HOR 018 ANNUAL REPORT for 19 2 6 of the Medical Officer of Health. — 1 — public health committee, 1926. The Mayor, Alderman W. G. Barrenger, J.P. Councillor E. Brooks (Chairman). The Deputy-Mayor, Councillor R. Steeds, J.P. Alderman H. B. Brackenbury. ,, J. A. Dunmore. H. E. Hill. Councillor L. Cooper. ,, J. Edwards. ,, P. Everington. ,, S. G. Goulding. ,, A. T. Hilt,. ,, W. E. Lee. ,, Mrs. K. H. Ray. ,, J. W. Rowlands. ,, R. H. L. Watson. ,, R. Ff. Wootton. maternity and child welfare committee, 1926. The Mayor, Alderman W. G. Barrenger, J.P. Councillor S. G. Goulding (Chairman). The Deputy-Mayor, Councillor R. Steeds, J.P. Alderman H. B. Brackenbury. ,, W. W. Kelland. Councillor J. Edwards. ,, P. Everington. ,, H. E. Hill. ,, W. E. Lee. ,, Mrs. K. H. Ray. ,, R. H. L. Watson. ,, R. Ff. Wootton. Co-opted Members. Mrs. ,T. H. Barrenger. Mrs. J. L. Bond. Mrs. A. L. M. Harvey. Miss A. M. Inward. Mrs. E. Piggott. Mrs. B. H. Walton — 2 — staff of public health department. *†{Medical Officer of Health W W. Jameson, M.A., M.D . M.R.C.P., D.P.H. +Deputy Medical Officer of Health and Medical Superintendent of Joint Isolation Hospital J. R. Prior, LL.B., M.D., D.P.H. *†Assistants for Maternity and Child Welfare Purposes Flora Shepherd, M.B. Jessie Muir, M.B. *†{Senior Sanitary Inspector Wm. Thorpe. *†Sanitary Inspectors Henry Eastwood. James Goodman. Joseph H. Jesse. John D. Chance. † Chief Clerk Wm. Gilroy.*†Assistant Clerks George E. Dorrell. James Wilson. David Mellows. *† Health Visitors A. Glover. J. I. Macpherson. E. Durnford. F. R. H. Ross. *†Midwife M. Andrews. *†Mortuary Keeper Charles F. Catlin. *†Motor-Ambulance Driver T. J. Skilbeck. *†Disinfectors Wm. H. Lewis. Wm. Rutter. j 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 Homsey. Ladies and Gentlemen, I have the honour to present to you my Annual Report for 1926 on the health of the Borough of Hornsey. The Report is less comprehensive than that for 1925, which was a survey report , and recorded the work done and the progress made during the preceding five years. The importance to health of open spaces in a developed area such as Hornsey is very great. I have called attention in the commencement of this report to the extent of these spaces, and have inserted a small map showing their relative positions in the Borough. On page 15 will be found a short housing and social survey of two adjoining areas, to which attention is particularly directed. My thanks are again due to the Chairmen of the Public Health Committee and of the Maternity and Child Welfare Committee for their consideration and help, and to Dr. Prior, Mr. Thorpe and Mr. Gilroy for their ungrudging assistance at all times. I have the honour to be, Ladies and Gentlemen, Your obedient servant, WILSON JAMESON, Medical Officer of Health. — 4 — statistics and social conditions for 1926. Area ... Population, (census 1921) Estimated population (middle of 1926) Number of inhabited houses (census 1921) Number of private families (census 1921) liateable value Product of a penny rate Births 2,874 acres. 87,691 89,850 17,333 23,353 £734,264 £3,023 Male 585 Female 621 Total 1,206 Birth-rate, 13.4 per 1,000 population. Deaths Male 419 Female 509 Total 928 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 47.2 Death-rate from Tuberculosis (all forms) per 1,000 living 0.76 Death-rate from Zymotic Disease per 1,000 living ... 0.17 open spaces. Hornsey is singularly fortunate not only in possessing a very considerable acreage of permanent open, spaces, but also in having just beyond its boundaries such pleasure grounds as Hampstead Heath, Parliament Hill Fields, Ken Wood, Alexandra Park and Waterlow Park, covering altogether an area of more than 700 acres. Public open spaces amount to 11 per cent, of the total acreage of the Borough, one of the highest percentages to be found among the great towns of England and Wales. It is impossible to over-estimate the importance to health of these open spaces in a district now almost completely developed. In addition, Hornsey owns 17 acres of permanent and 22 acre® of temporary allotments, while some 64 acres of Highgate golf BOROUGH OF HORNSEY.—PLAN SHOWING OPEN SPACES — 5 — course are within the Borough boundaries. The Crouch End Playing Fields, extending to more than 70 acres, and adjoining Queen's Wood, arc likely to be retained as playing Holds for all time. Indeed, it may be said that fully 16 per cent, of the area of the Borough consists of recreation ground open to the public, to a very large extent without restriction. Reference to the accompanying map will show the situation of the various public open spaces, and the following table sets out their areas and indicates the authorities responsible for their maintenance: Area in acres. By whom maintained. Finsbury Park KenWood Highgate Wood Alexandra Park (part of)... Cherry Tree Wood (part of) Queen's Wood Middle Lane Pleasure Ground Priory Park High Street Pleasure Ground Sundry small areas 120 6 69 88 10 51 8 8 1 1 312 L.C.C. Ditto. City Corporation. Alexandra Park Trustees. Finchley U.D.C. Hornsey Town Council. The Town Council's contribution in respect of the purchase of all these spaces amounted to less than £200 an acre, and maintenance costs are incurred in respect of less than one quarter of their total area. In 1816 Hornsey was described as "a pleasant village, situated in a low valley live miles from London, through which the New River flows. This place is a favourite resort of the good citizens of London. In its vicinity is a small coppice known by the name of Homsey Wood. 'The Hornsey Wood House' is a famous house of entertainment." Both the Wood and "Wood House" have disappeared, and Finsbury Park now occupies their site. Until comparatively recent years, much of the Borough consisted of pastoral land and wood-land, and it is a niatter of congratulation that the 120 acres of Highgate and Queen's Woods, regarded as part of the old Forest of Middlesex, - 6 — have been secured for the public enjoyment. Nowadays, when the importance of fresh air and sunlight is appreciated and understood as never before, residents in Hornsey should be grateful for the foresight of those who preserved so many natural beauty spots, not only in Hornsey, but also just beyond its boundaries. population, births and deaths. Population.—The estimated population in the middle of T926 was 89,850. The Registrar-General's estimate was 87,230—a decrease of 461 on the Census figures of 1921. It is highly improbable that the population of Hornsey has diminished during the past six years, as a considerable number of new houses have been built, including a large portion of the Council's new housing estate at Muswell Hill, and many houses have been divided into flats. Births.—Twelve hundred and six babies were born in Hornsey, the birth rate being 13.4 per 1,000 population—a slightdecrease on the figure (1,214) for the previous year. Thirty-one of the births were illegitimate. Thirteen hundred and eight births (including 115 transferred to other districts) were notified to the Medical Officer of Health under the Notification of Birth Acts. The excess of births over deaths for the year was 278. Deaths.—The total number of deaths during 1926 was 928 —the death rate being 10.3 per 1,000 population. The rate for 1925 was 10.6. The standardized death rate for the Borough was 9.2. This takes into account the age and sex distribution of the population of the Borough, and is a true index of the healthiness of the area. Causes of Death.—The most frequent causes of death, set out as percentages of the total deaths, were as follows: — Cancer 15.4 per cent. Pneumonia and Bronchitis 14.2 ,. ,, Heart disease 13.6 ,, ,, Cerebral haemorrhage and arterio-sclerosis 9.9 ,, Tuberculosis 7.3 ,, ,. — 7 — Table B. shows the number of deaths due to various causes during the past live years. Deaths from pulmonary tuberculosis have somewhat increased in number, whereas deaths from pneumonia and bronchitis show a decline. Thirty-four persons died as a result of violence, due mainly to the growing volume of motor traffic. Cancer.—In 1926 cancer caused 143 deaths in Hornsey— 57 of male and 86 of female residents. For the past six years the number of deaths occurring each year from this cause has been more or less constant, but prior to 1921 there had been a steady increase. The mortality from canccr has trebled itself in Hornsey in the first quarter of this century, and now amounts to a rate of 1.57 per 1,000 living, as compared with 1.33 for England and Wales. It must be remembered that cancer is a disease mainly of those who have reached the second half of their allotted span, and in a Borough such as Hornsey all undue proportion of elderly persons is to bo found. Indeed, the average age of Hornsey residents is higher than that for any other town of considerable size in Middlesex. Again the ratio of females to males is almost the highest in the county, a fact of some importance inasmuch as cancer occurs more commonly in women than in men. While the ratio of females to males has not altered materially for some time, the number of persons living in. the Borough over the age of 45 years has increased considerably since 1901. In that year persons aged 45 years and upwards formed 18 per cent, of the total population, in 1911 the percentage had risen to 23.4, and in 1921 it was 29.8. From these facts it will be seen that Hornsey is a district upon which the incidence of cancer is likely to fall more heavily than is the case in areas where the age and sex distribution of the population is different. But even if due allowance is made for these factors, it is evident that in Hornsey, as elsewhere, cancer is becoming a more frequent cause of death than formerly. This increase in cancer mortality is the common experience of modern civilisation. A great deal of research work has been, and still is being, carried out on the causation and the treatment of cancer, and the following facts are now established. Liability to the disease is not an attribute of any particular social class, profession or — 8 — occupation. Hereditary predisposition has not at present been proved to be of any practical importance in man. There is no scientific evidence that the use of any particular article of food increases the liability to cancer, nor will any known drug or preparation prevent the appearance of the disease or cure it when present. No danger of cancer has been proved to result from inhabiting houses or districts in which cancer happens to have been exceptionally common, nor, in spite of recent work on this aspect of the subject, can it be said that cancer is to be regarded as infectious or contagious. It is known that cancer not infrequently follows on chronic and prolonged irritation. Some tissues are more susceptible than others in this respect, such as the skin of the face, the insides of the cheeks, the tongue and the lower part of the bowel A elay pipe, a jagged tooth, or a badly fitting denture may be the source of irritation. This fact should be known and appreciated by all, for such sources of irritation can readily be avoided. The public should realise that the best that medical science can offer at the moment is early diagnosis and adequate treatment by operation, and if an early diagnosis of cancer is to be made the public must themselves seek medical advice on the first appearance of any suspicious sign. Recent investigations in regard to cancer of the breast in females have shown the importance of early and effective treatment. In the absence of such treatment, women so affected have roughly one-sixth of the normal duration of life to look forward to; those subjected to the complete operation during the comparatively late stage of the disease at which the average patient appears for treatment under present unsatisfactory conditions have about one-third of the normal duration to expect; while those so operated upon at an early age may anticipate approximately two-thirds of the normal after life-time. Infant Mortality Rate.