AC 4396 HORNSEY HOR 022 BOROUGH OF HORNSEY. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR 1930. R. P. GARROW, M.D., D.P.H. Borough of Hornsey. ANNUAL REPORT for 1930 of the Medical Officer of Health. "The Hornsey Journal," Ltd,, 161, Tottenham Lane, Hornsey, N.8. INDEX. Abbott, Dr. E., 41. Acts in force, 11. Admissions to Hospital, 52. Ambulances, 15. Ante-natal Clinics, 56. Area of Borough, 7. Artificial Light Clinics, 16. Assistant Medical Officer of Health, 41. Attack rate, infectious disease, 53. Bacteriological examinations, 10. Bakehouses, 19. Births and rates, 7, 46, 48, 51. Borough Nursing Association, 9. Butchers, 19. Byelaws in force, 11. Cancer deaths; 51. Carbide, 37, 38. Cellulose spirit, 37. Cerebro-spinal meningitis, 52, 53. Children Act, 1908, 5, 56. Cinemas, 20. Cleansing station, 35. Clinics, 16. Committees, 2. Contributions, annual, 9. Dairies, 30. Deaths and rates, 7, 48, 51, 54. „ Causes of, 49. „ in Institutions, 7. Dental scheme and treatment, 44. Diarrhoea, 8, 51. Diphtheria, 51, 52, 53. Diseases of Animals Acts, 35. Disinfection, 35. Dogs, Byelaws, 36. Drain tests, 18. Drainage, 17. Dysentery, 53. Encephalitis lethargica, 53. Engine sidings, Hornsey, 21. Enteric fever, 51, 52, 63. Erysipelas, 52, 53. Factories and workshops, 20, 57. Families (Census 1921), Number of, 7. Fish shops, 20. Fish frying, 22. Fly breeding, 35. Food inspection, 19, 30. „ surrendered, 32. „ samples, 32. Foster mothers and children, 45, 56. Grants to institutions, 9. Hairdressers (Sunday Closing) Act, 35. Health Committee, 1. Home Helps, 45. Home Nursing, 9. Hornsey Central Hospital, 13. Hornsey Deanery Association, 15. Hornsey Nursing Association, 9. Hospital Isolation, 13. Housing, 4, 5, 22, 25. Byelaws, 28. Demolished, 28. Families re-housed, 29. Flats, 22. House-to-house inspections, 20. New, 22. Newland Road Flats, 24, 30. Returns of work, 27. Statistics, 20, 22. Unfit houses, 27. Hydrocarbon, 37. Illegitimate births, 7. Infant deaths and rates, 7, 48, 51. „ causes, 50. Infantile paralysis, 52, 53. diarrhœa, 8, 51. Infectious disease— Diphtheria, 51, 52, 53. Notifications, 52, 53. Scarlet fever, 51, 52, 53. Immunization, 39. Inhabited houses, 7. Inquests, 35. Inspections made, 17, 19, 23. Isolation Hospital, 13. „ „ cases admitted to, 52. Laboratory work, 10. Legal proceedings, 30, 33. Local Government Act, 1929, 4, 45. Lying-in homes, 13, 14. Malaria, 53. Maternal mortality, 8, 14, 44. Maternity cases arrangements, 13. Maternity homes, 13, 14. Maternity and Child Welfare Committee, 2. Maternity and child welfare— Analysis of attendances, 56. Ante-natal. 56. Births notified, 46. Centres, 16, 41, 42, 43. Conference, 45 Dental treatment, 44. Home helps, 45. Hospital arrangements, 13. Massage. 45. Maternity and child welfare (contd.)— Maternal deaths, 8, 14, 44. Midwife, 9, 44, 56. Milk grants, 44. „ „ Increase of age limit, 44. Sessions, 16, 56. Staff, 41, 42, 43. Time-table, 10. Voluntary Committees, 41, 42, 43, 45. X-ray treatment, 44. Year's work, 56. Measles, 8, 9, 51, 53. Meat Inspection, 31. Meningitis, 52, 53. Mental defectives, 15. Midwife's fees, summonses, 44. Midwives, 9. Milk grants, 44. „ „ scale, 44. „ licences, 30. „ prosecutions, 30. „ samples, 30. Mortuary, 35. Moselle Brook, 17. Mosquitoes, 35. Muir, Dr. J. S., 41. National Health Insurance, 10. Newland Road Estate, 22. North Middlesex Hospital, 13. Notices served, 20, 24. Notification of Births Act, 46. Nursing Association, 9. Nursing homes, 14. Offensive trades, 21. Ophthalmia neonatorum, 14, 39, 52. 53 Orthopaedic scheme & work, 14, 16, 45. Outworkers, 20, 58. Overcrowding, 25, 26. Para-typhoid, 52, 53. Petroleum Acts, 37. Pneumonia, 52, 53. Poisons Act licences, 37. Polio Encephalitis, 53. Poliomyelitis, 52, 53. Population, 7, 48, 51. Pool-spraying, 35. Preface, 4. Puerperal fever and pyrexia, 9, 14, 44, 52, 53. Rag and bone dealers, 22. Rag Flock Act, 22. Rateable value and produce of Id. rate, 7. Refuse disposal, 17. Refuse shoots, 18, 20. Regulations In force, 12. Rent and Mortgage Interest (Restrictions) Act, 18. Restaurants, 19. Rivers and streams, 17. St. James's Lane, 20, 21. 27. St. Luke's Hospital, 13. Sale of Food and Drugs Act, 30. Sanitary notices served, 20, 24. Sanitary work, 18. Scarlet fever, 51, 52, 53. School clinics, 16. Schools, 22. Shoots, refuse, 18, 20. Shops Acts, 33. „ „ Summonses, 33. „ number of, 33. Slaughter-houses, 31. Small-pox, 18, 39, 52, 53. Smoke nuisances, 21. Statutory notices, 20. Staff, Health Department, 3. Still births, 7. Summonses, 30, 33. Tables, List of, 47. Times-table, Centres and Clinics. 16 Tonsils and adenoids, Nursing, 9. Tuberculosis, Cases of, 40, 52, 54. Deaths & rates, 51, 54. „ Dispensary, 16. Sanatoria & beds, 14, 40 Typhoid fever, 51, 52, 53. Unfit houses, 27. Unmarried Mothers' Home. 15. Vaccination, 39. Venereal disease clinics. 16. Verminous houses, 18. Veterinary Inspector's report, 35 Visits by Inspectors, 17, 19, 23. Vital statistics, 7, 48, 51, 54. Voluntary Committees, 41, 42, 43. 45. Ward's Cottages, 20, 21. Water supply, 17. Whooping-cough, 8, 9, 51. Woodside Cottages. 20. 21. Workshops, 57. X-ray treatment, 44. Zymotic death-rate. 7. HEALTH COMMITTEE as at 31st December, 1930. The Mayor, Councillor C. H. Summersby, J.P., 109, Muswell Hill Road, N.10. Councillor J. W. Shipp (Chairman), 12, Berkeley Road, N.8. Alderman W. W. Kelland, M.A., 14, Hillside Mansions, N.6. Councillor Mrs. J. H. Barrenger, 18, Fordington Road, N.6. ,, E. Brooks, 122, Crouch Hill, N.8. Mrs. C. M. Cave, 10, Wood Vale, N.10. ,, J. Edwards, 102, Turnpike Lane, N.8. ,, P. Everington, 81, Mount View Road, N.4. ,, S. G. Goulding, Woodlands, Cranley Gardens, N.10. ,, Mrs. M. N. Hill, 16, Bishopswood Road, N.6. ,, Dr. J. D. R. Monro, Fairport, Fortis Green, N.10. ,, R. Steeds, 19, Coolhurst Road, N.8. „ L. J. Valette, 59, Allison Road, N.8. ,, W. V. Wall, 168, Stroud Green Road, N.4. ,, H. J. Williams, 105, The Chine, N.21. ,, C. Winkley, 72, Woodside Avenue, N.10. 2 MATERNITY & CHILD WELFARE COMMITTEE as at 31st December, 1930. The Mayor, Councillor C. H. Summersby, J.P., 109, Muswell Hill Road, N.10. Councillor Mrs. C. M. Cave (Chairman,), 10, Wood Vale, N.10. Alderman W. W. Kelland, M.A., 14, Hillside Mansions, N.6. Councillor Mrs. J. H. Barrenger, 18, Fordington Road, N.6. ,, E. Brooks, 122, Crouch Hill, N.8. ,, J. Edwards, 102, Turnpike Lane, N.8. ,, P. Everington, 81, Mount View Road, N.4. „ S. G. Goulding, Woodlands, Cranley Gardens, N.10. ,, Mrs. M. N. Hill, 16, Bishopswood Road, N.6. ,, D. V. Johnson, 54, Coolhurst Road, N.8. ,, Dr. J. D. R. Monro, Fairport, Fortis Green, N.10. ,, J. W. Shipp, 12, Berkeley Road, N.8. ,, R. Steeds, 19, Coolhurst Road, N.8. ,, L. J. Valette, 59, Allison Road, N.8. „ W. V. Wall, 168, Stroud Green Road, N.4. Co-opted Members. Mrs. L. J. Bond, 125, Mount View Road, N.4. Mrs. F. O. Dixon, 56, Talbot Road, N.6. Miss A. M. Inward, 29, Endymion Road, N.4. Miss B. Knox, 3, North Hill, N.6. Mrs. E. Piggott, 13, Rookfield Avenue, N.10. Mrs. B. Walton, 19, Etheldene Avenue, N.10. 3 STAFF OF PUBLIC HEALTH DEPARTMENT. †*Medical Officer of Health E. P. Garrow, M.D., D.P.H. †*Deputy Medical Officer of Health and Assistant Medical Officer of Schools and Maternity and Child Welfare Centres Edith I. L. Abbott, M.B., B.S., D.P.H. ‡*Assistant Medical Officer for Maternity and Child Welfare Jessie Muir, M.B., Ch.B. †*Senior Sanitary Inspector Henry Eastwood, Cert. R.San.I., Cert. Insp. of Meat and Foods. †*Sanitary Inspectors J. Goodman, Cert. R.San.I. J. H. Jesse, Cert. R.San.I., Cert. Insp. of Meat and Foods. J. D. Chance, Cert. R.San.I., Cert. Insp. of Meat and Foods. A. E. Gooday, Cert. R.San.I., Cert. Insp. of Meat and Foods. †Chief Clerk W. Gilroy, †Assistant Clerks E. Cheesman, a. wickham. D. Bryant (Temporary). †*Health Visitors A. Glover. J. I. Macpherson, Dip. N.H.S., H.V. cert., C.M.B. E. Durnford, H.V. Cert., C.M.B. A. Godden, H.V. Cert., C.M.B. †*Midwife M. Andrews, c.m.b. †Mortuary Keeper C. F. Catlin. †Disinfectors W. H. Lewis. P. Hall. †Motor-Ambulance Driver P. Martin. †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. 4 To the Mayor, Aldermen and Councillors of the Borough of Hornsey. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Report on the Health of the Borough of Hornsey for the year 1980. Annual reports of Medical Officers of Health are of two kinds—Ordinary Reports, which contain a record of the work done during the year and the vital statistics for the year, and Survey Reports every fifth year of a more detailed character, surveying the progress made during the quinquennium. The last survey report was submitted by your Medical Officer of Health in 1925. This report for 1930 should in the ordinary course of events be a Survey Report, but Circular 1,119 of 18th June, 1930, addressed by the Ministry of Health to all Local Authorities, says:— "Although the Annual Report for 1930 will be a Report of a more simple character than the full Survey Eeport which the Medical Officer of Health was asked to prepare for 1925, it should, for the following reasons, contain information on certain matters in more detail than has been given in the Reports for the last four years, viz.:— "(a) The transfer of the Poor Law functions, in pursuance of the Local Government Act, 1929, and the other changes effected by that Act, have necessitated a careful survey, by the Medical Officers of Counties and County Boroughs, of the Hospital and other Medical Services available in their respective areas. The information obtained in this connection should be given in the Annual Eeport for 1930 on the lines indicated in the Section of Appendix I. to this