectant mother is taught how to safeguard the health of her unborn child. Causes of Death.—A tabulated statement showing the principal causes of death is given in the Appendix (Table B.). It is desirable, however, to make a few comments on it here. There were no deaths from Small-pox or Enteric (typhoid) Fever. There were 2 deaths from Scarlet Fever. This disease as a cause of mortality is negligible to-day, and of a very different nature to the Scarlet Fever of twenty-five years ago. It is a matter for regret that there were 7 deaths from Diphtheria. Delay in the adequate treatment of any disease diminishes the patient's chance of recovery, but in no disease is delay more deadly than in Diphtheria. Last year a certain amount of public discussion arose from a suggestion that gross neglect of diphtheria cases should be reported to the Coroner, and this discussion was of value in directing attention to the gravity of this disease and to the need for prompt measures in its treatment. Diphtheria Anti-toxin is supplied by the Town Council, and for the convenience of doctors it is kept at the Town Hall, the Isolation Hospital, the School Clinic and at the two Maternity Centres. Measles caused 3 deaths. Whooping Cough caused 7 deaths. Summer Diarrhoea caused the deaths of only 3 infants during the year. This disease is fly-borne; and, in the absence of flies, the summer diarrhoea is non-existent. The cold and wet summer — 9 — of 1922 was prejudicial to the breeding of flies, and, in addition, an active anti-fly campaign was conducted by the Health Department from March to September. The breeding-places of flies were discovered and abolished, manure-heaps were removed and sprayed with borax, and instruction was given to the mothers at the maternity centres regarding the protection of their infants from the few flies that were found in the district. Cancer was given as the cause of death in 145 instances. Reference to Table C. will show how the death-rate from Cancer has increased of recent years. Much of this increase is due to the fact that we have a larger proportion than formerly of persons over 45 years of age. Tuberculosis was given as the cause of death in 70 instances Details are shown in Tables B. and C. The general problem of the control and treatment of tuberculosis is in the hands of the Middlesex County Council. Heart Disease caused 89 deaths. Old Age was returned as the cause of death in 81 cases. Altogether 468 persons over the age of 65 died in the Borough during the past year. Venereal Diseases cause an amount of invalidism and mortality which is difficult to estimate. Many cases of blindness, deafness, paralysis and heart disease are due either to gonorrhoea or to syphilis, and to these diseases we can attribute a large number of all abortions, miscarriages, still births and deaths of newly-born children. It has been stated that, directly and indirectly, venereal diseases cause more deaths than Cancer and Tuberculosis together; however that may be, they certainly give rise to much more disability and crippling. On no subject connected with health is education more necessary; for, of all the infectious diseases, these are the most disastrous and fatal. In the future, when Continuation Schools are established and when hygiene is taught in our Secondary Schools, an opportunity will arise for giving the young adults of this country some instruction regarding the dangers of these infections. 10 SANITARY CIRCUMSTANCES OF THE BOROUGH. Water Supply.—The water supply of the district is from the mains of the Metropolitan Water Board. There are no wells or private supplies of water in the Borough. Closet Accommodation, Drainage and Sewerage.—All houses in the Borough are connected to the public sewers, and 166 tests of drains were made during the year. The majority of the sewage passes into the London sewers; a small part from some of the northern area is treated on the Corporation Sewage Farm in Coppett's Road. The final effluent from this sewage farm is invariably of a very high standard of purity. During the early months of 1922, when hunting out fly-breeding grounds, we discovered some pail closets on the sidings of the Great Northern Railway at Haringey, and some adjacent to the New River at Hornsey. Immediate steps were taken to improve the condition of these latrines, and it can now be said that tbey are of no danger to the public health. Scavenging.—Hornsey is a very clean town, and its roads and footpaths are frequently scavenged. The importance of tarspraying and of cleanliness is considerable from the point of view of the public health. There are 18 stables in the Borough, and special attention was given to these by the Health Department during the spring and summer in order to prevent the breeding of flies. The Inspectors made altogether 716 visits to these premises. House Refuse.—This is removed once a week from ordinary dwelling-houses and twice a week from flats, and is disposed of by burning in the Corporation Refuse Destructor. Arrangements have been made to deal with trade refuse which is brought to the Refuse Destructor by the shopkeepers. During the year the Town Council served notices on 128 householders to provide proper and sufficient ash-bins. Mortuary.—The public mortuary and coroner's court are situated in Hornsey. During the year 66 bodies were placed in the mortuary and 64 inquests were held at the coroner's court. — 11 — Cleansing Station.—A cleansing station has been established at the Hornsey Depot, primarily with the object of cleansing school children. During the year it was used in addition for the cleansing of 20 adults. Disinfection.—A steam disinfector at the Hornsey Depot serves to disinfect bedding, clothes and other articles from infected houses. Disinfection is offered now to householders, and is gratefully accepted, after deaths from cancer and tuberculosis as well as after the ordinary infective and contagious complaints. During the year 11,439 articles were disinfected. Two motorvans are employed in the collection and returning of such articles. Sanitary Inspection of the District.—Throughout the year inspection of the district was made by the Medical Officer of Health and the five Sanitary Inspectors. As the result of these inspections insanitary conditions were found on 3,815 occasions. Details of these defective and unhealthy conditions are given in Table D., and the work done by the inspectors is shown in Table E. In order to have these insanitary conditions abated 1,418 preliminary intimations were sent out from the office drawing the attention of the owner or occupier to the defects. In addition, 255 statutory notices were served and were obeyed, with the exception of 17 which were outstanding at the end of the year. In discovering defects and in seeing that these were properly remedied the inspectors made 13,903 visits during the year. PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BY-LAWS AND REGULATIONS. (a) Common Lodging-houses, (b) Offensive trades, (c) Underground sleeping-rooms, (d) Vans, (e) Canal boats, (f) Houses let in lodgings. None of these are found in the Borough. (g) Outworkers.—There were 137 outworkers on the register at the end of 1921. All their premises were visited, and generally the conditions found were satisfactory. (h) Factories and Workshops.—There are 83 factories and 245 workshops in the Borough. All of them are small establishments. They were visited on 777 occasions, and any unhealthy conditions that were discovered were remedied. — 12 — (j) Bakehouses.—There are 33 premises on the register which are used as bakehouses. They were visited 88 times. (k) Other Food Premises.—Frequent visits were made to premises where food is prepared or sold, and these were found generally to be of a high sanitary standard. (1) Places of public entertainment were visited and inspected 28 times. (m) Rag Flock Act.—Seventeen inspections were made under this Act, and the conditions found were generally satisfactory. (n) Shops Acts.—The sanitary inspectors act as inspectors under the Shops Acts. They made &43 visits during the year, and found that generally the provisions of the Acts are observed. In cases of infringement the offender has been cautioned. (o) Schools.—The Medical Officer of Health is also the School Medical Officer, and this ensures co-ordination between the two Health Services. A special report is issued on the School Medical Service. FOOD. The administration of the Sale of Food and Drugs Acts is in the hands of the Middlesex County Council. Unsound Food.—No unsound meat, fish, fruit or vegetables were found exposed for sale during the year, but about 2,600 lbs. of food that was unfit for human consumption was voluntarily surrendered to us by provision dealers. No instances of food poisoning came to my notice during the year. There are 7 Slaughter-houses in the Borough. They are well kept. Last year they were inspected on 76 occasions. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. (See Tables F. and K.). Small-pox.—There have been no cases of small-pox in the Borough during the year, although the disease occurred in neighbouring areas and was prevalent in London during the autumn. 