—There were 57 deaths of infants under one year of age in 1926. This is equal to an infant mortality rate of 47.2 per 1,000 births—the third lowest figure in the history of the Borough. The lowest rate (41 per 1,000 births) was that for 1924. The infant mortality rate for England and Wales was 70. — 9 — (Jut-Relief.—During 1926 the Guardians distributed the following sums in out-relief : — Cases. Cost. Ordinary 493 £11, SOB 10 4 Unemployed 501 £5,380 7 3 994 £17,188 17 7 summary of nursing, hospital and other institutions available in the district. Nursing.—Steps have been taken to form a District Nursing Association for the greater part of the Borough. The association will be affiliated to the Queen "Victoria's Jubilee Institute for Nurses, and it is expected that both the St. Mary's and the Highgate Nursing Associations will enter the scheme. A commencement will be made with four nurses for that part of the Borough west of the L. & N.E. Railway and north of the L.M.S. Railway, in place of two as at present. The North Loudon Nursing Association continues to undertake the nursing of children below school age in the southern and eastern parts of the Borough, for which the Council pay a sum of Is. 4d. a visit. This arrangement was instituted in November, 1925. The Hornsey Deanery Association for Preventive and Rescue Work at 109, Upper Tollington Park, receives unmarried mothers and their babies. A grant of £50 was made by the Council during the year, and the Association also receives a grant from the Ministry of Health. 'Hospitals.—The North Middlesex Hospital (Edmonton Union) has accommodation for 1,034 in-patients. The number of Hornsey cases admitted during the year was 800, viz., 124 maternity cases and 070 other cases. Twenty-six of the maternity cases were mothers attending the Council's Welfare Centres. The Hornsey Cottage Hospital, with 43 beds, dealt with 813 in-patients and 872 out-patients during the year. Midwives. In addition to the Municipal Midwife, who is controlled and paid by the Council, there are 13 Midwives notified to the County Council as practising in the Borough. The County Council is the supervising authority under the Midwives Act. — 10 — Lying-in Homes..—There are 16 Lying-in Homes registered with the County Council under the Middlesex County Council (General Powers) Act, 1921. Clinics and Treatment Centres.— Maternity and Child Welfare Centres. (No. 1.) Brook lioad Hall, N.8. (opened 1916). Wednesday and Friday, 10-12 and 2-4. Thursday (Ante-natal), 2-4. (No. 2) 22, Wightman Road, Harringay, N.4. (opened 1918). Tuesday, 10-12 and 2-4. 1st and 3rd Monday in month (Ante-natal), 2-4. (No. 3) Church Koad, 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 lioad Centre *| Wightman lioad Centre I 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 Road, N,7. Men—Monday, Wednesday, Thursday and Friday, 6-8 p.m. Women—Monday, 2.30-4 p.m., Tuesday and Thursday, 6-8 p.m. Women—Monday, 2.30-4.30 p.m. Prince of Wales' Hospital, Tottenham, N. Men—Monday 7-8 p.m., Wednesday 6-7 p.m., Friday 6.30-8 p.m. Women—Monday 6-7 p.m., Wednesday 4.30-6 p.m., Friday 5.30-6.30 p.m. — 11 — 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. Infectious Disease.—Cases of infectious disease are sent to the Isolation Hospital, Coppett's 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 arrangement for the treatment of cases of small-pox in the Uxbridge Joint Small-Pox Hospital at Yeading, Middlesex, is still in force. Tuberculosis.—There are 762 beds available under the Middlesex County Council scheme for the treatment of tuberculosis in sanatoria. 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 889 persons on 798 occasions, as follows :—233} street accidents and 565 private and other cases. The Ambulance for the medical services of the Borough, which is used mainly for the conveyance of school children, has covered 12,140 miles during the year. Mortuary.—During the year 54 bodies were brought to the mortuary at the Sanitary Depot, Hornsey, and 52 inquests were held by the Coroner. sanitary circumstances. Smoke Abatement.—Complaints have been received from time to time of the emission of smoke, dust and fumes from the engine sheds adjoining Hornsey Station and belonging to the L. & N.E. Railway Co., and observation is periodically kept on the sheds. As a result of communications from the Council, the Company has promised to do all in its power to avoid these causes of complaint. Sanitary Work.—The following survey of work done by the Sanitary Inspectors has been supplied to me by Mr. Thorpe, the Senior Inspector. — 12 — Inspections. House-to-house inspections Increase of Rents Acts inspections Inspections Re-inspections and works in progress Visits to Factories, Workshops and Outworkers Visits to Petroleum Stores Visits to Slaughter-houses Visits to Bakehouses Visits to Cowsheds, Dairies and Milk-shops Visits to Ice-cream premises Visits to Food shops Visits to Stables Visits to Urinals Visits to Cinemas Smoke inspections Visits re Infectious Disease notified ,, other Infectious Disease ,, Vermin ,, Tuberculosis, etc. ,, Deaths 390 4 934 8,478 1,240 3H 399 71 79 78 935 251 65 41 5 242 21 32 106 123 Notices Served. Informal Notices served (general) do. do. do. (Increase of Rents Acts) Statutory Notices served : — Under sec. 41, Public Health Act, li875, to examine drains Under sec. 41, Public Health Act, 1875, to relay drains Under sec. 91, Public Health Act, 1875, to abate nuisances In 156 instances where the Occupier was also the owner the work was earned out without a written notice. Summary of Sanitary Improvements carried out. Drainage.— Number of houses and premises re-drained Repairs or amendments to existing drains Drains or gullies unstopped or cleansed Manholes provided Manholes altered and repaired 4 7 7 94 17 95 66 27 18 — 13 — Intercepting traps fixed New gullv traps fixed New soil-pipes and ventilating shafts fixed Soil-pipes and ventilating shafts repaired Water tests applied Smoke tests applied Drains examined, Public Health Act, 1875 (Section 41) Water-closets and Sanitary Fittings.— New water-closet basins fixed Water-closets unstopped, cleansed or repaired New check cisterns fitted to water-closets Existing check cisterns repaired Water-closet apartments repaired New impervious sinks provided New waste-pipes fixed Waste-pipes trapped, repaired or unstopped Miscellaneous.— Roofs repaired Eaves guttering renewed, cleansed or repaired New eaves guttering provided Rain-water pipes provided Rain-water pipes repaired or unstopped Stack pipes disconnected from drains Damp walls remedied Paving of yards repaired Floors of rooms repaired Rooms cleansed, distempered or re-papered Workrooms cleansed and repaired Drinking-water cisterns repaired, cleansed and covered Movable sanitary dustbins provided Accumulations of manure and refuse removed Stoves and ranges repaired Coppers repaired Miscellaneous Infectious Disease and Disinfection.— Number of rooms fumigated after infectious disease Verminous rooms fumigated Number of articles disinfected Number of articles destroyed 21 87 25 43 68 142 7 79 65 16 57 10 38 22 123 295 139 47 17 108 6 93 125 84 532 49 138 111 65 17 20 564 645 83 7,521 238 — 14 — Complaints. — Complaints were received in respect of 230 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 : — Description of Premises. Dairies and Milkshops Ice-cream premises Bakehouses Restaurant kitchens Slaughter-houses Butchers' shops Fish shops Shops re Food supplies Factories, Workshops and Outworkers' work-places Cinemas No. in District. 33 59 31 35 5 52 24 216 470 7 The Rent and Mortgage Interest (Restriction) Acts.— Four formal applications for certificates under the Bent and Mortgage Interest (Restriction) Acts were received. In each instance the necessary repairs were carried out by the owners. Petroleum Acts, etc.— Two-gallon-tin Bulk Stores. Stores. Number of licences in force Carbide of Calcium.— Number of licences in force 66 6 43 23 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.—Eighteen visits have been made to upholsterers' premises where rag flock was being used. Shops Acts.—Regular inspections have been made in regard tc the closing of shops at the hours set down in the Shops (Early Closing) Act. Generally speaking this Act is well observed, but — 15 — 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 premises. It is pleasing to report that in no instance have the conditions been found other that satisfactory. Factory and Workshop Acts, 1901 and 1907.—The total number of Factories, Workshops and Work-places on the register is 470. The businesses carried on at the respective premises are as follows: — Bakehouses 31 Dressmakers and Milliners 76 Bootmakers 53 Tailors 32 Laundries 13 Motor and Cycle Engineers 49 Restaurant Kitchen and Cooked Meats 35 Other Trades 181 470 housing. There are in Hornsey two small adjoining areas—one comprising the streets east of Nightingale Lane and the other Nightingale Lane and the streets immediately to the west—which are excellent for purposes of comparison. Both are equally well situated as regards open spaces. The accompanying table shows some of the vital statistics for these two areas. — 16 — section a.—Catnpsbourne Road, Myddelton Road, Boyton Road, Pembroke Road, Brook Road, Eastfield Road and Newlands Road. section b—Nightingale Lane, North View Road, South View Road, Hawthorn Road and Beechwood Road. Section a Houses. Total Parsons. Census Population 1921. Parsons per house. 464 4189 All ages. Under 14. 14 and over. M. F. M. F M. F. 2039 2150 721 755 1318 1395 9.07 Section B • 736 3006 1447 1559 415 408 1032 1151 4.08 Notk.—The majority of the houses in Section A have three floors, whereas in Section B they have two floors or are self-contained flats Year. Birth Rates. Infaat Mortality Rates. Death Rates. Infectious Disease Attack Rates. Inward Transfer Deaths Percentage. T.B. Death Rate. Borough a b Borough a b Borough a b Borough a b Borough a b Borough a b 1921 16.7 30.0 16.3 49 87 20.4 11.0 10.8 7.3 10.1 26.6 22.2 31 61 36 1.0 1.6 2.3 1922 15.4 29.9 14.3 54 89 0 11.2 10. 