circular which is headed ' General Provision of Health Services in the Area.' "(b) The proposals of the Government in relation to Housing, which are embodied in the Housing Bill at present before Parliament, will necessitate the early directing of special attention on the part of Medical Officers of Health to Housing defects in their areas and the compilation of accurate records regarding the Housing position generally. For this reason the 5 section on Housing contained in the Annual Report for 1930 should be on a more extensive scale than usual, as indicated in Appendix I." In regard to the former of these special matters, namely, the transfer of the Poor Law from the Edmonton Guardians to the County of Middlesex, there is very little to record so far as the Municipal Borough of Hornsey is concerned. The only additional work falling to the Health Department is the supervision of foster children under Part I. of the Children Act, 1908. This work is done by the Health Visitors in the course of their routine visiting. The other matter upon which more detailed information is asked for is the important question of Housing. The Housing Act, 1930, confers on local authorities new duties and powers in regard to Housing in their areas. One of these is the duty of furnishing to the Minister of Health a statement of the measures proposed to be taken in the next five years to improve the Housing conditions of the people. The Act is an incitement to local health authorities "to wipe out the slums," which are a disgrace to many of our large industrial cities. There has been some loose talk in Hornsey about the slums of the Borough. With the exception of certain small groups of houses (numbering 86 houses in all), so old and decayed that they have outlived their usefulness as human habitations, the Borough of Hornsey has no slums. Details of the work done, and, the Housing statistics, will be found in the Report. I desire to acknowledge the good work done by the Sanitary Inspectors in response to your Committee's desire to pursue an active campaign in Housing, and in maintaining a healthy environment for the population of the Borough. Sound health is not, however, a question only of the houses we live in, but the kind of lives we live in them. Equally important, therefore, is the work of officers whose duty it is to provide education in personal hygiene from infancy onward. Excellent work of this kind is constantly being carried on at the 6 Centres, in the Schools, in the homes, and I wish to acknowledge the help and co-operation of Assistant Medical Officers, Health Visitors, School Nurses, voluntary workers and various institutions and organisations too numerous to mention. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, R. P. GARROW. 7 STATISTICS FOR 1930. Social and Economic Statistics. Area 2,874 acres Population (Census 1921) 87,691 Do., Registrar-General's last estimate (1929) 88,450 Number of inhabited houses (Census 1921) 17,333 ,, ,, ,, ,, (end of 1930) according to Rate Books 21,050 Number of private families (Census 1921) 23,353 Rateable value (General Rate) £993,582 Product of a penny rate £4,131 Since the Report was printed the Preliminary Report of the Census, 1931, has been published, giving the following information:— Population. 1921. 1931. M. F. Total. M. F. Total. Hornsey 37,798 49,861 87,659 41,325 54,199 95,524 Middlesex 578,385 674,617 1,253,002 769,178 869,343 1,638,521 The increase in population is 7,865, equal to 9.0 per cent. The statistics in the Report are calculated on the RegistrarGeneral's last published estimate, namely, 88,450. Deaths— Male 492, Female 555 Total 1,047 Death-Rate 11.8 per 1,000 population. Percentage of total births occurring in Institutions 38.6 Zymotic Death-Rate per 1,000 population, 0.23. Number of women dying in, or in consequence of, child-birth:— From Sepsis 1 ,, other causes 3 8 Deaths of Infants under 1 Year of Age. Legitimate Males 25, females 20 = 45 Illegitimate 1, ,, 4 = 5 Total 50 Infant Death-Rate per 1,000 live births. Legitimate 38.9, Illegitimate 94.3—Total 41.35. Deaths from Measles (all ages) 0 Deaths from Whooping-Cough (all ages) 0 Deaths from Diarrhœa (under 2 years of age) 10 9 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. NURSING IN THE HOME. Home nursing, or, as it used to be called, "district nursing," is carried out for the entire Borough by the Borough of Hornsey Nursing Association, which is affiliated with the Queen's Institute of District Nursing. The staff of five trained nurses, working under a Superintendent Nurse, provide a very important social service—skilled nursing in the homes of the people. It is a very economical form of service, as it prevents many patients being sent to hospitals and other institutions, and also enables hospital cases to be discharged to their homes at an earlier date than would otherwise be possible. The Association is supported by donors' subscriptions, members' subscriptions, fees, subscriptions from churches and charities, and is subsidised by the Hornsey Borough Council (25 guineas), Middlesex County Council (£25), and Hornsey Education Committee (£5). For these grants the Association undertakes the nursing of cases of puerperal fever and pyrexia, whooping cough and measles, and the week-end care of children operated on for adenoids and enlarged tonsils. I desire also to acknowledge the willingness of the nurses to undertake any suitable case referred to them during the week-ends, when the Council's staff of school nurses and health visitors are not on duty. A total of 9,836 visits were paid to 469 cases during the year. These included 18 cases of pneumonia, 4 cases of measles and 2 cases of puerperal fever. MIDWIVES. There are 14 practising midwives residing in the area, one of whom is a whole-time municipal midwife, who, in addition to conducting 144 confinements during the year, attended all the ante-natal sessions at the Centres. 10 NATIONAL HEALTH INSURANCE. "Give particulars of any important points in which the work of the local authority is related to or is administered in co-operation with this service." It is not possible to furnish any information under this heading, because this service is administered by the Middlesex Insurance Committee, and the work of medical attendance on insured persons does not in any way overlap any of the health activities of the Borough Council. If and when the medical benefits of National Health Insurance are extended to the dependants of the insured persons, the position will be entirely different. Such extension would result in overlapping between Maternity and Child Welfare and 'School Medical Services of the Council and the domiciliary medical attendance on the families by the insurance practitioners. The difficulty seems sufficiently remote in time not to require efforts for its solution at the moment. LABORATORY FACILITIES. Specimens for bacteriological examination are dealt with in the laboratory of the Isolation Hospital, and foods are submitted for analysis to the Middlesex County Council. The specimens examined in the laboratory during 1930 were as follows: — Negative. Positive. Diphtheria specimens 1,043 90 Sputum ,, 183 22 Enteric ,, 4 1 Other ,, 18 1 1,248 114 Total 1,362 11 LIST OF ACTS, BY-LAWS & REGULATIONS RELATING TO PUBLIC HEALTH IN FORCE IN THE BOROUGH, WITH DATE OF ADOPTION. Adoptive Acts.— Infectious Disease (Notification) Act, 1889 (1st January, 1890). Infectious Disease (Prevention) Act, 1890 (9th December, 1690). 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 (from 1st May, 1893). Public Baths and Wash-houses Acts, 1846, 1847, 1878 and 1882 (6th July, 1896). Housing of the Working Classes Act, 1890, Part III. (20th July, 1896). Public Health Acts Amendment Act, 1907, sections 15 to 17, 19 to 27, 30, 31 and 33 in Part II., Parts III., IV., V. and VI., and section 95 in Part X.—by Order of Local Government Board, and section 81 (modified) in Part VII., sections 87 and 90 in Part VIII. and Part IX.— by Order of the Secretary of State (Home Office). The Local Government and Other Officers' Superannuation Act, 1922 (from 1st January, 1924). Public Health Act, 1925, Part II., relating to Streets and Buildings, Part III., containing Sanitary Provisions, Part IV., relating to Verminous Premises, etc., and Part V., relating to Watercourses and Streams, etc. (from 1st February, 1926). BY-LAWS, REGULATIONS, ETC., RELATING TO PUBLIC HEALTH IN FORCE IN HORNSEY. By-laws have been made as follows:— Cleansing of Earth-closets (22nd November, 1879). Common Lodging-houses (22nd November, 1879). 12 Slaughter-houses (22nd November, 1879). Revised 24th November, 1930). Management of Mortuary (6th December, 1886). Decent Conduct of Persons using Sanitary Conveniences (21st May, 1894). Houses Let in Lodgings or occupied by members of more than one family (21st September, 1896). For Good Rule and Government of the Borough, 1904, 1909, 1913, 1922 and 1929. Nuisances in the Borough (10th June, 1907). With respect to New Streets and Buildings in the Borough (11th May, 1908, and 17th December, 1923). With respect to Wireless Loud-Speakers, etc. (25th November, 1929). Under Petroleum (Consolidation) Act, 1928, as to Filling Stations, etc. (20th January, 1930). Repealing Byelaws as to Cleansing Footways, Ac. (21st October, 1929). Dogs (G.R. & G). (17th February, 1920). Houses Let in Lodgings (24th March, 1930). Offensive Trades (12th June, 1911, and 23rd July, 1928). Also, Regulations have been made as to— Management of Sanitary Conveniences (21st May, 1894). Dairies, Cowsheds and Milkshops (19th June, 1899). Under Swine Fever Order (14th March, and 14th May, 1904, and 1st March, 1905). Under the Dogs Order, 1906 (21st January, 1906). As to Cleansing, etc., under Order as to Parasitic Mange in Horses, &c. (13th December, 1909). Under Section 17 (7) of the Housing, Town Planning, &c., Act, 1909 (20th July, 1914). 