13 Although no cases of small-pox were notified in Hornsey, we suffered from several " false alarms," which served the useful purpose of testing the efficiency of our methods for dealing with an actual case of the disease. At one time it seemed not unlikely that London would be attacked by a small-pox epidemic, and it was therefore considered desirable to take certain precautionary measures in this Borough. Some twelve thousand leaflets, urging the desirability of vaccination or re-vaccination, were sent out to the public elementary, secondary and private schools in the Borough; and the doctors who practise in Hornsey were circularised regarding the disease so that they might co-operate as much as possible with the Health Department in discovering the first case. Posters supplied by the Guardians were displayed throughout the Borough; and it is satisfactory to be able to report that the public, and especially the unvaccinated children, availed themselves to a great extent of the offer of vaccination. Small-pox does not tend to spread and to become epidemic in a wellvaccinated community, and, although this Borough is never safe from an imported case of small-pox, yet it is in a far stronger position now to withstand an epidemic than it was in the late summer of last year. The widespread neglect of vaccination in former years has been due much more to the indolence and apathy of parents than to any conscientious objections which they may have had to this certain method of preventing disease ; and there are very few persons who, in the face of an epidemic of smallpox, are found to hold their objections tenaciously. The Borough of Hornsey contains no small-pox hospital, but arrangements have been made for the treatment and isolation of its small-pox patients at the small-pox hospital of the Uxbridge Joint Hospital Board. The Borough of Hornsey now has the right to use ten beds in this hospital. Typhus Fever, Continued Fever, Cholera, Dysentery, Relapsing Fever, Trench Fever, Cerebrospinal Fever, Poliomyelitis.—There were no cases of these diseases notified. Diphtheria.—There were 123 cases of this disease notified during the year. The cases were scattered and not related to a milk supply. Diphtheria is almost always a case-to-case infection, and is spread by missed cases and carriers. One small 14 outbreak occurred at Campsbourne School, and swabs were taken from the noses and throats of all suspected children in the same class. One child, who subsequently admitted to have been ailing, was found to harbour the bacilli of Diphtheria in her throat. She was sent to the Isolation Hospital, and the outbreak ceased promptly. Year by year, in preparing my Annual Report, I have been able to record the occurrence of a school diphtheria outbreak which was immediately checked by swabbing and by isolating those who were found to be infective. In some quarters I believe that the swabbing of contacts is regarded as being expensive, troublesome and not worth the bother: that, however, is not my experience. Given a nurse who is able to take the swabs properly, and a bacteriologist who is competent to examine them, the control of diphtheria in a school or institution is a matter of no great difficulty. That, at any rate, has been our fortunate experience in Hornsey. Scarlet Fever has shpwn a marked decline in 1922 compared to the previous year. Altogether 280 cases were notified (Tables F. and K.). The disease spreads by personal contact, and it isi the mild and " missed " cases which give rise to others. No cases were traced to infected milk during the year under review. Scarlet Fever to-day is a trival complaint, and very different from that dreadful disease so rightly feared by our parents and grandparents. Erysipelas was notified on 24 occasions. This disease is no more infectious or contagious than a poisoned finger or a carbuncle, and there is no reason whatever why it should be a notifiable disease. Cases of erysipelas can safely be nursed in their homes or in ordinary wards of a general hospital, provided that reasonable cleanliness is observed. Encephalitis, Malaria and Enteric Fever.—Only one case of each of these diseases was notified. They call for no special comment. Pneumonia.—One hundred and four notifications were received of this infectious disease. Pneumonia, especially in children and in old people, is one of the most common causes of death; and, in order to attempt to reduce the numbers of cases during the autumn and winter of 1922, a mixed vaccine was sent — 15 — free by the Health Department to those doctors in the Borough who desired to use it. Out of 98 doctors practising in Hornsey, 60 availed themselves of this offer. There are strong grounds for believing that the use of such a vaccine at suitable intervals throughout the winter months affords considerable protection against those micro-organisms that cause pneumonia and bronchitis. Those who are liable to such respiratory infections certainly seem to benefit by the administration of such a vaccine. Puerperal Fever.—There were 2 notifications of this disease during the year. Ophthalmia neonatorum.—This acute inflammation of the eyes of newly-born children was notified on 10 occasions. The condition is generally gonorrhceal. The Health Visitors visited the cases. One child lost its sight in consequence of this terrible infection, which is one of the common causes of blindness. Tuberculosis.—During the year 112 cases of tuberculosis were notified. Although the administrative control of this disease is in the hands of the Middlesex County Council, we take every opportunity of disinfecting those houses from which a case of tuberculosis has gone, and offer disinfection also from time to time during the illness. During the year 97 rooms which had been occupied by tuberculous people were disinfected, and 628 articles were sterilised by steam. Disinfection.—During the year 875 rooms were disinfected by sidphur or formalin, and 11,439 articles were passed through the Council's steam disinfector. In addition to these, 178 articles were destroyed after infectious diseases. Note.—The attack-rates of the population of Hornsey from certain infectious diseases have been worked out for the last twenty years, and are given in Table K. in the Appendix. ISOLATION HOSPITAL. At the end of September the Isolation Hospital in Coppett's Road ceased to be the property of the Borough of Hornsey. For many years past an arrangement has been under review by the Councils of Hornsey, Finchley and Wood Green with the object of making this institution a joint hospital, owned equally by the — 16 — three districts. The negotiations to bring this about were completed during 1922, and the Hospital is now the joint property of these three Authorities, and is managed by a Commitee composed of members from each of the three Councils. The Medical Officers of Health of the three districts act in the capacity of consulting Medical Officers to the Hospital, and Dr. J. R. Prior, the former Resident Medical Officer, has been appointed its Medical Superintendent. The diseases ordinarily admitted to the Isolation Hospital are Scarlet Fever and Diphtheria. Occasionally a case of Puerperal Fever, of Erysipelas, or of Enteric Fever is admitted. Considering the mild nature of Scarlet Fever and its very low rate of mortality, it may be considered more logical to keep cases of this disease in their own homes and to send some other more infectious and more deadly condition, such as Measles or Summer Diarrhoea, into the Hospital instead of admitting Scarlet Fever. Unfortunately there still exists in the public mind a great horror of " fever," and a corresponding disregard for far more serious diseases; and it is to be feared that the exclusion of Scarlet Fever from the Hospital would not meet with the approval of the public. In order to save lives and to improve the public health, it may be necessary, in the future, when the people are more enlightened, to make a change in the character of the cases now sent into hospital. During the year under review there were admitted to the Hospital from the Borough of Hornsey 223 cases of Scarlet Fever, 106 cases of Diphtheria, 2 cases of Erysipelas, 1 case of Enteric Fever, 1 case of Measles, 1 case of Whooping Cough and 1 case of Meningitis. MATERNITY AND CHILD WELFARE. (See Tables G., H. and J.). On no branch of Preventive Medicine can money and energy be better spent than upon Maternity and Child Welfare Work. If an infant can be given a good start in life and escape the dangers that so easily beset it during the first few years of existence, a healthy constitution is established which will enable the child to grow and prosper into a healthy adult and a useful member of society. — 17 — It is difficult to estimate the amount of vital force and money that is wasted in the premature deaths of infants; but it is interesting to notice that if the infant mortality rate of forty years ago in Hornsey existed to-day, we should, during the past year, have witnessed the deaths of 91 children under one year of age who are now alive and well. During the past ten years approximately 710 children's lives have been saved which would have been lost had they been living under the conditions that were found in 1880-1890. Although these figures are remarkable, they tell only a small part of the truth; for they make no allowance for the large number of children who have been saved from attacks of non-fatal sickness. An infant who has passed through a bad attack of diarrhoea or survived a severe attack of measles or of whooping cough, is a child who subsequently is often badly damaged : its health is sub-normal, its nutrition is impaired, its powers of resistance are lowered. Such a survivor tends to become one of those human wrecks which we see, too frequently, in our hospitals and poor-law infirmaries. The great reduction in infant mortality and in infant sickness has prevented many a child from becoming a chronic invalid in after days. Staff.