HOR 017 ANNUAL REPORT for 1925 of the Medical Officer of Health. INDEX. Acts adopted, 18. Allotments, 8. Ambulance arrangements, 12, 29. Appointment of Veterinary Inspector, 34. Area of Borough. 4. Bakehouses, 18, 19. Births and Birth-rate, 4, 9, 37, 38, 41. Butchers' Shops, 18, 23. By-Jaws and Regulations in force, 13 Cancer, 28, 41. Carbide Licences, 18. Census figures, 8, 19. Cerebro Spinal Meningitis, 42. Chart of Births, Deaths and Infant Mortality. 38. Cinemas, 18, 19. Cleansing Station, 28. Complaints made, 17. Condensed Milk, 23. Contributions to Institutions, 12. Cottage Hospital, 10, 12, 46. Dairies, 18, 21. Deaths and Death-rate, 4, 10, 34, 37, 38. 41. Deaths, causes and age of. 39, 40. Description of District, 4, 8. Diarrhoea, 34. 41. Diphtheria, 25, 26. 41, 42. „ Anti-Toxin, 26. ,, return cases. 26. ,, Schick test. 26. Diseases of Animals Acts, 34. Disinfection, 17, 28, 29. District Nurse. 11. Dried Milk. 23. Dust collection. 6, 14. Dust Destructor. 15. Dwellings, 5, 19, 49. Dysentery, 42. Early Closing of Shops, 18. Encephalitis Lethargica, 27, 42. Engine Sheds, Hornsey, 15. Enteric Fever, 27, 41, 42. Erysipelas, 42. Factory and Workshop Acts. 18, 19. ,, ,, ,, „ Return 47. Families. 1921. Number of, 4, 8, 19. Food adulteration. 6, 25. „ inspections. 24. ,, samples. 25. „ shops, 18. unsound. 23, 24. Foster Mothers. 34. Furnishing Trades' Institution. 46. Health Visitors, 32, 33. Highgate Centre. 11, 32. Highgate Nursing Association. 10, 12, 28. Historical (1873), 4. Hornsey Deanerv Association. 10, 12, 33, 46. Hornsey Local Board, 5. Hospitals.— Hornsey Cottage. 10,12, 46. Isolation. 7, 12, 29, 30, 42. North Middlesex. 10, 11, 32. Royal Free, 11, 32. Santa Claus Home, 34, 46. Small-Pox, 12, 29. St. Margaret's, Kentish Town, 28. Tuberculosis, 12, 31. House-to-house inspections, 20, 49. Housing conditions, 19, 20. „ Return as to, 49. „ Schemes, 19. Ice-cream premises, 18. Illegitimate Births, 9, 10. Increase of Rents Act. 16, 18, 21. Infant Death-rate. 4, 10, 34, 37, 38. ,, ,, ,, causes and ages of, 40, 41. Infectious disease.— . Ambulance arrangements, 29. Anti-Toxin, 26. Cancer, 28, 41. Cases notified, 16, 42, 43. (1901-1925), 43. Control of cases notified. 12, 25. Diphtheria, 25, 26, 41, 42. Dysentery. 42. Encephalitis Lethargica. 27, 42. Enteric Fever, 27, 41, 42. Erysipelas. 42. Influenza, 27. Isolation Hospital, 7, 12, 29, 30, 42. Malaria, 42. Measles. 27, 41, 42. Meningitis, 42. Mumps. 42. Non-notifiable. 10, 28. Ophthalmia Neonatorum, 27. 42. Pneumonia. 27, 29, 42. Poliomyelitis, 42. Return cases, 26. Scarlet Fever. 25, 26, 41, 42. Schick test, 26. Small-Pox. 11, 27, 29. Tuberculosis. 4, 11, 12, 16, 30, 31, 42, 44. Tvphoid Fever. 27, 41, 42. Whooping Cough, 27, 34, 41, 42. Influenza and Pneumonia, 27, 42. Inhabited houses, 4, 8, 49. Inspections made, 15, 17, 47, 49. Institutions in Borough, 10, 11, 33, 46. Insulin treatment. 33. Isolation of infectious cases, 7. Isolation Hospital, 7, 12, 46. ,, „ Admissions to, 42. „ „ Ambulance ments, 29. „ ,, Laboratory work. 29. ., ,, new buildings, 29. Kitchener Home. 26, 46. Laboratory work. 29. Legal Proceedings, 35. Licences, Carbide. 18. Milk. 21. Petroleum, 18. London Diocesan Penitentiary, 46. Malaria. 42. Maternal mortality. 34. Maternity and Child Welfare.— Ante-natal work, 32, 34. Centres, 11. Committee, 1. Convalescent homos, 33. Co-oporation with School Clinic, 28, Dental work, 33. Doctor's sessions, 11, 32. Health Talks, 83. Health Visitors, 32, 33. Highgate Centre, 11, 32. Insulin treatment, 33. Lying-in arrangements, 10, 11, 32. Massage, 33. Midwife, 11, 31, 32, 45. Mothercraft Training Society, 33, 46. Parents' Committees, 33. Record of work. 45. Supply of milk to Mothers and Children, 33. Still Births, 34. Tonsils and Adenoids. 33. Voluntary Workers. 33. Maternity cases arrangements, 10, 11, 32. Measles, 27, 41, 42, 43. Meat Regulations, 23. surrendered, 23, 24. Midwives. 11, 81, 32, 45. Milk condensed and dried, 23. Milk, Special Designated Licences, 21. ,, ,, „ description of 22. „ prices, 23. ., samples taken, 23. ,, shops. 18, 21. ,, supplied to Mothers and Children. 33. Mortuary, 12. Mosquitoes. 35. Mothercraft Training Society, 83, 46. Mumps. 42. North London Nursing Association, 10. 28 North Middlesex Hospital. 10, 11, 32. Notices served, 16, 49, 50. Nursing Homes, 12. Nursing of non-notifiable diseases, 10. 28. Oakeshott, Dr.. extracts from Report, 5. Occupations of residents, 9. Offensive trades, 15. Open spaces, 8. Ophthalmia Neonatorum. 27, 42. Out-relief figures. 9. Outworkers, 18, 48. Overcrowding, 20. Petroleum stores. 18. Pneumonia. 27, 29, 34, 42. Poliomyelitis. 42. Population, 4, 8, 87. „ . Increase of, 8. Preface, 3. Private families (1921), 4. Product of 1d. rate. 4. Public Health Act (sec. 41), notices, 16. Public Health Committee, 1. Public Health (Meat) Regulations, 23. Puerperal Fever, 42, 48. Rag Flock Act, 18. Rateable value, 4, 8. Rate, produce of Id., 4. Refuse Collection, 6, 14. Regulations in force, 13, 14. „ as to Tuberculosis, 30. Rent and Mortgago Interest (Restriction) Act, 16, 18, 21. Residential Institutions, 10, 33, 46. Restaurants, 18. Return cases of Scarlet Fever and Diphtheria, 26. Royal Free Hospital, 11, 32. St. George's Retreat House, 46. Sale of Food and Drugs Act, 23. Sanitary circumstances, 16, 49. „ inspectors' work, 15, 16, 17. ,, notioes served, 16. work carried out. 16, 49. Santa Claus Home, 34, 46. Scabies, 28. Scarlet Fever, 25 , 26, 41, 42. „ „ Return cases, 26. School Clinic. 11, 28, 33. Schools, 15, 28, 33. Schick test, 26. Sewerage and Sewage disposal, 4, 14. Shops Acts, 18, 19. Slaughter-houses. 18, 23, 24. Small-pox, 12, 27, 29. Smoke abatement, 15, 16. Staff, Public Health Department, 2. Standardized death-rate, 4, 10. Statistics (1925), 4. Statutory notices, 16, 49, 50. Still Births, 34. Storm-water disposal, 14. Summonses, 35. Tables, List of. 36. Tonsils and Adenoids, 33. Trade refuse, 14. Tuberculosis.— Beds available, 12, 31. Deaths, 4, 81, 41, 44. Dispensary. 11. In milk trade. 81. Notifications, 44. Register of cases, 30, 42. Regulations, 30. Visits as to, 16. Tvphoid fever, 27, 41. 42. Unsound food. 23. 24. Uxbridge Small-pox hospital, 12, 29. Vaccjnation, 27. Vaccine. Supply of. 27. Venereal disease clinic. 11. Verminous persons. Cleansing of, 28. Veterinary Inspector. 34. Vital Statistics. 4. 10. 37. Voluntary Workers. 33. Water supply, 7. 14. Water-closets, 16. , Wells. 7. Whooping Cough. 27, 84, 41, 42. Workmen's Dwellings, 19, 49. Zymotic death-rate. 4. — 1 — PUBLIC HEALTH COMMITTEE, 1925. The Mayor, Councillor R. Steeds, J.P. Councillor H. E. Hill (Chairman). The Deputy-Mayor, Councillor P. Everington, J.P. Alderman \V. G. Barrenger. ,, H. B. Brackenbury. ,, H. E. Cooper, J.P. „ W. W. Kelland. Councillor E. E. Brooks. ,, L. Cooper. ,, J. Edwards. ,, S. G. Goulding. ,, A. T. Hill. ,, W. E. Lee. Mrs. K. H. Pay. ,, J. W. Rowlands. ,, R. Ff. Wootton. MATERNITY AND CHILD WELFARE COMMITTEE, 1925. The Mayor, Councillor R. Steeds, J.P Councillor S. G. Goulding (Chairman). The Deputy-Mayor, Councillor P. Everington, J.P. Alderman W. G. Barrenger. ,, H. B. Brackenbury. ,, H. E. Cooper, J.P. ,, W. W. Kelland. Councillor L. Cooper. ,, J. Edwards. ,, H. E. Hill. W. E. Lee. ,, C. Oates. Mrs. K. H. Ray. Co-opted Members. Mrs. J. H. Barrenger. Mrs. J. L. Bond. Mrs. A. L. M. Harvey. Mrs. E. Piggott. Mrs. B. H. Walton. Miss A. M. Inward. —2— STAFF OF PUBLIC HEALTH DEPARTMENT. *†Medical Officer of Health ‡ Deputy Medical Officer of Health and Medical Superintendent of Joint Isolation Hospital *‡Assistants for Maternity and Child Welfare Purposes *† Senior Sanitary Inspector *† Sanitary Inspectors † Chief +++--Clerk † Assistant Clerks * † Health Visitors *† Midwife † Mortuary Keeper † Motor-Ambulance Driver † Disinfectors W. W. Jameson, M.A., M.D., D.P.H. J. R. Prior, LL.B., M.D., D.P.H. Flora Shepherd, M.B. Jessie Muir, M.B. Wm. Thorpe. Henry Eastwood. James Goodman. Joseph H. Jesse. John D. Chance. A. E. Hollox (resigned). Wm. Gilroy. George E. Dorrell. James Wilson. David Mellows. A. Glover. J. I. Macpherson. E. Durnford. F. R. H. Ross. M. Andrews. Charles F. Catlin. T. J. Skilbeck. Wm. H. Lewis. Wm. Rutter. ‡ Veterinary Inspector under Diseases of Animals Acts F. G. Buxton, M.R.C.V.S. Note:—‡ Whole time Officers. ‡ Part time Officers. * Officers in respect of whom salary contribution is made under the Public Health Acts or by Exchequer Grants. — 3 — To the Mayor, Aldermen and Councillors of the Borough of Hornsey. Ladies and Gentlemen, I have the honour to present to you my first Annual Report on the health of the Borough. This Report gives a survey of the work done and the progress made during the past five years, though it deals in the main with matters arising during 1925. I have included a short extract from the Report of the Medical Officer of Health of fifty years ago. It is interesting to compare present conditions with those which prevailed at that time. The vital statistics for the past year have been satisfactory. In particular the infantile mortality rate remains low, a matter of no little importance in view of the declining birth-rate. I should like to take this opportunity of thanking the Chairmen of the Public Health Committee and of the Maternity and Child Welfare Committee for their consideration and help during my first year of office and of acknowledging at the same time the great assistance afforded me by Mr. Thorpe and by Mr. Gilroy. The whole of my staff have rendered good service. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, W. WILSON JAMESON. — 4 — STATISTICS FOR 1925. Area 2,874 acres. Population (census 1921) 87,691 Estimated population (middle of 1925) 89,064 Number of inhabited houses (census 1921) 17,333 Number of private families (census 1921) 23,353 Rateable value £728,410 Product of a penny rate £2,944 Births Male 6211 Total 1,214 Female 593 Birth-rate, 13.6 per 1,000 population Deaths Male 433 Total 946 Female 513 Death-rate, 10.6 per 1,000 population. Standardized death-rate, 9.5. Death-rate of Infants under one year of age per 1,000 births 43.6 Death-rate from Tuberculosis (all forms) per 1,000 living 0.6 Death-rate from Zymotic Disease per 1,000 living 0.13 HISTORICAL. Prior to 1867 the area which is now known as the Borough of Homsey comprised the districts of Homsey and Highgate. "Hornsey was still in the fields; Highgate was preparing for the change which the railway then about to be opened would soon inevitably bring about. Hornsey was ruled by three and Highgate by four distinct and independent boards, each possessing absolute power to tax the ratepayer, and each involving the cost of separate management. The houses of the poor were overcrowded and unhealthy. The roads were in a most unsatisfactory condition, unlighted, unchannelled, the paths without kerbs, and, worse than all, there was no system of disposing of the sewage, such as we now happily have the advantage of; every house stood over, or in close proximity to, a cesspool, the effluent of which found its way through partial pipe drainage into the field ditches and so ultimately into the River Lea." It was to remedy this state of things and to regulate and control — 5 — the requirements of the growing parish that the Hornsey Local Board was formed. The Board held its first meeting on the 7th November, 1867. The new Board set about its task in no half-hearted manner, and a few extracts from the reports of the Medical Officer of Health at that time—Dr. Oakeshott—may prove of interest: — In 1873 Dr. Oakeshott wrote as follows: — "Dwellings.—The cottage property in Highgate, more than any other portion of the District, cannot be said to be in such condition 'as to leave nothing to be desired'—in many cases damp, dilapidated, dirty and overcrowded, not by lodgers, but by large families with small means, want of management and cleanly habits. The condition due not so much to neglect of the landlord as of the occupier, as may be seen in adjoining cottages of the group, one a picture of neatness and comfort, the next of destitution and dirt. If Hornsey has suffered more from invasion of the builder, who has run up houses by the hundred with all modern appliances of water supply and closets, while as yet there was no possible overflow even from the cesspools, Highgate may be said to have its special grievance in its connection with times that are past. Until the last few years the great highway to the North, and the first stage out of London, when perhaps 60 or 80 coaches stopped daily, Highgate possessed a colony of horse-keepers, grooms and drovers, who, after their occupation was gone, still lingered on the spot, and have left their cottages and their families too in an equally dilapidated and wretched state. No doubt this is the channel through which runs a large portion of that relief drawn from the Union weekly, amounting, I understand, to a very considerable sum. Not the least important sanitary work carried out here a short time since, and very appropriately largely aided by a member of this Board, was the drafting off a number of younger members of this colony to Canada, a work worthy of imitation and to a larger extent. I may say that with one or two exceptions I have met with a perfect readiness on the part of the landlords or — 6 — their agents to carry out any measures I have had occasion to suggest, and only in one instance has it been necessary to condemn a house as unfit for habitation, and this has remained closed and unoccupied ever since. "Dust.—The collection of refuse, an institution of only about a couple of years' standing in the district, is not only an expensive, but important, sanitary work, and neither pains nor expense should be spared to make it thoroughly efficient. Decomposing vegetables and other matter commonly stored either within or close to dwelling-houses, and from which the gases evolved are constantly wafted through the building, are not only offensive, but highly dangerous, and should be frequently and regularly removed. Early in the year it seemed desirable, and an arrangement- was made, that those groups of cottages where a large number of people are crowded into a small space, should be visited by the dust collector on a certain day and at regular intervals. Many complaints have been received that the collector fails to call, although notice is placed in the window. These have been at once referred by the inspector to the contractor, and, I understand, are all promptly attended to. Perhaps if in addition to placing the card in the window the cry of the collector were listened for it might often save the trouble of sending to the office and thus avoid delay. "Adulteration of Food.—An analyst was not appointed by the Court of Quarter Sessions until October, since which time the inspector has submitted for examination samples of mustard and coffee, both of which were pronounced pure; also seven samples of milk, three of which were found to be adulterated and the vendors prosecuted and fined. By a singular coincidence, to say the least, this adulterated milk was obtained from the very same limited area in which occurred the deaths of the young children from diarrhoea, which were referred to in my report for October, and which were the subject of a correspondence at that time between the Local Government Board and myself, with by no means, in my opinion, a satisfactory result, at any rate so far as the prevention of such singular coincidences in the future. "Closing of Wells.