13 HOSPITALS. (a) Within the Borough. (1) Hornsey Central Hospital for general, medical or surgical or special cases (48 beds) is situated in the centre of the Borough. It is staffed by the Medical Practitioners of Hornsey, together with Consulting Physicians, Surgeons and Specialists. A new Home for the Nursing Staff was opened in 1930. (2) Hornsey, Finchley and Wood Green Joint Isolation Hospital, situated at Coppett's Road, on the northern boundary of the Borough, has 150 beds. (On Ministry of Health basis, 102 beds.) (3) St. Luke's Hospital for early mental cases (50 beds) is situated at Woodside Avenue, Muswell Hill. (b) Without the Borough. (1) Hospitals of Middlesex County Council. (2) Hospitals of London County Council. (3) The London Voluntary Hospitals, general and special. Although the Borough of Hornsey has no large hospital for general or special diseases within its boundary, its situation in relation to London places every kind of hospital service within easy reach of its inhabitants. It is not possible to specify in detail the number of beds available for male and female patients suffering from the different classes of diseases requiring hospital treatment, but the following table indicates the wide range of hospital or institutional service available:— CLASS OF CASE HOSPITALS OR INSTITUTIONS. General Medical and Surgical Hornsey Central Hospital North Middlesex Hospital (M.C.C.) London Voluntary Hospitals Children Hornsey Central Hospital North Middlesex Hospital (M.C.C.) London Voluntary Hospitals (Special Children's Hospitals and Children's Wards in General Hospitals) Maternity North Middlesex Hospital (M.C.C.) London Voluntary Hospitals (Special Maternity Hospitals and Maternity Wards of General Hospitals) 14 CLASS OP CASE. HOSPITALS OR INSTITUTIONS. Venereal Diseases London Special V.D. Hospitals V.D. Departments of General Hospitals in London Tuberculosis Sanatoria of Middlesex County Council North Middlesex Hospital (M.C.C.) London Special Chest Hospitals Chronic Sick North Middlesex Hospital (M.C.C.) Mental Middlesex County Asylum North Middlesex Hospital St. Luke's Hospital in the Borough of Hornsey (for early mental cases) Mental Deficiency— Ineducable Middlesex County Council Educable Oak Lodge Special Day School Orthopaedic Royal National Orthopasdio Hospital, London and Stanmore, Orthopaedic Departments of London General and Children's Hospitals Ear, Nose and Throat Hornsey Central Hospital Special Ear, Nose and Throat Hospitals in London Ear, Nose and Throat Departments of London General Hospitals Purperal Fever and Pyrexia Special Wards of London County Council Hospitals Ophthalmia Neonatorum Special Wards of London County Council Hospitals Other Cases—Dental, Ophthalmic, All provided for at one or other of Massage, etc. the Hospitals mentioned above MATERNITY AND NURSING HOMES. The Nursing Homes Registration Act, 1927, is administered in the Borough of Hornsey by the Middlesex County Council. There are 24 registered Nursing Homes in the Borough. MATERNAL, MORTALITY. Four maternal deaths occurred in the total of 1,209 births during the year — representing a maternal mortality rate of 3.3 per 1,000 births. No special arrangements have been made for the investigation of maternal deaths or of cases of puerperal fever or puerperal pyrexia. 15 INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS AND HOMELESS CHILDREN. These are cared for by the Middlesex County Council and by the Hornsey Deanery Association for Preventive and Rescue Work at Beacon Lodge, Eastern Road, Fortis Green. INSTITUTIONAL PROVISION FOR THE CARE OF MENTAL DEFECTIVES. The authority responsible for this is the Middlesex County Council. AMBULANCE FACILITIES. (a) For Infectious Cases.—All infectious cases removed to Hospital are carried by the ambulance service of the London County Council. (b) For Non-infactious and Accident Cases.—Non-infectious and accident cases are conveyed by the Borough Ambulance. The following is a statement of the work done during the year:— Number of occasions on which the Ambulance has been used 980 Number of persons conveyed 1,003 Number of street accidents 155 Number of persons conveyed, re ditto 176 Number of accidents on public and other premises 33 Number of persons conveyed, re ditto 34 Sudden illness in street or public premises 152 Number of persons conveyed, re ditto 151 Number of other cases 640 Number of persons conveyed, re ditto 642 There were 24 oases of accident or illness in streets within the Borough attended by other ambulances, owing to the Borough Ambulance being otherwise engaged. Another ambulance—which travelled 11,243 miles during the year and carried 20,549 passengers—under the supervision of the Health Committee, is employed in the Medical Services of the Borough, chiefly for the transport of physically and mentally defective children. 16 CLINICS AND TREATMENT CENTRES. Nature of Provision Address Sessions per week Provided by Maternity and Child Welfare Centres (Consultations) (1) Brook Road Hall, Hornsev, N 8. Infants 3½ Antenatal 1 Hornsey Borough Council (2) 22. Wightman Rd., Harringay, N.4. Infants 2-3 Antenatal 1 (fortnightly) do. (3j Church Road, Highgate, N.G. Infants 1 Antenatal 1 (monthly) do. (4) Coldfall Avenue, Muswell Hill, N.10 Infants 1 (fortnightly) Anienatal 1 (monthly) do. Day Nurseries School Clinics (1) 5 Topsfield Parade, M.S. Medical 2 Hornsey Education Committee Oculist 2 Aurist 1 Dental 10 (Nurse'streatments daily) (2) Coldfall School. Medical (Nurse's treatments daily) do. Orthopasdic Clinics School Surgeon 1 (monthly) Clinic Massage 2 Artificial Light Clinics Tuberculosis Dispensaries (10) Alexandra Road, N.8. 2¼ Middlesex County Council Treatment Royal Northern Men 4 Middlesex County Council Centres for Venereal Hospital, Holloway Road, N.7. Women 3 Diseases Prince of Wales' Hospital, Tottenham, N. Women ... 3 SANITARY CIRCUMSTANCES OF THE AREA. Water. — The Borough water supply is provided by the Metropolitan Water Board. It is adequate in quantity and excellent in quality for drinking, but is a hard water for washing purposes. The construction of a large new reservoir within the Borough (on Highgate Golf Course) has been completed during the year. Rivers and Streams.—During the early part of the year the sanitary inspectors were engaged in tracing sources of pollution of the River Moselle. These, when discovered, were promptly dealt with. Drainage and Sewerage.—There is no important extension of sewerage to report in 1930. Drainage, sewerage and sewage disposal are satisfactory in all parts of the area. Closet Accommodation. — The entire Borough has water carriage. Scavenging. — The collection of house refuse has been improved during the year by the purchase of modern vehicles to replace some of the older vehicles. SANITARY INSPECTION OF THE AREA. The following statement of the work of the Sanitary Inspectors has been prepared by Mr. Henry Eastwood, Chief Sanitary Inspector: — The total number of visits during the year was 15,729 and the number of defects or nuisances remedied 4,631. At the end of the year defects or nuisances were either in hand or outstanding at 115 premises. The visits made, the notices served and the sanitary improvements carried out are recorded in the following tables: — Visits. House-to-house inspections 334 Special inspections 1,771 Re-inspections 8,729 Transfer to Council Houses 10 Notifiable infectious diseases 485 Other . do. do. 0 Tuberculosis 74 Deaths 125 17 18 Verminous houses 12 Scabies 0 Shops Act 919 Factories, workshops and outworkers 1,161 Rent Restriction Act 4 Cinemas, &c. 22 Overcrowding 242 Petroleum stores 384 Rag Flock Act 4 Dairies and milkshops 124 Bakehouses 50 Slaughter-houses 141 Butchers' shops 87 Restaurant kitchens 37 Other food shops 188 Annual licences 36 Stables 51 Urinals 16 Smoke observations 30 Refuse tips 58 Fee tests 11 Water tests applied (new drains) 34 Smoke and chemical tests applied (old drains) 55 Drains examined under Sec. 41, Public Health Act, 1875 .. 15 Small-Pox Contacts.—Visits 578 15,787 SUMMARY OF SANITARY IMPROVEMENTS CARRIED OUT. Drainage. Number of houses and premises redrained 25 Repairs or amendments to existing drains 220 Drains or gullies unstopped or cleansed 238 Manholes provided 45 do. repaired 51 Intercepting traps fixed 14 New gully traps fixed 127 New soil pipes and ventilating shafts fixed 67 Soil pipes and ventilating shafts repaired 47 Fresh-air inlets provided or repaired 66 19 Water-Closets and Sanitary Fittings. New water-closet basins fixed 176 Water-closets unstopped, cleansed or repaired 78 New check cisterns fitted to water-closets; existing check cisterns repaired 98 New sinks provided 183 New waste-pipes fixed 136 Waste-pipes trapped, repaired or unstopped 275 Miscellaneous. Roofs repaired 314 Eaves guttering renewed, cleansed or repaired 181 Rain-water pipes provided, repaired or unstopped 156 do. disconnected from drains 8 Damp walls remedied 118 Damp-proof courses inserted 60 Paving of yards repaired 160 Structural repairs of premises 481 Rooms cleansed, distempered or papered . 