5 8.3 6.2 17.6 12.3 32 50 40 0.8 0.7 1.0 1923 14.4 22.9 12.3 51 83.3 0 10.5 8.1 6.6 4.2 14.1 6.9 33 47 45 0.6 0.7 1.0 1924 13.4 24.3 14.3 41 19.6 0 10.4 10.0 6.3 4 5.2 4.6 33 55 42 0.6 0.9 1.6 1925 13.6 25.3 13.6 43.6 38.0 24.6 10.6 8.8 7.9 3.3 3 4 3.3 34 31 54 0.5 0.7 1.0 1926 13.4 18.8 11.6 47.2 25.9 28.6 10.3 8.1 7.3 4 5.8 2.2 37 64 63 0.8 0.2 0.3 * These are deaths of Hornsey residents occurring outside the Hr>rou«»H J« '■ — 17 — Section A. consists mainly of rather old houses each originally intended for occupation by one family only, but now inhabited by two, three or even four families. These houses are owned by a great many different landlords, most of whom spend a considerable amount of money on their property. There is some overcrowding, sub-letting is extremely common, and certain of the tenants are of a careless and irresponsible type. Section B. is a block of property owned and managed very largely by the Borough Council and by the Metropolitan House Investment Company. The tenants have been to a large extent selected, most families live in self-contained dwellings, and there is very little overcrowding. I am indebted to Mr. Parry, the Relieving Officer, for the following particulars of the number of families relieved during 1926 (excluding those in temporary distress as a result of the general strike) and of the number of persons removed to the North Middlesex Hospital from the various streets in the two sections: — Section A. Families receiving relief. Persons admitted to North Middlesex Hospital. Campsbourne Road 69 37 Myddelton Road 48 19 Boy ton Road 40 13 Pembroke Road 10 3 Brook Road 46 13 Eastfield Road ... 14 7 Newlands Road 8 1 235 93 Section B. Nightingale Lane 4 2 North View Road 12 4 South View Road 10 3 Hawthorn Road 4 5 Beechwood Road 5 1 35 15 — 18 — The 1921 Census rove-aled the following facts: — Borough. Sec. A. Sec. 13. Proportion of females per 1,000 males 1,319 1,059 1,077 Percentage of persons under 14 19.6 35 27.3 Number of persons per house 4.84 9.07 4.08 Although the number of persons in the two sections is too small to allow of an accurate calculation of rates, it may be said that an examination of the tabulated figures shows: — Section A. (1) A high birth rate. (2) A high infantile mortality rate during 1921-1923, but a remarkable decline in the rates for 1924-1926. (3) A lower general death rate than that for the Borough as a whole. (4) The occurrence outside the Borough—probably in institutions—of some 51 per cent, of all deaths. (5) A tuberculosis death rate not materially higher than that for the whole of the Borough. (6) A high infectious disease attack rate. Section B. (1) A birth rate rather lower than that for the whole of the Borough. (2) An amazingly low infantile mortality rate. (3) A very low general death rate. (4) The occurrence outside the Borough—probably in institutions—of some 47 per cent, of all deaths. (5) A tuberculosis death rate higher than that for the whole of the Borough. (6) An infectious disease attack rate rather higher than that for the Borough, but considerably lower than that for Section A. During the last three years 75 persons from Campsbourne Road have been placed in Council houses, 113 from Myddelton Road, 38 from Boyton ltoad and 40 from Brook Road. This total of 266 persons represents 42 separate families, the average number in each family being 6.33. In addition, a great deal of public health work of all soils is carried out, particularly in — 19 — Section A. All infant welfare centre is situated in the middle of it, a health visitor, a school nurse and a sanitary inspector spend a great deal of time among the families, and everything possible is done to educate the inhabitants in the simple principles of personal hygiene. It is certain that the work undertaken by the Town Council is beginning to show some return in an improvement in the general condition cf this area. At the same time it cannot be denied that many of the tenants of Section A. are of a class that can be housed satisfactorily only in property subject to frequent inspection and rigid control. House-to-house Inspection.—The following table gives a comparison of post-war and pre-war conditions as a result of house-to-house inspeotions in a number of roads: — Pre-war. Post-war. Number of houses inspected 121 121 Average number of rooms per house 5.6 5.6 Total number of families 169 133 Total number of persons over 10 years 519 579 Total number of persons under 10 years 162 90 Average number of persons per house 4.9 5.0 Average number of persons per room 0.95 0.93 Average number of persons per room used for sleeping 1.7 1.7 Number of houses with more than 2 persons per room 0 0 Number of houses with more than 2.5 persons per bedroom 5 9 Number of houses sub-let 36 45 (N.B.—A child under 10 years is counted as 0.5 person.) inspection and supervision of food. Milk.—The following are the registration and licensing figures for 1926 : — Premises registered as milk-shops 40 Licensed pasteurizing plants 2 Premises licensed for sale of "Pasteurized Milk " 18 Premises licensed to sell " Certified Milk " 6 Premises licensed to sell " Grade A (tuberculin tested) Milk " 1 — 20 — The Milk and Dairies Order, 1920, came into operation, on the 1st March, 1926. This order provides for the registration of premises as well as of persons. It places upon County or County Borough Councils the responsibility for the inspection of cattle and lays down certain standards required for the maintenance of dairies and cowsheds in a sanitary condition. The Order further gives the Medical Officer of Health authority to enter registered promises and examine any persons suspected to be suffering from infectious disease and to prohibit for specified times infected persons from engaging in the milk trade. The Medical Officer of Health may even stop a supply of milk for a period of twenty-four hours (to be renewed if necessary) if he is of opinion that any person within his district is suffering from infectious disease caused by the consumption of such milk. Cow-keepers must keep their cowsheds clean and must not allow the access to any cowshed or milk store to be rendered uncleanly with dung. Cows must be cleaned before being milked, milker's hands must be washed and dried before milking and must as far as practicable be kept dry. Milk must be cooled without delay to a temperature not more than 5 degrees F. above the temperature of the available water supply. Milk churns must be provided with effective lids without "ventilation" openings, and must not be opened during railway transit save by persons having statutory authority in that behalf. When milk is delivered in bottles, such bottles must be filled and closed on registered premises, and no one is permitted to tamper with the discs used for closing the bottles after they have left the dairy premises. The Order, indeed, contains many provisions that should help local sanitary authorities very considerably in obtaining better regulation of the milk trade. 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. Clean Food Exhibition.—The Town Council was not only the first local authority in this country to hold an exhibition under the powers granted in the Public Health Act, 1925), but was also the first to institute a campaign in favour of clean — 21 — food. The exhibition, which was opened by the Minister of Health, was held in Christ Church Hall, Crouch End, from the 2nd to tho 5th of March, 1920. More than 10,000 persons visited the exhibition, including over 3,000 pupils from the Secondary and Elementary Schools, who were conducted round the various exhibits in the mornings. Short lectures on problems connected with the hygiene of food were given each afternoon and evening, and a number of interesting films was shown. The exhibition created a great deal of interest, both locally and throughout the surrounding areas, and did much to stimulate public opinion with regard to the importance to health of a pure and clean food supply. Great assistance was given the organisers, not only by many members of the Town Council, but also by a largo and enthusiastic body of voluntary workers. Tuberculosis Order, 1925.—Under the powers given in this Order, three cows were examined by the Council's Veterinary Inspector and one animal was slaughtered. It was found to be suffering from tuberculosis in an early stage, and the owners received compensation on tho approved scale. As a result of representations made to them, the owners decided to discontinue the keeping of stalled cows in the Borough. 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 slaughter-houses 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 was it found necessary to seize any portion of a carcase or any organ. During the year the carcases of 2,843 sheep, of 195 beasts, of 27 pigs and 5 calves were inspected under the Regulations, and meat amounting to 395 lbs., together with 1,113 lbs. offal, was surrendered voluntarily on account of some diseased condition. All diseased meat and offal are destroyed in the Corporation incinerator. Slaughter-houses.—The following is a statement regarding the slaughter-houses in the Borough: — In Dec., 1925. In Dec., 1926. Licensed 5 5 — 22 — Other Foods.—Particular attention was paid to all premises where food is prepared or sold. During the year 1,163 visits of inspection were paid to the various food premises in the Borough. Sale of Food and Drugs Act.—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: — List of Samples Purchased in Hornsey during tiie year ended 31st december, 1926 Article. Taken. Adulterated, Milk 241 8 Cream 2 2 Butter 36 3 Arrowroot 3 — Apples 15 4 Pears 1 1 Cream bun 8 2 Confectionery 1 — Meat, cooked 1 — Meat, essence 1 — Fish paste 1 — Mustard 4 1 Vinegar 2 — Lemonade powder 1 — Gin 12 2 Whisky 4 — 333 23 Prosecutions 3 Convictions 3 Vendors cautioned 4 infectious disease. Scarlet Fever and Diphtheria.—Both these diseases showed a rather higher incidence in 1926 than in 1925—the number of notifications being 140 as compared with 126 in the case of scarlet — 23 — fever, and 116 as compared with 53 in the case of diphtheria. Sixty-eight per cent, of the cases of scarlet fever and eightynino per cent, of the cases of diphtheria were removed to hospital. The former disease caused no deaths, the latter only one. Scarlet fever still continues to be of a mild typo, and the policy of removing to hospital large numbers of the sufferers is of doubtful public health value; many cases could quite well be nursed at home and more accommodation in hospital would thus become available for severe cases of measles and of whooping cough. Authority has been given for the Schick testing of young children at the Infant Welfare Centres and for their subsequent immunization against diphtheria. The work will actually be commenced during 1927. The following table shows the incidence of infecting cases discharged from hospital since 1921 : — YEAR. SCARLET FEVER. Persons Infected '' Return Cases" Infecting Cases. Percentage of infecting cases. DIPHTHKRI A. Persons Infected '• Return Cases'' Infecting Cases. Percentage of infecting cases. 1921 571 14 12 2.1 189 2 I 0.53 1922 201 10 7 3.43 103 — — — 1923 100 5 5 5.0 113 — — — 1924 159 14* 7 4.4 33 — — — 1925 77 1 1 1.3 43 — — — 1926 89 4 2 2.2 101 — — — * Including two cases belonging to other Hospitals. "Return cases" mean 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. - 24 - Tuberculosis.—The following statement shows the condition of the register at the beginning and at the end of the year: — No. of cases at commencement ot 1926. No. of cases added to register during 1926. No. of cases removed from register during 1926. No. of cases on register at end of 1926. Pul. Non. Pul. Pul. Non.