—In Southwood Lane, a short distance below the Board-room, there are two surface wells by the roadside which formerly were an important part of the water supply to the District. They are now nothing but a nuisance and an expense. One is still open and a receptacle for all kinds of refuse, the other has had a pump placed over it three or four times, which is always out of order, never of the slightest use and never required. I would recommend that the Surveyor be instructed to lay the pipes necessary to drain them oft' and that they may be finally closed. "Isolation of the Infectious Sick.—One word on another very important question—that of promptly removing the sick in cases of infectious disease. It is scarcely too much to say, if this could be readily accomplished, it would at once effect a larger saving of life than all the sanitary legislation of the next twenty years is likely to do. In the Metropolis alone nearly 3,000 deaths from scarlet fever were registered last year, and large numbers from other contagious diseases also. A magistrate may order the removal to a hospital of any persons suffering from infectious disease if they are without proper lodging or lodged in a room occupied by more than one family. Also Sanitary Authorities may provide temporary places or hospitals for the reception of the sick, but have no power except under the circumstances named, to compel people to make use of them. It is more than doubtful indeed if any compulsory power will ever be able to accomplish what is required. We have seen within the last few months what a strong objection people have to the removal of their children sick with fever to hospital. We must look to the growth of a different sentiment than prevails at present in such matters, and perhaps to the establishment of institutions with other and kindlier associations than are usually connected in the popular mind with hospitals. Is it Utopian to believe that, when once the educated and intelligent fully realise its great importance and what an immense boon it would be to individual families as well as the public generally some plan might be devised, perhaps at no distant period, to provide, in every village and town, a comfortable, — 8 — well-ventilated home where the sick might be funded by well-trained doctors and nurses. Thus the distress and misery from these scourges might be reduced to a minimum." Since those days the population of this area has grown from 11,098 to 89,000, the number of inhabited houses from 1,080 to 19,822, and the rateable value from £77,000 to £728,410. NATURAL AND SOCIAL CONDITIONS OF HORNSEY. General.—The Borough of Hornsey is a residential area well situated on the Northern Heights. Its freedom from factories and its considerable elevation above sea level, amounting to 427 feet at the highest point, combine to make it one of the most desirable of all the towns in the Greater London area. Finsbury Park, Queen's Wood, Highgate Wood and part of Alexandra Park are within the Borough; Ken Wood, Hampstead Heath, Waterlow Park and Cherry Tree Wood adjoin. Permanent open spaces constitute over 10 per cent. of the total acreage and before long it is hoped that between 70 and 80 acres in Crouch End will be retained for all time as playing-fields. There are in addition 14 acres of permanent, and 32 acres of temporary, allotments, while some 64 acres of the Highgate golf course are situated within the Borough boundaries. Population.—The estimated population at the middle of 1925 was 89,064. The Registrar General's estimate was 87,210—an actual decrease of 481 on the census figures of 1921. It is impossible that the population of Hornsey could have diminished during the past five years. A considerable number of new houses has been built and many houses formerly intended for the occupation of one family only have been divided into flats. There is, too, a gradual removal of families from the Holloway and Stoke Newington areas into Stroud Green and Harringay. Census Figures.—At the census of 1921 the number of private families in the Borough was 23,353, with an average of 3'7 persons per family—a decline of 0.5 since 1911. The average age of males was 32.5 and of females 34.6 years. These were the highest figures for towns of any size in Middlesex and indicate that a larger proportion of elderly people is to be found in Hornsey — 9 — than in any other of the northern or western suburbs. Again, with the exception of Ealing, the ratio of females to males (namely, 1,319 females per 1,000 males) was greater in Hornsey than anywhere else in the County of Middlesex. These facts show that Hornsey is a residential area where a good many retired persons and middle-class families have taken up their abode. The accompanying tables give the occupations followed by males and females of 12 years of age and over at the last census: — Males. Percentage. Commercial, finance and insurance work 17 Clerical work 17 Retired or of independent means 14 Transport workers 8 Professional occupations 6 Public administration and defence 5 Females. Retired or of independent means 64 Personal service 12 Clerks and typists 9 Professional occupations 4 Out-Relief. — During 1925 the Guardians distributed the following amounts in out-relief: — Cases. Cost. Ordinary 444 £11,559 13 2 Unemployed 310 £3,062 6 8 DEATHS, BIRTHS, INFANT MORTALITY RATE, ETC. Births.—Twelve hundred and fourteen babies were born in Hornsey in 1925, the birth-rate being 13.6 per 1,000 population, a slight increase over the figure in the previous year. One thousand three hundred and five births (including 121 transferred to other districts) were notified to the Medical Officer of Health under the Notification of Births Acts. There were 39 illegitimate births in 1925. The excess of births over deaths for the year was only 268. — 10 — Deaths.—The total number of deaths during 1925 was 946— the death-rate being 10'6 per 1,000 population. The rate for 1924 was 10.4. The standardized death-rate for the Borough is 9.5. The standardized death-rate is obtained by multiplying the figure of 10.6 by the factor 0.894, supplied by the Registrar-General, and takes into account the age and sex distribution of the population of the Borough. It gives a true index of the healthiness of the area. Infant Mortality Rate. — In 1925 there were 53 deaths of infants under one year of age, according to the Registrar-General's returns- This is equivalent to an infantile mortality rate of 43.6 per 1,000 births, the second lowest figure in the history of the Borough. The lowest rate (41 per 1,000 births) was that for 1924. The infantile mortality rate for illegitimate children was 77.0 per 1,000 births. SUMMARY OF NURSING, HOSPITAL AND OTHER INSTITUTIONS AVAILABLE IN THE DISTRICT. A list of residential institutions will be found in Table J. (p. 46). Hospitals. — The North Middlesex Hospital (Edmonton Union) has accommodation for 1,034 in-patients. The number of Hornsey cases admitted during the year was 648. The Hornsey Cottage Hospital, with 49 beds, dealt with 813 cases during 1925. Nursing.—The North London Nursing Association undertakes nursing of children below school age in the southern part of the Borough, for which the Council pays a sum of 1s. 4d. a visit. This arrangement was instituted in November, 1925. The Highgate District Nursing Association carries on its work in the Highgate District, and the Council last year voted a sum of £10 10s. Od. to its funds. The Hornsey Deanery Association for Preventive and Rescue Work at 109, Upper Tollington Park, receives unmarried mothers and their babies. A grant is made by the Ministry of Health and the Council. — 11 — There is a District Nurse in connection with St. Mary's Parish Church, but no financial help is given. Midwives.—In addition to the Municipal Midwife, who is controlled and paid by the Council, there are 17 Midwivos notified to the County Council as practising in the Borough. The County Council is the supervising authority under the Midwives Acts. Clinics and Treatment Centres.— Maternity and Child Welfare Centres. (No. 1.) Brook Road Hall, N.8. (opened 1916). Wednesday and Friday, 10-12 and 2-4. Thursday (Ante-Natal), 2-4. (No. 2.) 22, Wightman Boad, Haringey, N.4 (opened 1918). Tuesday, 10-12 and 2-4. 1st and 3rd Monday in month (Ante-Natal), 2-4. (No. 3.) All Saints' Hall, Church Boad, Highgate, N.6 (opened October, 1925). Friday, 2-4. 2nd Friday in month (Ante-Natal), 10-12. School Clinics. Topsfield Parade, Crouch End, N.8. Daily, 9-5. Saturdays, 9-1. Brook Boad Centre Wightman Road Centre Highgate Centre Daily, 9-10 a.m. Tuberculosis Dispensary (Middlesex County Council).— 10, Alexandra, Road, Hornsey. Tuesday and Thursday, 2.30 p.m. Wednesday, 10 a.m. Venereal Disease Clinic (Middlesex County Council).— Royal Northern Hospital, Holloway Boad, N.7. Monday, Wednesday, Thursday and Friday, 7-8 p.m. Maternity.—An arrangement is made with the North Middlesex Hospital and the Royal Free Hospital for the reception of maternity cases attending the Maternity and Child Welfare Centres at charges of 6/- and 10/- a day respectively. — 12 — Infectious Disease.—Cases of infectious disease are sent to the Isolation Hospital, Coppetts Road, Muswell Hill, N.10, which is controlled by a joint Hospital Committee for the districts of Hornsey, Finchley and Wood Green. Small-Pox.—The Council has an arrangement for the treatment of cases of small-pox in the Uxbridge Joint Small-Pox Hospital at Yeading, Middlesex. Tuberculosis.—There are 757 beds available under the Middlesex County Council scheme for the treatment of tuberculosis in sanatoria. Nursing Homes.—There are some 25 private Nursing Homes in the Borough. The Council have during the year made the following contributions to Institutions in the Borough :— Hornsey Cottage Hospital—£50. Hornsey Deanery Association for Preventive and Rescue Work—£25. Highgate District Nursing Association—£10 10s. Od. Ambulances.—The Borough Ambulance is kept at the Central Fire Station under the control of the Borough Engineer and Surveyor, and during the year has been used for the conveyance of 773 persons on 733 occasions, 188 cases being street accidents and 545 private and other cases. There is also a Ford Ambulance for the medical services of the Borough, which is used mainly for the conveyance of school children. During the year this conveyance has covered 7,051 miles. Mortuary.—During the year 77 bodies were brought to the Mortuary at the Sanitary Depot, Hornsey, and 75 inquests were held by the Coroner. The floor of the post-mortem room has been relaid and a new water-closet has been fixed at the Coroner's Court. — 1.3 — LIST OF ACTS, BY-LAWS & REGULATIONS RELATING TO PUBLIC HEALTH IN FORCE IN THE BOROUGH, WITH DATE OF ADOPTION. Adoptive Acts.— Infectious Disease (Prevention) Act, 1890 (9th December, 1890). Public Health Acts Amendment Act, 1890, Parts 2, 3 and 5 (9th December, 1890). Museums and Gymnasiums Act, 1891, so far as it relates to Museums only (1st May, 1893). Public Baths and. Wash-houses Acts, 1846, 1847, 1878 and 1882 (6th July, 1896). Public Health Acts Amendment Act, 1907, sections 15 to 17, 19 to 27, 30, 31 and 33 in Part II., Parts III., IV., V. and VI., and section 95 in Part X.—by Order of Local Government Board, and section 81 (modified) in Part VII., sections 87 and 90 in Part VIII. and Part IX.— —by Order of the Secretary of (State (Home Office). The Local Government and Other Officers' Superannuation Act, 1922 (14th November, 1923). Public Health Act, 1925, Part II., relating to Streets and Buildings, Part III., containing Sanitary Provisions, Part IV., relating to Verminous Premises, etc., and Part V., relating to Watercourses and Streams, etc. (from 1st February, 1926). BY-LAWS, REGULATIONS, ETC., RELATING TO PUBLIC HEALTH IN FORCE IN HORNSEY. By-Laws have been made as follows : — Cleansing of Earth-Closets (22nd November, 1879). Common Lodging-Houses (22nd November, 1879). Slaughter-Houses (22nd November, 1879). Management of Mortuary (6th December, 1886.) Decent Conduct of Persons using Sanitary Conveniences (21st May, 1894). Houses Let in Lodgings or occupied by members of more than one family (21st September, 1896). For Good Pule and Government of the Borough, 1909, 1913 and 1922. — 14 — Nuisances in the Borough (10th June, 1907). With respect to New Streets and Buildings in the Borough (11th May, 1908, and 17th December, 1923). Also, Regulations have been made as to— Management of Sanitary Conveniences (21st May, 1894). Dairies, Cowsheds and Milkshops (19th June, 1899). Hornsey Swine Fever Regulations, 1904 (14th May, 1904). Regulations under Swine Fever Order of 1894 as to Movement of Swine (14th March, 1904, and 1st March, 1905). Regulations under the Dogs Order, 190G. Regulations as to Cleansing, &c., under Order as to Parasitic Mange in Horses, &c. Regulations under section 17 (7) of the Housing, Town Planning, &c., Act, 1909 (20th July, 1914). SANITARY CIRCUMSTANCES. Water Supply. — Hornsey is supplied with water from the New River (Metropolitan Water Board). The supply is ample and its quality is uniformly satisfactory. Sewerage and Sewage Disposal.—The drainage of about 200 acres on the northern slope of Muswell Hill is treated at a small sewage farm north of the Joint Isolation Hospital. The purification plant consists of tanks, contact beds and final land irrigation. The resulting effluent is always well within the standards laid down by the Sewage Commissioners. The sewage for the remaining portion of the Borough flows into the London County Council's system of sewers. Storm-water, save that from about 300 acres, is discharged by a separate system of storm-water sewers into various streams having their sources within the Borough. Refuse Collection.—Refuse is collected twice weekly in the case of flats and weekly elsewhere throughout the Borough. The collection is made by the Council's own workmen. A daily average of 95½ tons was so collected during 1925. Trade refuse for the year amounted to 427 tons. No charge is made for the destruction of trade refuse, but in this case the refuse has to be — 15 — delivered at the central depot by the tradesmen. The incinerator was built in 1888 by Messrs. Heenan and Froude and has recently been reconstructed. Smoke Abatement. — Complaints have been received from time to time with regard to the emission of smoke, dust and fumes from the engine-sheds of the London and North Eastern Railway adjoining Hornsey Station. Observations have been kept on these sheds during 1925, and, although " black " smoke was not detected, yet a considerable amount of dark smoke and unpleasant fumes was noticeable. It seems singularly unfortunate that a railway company should choose a residential neighbourhood as a site for the clinkering and re-firing of many of their main-line locomotives. Offensive Trades.—There are no offensive trades carried on within the Borough. Schools. — Reference is made to the sanitary condition of schools, and to other matters relating to schools, in the Report of of the School Medical Officer. Sanitary Work.