607 Work-rooms cleansed or repaired 29 Drinking-water cisterns repaired, cleansed and covered 114 Sanitary dustbins provided 124 Accumulations of manure and refuse removed 47 Stoves, ranges, and coppers repaired or renewed 97 Sundry items 265 Overcrowding abated 24 4,631 PREMISES INSPECTED PERIODICALLY. The following premises were inspected periodically during the year, and any matters requiring attention were dealt with: — No. in district. Dairies and milkshops 31 Milk purveyors in connection with other businesses 35 Bakehouses 31 Restaurant kitchens 33 Slaughter-houses 5 Butchers' shops 54 20 No. in District. Fish shops 26 Factories, workshops and work-places 877 Outworkers' premises 143 Cinemas 7 Places of public entertainment 29 Shoots (refuse) 2 Overcrowded houses 43 HOUSE-TO-HOUSE INSPECTIONS. No. of Houses inspected. Alexandra Cottages 48 Brook Road 12 Castle Yard' 11 Eastfield Road 29 Enfield Road 35 Myddelton Road 40 Orchard Road 37 Rathcoole Gardens 45 St. James's Lane 6 St. James's Place 26 St. James's Terrace 11 Ward's Cottages 15 Weston Park 7 Woodside Cottages 12 334 HOUSING WORK SUMMARY. Dwelling-houses inspected 1,618 ,, found to be in any respect unfit 1,104 ,, in connection with which Preliminary Notices have been served 780 ,, in connection with which Statutory Notices have been served 91 ,, where work has been done on personal request 324 ,, where work was outstanding at the end of 1930 119 21 Dwelling-houses where work was outstanding at the end of 1929 (now completed) 191 ,, demolished by owners to make room for new buildings 4 ,, found to be overcrowded 67 ,, at which overcrowding was abated 24 ,, visited re overcrowding 242 ,, found to be unfit for human habitation— (a) Demolished by owner 1 (b) Under consideration by Council 26 27 ,, purchased by Council for the purpose of demolition and re-housing— Woodside Cottages 10 (also Factory adjoining) Ward's Cottages 14 North Hill 2 26 SMOKE ABATEMENT. Smoke observations have been kept on 30 occasions. Laundry.—In consequence of complaints received and as the result of representations made, the proprietors of a Laundry factory have gone to considerable expense in fitting apparatus in order to mitigate the nuisance complained of. HORNSEY ENGINE SIDINGS. As a result of repeated representations by the Council, the London and North Eastern Railway Company have installed improved means of coaling their engines at the Hornsey Sidings. While the nuisance from coal dust has thus been reduced, the smoke from the engines when newly fired and getting up steam continues to pollute the air of North Haringey. OFFENSIVE TRADES. In February, 1928, the Council made an order and adopted Byefaws, confirmed by the Ministry of Health, declaring the trades of Rag and Bone Dealer and Fish Frier to be Offensive Trades. 22 There are 13 Fried Fish shops in the Borough. These have been inspected frequently in order to see that the Byelaws are observed. One Fried Fish shop, at the request of this department, has been re-modelled and an entirely modern range and plant fitted. Two applications have been made to establish new Fried Fish shops, but have not been proceeded with-. There are no Bag and Bone Dealers' premises in the Borough. SCHOOLS. See Report of School Medical Officer. RAG FLOCK ACT, 1911 & 1928. Four visits have been made to upholsterers' premises where Rag Flock is used. There is no Rag Flock manufactured in the district, the supply being obtained from manufacturers who guarantee that it complies with the requirements of the Act. HOUSING. Number of New Houses erected during the year: — (a) Total, including numbers given separately under (b) (i) By the Local Authority 33 flats (ii) By other Local Authorities 0 (iii) By other bodies and persons 61 Do., Houses turned into flats 20 (b) With State assistance under the Housing Acts:— (i) By the Local Authority— (a) For the purpose of Part II. of the Act of 1925 0 (b) For the purpose of Part III. of the Act of 1925 0 (c) For other purposes 0 (ii) By other bodies or persons 0 23 1. Inspection of Dwelling-houses during the year: — (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) and the number of inspections made 1,618 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925, and the number of inspections made 334 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 27 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,104 2. Remedy of defects during the year without service of formal Notices :— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,085 3. Action under Statutory Powers during the year:— A.—Proceedings under section 3 of the Housing Act, 1925: — (1) Number of dwelling-houses in respect of which Notices were served requiring repairs 0 (2) Number of dwelling-houses which were dered fit after service of formal Notices: — (a) By owners 0 (h) By Local Authority in default of owners 0 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 1 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 91 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices: — (a) By owners 72 (b) By Local Authority in default of owners 0 C.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925: — (1) Number of representations made with a view to the making of Closing Orders 1 (2) Number of dwelling-houses in respect of which Closing Orders were made 0 (3) Number of dwelling-bouses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 0 (4) Number of dwelling-houses in respect of which Demolition Orders were made 0 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 4. Number of houses owned by the Local Authority 895 distinguishing (1) those built in the last two years and held under Part III. of the Housing Act, 1925, (2) Part II. of the Housing Act, 1925, and (3) other powers: — (1) Part III., 33 Flats at Newland Boad 33 (2) Part II., Woodside Cottages, 16 houses, and Ward's Cottages and North Hill, 16 houses acquired to be pulled down for new housing scheme 32 24 25 (b) Housing Conditions. (1) General Observations.-—Housing conditions in Hornsey have been the subject of close attention by the Health Committee and its officers during 1930. The general standard of housing is high. The district is of modern development as a good-class residential suburb of London. The Borough is justly proud of its fine streets, roads and avenues, its well-kept houses and gardens, its beautiful open spaces. Yet there is cause for anxiety. Hornsey, like every other town in the outer ring of London, has its " housing problem." The problem is overcrowding, and is caused by outside factors, largely beyond local control. Two important factors are constantly operating — the tendency of families in London to move outwards into the suburbs as the more central parts of the Metropolis become converted to business premises; and the general tendency of industry in England to drift southwards. Middlesex is becoming one of the most industrial counties in England. New factories are springing up almost every month along the great new arterial roads of the county. We have, therefore, on the one hand, the natural increase in population, together with these outside or unnatural causes of increase, and, on the other hand, a fully developed district with literally not one acre of land on which to build new houses. In addition, there is the desire of large sections of the population to occupy smaller houses. The result is the wholesale conversion of good-class residences once in single occupation into flats, sub-let rooms, houses let in lodgings, or tenements. Homsey's housing problem is therefore not unfit houses, unhealthy areas, or shortage of houses, but the much more difficult problem of preventing the district from undergoing the change in social status which has overcome large areas in the adjoining parts of the County of London. The district has, however, certain natural advantages, which tend towards stabilising its good housing conditions and social character. It is situated on the " Northern Heights " at an elevation of, roughly, 200 to 400 feet above sea level, which gives it a climatic advantage over the lower levels towards the River Thames. As the Official Guide to Hornsey puts it, "there is fresh air all over Hornsey"— a fact which its residents experience on returning home after the day's work in London. In addition to its elevation, the undulating or hilly character of the district is a factor in preventing deterioration. Flat districts are more prone to decay than hilly districts. These natural advantages, together with the firm determination of the Council to preserve the amenities of the Borough and its high standard of housing, should maintain Hornsey's position as one of the most favoured residential districts in or near London. (2) Sufficiency of Supply of Houses.—The Medical Officer of Health is requested to discuss the extent of the shortage of houses, any important changes of population and any special difficulties in the -way of providing suitable sites for new houses. The position in Hornsey is that the houses are sufficient for the area, but insufficient for the population. There are many more families living in the Borough than its houses were ever intended to contain, and there are no housing sites available within the district. (3) Overcrowding. — The above conditions result in social overcrowding, that is to say, two, three, four or (in exceptional cases) five families living in houses originally intended for one middle-class family. It should, however, be borne in mind that many of these houses have spacious rooms, well lit and well ventilated. Further, the average family to-day is very much smaller m numbers than the average family in the days when these houses were built. The minimum cubic space required under the Byelaws with respect to houses let in lodgings is 360 cubic feet per person over 10 and 250 cubic feet per person under 10 years of age. As measured by this standard there is very little legal overcrowding. Special attention has been given by the sanitary inspectors to overcrowded dwelling-houses, and a quarterly report under this heading is submitted to the Health Committee. During 1930 67 houses were found to be overcrowded. In 24 of these the overcrowding was abated. This work involved 242 visits. 