—The organisation of the Maternity and Child Welfare Work in the Borough is under the control of the Medical Officer of Health. He is assisted by a part-time lady doctor, Dr. Flora Shepherd, who conducts infant consultations at Brook Road Centre on two days in the week and at Wightman Road Centre on one day in the week. An ante-natal clinic is also held at both the centres by Dr. Jessie Muir, who is paid for her service from funds collected by the mothers themselves. In addition, there are three Health Visitors whose duties are to visit and advise mothers and to help in the work at the centres. A midwife is engaged by the Town Council, and her work is much appreciated by the mothers. Voluntary Workers.—It would not be possible to do such good work at the centres if we were not helped by a number of voluntary workers. These ladies devote much time to their valuable work, both at Brook Road and at Wightman Road, and it is largely owing to their unselfish labour and untiring activity that our Maternity and Child Welfare Work has been so successful during the year. 18 Future Extension of Work.—In my Report for 1921 I wrote on this matter as follows :— " The Maternity Committee is aware that there is need for the extension of our activities. It was felt, however, that, in view of the economic situation, any extension of the work at the present time would be undesirable. The Committee recognises that there is a real need both for additional sessions at our two centres and also for a third centre to be opened at Highgate. It is hoped that when the financial position is less difficult our valuable work among the mothers and young children may be extended." These words are equally true to-day. It is undeniable that we have done and are doing very good work; but there is plenty more that is waiting to be done. Our infant sickness will not be materially reduced, nor our infant death-rate lessened, until we further increase our staff and the number of sessions that are held. The time may not yet be opportune for this additional expenditure of money; but I hope the day for this will not be long delayed. We need especially more sessions for ante-natal work, at which expectant mothers may consult and be advised by the doctor; for, until we have these, and until they are attended by the majority of expectant mothers, we shall not see much reduction in the rate of infant mortality that is due to ante-natal causes. Milk (Mothers and Children) Orders.—After careful investigation of oases, milk is allowed free or at half-price to pregnant women and nursing mothers and to children under one year of age. During the year 297 applications for milk were received, and of these 257 were granted, the remainder being refused. Milk from a dairy, or dried milk, is given according to the needs of the case. Home for Unmarried Mothers.—There is a small but admirable home situated in Upper Tollington Park where unmarried mothers are received and cared for until and after their confinements. This home receives a grant from the Town Council, and the mothers and babies attend the Maternity Centre in Wightman Road. 19 OTHER DETAILS OF ADMINISTRATION. Staff.—There are five Sanitary Inspectors and four Clerks in the Medical Officer's Department. In addition, there are two caretakers attached to the maternity centres; one caretaker at the coroner's court and mortuary, and two disinfectors. Occasional labour for drainage work is obtained as it is required. All the members of staff have done work of a high standard of excellence throughout the year; and the thanks of the Medical Officer are due to all of them, and especially to the Senior Sanitary Inspector, Mr. Thorpe, and to the Chief Clerk, Mr. Gilroy. Borough Laboratory.—This is situated at the Isolation Hospital. The majority of the specimens examined were from the Hospital itself and from the School Clinic. During the year 1,217 specimens were examined in the laboratory, and of these 1,030 were swabs taken for the diagnosis of diphtheria infection. CONTAGIOUS DISEASES OF ANIMALS ACTS. No cases of suspected Rabies were reported, and no cases of Parasitic Mange were brought to our notice. The Veterinary Inspector, Mr. J. Buxton, M.R.C.V.S., granted several certificates for the movement of animals during the year, and also examined some cows and steers which were stated to have been in contact with infectious disease. HOUSING. Hornsey is mainly a residential town of good-class houses, but here and there are patches of inferior house property. There are, however, no insanitary areas and no slums. A slum can be defined as a collection of dwellings which are grossly overcrowded and in such an insanitary condition that they are not fit for human habitation. Certainly there are houses in the Borough overcrowded, but none in which insanitation co-exists with the overcrowding. The Health Department perpetually has under review the poorer class of house, and, by timely repairing, these properties are prevented from further disintegration. 20 Speaking generally, the condition of the poorer house property in Hornsey has improved during the last few years. During the War and in the years immediately succeeding it, the cost of repairs was excessive, and it was difficult to persuade property owners to do much to their houses. Now, however, prices are more reasonable, and labour is easier to obtain: the result is that the necessary repairs are carried out, and this class of house is better than it was three or four years ago. Many houses in the Borough which were originally intended and built for the use of one family are now occupied by two or more families, and it is in these especially that sanitary supervision is needed. If two, three or four families share a sink or water-closet, it is no one's business to keep it clean: it is the business of nobody to look after the common passage and the common back-yard. Another evil associated with the sub-letting of these houses is that many of the families have no proper cooking-place: there is only one cooking range or gas-cooker in the house, and only one family has access to it. The remainder have to get along as best they can by cooking on a bedroom fire or on a gas-ring. Hot water and baths are unknown luxuries in many of these tenements, and it is not to be wondered at that vermin are sometimes found in these houses. Indeed, it is a matter for astonishment that so many people in such adverse circumstances manage to keep themselves and their homes clean and respectable. As I stated in my last Annual Report, I do not think that the provision of more working-class houses would materially diminish this overcrowding, for the reason that the families now living in one or two rooms could not afford to live in larger houses and to pay an additional rent. It is difficult to obtain figrures which are comparable year to year regarding overcrowding; but my personal experiences during 1922 lead me to believe that the overcrowding was not so acute as it was during 1921. The house shortage, as far as Hornsey is concerned, is mora a national than a local problem. During the year under review we discovered 39 houses that were bug-infested. It is not an easy matter to rid a house of these creatures, for they are more than usually tenacious of life, — 21 — and hide away in cracks and crannies, behind skirting boards and under wallpaper, and in holes in the plaster and in windowsashes, where it is difficult to reach them. These houses were, however, energetically disinfested, and relapses were reported in only seven instances. The houses are being kept under special observation. Some statistical details regarding the work of the Health Department in the matter of housing are given in Tables D., E. and L., which last-named table gives the results of house-to-house inspection of 497 premises. LIST OF TABLES. TABLE A.—Vital Statistics, 1901-22. TABLE B.—Causes of, and ages at, death during the year 1922. TABLE C.—Death-rates per 10,000 population from Cancer and Consumption, 1901-1922. TABLE D.—Nuisances and other defects discovered. TABLE E.—Work of the Inspectors during the year. TABLE F.—Cases of Infectious Disease notified in 1922. TABLE G.—Chart showing Infant Mortality and the General Death-Bate 1883-1922. TABLE H.—Work done at the Maternity and Child Welfare Centres during the year. TABLE J.—Infant Mortality during the year 1922. TABLE K.—Attack-rates per 10,000 population from Scarlet Fever, Diphtheria and Enteric Fever, 1901-1922. TABLE L.—House-to-house Inspection in 1922. TABLE M.—Age distribution of population, 1901, 1911 and 1921. TABLE N.—Death-rates at various ages, Hornsey and England and Wales. TABLE A. BOROUGH OF HORNSEY VITAL STATISTICS, 1902—1922. Year. Estimated Mid-Year Population. Birth Kate per 1,000 Population. Death Kate per 1,000 Population. Infant Mortality per 1,000 Births. Zymotic Death Kate per 1,000 Population. 1902 74,653 20.8 8.6 82 0.5 1903 75,757 20.6 8.0 83 0.6 1904 76,861 21.6 8.9 86 0.9 1905 77,945 20.0 8.7 67 0.5 1906 79,069 20.1 9.8 84 0.9 1907 80,173 19.0 9.5 76 0.5 1908 81,254 18.2 9.2 63 0.5 1909 82,378 18.3 9.5 57 0.4 1910 83,401 16.7 8.8 69 0. 3 1911 84,592 17.5 9.6 78 0.9 1912 84,840 16.3 9.9 75 0.4 1913 85,122 16.7 9.7 56 0.5 1914 85,456 17.8 9.2 57 0.5 1915 85,800 15.5 12.2 80 1.0 1916 86,147 16.0 11.5 46 0.3 1917 86,450 11.3 10.9 70 0.3 1918 86,942 11.7 13.8 61 0.5 1919 87,100 13.6 11.4 64 0.2 1920 87,410 19.3 10.3 54 0.5 1921 87,691 15.9 11.0 51 0.6 1922 88 007 15.5 11.2 52 0.3 105 Great Towns (Rates in 1922) 21.5 13.0 81 — 155 Smaller Towns (Rates in 1922) 20.5 11.7 75 — London (Rates in 1922) 21.4 13.4 73 — ENGLAND and WALES (Rates in 1922) 20.6 12.9 77 — TABLE B. CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1922. CAUSES OF DEATH All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and over. 1 Enteric Fever 0 ... ... ... ... ... ... ... ... 