—Mr. Thorpe, the Senior Sanitary Inspector, has supplied me with the following summary of work done by the Sanitary Inspectors during the year. A short study of it will give some idea of the great variety of work undertaken by the Inspectors. This work is often carried out in the face of considerable difficulties, and the high standard of efficiency attained in the Borough reflects great credit on the tact and skill of Mr. Thorpe and his staff. Inspections. House-to-House inspections 629 Increase of Rents Acts inspections 18 Inspections 1,089 Re-Inspections and works in progress 8,636 Visits to Factories, Workshops and Outworkers 1,315 Visits to Petroleum Stores 254 Visits to Slaughter-houses 266 Visits to Bakehouses 81 Visits to Cowsheds, Dairies and Milk-shops 113 Visits to Ice-cream premises 98 — 16 — Visits to Food shops 861 Visits to Stables 385 Visits to Urinals 58 Visits to Cinemas 36 Smoke inspections 13 Visits re Infectious Disease notified 235 ,, other Infectious Disease 24 ,, Vermin 12 ,, Tuberculosis, etc. 1,054 ,, Deaths 157 Total number of inspections and re-inspections 15,334 Notices Served. Informal Notices served (general) 1,311 do. do. do. (Increase of Rents Acts) 9 Statutory Notices served :— Under sec. 41, Public Health Act, 1875, to examine drains Under sec. 41, Public Health Act, 1875, to relay drains 10 10 Under sec. 91, Public Health Act, 1875, to abate nuisances 114 Summary of Sanitary Improvements Carried Out. Drainage.— Number of houses and premises re-drained 15 Repairs or amendments to existing drains 93 Drains or gullies unstopped or cleansed 82 Manholes provided 26 Manholes altered and repaired 17 Intercepting traps fixed 16 New gully traps fixed 76 New soil-pipes and ventilating shafts fixed 29 Soil-pipes and ventilating shafts repaired 34 Water tests applied 50 Smoke tests applied 127 Drains examined, Public Health Act, 1875 (Section 41) 10 Water-closets and Sanitary Fittings.— New water-closet basins fixed 66 Water-closets unstopped, cleansed or repaired 102 New check cisterns fitted to water-closets 18 — 17 — Existing check cisterns repaired 56 Water-closet apartments repaired 25 New impervious sinks provided 30 New waste-pipes fixed 22 Waste-pipes trapped, repaired or unstopped 76 Miscellaneous.— Roofs repaired 341 Eaves guttering renewed, cleansed or repaired 181 New eaves guttering provided 20 Rain-water pipes provided 23 Rain-water pipes repaired or unstopped 124 Stack pipes disconnected from drains 6 Damp walls remedied 80 Yards paved 3 Paving of yards repaired 146 Floors of rooms repaired 102 Rooms cleansed, distempered or re-papered 554 Workrooms cleansed and repaired 22 Drinking-water cisterns repaired, cleansed and covered 106 Movable sanitary dustbins provided 130 Accumulations of manure and refuse removed 60 Stoves and ranges repaired 26 Coppers repaired 18 Miscellaneous 491 Infectious Disease and Disinfection.— Number of rooms fumigated after infectious disease 721 Verminous rooms fumigated 42 Number of articles disinfected 5,880 Number of articles destroyed 134 Complaints.—Complaints were received in respect of 256 alleged nuisances. All the premises concerned were inspected and, where nuisances were found, the necessary steps were taken to have them abated. Premises periodically inspected. — The following premises were visited periodically during the year and any matters found requiring attention were dealt with;— — 18 — Description of Premises. No in District Dairies, Cow-sheds and Milkshops 30 Ice-cream premises 56 Bakehouses 32 Restaurant kitchens 30 Slaughter-houses 5 Butchers' shops 55 Fish shops 26 Shops re Food supplies ... 211 Factories, Workshops and Outworkers' work-places ... 421 Cinemas ... ... ... ... ... 7 The Rent and Mortgage Interest (Restriction) Acts.— Eighteen formal applications for certificates under the Kent and Mortgage Interest (Restriction) Acts were received. In nine instances the necessary repairs were carried out by the owners; one certificate was issued and five refused; three applications were withdrawn. Petroleum Acts, etc.— Two-gallon-tin Stores. Bulk Stores. Number of licences in force 60 ... 43 17 Carbide of Calcium.— Number of licences in force ... 6 The premises where petrol is stored are visited regularly and a list with particulars is sent to the Superintendent of the Fire Brigade each year. Rag Flock Act.—Nineteen visits have been made to upholsterers' premises where rag flock was being used. Shops Acts.—Regular inspections have been made in regard to the closing of shops at the hours set down in the Shops (Early Closing) Act. Generally speaking this Act is well observed, but where an infringement has occurred the attention of the shopkeeper has been called to the matter and an undertaking obtained that the contravention will not recur, in all cases with satisfactory results. Close attention is paid to the provisions of the Shops Act, 1912, and to the closing of shops for the weekly halfholiday. Apart from neglect to display the prescribed forms in a few instances, all of which have received attention on notice being given to the shopkeeper, the Act has been strictly observed. Cinemas, etc—All the Cinemas and places of public entertainment have been periodically visited, attention being directed to the sanitary conveniences and the general cleanliness of the — 19 — premises. It is pleasing to report that in no instance have the conditions been found other than satisfactory. Factory and Workshop Acts, 1901 and 1907. — The total number of Factories, Workshops and Work-places on the register is 421. The businesses carried on at the respective premises are as follows:— Bakehouses 32 Dressmakers and Milliners 31 Bootmakers 45 Tailors 41 Laundries 9 Motor and Cycle Engineers 39 Restaurant Kitchen and Cooked Meats 39 Other Trades 185 421 HOUSING. General Conditions.—The census of 1921 shows that the average number of rooms per dwelling in Hornsey was 6.97 (the highest figure in Middlesex), that there were 1.38 rooms per person (the third highest figure in the County), and that the percentage of families living more than two persons in a room was 3'2. The increase in the number of private families between 1911 and 1921 was 178 per cent., whereas the increase in the number of dwellings was only 6.3 per cent. The preparation of a housing scheme under the Housing of the Working Classes Act was undertaken in 1896, and in 1898 the first cottages in Hornsey were ready for occupation. Since then 436 cottages have been erected by the Town Council at Hornsey and Highgate, and 142 at the Coppetts Road site, making a total of 578. At the end of 1925 some 56 cottages at the latter site were in course of erection and sanction for another 229 has been obtained. The accommodation at these dwellings ranges from small flats containing living-room, one bedroom, scullery and water-closet, to cottages containing sitting-room, living-room, four bedrooms, bathroom and water-closet. Inclusive rents vary from 8s. l0d. to 20s. 6d. per week. Private enterprise has been responsible for the erection of 214 houses during 1925 and for the conversion of houses into flats in 14 instances. — 20 — Overcrowding exists in Hornsey as elsewhere, but probably to a less degree than in many parts of the Metropolitan and Greater London areas. Instances of overcrowding are not infrequently discovered by officers of the department during their routine inspection work and there can now be few cases not known to the department. Attempts are made to have some rearrangement of the sleeping accommodation brought about in those cases where boys and girls above a certain age are found to be occupying the same bedroom, and constant observation is kept upon many of the most careless families. Numbers of cases of overcrowding are referred to the Surveyor with a recommendation that their claims for a Council dwelling should receive special consideration. Such consideration is always given, and in many instances overcrowding has been considerably relieved by transference of a family from a crowded house to one of the new dwellings on the Coppetts Road Estate. The Surveyor in his turn notifies the Public Health Department of all premises about to be vacated by families who have been accepted as tenants by the Town Council. In this way the Inspectors are able to control to some extent the future sub-letting of such houses. As a result of the most recent efforts of the Town Council in this direction 78 houses formally occupied by 689 persons are now occupied bv only 425. House-to-House Inspection.—The following table gives a comparison of post-war and pre-war conditions as a result of house-to-house inspections in a number of roads: — Pre-War. Post-War. Number of houses inspected' 210 210 Average number of rooms per house 6.07 6.07 Total number of families 270 316 Total number of persons over 10 years 932 1,026 Total number of persons under 10 years 439 402 Average number of persons per house 5.5 58 Average number of persons per room 0.90 0.96 Average number of persons per room used for sleeping 1.8 1.9 Number of houses with more than 2 persons per room 1 2 Number of houses with more than 2.5 persons per bedroom 21 22 Number of houses sub-let 59 87 (N.B.—Children under 10 years counted as 0.5 persons.) — 21 — The general standard of houses in Hornsey is good. As a rule no great difficulty is experienced in persuading property owners to carry out necessary repairs. Action in the case of persistent refusal to undertake work is usually taken under the nuisance section of the Public Health Act, 1875, and during the year in only one instance was it found' necessary to take legal proceedings. The Rent and Mortgage Interest (Restriction) Acts have proved helpful in securing the carrying out of repairs. During the year 18 applications under these Acts were received; the necessary work was carried out in nine instances; three applications were withdrawn; one certificate was granted and five refused. The landlord is not always the only person responsible for the dilapidated condition of dwellings. Instances could be cited where in a. row of cottages, all owned by the same individual, several cottages are maintained in a clean and satisfactory state, whereas others are filthy and in disrepair. In the one case the tenants are clean and careful and in the other dirty and careless. The Town Council possesses little or no legal power to deal with unsatisfactory tenants. INSPECTION AND SUPERVISION OF FOOD. Milk.—Premises registered for the sale of milk and milk licences, 1925: — Premises registered as milk-shops 42 Pasteurizing plants licensed 2 Premises registered for sale of " Pasteurized Milk " 19 Premises registered to sell "Certified Milk " 6 Premises registered to sell "Grade A (tuberculin tested) Milk " 1 Nearly all milk consumed in Hornsey is brought from considerable distances and the larger bulk of it is pasteurized. During the five years' period under review a good deal of legislation regarding milk has been enacted. Extended powers have been granted in connection with the registration of dairymen, the supervision of employees, and the control of the sale of tuberculous milk. In addition, a scheme for grading milk according to methods of production and to bacteriological standards has been introduced. — 22 — These graded milks are known as "Certified," "Grade A," "Grade A (tuberculin tested)," and "Pasteurized." No milk can be sold under any of these designations unless the producers and the retailers have obtained licences from the various local authorities concerned, and no licence is granted unless certain conditions are complied with and certain standards of cleanliness are attained. "Certified milk" is milk produced from a herd free from tuberculosis as proved by repeated tuberculin tests. It must be bottled on the farm immediately after production and the bottles must be provided with a special cap on which must be printed the day of production and the words "Certified Milk." The milk must not at any time be treated by heat and must not at any time before delivery to the consumer be found to contain: — (a) more than 30,000 bacteria per cubic centimetre, and (b) any coliform bacilli in one-tenth of a cubic centimetre. "Grade A milk" is milk produced from a herd examined once in every three months by an approved veterinary surgeon. No tuberculin tests are necessary. This milk as a rule is delivered to consumers in bottles capped and marked in a specified manner and, unless a special licence for pasteurized milk has been obtained, the milk must not be treated by heat. "Grade A milk" must not at any time before delivery to the consumer be found to contain: — (a) more than '200,(XX) bacteria per cubic centimetre, and (b) any coliform bacilli in one-hundredth of a cubic metre. "Grade A (tuberculin tested) milk" is produced from a herd tested periodically with tuberculin, but the bacteriological standards and the methods of retail are the same as in the case of "Grade A milk." "Pasteurized milk" is milk which has been retained at a temperature of not less than 145 degrees and not more than 150 degrees Fahrenheit for at least half-an-hour and has been cooled immediately afterwards to a temperature of not more than 55 degrees Fahrenheit. Every vessel containing this milk must — 23 — hear a suitable label with the words " Pasteurized milk," and the milk itself must not contain at any time before delivery to the consumer more than 100,000 bacteria per cubic centimetre. These milks are clean, for bacteriological standards are the only standards by which cleanliness of milk can be judged. In March, 1925, the retail price of "Certified milk" was Is. l£d. a quart, of "Grade A (tuberculin tested) milk" lid., of "Grade A milk " 9d., and of " Pasteurized " 7d. The lowest price of ordinary milk unaccompanied by any guarantee of cleanliness was 7d. a quart. The public should insist upon having one or other of the "designated " milks, delivered in bottles. Bottling milk in the streets will probably be prohibited in the near future by the Minister of Health. Clean milk is not only safe milk, but its keeping qualities are better. Important regulations have also been introduced regarding the labelling of condensed milk and of dried milk. Eighteen samples of milk from roundsmen have been taken by the Chief Inspector and submitted to bacteriological examination. In all cases where the results proved unsatisfactory the milk was not being sold under any of the official designations. Meat.—Under the Public Health (Meat) Regulations, 1924, notice of intention to slaughter has to be sent to the Town Hall by all butchers who have a slaughter-house in Hornsey. In this way the Inspectors are enabled to inspect the carcase and organs of every animal killed in the Borough. The general standard of meat sold in Hornsey is good, and in no case has it been found necessary to seize any portion of a carcase or any organ. During the year the carcases of 1,395 sheep, of 140 beasts and of two pigs have been inspected under the Regulations and in 16 cases meat, amounting to 500 lbs. in weight, was surrendered voluntarily on account of some diseased condition. All diseased meat is destroyed at the Corporation incinerator. These regulations also require occupiers of shops and stalls to take all precautions necessary to protect meat from contamination by dust and flies. There are no street stalls in Hornsey, — 24 — So far as shops are concerned, the only satisfactory means of complying with the regulations is to fit a modern plate-glass front. This has 'been done in about 25 per cent, of butchers' shops in the Borough and it is only to be expected that traders showing such care will secure a greater share of public patronage than will their less enterprising rivals, who, although they have taken some steps towards improving conditions, have still left much to be done. It is quite certain that the public are being much more critical in their attitude with regard to the handling of food, and traders will find it in their own interests to adopt modern and clean methods of shop practice. Slaughter-houses.