26 27 (4) Fitness of Houses.—(a) No special difficulties have been experienced in dealing with unfit houses under the Public Health and Housing Acts and the Byelaws made under section 6 o£ the Housing Act, 1925. (b) Programme.—A return has been made* to the Ministry of Health under section 25 of the Housing Act, 1930, setting out a five-year programme of repair of houses and replacement of unfit houses. (c) Water Supply.—There are 58 houses in the Bqrough which have not an adequate internal water supply. All of these are included in the five-year programme with a view to their having the defects remedied. (d) Sanitary Accommodation.—Forty houses haveno separate water-closets or other adequate sanitary accommodation. These difficulties will be made good in the five-year programme of repair and replacement. (5) Unhealthy Areas.—A survey of the Borough for the purpose of making the return required by the Ministry of Health under section 25 of the Housing Act, 1930, resulted in 86 houses being regarded as so unfit as to be beyond repair. This number is made up of seven groups, containing respectively 4, 6, 9, 10, 15, 16 and 26 houses. It would be quite misleading to refer to these as " slums," or even as " unhealthy areas." They are simply nests of old houses in a state of senile decay. The largest group (26 houses) was built about 115 years ago on the southern slope of Muswell Hill. For the greater part of a century this little hamlet enjoyed a position of splendid isolation, looking south across cornfields towards Shepherds Hill, and enjoyed shelter from the north and east winds by the high ground on which the Alexandra Palace and modern Muswell Hill are built. The more recent development of the district has resulted in this old property being surrounded on all sides by modern houses. The picturesque hamlet of a bygone age is now sadly out of keeping with its surroundings, and the time has arrived for it to be treated as a " clearance area." 28 The second largest group of unfit houses (16) is situated on North Hill, Highgate, in the heart of first-class residential properties. The third group (15) is in Tottenham Lane. The fourth (10), the fifth (9), the sixth (6), and the seventh group (4) are all in Highgate. The dwelling-house, No. 14, Woodside Cottages, was represented as being in a state so dangerous or injurious to health as to be unfit for human habitation, on the 12th of March, 1930. The Agents were communicated with, and as a result the house was demolished on the 1st of May, 1930, without the necessity of formal action. (6) Byelaws relating to Houses intended or used for occupation by the working classes and let in lodgings or occupied by members of more than one family.—These byelaws were made on 24th March, 1930, and confirmed on 13th May, 1930. They do not apply to any lodging-house in which the occupier resides and not more than one family is lodged. Parts of these byelaws, involving structural alterations, do not apply to any lodginghouse the rent of which is for the time being controlled by the Rent and Mortgage (Restrictions) Acts, 1920 and 1923. In spite of these limitations it is hoped that the enforcement of the byelaws will strengthen the campaign for better housing conditions amongst families living in divided houses. Thirty-four houses have been dealt with under these Byelaws during the six months and the following works carried out: — Byelaw No. 11 (a) Cleanliness of drains 2 11 (b) Provision of sinks 8 11 (c) Provision of suitable window 1 11 (f) Repair of sash-cords 21 12 (b) Cleansing of bedding 1 15 (b) Additional water supply 8 15 (c) Accommodation for washing clothes 6 15 (d) Accommodation for storage of food 14 29 Be-Housing.—During the year 72 families, representing 314 persons, have been re-housed, as follows: — Families. Persons. Lynton Road 1 3 Myddelton Road 8 40 Boy ton Road 5 27 Campsbourne Road 3 13 Brook Road 1 4 Pembroke Road 1 6 South View Road 2 13 North View Road 3 9 Beechwood Road 4 15 Hawthorn Road 5 17 Nightingale Lane 1 2 Ashford Avenue 1 4 Palace Road 1 4 St. Joseph's Road 1 8 Middle Lane 1 4 Bathcoole Gardens 1 3 St. Mary's Road 2 8 Montague Road 1 4 Westfield Road 1 4 Haringey Road 1 3 Inderwick Road 1 7 Haringey Grove 1 3 Clarendon Road 1 3 Malvern Road 1 4 Turnpike Lane 2 7 Denmark Road 1 6 Endymion Road 1 4 Lothair Road 1 4 Crouch Hill 1 3 Eastwood Road 1 4 Woodside Avenue 1 3 Hill Boad 2 15 Steeds Road 2 9 Colney Hatch Lane 1 5 Alexandra Gardens 1 6 Milton Avenue 1 5 30 Families. Persons. Archway Road 1 2 Woodside Cottages, Churchyard Bottom 4. 15 North Hill 1 4 North Road 2 11 Orchard Road 1 3 72 314 These totals include the 33 tenants who have been housed in the Newland Road Flats at Hornsey. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. Dairies and Milkshops. At the end of the year there were 31 dairies within the Borough and 35 other shops from which milk was retailed. Eighteen dairymen supply milk within the Borough who operate from other districts. There are no cowsheds within the Borough. The dairies and milkshops are inspected periodically. A high standard of cleanliness exists. The Milk (Special Designations) Order, 1923. During the year licences were granted as follows: — For sale of Pasteurised Milk 20 ,, Certified Milk 4 ,, Grade "A" (T.T.) Milk 8 ,, Grade "A" Milk 2 ,, Grade "A" (Pasteurised) 2 Twelve samples of milk taken from roundsmen's barrows and sent for bacteriological examination gave results varying from 6,800 to 88,500 organisms per cubic centimetre, as compared with the limit of 100,000 organisms allowed for pasteurised milk. Legal proceedings were taken under Article 31 (2) of the Milk and Dairies Order, 1926, for selling milk in bottles not filled and closed on registered premises. The roundsman was fined £2. 31 (b) Meat and Other Foods. The Public Health (Meat) Regulations, 1924, came into operation on the 1st day of April, 1925. Under these regulations notice of intention to slaughter has to be sent to the Town Hall by all butchers who have a slaughterhouse in Hornsey. In this way the inspectors are enabled to inspect the carcase and organs of every animal killed in the Borough. The general standard of meat sold in Hornsey is good, and in no case has it been found necessary to seize any portion of a carcase or any organ. Other Foods.—Particular attention has been paid to all premises where food is prepared or sold, and it is only by frequent inspection that satisfactory standards of cleanliness can be maintained. During the year the carcases of 1,024 sheep and 4 bullocks have been inspected under the Regulations, and offal amounting to 49£lbs. was surrendered voluntarily on account of some diseased condition. All diseased meat is destroyed at the Council incinerator. Slaughter-Houses.—The following is a statement regarding the Slaughter-houses in the Borough: — 1920. 1925. 1930. Licensed 7 5 5 Slaughtering of Animals during the last 5 Years. The table below is interesting as showing a steady decrease in the number of animals slaughtered in the Borough during the last 5 years: — Beasts. Sheep. Swine. Calves. 1926 195 2,843 27 0 1927 144 2,374 21 16 1928 58 1,526 0 1 1929 21 1,303 0 1 1930 4 1,024 0 0 The Byelaws relating to Slaughter-houses were revised in November, 1930, and the use of a " mechanical killer " made compulsory in the slaughter of any bull, ox, cow, heifer or calf. 32 Unsound Food.—Unsound food was surrendered and destroyed as follows: — Lungs 31¾ lbs. Liver 17½ „ Sausage meat 30 „ Haddocks 98 „ White Bream Fillets 7 ,, Apples containing traces of arsenic 20 „ 203¼ lbs. List of samples taken in Hornsey and examined during the year by the Middlesex County Council:— Article. Taken. Adulterated. Milk 184 5 Milk, sterilised 3 — Apples 4 — Arrowroot 2 — Butter 10 — Cream 4 — Gin 5 — Meat 18 1 Pastry 1 — Pepper 1 — Preservative 3 — Rice Flour 3 1 Rum 1 — Sausages 29 6 Sausage colouring 1 — Whisky 11 — 280 13 Number of prosecutions 1 Number of convictions 1 33 SHOPS ACTS. The Shops Acts, 1912-1913, and the Shops (Hours of Closing) Act, 1928, may be cited together as the Shops Acts, 1912 to 1928. Six hundred and thirty-nine visits have been paid to shops during the year and, apart from a number of minor infringements, which were dealt with, the provisions of the Shops Acts, 1912-1928, have, generally speaking, been well observed. Letters have been sent in eleven instances where contraventions have occurred after verbal notices, and undertakings obtained that recurrences will not take place. Legal Proceedings were taken under Section 1 of the Shops (Hours of Closing) Act, 1928, for being open for the service of customers and selling tobacco after the prescribed hour. The Magistrates fined the shopkeeper £2 0s. 0d. There are 1,225 shops in the Borough engaged in the following trades: — Grocers 118 Confectioners 97 Drapers and Costumiers 73 Boots 72 Greengrocers 68 Stationers and Newsagents 55 Butchers 54 Restaurant Kitchens 50 Tobacconists 50 Hairdressers and Barbers 45 Tailors and Outfitters 43 Furniture and Upholsterers 36 Public-houses 35 Off-licences 35 Dairies and Milkshops 31 Coal Merchants 30 Bakers 29 Chemists 28 Fishmongers 25 Oil and Colour Shops, General and Domestic Stores 23 34 Milliners 18 Ironmongers and Hardware 18 Gas, Eleetrical and Wireless Fittings 17 Clothes Pressing (Cleaning and Repairing) 15 Florists 13 Builders and Decorators 13 Watches and Jewellery 11 Cycles and Motor Repairs 11 Hosiers 10 Pianos and Music 9 Corn Chandlers 8 Photographers 8 Wardrobe Dealers and Dress Agencies 8 Boobs 7 Saddlers and Leather Goods 7 Cooked Meats 7 Picture Frames 5 Carpets and Lino 5 Art Needlework and Wool 5 Bazaars 4 Umbrellas 3 Toys 3 Timber Merchants 3 Sewing Machines 3 Opticians 2 Pawnbrokers 2 Blinds 2 Baby Carriages 2 Antique Shops 2 Furriers 2 Corsets 1 Cotton Goods (Cottons and Shirts) 1 Herbalist 1 Basket Ware 1 Cutler 1 1,225 35 Hairdressers' & Barbers' Shops (Sunday Closing) Act, 1930. This Act came into operation on the first day of January, 1931, and provides for the compulsory closing of hairdressers' and barbers' shops on Sundays. An exception is made in the case of a person of the Jewish religion. The provisions of this Act is carried out by the Sanitary Inspectors, who are also responsible for the carrying out of the Shops Acts, 1912 to 1928, and will necessitate occasional Sunday morning duty. FLY BREEDING. Allotment holders and those in charge of refuse shoots were notified in April respecting preventive measures to be taken to obviate fly breeding. Mosquitoes.