2 Small-pox 0 ... ... ... ... ... ... ... ... 3 Measles 3 ... 2 1 ... ... ... ... ... 4 Scarlet Fever 2 ... 1 ... 1 ... ... ... ... 5 Whooping Cough 7 4 2 1 ... ... ... ... ... 6 Diphtheria and Croup 7 ... ... 3 3 1 ... ... ... 7 Influenza 40 1 ... ... ... ... ... 12 17 8 Erysipelas 1 ... ... ... ... ... ... ... 1 9 Pulmonary Tuberculosis 57 ... ... ... ... 16 23 22 2 10 Tuberculous Meningitis 5 ... ... 1 4 ... ... ... ... 11 Other Tuberculous Diseases 8 ... ... ... 1 3 1 2 1 12 Cancer 145 1 ... 1 ... 2 12 70 59 13 Rheumatic Fever 6 ... ... ... 2 ... ... 1 3 14 Meningitis 4 1 ... 1 ... ... 2 ... ... 15 Organic Heart Disease 89 ... ... ... 1 1 9 31 47 16 Bronchitis 72 1 1 1 ... ... 4 6 59 17 Pneumonia 80 7 3 2 ... 2 6 26 34 18 Other Respiratory Diseases 3 ... ... ... ... ... ... 1 2 19 Diarrhoea and Enteritis 3 3 ... ... ... ... ... ... ... 20 Appendicitis 12 ... ... ... 3 2 5 ... 2 21 Cirrhosis of Liver 5 ... ... ... ... ... ... 3 2 21a Alcoholism 4 ... ... ... ... ... ... 3 1 22 Nephritis 34 ... ... ... ... 1 3 11 19 23 Puerperal Fever 3 ... ... ... ... 1 2 ... ... 24 Other accidents of Pregnancy and Parturition 2 ... ... ... ... ... 2 ... ... 25 Congenital Debility, etc. 42 41 ... ... 1 ... ... ... ... 26 Violent Deaths 29 4 ... 3 1 ... 3 11 6 27 Suicide 13 ... ... ... ... ... 2 9 2 28 Other Defined Diseases 316 8 ... 4 5 3 22 63 211 29 Ill-defined Diseases ... ... ... ... ... ... ... ... ... Total 992 72 11 18 22 26 104 271 468 TABLE C. DEATH.RATES PEE 10,000 POPULATION, from CANCER AND TUBERCULOSIS Year. Cancer. Tuberculosis. 1901 6.3 8.6 1902 6.8 9.1 1903 8.2 8.7 1904 6.3 10.0 1905 8.6 9.4 1906 8.2 7.6 1907 9.5 8.6 1908 10.3 8.5 1909 9.1 10.1 1910 10.5 7.2 1911 12.1 9.2 1912 13.4 7.0 1913 10.3 8.1 1914 9.1 6.0 1915 11.5 8.9 1916 12.3 12.2 1917 13.1 9.5 1918 14.8 10.2 1919 13.7 8.8 1920 13.6 8.4 1921 16.1 10.0 1922 16.5 7.9 TABLE D. NUISANCES AND DEFECTS DISCOVERED, 1922. No. of Premises requiring structural repairs 855 ,, ,, ,, „ cleansing and limewashing 321 Drains choked 63 ,, otherwise defective 168 Defective W.C. fittings 262 ,, Yard surfaces 128 ,, Eaves and downspouts 320 ,, Manure receptacles and ashbins 145 ,, Sinks and waste-pipes 77 ,, Urinals 13 Offensive accumulations 50 Animals improperly kept 11 Other nuisances and defects 1,559 Total number of nuisances and defects 3,815 Total number of all visits to all premises for all purposes 13,003 TABLE E. WORK DONE DURING THE YEAR 1922. No. of visits re Infectious Diseases 1,220 ,, ,, houses visited re Infectious Diseases 840 ,, ,, ,, disinfected after Infectious Diseases „ „ „ „ „ other „ ,, ,, drains (smoke) tested 150 „ „ „ (water) „ 16 ,, ,, visits to Outworkers 309 „ ,, ,, ,, Factories and Workshops 777 ,, ,, ,, ,, Slaughter-houses 76 ,, ,, ,, ,, Bakehouses 88 ,, ,, ,, ,, Rag-Flock 17 ,, ,, ,, ,, Places of Public Entertainment 28 ,, ,, ,, ,, Dairies 57 ,, ,, ,, ,, Other food shops or provision stores 301 ,, ,, ,, ,, Under Shops Act 943 ,, ,, ,, ,, Schools 2 ,, ,, ,, ,, Houses under Rent Act 62 ,, ,, ,, ,, Other premises 9,586 TABLE F.—INFECTIOUS DISEASES NOTIFIED DURING 1922. Scarlet Fever. Diphtheria. Enteric Fever. Malaria. Puerperal Fever. Erysipelas. Ophth. Neon. Pneumonia. Encephalitis Lethargica. Tuberculosis. Total. Admitted to Hospital Phthisis. Other forms. Highgate 25 10 0 0 0 1 1 9 0 9 3 58 28 Muswell Hill 7 16 0 0 0 2 0 13 1 11 1 51 14 Crouch End 18 2 0 0 1 3 2 7 0 7 1 41 9 West Hiirnsey 64 41 0 0 1 6 5 28 0 20 5 170 94 East Hornsey 51 25 1 1 0 7 0 10 0 17 2 114 65 Nth. Haringey 53 11 0 0 0 1 2 14 0 11 1 93 43 Sth Haringey 30 6 0 0 0 1 0 5 0 9 1 52 25 Stroud Grceu.. 22 5 0 0 0 2 0 7 0 8 1 45 17 Finsbury Park 16 7 0 0 0 1 0 11 0 4 1 40 13 T otal 286 123 1 1 2 24 10 104 1 96 16 664 A dmitted to Hospital 201 103 1 0 1 2 0 0 0 — — 308 Scarlet Fever. Diphtheria. Enteric Fever. Malaria. Puerperal Fever. Erysipelas. Ophth. Neon. Pneumonia. . Encephalitis Lethargica. Tuberculosis. Total. Admitted to Hospital Phthisis. Other forms. 1st quarter 123 53 0 0 1 8 2 52 1 25 3 268 118 2ud quarter 56 22 1 0 0 5 4 21 0 21 4 134 56 3rd quarter 57 15 0 1 1 4 1 7 0 27 5 118 62 4th quarter 50 33 0 0 0 7 3 24 0 23 4 144 72 Total 286 123 1 1 2 24 10 104 1 96 16 604 308 TABLE G. Showing Death-Rate and Infant Mortality Rate in Hornsey, 1863-1922. INFANT MORTALITY RATE DEATH HAT£. NOTE.—The Death-Rate is shown as an interrupted line. The Infant Mortality Rate is shown as columns in which the post-natal causes of mortality are represented by the unshaded part, and the ante-natal causes by the shaded part. It will readily be seen that although the Infant Mortality due to post natal causes has declined considerably, yet that due to ante-natal causes has shown no diminution. TABLE H. MATERNITY AND CHILD WELFARE WORK DONE DURING THE YEAR 1922. Nature of Work. Centres. No. 1. No. 2. Total. Number of Sessions held 199 100 299 Number of Ante-natal Sessions held 39 7 46 Number of Mothers seen by Doctor:— Ante-natal 323 71 394 Post-natal 855 292 1,147 Number of Babies entered on Register:— During Year 624 267 891 Maximum Number of Babies on Register:— During any one month 971 433 1,404 Number of Babies seen by Doctor 4,877 2,372 7,249 Number of Babies weighed 7,737 3,562 11,299 Children Normal—general advice given 1,569 1,142 2,711 Suffering from incorrect feeding 348 209 557 Suffering from Rickets 135 84 219 Suffering from Wasting 44 122 166 Difficult Nutrition 401 226 627 Suffering from other Diseases 967 332 1,299 Referred to own private Doctors 47 56 103 Referred to Hospitals 206 71 277 Health Talks given by Nurses 58 47 105 Visits paid by Nurses:— To expectant Mothers 324 151 475 To Infants under one year 2,642 1,362 4,004 To Children aged 1-5 years 1,895 1,510 3,405 Total Visits paid by Nurses 4,861 3,023 7,884 TABLE J.—INFANT MORTALITY DURING 1922. CAUSES OF DEATH. Deaths from staked causes at various Ages under One Year of Age. Total Deaths under One Year. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Whooping Cough — — — — 0 1 — 1 2 4 Tuberculous Meningitis — — — — 0 — — — — 0 Other Tuberculous Diseases — — — — 0 — — — — 0 Convulsions — — — — 0 — — — — 0 Bronchitis — — 1 — 1 1 — — — 2 Pneumonia — — — — 0 3 3 1 — 7 Diarrhoea — — — 1 1 2 — — — 3 Rickets — — — — 0 — — — — 0 Injury at Birth 2 1 — — 3 — — — — 3 Premature Birth 15 3 2 1 21 — — — — 21 Atrophy, Debility and Marasmus 4 2 1 2 9 4 2 1 — 16 Other Causes 1 — 3 2 6 4 4 1 1 16 Total 22 6 7 C 41 15 9 4 3 72 TABLE K. ATTACK-RATES PER 10,000 POPULATION FROM SCARLET FEVER, DIPHTHERIA AND ENTERIC FEVER. Year. Scarlet Fever. Diphtheria. Enteric Fever. 1902 35.0 13.2 4.8 1903 26.8 8.1 1.9 1904 25.6 13.1 1.9 190S 33.4 19.8 2.6 1906 52.0 19.9 3.1 1907 35.3 12.2 1.4 1908 29.5 11.5 1.0 1909 26.9 18.3 0.5 1910 20.7 12.6 1.1 1911 21.2 15.7 0.7 1912 16 .2 10.3 1.0 1913 24.2 13.5 1.2 1914 40.7 11.8 1.1 1915 21.1 12.2 2.9 1916 11.9 8.8 0.9 1917 15.3 7.7 0.4 1918 10.1 7.6 0.9 1919 23.3 10 .0 0.6 1920 27.9 17.0 0.6 1921 67.4 21.5 0.2 1922 32.5 13.9 0.1 TABLE L.—HOUSE-TO-HOUSE INSPECTIONS, 1922. Premises. Houses or Tenements. Defective Drains. Obstructed Drains. Defective Sanitary Fittings. Defective Water-closets. Rainwater Pipes, Gutters, etc. Defective Pavings. Dampness. No Damp Course. Dirty Premises. Overcrowding. Dustbins. Drinking-water Cisterns dirty. Do. without covers. Other Defects. Satisfactory. Myddelton Road 17 — — 4 — 12 3 11 2 9 — 5 2 5 10 2 Clarendon Road 54 — — 7 1 20 6 23 - 28 - 15 5 2 25 14 Rathcoole Gardens 208 — 3 45 1 86 6 9 — 23 - 12 14 14 42 17 St James' Lane 29 - - — 1 4 — 1 — - — 6 — 1 - 19 North Hill 46 — - — 2 5 1 2 — 17 — 1 3 1 6 26 North Road Cottages 22 — — — 6 1 2 — — 10 — — - — 3 6 Castle Yard 11 — — 4 2 3 — — — — - — — — — 3 Southwood Lane 34 3 — 7 6 8 2 5 — 14 — 5 4 3 15 16 Middle Lane 6 1 6 4 1 2 1 — — — - 1 1 1 7 — Fortis Green 4 4 3 1 — 3 2 — — 1 - — — 1 4 - Archway Road 40 — — — — — — — — 17 - - — — — 24 Townsend's Yard 9 — — 3 2 4 2 3 - 2 — 1 — 1 5 2 Coppett's Road 17 — — — — 3 1 1 — — — — — — — 13 Total 497 8 12 75 22 151 26 55 2 121 0 46 29 29 117 142 TABLE M. AGE DISTRIBUTION OF POPULATION OF HORNSEY, 1901, 1911 and 1921. AGES. 1901. 1911. 