—The following is a statement regarding the slaughter-houses in the Borough: — In 1920. In Jan., 1925. In Dec., 1925. Licensed 7 5 5 Other Foods. — Particular attention has been paid to all premises where food is prepared or sold, and it is only by frequent inspection that satisfactory standards of cleanliness can be maintained. Registration, if not licensing, of all such premises would do much to bring about better conditions than would any other procedure. During the year 1,718 visits of inspection were paid to the various food premises in the Borough. Unsound Food.—The following unsound food was surrendered and destroyed: — Beef (2 forequarters) 250 lbs. Liver 217 „ Lungs 33 „ Fish 96 „ Cod roe 25 „ Kippers 1 box Crabs 1 kit Sale of Food and Drugs Acts.—Mr. Robinson, Chief Officer of the Public Control Department of the Middlesex County Council, has very kindly sent me the following figures for inclusion in this report:— — 25 — " List of Samples purchased in Hornsey during tiie Year ended 31st December, 1925. Article Taken. Adulterated. Milk 282 8 Cream 12 8 Butter 24 — Arrowroot 1 — Bread 1 — Carraway seeds 7 1 Cinnamon 7 — Cod liver oil and malt 3 1 Coffee 5 — Curry powder 3 — Fish paste 5 — Food colour 1 — Fruit, crystallized 7 — Ginger, ground 3 — Meat, cooked 5 — Mincemeat 1 — Nutmeg, ground 4 — Sweets 2 — 373 18 Prosecutions 5 Convictions 4 Penalty imposed as costs 1 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. (See Tables F. and G., pp. 42 and 43). Scarlet Fever and Diphtheria.—The five years' period under review has been marked by the most widespread outbreaks of scarlet fever and of diphtheria Hornsey has ever experienced. In 1921 no fewer than 591 cases of scarlet fever and 189 cases of diphtheria were notified. Since then both diseases have declined in extent. Scarlet fever has of late years been mild in type, but diphtheria still shows at times a marked degree of virulence. — 26 — The following table shows the incidence of infecting cases discharged from hospital since 1920:— YEAR. SCARLET FEVER. Persons infect«d. "Return Cases" Infecting cases. Percentage of infecting cases. DIPHTHERIA. Persons infected. "Return Case*?" Infecting cases. Percentage of infecting cases. 1921 571 14 12 2 1 189 2 1 0.53 1922 201 10 7 3 43 103 — — — 1923 100 5 5 5 0 113 — — — 1924 159 14* 7 44 33 — — — 1925 77 1 1 13 43 — — — * Including 2 cases belonging to other Hospitals. "Return cases" means cases occurring in the same house or elsewhere, and apparently traceable to the person released, within a period of not less than twenty-four hours or not more than twenty-eight days, after his return or release from isolation. The Medical Officer of Health visits all households where "return cases" of scarlet fever or of diphtheria have occurred and the infecting cases are carefully examined for some evidence of continuing infection. Diphtheria anti-toxin is always available for practitioners at six different points in the Borough, but inasmuch as most cases of this disease are removed forthwith to hospital the demand for anti-toxin is not great. The giving of anti-toxin to doubtful cases, after a throat swab has been taken but before the bacteriological report has been received, might wiell be extended. In 19.22 my predecessor applied the Schick test for susceptibility to diphtheria to all the boys at the Kitchener Memorial Home. In 12 cases out of 51 tested the results were positive. These positive reacters were all given two doses of toxin—anti-toxin mixture (½ c.c. and 1 c.c.). In 1923 only six of these cases were still in the Home, and four gave negative results when the Schick test was re-applied. The remaining two were found to be suffering from diphtheria at the time of re-testing. It is — 27 — probable that the original doses of toxin-anti-toxin mixture injected were not large enough to produce any degree of lasting immunity. Influenza and Pneumonia.—Influenza was responsible for 40 deaths in 1922, as compared- with 12 in 1925. Most of these deaths were of persons of 45 years or over. There has been occasional prevalence of influenza during the past five years, but the disease has never assumed real epidemic proportions, nor has the mortality rate beien high. Since 1922 an anti-catarrhal vaccine has been supplied to medical practitioners by the Town Council at cost price. During the year 480 c.c. of this vaccine have been issued, and most of those who have used it speak favourably of the results obtained. The vaccine is prepared by the Lister Institute and contains in each cubic centimetre— B. Influenza 400 Millions. Pneumococci 200 ,, Streptococci 60 ,, M. Catarrhalis 50 ,, Other Notifiable Diseases.—Typhoid fever (including paratyphoid fever) was rather more prevalent in 1925, when 10 cases were notified. Only one death from tohis group has occurred during the past five years, and that in 1923. Encephalitis lethargica (sleepy sickness) was notified last year on 7 occasions, the greatest number of notifications (10) during the five-year period being received in 1924. There has been no small-pox in the Borough during the five years under review, nor have any vaccinations been performed by the Medical Officer of Health under the Public Health (Small-pox) Regulations, 1917. There were 7 deaths from whooping cough and 2 deaths from measles among children under five years of age during the past year. Ophthalmia Neonatorum.—Four cases of Ophthalmia Neonatorum were notified during the year. All these cases were visited by the Health Visitors and attention given where necessary. An arrangement exists with the Metropolitan Asylums — 28 — Board for the admission of cases of this disease to St. Margaret 's Hospital, Kentish Town, if required, but none of the cases mentioned was treated in this Hospital. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 4 3 1 4 0 0 0 Non-Notifiable Infectious Diseases.—The two main sources of information regarding such diseases are the Infant Welfare Centres and the Schools. Arrangements have been made with the Highgate Nursing Association and with the North London Nursing Association for the nursing of cases—more especially of measles-—referred to them by the Medical Officer of Health. These arrangements affect only certain wards in the Borough, and might well be extended. Cancer.—The death-rate from cancer shows small fluctuations. In 1925 it amounted to T57 per 1,000 population. In 1924 the rat© was 1.69. In England and Wales the deathrate for cancer in 1924 was 1.29 per 1,000 population. The fact that Hornsey contains an undue proportion of elderly persons accounts for the higher rates prevalent in the Borough, for cancer is essentially a disease of those in the later years of life. Cleansing and Disinfection.—Verminous persons and persons suffering from scabies may be cleansed at the Cleansing Station, High Street, Hornsey. A well-equipped station is provided, and during 1925 sixteen adults and 151 school children received treatment. The clothing of such persons is disinfected! at the time of cleansing, and in many cases it is found possible to disinfect the houses as well. Disinfection is offered in cases of death from tuberculosis, cancer, pneumonia and other diseases. In 111 of the 246 instances in which the service was offered it was accepted. — •29 — The following is a record of the disinfection work carried out during the year: — Premises. Rooms disinfected. Articles disinfected. Articles destroyed. Notifiable diseases 215 243 3,434 2 Non-notifiable diseases 362 478 2,446 132 Isolation Hospital.—It has been decided to enlarge the Joint Isolation Hospital and to re-arrange the existing accommodation. The new buildings will include (a) an isolation block, of cruciform shape, containing 20 cubical wards, (b) a new nurses' home containing 39 bedrooms, and (c) an entrance lodge. Hornsey's share of the cost of these additions will be £8,081. The extensions will be completed before the end of 1927, and the Hospital will then contain 12.3 beds. It is felt that the addition of 20 cubical isolation wards will enable the remaining bed accommodation in the Hospital to be used to full advantage. During 1925 arrangements have been made with the Metropolitan Asylums Board (Ambulance Section) for the removal to hospital of all infectious persons whose admission to hospital has been authorised. These arrangements have proved very satisfactory, and the cost works out at approximately 17s. 9d. per case. Small-Pox Hospital. — In 1921 the Town Council entered into an agreement with the Uxbridge Joint Hospital Board for the reception of Hornsey patients suffering from small-pox in the Board's Smallpox Hospital at Yeading, Hayes, Middle-ex. This hospital has accommodation for 48 beds, and of these 10 are allocated to Hornsey. Laboratory Work. — With the exception of the more complicated blood tests all the routine bacteriological work is carried — 30 — out at the laboratory of the Joint Isolation Hospital. The following district work was done during 1925: — Negative. Positive. Examinations for diphtheria bacilli 569 56 ,, ,, tubercle bacilli 217 25 ,, ringworm 10 10 ,, ,, typhoid bacilli 6 1 Other examinations 6 Total 900 out at the laboratory of the Joint Isolation Hospital. TUBERCULOSIS. Under the Public Health (Tuberculosis) regulations, dated 18th December, 1924, it is required that a quarterly return shall be compiled showing:— (a) The number of cases of tuberculosis on the register at the commencement of the quarter. (b) The number of cases notified during the quarter. (c) The number of cases removed from the register during the quarter, with name and address and reason of removal. (d) The number of cases remaining on the register at the end of the quarter. Separate figures are to be given for males and females and for pulmonary and non-pulmonary cases. These new Regulations made it necessary for inquiries to be made at the addresses of' all cases on the register, and this entailed over 1,000 visits. The following statement shows the condition of the register at the beginning and at the end of the year:— No. of cases at commencement of 1925. No. of cases added during 1925. No. of cases removed during 1925. No. of cases on register at end of 1925. Pul. Non.-Pul. Pul. Non.-Pul. Pul. Non.-Pul. Pul. Non.-Pul. Males 355 52 51 6 224 17 182 41 Females 296 56 55 3 183 25 168 34 — 31 — The cases removed from the register are for the following reasons:— Deaths 170 Removed from district 273 Disease arrested 6 449 The average number of beds in residential institutions available for Middlesex patients suffering from tuberculosis during the year 1925:— Observation. Pulmonary tuberculosis. Nonpulmonary tuberculosis. Total. Adult Males 9 301 41 351 Adult Females 7 198 34 239 Children under 15 8 65 94 167 Total 24 564 163 757 The number of deaths from tuberculosis in Hornsey has fallen during the past five years from 87 in 1921 to 51 in 1925 —the death-rate per 1,000 population in 1925 was 06. In 1924 the death-rate in England and Wales for tuberculosis (all forms) was 1.05. A detailed list of new cases of, and deaths from, Tuberculosis will be found in Table H. (p. 44). No action has had to be taken during the year either with regard to tuberculous employees in the milk trade or with regard to the compulsory removal to hospital of persons suffering from tuberculosis in an infectious stage. MATERNITY AND CHILD WELFARE. Midwives.—The Hornsey Town Council appointed a municipal midwife in 1921. Her services have been increasingly popular in the Borough, as the following record of cases attended shows: — 1922 41 1923 60 1924 79 1925 105 — 32 — A charge of 35s. per case is made for the midwife's attendance, but this charge may be remitted in part in necessitous cases. During 1925 a sum of £172 18s. 0d. was recovered from lying-in women who were attended by the municipal midwife. The midwife attends all ante-natal clinics (about 60 in the year), and during 1925 made 1,681 visits to mothers in their homes. The supervision of midwives is the duty of the Middlesex County Council. Maternity Homes.—Although the Borough has no maternity home of its own, the Town Council has made arrangements for the admission of lying-in women, on the recommendation of their Medical Officer, to the North Middlesex Hospital and to the Royal Free Hospital, at. a charge in the former instance of 6s. a day and in the latter of 10s. a day. During 1925 thirty women from Hornsey were admitted to one or other of these institutions at a total cost of £162 4s. 0d. Towards this sum the mothers themselves contributed £70 16s. 6d. Centres.—There are now three Maternity and Child Welfare centres in the Borough, the third centre having been opened at Highgate in October, 1925. The new centre is situated in a building belonging to All Saints Church at the junction of Church Road and North Hill. The accommodation consists of two large rooms and two small rooms on the first floor with useful attics above and kitchen premises below. Gas heating has been installed throughout, and a pram shed has been built in the adjoining yard. The total cost of the necessary alteration and re-decoration amounted to £279. Seven ordinary sessions are held weekly and seven antenatal sessions monthly throughout the Borough. Dr. Flora Shepherd attends the former and Dr. Muir the latter. Attendances of mothers are highly satisfactory, as reference to Table I. will show. The average number of attendances at each ordinary session was 42.1, and at each ante-natal session was 9. Health Visitors.— An additional Health Visitor was appointed in 1925, there being now four women engaged in this work. The health visiting staff and the school nursing staff are quite separate, save in one respect, that both staffs — 88 — undertake to apply simple dressings to children referred to the centres from the schools between 9 and 10 a.m. during school terms. In return for this service certain cases of defects of the eyes or teeth, or of enlarged tonsils and adenoids, referred from the centres are dealt with at the school clinic. The Health Visitors attend the ordinary sessions at the centres, and hold themselves special sessions, when health talks are given. Details of the work of the Health Visitors and of the Municipal Midwife will be found in Table I. (p. 45). Voluntary Workers.—Each Centre has its own committee of voluntary workers who assist in various ways on the days when the centres are open and who are responsible for much social work of great importance. During the year the Voluntary Committees at the three centres provided dental treatment in 32 cases, massage in 86 cases, and insulin treatment for six months in one case. Thirteen mothers and 12 babies were also sent to convalescent homes. Instruction in the making of clothing has been given to mothers, and in necessitous cases garments have sometimes been provided free of cost. In one case a home-help was arranged for. The responsibility for the raising of the money necessary for all these activities rests with the Voluntary Committees, who are assisted by committees of the mothers attending the centres, and in one case, at any rate, by a very active fathers' committee. It is quite certain that without the co-operation of the Voluntary Committees and of mothers' and fathers' committees the Council's Maternity and Child Welfare Scheme would not play the important part in the life of the Borough that it undoubtedly does at the present time. Supply of Milk to Mothers and Children.—During the year 175 cases have received milk free or at less than cost price. The sum so expended has amounted to £67 17s, 7d. Residential Institutions (Table J.).