- Pul. Pul. Non. Pul. Pul. Non.-Pul. Males 182 41 63 13 42 1 203 53 Females 168 34 48 15 32 1 184 48 The cases were removed from the register for the following reasons: — Deaths 42 Removed from district 19 Cured or disease arrested 15 76 The average number of beds in residential institutions available for Middlesex patients suffering from tuberculosis during the year 1926: — Observation. Pulmonary tuberculosis. Nonpulmonary tuberculosis. Total. Adult Males 9 295 38 342 Adult Females 7 200 39 246 Children undei 15 8 57 109 174 Total 24 552 186 762 The number of deaths from tuberculosis in Hornsey was 68 in 1926—the death-rate being 0.76 per 1,000. The rate in 1925 was 0.6. A detailed list of new cases of, and deaths from, tuberculosis will be found in Table G. (p. 37). Influenza an-d Pneumonia.—The incidence of these two two diseases remained much the same as in 1925—13 deaths occurring from the former and 68 from the latter. Most of these 25 — deaths were of persons aged 05 years and over. The notifications of pneumonia numbered 56. The anti-catarrhal vaccine supplied at cost price by the Town Council to medical practitioners was used to a considerable extent during the year, some 4,800 c.c. having been issued. Other Infectious Diseases.—Four cases of enteric fever were notified, with 1 death. Six cases of encephalitis lethargica were notified with two deaths, and 2 cases of infantile paralysis. Measles was responsible for 7 and whooping cough for 3 deaths during-the year. No case of small-pox occurred in the Borough. Ophthalmia Neonatorum.—Seven cases of Ophthalmia Neonatorum were notified (luring the year. All these cases were visited by the Health Visitors and attention given where necessary. An arrangement exists with the Metropolitan Asylums 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. Notified. Treated Vision U nimpaired. Vision I mpaired. Total Blindness. Deaths. At Home. In Hospital. 7 7 0 7 0 0 0 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 1926 seven adults and 292 school children received treatment. Tlie clothing of such persons is disinfected at the time of cleansing, and in many cases it is found possible to disinfect the homes as well. Disinfection is offered in cases of death from tuberculosis, cancer, pneumonia, and other diseases. In 114 of the 222 instances in which the service was offered it was accepted. — 26 — The following is a record of the disinfection work carried out during the year: — Premises. Rooms disinfected. Articles disinfected. Articled destroyed. Notifiable diseases 269 286 4187 25 Non-notifiable diseases 376 402 2334 213 Isolation Hospital.—The extensions outlined in last year's report are well on the way to completion, and the new premises should be ready for occupation, during the summer of 1927. Laboratory Work.—With the exception of the more complicated blood tests all the routine bacteriological work is carried out at the laboratory of the Joint Isolation Hospital. The following district work was done during 1926: — Positive. Negative. Total. Examinations for diphtheria bacilli 100 839 939 ,, ,, tubercle bacilli 22 185 207 ,, „ ringworm 7 2 9 ,, ,, typhoid bacilli 1 8 9 Other examinations 11 130 1,034 1,175 MATERNITY AND CHILD WELFARE. Midwives.—The Hornsey Town Council appointed a municipal midwife in 1921. Her services continue to be increasingly popular in the Borough, as the following record of cases attended shows: — 1922 41 1923 60 1924 79 1925 105 1926 153 — 27 — A charge of 85s. per case is made for the midwife's attendance, but this charge may be remitted in part in necessitous cases. During 1926 a sum of £202 8s. Od. was recovered from lying-in women who were attended by the municipal midwife. The midwife attends all ante-natal clinics (about 70 in the year), and during 1926 made 2,492 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 1926 twentyfive women from Hornsey were admitted to one or other of these institutitions at a total cost of £119 2s. Od. Towards this sum the mothers themselves contributed £72 2s. Od. Centres.—The three Maternity and Child Welfare Centres in the Borough have proved as popular as ever. Four hundred and twenty-six sessions, including 85 ante-natal sessions, were held during the year, and at these sessions 894 babies and 265 expectant mothers attended as first cases. More than 16,000 attendances were made by mothers and babies at the Centres. The four health visitors paid altogether 10,093 home visits, of which 1,548 were first visits. The visiting of mothers in their homes by tactful and competent health visitors is a vital part of a Maternity and Child Welfare Scheme. Details of the work done will be found in Table H., page 38. The Voluntary Committees attached to the Centres have again made themselves responsible for a great deal of useful work. Duriug the year they raised very considerable sums of money, and thus were able to provide the following services in connection with the Centres: — Dental treatment 27 Massage 85 Home help 1 Sent to convalescent homes 21 - '28 The Fathers' Committee at Brook Road Centre contributed no less than £20 towards the cost of these services. At Highgate Centre a Mothers' Social Club has been established, and meets weekly. Supply of Milk tu Mothers and Children.—During the year 206 cases have received milk free or at less than cost price. The sum so expended amounts to £41 Os. lOd. Maternal Mortality.—Three mothers died as a result of their confinements—the maternal mortality rate was thus 2.48 per i,000 births. Two of these deaths were due to puerperal sepsis, one being the result of a septic miscarriage. All three cases died in institutions, and none attended the Council's ante-natal consultations. The Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, came into operation on the 1st October, 1926, and provide for the notification by Medical Practitioners of all oases of puerperal pyrexia which is defined as "any febrile condition (other than a condition which is required to be notified as puerperal fever) occurring in a woman within 21 days after child-birth or miscarriage in which a temperature of 100.4 F. or more has been sustained during a period of 24 hours or has recurred during that period." The Town Council, in its desire to make some return for these notifications, has made available for practitioners the following forms of assistance: — (a) The services of one or other of the following obstetric consulting surgeons: — Dr. J. B. Banister, 39, llarley Street, VV.l. (Telephone : Mayfair 4943), also Charing Cross and Queen Charlotte's Hospitals. Dr. Aleck W. Bourne, 27, llarley Street, W.l. (Telephone: Langham 4012), also St. Mary's and Queen Charlotte's Hospitals. Dr. C. S. Lane-Roberts, 20, Upper Park Road, Hampstead, N.W.3. (Telephone: Primrose Hill 8100), also St. Bartholomew's, Royal Northern and Queen Charlotte's Hospitals. — 29 — Dr. Leslie Williams, Senior Assistant, Obstetric Unit, University College Hospital (Telephone: Museum 4801), and 10, Chandos Street, W.l. (Telephone: Langhani 1582). (b) Thu bacteriological examination of blood, etc., by Dr. Shaw, Pathologist to the Royal Northern Hospital. (c) The admission of cases, when possible, to the Joint Isolation Hospital. (d) The provision of a trained visiting nurse by the North London Nursing Association. During the last, three months of 1926 six notifications of puerperal pyrexia and two of puerperal fever were received, and one request for the services of an obstetric consultant was made. Infantile Mortality.—The number of Hornsey infants who died before reaching the age of 12 months was 57; of these 29 died in the first week of life and 40 in the first month. Premature birth accounted for 19 of the infant deaths, pneumonia for 13, and debility and wasting for 10. The infantilei mortality rate was 47.2 per 1,000 births—the highest rate for the last three years, but the third lowest figure on record for the Borough. DISEASES OF ANIMALS ACTS. The following is a summary of the work carried out by Mr. F. G. Buxton, the Veterinary Inspector, during the year: — Forty-nine licences were issued, viz., sheep 29, beasts 15, pigs 2, and pigeons 3. Forty-five inspections were made, under the Diseases of Animals Acts, of animals brought into the Borough, viz.: — 502 sheep, 217 pigs and 47 beasts. The tuberculin test was applied to three cows; one was found fo be infected and was slaughtered under the Tuberculosis Order, 1925. — 30 — LIST OF TABLES. TABLE A.—Vital Statistics, 1901-1926. TABLE B.—Causes of, and ages at, death in 1926, and Summary 1921-1926. TABLE C.—Infant Mortality in 1926. TABLE D.—Births, Deaths, Infant Deaths, and Deaths from certain diseases, 1901-1926. TABLE E.—Cases of Infectious Disease notified in 1926. TABLE F.—Cases of Infectious Disease notified 1901-1926. TABLE G.—Notifications of, and deaths from, Tuberculosis, 1926. TABLE H.—Work done at the Maternity and Child Welfare Centres and by Municipal Midwife, 1926. TABLE I.—List of Acts, By-laws and Regulations in force in the Borough. TABLE J.—Inspection of Factories, etc., 1926. TABLE K.—Statistics as to Housing conditions, 1926. - 31 - TABLE A. BOROUGH OF HORNSEY VITAL STATISTICS, 1901-1926. Year. Estimated Mid-Year Population. Birth Rate per 1,000 Population. Death Rate per 1,000 Population. Infant Mortality per 1,000 Birtbe. 1901 73,549 20.5 8.3 84 1902 74,652 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 81,284 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 43.6 1926 89,850 13.4 10.3 472 105 Great Towns (Rates in 1926) 18.2 11.6 73 157 Smaller Towns (Rates in 1926) 17.6 10.6 67 London (Rates in 1926) 17.1 11.6 64 ENGLAND and WALES (Rates in 1926) 17.8 11.6 70 — 32 — TABLE B.—CAUSES OF, AND AGES AT, DEATH DURING THE YEARS 1921-G. CAUSES OF DEATH 1926 All Age. Under 1 year. 1 and under 2 years. 3 and under 5 years. 5 and under 16 years. 15 and under 26 years. 25 and under 45 years. 45 and under 65 years. 65 years and over. 1926 1925 924 1923 1922 1921 1 Enteric Fever ... ... ... ... 1 ... ... ... 1 0 0 1 0 0 2 Small-pox ... ... ... ... ... ... ... ... 0 0 0 0 0 0 3 Measles 2 4 ... 1 ... ... ... ... 7 2 2 4 3 1 4 Scarlet Fever ... ... ... ... ... ... ... ... 0 0 1 1 2 4 5 Whooping Cough ... 1 1 1 ... ... ... ... 3 7 2 1 7 2 6 Diphtheria and Croup ... ... ... 1 ... ... ... ... 1 1 2 4 7 13 7 Influenza 1 1 ... ... ... 3 1 7 13 12 19 11 40 22 8 Encephalitis Lethargica ... ... ... ... 1 1 ... ... 2 3 2 ... ... ... 9 Meningococcal Meningitis ... ... ... ... ... ... ... ... 0 3 1 5 4 5 10 Tuberculosis of Respiratory System ... ... 1 ... 6 29 20 5 61 46 54 47 57 71 11 Other Tuberculous Diseases ... ... ... 2 1 3 ... 1 7 5 6 11 13 16 1'2 Cancer, Malignant Disease ... ... ... ... 1 11 59 72 143 140 150 139 146 142 13 Rheumatic Fever ... ... ... ... ... 1 ... ... 1 3 5 1 6 3 14 Diabetes ... ... ... ... ... ... 1 1 2 10 7 ... ... ... 15 Cerebral Haemorrhage, etc ... ... ... ... 2 2 15 39 58 69 65 ... ... ... 16 Heart Disease ... ... ... 1 3 5 41 78 128 136 107 105 89 80 17 Arteriosclerosis ... ... ... ... ... 1 5 28 34 48 45 ... ... ... 18 Bronchitis 2 ... ... ... ... 3 9 50 64 88 93 78 72 87 19 Pneumonia (all forms) 9 1 5 1 ... 8 17 27 68 76 65 74 80 56 20 Other Respiratory Diseases ... ... ... ... ... 1 4 9 14 11 3 1 3 6 21 Ulcer of Stomach or Duodenum 1 • •• ... ... 