1921. Number of Persons living at various ages. Percentage of total Population at each age. Number of Persons living at various ages. Percentage of total Population at each age. Number of Persons liviag at various ages. Percentage of total Population at each age. Under 5 years 6,554 9.09 6,586 7.78 5,469 6.23 5 years but under 10 6,111 8.48 6,464 7.64 6,333 7.22 10 ,, ,, ,, 15 6.020 8.35 6,222 7.35 6,750 7.70 15 „ „ „ 20 7,729 10.72 7,549 8.92 6,941 7.91 20 ,, „ ,, 25 8,334 11.56 8,59.t 10.15 7,078 8.07 25 ,, ,, „30 7,534 10.45 8,422 9.95 7,325 8.35 30 „ „ ,, 35 6,737 9.34 7,763 9.17 7,299 8.32 35 ,, „ „ 40 5,454 7.56 6,963 8.23 7,370 8.40 40 ,, ,, „ 45 4,602 6.37 6,191 7.32 6,941 7.91 45 „ „ „ 50 3,502 4.97 5,174 6.11 6,406 7.30 50 „ „ „ 55 2,914 4.04 4,30S 5.09 5,527 6.30 55 „ „ „ 60 2,132 2.95 3,296 3.89 4,477 5.13 60 „ „ „ 65 1,742 2.41 2,659 3.16 3,537 4.07 65 „ „ „ 70 1,165 1.61 1,884 2.24 2,534 2.91 70 „ „ „ 75 763 1.05 1,280 1.53 1,836 2.09 75 and over 763 1.05 1,240 1.47 1,836 2.09 Total at all ages 72,056 100 84,592 100 87,659 100 Persons under 55 years 65,491 90.93 74,233 87.71 73,439 83.71 Persons over 55 years 6,565 9.07 10,359 12.29 14,220 16.29 TABLE N. DEATHS OF PERSONS PER 1,009 LIVING AT VARIOUS AGES. HORNSEY AND ENGLAND AND WALES, 1921. Age. Death Rate—Hornsey. Death Rate—England and Wales. Under 5 17.3 28.5 5 years but tinder 10 1.9 2.6 10 „ „ „ 15 1.8 1.8 15 „ „ „ 20 2.4 2.7 20 „ „ „ 25 1.5 3.3 25 „ „ „ 35 3.6 3.7 35 „ „ „ 45 3.8 5.2 45 „ „ „ 55 0.6 11.0 55 „ „ „ 65 17.3 22.1 65 „ „ „ 75 42.8 15.0 75 and over 143.2 193.8 Annual Report FOR 1922 ON THE SCHOOL MEDICAL SERVICE OF THE BOROUGH OF HORNSEY BY A. T. Nankivell, M.D. (lond.), D.P.H. (Camb.), Medical Officer of Health and School Medical Officer. PREFACE. To the Chairman and Members of the Education Committee. Ladies and Gentlemen, I have the honour of presenting to you my second Report upon the School Medical Service in the Borough of Hornsey. Throughout the year 1922 good work has been done in safeguarding the health of children of school age; and, although we have undertaken no additional lines of treatment and have embarked on no new schemes, we have made the most of the organisation at our disposal. This Report follows closely on the lines desired by the Board of Education; but, since a full report on our administration was given last year, it has been thought unnecessary to repeat much of the information then given. I should like to take this opportunity of thanking the Education Secretary and the members of his Staff for the help that they have given me during the past twelve months; and to express my appreciation of the work of the Assistant School Medical Officer (Dr. J. R. Prior) and of those other Doctors who have helped with the clinical side of the work. To the School Teachers and to the School Nurses I should like also to express my thanks for their hearty co-operation. I am, Your obedient Servant, A. T. NANKIVELL. January, 1923. 4 GENERAL. The object of our School Medical Service is to secure that every child shall be reasonably healthy during its school life, so that it may be able to profit by instruction and be able later to earn its own living. To attempt to teach an ailing child is a waste of public money, and to put a sick child later on to the labour market to struggle against a heavy handicap of invalidism is merely to recruit a population for the workhouse infirmary. By inspection of children when they enter school, and again when they are aged 8-9 years, and yet again when they are 12-14 years of age, we are able to detect the early signs of disease; and by means of our school clinic we are enabled to have this early disease remedied. The body of a child is plastic, and responds very readily to appropriate treatment. Owing to this repeated inspection and to the opportunity for adequate treatment, it is few, if any, children who pass through the critical years of 5-14 with physical conditions which are capable of being remedied. Very many of the children who enter our public elementary schools have benefited by previous attendance with their mothers at one of our Maternity and Child Welfare Centres. The records of these children are passed on to the School Medical Service, and we have therefore in many instances complete medical records of school children from birth. It would be logical to pass these records to the panel practitioner for his enlightenment; but unfortunately a gap exists of two years between the time that the child leaves school and the time when he joins the State Insurance Scheme. During these two years the growing boy or girl is under no definite medical care, and the health records are of use to no one. It is certainly regrettable that during two important years of life the State should take no means of safeguarding the child's health, and that after fourteen years of Municipal and State effort the child, at a difficult period of existence, should be without adequate medical supervision. This criticism does not, of course, apply to those children who enter a secondary school, nor to those in residential institutions: and if ever we have continuation schools or classes for the growing boy or girl together with adequate medical supervision of these we shall no doubt further improve the health of our young adults. 5 SANITARY CONDITION OF SCHOOLS. The conditions of sanitation in the schools are generally excellent, and I have nothing to add to the comments that I made in my last Report. ORGANISATION OF THE SCHOOL MEDICAL SERVICE. This remains as formerly, and calls for no special remarks. We have inaugurated no new schemes during the past year. I should like, however, to express my regret at the departure of the Clinic Clerk, Miss M. Ockleston, to whose devoted work much of our success at the School Clinic has been due. Owing to family reasons Miss Ockleston was compelled to resign her appointment towards the end of the year. EXTENT AND SCOPE OF THE WORK. During the year the school nurses made 944 visits to the schools and 1,146 visits to the homes of children. At these visits to the schools the nurses made a cursory examination of no less than 32,943 children, inspecting them for obvious defects, such as skin disease, sore eyes, discharging ears or verminous conditions. These inspections, though rapid and superficial, are of the greatest value, since they usually result in securing treatment for the condition before it becomes chronic and difficult to be cured. These "class-to-class" inspections are also of definite educative value to the children, to their parents and to the teachers. A summary of the work of the school nurses will be found in Table 10. The Routine Examination of children has been carried out as usual during the year, and does not call for special comment Three age-groups of children were examined, the entrants aged 5-6, the intermediates aged 8-9 and the leavers aged 12-13. The number of children examined in each school will be seen on reference to Table 8. The defects that were discovered at the routine inspection are shown in Table 2. 6 GENERAL REVIEW OF FACTS DISCLOSED BY MEDICAL INSPECTION. Malnutrition.—Out of 2,622 children examined at the routine inspection during the year, 234 were found to be suffering from malnutrition. The chief causes of malnutrition are (1) lack of sufficient food; (2) improper and indigestible food; (3) unsuitable home conditions; (4) excessive employment out of school hours; (5) illness and disease. Clothing and Footwear.—Out of 2,622 children examined at the routine inspection during the year, 40 were found to have defective clothing and 69 to have defective footgear. Uncleanliness.—Out of 2,622 children examined, 214 were found to be unclean at the time of the routine inspection. Five children had live lice in their heads, and 138 others had nits (or eggs of lice), and 41 were found to be flea-bitten. During the year, as the result of class-to-class inspection, the school nurses Lave discovered 1,084 children who were unclean. No child should pass through a school without learning one of the most important lessons, namely, that of the value of cleanliness; and this lesson is being taught both by the teachers and by the school nurses. The number of children reported to be dirty may appear considerable, but the general cleanliness of the school child shows now a vast improvement on ten years ago. To-day it is the adults more than the children who are lousy and dirty. The children are kept clean in the schools, and they are cleansed if necessary at the cleansing station, but they go home to be re infected with vermin from adults in the same house. Whenever we cleanse a child we offer to disinfect its bedding and bedroom, out we have no power to compel the verminous mother or elder sister to be clean. Despite this great hindrance to our work, the extermination of the school louse is slowly proceeding, and the children themselves are properly impressed with the horror of bringing a louse to school. Enlarged Tonsils and Adenoids.—Out of 2,622 children examined at the routine inspection 407 were found to have enlarged tonsils or adenoids or both of these conditions. 7 Defective Hearing.—Thirty deaf or partially deaf children were discovered during the year. Deafness is due in many cases to the presence of adenoids; in others, to middle ear disease, secondary to measles or to scarlet fever. Defective Vision.—Out of 2,622 children examined at the routine inspection, 235 were found to have defects of vision which required treatment. Details of these children are given in Table IV. B. Other Eye Diseases.—Out of 2,622 children examined at the routine inspection, 26 were found to be suffering from other diseases of the eyes or eyelids. Dental Diseases.—At the routine inspection, out of 2,622 children examined, 1,793 were found to have good teeth, 584 to have less than four bad teeth, and 245 to have more than four bad teeth. The School Dental Surgeons in their careful examination of children in the schools found that out of 6,600 children examined no less than 4,205 needed treatment. Rheumatism and Heart Disease.—Out of the 2,622 children examined, 26 were found to be suffering from organic lesions of the heart, the sequel in the majority of cases to a previous attack of rheumatism or rheumatic fever. In addition to the above, 49 children were found who had some functional heart condition, and 41 were anaemic. Bronchitis and Pre-tuberculous condition of the Lungs.—At the routine inspection, out of 2,622 children examined, 107 were found to be suffering from bronchitis or from pre-tuberculous lung conditions. Chronic bronchitis in children is of grave significance, and the most satisfactory method of treatment is that of sending the child to an open-air school or to a convalescent home. Tuberculosis.