—Stagnant pools were sprayed in April, and at other suitable times during the year, to prevent the breeding of midges and mosquitoes. From observations and enquiries made, this seems to have been efficacious, and to have been appreciated, especially by those living in the vicinities. DISINFECTION. Number of rooms fumigated after notifiable infectious disease 570 ii ii ii i» non j, ,, 160 ii ii >, I, T.B 80 ,, articles disinfected 10,032 ,, ,, destroyed 166 ,, verminous rooms disinfected 121 CLEANSING STATION. Eighteen adults and 143 children have been treated at the cleansing station for various reasons. Nine of the adults and 7 of the children belonged to Wood Green. MORTUARY. Sixty-two bodies were received at the mortuary and an inquest held on 18 of them. DISEASES OF ANIMALS ACT. Mr. F. G. Buxton, the Veterinary Inspector, reports that during the year he inspected 148 pigs and issued 1 removal licence. No action was necessarv under the Tuberculosis Order, 1925. DISINFECTION. Number of rooms fumigated after notifiable infectious disease 570 „ „ „ „ non „ „ 160 „ „ „ „ T.B. 80 ,, articles disinfected 10,032 ,, ,, destroyed 166 ,, verminous rooms disinfected 121 36 DOG NUISANCE. Byelaw made by the Town Council on the 17th February, 1930:— " No person being in charge of a dog in any street or public place, and having the dog on a lead, shall allow or permit such dog to deposit its excrement upon the public footway. "Any person offending against this Byelaw shall be liable to a penalty not exceeding Forty Shillings." The following is a copy of the poster which has been exhibited in prominent positions since June, 1930: — "Borough of Hornsey. Dog Nuisance. The Fouling of the Public Footways by Dogs is very offensive to the general public, as well as being Dangerous to Health. Dog Owners are asked to co-operate in keeping the pavement clean by training their dogs to use the gutter or roadway. All dogs are trained not to foul their owners' living rooms. They can easily be trained not to foul the footways; The attention of the public is drawn to the following Byelaw made by the Town Council: — " No person being in charge of a dog in any street or public place, and having the dog on a lead, shall allow or permit such dog to deposit its excrement upon the public footway. '' Any person offending against this Byelaw shall be liable to a penalty not exceeding Forty Shillings." Public Health Department, Town Hall, Highgate, N.6." As a result of inspections, it was found that passages and shop fronts suffer the most from fouling by dogs; that few dog-owners keep their dogs on leads, either early morning or late evening, or appear to realise, or care, how disgusting the fouling of the footpaths and shop fronts by dogs can become. 37 PETROLEUM ACTS, ETC. Under the Petroleum (Consolidation) Act of 1928 provision is made for the storage and safe keeping of Petroleum Spirit. Petroleum Spirit is defined as Petroleum, which when tested in a prescribed manner, gives off an inflammable vapour at a temperature of less than 73 degrees Fahrenheit. The number of premises licensed by the Council has steadily increased from year to year. The total number of licences for petroleum spirit is 71, and the quantity of petroleum which may be kept on licensed premises is 75,904 gallons, 4,994 gallons being kept in two-gallon cans and 70,910 gallons in underground tanks. The premises licensed were inspected from time to time and contraventions of the conditions attached to the licences, which have been few, dealt with. Plans relating to new petrol installations have been submitted to the Committee for their approval. The construction of new installations lias been carefully supervised and tanks and pipe lines for bulk storage installations tested. Carbide of Calcium. There are three premises licensed for the storage of Carbide of Calcium and the quantity stored under licence is 1 ton 10 cwts. 50 lbs. Hydrocarbon. There is 1 licence issued for the storage of 100 gallons of hydrocarbon. Cellulose Spirit. One licence for the storage of 20 gallons of cellulose spirit has been issued. Horticultural Poisons. There are two licences in force for the sale of horticultural poisons under the Poisons and Pharmacy Act. The Petroleum Spirit (Motor Vehicles, Etc.) Regulations. These came into force on 1st day of December, 1929. 38 They provide for the safe keeping and use of petrol for the purposes of motor vehicles, motor boats, aircraft and certain classes of engines mentioned in the Schedule. Petrol-driven Engines Used for Road-making. Under these Regulations it is provided that, for the keeping and use on any road of petroleum spirit for the purposes of any such engine, notice shall be given to the local authority. Cautions were given in four instances of contraventions of these regulations. Petroleum Spirit and Danger from Fire. In addition to the sand usually kept for putting out fires at licensed petroleum stores, suitable fire-extinguishing apparatus, available at once if required, has been provided in 59 instances. These include every petrol-filling station from which petroleum spirit is sold in the Borough. Garages are being similarly equipped, in addition to extinguishers kept on private cars. Attention has also been paid to the repair shops, particularly the small repair shops with oil-soaked wooden floors, to bring these into line with efficient fire-extinguishing apparatus. The number of fire-extinguishing apparatus kept on licensed premises, apart from those on private cars, was found to be 140. The Petroleum (Carbide of Calcium) Order, 1929. This came into operation in December, 1929, and makes provision for the labelling of packages and stores containing carbide of calcium, the wording now being " Carbide of Calcium— Dangerous if not kept dry. The contents of this package are liable if brought into contact with moisture to give off a highly inflammable gas." Visits have been made to each licensed storage place, and this order is observed. A list of all Licences issued under the Petroleum Acts, with particulars, is sent to the Superintendent of the Fire Brigade each year. 39 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The statistics of infectious diseases in the Borough are set out in Tables F. and G. The only novel feature in regard to the prevalence of infectious diseases was the appearance of small-pox on two occasions, first in South Harringay, where two brothers contracted the disease, and later in Stroud Green, where a single case occurred. Each case was dealt with in the usual way—removal to small-pox hospital and vaccination of the contacts. The disease was of the type now officially designated " Variola Minor," to distinguish it from " Variola Major," or Classical Small-pox. It is common knowledge that some of the older views regarding small-pox and vaccination have cracked up in face of newer knowledge relating to the types of small-pox and the sequela of vaccination. The subject is too long, too involved and too controversial to be discussed here, but the reader is referred to a recent Memorandum from the Ministry of Health entitled, "A review of certain present aspects of Small-pox Prevention in relation particularly to the Vaccination Acts, 1867-1907." Immunisation.—Artificial immunisation as a means of preventing or controlling infectious and epidemic diseases in the community is attracting more attention year by year. Its scope is extending to diphtheria, scarlet fever, influenza, pneumonia, tuberculosis and other diseases. There can be no doubt that a considerable measure of success attends these methods, but so long as the incidence and mortality rates of these diseases remain low, I do not anticipate any keen demand for the method, even with an active campaign of propaganda. In present circumstances I feel that there is so much to be done in environmental and personal hygiene and nurture in infancy and childhood that the time and energy of your staff are better spent in these directions. Ophthalmia Neonatorum.—One case of ophthalmia neonatorum was notified, and was treated in St. Margaret's Hospital (M.A.B.), Kentish Town. 40 Cases Notified. Treated. Vision unimpaired. Vision impaired. Total blindness. Deaths. At home. In hospital. 1 0 1 1 0 0 0 Tuberculosis.