1 3 6 1 12 6 0 ... ... ... 22 Diarrhoea, etc 3 ... ... ... ... ... ... ... 3 2 1 4 3 15 23 Appendicitis and Typhlitis ... ... ... ... 1 5 3 1 7 8 8 6 12 8 24 Cirrhosis of Liver ... ... ... 1 ... ... 4 ... 5 5 5 6 5 11 25 Acutc and Chronic Nephritis ... ... ... ... ... 2 11 18 81 25 34 35 34 25 26 Puerperal Sepsis ... ... ... ... ... 2 ... ... 2 0 1 0 3 0 27 Other accidents and diseases of Pregnancy and Parturition ... ... ... ... ... 1 ... ... 1 3 1 5 2 3 28 Congenital Debility and Malformation, Premature Birth 37 ... 1 ... ... ... .... ... 38 28 36 42 42 45 29 Suicide ... ... ... ... 1 ... 2 ... 3 4 10 12 13 12 30 Other Deaths from Violence 1 1 2 1 3 4 9 13 34 26 21 21 29 25 31 Other Defined Diseases 1 ... ... 7 5 21 38 113 185 179 182 312 321 310 32 Causes Ill-defined or Unknown ... ... ... ... ... ... ... ... ... ... ... 2 ... 6 Total 57 8 10 16 26 103 245 163 928 94 6 928 928 992 968 r Adapted from old Classified List. 33 TABLE C.—INFANT MORTALITY, 1926. CAUSES Or DEATH. Deaths from stated causes at various Ages under One Year of Age. Total Deaths tinder One Year. Under 1 Week. 1-2 Weeks. 9-3 Weeks. 8-4 Weeks. Total under 4 Weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-1 a Months. Whooping Cough — — — — 0 - - - — 0 Tuberculous Meningitis — — — — 0 — — — — 0 Other Tuberculous Diseases — — — — 0 — — — — 0 Convulsions 1 1 — — 2 — — 1 1 4 Bronchitis — — — 1 1 — — — — 1 Pneumonia 3 2 — — 5 1 S 2 2 13 Diarrhœa — — — — 0 1 1 — — 2 Rickets — - — — 0 — — — — 0 Injury at Birth 4 — — — 4 — — — — 4 Premature Birth 15 3 — — 18 1 — — — 19 Atrophy, Debility and Marasmus 3 — 4 — 7 — 2 1 — 10 Other Causes 3 — — — 3 1 — — — 4 Total 29 8 4 1 40 5 5 4 3 57 — 31 — TABLE D. BIRTHS, DEATHS, INFANT DEATHS, AND DEATHS FROM CERTAIN DISEASES, 1901-1926 YEAR. Population Census. Total Births Total Deaths Total Infant Deaths (under one year) Deaths from Measles Deaths from Whooping Cough Deathsfrom Diarhoea (under two years) Deathsfrom 8carlet Fever Deaths from Diphtheria Deaths from Typhoid Fever. Deaths from Cancer. Deaths from Tuber culosis (Pulmonary) Deathsfrom Tuberculosis (Non-Pulmonary) 1901 72,056 1,511 597 127 8 14 6 1 8 3 47 45 18 1902 1,565 620 129 7 9 1 0 9 6 51 45 22 1903 1,561 68y 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 1,893 737 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 191S 1,394 1,007 112 37 7 23 3 11 2 99 58 19 1916 1,404 928 04 0 5 8 0 11 1 106 84 20 1917 1.038 906 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 87,659 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 1,189 928 48 2 2 1 1 2 0 ISO 54 6 1925 1,214 946 49 2 7 2 0 1 0 140 46 5 1926 1,206 928 57 7 3 3 0 1 1 143 61 7 35 TABLE E.—INFECTIOUS DISEASES NOTIFIED, 1926. 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 s 5 IS 15 25 25 45 45 65 65 and over Scarlet Fever 24 23 4 21 18 19 10 14 7 0 21 83 29 7 0 0 140 89 7 0 Diphtheria 27 11 7 21 27 8 3 2 10 0 19 77 14 4 2 0 116 101 4 1 Enteric Fever 1 0 0 0 0 0 2 1 0 0 1 2 1 0 0 0 4 2 1 1 Erysipelas 3 3 1 5 2 4 0 2 2 2 0 1 2 6 9 2 22 2 5 0 Ophth. Neon. 1 0 0 2 0 1 2 1 0 7 0 0 0 0 0 0 7 0 0 0 Pneumonia 3 3 4 11 5 17 4 3 6 2 6 11 2 14 11 10 56 0 8 68 Puerperal Fever 0 1 0 0 1 1 0 1 0 0 0 0 0 4 0 0 4 0 3 1 Puerperal Pyrexia 1 1 2 1 0 1 0 0 0 0 0 0 1 5 0 0 6 0 1 0 Encephalitis Lethargica 2 2 1 0 o 1 0 0 0 0 0 1 2 2 1 0 6 2 1 2 Poliomyelitis 0 1 0 1 0 0 0 0 0 0 0 1 1 0 0 0 2 0 0 0 Tuberculosis Phthisis 10 10 7 13 25 14 10 9 13 0 1 2 18 64 21 5 111 — — 61 Other Horms 4 3 1 5 3 2 2 5 3 0 1 6 9 8 4 0 28 — - 7 Total 76 58 27 80 81 68 33 38 41 11 49 184 79 114 48 17 502 196 30 141 Admitted to Hospitals (except T.B.) 46 20 12 40 41 24 12 15 16 - - - - - - - - - - - Note.—The following non-notifiable infectious diseases were also admitted to the Isolation Hospital:—Measles 7, Corneal Ulcer 1. Mumps X, Diphtheria found to he Laryngitis 1, Enteric Fever found to be Tuberculosis 1, making a total of 207. - 36 TABLE F.—NOTIFICATIONS OF INFECTIOUS DISEASE, 1901-1926. Year. Population. Scarlet Fever. Diphtheria or Croup. Enteric Fever. Puerperal Fever. Puerperal Pyrexia. 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 1 — — — — — — — 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 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 88,007 286 113 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 1926 89,850 140 116 4 4 6 22 0 2 8 0 0 6 56 — — — 364 4.0 * Excluding measles and German measles. 37 TABLE G.—NOTIFICATIONS OF, AND DEATHS FROM, TUBERCULOSIS, 1926. AGE PERIODS. New Cases. Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M P M F 0—1 - 1- 6 — 1 — 1 — 1 — — 5 —15 2 — 3 3 — — 2 — 15 —25 9 9 3 6 3 3 — 1 25 - 35 13 18 3 3 4 7 — 1 35 —15 20 13 2 — U 7 1 1 45 -55 14 3 1 2 8 4 — — 55 -65 3 1 1 — 8 — — — 65 — and over 2 3 — — 2 3 — 1 Totals 63 48 13 15 36 25 3 4 Wards:— Highgate 7 3 3 1 2 2 — 1 Muswtll Hill 4 6 1 2 6 3 — 1 Crouch End 2 5 1 — 1 3 2 — West Hornsey 7 6 3 2 6 5 — 1 East Hornsey 17 8 1 2 8 3 — — North Haringey 6 8 1 1 4 4 — — South Haringey 5 5 1 1 2 2 — — Stroud Green 6 3 1 4 4 1 — — Finsbury Park 9 4 1 2 3 2 1 1 Totals 63 48 13 15 36 25 3 4 - 38 — TABLE H. MATERNITY AND CHILD WELFARE WORK, 1926. Nature of Work. Centres. Totals. No. 1. No.2 No. 3. Number of ordinary sessions held 197 93 51 341 Number of ante-natal sessions held 50 23 12 85 Number of individual Mothers seen by Doctor:— Ante-natal, New eases 162 67 36 265 „ Old case* 338 159 66 562 Post-natal, New cases 70 36 11 117 ,, Old caBss 83 47 61 191 Total attendances of Mothers 979 390 174 1,543 Number of babies attending Centres for first time 468 251 185 894 Number of individual babies on Centre registers 988 488 340 1,816 Attendance of babies at medical consultations 5,043 2,746 1,393 9,182 Total attendances of babies at Centres 7,696 4,158 2,757 14,611 Referred to own private doctors 70 61 7 138 Referred to hospitals 100 52 17 169 Health talks given by nurses 24 28 26 78 Examinations in Mothercraft 2 — 1 3 Lectures to parents — — 2 2 First visits Total visits First visits Total visits First visits Tota v isit First visits Total visits Visits paid by nurses:— To expectant mothers 110 142 47 79 37 62 194 283 To infants under one year 616 2,591 326 1,342 288 953 1,230 4,886 To children aged 1-5 years 51 2,272 18 1,695 55 957 124 4 924 Total visits paid by nurses 777 5,005 391 3,116 380 1,972 1,548 10,093 RECORD OF WORK OF MUNICIPAL MIDWIFE, 1926. Confinements attended 153 Ante-natal Clinics attended 74 do. visits 321 Post-natal visits 2,171 39 TABLE I. 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, ]922 (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-laics 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). 40 Houses Let in Lodgings or occupied by members of more than one family (21st September, 1896). For Good Rule and Government of the Borough, 1909, 1913 and 1922. 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 (21sfc 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, 1906. 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). 41 TABLE J.—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, a£ required. None of the Outworkers' premises was found to be in an unwholesome condition. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries) 319 30 0 Workshops (Including Workshop Laundries) 628 47 0 Workplaces (Other than Outworkers' premises) 27 8 0 Total 974 85 0 DEFECTS FOUND IN FACTORIES, WORKSHOPS & WORKPLACES. Particular*. (1) Numberot Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts:— Want of oleanliness 27 27 0 0 Want of ventilation 1 1 0 0 Overcrowding 0 0 0 0 Want of Drainage of floors 0 0 — — Other nuisances 29 29 0 u Sanitary accommodation insufficient 5 5 0 0 unsuitable or defective 22 22 0 0 not separate for sexes IS 16 0 0 Offences ttuder the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences (Excluding offences relating to outwork and offenses under the Sections mentioned in the Sehedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). 6 6 0 0 Total 85 85 0 0 *Including thoie specified in sestions 2, 3, 7 and 8 of the Factory and Workshop Act. 190l, as remediable under the Public Health Acts. 42 TABLE J. (contd.) OUTWORKERS. Nature of Work. (1) Outworkers. Instances. Notices served. Prosecutions. Wkaiuno Apparel:— Making, etc. 80 0 0 0 Cleaning and Washing — — — — Lace, lace curtains and nets 2 0 0 0 Curtains and furniture hanging 2 0 0 0 Fur pulling 1 0 0 0 Furriers 3 0 0 0 Fancy Goods 3 0 0 0 Artificial flowers 2 0 0 0 Umbrellas 3 0 0 0 Total 96 0 0 0 43 TABLE K. HOUSING CONDITIONS. STATISTICS YEAB ENDED 81st DECEMBER, 1U26. 1.—General. (1) Estimated population 89,850 (2) General death-rate 10.3 (8) Death-rate from tuberculosis (per 10,000 population) 7.6 (4) Infantile mortality 47.2 (6) Number of dwelling-houses of all classes 20,070 (6) Number of working-class dwelling-houses (viz., up to £80 r.v.) 10,857 (7) Number of new working-class houses erected during year 189 2.—Untit Dwellino-Hodbbs I.—Inspection. Houses inspected 984 House to house 890 Infectious disease 268 (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,824 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Begulations, 1910 390 (8) Number of dwelling-housee found to be in a state so dangerous or injurious to health as to be unfit for human habitation 0 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,157 II.—Bomedy of Defects without Service of formal Notice. Number of defective dwelling-houses rendered fit in consequenoe of informal action by the Local Authority or their Officers 978 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 notioes 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 44 TABLE K. (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 94 (2) Number of dwelling-houses in which defects were remedied— (a) by Owners 78 (b) by Local Authority in default of Owners 0 (c) Proceedings under sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909. (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 (3) Number of dwelling-houses in respect of which Closing Orders were determined, tho dwelling-houses having been rendered fit 0 (4) Number of dwelling-houses in respect of which Demolition Orders were made 4 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 4 S.—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 Nil (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 1926 OF THE School Medical Officer. Hornsey Education Committee. 