—There are several special institutions within the Borough to which mothers and babies may be admitted. The Motheroraft Training Society at Cromwell House has accommodation for 10 nursing mothers and for 15 infants; the Hornsey Deanery Association can receive — 34 — 10 unmarried mothers and 5 babies, and the Santa Claus Home 20 children suffering from conditions of the hip and spine requiring surgical supervision and nursing. There are in addition 19 registered foster mothers living in Hornsey. Maternal Mortality.—Three mothers died as a result of their confinements—the maternal mortality rate is thus 2.47 per 1,000 births. There were no deaths from puerperal sepsis. All of these maternal deaths occurred in lying-in institutions, and none of the mothers had attended one or other of the ante-natal clinics. Infantile Mortality.—The number of Homsey infants who died under one year of age was given by the Registrar-General as 53. Local returns made this figure 49. Premature birth accounted for 19 of these deaths, and weakness and wasting for ten. More than half of the deaths of infants occurred during the first four weeks of life. It is only by encouraging mothers to obtain medical advice during the later months of pregnancy that we can hope further to reduce the maternal mortality rate and deaths of infants in the first weeks of life. All deaths from pneumonia, bronchitis, diarrhoea and whooping cough occurred among children over four weeks of age. Twenty-seven notifications of still births were received in the office, 10 of which occurred outside the Borough, and all were investigated. Twelve of the still births occurred in institutions, and at eight of the others a doctor was in attendance. The infantile mortality rate—43.6 per 1,000 births—is the second lowest on record. DISEASES OF ANIMALS ACTS. The Veterinary Inspector under the Diseases of Animals Acts, Mr. J. Buxton, having retired, applications were invited for the appointment from the veterinary surgeons practising in the Borough, and Mr. F. Buxton was appointed in November, 1925. — 35 — In consequence of increased legislation on this subject it was found necessary to revise the scale of fees in force, and this was done at the time the new appointment was made. The following is a summary of the work carried out by the Veterinary Inspector during the year:— 2 cases of Sarcoptic Mange in horses were reported and confirmed microscopically. 43 Licences were issued 43 Inspections were made under the Diseases of Animals Acts, comprising:— 2 Inspections of horses affected with Sarcoptic Mange. 12 ,, of pigs brought into the Borough. 29 ,, of sheep and beasts brought into the Borough. A nil return under the Tuberculosis Order, dated July 13th, 1925. LEGAL PROCEEDINGS. One summons for non-compliance with a statutory notice was heard at Highgate Police Court; an order was made for the carrying out of the work and a fine of 10s. imposed. MOSQUITOES. The spraying of stagnant water on swampy ground with a view to preventing breeding of midges and mosquitoes was carried out, with some degree of success, on eight occasions. — 36 — LIST OF TABLES. TABLE A. Vital Statistics, 1901-1925. TABLE B.—Chart showing Births, Deaths and Infantile Mortality Rates, 1901-1925. TABLE C.—Causes of, and ages at, death in 1925, and Summary 1921-1925. TABLE D.—Infant Mortality in 1925. TABLE E.—Births, Deaths, Infant Deaths, and Deaths from certain diseases, 1901-1925. TABLE F.—Cases of Infectious Disease notified in 1925. TABLE Gr.—Cases of Infectious Disease notified 1901-1925. TABLE H.—Notifications of, and deaths from, Tuberculosis, 1925. TABLE I.—Work done at the Maternity and Child Welfare Centres and by Municipal Midwife, 1925. TABLE J.—List of Residential Institutions in the Borough. TABLE K.—Inspection of Factories, etc., 1925. TABLE L.—Statistics as to Housing conditions, 1925. — 87 — TABLE A. BOROUGH OF HORNSEY VITAL STATISTICS, 1901-1925. Year Estimated Mid-Year Population. Birth Rats per 1,000 Population. Death Rate per 1,000 Population. Infant Mortality per 1,000 Birthh. 1901 73,549 20.5 8.3 84 1902 74,653 20.8 8.6 82 1903 75,757 20.6 8.0 83 1904 76,861 21.6 8.9 86 1905 77,945 20.0 8.7 67 1906 79,069 20.1 9.8 84 1907 80,173 19.0 9.5 76 1908 81,254 18.2 9.2 63 1909 82,378 18.3 9.6 57 1910 83,401 16.7 8.8 69 1911 84,592 17.5 9.6 78 1912 84,840 16.3 9.9 75 1913 85,122 16.7 9.7 66 1914 85,456 17.8 9.2 57 1915 85,800 15.5 12.2 80 1916 86,147 16.0 11.5 46 1917 86,450 11.3 10.9 70 1918 86,942 11.7 13.8 61 1919 87,100 13.6 11.4 64 1920 87,410 19.3 10.3 54 1921 87,691 16.7 11.0 49 1922 88,007 15.4 11.2 54 1923 88,325 14.4 10.5 51 1924 88,661 13.4 10.4 41 1925 89,064 13.6 10.6 436 105 Great Towns (Rates in 1925) 18.8 12.2 79 157 Smaller Towns (Rates in 1925) 18.3 11.2 74 London (Rates in 1925) 18.0 11.7 67 ENGLAND and WALES (Rates in 1925) 18.3 12.2 75 TABLE B. CHART SHOWINC RATES OF BIRTHS, DEATHS & INFANTILE MORTALITY FOR FIRST QUARTER OF 20^ CENTURY. 39 CAUSES OF DEATH 1925 All Ages. Under 1 year. 1 and under 2 yearp. 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 years and over. 1925 1924 1923 1922 1921 1 Enteric Fever ... ... ... ... ... ... ... ... 0 0 1 0 0 2 Small-pox ... ... ... ... ... ... ... ... 0 0 0 0 0 3 Measles ... ... ... 2 ... ... ... ... 2 2 4 3 1 4 Scarlet Fever ... ... ... ... ... ... ... ... 0 1 1 2 4 5 Whooping Cough ... 4 ... ... ... ... ... ... 7 2 1 7 2 6 Diphtheria and Croup ... ... ... 1 ... ... ... ... 1 2 4 7 13 7 Influenza ... ... ... ... 1 1 1 9 12 19 11 40 22 8 Encephalitis Lethargica ... 1 ... ... 1 ... 1 ... 3 2 ... ... ... 9 Meningococcal Meningitis ... ... ... ... ... ... 1 ... 3 1 5 4 5 10 Tuberculosis of Respiratory System ... ... ... ... 12 21 11 2 46 54 47 57 71 11 Other Tuberculous Diseases ... ... ... 2 1 1 ... ... 5 6 11 13 16 12 Cancer, Malignant Disease ... ... ... 1 ... 15 54 70 140 150 139 145 142 13 Rheumatic Fever ... ... ... ... 1 ... ... 2 3 5 1 6 3 14 Diabetes ... ... ... ... ... 2 4 4 10 7 ... ... ... 15 Cerebral Hæmorrhage, etc. ... ... ... ... ... 3 15 51 69 65 ... ... ... 16 Heart Disease ... ... ... ... 3 9 30 93 136 107 105 89 80 17 Arterio-Scleroeis ... ... ... ... ... ... 7 41 48 45 ... ... ... 18 Bronchitis ... ... ... 1 ... 1 23 62 88 93 78 72 87 19 Pneumonia Call forms') ... 2 ... 1 2 13 21 30 76 65 74 80 56 20 Other Respiratory Diseases ... ... ... ... ... 1 1 9 11 3 1 3 6 21 Ulcer of Stomach or Duodenum ... ... ... ... ... ... 4 1 6 0 ... ... ... 22 Diarrhoea, etc. ... ... ... ... ... ... ... ... 2 1 4 3 15 23 Appendicitis and Typhlitis ... ... ... 2 2 2 ... 2 8 8 6 12 8 24 Cirrhosis of Liver ... ... ... ... ... 1 2 2 5 5 6 5 11 25 Acute and Chronic Nephritis ... ... ... ... ... 2 11 12 25 34 35 34 25 26 Puerperal Sepsis ... ... ... ... ... ... ... ... 0 1 0 3 0 27 Other accidents and diseases of Pregnancy and Parturition ... ... ... ... 1 2 ... ... 3 1 5 2 3 28 Congenital Debility and Malformation, Premature Birth 28 ... ... ... ... ... ... ... 28 36 42 42 45 29 Suicide ... ... ... ... ... 1 3 ... 4 10 12 13 12 30 Other Deaths from Violence 2 ... 2 2 2 2 6 10 26 21 21 29 25 31 Other Defined Diseases 5 1 2 1 7 19 49 95 179 182 312 321 310 32 Pauses Ill-defined or Unknown ... ... ... ... ... ... ... ... ... ... 2 ... 6 Total 49 8 8 13 33 96 244 495 946 928 H28 U92 968 Adapted from old Classified List. — 40 — TABLE D.—INFANT MORTALITY, 1925. CAUSES OF DEATH. Deaths from stated causes at various Ages under One Year of Age. Total Deaths under One Year. Under 1 Week. 1-2 WeekB. 8-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Whooping Cough — — — — 0 1 — 2 — 3 Tuberculous Meningitis — — — — 0 — — — — 0 Other Tuberculous Diseases — — — — 2 — — — — 0 Convulsions 2 — — — 0 — — — 1 3 Bronchitis — — — — 0 — — 1 — 1 Pneumonia — — — — 0 — 2 1 2 6 Diarrhœa — — — — 0 1 — — 1 2 Rickets — — — — 0 — — — — 0 Injury at Birth — — — — 0 — — — — 0 Premature Birth 16 1 1 — 18 1 — — — 19 Atrophy, Debility and Marasmus 2 — 1 1 4 2 3 — 1 10 Other Causes 2 — — — 2 3 1 — — 6 Total 22 1 2 1 26 8 6 4 5 49 — 41 - TABLE E. BIRTHS, DEATHS, INFANT DEATHS, AND DEATHS FROM CERTAIN DISEASES, 1001-1925. YEAR. Population Census. Total Births Total Deaths Total Infant Deaths (under one year) Deaths fr»m Measles Deaths from Whooping Cough Deathsfrom Diarhoea (under two years) Deathsfrom Scarlet Fever Deaths from Diphtheria Deaths from Typhoid Fever. Deaths from Cancer. Deaths from Tuber culosis (Pulmonary Deaths from Tuberculosis (Non-Pulmonary) 1901 72,056 1,511 597 127 8 14 6 I 8 3 47 45 18 1902 1,565 620 129 7 9 1 0 9 6 51 45 22 1903 1,561 589 130 15 19 1 I 8 1 62 46 20 1904 1,659 690 143 18 17 21 I 7 2 49 54 23 1905 1,567 696 106 9 10 6 3 8 2 65 58 16 1906 1,603 769 136 18 4 22 6 13 5 65 47 13 1907 1,524 766 116 5 19 3 4 9 4 76 50 19 1908 1,485 752 95 12 11 3 3 9 2 84 53 16 1909 1,508 787 87 12 12 0 3 10 0 75 57 26 1910 1,393 737 97 1 10 0 4 8 3 88 41 18 1911 84,592 1.479 812 116 20 15 35 1 6 1 103 55 23 1912 1,385 840 105 5 2 13 3 2 2 114 43 17 1913 1,425 824 81 12 8 12 0 4 3 96 55 14 1914 1,529 791 88 1 4 21 1 7 1 82 44 10 1915 1,394 1,007 112 37 7 23 3 11 2 99 58 19 1916 1,404 928 64 0 5 8 0 11 1 106 84 20 1917 1,(138 906 73 14 6 3 0 6 0 113 58 25 1918 1,037 1,094 64 6 13 7 2 8 0 130 76 13 1919 1,188 992 76 0 0 6 2 3 1 119 66 11 1920 1.707 657 93 4 7 7 3 20 2 119 61 12 1921 87,859 1.468 968 72 1 2 14 4 13 0 142 71 16 1922 1.372 992 72 3 7 3 2 7 0 145 57 13 1923 1,277 928 64 4 1 3 1 4 1 139 47 11 1924 1,189 938 48 2 2 1 1 2 0 150 54 6 1925 1,214 946 49 2 7 2 0 1 0 140 46 5 — 42 — TABLE F.—INFECTIOUS DISEASES NOTIFIED, 1925. DISEASE WARDS. AGES Total Admitted to Joint Hospital. Admitted to other Hospitals. Registered Deaths. Highgate Muswell Hill. Crouch End West Hornsey East Hornsey North Haringey South Haringey Stroud Green Finsbury Park. 0 1 5 15 25 45 65 and I 5 15 25 45 65 Scarlet Fever 13 15 7 19 25 9 18 11 9 1 26 79 13 6 1 0 126 79 7 0 Diphtheria 9 5 3 10 17 3 1 i 4 0 10 25 10 7 1 0 53 43 7 1 Bnteric Fever 1 4 0 0 2 1 1 i 0 0 1 2 1 2 4 0 10 2 3 0 Puerperal Fever 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 Erysipelas 4 4 3 0 3 4 2 l 5 0 0 1 4 6 11 4 26 5 2 0 Ophth. Neon 0 0 0 0 1 1 0 0 2 4 0 0 0 0 0 0 4 0 1 0 Pneumonia 7 10 4 14 8 9 2 3 3 3 5 8 10 12 13 9 60 0 6 76 Malaria 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 0 0 0 Dysentery 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 1 0 Encephalitis Letliargica 1 0 0 0 2 3 I 0 0 0 0 0 2 3 2 0 7 1 3 3 Cerebro Spinal Meningitis 0 0 0 0 0 1 0 0 o 0 2 0 0 0 0 0 2 0 2 0 Poliomyelitis 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 2 0 0 0 Tuberculosis Phthisis 19 15 4 18 16 9 5 8 0 0 5 20 62 17 2 106 46 Other Forms 1 0 1 1 3 1 1 1 0 0 3 4 1 1 0 0 9 — — 5 Total 57 53 23 62 77 41 31 28 36 8 47 124 63 102 49 15 408 130* 32 131 Admitted to Hospitals except T.B. 25 19 10 25 39 13 12 7 10 - - - - - - - 160 - - - Note.—The following non-notifiable infectious diseases were also admitted to the Isolation Hospital:—Whooping Cough 2, Meaeles 2, Mumi>s 2, 1 Scarlet Fever found to be Sepsis, making a total of 137. * Including 2 Hornsey cases contracted in and transferred from North Middlesex Hospital. — 43 — TABLE G—NOTIFICATIONS OF INFECTIOUS DISEASE, 1901-1925. Year. Population. Scarlet Fever. Diphtheria or Croup. Enteric Fever. Puerperal Fever. Erysipelas. Cerebral Spinal Meningitis. Polio-Myelitis. Ophthalmia Neonatorum. Malaria. Dysentery. Encephalitis Lethargica. Pneumonia. Small-Pox. Measles. German Measles. Total. Attack rate per 1,000 population. 1901 73,549 501 134 35 5 40 — — — — — — — 10 — — 725 9.8 1902 74,653 261 99 38 — 33 — — — — — 35 — — 466 6.2 1903 75,757 203 62 15 2 25 — — — — — 2 — — 309 4.1 1904 76,861 197 101 16 5 40 — — — — — — — — — — 359 4.6 1905 77,945 261 153 20 3 39 — — 1 — — 477 6.1 1906 79,069 411 157 25 1 37 — — — — — — — — — 631 7.9 1907 80,173 283 98 11 5 34 1 — — — — — — — — — 432 5.3 1908 81,254 239 93 9 3 39 — — — — — — — — — — 383 4.7 1909 82,378 221 151 4 1 37 — — — — — — — — — — 414 5.0 1910 83,401 173 105 10 1 30 — — — — — — — — — — 319 3.8 1911 84,592 179 133 6 2 40 — — — — — — — 1 — — 361 4.2 1912 84,840 138 88 9 3 39 1 1 — — — — — — — — 279 3.2 1913 85,122 206 115 10 2 26 — — — — — — — — — — 359 4.2 1914 85,456 346 101 9 1 24 — — 11 — — — — — 492 5.7 1915 85,800 182 105 18 5 35 9 3 I — — — — — — — 358 4.1 1916 86,147 103 77 8 1 32 2 6 9 — — — — — 207 281 726 2.7 1917 86,450 132 66 4 1 28 4 0 1 — — — — — 1,227 881 2,344 2.7 1918 86,942 89 67 8 2 23 1 3 2 — — — — — 796 119 1,110 2.3 1919 87,100 203 87 6 4 42 4 1 5 21 2 5 112 — 224 285 1,001 5.7 not now notifiable. 1920 87,410 245 149 6 2 27 1 3 8 10 2 4 98 — — — 555 6.3 1921 87,691 591 189 2 2 36 — 2 6 1 1 6 42 — — — 878 10.1 1922 88,007 286 1 23 1 2 24 — — 10 1 — 1 104 — — — 552 6.2 1923 88,325 126 133 1 — 24 2 — 6 4 — 2 75 — — — 373 4.2 1924 88,661 215 40 3 1 26 — 1 1 — — 11 61 — — — 359 4.0 1925 89,064 126 53 10 1 26 2 2 4 1 1 7 60 — — — 293 3.3 * Excluding measles and German measles. — 44 — TABLE H.—NOTIFICATIONS OF, AND DEATHS FROM, TUBERCULOSIS, 1925. AGE PERIODS. New Cases. Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M P M F M F 0-1 1-5 — — 3 — — — 1 — 5 -15 3 2 1 3 2 15 -25 6 14 1 6 6 — 1 25 -35 18 19 6 6 1 35 -45 13 12 1 — 5 4 — 45 -55 8 3 — — 4 3 — 55 - 65 3 3 — 4 — 65 — and over — 2 — — 2 — — — Totals 51 55 6 3 27 19 3 2 Wards ;— Highgate 7 12 1 5 5 1 Muswell Hill 7 8 4 3 — 1 Crouch End 4 1 1 — West Hornsey 10 8 1 6 1 1 1 Hast Hornsey 9 7 2 1 1 4 North Haringey 6 3 — 1 3 2 1 South Haringey 2 3 1 1 2 Stroud Green 4 4 1 3 1 Finsbury Park 6 6 — — 3 1 — — Totals 51 55 6 3 27 19 3 2 — 45 — TABLE I. MATEBNITY AND CHILD W'ELFABE WOBIv, 1925. Nature of Work. Centres. Totals. No. 1. No. 2. No. 3. Number of ordinary sessions held 194 96 (3 months). 11 301 Number of ante-natal sessions bald 53 22 1 76 Number of individual Mothers seen by Doctor:— Ante-natal, New cases 189 46 2 237 ,, Old cases 341 101 5 447 Post-natal, New cases 102 31 2 185 ,, Old cases 16S 87 17 269 Total attendances of Mothers 1,291 321 27 1,639 Number of babies attending Centres for first time 516 254 47 817 Number of individual babies on Centre registers 1,125 501 158 1,784 Attendance of babies at medical consultations 5,815 2,723 284 8,822 Total attendances of babies at Centres 8,512 3,741 522 12,775 Eeferred to own private doctors 56 42 3 101 Referred to hospitals 155 79 12 246 Health talks given by nurses 25 23 8 56 Examinations in Mothercraft 2 — — 2 Lectures to parents by M.O.H. 2 — — 2 Visits paid by nurses : — To expectant mothers First visits 173 Total visits 368 First visits 52 Total visits 148 First visits 3 Total Visits 5 First Visits 228 Total Visits 521 To infants under one year 723 3,003 373 1,577 58 252 1,154 4,832 To children aged 1-5 years 64 2,285 57 1,537 12 143 133 3.965 Total visits paid by nurses 5,650 3,262 400 9,318 RECORD OF WORK OF MUNICIPAL MIDWIFE, 1925. Confinements attended 105 Confinements on books at end of year 35 Ante-natal Clinics attended 62 do. first visits 118 do. other ,, „ 149 Post-natal visits 1,414 — 46 — TABLE J._RESIDENTIAL INSTITUTIONS IN THE BOROUGH, 1925. Name of Institution Purpose If supported by voluntary contributions Accommodation for inmates (other than Staff) No. of Staff. Isolation Hospital Treatment of infectious disease (Hornsey, Finchley and Wood Green) No 103 40 female 4 male Hornsey Cottage Hospital Surgical, medical, X-ray and massage Yes 49 21 Nursing 7 Domestic St. George's Retreat House Home of temporary rest for all classes of persons Yes, and by inmates 23 6 London Diocesan Penitentiary For homeless women Yes 87 8 Mothercraft Training Society Training centre for nurses and mothers, and out patient clinics Yes Nursing Mothers 10 Infants 15 9 Hornsey Deanery Association for Preventive and Rescue Work Shelter and care of unmarried mothers and their babies Grant from Ministry of Health and Hornsey Boro' Council and Voluntary contributions 10 girls 5 babies 3 Santa Claus Home Children's Home for treatment of hip and spinal diseases, needing surgical supervision and nursing Yes 20 12 Kitchener Memorial Home Care of destitute or partially destitute boys Yes 48 4 Furnishing Trades' Benevolent Association Orphan children Yes 36 4 — 47 — TABLE K—FACTORIES, WORKSHOPS AND WORKPLACES. The following is a summary of the result of inspections made at Factories, Workshops and Workplaces during the year, with a list of Outworkers' premises, a copy of which has been forwarded to the Home Office, as required. None of the Outworkers' premises was found to be in an unwholesome condition. Premises. Number of Inspections. Written Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) Workshops (Including Workshop Laundries) Workplaces (Other than Outworkers' premises) 329 637 33 22 27 4 0 0 0 Total 999 S3 0 DEFECTS FOUND IN FACTORIES, WORKSHOPS & WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.A1. (1) (2) (3) (4) (5) Nuisances tinder the Public Health Acts : — * Want of cleanliness 22 22 0 0 Want of ventilation 3 3 0 0 Overcrowding 1 1 0 0 Want of Drainage of floors — — — — Other nuisances 5 5 0 0 Sanitary accommodation ' insufficient unsuitable or de- 2 12 2 12 0 0 0 0 not separate for sexes 1 1 0 0 » Offences under the Factory and Workshop Acts:— Illegal occupation of underground Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). 