—Out of 2,622 children examined, 4 were found to be suffering from definite pulmonary tuberculosis, and 3 others had some other form of tuberculosis. 8 Ringworm.—During the year under review 26 children were found who were suffering from ringworm of the scalp and 10 who had ringworm of the skin. Impetigo or Infectious Sores.—During the year 234 children were discovered who were suffering from impetigo. Scabies or the Itch.—During the year 40 children were found to be suffering from this irritating condition. Enlarged Lymphatic Glands.—Out of 2,622 children examined 257 were found to have enlargement of the lymphatic glands. In the majority of instances these enlargements were secondary to decayed teeth or to inflamed tonsils or to some other septic condition. In a few cases the enlargement was tuberculous in nature. Mental Deficiency.—During the year under review 12 children were seen who were mentally defective. The mentally defective children in the school at Finchley were inspected twice during the year by the School Medical Officer. A REVIEW OF THE METHODS EMPLOYED FOR TREATMENT. Treatment can be provided for the ailing child in one of three ways:—(1) From the general practitioner in his capacity as family physician; (2) at the voluntary Hospitals; and (3) at the School Clinic. The School Clinic is situated in Topsfield Parade, Crouch End, and during the year it has been instrumental in providing treatment for 4,137 children, who attended there on 11,137 occasions. The treatment of various conditions will now be described under the same headings and in the same order as those in the previous section of this Report. Malnutrition.—I consider that there is very little, if any. malnutrition in Hornsey that can be attributed to insufficiency of food. There is some, however, that is due to the ignorance 9 of parents who feed their children on substances that are unsuitable. Sweetstuffs, pickles and strong tea is not a suitable diet for a growing child, and the careless mother is often to blame for the malnutrition of her children. These, too, are days when amusement and excitemeht night by night is too often part of the existence of a child. Children are allowed to roam the streets or to spend their evenings at the pictures when they ought to be in bed and asleep. Several instances of malnutrition being associated with late hours and lack of repose have come to my personal notice during the year. This is a matter for which it is difficult to find a remedy, for to bring a sense of her duty to the bad mother is well-nigh impossible. Milk and cod liver oil are provided in certain cases where the School Medical Officer thinks that a child will benefit thereby. The milk is provided by the Care Committees, and in some instances the parents of the children pay for the milk: in other cases it is given free to necessitous cases after inquiry has been made into the home circumstances of the children. All the children, about 50 in number, who have received milk during the year are inspected from time to time by the School Medical Officer, and are weighed monthly by a School Nurse. Without exception during the year these children who have been receiving milk at the schools have done well. They have gained in weight, and are more vigorous and healthy than they were before the milk was given them. In some instances the teachers report definite improvement in a child's mentality, and the parents also remark upon their children's improved physique. Milk is a cheap and perfect food, and contains all those factors necessary for growth and development. Several children who have been given malt and cod liver oil during the year have also shown marked improvement. There is one great advantage, however, that milk has over cod liver oil: the milk is drunk by the child at school under proper supervision, and there is no doubt that twice a day the child receives its milk. But the cod liver oil and malt is generally taken at home, and, being pleasantly sweet and sticky, it is no doubt sampled and enjoyed by all the children of the family to the detriment of the delicate child, who is robbed of his fair share of it. To obviate this the Head Mistress of one department gives in school their doses of oil and malt to the children for whom it has been ordered, 10 A few children suffering from malnutrition which was associated with illness were sent to convalescent homes during the year. Uncleanlincss.—The Education Committee has provided an excellent cleansing station where verminous and unclean children can be cleansed and their clothes can be sterilised. During the year 121 children passed through this cleansing station, and made altogether 142 attendances. Adenoids and Enlarged Tonsils.—Four children are operated on every Saturday morning at the School Clinic for these conditions. At the end of the year there were 58 children waiting for this operation. I wish again to put on record that, although the arrangements made for these operations at the Clinic are as perfect as possible the Clinic itself is no place in which to perform this operation, of which the results are sometimes very serious. It would be better if all children who need this operation could be admitted into hospital and kept there for fortyeight hours in order to recover from the effects. As this does not appear to be at present a practicable arrangement we continue to perform these operations at the School Clinic and take every possible precaution to minimise danger to the children. I am glad to be able to report that during the year under review all the operations were safely performed. Defective Hearing.—Cases of chronic otorrhcea are treated at the School Clinic, and these take up a large part of the time of the school nurse. During the year under review 106 children with ear discharge attended on 1,275 occasions at the Clinic. Defective Vision.—Children who are found to be suffering from defective vision are treated at the School Clinic and examined by the Assistant School Medical Officer, who prescribes for them the necessary glasses and gives what other treatment is necessary. This arrangement has worked satisfactorily during the year, and 314 children attended on 1,613 occasions for examination and treatment. 11 Dental Diseases.—Two part-time dentists are employed by the Committee to examine and to treat children who have defective teeth and oral sepsis. During the year they have done much good work. Details of their examinations and treatments are given in Table IV. D. Rheumatism and Heart Disease.—The majority of cases of heart disease discovered during the year did not appear to be in need of treatment. In certain cases directions regarding the child's general health were given to the parents. Bronchitis and Pre-tuberculosis.—Apart from general instructions to parents and the administration of cod liver oil and malt it was not possible to do much for this group of ailing children. Some individual cases were referred to the Tuberculosis Officer. Tuberculosis.—Children discovered to be suffering from active tuberculosis were in all instances referred for advice and treatment to the Tuberculosis Officer. Ringworm.—The skin infection is treated at the School Clinic. Children with ringworm of the scalp are referred for treatment to a local doctor who is an expert at X-Ray work. This has already resulted in a diminution of the number of cases of this condition. During the year 14 children received X-Ray treatment for ringworm of the scalp. Impetigo.—This is treated successfully at the School Clinic, and 199 children suffering from this complaint made 733 attendances during the year. Scabies.—Children with scabies are treated at the cleansing station. During the year 40 children underwent the treatment there, and attended on 172 occasions. In every case the Health Department offered to disinfect free of cost the bedding and bedroom at the house where the child lived. To cure a child of scabies and to send it home to sleep in an infected bed is obviously a waste of time and money. Enlarged Lymphatic Glands.—The conditions, such as septic skin troubles, which give rise to enlargements of the glands are treated at the Clinic. 12 Mental Deficiency.—Children who can benefit by instruction in a special non-residential school are sent to the school in Finchley, which is shared by Finchley, Wood Green and Hornsey. Other conditions.