1926. The Worshipful The Mayor, Alderman W. G. Barrenger, J.P Alderman W. W. Kelland, M.A. (Chairman). Alderman B. H. Jenkinson (Vice Chairman). Alderman H. B. Brackenbury, H. E. Hill, Councillor A. A. Bell, „ G. F. V. Cutting, „ A. J. Marriott, „ E. W. Mayatt, Councillor J. W. Rowlands, „ J. W. Shipp, „ c. H. summersby, (resigned) „ R. H. L. Watson, „ R. Ff. Wootton, „ Mrs. C. M. Cave. Co-optative Members: The Rev. E. D. Arundell, M.A. Mr. T. P. McNaught, (resigned) Mr. H. Tompkins, Rev. H. C. Montgomery Mrs. A. Holman, J.P., Campbell, M.A., M.C., Miss I. Jameson, M.A., Mr. J. Horsbuuuh (resigned), Mrs. J. Whitehead. Secretary: Mr. A. W. Allen, M.A. STAFF. School Medical Officer School Oculist and School Medical Inspector Aurist Radiologist Medical Officers attending Minor Ailments Clinic Dentists Nurses Clerk Assistant Clerk W. W. Jameson, M.A., M.D., M.R.C.P., D.P.H. J. R. Prior, M.D., D.P.H. A. R. Friel, M.A., M.D., F.R.C.S. (I.). J. Morison, M.D. H. D. Apergis, M.R.C.S. W. J. Jenner, M.D. J. K. R. Bryce, L.D.S. (resigned). R. L. Close, L.D.S. (resigned). F. O. Hume, L.D.S. C. H. Rubra, L.D.S. S. T. Taylor, L.D.S. Miss M. Anscombe. Miss L. M. Oliver. Miss F. E. Paris, Miss H. M. Croak. Miss V. Powell PREFACE. To the Chairman and Members of the Education Committee of the Hornsey Town Council. Ladies and Gentlemen, I have the honour to present to you my second Annual Report on the health of the elementary school children in the Borough of Hornsey. Steady progress has been made during 1926 in all the work of the School Medical Service, but no noteworthy innovations have been introduced. The system of staffing the School Clinic by local medical practitioners and local dentists is working admirably, an«l is largely responsible for the popularity of the service. My thanks are particularly due to Mr. Allen, your Secretary, to Dr. Prior and to Mr. Hatcher for their readiness to help at all times. I have the honour to be, Your obedient Servant, WILSON JAMESON. 3 GENERAL. As the tabulated results of medical inspection and treat ment show, there has been a general increase in the amount of work done in the Borough during the past year. Coordination with the Maternity and Child Welfare Service has been strengthened, and, in particular, great use has been made of the facilities offered at the three "Welfare Centres" for the treatment of school children suffering from minor ailments. Increasing numbers of children under hve years of age attend the Central School Clinic for such conditions as ear discharge and squint, and it is hoped that by the early treatment of defects of this nature children will be spared much disability in later life. Minor structural alterations have been carried out in certain of the schools, and plans for the construction of a new school near the Coppett's lioad housing estate are before the Town Council at the moment of writing. The provision of a new school in this situation becomes increasingly urgent as the housing scheme nears completion, and it is hoped that building operations will shortly be commenced. In the meantime the cost of the conveyance of children to and from the various schools in the Borough is still being undertaken by the Education Committee. In all the departments where children living at a distance remain on the school premises during the mid-day interval arrangements have been continued to enable such children to have their dinners in an orderly and comfortable manner. At each school the meal is supervised by a teacher or by a senior prefect, and facilities are given for warming the food brought by pupils. MEDICAL INSPECTION AND TREATMENT. Bather more than 37 per cent. of the children on. the rolls of the various schools were inspected on a routine basis during 1926, while no less than 1,795 special inspections were also made —practically all of them at the School Clinic. The following are notes on the principal defects discovered and the means of treatment available: — (a) Uncleanliness.—Verminous conditions were found to be present in 42 per cent. of the children submitted to medical 4 inspection, while 0.8 per cent, were unclean but not verminous. The figures for 1925 were 4.7 per cent, and 1.3 per cent, respectively. Nearly 33,000 inspections of children were made by the school nurses, and 755 individual children (845 in 1925) were found to be dirty or verminous. A small but definite improvement has thus to be recorded. In no case was the degree of uncleanliness marked, but the number of children affected is still a matter of concern. Two hundred and twenty-one children were cleansed at the Cleansing Station, in 42 instances under the powers given in section 87 of the Education Act, 1921. In three eases legal proceedings were taken against parents who allowed their children to become verminous again after com pulsory cleansing. (b) Minor Ailments.—The daily treatment of minor ail ments at the three "Welfare Centres" in the Borough has been of great assistance. All children requiring frequent dressings or applications can thus receive attention from the nurses without having to make the journey to the Central Clinic. In Table IV. (A) defects treated as minor ailments are set out, and it will be seen that 1,047 such defects were dealt with during the year. Special inspections at the two weekly medical sessions numbered 1,433. (c) Tonsils and Adenoids.—One or other or both of these conditions existed in 10.6 per cent. of the children inspected, while 3 per cent. were referred for early operation. One hundred and thirty-seven children were submitted to operation at the Clinic, and 27 received similar treatment elsewhere. The importance of dealing early with tonsillar sepsis is being emphasised at present as a result of a series of investigations into the causation of rheumatism in elementary school children. (d) Tuberculosis.—Routine medical inspection revealed no cases of definite tuberculosis among the school children: 9 cases were, however, regarded as suspicious. Altogether 34 children were referred to the Tuberculosis Officer during the year for observation and report. It is only fitting here to acknowledge the valuable assistance always given so readily by Dr. Dobson, the local Tuberculosis Officer. A certain number of delicate children coming from homes where a consumptive was living were sent either to the Ogilvie Home at Olacton or to the School of Recovery at Parkstone. 5 (e) Skin Disease.—At routine inspection only 10 wises of skin disease were discovered. Special inspections, however, revealed 181 cases of impetigo, 15 cases of ringworm of the body, 9 of ringworm of the scalp and 12 of scabies. All these cases received treatment through the School Medical Service. The 12 children suffering from scabies were dealt with at the Cleansing Station, making altogether 38 attendances, and 7 of the children affected with ringworm of the scalp received X-ray treatment. (f) External Eye Disease.—Forty-three children, or 1'6 per cent, of those inspected, suffered from some form of external eye disease. Many more cases were found at special inspections, and there were altogether 110 such cases treated at the Eye Clinic and 58 at the Minor Ailment Clinics. (g) Vision.—One hundred and sixty-five children, or 6 per cent, of those examined, had defective vision. The School Oculist treated 735 defects of the eye during the year, 368 of these defects being errors of vision. Spectacles were prescribed in 251 cases, and by the end of the year had been obtained in all but two instances. (h) Ear Disease and Hearing.—Thirty-two cases of defective hearing were investigated as a result of routine inspection, and 21 children suffering from ear discharge were referred for treatment. The weekly Aural Clinic conducted by Dr. Friel has been continued during the year with excellent results. Dr. Friel reports as follows:— "The Clinic is held on Saturday mornings during school terms. The majority of the patients suffered from ear discharge; others came complaining of deafness. The discharging ears were treated on the lines described in the report for 1925. Most of the cases of Acute Inflammation were in babies or children under school age sent up from the Infant Welfare Centres. It is to be noted that in 7 ears the final result was not known. Two of these cases had left school and two others were attending hospital. 6 There were 20 patients suffering from deafnes^ which was due in most instances to present or past inflammation in the ear. Most of the deaf cases were treated by Politzerisation. Breathing exercises were often prescribed. An analysis of the causes of suppuration and a summary of the results in the cases of otorrhea is shown in the accompanying table:— Cases of Otorrhœa. Cause of Suppuration. Total ears. Cured. Lost sight of. Still under treatment Operation necessary. Acute otitis media 26 24 2 Chronic suppurative otitis media due to— Tympanic sepsis 23 21 1 1 Tympanic sepsis + granulations 2 1 1 Tympanic sepsis + polypus 5 4 1 Tympanic conditions + rhinitis 1 1 Tympanic conditions 4- attic disease 4 ] 3 + Mastoid disease No operation 15 2 3 1 9 Operation already 6 4 2 Diffuse external otitis 2 2 Localised external 1 1 85 60 7 9 9 A. R. Friel, Aurist." (i) Dental Defects.—As a result of medical inspection some 24 per cent, of the children appeared to be suffering from dental caries, 5 per cent. having four or more teeth decayed and 19 per cent. three or less than three. The school dentists, who have been engaged during eight sessions every week, examined 4,658 children and referred 63 per cent, for treatment (68 per cent in 1925). Of the children so referred some 68 per cent, actually obtained treatment. A large number of 7 attendances was made by the children undergoing treatment at the dental clinic, and the average amount of work done in each case was greater than in the preceding year, 68 per cent, actually obtained treatment. A general anaesthetic was administered on 1,394 occasions, as it has been found that both parents and children regard with much less dread the extraction of teeth under gas or ethyl chloride than under local anaesthesia. Indeed the school dentists maintain that the popularity of the dental service is based largely on the elimination of pain. More particularly is this so in the case of very young children, to whom increased attention has been paid during the year under review. The parents of these younger children, that is the "Entrants" group, were specially invited to attend the dental inspections, and the dentists took the opportunity of impressing upon them the necessity of proper attention to the teeth in the early years of life. (j) Crippling Defects.—Six cases of organic heart disease and 8 of paralysis were discovered at medical inspection. Reference to Table III. will show the number of crippled children in Hornsey. It will be noted that. 5 of such children were sent to hospital schools during 1926, 1 to a residential school and 1 to a day school for cripples, while 49 were attending the ordinary elementary schools. While no organised orthopaedic scheme exists in the area, no delay has occurred in obtaining suitable treatment for children suffering from crippling defects. FOLLOWING UP. Any scheme of medical inspection and treatment is incom plete unless arrangements exist for visiting the homes of the children and seeing that the advice given is in fact being followed. Much assistance is obtained from the head teachers of the various departments, while the actual visiting is done by the school nurses with the help of the attendance officers. Too much stress cannot be laid on the importance of this aspect of the work. In 1926 the school nurses paid 1,261 visits to various school departments and 1,587 home visits. 8 INFECTIOUS DISEASE. In the first few months of the year measles became epidemic in practically all the infant departments. Whooping cough affected Crouch End, St. Marv's, Campsbourne and Highgate Junior Schools in October, November and Dec-ember, and Holy Innocents' School in June and July, while chicken pox caused a fall in attendance in St. Mary's and South Harringay Junior Schools in February and March. Twelve cases of diphtheria occurred among children attending Highgate Council School between October and November. The usual practice of excluding from school individual children, whether infected or merely contacts, was followed, and in no case was it found necessary to consider the question of school closure. 