7 7 0 0 Total 93 53 0 0 •Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. — 48 — TABLE K.—Contd. OUTWORKERS. Nature of Work. Outworkers. Instances. Notices served. Prosecutions. (1) Wearing Apparel :— Making, etc 100 0 0 0 Cleaning and Washing — — — — Lace, lace curtains and nets 5 0 0 0 Curtains and furniture hangings 1 0 0 0 Furniture and upholstery 3 0 0 0 Ftir pulling 4 0 0 0 Artificial flowers 5 0 0 0 Paper, etc., boxes, paper bags 1 0 0 0 Christmas crackers, Christmas stockings, etc 1 0 0 0 Total 120 0 0 0 — 49 — TABLE L. HOUSING CONDITIONS. STATISTICS YEAE ENDED 31st DECEMBER, 1925. 1.—General. (1) Estimated population 89,004 (2) General death-rate 10.6 (3) Death-rate from tuberculosis (per 10,000 population) 5.8 (4) Infantile mortality 43 .6 (5) Number of dwelling-houses of all classes 19,822 (6) Number of working-class dwelling-houses (viz., up to £30 r.v.) 10,608 (7) Number of new working-class houses erected duriiig year . 98 2.—Unfit Dwelling-Houses. I.—Inspection. Houses inspected 1,089 House to house 020 Infectious disease 235 (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,718 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 029 (3) Number of dwelling-houses found to be in a state so gerous or injurious to health as to be unfit for human habitation 0 (4) Number of dwelling-houses (exclusive of those referred to undef the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,311 II.—Remedy of Defects without Service of formal Notice. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 1,507 III.—Action under Statutory Powers. (a) Proceedings under section 28 of the Housing, Town Planning, etc., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 0 (2) Number of dwelling-houses which were rendered fit— (a) by Owners 0 (b) by Local Authority in default of Owners 0 — 50 — TABLE L.—Contd. (8) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by Owners of intention to close 0 (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 114 (2) Number of dwelling-houses in which defects were remedied— (a) by Owners 98 (b) by Local Authority in default of Owners 0 (c) Proceedings under sections 17 and 18 of the Housing, Town Planning, etc., Act, 1919. (1) Number of representations made with a view to the making of Closing Orders 0 (2) Number of dwelling-houses in respect of which Closing Orders were made 0 (8) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 0 (4) Number of dwelling-houses in respect of which Demolition Orders were made 0 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 8.—Unhealthy Areas. Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I., to (b) Part II., of the Act of 1890:— (1) Name of area (2) Acreage (3) Number of working-class houses in area (4) Number of working-class persons to be displaced ■■■ ) IV.—Number of houses not complying with the building bye-laws erected with consent of Local Authority under section 25 of the Housing, Town Planning, etc., Act, 1919 0 V.—Staff engaged on housing work with, briefly, the duties of each Officer ANNUAL REPORT FOR 1925 OF THE School Medical Officer. Hornsey Education committee, 1925. The Worshipful The Mayor, Alderman W. G. Barrenger, J.P. Alderman W. \V. Kelland, M.A. (Chairman). Alderman H. B. Brackenbury, Councillor J. W. Rowlands. ,. B. H. Jenkinson, „ J. W. Shipp, Councillor A. A. Bell, ,, C. H. Summersby, „ G. F. V. Cutting, ,, R. H. L. Watson, ,, A. J. Marriott, ,, R. Ff. Wootton, ,, E. W. Mayatt, ,, Mrs. C. M. Cave. Co-optative Members : The Rev. E. D. Arundell, M.A., Mr. H. Tompkins, Mr. J. Horsburgh, Miss I. Jameson, M.A., Mr. T. P. McNaught, Mrs. J. Whitehead. Secretary: Mr. A. W. Allen, M.A. STAFF. School Medical Officer W. W. Jameson, M.A., M.D., M.R.C.P., D.P.H. School Oculist and School Medical Inspector J. R. Prior, M.D., D.P.H. Aurist A. R. Friel, M.A., M.D., F.R.C.S. (I.). Radiologist J. Morison, M.D. Medical Officers attending Minor Ailments Clinic E.C. Girling, M.D..D.T.M.&H. H. V, O'Shea, M.D. Dentists J. K. R. Bryce, L.D.S. R. L. Close, L.D.S. C. H. Rubra, L.D.S. S. T. Taylor, L.D.S. Nurses Miss M. Anscombe. Miss L. M. Oliver. Miss F. E. Paris. Clerk Miss H. M. Croak. Assistant Clerk Miss V. Powell, PREFACE. To the Chairman and Members of the Education Cimmittec of the Hornsey Town Council- Ladies and Gentlemen, I have the honour to present to you my first Annual Report on the health of the elementary school children in the Borough of Hornsey. The difficult task of talcing over duties in a new area has been rendered pleasant for me by reason of the sympathy and active assistance I have invariably received from all those connected with the School Medical Service. I desire especially to place on record the help given me by Mr. Allen, your Secretary, by Dr. Prior, and by Mr. Pateman, the late Chief Attendance Officer. The amount of work accomplished during the past year shows that the steady growth in the popularity of the School Medical Service seen in previous years has been well maintained. The only development of note has been the institution of a special clinic for the treatment of children suffering from eardischarge. In this connexion attention is directed to the report of Dr. Friel on page 11. I have the honour to be, Your obedient Servant, W. W. JAMESON. — 3 — GENERAL. The School Medical Service in Hornsey now forms a very important part of the work of the Local Education Authority. Medical advice and certain forms of treatment are available for all children attending the elementary schools, and, as the figures in the various tables at the end of the Report will show, parents take full advantage of the facilities offered. The public are beginning to realise that physical efficiency is just as important as adequate mental equipment. With the exception of the School Medical Officer and of Dr. Prior, who conducts the Eye Clinic and the routine medical inspections, all the medical and dental officers connected with the School Medical Service are engaged on a sessional basis. The experience of the past twelve months will be found in the following pages, the arrangement of the subject matter being in accordance with the suggestions of the Board of Education. CO-ORDINATION. Arrangements have been made for the transfer of information between the Maternity and Child Welfare Service and the School Medical Service. Children whose progress has been in any way unsatisfactory are referred specially to the School Medical Officer on their attaining school age, and an effort is being made to render the system as complete as possible. Cases of squint, of dental caries, of enlarged tonsils and adenoids are at times referred from the Child Welfare Centres for treatment at the School Clinic. In addition, school children requiring simple dressings are allowed to attend at the Centres between the hours of 9 a.m. and 10 a.m. daily, when either the School Nurses or the Health Visitors apply the treatment prescribed. This arrangement prevents the children being out of certain schools for considerable periods, as was the case when the longer journey to the central School Clinic had always to be made. Since the S)th of November, the date on which this new system came into force, 77 school children have made 564 such attendances at the various Centres. There are no nursery schools in the Borough, nor are children under the age of five years admitted to any of the infant departments. _ 4 — SCHOOL HYGIENE. Inspections of all school premises have been made during the year. The majority of the schools may be considered satisfactory, but the sanitary annexes in Crouch End School and in the Girls' and Infants' Departments of St. Mary's Schools require reconstruction, while the class-room accommodation in St. Mary's Boys' and Infants' Departments, in St. James's School and in Crouch End School has for some time been a matter of concern to the Education Committee. Sites for two new schools have been acquired and plans are in course of preparation. Arrangements have been made for the conveyance by motor of the youngest children attending Muswell Hill School to and from their homes on the Coppett's Road housing estate during the dinner hour. The distance is too great for very young children to walk, while the traffic on Muswell Hill is both fast and frequent. In eleven departments where certain children living at a distance remain on the school premises during the mid-day interval arrangements have been made for such children to have their dinner in an orderly and comfortable manner. The Education Authority has provided the table-linen, cutlery, crockery and cooking utensils required, and has given permission for the existing gas-stoves to be used for warming the food brought by the pupils. At each school the meal is supervised by a teacher or by a senior prefect. The pupils themselves take it in turn to lay the tables, and in most schools they do the necessary clearing away and washing up after the meal. MEDICAL INSPECTION. The numbers of children inspected in accordance with the Board's Schedule will be found in Table 1. Some 28 per cent. 6f the children on the rolls of the various schools were reviewed in routine inspection. In addition a large number of special inspections was made. These special inspections include children referred for fuller examination from the routine inspections and others sent to the central Clinic at the instance of the Head Teachers, the Attendance Officers and the School Nurses. — 5 — The commonest defects found at routine inspection were decayed teeth, sub-normal nutrition, enlarged tonsils and adenoids, uncleanliness, defective vision, enlarged cervical glands and bronchitis. The children referred for special examination suffered mainly from minor skin diseases, enlarged tonsils and adenoids, anæmia, defective hearing or other conditions associated with the ear, eye defects and bronchitis. (a) Uncleanliness.—Verminous conditions were present in the heads of 4.7 per cent. of the children examined. Another 1.8 per cent, of children were dirty. The School Nurses made nearly 32,000 inspections of children during the year, and found 845 children suffering from uncleanliness. The degree of uncleanliness was usually slight, but, inasmuch as a little care on the part of the parents will readily prevent these conditions, such a figure must be regarded as unsatisfactory. Some excuse may be found for carelessness in the case of families living in very overcrowded rooms without adequate washing facilities, but in many of the cases not even this excuse could be offered. One hundred and fifty-one children were cleansed at the Cleansing Station, in 15 cases under the powers given in section 87 of the Education Act, 1921. In all these cases the clothing was disinfected and attempts were made to deal with any adverse conditions found present in the homes. It is possible in this connexion that the new powers given in the Public Health Act, 1925, will prove useful during the coming year. (b) Minor Ailments.—Few cases of minor ailments were discovered at routine inspection. Such conditions are usually detected either by the Teachers or by the School Nurses and are dealt with promptly at the Minor Ailment Clinic or by private practitioners. (c) Tonsils and Adenoids.—One or other or both of these conditions existed in 8 per cent. of the children inspected. Only 1.7 per cent. were, however, referred for immediateoperation. (d) Tuberculosis-—Only one case of definite tuberculosis of the lungs and another of glandular tuberculosis were detected at routine inspection. Seventeen cases of suspected tuberculosis, or 0.23 per cent. of the children on the rolls of the schools, were referred for treatment or observation. These included cases discovered as a result 'of special examinations. — 6 — (e) Skin Disease.—Routine inspections revealed only 5 cases of skin disease, whereas special examinations detected 246 cases of sores and other conditions, 16 of scabies or itch, 18 of ringworm of the body and 8 of ringworm of the scalp. (f) External Eye Disease.—Under this heading are grouped such eye conditions as sore lids, inflamed and ulcerated eyes and squint. Only 19 children, or less than 1 per cent., suffered from one or other of these diseases at the time of routine inspection. On the other hand, 93 such cases were sent to the Eye Clinic for special examination and treatment during the year. (g) Vision.—Some 6 per cent. of the children inspected had defective vision, a rather lower percentage than that obtained last year. Most of these children were dealt with at the central Clinic. (h) Ear Disease and Heating.—Ear discharge was found in 15 of the children inspected, or 0.7 per cent., but, including children specially inspected, as many as 62 were treated for this condition at the Aural Clinic. Twenty-two cases of defective hearing were reviewed. (i) Dental Defects.—Some 27 per cent. of the children at medical inspection showed evidence of dental caries, 3 per cent. had four or more teeth decayed, while 24 per cent. had from one to three teeth decayed. The School Dentists examined 3,812 children and found that 68 per cent. required treatment. Examination of the teeth by a qualified dentist with the aid of a probe and a dental mirror is much more likely to reveal early caries than is the type of examination that can be made by a medical man at routine medical inspection. (j) Crippling Defects.—Three cases of organic heart disease and 39 cases of deformity of one sort or other were discovered during the various inspections. Infantile paralysis accounted for most of the serious cases of deformity. Much can be done by early diagnosis and skilled orthopaedic treatment to diminish the after effects of this crippling disease. It is hoped that some special remedial treatment for these defects will be undertaken by the Education Authority in the near future. (k) Other Conditions.