—One hundred and fifteen children suffering from minor injuries made 316 attendances at the Clinic during the year, and 111 children with other skin diseases came for treatment on 264 occasions. Altogether during 1922 there were 705 children who came to the Minor Ailment Clinic for treatment by the Doctor and Nurse; these children made 3,088 attendances. It is obvious that the Minor Ailment Clinic is doing very good work, and is providing medical treatment and advice for children who otherwise would be without it. The children who attend the Minor Ailment Clinic come from poor houses where medical treatment by a private doctor would be a luxury that could not be afforded. Many of the ailments treated and cured at the Clinic are of a nature which parents tend to regard as trifling and of no importance; and, if it were not for the Clinic, no medical treatment would be obtained for the child with the sore eyes, discharging ears and other minor ailments. GENERAL REVIEW OF HOME CONDITIONS AND EMPLOYMENT. Under this heading I have nothing to add to the remarks which I made in my last Report. ACTION TAKEN TO DETECT AND PREVENT THE SPREAD OF INFECTION IN SCHOOLS. This is, generally speaking, the same as last year. The teachers, school attendance officers, nurses and medical officers are always on the watch for possible cases of infectious disease, and no doubt the good health of the school children during the year was due, in part, to this carefulness. The year under review was a non-epidemic year, in marked distinction to the two or three preceding. We have suffered from no epidemics in the schools, and only a few sporadic cases of infectious diseases have been reported. It seemed at one 13 time that Diphtheria might become prevalent in Campsbourne Girls' School, but timely swabbing and the detection of an infected child prevented this. During the Small-pox scare in the early winter, leaflets were circulated throughout the schools calling attention to the value of vaccination. One of these leaflets is reproduced in the Appendix to this Report. In order still further to check the incidence of infectious disease in the schools it would be desirable to have sufficient trained nurses in order that one of these might visit every class daily and follow to their homes such children as were absent. The daily presence of a nurse in a school is certainly calculated to reduce the amount of infectious disease, since she becomes aware of early cases of illness. When the financial position is less difficult and more money can be spent on public health this is no doubt one of the first extensions of our work that will be undertaken. LEGAL PROCEEDINGS. It was found necessary to take legal proceedings during the year in 2 cases under S. 122 of the Children's Act. In both cases fines were imposed on the parents of the verminous children. Under the same section 280 preliminary and 99 statutory notices were served on parents, and children were compulsorily cleansed in 31 instances. In five cases notices under S. 12 were served with satisfactory results. BOROUGH OF HORNSEY. MEDICAL OFFICER'S DEPARTMENT. SMALL-POX. Small-pox has been present in the Midlands and in Lancashire and Yorkshire during the last year, and it has now come to London. Small-pox is a disfiguring disease, and it is often fatal. Recently out of the first thirty-seven cases of Small-pox at Poplar no less than eleven persons died. Small-pox is very infectious, and spreads rapidly among persons who have not been vaccinated. People who have been recently vaccinated cannot be attacked by Small-pox. The Nurses and Doctors who work in Small-pox Hospitals never get the disease because they are vaccinated. Vaccination is a very cheap and safe form of insurance against this terrible disease. Parents are advised to have their children vaccinated so that they may be protected against Small-pox. Vaccination can be performed by any private Doctor, or, free of charge, by either of the Public Vaccinators, who are:— Dr. S. C. Pritchard, 1, North Road, Highgate, N.6. Dr. T. E. A. Pearman, 81, Hillfield Avenue, Hornsey, N.8. Vaccination protects against Small-pox for at least seven years. Persons who have not been vaccinated for seven years are advised to be re-vaccinated. A person sickening for Small-pox is ill for two days before spots appear on the face, body and limbs. The advice of a Doctor should at once be taken if these symptoms appear in any member of the family. A. T. NANKIVELL, M.D., D.P.H., Medical Officer of Health and School Medical Officer, Hornsey. 8th November, 1922. BOROUGH OF HORNSEY. BAD TEETH AND ILL-HEALTH Very many people do not understand how much ill-health and disease is caused by dirty mouths and bad teeth. Very many illnesses start because of bad teeth. Nobody wants to suffer from chronic ill-health, and no one wants a child to grow up only to be an invalid. The following diseases and enfeebling conditions are caused through bad teeth:—Ulceration and Inflammation of the Mouth and Throat, Gastritis, Dyspepsia and Indigestion, some cases of Appendicitis, Enlarged Glands and Abscesses in the Neck, Tuberculosis (or Consumption), Rheumatism, Anaemia. All these crippling conditions, which wreck the health and happiness and lead to disease and death, are caused by bad teeth. It is especially important to take care of the teeth of growing children. Decayed teeth should be pulled out or filled, and no child should be allowed to keep even one rotten tooth in its mouth. One bad tooth makes others go bad, and a child who has bad teeth is a child who is being slowly poisoned. It is especially important to take care of the first set of teeth (the milk teeth), for, if these are allowed to decay, then the permanent teeth will be damaged. We all of us want to see the children in this town growing up strong and healthy, and for this reason the Education Authority has established a Dental Clinic at 5,Topsfield Parade (close to the Clock Tower), Crouch End, where Dental Surgeons will give dental treatment to all school children. In this way we hope to save the lives of some children and to safeguard the health of many more. It is never too early to begin to prevent disease, and it is much easier and better to put a child's teeth right than to try to cure the young man or woman in a few years' time who has some crippling and distressing disease. So while the child is at school make the fullest use of the Dental Clinic that has been provided for the treatment of school children's teeth, and the child will thank you in years to come. To prevent the decay of teeth. 1. Do not let the child eat sweets, especially at night-time. 2. Make it use a toothbrush night and morning. Take an interest in the Health and the Teeth of your Child. A. T. NANKIVELL, M.D., School Medical Officer, Hornsey. LIST OF TABLES. TABLE (1)—Number of Children Inspected. ,, (2)—Defects found on examination. ,, (3)—Return of Exceptional Children in Area. ,, (4) — (a) Treatment of Minor Ailments. (b) ,, ,, Visual Defects. (c) ,, ,, Defects of Nose and Throat. (d) ,, ,, Dental Defects. ,, (5)—Summary of Treatment of Defects in Table 4. ,, (6)— ,, relating to Children Inspected. ,, (7)—Accommodation, etc., at Schools in the Borough. ,, (8)—Number of Children Examined at each School. ,, (9)—Work done at Minor Ailments Clinic. ,, (10)—Summary of Work done by School Nurses. ,, (11)—Age and Sex Distribution of Children and Young Adults in Hornsey. TABLE 1. NUMBER OF CHILDREN INSPECTED, 1st January, 1922, to 81st December, 1922. A. Routine Medical Inspection. Years °f Age Entrants. Intermediate Group. Leavers. Grand Total 5 6 Other ages. Total 8 12 13 14 Other ages Total Boys 281 143 47 471 465 353 68 5 50 476 1,412 Girls 182 151 48 381 423 300 58 8 40 406 1,210 Totals 463 294 95 852 888 653 126 13 90 882 2,622 B. Special Inspections. Special Cases. Re-examinations Boys 931 1,180 Girls 757 1,088 Totals 1,688 2,268 C. Total Number of Individual Children Inspected. 4,310. TABLE 2.—RETURN OF DEFECTS FOUND IN THE COURSE OF MEDICAL INSPECTION IN 1922 Defect or Disease. Routine Inspections] Specials Number referred for Treatment. Number requiring to be kept under observation but not referred for Treatment. Number referred for Treatment. Number requiring to be kept under observation but not referred for Treatment. Malnutrition 14 122 20 6 Uncleanliness, head 173 – 2 – „ body – – – – Skin Ringworm, head 1 – 29 – ,, body 1 – 9 – Scabies 3 – 38 – Impetigo 3 – 231 – Other Diseases (non-Tuberculous) 7 1 164 2 Eye Blepharitis 7 – 24 – Conjunctivitis 1 – 37 – Keratitis 1 – 2 – Corneal Ulcer 1 – – – Corneal Opacities 3 – 3 – Defective Vision 195 5 103 – Squint 40 4 16 – Other Conditions 2 – 24 – Ear Defective Hearing 25 4 15 – Otitis Media 16 1 78 – Other Ear Diseases 2 1 27 – Nose and Throat Enlarged Tonsils 80 45 8 3 Adenoids 10 5 2 3 Enlarged Tonsils and Adenoids 44 7 41 2 Other Conditions 11 2 64 9 Enlarged Cervical Glands (non-Tuberculous) 105 38 8 5 Defective Speech 4 3 – 1 Teeth: Dental Diseases 305 – 15 – Heart and Circulation Heart Disease: Organic 3 7 – 1 Functional 1 38 2 14 Anæmia 4 14 41 67 Lungs Bronchitis - 5 15 10 3 Other non-Tuberculous Disease 4 4 16 16 Tuberculosis Pulmonary: Definite 4 – 4 – Suspected 6 29 1 13 Non-Pulmonary: Glands 1 – 2 2 Spine – – – – Hip – – – – Other Bones and Joints – – 1 – Skin – – – – Other Forms 1 1 3 1 Nervous System Epilepsy – 5 3 3 Chorea 1 1 3 17 Other Conditions – 1 1 8 Deformities Rickets – 7 – – Spinal Curvature – – 2 – Other Forms 3 8 2 2 Other Defects and Disease 14 13 278 31 Number of Individual Children having defects which required treatment or to be kept under observation 2,120 TABLE 3 —NUMERICAL RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA IN 1922. Boys Girls Total Blind (including partially blind) within the meaning of the Elementary Ed. (Blind & Deaf Children) Act, 1893. Attending Public Elementary Schools – – – Attending Certified Schools for the Blind 2 1 3 Not at School – – – Deaf and Dumb (including partially deaf) within the meaning of the Elementary Ed. (Blind & Deaf Children) Act, 1893. Attending Public Elementary Schools – – – Attending Certified Schools for the Deaf 2 6 8 Not at School – 1 1 Mentally Deficient. Feeble Minded. Attending Public Elementary Schools – – – Attending Certified Schools for Mentally Defective Children 11 10 21 Notifie4 to Local Control Authority by Local Education Authority during year 5 5 10 Not at School 3 2 5 Imbeciles. At School – – – Not at School 5 5 10 Idiots – – – Epileptics. Attending Public Elementary Schools – – – Attending Certified Schools for Epileptics 3 – 3 In Institutions other than Certified Schools – – – Not at School 1 1 2 Physically Defective. Pulmonary Tuberculosis. Attending Public Elementary Schools 43 25 68 Attending Certified Schools for Phy. Def. Children – – – In Institutions other than Certified Schools (Sanatoria) 4 3 7 Not at School 1 2 3 Crippling due to Tuberculosis. Attending Public Elementary Schools 9 4 13 Attending Certified Schools for Phy. Def. Children – – – In Institutions other than Certified Schools – – – | Not at School – – – Crippling due to other causes than Tuberculosis, i.e. : Paralysis. Rickets. Traumatism. Attending Public Elementary Schools 7 10 17 Attending Certified Schools for Phy. Def. Children – – – In Institutions other than Certified Schools – – – Not at School 4 3 7 Other Physical Defectives, eg— Delicate and other Children suitable for admission to Openair Schools. Children suffering from Severe Heart Disease. Attending Public Elementary Schools 71 53 124 Attending Open-air Schools – – – Attending Certified Schools for Phy. Def. Children other than Open-air Schools – – – Not at School 3 3 6 Dull or Backward Retarded 2 years – – 178 Retarded 3 years – – 126 . TABLE 4.