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 34 children were sent for six weeks or longer to one or other of these institutions. The improvement in the health of the 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 need of a day open-air school still exists in Hornsey, and it is hoped that, as soon as the present period of financial embarrassment has passed, this will be met. There are large numbers of children whose condition, while not warranting the heavy expenditure incurred by treatment in a residential institution, would improve enormously under the carefully planned regime of a special school for physically defective children. Playground classes were held in most of the schools during the summer months, and in six of the departments light weather-proof shelters have been erected to accommodate such classes. Two school camps were organised during the year, 94 children from Campsbourne School attending one and 28 children from St. Michael's and Highgate Schools the other. 9 PHYSICAL TRAINING. The Board's schedule of physical training is followed in all the schools, and considerable interest is being taken in organised games and in swimming. Organised games and school sports are held at the school field in Redston Road, the Rokesly Avenue School site, Highgate Woods and Finsbury Park. Bach school has its own annual sports day, and an annual inter-school athletic meeting is also held. Parents attend these gatherings in large numbers, and the arrangements, organised by the school staffs in their spare time, reflect great credit on all concerned. At the Redston Road ground three new drinking fountains have been installed. These fountains are of the modern hygienic type, and proved highly satisfactory during last summer. As regards swimming, 1,024 children made 50 per cent, or more of the possible number of attendances at the school bath during the summer. Of these children 289 could swim at the beginning of the session, and at the end of the session another 349 had been taught 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 1926. Much success is due to the Sectional Secretaries, who, by carrying through league competitions, awaken keen enthusiasm not only among the children actually playing, but among those who witness the games. The competitions in football, tennis, netball and athletics have been extended this year in order to cater for those scholars attending 'Upper Top' schools who remain at school during their sixteenth year. This has meant much more organisation, both for fitting in the fixtures, venues of the games and neutral 'umpires' or 'referees,' but the results have justified the extra time devoted by the teachers concerned. A further development has materialised in netball, which section has become affiliated to the Middlesex Netball Association. The knock-out competition is in progress at the time of writing, but both players and teachers have distinct hopes of reaching the final round. 10 The football section is nearing the end of a very full season. Three Lie agues and one Cup Competition (Inter-School) have been successfully carried through, while three Inter-District competitions have been played. In the latter the success lias been scanty, owing to being drawn against the very strong Tottenham teams away from home in each competition, Corinthian, Sun and Dewar. The teachers concerned, however, have derived immense satisfaction from the numerous favourable comments upon the sportsmanlike way in which the Hornsey boys have played the game and lost. Another very successful Swimming Gala was held at the Hornsey Road Baths. The standard of the swimming was higher, in most cases, than was shown at the 1925 gala. The Association have hopes that this section, too, will derive benefit and development from a suggested Middlesex Swimming Association and a renewed affiliation to the London Schools' Swimming Association." CO-OPERATION WITH PARENTS AND OTHERS. All parents are invited to attend medical inspections, and 77.5 per cent, availed themselves of the opportunity, As a rule parents take an active interest in the work, and are only too glad to follow the advice given. Head masters are in close consultation with the School Medical Inspector during medical inspection, and do everything in their power to induce parents to carry out the Inspector's instructions. 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 weekly at the school clinic when a special session is held by the School Medical Officer for the purpose of dealing with various types of special cases. The Care Committees in Hornsey play an important part in safeguarding the physical well-being of the school children. A Central Care Committee co-ordinates the work of four District Care Committees, and an excellent system of co-operation exists between voluntary workers, teaching staffs, the education administration staff and the school medical staff. The following 11 figures give some idea of the practical help rendered by the District Care Committees during 1926:— Number of Cases. Free. Part Payment. Full cost paid by parents. Total. Milk 78 4 260 342 Cod liver oil and malt 24 30 178 232 Spectacles 10 40 113 163 Surgical appliances 1 3 — 4 Boots and clothing 156 — — 156 In addition 79 children were given a short holiday at the seaside mainly as a result of the efforts of the Care Committees. Most of the schools have their own boot and clothing clubs, organised by members of the District Care Committees and their friends. These clubs have proved to be most useful institutions. 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 or deriving beneficial instruction in special schools are sent to suitable institutions. Thus, during 1926, 10 children attended a special class in Wood Green for the partially blind and 1 a special class in the London area, 7 a class for deaf children in Tottenham, 3 a residential school for deaf children, 30 the Joint Special School in Finchley for feeble-minded children and 2 a certified school for epileptics. Six mentally defective children incapable of deriving: benefit from education in the Joint Special School were referred to the Middlesex County County Council, the Local Authority under the Mental Deficiency Act. During the year 39 children were examined by the School Medical Officer with a view to their admission to the Joint Special School, and of these children 14 were actually admitted 12 No Homsey child was discharged from the Special School during 1926, but of the 16 children from other districts who left during the year the following facts are known: — Left the area 2 Died 1 At home (one making rugs for sale) 2 Attending other schools 2 Errand boys 3 Institutional case 1 Working with fathers 2 Pawnbroker's assistant 1 Hawker 1 Not under proper control 1 In Table VII. will be found some account of the after histories of Hornsey children who have left the Joint Special School during the past six years. Suitable after-care is essential in the case of these mentally sub-normal children, for with encouragement and supervision many of them can become useful members of the community. In Hornsey this work is undertaken by the District Gare Committei©s. It is worthy of note that, in a handicraft competition, open to all schools, secondary and elementary, in the north of London, work done by children at the Joint Special School won two first prizes and one second prize, and in certain other classes the Special School exhibits were the only ones submitted. STAMMERERS' CLASS. Miss Kennedy, who conducted the stammerers' classes with such success, left last summer, and Miss Bains was appointed in her place. Miss Bains commenced work in November, and is proving a highly efficient and popular teacher. Two classes are held at the Education Offices, Crouch End, each class meeting for a period of three-quarters of an hour twice weekly. Altogether 24 children attended the classes during the year. GENERAL. Legal Proceedings.—Two hundred and sixty-two preliminary and 91 final notices were sent to parents during 1926 under the powers given in the Education Act, 1921, relating to verminous 13 elementary school children. Forty-two children were compulsorily cleansed at the Central cleansing station. Proceedings were taken in 3 cases against parents who neglected to keep their children clean after such compulsory cleansing. Employment of School Children.—In no case did employment appear to affect adversely the health of children attending the elementary schools. Medical Inspection of Secondary School Pupils.—The secondary school pupils are inspected by medical practitioners working under the direction of the Hornsey School Medical Officer, who is specially appointed for this purpose by the Middlesex Education Committee. This work, though quite separate from, is carried out in close co-operation with the elementary school medical service. Arrangements exist for the transfer to the secondary schools of all medical records of entrants from the elementary schools whether scholarship or fee-paying pupils. 14 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 11.—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.—List of schools, accommodation and number on rolls. ,, VI.—Return of children inspected at each school. ,, VII.—After histories of Hornsey children who left the Joint Special School for Mentally Defective Children, 1921-1926. 15 TABLE I.—RETURN OF MEDICAL INSPECTIONS, 1926 (a) Routine Medical Inspections Number of Code Group inspections— Entrants 979 Intermediates 966 Leavers 673 Total 2,618 Number of other routine inspections 106 (b) Other Inspections Number of special inspections 1,795 Number of re-inspections 3,328 Total 6,118 16 TABLE II. (A)—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 81st DECEMBER, 1926. Defect or Disease. Routine Inspections Special Inspections No. of Defects. No of Defects. Requiring treatment. Requiring to be kept underobservation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment. (l) (2) (3) (4) (5) Malnutrition – 194 – – Uncleanliness 141 – – – (See Table IV. Group V). Skin Ringworm, scalp 3 — 6 — body — — 11 — Scabies 2 — 10 – Impetigo 1 – 60 – Other Diseases (non-Tuberculous) 3 1 101 — Eye • Blepharitis 7 – 19 – Conjunctivitis 3 — 13 — Keratitis – — 1 — Corneal Opacities — Defective Vision (excluding Squint) 165 — 109 – Squint 9 — 37 — Other Conditions 23 1 72 — Ear Defective Hearing 10 6 16 Otitis Media - 15 6 59 Other Ear Diseases - 2 1 30 — Nose and Throat / Enlarged Tonsils only 54 197 51 2 Adenoids only - 2 6 5 2 i Enlarged Tonsils and Adenoids 28 2 32 — I Other Conditions 2 5 81 – Enlarged Cervical Glands (Non-Tuberculous) 1 211 26 – Defective Speech — 8 – – Teeth—-Dental Diseases 652 – 45 (See Table IV., Group IV.)