—Enlargement of the neck glands was observed in 4'9 per cent. of the children. The condition was not — 7 — considered to be tuberculous in character, but due rather to septic states of the mouth and throat. Some 9 per cent. of the children inspected were below their proper nutritional standard. Serious malnutrition, however, is not at all common amongst Hornsey school children. The height and weight of each child are compared with the heights and weights as set out in the table compiled by Stephenson. It is hoped that a more modern table will be available before long. INFECTIOUS DISEASE. Several localised outbreaks of infectious disease occurred in certain of the schools during 1925. Whooping-cough and mumps caused a good many absences in St. Mary's Schools during the first half of the year; chicken-pox and mumps were prevalent in Stroud Green School from March to May; explosive outbursts of measles, fortunately of a mild type, occurred in Stroud Green School in October and in South Harringay and Muswell Hill Schools in December. In St. Mary's Infants' School thirteen cases of diphtheria were notified during the months of November and December, but the disease disappeared just before the Christmas vacation. The School Medical Officer and the School Nurses paid frequent visits to the departments affected and examined large numbers of children in the hope of detecting any early or missed cases of the diseases in question. The Attendance Officers assisted by obtaining accurate information regarding children absent on account of indefinite illness. In no case was it considered necessary to close any school or department. FOLLOWING UP. Following up visits are visits paid by the School Nurses, and sometimes by the Attendance Officers, to the homes of children who have been found to require treatment of some sort. Most of this work is done by two of the Nurses. During the year 1,115 visits were paid to various school departments, and 1,351 to children's homes. A surprising amount of ignorance and apathy still exists with regard to the necessity of obtaining treatment for many of the ailments suffered by children, ahd it is only by persistently following up the castes to their homes that good results can be achieved. — 8 — MEDICAL TREATMENT. Provision has been made at the central Clinic for the treatment of minor ailments, of eye defects, of oral sepsis and of dental caries, of enlarged tonsils and adenoids and of discharging ears. Dr. Morison, Consulting Radiologist to the Royal Northern Hospital, applies X-ray treatment at his private residence to all cases of ringworm of the scalp referred to him. A special clinic for the treatment by ionization of discharging ears has been in operation during the year with very gratifying results. So far no arrangements have been made for the treatment by ultra violet radiation of certain conditions in school children known to benefit by the application of these rays. It is hoped that before long some provision of this sort will be available in the Borough. (a) Minor Ailments.—It will be seen in Table IV. A. that 848 cases of minor illness received advice or treatment during the year at the various clinics. Special reference has been made on page 4 to the increased facilities for the daily treatment of minor ailments that have been in force during the last two months of 1925. Two medical practitioners attended on 83 occasions at the central Clinic to examine children referred there for special inspection and investigated 2,022 separate defects. All sorts of cases were dealt with at these inspections, the most common complaints being defects of the nose and throat, debility, anaemia and malnutrition, bronchitis and enlarged neck glands. There is no doubt as to the popularity of these medical sessions, and one of their great advantages is that many children come under medical supervision much earlier than would be the case had Head Teachers and parents to wait for medical advice till such time as routine medical inspections were carried out in the various schools. (b) Tonsils and Adenoids.—At the Clinic 138 children were operated on for enlarged tonsils and adenoids, while 73 other children received similar treatment elsewhere. All possible precautions are taken with regard to the cases dealt with at the Clinic. The patients are conveyed to their homes by ambulance in the company of a nurse, and should any child appear to be suffering unduly from the effects of the operation arrangements are made for his, or her, admission to the Cottage Hospital — 9 — Printed instructions regarding the after-care are supplied in all cases. (c) Tuberculosis.—All cases of definite or suspected tuberculosis are referred either to their own doctors or to the Tuberculosis Officer, 40 children having been referred to the latter officer during the year. Considerable numbers of delicate children coming from families where cases of tuberculosis have occurred have been kept under observation during the year, some of them having been sent to open-air residential schools for varying periods. (d) Skin Diseases.—The most common skin disease among school children is impetigo, a certain type of sore found usually on the face. One hundred and thirty-one cases of this disease were treated at the central Clinic. Eighteen cases of ringworm of the body, 8 of ringworm of the scalp and 16 of scabies or itch were dealt with by the School Medical Service. Five of the cases of ringworm of the scalp received X-ray treatment Eleven of the children suffering from scabies attended the Cleansing Station, making 35 attendances in all. (e) External Eye Disease.—All cases of external eye disease of any severity are seen by the School Oculist. During the year 93 such cases were dealt with at the Eye Clinic, in addition to 48 cases treated at the Minor Ailments Clinic. (f) Vision—Four hundred and twenty-five defects of the eye were treated by the School Oculist, and of these cases 349 consisted of errors of vision. Spectacles were prescribed for 211 children, and at the end of the year only 6 of these children had not obtained their spectacles. The assistance of the Attendance Officers and of the Care Committees has been particularly valuable in this connexion. (g) Ear Disease and Hearing.—Dr. Friel, Aurist to the London County Council and to the Tottenham Education Authority, attends at the Clinic every Saturday morning during school terms for the purpose of inspecting and treating children suffering from ear-discharge. Treatment by ionization has been employed in many of these cases, and attention is directed to the accompanying short report by Dr. Friel. An expert aurist's opinion in cases of chronic ear-discharge is essential, and the institution of an Aural Clinic has proved most successful in Hornsey. — 10 — "The treatment of otorrhæn adopted at the Clinic depends on recognising that sepsis is the essential factor in the cause of both acute and chronic suppuration. The essential difference between these is that in the former there is infection by one species of micro-organism and the tissues usually show signs of considerable inflammation. In 'chronic otorrhæa' the discharge is infected by several varieties, and the tissues are irritated, but not acutely inflamed. Factors in addition to sepsis may aid in keeping up the suppuration, Such factors are granulations, polypi, caries, etc. The area of sepsis is important. It may be limited to an accessible place, the tympanum is usually such, or it may extend into the mastoid antrum, which is nearly always beyond the reach of treatment without operation. From what has been said it is plain that where sepsis alone is responsible the treatment should be antiseptic in nature, but where another factor is present, such as a polypus, this should first be removed and the sepsis dealt with subsequently. Occasionally inflammation in a neighbouring organ, such as the nose or throat, may be mainly responsible for the continuance of the discharge. If so, the neighbouring area, as well as the ear, is treated. In moderate or severe cases of discharge from the ear due to sepsis in the tympanum zinc ionization is the mainstay of the treatment adopted, while in slight cases or cases nearly well the blowing of boracic powder into the ear is found to be sufficient. Where the sepsis involves an area difficult of access an effort is made by the use of special instruments to bring the ionizing fluid and the electric current into contact with the surface involved, but in many cases this is impossible unless an operation is done to make the part involved accessible. This necessitates the child being sent to hospital. It is important that a child should not be discharged from treatment at a hospital until quite well, as secondary changes are in time likely to develop, which make the case almost, if not quite, incurable. Treatment is given to the children once a week or once a fortnight. Daily treatment is not prescribed except in an acute case. Every effort is made to avoid re-infection of the ear by asking the mother to take care that water does not enter it. — 11 — If the subjoined table be referred to it will be seen that 58 out of the 62 cases involved the middle ear and 4 the external part only. Of the 58 one was acute inflammation— the mastoid was involved, and the child was sent to hospital. Of the 57, in 32 the disease was limited to the tympanum; in 25 the attic or mastoid was involved. This is a larger proportion of attico-mastoid cases than should be expected to be present in succeeding years. They are the accumulation of several years. Eight of these recovered. The majority of the remainder will require hospital treatment. Where the external ear only was involved all recovered. The clinic was started in January, 1925, and is held on Saturday mornings during term from 9.30-11. The children are given appointments as to the day and hour at which they are expected. Statistics of Otorbhæa Clinic, 1925. Cause of Suppuration Total Ears. Cured Lost Sight of Under Treatment Sent for Operation Other Treatment Acute Inflammation (acute suppurative otitis media) 1 1 (sub-acute mastoid) Chronic Suppurative Otitis Media due to I. Tympanic conditions (a) Tympanic sepsis 18 17 1 (b) Tympanic sepsis granulation. 5 3 1 1 (c) Tympanic sepsis polypus. 9 8 (left school) 1 II. Tympanic conditions. Throat, nose or mouth conditions. III. Tympanic conditions. Attic disease, 9 6 4 mastoid disease (no operation), 9 2 6 1 mastoid disease (operation already) 7 1 4 2 (to hosp.) External Otitis Media 4 4 TOTALS 62 40 1 17 2 2 A. R. Friel, Aurist. January 8th, 1925." — 12 — (h) Dental Defects.—During the year 6 dental sessions a week have been held during school terms, the dentists having attended on 18 occasions for inspection and on 243 for treatment. As a result of these inspections 2,584 children were found to require treatment, and 1,989 were actually treated. The dental service is deservedly popular in the Borough, and arrangements have been made for increasing the number of sessions from 6 to 8 per week during 1926. Full details of the work done will be found in Table IV. D. (i) Crippling Defects.—Each case is dealt with specially as it arises, and institutional treatment has always been made available when such treatment was considered necessary. During 1925 three crippled children have been sent to certified residential schools. OPEN-AIR EDUCATION. Two places for boys and two for girls are reserved at the School of Recovery, Parkstone, and a similar number at the Ogilvie Home, Clacton. During the year 26 children were sent for six weeks or longer to one or other of these institutions. The resulting improvement in the health of these children was usually marked, more particularly in the case of such as were allowed to remain in the open-air school for a longer period than six weeks. The Town Council has under consideration the advisability of erecting a day open-air school at Coppett's Road, Muswell Hill. This school would accommodate 125 children from Hornsey and Wood Green. In the last quarter of the year the School Medical Officer examined over 700 children referred to him as suitable for such a school by Head Teachers, School Nurses and other officials, and finally selected some 75 children, or about 1 per cent. of the number on the rolls of the various schools, as being of a type likely to benefit from this form of education. The majority of the children selected either suffered from malnutrition or debility or were delicate children coming from tuberculous families. Playground classes are held in most of the schools during the summer months, and in six of the departments light weatherproof shelters have been erected to accommodate such classes. — 13 — Two school camps were organised during the year, 80 children from Campsbourne School attending one and 35 children from St. Michael's and Highgate Schools the other. PHYSICAL TRAINING. The Board's schedule of physical training is followed in all schools, and considerable interest is being taken in organised games and in swimming. Organised games are played at the school field in Redston Road, at the Rokesly Avenue School site, at Highgate Woods and in Finsbury Park. At the Redston Road ground more suitable arrangements will have to be made during the coming year for the provision of drinking water. The school swimming bath is situated on the County School and South Harringay School site, and is used only during the summer months. The bath is too small for the needs of the school population in the Borough, but is well kept, the water being changed daily and maintained at a suitable temperature. During the year 1,659 children used the bath and 430 learned to swim. The following report is written by Mr. W. B. Ouseley, General Secretary and Treasurer of the Hornsey Schools' Sports' Association:— "The Association has actively engaged the Hornsey scholars in football, cricket, tennis, netball, athletics and swimming during the year 1925. Much of the success is due to the Sectional Secretaries, who, by carrying through league competitions, awaken keen enthusiasm not only among the playing children, but among those who witness the games. Great care is taken to instil into the children a love for the true ideals of amateur sport; the keen, hard and sporting way in which the children play is ample reward to the many teachers who give up so much of their own time. The successful schools in the different sections this year are Football, North Harringay (league), Stroud Green (cup); Cricket, North Harringay; Tennis, Crouch End; Netball, St. Mary's; Athletics, Stroud Green; Swimming, Stroud Green and South Harringay. — 14 — Football and Netball District teams have competed against other districts in their respective branches. The Football team reached the third round in the Corinthian Shield, an achievement when it is realised the number of schools from which some opposing districts can select. The Hornsey Schools' Netball team has defeated with comparative ease all the surrounding districts. Competitive swimming has been in abeyance since the War until this season, when a very successful gala was held at Hornsey Road Baths,. The standard of swimming suggests some early London successes now that galas have started again." PROVISION OF MEALS. No school meals are provided in Hornsey, but milk is given to certain children during the winter months, either free or at prices varying according to the parents' circumstances. The Care Committees undertake all the arrangements in connexion with the supply of milk and find the money required to finance the scheme. Children receive milk only on the recommendation of the Medical Officers, and all such children are weighed and measured periodically by the School