—Sanatorium provision for all forms of tuberculosis in Hornsey is made by the Middlesex County Council. There are 857 beds available under the Middlesex County Council scheme for the treatment of tuberculosis in sanatoria, allotted as follows :— Observation. Pulmonary tuberculosis. Nonpulmonary tuberculosis. Total. "Sanatorium " Beds. "Hospital " Beds. Disease of Bones & Joints. Other conditions. Adult Males 9 248 62 39 9 367 Adult Females 7 183 39 26 20 275 Children under 15 8 56 1 115 35 215 Total 24 487 102 180 64 857 The total number of cases on the Tuberculosis Register at the end of 1930 was, 603, an increase of 40 during the year. Dr. Dobson, the Middlesex Tuberculosis Officer for Hornsey, has kindly supplied the following particulars of Hornsey cases of tuberculosis:— New Tubercular cases 91 New non-Tubercular cases 118 Undiagnosed cases 4 Total 213 41 Transfers in (Tubercular), not included in above 14 Cases supervised at or from the dispensary during 1930 (all Tubercular) 308 Tubercular cases still on the Register on 1st Jan., 1931 224 Undiagnosed 4 Total 228 MATERNITY AND CHILD WELFARE. Personnel. During the year changes have been made in the medical personnel in connection with the Maternity and Child Welfare Centres. On 1st April Dr. E. Abbott took up her duties as Assistant Medical Officer of Health, Assistant School Medical Officer and Assistant Medical Officer for Maternity and Child Welfare Work, and a rearrangement of the work was therefore necessary. Dr. Jessie Muir gave up her appointment as wholetime Medical Officer at the Centres and reverted to her position as part-time officer. Miss A. Godden was appointed in January as Health Visitor at Brook Road Centre to succeed Miss Lewis, who resigned in December. CENTRES. No. 1 Centre.—St. Mary's Mission Hall, Brook Road, serving East and West Hornsey, Crouch End and North Haringey areas. Voluntary Committee: Mrs. E. Piggott (Chairman) 13, Rookfield Avenue, N.10. Mrs. B. H. Walton (Hon. Sec. and Treas.) 19, Etheldene Avenue, N.10. Mrs. Bishop 71, Sunnyside Road, N.19. Miss Bligh 25, Summerland Mans., N.10. Miss Creswell 35, Bishopswood Avenue, N.10. Mrs. Danks 4a, Coolhurst Road, N.8. Mrs. Eason 13, Woodberry Crescent, N.10. 42 Miss Faulkner 9, Aubrey Road, N.8. Miss Goodman 19, Cranmore Way, N.10. Mrs. A. M. L. Harvey 41, The Chine, N.10. Mrs. Hume 5, Prince's Avenue, N.10. Mrs. Merry 20, Etheldene Avenue, N.10. Mrs. Moore 58, Rosebery-road, N.10. Mrs. Price 79, Park Avenue South, N.8. Miss Read 84, Cranley Gardens, N.10. Miss Ida Smith 43, Weston Park, N.8. Mrs. Sparkes 3, Crouch Hall Road, N.8. Mrs. Strohmenger "Harwell House," Western Road, N.2. Mrs. Williamson 84, Cecile Park, N.8. Health Visitors: Mrs. E. Durnford and Miss A. Godden. Clinics:— 2nd and 4th Mondays 2-4 p.m. (Dr. Abbott). Wednesdays 10-12 a.m. and 2-4 p.m. (Dr. Muir). Thursdays 10-12 a.m. and (Ante-Natal) 2-4 p.m. (Dr. Muir). No. 2 Centre.—No. 22, Wightman Road, serving Stroud Green, Finsbury Park and South Haringey areas. Voluntary Committee: Mrs. J. H. Barrenger (Chairman) 18, Fordington Road, N.6. Miss A. M. Inward (Hon. Sec. and Treas.) 29, Endymion Road, N.4. Mrs. L. J. Bond 125, Mount View Road, N.4. Mrs. Bridgman 5, Seymour Road, N.8. Mrs. Cutting 10, Strafford Gate, Potter's Bar. Mrs. Harris 45, Barrington Road, N.8. Mrs. J. Inward 99, Pemberton Road, N.4. Miss King 45, Wood Vale, N.10. Mrs. May 16, Fordington Road, N.6. Mrs. Newman 2, Endymion Road, N.4. Mrs. Spredbury 9, Wood Vale, N.10. Mrs. L. C. iSwinstead 15, Avenue Road, N.6. Health Visitor: Miss A. Glover. 43 Clinics :— 1st and 3rd Fridays 10-12 a.m. (Dr. Abbott). Tuesdays 10-12 a.m. and 2-4 p.m. (Dr. Muir). 1st and 3rd Tuesdays 2-4 p.m. (Ante-Natal). (Dr. Muir). No. 3 Centre.—All Saints' Hall, Church Road, serving Highgate and Muswell Hill areas. Voluntary Committee: Mrs. Dixey (Chairman)"Crossways," 27, Stormont Road, N.6. Mrs. Hill (Hon. Sec.) 16, Bishopswood Road, N.6. Miss B. Knox (Hon. Sec.) 3, North Hill, N.6. Miss Reavely (Hon. Treas.) 79, Gower Street, W.C.I. Mrs. Compton 73, Addison Road, Kensington, W.14. Mrs. Dixon 56, Talbot Road, N.6. Miss Grant "Tregarthen," Cranley Gardens, N.10. Miss Groser 36, Wood Lane, N.6. Miss Hodgson "Belle Vue," Church Rd., N.6. Miss Jenkin 16, Claremont Road, N.6. Miss McAllan 28, Glasslyn Road, N.8. Mrs. A. L. Thomson 2, View Road, N.6. Miss Wood 38, Church Crescent, N.10. Health Visitor: Miss J. Macpherson. Clinics:— Fridays 2-4 p.m. (Dr. Abbott). 2nd Fridays (Ante-Natal) 10-12 a.m. (Dr. Abbott). Sub-Centre at Coldfall School, serving the Council's Coppetts Road Estate. Health Visitor (part time): Miss F. Ross. Clinics:— 1st and 3rd Fridays 10.12 a.m. (Dr. Abbott). 4th Friday (Ante-Natal) 10-12 a.m. (Dr. Abbott). Table H. on page 56 gives a statistical record of the work done at the Centres and by the Borough Midwife. 44 There were four deaths due to child-birth, the maternal mortality rate being 33 per 1,000 births. There were 4 cases of puerperal fever, all of which went to hospital, and 15 cases of puerperal pyrexia, 13 being treated in hospital. Midwifery. The Municipal Midwife attended 144 births. A reduction of her fee was made in 30 necessitous cases. Nine hundred and eighty births have been attended by the Midwife since the appointmnt was first made in 1922. Summonses were taken out against defaulters of payment of the Midwife's fee and the magistrate made an order in each case. X-Ray Treatment. One expectant mother was sent to University College Hospital from the Ante-Natal Clinic for examination. Mii,k—Mothersand Children Order. Five hundred and twenty-two applications for milk under this Order were granted during the year. In March the age of children eligible for milk under the Order was increased from 3 to 5 years. Dental Clinic. The following is a reeord for the year of the Dental Clinic for Mothers and Children which was started in 1928:— 1930. Individual cases treated 1ll Total attendances made 519 Teeth extracted 368 Gas cases 102 Inspections 59 Local injections 29 Fillings 156 Dentures provided 33 Awaiting dentures 21 Attendances for dentures 152 Other treatments, scaling, gum treatment, etc 120 Cases finished 58 45 Orthopaedic Scheme. In conjunction with the Education Committee an orthopaedic scheme has been established. A Clinic is held monthly at the School Clinic, conducted by a Surgeon from the Royal National Orthopaedic Hospital, who examines and prescribes treatment for cases referred to him by the Medical Officers of the Centres. Massage, electricity and remedial exercises are carried out by a nurse from the Hospital. Cases requiring operative treatment are sent to the country branch of the Hospital at Stanmore. The cost is divided between the Education and Maternity Committees in proportion to the number of cases sent by each. Joint Voluntary Committee. The Voluntary Committees of the three centres meet quarterly as a Joint Voluntary Committee to discuss matters of common interest and to make recommendations to the Maternity and Child Welfare Committee. Home Helps. A register of home helps has been compiled by the Voluntary Committees and has proved useful in many cases of mothers requiring help during the confinement period. Conferences. The Committee has been represented at the following Conferences during the year:—Birth Control at the Central Hall, Westminster, in April; Physical and Psychological Defects in Children at Drapers' Hall in November. Foster Children—Children Act, 1908. Under the Local Government Act, 1908, the duties carried out by the Edmonton Guardians were transferred to the Council as from 1st April, 1931. This work is undertaken by the Health Visitors, and during the year visits have been paid to foster children. A register of Foster Mothers and Foster Children is kept by the Medical Officer of Health at each Centre, and the following is a summary of the Register: — Number transferred at 1st April 20 Number added during year 27 Number taken off register during year 24 Number on register at end of year 23 46 Notification of Births Acts, 1907 & 1915. All live births and still births of seven months and over must be notified to the Medical Officer of Health within 36 hours. The number of births notified under the Acts during 1930 was: — Male. Female. Total. Live births 627 601 1,228 Still births 18 20 38 645 621 1,266 The births were notified:— By parents 82 By doctors 248 By Borough Midwife 140 By other midwives 417 By Hospitals 169 By others 210 1,266 Unnotified (from Registrar's Return): — Live births 77 Still births 5 82 1,348 Of this number there were:— Live births. Still births. Occurring in the Borough and transferred to other districts 192 4 Occurring in Hospitals, etc., outside the district belonging to Hornsey 355 13 The 1,152 net number of births belonging to Hornsey were divided among the districts of the Centres as follows:— Brook Road 549 Wightman Road 278 Highgate 280 Coldfall Sub-Centre 45 41 LIST OF TABLES. TABLE A.—Vital Statistics, 1909-1930. TABLE B.—Causes of, and ages at, death in 1930 and Summary 1921-1929. TABLE C.—Infant Mortality in 1930. Causes of and ages at death. TABLE D.—Births, Deaths, Infant Deaths, and Deaths from certain diseases, 1901-1930. TABLE E.—Cases of Infectious Disease notified in 1930. TABLE F.—Cases of Infectious Disease notified 1909-1930. TABLE G.—(1) Notification of, and deaths from, Tuberculosis, 1930. ,, (2) Tuberculosis Register, 1930. TABLE H.—Work done at the Maternity and Child Welfare Centres and by Municipal Midwife, 1930. TABLE I.—Inspection of Factories, Outworkers, etc:, 1930. 48 TABLE A. BOROUGH OF HORNSEY VITAL STATISTICS, 1909-1930. Year Estimated Mid-Year Population. Birth Bate per 1,000 Population. Death Bate per 1,000 Population. Infant Mortality per 1,000 Births. 