– Heart and Circula tion I Heart Disease : Organic — 5 1 Functional — 37 — 3 Anaemia — 4 96 – Lungs Bronchitis 1 41 68 – Other Non-Tuberculous Diseases — 1 5 – Tube culosis Pulmonary Definite – – Suspected 2 7 — Non-Pulmonary: Glands — — – Spine — – Hip — — — Other Bones and Joints – — — — Skin – — — — Other forms – — — Nervous Systen Epilepsy 5 — — Chorea – 1 4 — Other conditions – 1 24 – Defornities Rickets – — 1 – Spinal Curvature – 4 – Other Forms – 2 1 – Other Defects and Disease 4 34 589 – 17 TABLE II—(Contd.). (13)–NUMBER OF INDIVIDUAL CHILDREN FOUND AT ROUTINE MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UNCLEANLINESS AND DENTAL DISEASES). Group Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. (1) (2) (S) (4) Code Groups:— Entrants 979 41 4.2 Intermediates 966 179 18.5 Leavers 67J 96 14.2 Total (code groups) 2,618 316 12.0 Other routine inspactions 106 13 12.2 18 TABLE III.—RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Boys Girls Total Blind (including partially blind). (i) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind – – – Attending Public Elementary Schools — At other Institutions — — — At no School or Institution — — — (ii) Suitable fortraining in a School or class for the partially blind. Attending Certified Schools or Classes for the Blind 6 6 12 Attending Public Elementary Schools At other Institutions — — – At no School or Institution — — — Deaf (including deaf and dumb and partially deaf). (i) Suitable for traini n g 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 – – – (ii) 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 12 18 30 Attending Public Elementary Schools – – – At other Institutions — — — At no School or Institution — — — Notified 10 the Local Control Authority during the vear. Feebleminded 3 3 6 Imbeciles — 1 1 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 6 At no School or Institution — 1 1 19 TABLE III—(Contd.). 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 I nstitution – — — Non-infectious but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 3 2 5 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 20 21 41 At Certified Day Open-air Schools – – – At Public Elementary Schools 55 56 111 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 orlnstitution — — — 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 2 3 5 At Certified Residential Cripple Schools 1 — 1 At Certified Day Cripple Schools — — — At Public Elementary Schools 16 14 30 At other Institutions 2 0 2 At no School or Institution 1 — 1 20 TABLE IV. (A) —RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1926. TREATMENT TABLE. Group 1.—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 9 — 9 Ringworm-Body 15 — 15 Scabies 12 — 12 Impetigo 181 — 181 Other Skin Diseases 118 5 123 Minor Eye Defects (External and other, but excluding cases falling in Group II). 58 — 58 Minor Ear Defects 108 4 112 Miscellaneous {e.g., minor injuries, bruises sores, chilblains, etc.) 536 1 537 Total 1,037 10 1,047 21 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). 368 58 — 426 Other Defect or Disease of the eyes (excluding those recorded in Group 1). 110 7 — 117 Total 478 65 — 543 Total number of children for whom spectacles were prescribed (а) Under the Authority's scheme 251 (b) Otherwise—0. Total Number of children who obtained or received spectacles (а) Under the Authority's scheme 249 (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) 137 27 164 80 244 22 TABLE IV.—(Contd.). Group IV.—Dental Defects. (1) Number of Children who were:— (o) Inspected by the Dentist:— Aged Routine Age Groups 5 237 6 690 7 310 8 325 9 375 10 654 11 411 12 697 13 350 14 103 15 18 Total 4,170 Specials 488 Grand Total 4,658 (b) Found to require treatment 2,898 (c) Actually treated 1,973 (d) Re-treated during the year as the result of periodical examination 788 (2) Half-days devoted to Inspection 24 Treatment 316 Total 340 (3) Attendances made by Children for treatment 5,164 (4) Fillings Permanent teeth 2,154 Temporary teeth 668 Total 2,822 (5) Extractions Permanent teeth 586 Temporary teeth 4,437 Total 5,023 (6) Administrations of general anaesthetics for extractions 1,394 (7) Other operations Permanent teeth 261 Temporary teeth 444 Total 705 Group V —Uncleanliness and Verminous conditions. (i) Average number of visits per school made during the year by the School Nurses—52. (ii) Total number of examinations of children in the schools by School Nurses—32,707. (iii) Number of individual children found unclean—755. (iv) Number of children cleansed under arrangements made by the Local cation Authority—221. (v) Number of cases in which legal proceedings were taken— (a) Under Education Act, 1921—3. (b) Under School Attendance By-laws—0. 23 TABLE V. LIST OF SCHOOLS IN THE BOROUGH. School. Department. Authorized accommodation. Average No. on the Rolls For yr. ended 31/12/26. Muswell Hill Junr. Mixed 220 221.2 St. Michael's Senr. Mixed 238 145 ,, Junr. Mixed 175 124.9 Highgate Senr. Mixed 444 284.5 ,, Junr. Mixed 354 228.7 North Harringay Boys' 416 433.6 ,, ,, Girls' 416 393.9 ,, ,, Junr. Mixed 462 424.5 South Harringay Senr Mixed 570 438.5 ,, ,, Junr. Mixed 300 264.2 Stroud Green Boys' 418 360.8 ,, ,, Girls' 418 359.2 ,, ,, Junr. Mixed 426 336 St. Mary's Boys' 237 232.1 ,, Girls' 235 249 ,, Infants' 220 217.5 Crouch End Boys' 456 348.6 ,, ,, Girls' 450 301.3 ,, ,, Junr. Mixed 411 347.8 Holy Innocents' Infauts' 101 110 St. James' Mixed & Inf. 269 316.4 Campsbourne Boys' 450 374.8 „ Girls' 450 366.7 ,, Infants' 473 452.2 Totals 8,609 7,331.1 24 TABLE VI.—ROUTINE MEDICAL INSPECTION, 1926. Number of children inspected at each school. YEARS OF AGE. 5 6 7 8 9 10 11 12 13 14 15 TOTALS. School. B. G. 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 15 17 19 15 1 3 9 11 2 1 2 1 — — — 1 — — — — — — 48 49 97 St. Michael's 11 10 13 8 5 1 14 14 1 2 — 1 — — 14 12 1 5 — 1 — — 59 54 113 Highgate 18 27 7 27 6 4 23 17 2 11 — 5 2 2 15 25 3 8 — 1 — — 76 127 203 North Harringay 44 41 41 23 6 7 35 39 13 10 5 5 4 7 65 73 8 4 22 14 — 2 243 225 468 South Harringay 29 37 25 18 5 4 19 16 6 6 5 3 6 2 17 17 4 3 10 14 — — 126 120 246 Stroud Green 33 40 17 11 9 4 35 35 14 12 8 8 5 7 39 45 17 16 21 18 1 — 199 196 395 St. Mary's 24 13 17 18 1 4 35 33 10 6 4 2 5 3 29 19 4 7 — — — — 129 105 234 Crouch End 53 45 17 32 33 32 33 30 3 4 1 2 1 2 54 35 4 3 2 — — — 201 185 386 Holy Innocents' 10 9 15 7 2 3 — 3 — — — — — — — — — — — — — — 27 22 49 St. James' — 4 8 10 3 5 8 14 8 4 1 1 2 4 11 16 4 2 — — — — 45 60 105 Campsbourne 59 52 20 20 53 47 38 28 5 6 1 2 1 3 32 48 8 5 — — — — 217 211 428 Total 296 295 199 189 124 114 249 240 64 62 27 30 26 30 276 291 53 53 55 48 1 2 1,370 1,354 2,724 979 966 673 106 TABLE VII.—MENTALLY DEFECTIVE CHILDREN. After-histories of Hornsey children who left the Joint Special School, 1921-1926. No. Sex. Date of Birth. Date of Leaving. REMARKS as to career since leaving school, present industrial status, etc. 1 Boy 18/ 6/07 18/11/21 Is reported to be working as an electrical engineer, and to be doing well. 2 Girl 23/ 1/08 9/ 9/21 Was a housemaid in a doctor's family for three years and reported as "Excellent." Now a ward-maid at a large hospital. 3 Girl 25/ 4/09 26/ 8/21 Attended for two years and then excluded by S.M.O. as "ineducable." A "mongolian." Notified to County for Institutional treatment. Helping at home. 4 Boy 13/10/07 26/ 8/21 Excluded from school by S.M.O. as "ineducable" and notified to County for Inxtitutional treatment. Still at home. Does shopping and minds house, as the mother has to work to help support the boy. 5 Boy 26/ 6/08 26/ 8/21 Excluded by S.M.O. as "ineducable." Notified to County for Institutional treatment, and is now at Stoke Park, Bristol. 6 Boy 15/ 4/13 26/ 8/21 Attended for six months and then excluded by S.M.O. as "ineducable." Mentally defective and physically defective. Notified to County for Institutional treatment. Still at home. 7 Boy 1/ 3/06 10/ 6/21 Has assisted father as upholsterer since he left school and is quite useful. 8 Boy 3/ 5/09 3/ 6/21 At Leavesden Mental Hospital, Watford. This boy left the school after three years, to enter a blind institution. Notified to County under Section 30 (e) of the Mental Deficiency Act. 9 Boy 20/ 2/05 8/ 4/21 Helping father as chimney sweep. Pushes barrow and runs odd jobs. Very useful. 10 Girl 7/ 9/14 18/ 5/23 Excluded by S.M.O. and notified to County for Institutional treatment. Still at home. 11 Girl 26/ 9/06 12/ 1/23 Notified "strongly" to County for Institutional treatment on account of "lack of moral control." Is in an institution at Caterham. 12 Boy 30/ 8/13 21/12/22 Entered private residential institution. 13 Girl 17/ 9/10 10/11/22 Excluded by S.M.O. and notified to County for Institutional treatment. Still at home. Child has improved, but is unable to do anything for herself. 14 Boy 15/10/11 13/10/22 Notified to County for Institutional treatment after exclusion from school by S.M.O. Now at Stoke Park Institution, Bristol. 15 Girl 2/ 2/06 1/ 9/22 Notified to County for Institutional treatment. Still at home, doing daily domestic work. 16 Boy 2/ 8/06 7/ 7/22 Several situations have been found for this boy through the Juvenile Employment Office. Now acting as parcel carrier. It is reported that his brother has taught him a good deal in the evenings. 17 Girl 5/ 9/10 16/ 6/22 Left district. 18 Girl 15/ 3/06 28/ 4/22 Notified to County for Institutional treatment. No use for domestic work, but reliable with children. Helping at home. 19 Boy — 6/ 3/25 Notified to County for Institutional treatment. Assisting father as greengrocer and still doing well. 20 Girl 15/ 6/08 23/ 1/25 Notified to County for Guardianship after remaining at school until she was 17 Working in a fried-fish shop, earning £1 per week. 21 Boy 27/ 4/10 23/ 7/24 Was working with builder, but is now out of work. Would like to get a job at carpentry. Seems clever with his fingers. Tall boy and well set up; can only write his name. 22 Girl 16/ 1/08 2/ 5/24 Notified to County for Guardianship. Child at first worked at a surgical instrument maker's, but was unsatisfactory. Now assists father as tailor's presser and doing well. 23 Boy 4/11/07 11/ 1/24 Notified to County for Institutional treatment. Working at home at basketmaking. Doing well. General appearance good. 24 Boy 27/ 5/09 28/ 9/23 Deceased. 25 Girl 6/ 6/07 31/ 8/23 Notified to County for Institutional treatment. Child is epileptic as well as mentally deficient. Still at home. Doing daily domestic work. 26 Boy 28/ 4/07 31/ 8/23 Notified to County for Institutional treatment. Now assisting milk roundsman Unable to do anything else. 27 Boy 20/ 2/10 16/ 4/26 Working on a poultry farm in Essex and stated to be doing well. 28 Boy 31/12/09 4/12/25 Admitted to Council School from Darenth Institution. Left school on attaining age of 14 and had several jobs—unable to keep any work. At parents' request, the boy was examined by the S.M.O. and certified as mentally deficient. Family have now left district. 29 Girl 31/10/11 13/11/25 Left school to enter Convent School. Now re-admitted to Special School at parents' request. 30 Girl 20/ 5/11 11/ 9/25 Doing daily work. 31 Girl 8/ 6/08 28/ 8/25 Doing bead work. 32 Girl 12/ 5/09 28/ 8/25 Engaged in daily domestic work and doing well. 33 Boy 24/11/12 12/ 6/25 Has now been certified as fit to attend ordinary school. 34 Boy 21/ 2/11 1/ 5/25 Working at a laundry, where he has been since leaving school. Doing well. 35 Boy 2/12/10 1/ 5/25 Working at a laundry. 36 Boy 14/ 9/08 13/ 3/25 This boy has been found several situations through the Juvenile Employment Office, but has been unable to keep any. He is now assisting a milk roundsman.