—A. TREATMENT OF MINOR AILMENTS. DISEASE of DEFECT. NUMBER OF CHILDREN. Referred for Treatment. Treated. Total. Under Local Education Authority's Scheme. Otherwise. Skin— Ringworm, Head 26 24 2 26 Ringworm, Body 10 9 1 10 Scabies 41 40 1 41 Impetigo 234 232 2 234 Minor Injuries 225 209 16 225 Other Skin Diseases 171 164 7 171 Ear Disease 163 124 9 133 Eye Disease (external and other) 71 63 3 66 Miscellaneous 292 132 85 217 B. TREATMENT OF VISUAL DEFECT. Number of Children. Referred for Refraction. Submitted to Refraction. For whom Glasses were prescribed. For whom Glasses were provided. Recommended for Treatment other than by Glasses. Received other forms of Treatment. For whom no Treatment was considered necessary. Under Local Education Authority's Scheme. By Private Practitioner or Hospital. Otherwise. Total. Under Local Education Authority's Scheme. 354 314 18 — 332 244 230 * 71 84 66 *This Number includes several children for whom glasses were prescribed during the latter part of 1921, but who did not obtain glasses until 1922. C. TREATMENT OF DEFECTS OF NOSE AND THROAT. Referred for Treatment. NUMBER OF CHILDREN. Received Operative Treatment. Received Other Forms of Treatment. Under Local Education Authority's Scheme. By Private Practitioner or Hospital. Total. 373 146 24 170 91 D. TREATMENT OF DENTAL DEFECTS. (1) Number of Children dealt with. Years of Age Age Groups. Specials. Total. 6 7 8 9 10 11 12 13 14 (a) Inspected by Dentist 629 757 802 842 872 766 745 665 252 270 6,600 (6) Referred for Treatment 4,015 190 4,205 (c) Actually Treated 1,979 110 2,089 (d) Re-treated*(result of periodical examination) 591 • Cases under this head are also included under (C) above. (2) Particulars of Time Given and of Operations Undertaken. No. of half-days devoted to Inspection. No. of half-days devoted to Treatment. Total No. of Attendances made by the Children at the Clinic. No. of Permanent Teeth. No. of Temporary Teeth. Total No. of Fillings. No. of Administrations of General Anaesthetics. No. of Other Operations. Extracted. Filled. | Extracted. Filled. Permanent. Temporary. 31 178 3,001 598 1,041 2,762 238 1,279 470 101 16 TABLE 5.—SUMMARY OF TREATMENT OF DEFECTS AS SHOWN IN TABLE 4 (A., B., C., D.). DISEASE OR DEFECT. Number of Children. Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. Total. Minor Ailments 1,233 997 126 1,123 Visual Defects 354 314 18 332 Defects of Nose and Throat 373 237 24 261 Dental Defects 4,205 2,089 — 2,089 Total 6,165 3,637 168 3,805 Table 6.—SUMMARY relating to children medically inspected at the routine inspections during the year 1922. (1) The total number of children medically inspected at the Routine Inspections* 2,622 (2) The number of children in (1) suffering from— Malnutrition 234 Skin Disease 23 Defective Vision (including Squint) 408 Eye Disease 26 Defective Hearin 30 Ear Disease 26 Nose and Throat Disease 418 Enlarged Cervical Glands (non-Tubercular) 257 Defective Speech 26 Dental Disease 829 Heart Disease: — Organic 26 Functional 49 Anaemia 41 Lung Disease (non-Tubercular) 70 Tuberculosis:— Pulmonary, definite 4 ,, suspected 37 Non-Pulmonary 3 Disease of the Nervous System 15 Deformities 67 Other Defects and Diseases 59 (3) The number of children in (1) suffering from Defects (other than Uncleanliness or Defective Clothing or Foot-gear) who require to be kept under observation (but not referred for treatment) 246 (4) The number of children in (1) who were referred for treatment (excluding Uncleanliness, Defective Clothing, etc.) 714 (5) The number of children in (4) who received treatment for one or more Defects (excluding Uncleanliness, Defective Clothing, etc.) 434 * Specials are not included in this Table. TABLE 7. List of Schools in the Borough. School. Department. Authorized Accommodation. No. on the Rolls. Average Attendance. Muswell Hill Juniors 220 119 107 St. Michael's Senr. Mixed 238 191 167 „ Junr. Mixed 192 151 126 Highgate Senr. Mixed 444 315 287 „ Junr. Mixed 354 192 170 North Harringay Boys 465 443 412 „ Girls 465 492 439 „ Junr. Mixed 508 405 340 South Harringay Senr. Mixed 584 464 444 „ Junr. Mixed 300 199 163 Stroud Green Boys 418 405 378 „ Girls 418 361 316 „ Infants 426 250 199 St. Mary's Boys 237 253 228 „ Girls 235 259 236 „ Infants 220 210 184 Crouch End Boys 456 457 421 „ Girls 450 417 377 „ Infants 411 292 249 Holy Innocents' Infants 101 103 92 St. James' Mixed 269 258 225 Campsboume Boys 450 491 419 „ Girls 450 506 392 „ Infants 473 429 350 Totals . 8,784 7,662 6,721 ■ TABLE 8.—ROUTINE MEDICAL INSPECTION. Number of Children examined at each School. YEARS OF AGE. 5 6 7 8 9 10 11 12 13 14 totals. School. B. G. B. G. B. G. B. G. B G. B. G. B. G. B. G. B. G. B. G. B. G. Total Muswell Hill 10 9 5 5 7 — 13 7 4 2 — 1 — — — — — — — — 39 24 63 St. Michael's 15 7 1 9 3 3 17 21 5 4 1 2 — 1 21 13 1 1 — — 64 61 125 Highgate 8 10 7 7 — 5 21 15 3 5 7 2 3 1 22 15 1 5 1 — 73 65 138 North Harringay 57 31 21 20 12 11 75 78 6 11 1 3 6 4 53 66 8 4 — 2 239 230 469 South Harringay 18 10 9 10 2 3 24 26 7 5 2 1 4 2 30 19 2 1 1 1 99 78 177 Stroud Green 36 22 17 15 6 3 52 39 11 10 6 2 5 3 54 29 6 3 2 2 195 128 323 St. Mary's 26 15 9 13 6 5 39 23 11 13 2 2 1 1 23 25 5 6 — — 122 103 225 Crouch End 46 34 24 23 — 7 66 63 10 4 3 5 1 3 61 52 6 6 — 1 217 198 415 Holy Innocents 14 9 3 7 2 1 — 1 1 — — — — — — — — — — — 20 18 38 St. James' 8 6 8 2 1 1 10 9 4 3 5 3 1 — 19 15 2 1 — 1 58 41 99 Campsbourne 43 29 39 40 8 9 57 63 29 21 2 3 — 1 70 66 37 31 1 1 286 264 550 Total 281 182 143 151 47 48 374 345 91 78 29 24 21 16 353 300 68 58 5 8 1,412 ,210 2,622 TABLE 9. WORK DONE AT MINOR AILMENTS CLINIC, 1922. No. of Inspection Clinics Held. Total No. of Attendances at Inspection Clinics. Average Attendance at Inspection Clinic. Total No. of Attendances for Treatment, No, of Cases dealt with. No of Re-Exami nations of these Children. No, of Cases cured and returned to School, No. of cases referred to private Doctor or Hospital or not requiring treatment. No, of Cases still on Register, 87 3,369 39 3,337 1,632 1,737 1.410 337 127 details of the ailments dealt with. Ringworm, Head 29 Nose and Throat Diseases 217 Do. Body 9 Enlarged Cervical Glands 18 Bronchial Catarrh (Bronchitis) 14 Scabies 40 Tuberculosis (susp, non.-pulm.) 29 Impetigo 232 Infectious Diseases 18 Other Skin Disease 176 Heart Disease 30 Epilepsy 4 Minor Injuries 225 Chorea 22 Other Nervous Diseases 12 Ear Disease 137 Debility, Anæmia and Malnutrition 150 Eye Disease 73 Dental Disease 20 Rheumatism 1 Deformities 12 Abdominal Complaints and Enuresis 39 Miscellaneous 85 Lungs (non.-T.b.) 40 Total 1,632 TABLE 10.—SUMMARY OF WORK OF THE SCHOOL NURSES, 1922. Visits to Schools. Home Visits re Defective Children. Schools. Dept. No. of Visits re Uncleanlines No. Examined. No. of Individual Children found Unclean. No. of Visits to Schools re other work. Verminous Conditions. Teeth. Defective Vision, Tonsils and Adenoids. Lungs. Heart. Ears. Impetigo. Scabies,. Ringworm, Muswell Hill Mixed 23 806 15 10 3 — 9 4 — — — 3 — — St. Michael's Senr. 15 583 14 13 — 6 — — — — — — — ,, ,, Junr. 22 1,016 28 11 6 — 2 7 — — — 2 — — Highgate Senr. 14 988 11 17 — — 4 9 — — — — — — ,, ,, Junr. 22 866 14 18 1 — 9 35 4 — — — — — North Harringa Boys 16 1,225 49 19 8 — 4 11 — 2 — 2 4 2 ,, ,, Girls 25 2,313 125 19 12 — 14 6 — — — 2 2 1 ,, ,, Infants 30 1,881 60 10 13 1 8 27 2 — 2 4 4 4 South Harringay Senr. 15 1,125 29 10 7 2 6 17 2 — — 1 2 3 ,, ,, Junr. 12 478 6 12 10 2 1 10 1 1 1 4 Stroud Green Boys 7 1,191 5 27 4 9 15 — 1 — — — 3 ,, ,, Girls 18 1,293 23 17 8 — 15 9 — — 1 — — — ,, ,, Infants 16 1,080 14 14 9 6 32 — — 1 — — 1 St. Mary's Boys 15 1,149 13 15 5 2 3 2 — —1 1 — — 2 ,, ,, Girls 7 782 24 26 — — — 3 — 3 — — — — ,, ,, Infants 9 732 12 13 3 — — 8 — — — — — 3 Crouch End Boys 16 1,592 32 25 1 — 18 4 — 2 5 —8 2 1 ,, ,, Girls 42 3,179 102 30 14 — 20 25 4 — 5 7 1 3 ,, Infants 32 1,664 65 29 16 — 19 37 2 — 4 6 5 4 Holy Innocents' Infants 16 520 12 12 10 — — 2 — — — — — 2 St. James' Mixed 22 838 22 13 3 — 2 11 — — — 1 — Campsbourne Boys 24 2,135 74 30 4 — 17 12 3 1 1 10 — 2 ,, Girls 34 3,239 203 35 14 — 25 22 1 3 2 2 — 2 ,, Infants 27 2.268 132 40 19 — 13 48 1 1 1 1 — 6 Totals 479 32,943 1,084 465 170 7 210 356 20 14 24 50 20 43 TABLE 11.—AGE AND SEX DISTRIBUTION OF YOUNG PERSONS IN THE BOROUGH OF HORNSEY, 1911 and 1921. Age last Birthday. 1911. 1921. Males. Females. Males. Females. 0 742 623 638 639 1 628 614 677 692 2 682 651 448 446 3 610 634 447 443 4 721 699 546 493 5 628 655 609 588 6 652 672 650 606 7 675 705 636 659 8 616 626 677 610 9 628 607 615 681 10 596 671 691 675 11 628 633 673 641 12 576 619 671 687 13 569 614 654 713 14 660 656 685 660 15 585 750 620 701 16 605 843 612 752 17 564 940 629 778 18 630 927 569 843 19 667 1,038 587 850