Nurses. CO-OPERATION WITH PARENTS AND OTHERS. All parents are invited to attend medical inspections, and 74 per cent. availed themselves of this opportunity. It is only in a comparatively small number of cases that parents fail to show appreciation of the efforts of the School Medical Service on the children's behalf. Head teachers are in close consultation with the School Medical Inspector during medical inspection, and do leverything in their power to induce parents to carry out instructions given at such inspections. Excellent working arrangements exist between the School Medical Staff and the Attendance Officers, who assist actively in the work of following up. The Chief Attendance Officer attends all meetings of the Care Committees, and in this way acts as a liaison officer between the voluntary workers and the School Medical Staff. — 15 — The four Care Committees in Hornsey accomplish a great deal of useful work and play an indispensable part in the scheme of medical treatment. During the year they assisted parents in 62 cases to obtain spectacles prescribed by the School Oculist, in 3 cases to obtain surgical boots, in 18 cases to obtain a summer holiday for the children, and in many cases to obtain milk free or at reduced cost for debilitated children. In addition, the Committees provide boots and clothing for children in very poor circumstances. The Central Care Committee has appointed a small SubCommittee to collect funds and to co-ordinate the efforts of the District Care Committees and the schools in the work of providing holidays for necessitous children suffering from anaemia and other similar conditions. As a result of a special appeal a considerable sum was collected during the year, and 56 children were sent away for a stay of at least two weeks at the seaside. In certain cases recommended by the School Medical Officer the period of holiday was considerably extended, and in every case the parents were required to make a contribution, however small, towards the expenses incurred. The Sub-Committee also made a donation towards the cost of sending the boys from the Kitchener Home to a holiday camp, and the girls from the St. Catherine's Home for a holiday at the seaside. The voluntary workers give much of their time to the carrying out of this work, and their co-operation has been of great value. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. All defective children coming under the notice of the Head Teachers, Attendance Officers and other officials are referred for examination to the School Medical Officer. Those children, incapable of being educated in ordinary schools but capable of deriving benefit from instruction in special schools, are sent to suitable institutions. Thus 7 children have attended a special class for the partially blind, 7 a class for the deaf, 17 the Joint Special School for feeble-minded children and 2 a certified school for epileptics. Mentally defective children incapable of deriving benefit from education in the Joint Special School are referred to the Middlesex Covinty Council, the Local Authority under the Mental Deficiency Act. — 16 — During the year 16 children have been examined by the School Medical Officer with a view to their admission to the Joint Special School, and of these children 7 have actually been admitted. Since the Joint Special School for feeble-minded children was opened in March, 1916, sixty-five children (36 boys and 29 girls) have passed through this school. The Central Care Committee undertakes the supervision of such of these children as are not notified to the Middlesex County Council on their leaving school. Most of the actual visiting has been done by the chief attendance officer, and Miss Wyldes, the head mistress, takes a great interest in the children and keeps valuable records of their progress after leaving school. The following is a summary of the after histories:— Returned to public elementary schools or now known to be Boys. Girls. Total. in steady work 12 10 22 Sent to private schools 2 2 4 Doing "odd jobs" 3 — 3 At home—not working 7 10 17 In institutions 7 5 12 Left the district 4 2 6 Dead 1 — 1 36 29 65 STAMMERERS' CLASS. Two classes are held at the Education Office, Crouch End, each class meeting for a period of three-quarters of an hour twice weekly. The classes are conducted by Miss B. Kennedy, an experienced instructress on the staff of the London County Council. The psychology of stammering children is little understood by those not trained in their management, and the beneficial effects of the treatment of such children in a special class, though gradual in development, are nevertheless sure. This defect almost invariably causes acute distress to the unfortunate sufferer, and is usually a serious handicap in adult life. Altogether 14 children have attended the classes during the year. — 17 — LEGAL PROCEEDINGS. One hundred and forty preliminary and 19 statutory notices, under the powers given in the Education Act, 1921, relating to verminous elementary school children, were sent to parents during 1925. Fifteen children were compulsorily cleansed. In 8 cases notices were served on parents under Section 12 of the Children Act, 1908, for failure to provide adequate medical treatment for their children. In all cases the notices were complied with. No proceedings in Court had to be taken. GENERAL. There are no nursery schools and no continuation schools in the Borough. The secondary school children are inspected by medical practitioners working under the direction of the Hornsey School Medical Officer, who is specially appointed by the Middlesex Education Committee for this purpose. This work, though quite separate from, is carried out in close co-operation with the elementary school medical service. Employment of children of school age is limited in Hornsey to children over the age of 13 years, and the hours during which employment may be followed are so restricted by by-laws that no harm is likely to result to the children concerned. LIST OF TABLES. TABLE I.—Number of Children Inspected. ,, II. (a).—Defects found on examination. ,, II. (b).—Number of Individual Children found to require Treatment. ,, III.—Return of Exceptional Children in Area. ,, IV.—Return of Defects Treated. Group I.—Minor Ailments (excluding Uncleanliness). Group II.—Defective Vision and Squint (excluding Minor Eye Defects). Group III.—Treatment of Defects of Nose and Throat. Group IV.—Dental Defects. Group V.—Uncleanliness and Verminous Conditions. ,, V.—Accommodation, etc., at Schools in the Borough. ,, VI.—Number of Children Examined at each School. TABLE I— RETURN OF MEDICAL INSPECTIONS, 1925. (a) Routine Medical Inspections. Number of Code Group Inspections— Entrants 637 Intermediates 724 Leavers 627 Total 1,988 Number of other Routine Inspections 45 (b) Other Inspections. Number of Special Inspections 2,234 Number of Re-inspections 3,313 Total 5,547 TABLE II. (A)— RETURN OP DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1925. Defect or Disease. Routine Inspections Special Inspections No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. (1) (2) (3) (4) (6) Malnutrifion 191 Uncleanliness (See Table IV, Group V). 126 — — — Skin — — 8 — ,, body — — 18 — Scabies — — 16 — Impetigo 1 — 117 — Other Diseases (non-Tuberculous) 1 3 129 — Eye Blepharitis 8 — 23 — Conjunctivitis 3 — 22 — Keratitis — — — — Corneal Opacities — — — — Defective Vision (excluding Squint) 126 100 Squint 7 — 23 — Other Conditions 1 — 63 — Ear Defective Hearing 4 2 16 — Otitis Media 14 1 71 — Other Ear Diseases 1 1 55 — Nose and Throat Enlarged Tonsils only 27 125 63 6 Adenoids only 1 3 44 3 Enlarged Tonsils and Adenoids 8 1 88 4 Other Conditions — 1 84 3 Enlarged Cervical Glands (Non-Tuberculous) 100 42 2 Defective Speech — 11 — — Teeth—Dental Diseases (See Table IV., Group IV.) 565 — 11 — Heart and Circulation Heart Disease: Organic — 3 — 3 Functional — 32 — 13 Anaemia — — 151 — Lungs Bronchitis — 48 56 1 Other Non-Tuberculous Diseases 1 5 41 — Tuberculosis Pulmonary: Definite — 1 — — Suspected 2 4 6 5 Non-Pulmonary: Glands — 1 — — Spine — — — — Hip — — — — Other Bones and Joints — — — — Skin — — — — Other Forms — — — — Nervous System Epilepsy — 1 1 1 Chorea — 2 10 4 Other Conditions — 8 5 — Deformities Rickets — — — — Spinal Curvature — — — — Other Forms 1 20 13 5 Other Defects and Disease — 12 658 15 TABLE II.—(Contd.). (B)—NUMBER OF INDIVIDUAL CHILDREN FOUND AT ROUTINE MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UNCLEANLINESS AND DENTAL DISEASES). Group (1) Number of Children. Percentage of Children found to require treatment. (4) Inspected. (2) Found to require treatment. (3) Code Groups:— Entrants 637 35 5.8% Intermediates 724 89 12.8% Leavers 627 70 11.2% Total (code groups) 1,988 194 9.8% Other routine inspections 45 3 6.7% TABLE III—RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Blind (including partially blind). Boys Girls Total (i) Suitable for training in a School or C lass for the totally blind. Attending Certified Schools or Classes for the Blind — — Attending Public Elementary Schools — At other Institutions — — At no School or Institution — — (it) Suitable fortraining in a School or class for the partially blind. Attending Certified Schools or Classes for the Blind 2 5 7 Attending Public Elementary Schools 1 1 2 At other Institutions — At no School or Institution 1 — 1 Deaf (including deaf and dumb and partially deaf). (i) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 3 4 7 Attending Public Elementary Schools — — — At other Institutions 1 1 At no School or Institution — — — (it) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf — — — Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Mentally Defective. Feebleminded (cases not notifiable to the Local Control Authority.) Attending Certified Schools for Mentally Defective Children 6 11 17 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Notified to the Local Control Authority during the year. Feebleminded 1 1 Imbeciles 3 1 4 Idiots — — — Epileptics Suffering from severe epilepsy. Attending Certified Special Schools for Epileptics 2 — 2 In Institutions other than Certified Special Schools — — — Attending Public Elementary Schools — — — At no School or Institution — — — Suffering from epilepsy which is not severe Attending Public Elementary Schools 3 — 3 At no School or Institution — 1 1  Boys Girls. Total Physically Defective Infectious pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At other Institutions — — — At no School or Institution — — — Noninfectious but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 1 At Certified Residential Open Air Schools — — — At Certified Day Open-air Schools — — — At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Delicate children (e.g., pre-or latent tuberculosis, malnutrition, debility, anaemia, etc ) At Certified Residential Open-air Schools 18 8 26 At Certified Day Open-air Schools — — — At Public Elementary Schools 51 45 96 At other Institutions — — — At no School or Institution — — — Active nonpulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board — — — At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Crippled Children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease. At Certified Hospital Schools 1 — 1 At Certified Residential Cripple Schools — 2 2 At Certified Day Cripple Schools — — — At Public Elementary Schools 20 11 31 At other Institutions 1 3 4 At no School or Institution 4 1 5 TABLE IV. (A)—RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1925. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.). DISEASE OR DEFECT. Number of Defects treated or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. 1 (2) (3) (4) Skin— Ringworm-Scalp 8 — 8 Ringworm-Body 18 — 18 Scabies 16 — 16 Impetigo 141 — 141 Other Skin Diseases 135 8 143 Minor Eye Defects (External and other, but excluding cases falling in Group II). 52 1 53 Minor Ear Defects 155 4 159 Miscellaneous (e.g., minor injuries, braises, sores, chilblains, etc.) 310 — 310 Total 835 13 848 TABLE IV.—(Contd ). Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. Number of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by private practitioner or at hospital,apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report). 315 34 — 349 Other Defect or Disease of the eyes (excluding those recorded in Group 1). 68 8 — 76 Total 383 42 — 425 Total Number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 211 (4) Otherwise—0. Total Number of children who obtained or received spectacles (а) Under the Authority's Scheme 205 (b) Otherwise—0. Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 138 73 211 91 302 TABLE IV—(Contd.). Group IV.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist:— Aged Routine Age Groups 5 27 6 358 7 414 8 482 9 477 10 522 11 391 12 418 13 434 14 146 15 49 Total 3,718 Specials 94 Grand Total 3,812 (b) Found to require treatment 2,584 (c) Actually treated 1,989 (d) Re-treated during the year as the result of periodical examination 1,029 (2) Half-days devoted to Inspection 18 Treatment 243 Total 261 (3) Attendances made by Children for treatment 4,415 (4) Fillings Permanent teeth 1,278 Temporary teeth 577 Total - 1,855 (5) Extractions Permanent teeth 492 Temporary teeth 3,412 Total - 3,904 (C) Administrations of general anaesthetics for extractions 1,127 (7) Other operations Permanent teeth 44 Temporary teeth 472 Total - 516 Group V.—Uncleanliness and Verminous conditions. (i) Average number of visits per school made during the year by the School Nurses—26. (ii) Total number of examinations of children in the schools by School Nurses—31,859. (iii) Number of individual children found unclean—845. (iv) Number of children cleansed under arrangements made by the Local cation Authority—151. (v) Number of cases in which legal proceedings were taken:—Nil, TABLE V. LIST OF SCHOOLS IN THE BOROUGH. School. Department. Authorized Accommodation. Average No. on the Rolls for yr. ended 31/12/25. Muswell Hill Juniors 220 149.1 St. Michael's Senr. Mixed 238 165.6 „ Junr. Mixed 192 127.1 Highgate Senr. Mixed 444 287.6 „ Junr. Mixed 354 203.1 North Harringay Boys 416 422.4 „ „ Girls 416 412.9 „ „ Junr. Mixed 462 405.9 South Harringay Senr. Mixed 570 435.9 „ „ Junr. Mixed 300 240.9 Stroud Green Boys 418 373.9 „ „ Girls 418 381.2 „ „ Infants 426 291.9 St. Mary's Boys 237 231.9 „ Girls 235 246.1 „ Infants 220 215.8 Crouch End Boys 456 351.3 „ „ Girls 450 353 „ „ Infants 411 306 Holy Innocents' Infants 101 109.2 St. James' Mixed 269 308.9 Campsbourne Boys 450 398 „ Girls 450 391.3 „ Infants 473 445.8 Totals 8,626 7,254.8 TABLE VI.—ROUTINE MEDICAL INSPECTION, 1925. Number of Children Inspected at each School. years op 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 9 4 5 — 1 — 9 7 — 2 1 1 — — 3 — — — — — 28 14 42 St. Michael's 14 10 5 6 3 — 4 8 2 3 1 1 — — 11 5 1 2 — — 41 35 76 Highgate 18 12 6 15 2 3 26 25 — 4 1 1 2 30 14 1 1 2 — 86 77 163 North Harringay 13 18 5 12 2 3 39 31 10 14 1 4 1 3 47 58 3 8 12 6 133 157 290 South Harringay 21 18 10 7 5 6 28 20 9 13 8 3 1 1 29 36 11 10 9 4 131 118 249 Stroud Green 33 26 8 10 1 2 39 39 4 6 7 8 1 1 56 33 3 7 4 6 156 138 294 St. Mary's 30 21 12 11 6 6 33 24 4 8 2 — 1 — 14 21 8 7 1 — 111 98 209 Crouch End 12 12 5 2 2 — 31 41 5 4 3 5 — 2 34 18 3 4 — — 95 88 183 Holy Innocents' 14 17 10 6 2 2 3 2 — — — — — — — — — — — — 29 27 56 St. James' 4 10 4 3 5 2 11 5 — 2 4 2 2 2 15 11 1 1 — — 46 38 84 Campsbourne 40 48 14 16 3 5 57 49 13 5 6 3 4 2 58 52 5 6 — 1 200 187 387 Total 208 196 84 88 32 29 280 251 47 61 34 28 10 13 297 248 36 46 28 17 1,056 977 2,033