1909 82,378 18.3 9.5 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 56 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 10.6 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 47.2 1927 90,000 1.3 11.2 38.3 1928 90,250 12.1 12.1 61.3 1929 90,500 Regr..General 88,450 13.8 12.7 5405 1930 88,450 13.7 11.8 41.35 107 County Borough and Great Towns, including London (Rates in 1930) 16.6 11.5 64 159 Smaller Towns (Rates in 1930) 16.2 10.5 55 London (Rates ill 1930) 15.7 11.4 59 ENGLAND and WALES (Rates in 1930) 16.3 11.4 60 49 TABLE B.—CAUSES OP, AND AGES AT, DEATH DURING THE TEN YEARS 1921-1930. CAUSES OF DEATH M.O.H. Returns, 1930. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and over. All ages 1930. Registrar-General's returns. 1929 1928 1927 1926 1925 1924 1923 1922 1921 All causes—Certified ... ... ... ... ... ... ... ... ... Uncertified ... ... ... ... ... ... ... ... ... 1 Enteric Fever ... ... ... ......... ... ... ... ... 0 ... 1 1 1 ... ... 1 ... ... 1 2 Small-pox ... ... ... ... ... ... ... ... 0 ... ... ... ... ... ... ... ... ... 2 3 Measles ... 2 2 ... ... ... ... ... 4 ... 7 ... 8 1 2 4 3 1 3 4 Scarlet Fever ... ... ... ... 1 1 ... ... 2 ... 2 1 ... ... 1 1 3 3 4 5 Whooping Cough ... ... ... ... ... ... ... ... 0 14 1 ... 3 8 2 1 7 2 5 6 Diphtheria ... 1 ... 3 ... ... ... ... 4 3 6 6 1 1 2 6 6 13 6 7 Influenza ... ... ... ... ... 2 ... 1 3 65 16 51 17 20 22 14 47 24 7 8 Encephalitis Lethargica ... ... ... ... ... ... ... ... 0 2 3 1 2 3 2 1 ... 3 8 9 Meningococcal Meningitis ... ... ... ... ... ... ... ... ... 0 ...... 2 1 ... ... ... ... ...... ... 9 10 Tuberculosis of Respiratory System ... ... 1 ... 10 21 19 5 56 57 60 57 59 48 55 47 60 74 10 11 Other Tuberculous Diseases ... 1 1 1 1 2 1 7 16 12 7 8 7 7 11 13 12 11 12 Cancer, Malignant Disease... ... ... ... ... 1 12 70 73 156 147 134 188 147 143 146 136 143 136 12 13 Rheumatic l ever ... ... ... ... ... ... ... ... 0 1 4 2 2 3 3 2 4 5 13 14 Diabetes ... ... ... ... ... 3 1 6 10 13 9 19 7 13 9 10 14 8 14 15 Cerebral Hemorrhage, etc ... ... ... ... ... 2 22 81 105 57 49 43 60 68 5! 60 54 68 15 16 Heart Disease ... ... ... ... 3 5 46 88 142 263 188 200 160 163 141 126 116 122 16 17 Arteriosclerosis ... ... ... ... ... ... 4 33 37 63 73 55 41 60 46 44 44 40 17 18 Bronchitis 1 ... ... 1 ... 2 14 53 71 45 48 58 47 61 71 55 65 72 18 19 Pneumonia (all forms) 4 2 ... 1 2 6 26 36 77 64 58 60 55 64 67 68 67 46 19 20 Other Respiratory Diseases ... ... ... ... ... 1 2 2 5 18 10 12 10 16 16 9 20 23 20 21 Ulcer of Stomach or Duodenum ... ... ... ... ... 1 6 6 13 13 13 12 9 7 6 8 8 4 21 22 Diarrhoea (under 2 years) 7 3 ... ... ... ... ... ... 10 2 2 3 2 3 1 5 3 15 22 23 Appendicitis 1 ... ... ... 1 4 7 3 16 5 9 13 6 6 9 7 11 7 23 24 Cirrhosis of Liver ... ... ... ... ... 2 2 1 5 3 4 8 4 6 4 6 6 11 24 25 Acute and Chronic Nephritis ... ... ... ... 2 1 15 24 42 34 31 31 31 25 35 32 36 24 25 26 Puerperal Sepsis ... ... 1 ... ... 1 0 3 1 2 1 1 2 ... 26 27 Other accidents and diseases of Pregnancy and Parturition ... ... ... ... ... 5 ... ... 3 5 1 3 2 3 2 5 3 4 27 28 Congenital Debility and Malformation, Premature Birth 26 ... ... ... ... ... ... ... 26 36 42 27 31 26 29 38 36 34 28 29 Suicide ... ... ... ... ... 3 8 3 14 13 10 6 33 4 10 12 12 11 29 30 Other Deaths from Violence 1 ... ... ... 3 6 5 11 26 25 30 23 6 27 20 22 22 21 30 31 Other Defined Diseases 10 2 2 2 4 13 42 137 211 161 173 167 171 170 175 196 190 185 31 32 Causes Ill-defined or Unknown ... ... ... ... ... ...... ... ... ... ... ... ... 1 ... 1 ... ... ... 32 Total 50 11 6 8 28 91 290 563 1047 1130 1000 1009 926 956 938 928 995 968 50 TABLE C-iNFANT MORTALITY. 1935 Deaths from stated causes at various Ages under one year of Age. Total Deaths under One Year. CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 1-3 Months. 3-6 Months. 69 Months. 9-12 Months. Meningitis — — — — 0 — 1 — — 1 Convulsions — — - 1 1 — — 1 2 Bronchitis — — — — — — 1 — — 1 Pneumonia — 1 — — 1 — 1 1 1 4 Peritonitis 1 — — — 1 — — — - 1 Diarrhoea — — — — — 2 2 — 3 7 Haemorrhage I — — — 1 — — — — 1 Status Lymphaticus — — — 1 1 — — — — 1 Jaundice l - 1 — 2 — — — — 2 Injury at Birth 2 — — — 2 — — — — 2 -Inattention at Birth 2 — — — 2 — — — — 2 Premature Birth 9 2 — 1 12 2 - — 1 15 Atelectasis 2 — — — 2 — — — — 2 Atrophy, Debility and Marasmus 1 — 1 — 2 1 — — — 3 Congenital Heart Disease 1 - 1 — 2 — — — 1 3 Appendicitis — — — — — — — 1 — 1 Otitis Media — — — — - — — 1 — 1 Burns — — — — — — — — 1 1 Certified 20 3 • 3 3 29 5 5 4 7 50 Total Uncertified — — — — — — — — — — 51 TABLE D. BIRTHS, DEATHS, INFANT DEATHS, AND DEATHS FROM CERTAIN DISEASES, 1901-1930. YEAR. Population Census. Total Births Total Deaths Total Infant Deaths (under one year) Deaths from Measles Deaths from Whooping Cough Deaths from Diarrhoea (under two years) Deaths from Scarlet Fever Deaths from Diphtheria Deaths from Typhoid Fever. Deaths from Cancer. Deaths from Tuber culosis (Pulmonary Deaths from Tuberculosis (Non-Pulmonary) 1901 72,056 1,511 597 127 8 14 6 I 8 3 47 45 18 1902 1.565 620 129 7 9 1 0 9 6 51 45 22 1903 1,561 589 130 15 19 1 I 8 1 62 46 20 1904 1,659 690 143 18 17 21 1 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 60 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 8 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 1915 1,394 1,007 112 37 7 23 3 11 2 99 58 19 1916 1,404 928 64 0 5 8 0 11 1 106 84 20 1917 1,038 906 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 15 3 13 0 136 74 12 1922 1,372 992 72 3 7 3 3 6 0 143 60 13 1923 1,277 928 64 4 1 5 1 6 1 336 47 11 1 924 1.189 928 48 2 2 1 1 2 0 146 55 7 1925 1.214 946 49 1 8 3 0 1 0 143 48 7 1926 1,206 928 57 8 3 2 0 1 1 147 59 8 1927 1,201 1,012 46 0 0 4 1 6 1 131 68 6 1928 1,191 995 71 6 1 3 2 6 1 132 59 10 1929 1.221 1,128 67 0 13 2 0 7 0 143 58 15 1930 1,209 1,047 50 4 0 10 2 4 0 156 57 7 TABLE E.—INFECTIOUS DISEASES NOTIFIED 1930. DISEASE WARDS. AGES Total Admitted to Joint Hospital. Admitted to other Hospitals. Registered Deaths Highgate Muswell Hill. Crouch End West Hornsey Bast Hornsey North Haringey South Haringey Stroud Green Finsbury Park. 0— 1 1— 5 5— 15 15— 25 25— 45 45— 65 65 and over Small Pox 2 — 1 — 1 1 1 — — 3 - 3 0 Scarlet Fever 37 72 24 69 46 35 33 12 18 2 59 215 42 22 6 — 346 275 4 2 Diphtheria 4 22 10 27 21 4 7 11 9 2 23 72 10 6 2 0 115 105 3 4 Enteric Fever 1 0 0 1 2 1 0 0 0 0 0 2 1 1 1 0 5 5 — 0 Para Typhoid 1 o 1 0 0 1 0 1 0 0 0 1 1 1 1 0 4 4 — 0 Erysipelas 6 5 6 3 4 4 0 6 2 2 2 0 2 9 16 5 36 13 3 0 Ophth. Neon. 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 Pneumonia 8 11 1 11 11 8 0 6 5 1 7 6 7 16 14 10 61 5 8 77 Puerperal Fever 1 0 0 0 0 1 1 1 0 0 0 0 0 4 0 0 4 0 4 1 Puerperal Pvrexia 4 1 1 2 3 1 0 0 3 0 0 0 4 11 0 0 15 0 13 0 Poliomyelitis 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 Cerebro spinal Meningitis 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 — 0 63 112 43 113 88 55 43 37 38 8 91 299 68 71 40 15 592 408 39 Tuberculosis: Pulmonary 16 21 7 23 14 10 11 18 13 — — 1 30 66 30 6 133 56 NonPulmonary 2 2 0 4 4 3 1 0 4 — 3 7 3 5 2 — 20 7 Total 80 135 50 140 106 68 55 55 55 8 94 307 101 142 72 21 745 Admitted to Joint Isol. Hospital 37 76 28 87 68 35 31 22 24 Other Hptls. (except T.B.) 10 6 1 5 3 1 3 4 6 52 TABLE F.—NOTIFICATIONS OF INFECTIOUS DISEASE, 1909-1930. Year. Population. Scarlet Fever. Diphtheria or Croup. Enteric Fever. Para Typhoid. Puerperal Fever. Puerperal Pyrexia. Erysipelas. Cerebral Spinal Meningitis. Polio-Myelitis. Ophthalmia Neonatorum. Malaria. Dysentery. Encephalitis Lethargica. Polio-Encephalitis. Pneumonia. Small-pox. Measles. German Measles. Total Attack rate per 1,000 population. 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 — 1 — — — — — 1,227 881 2,344 2.7 * 1918 86,942 89 67 8 — 2 23 1 3 2 — — — — — — 796 119 1,110 2.3 * 1919 87,100 203 87 6 — 4 42 4 1 5 21 2 5 — 112 — 224 285 1,001 5.7 * not now notifiable 1920 87,410 245 149 6 — 2 27 1 3 8 10 2 4 — 98 — — — 555 6.3 1921 87,691 591 189 2 2 36 2 6 1 1 6 — 42 — - — 878 10.1 1922 88,007 286 123 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 2 8 — — 6 56 — — — 364 4.0 1927 90,000 179 92 6 1 1 14 34 2 3 5 1 — — — 89 — — — 427 4.7 1928 90,250 328 104 4 — 3 22 24 4 1 6 1 — 2 — 94 — — — 593 6.5 1929 89,450 249 129 3 2 3 8 30 3 1 5 2 — — 1 163 — — — 599 6.6 1930 89,450 R.-Gen.'s Estimate 346 115 5 4 4 15 36 1 1 1 — — — — 61 3 — 592 6.6 * Excluding measles and German measles. TABLE G. (1).—NOTIFICATIONS OF, AND DEATHS FROM, TUBERCULOSIS, 1930. AGE PERIODS. New Cases. Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 — 1 — — — — — — 1 1 - 6 — — 3 — 1 — 1 5 — 15 1 — 5 2 — — 1 — 15 — 25 9 21 3 — 5 5 1 — 25—35 24 16 2 1 5 6 1 — 35 — 45 13 13 2 — 9 1 1 — 45 - 65 10 6 — 1 5 3 — — 55 — 65 13 1 — 1 10 1 — 1 65 and over 3 3 — 2 3 Totals 73 60 12 8 36 20 4 3 Wards;— Highgate 7 9 1 1 2 2 — — Muswell Hill 11 10 — 2 6 — — — Crouch End 4 3 — — 4 3 2 1 West Hornsey 13 10 4 — 6 3 — — East Hornsey 6 8 .3 1 3 5 — — North Haringey 8 2 1 2 3 4 1 1 South Haringey 8 3 1 — 2 1 1 — Stroud Green 10 8 — — 6 2 — — Finsbury Park 6 7 2 2 4 — — 1 Totals 73 60 12 8 36 20 4 3 54 55 TABLE G. (2).—TUBERCULOSIS REGISTER, 1930. No. of cases at commencement of 1930. No. of cases added to register during 1930. No. of cases removed from register during 1930. No. of cases on register at end of 1930. (1) (2) (3) (4) Pul. Non.-Pul. Pul. Non.-Pul. Pul. Non.-Pul. Pul. Non.-Pul. Males 216 68 73 12 52 11 237 69 Females 220 59 60 8 44 6 236 61 Totals 436 127 133 20 96 17 473 130 563 153 113 603 Cases removed from the Register shown in Column 3 are accounted for as follows:— Cured. Removed to another area. Died at Home. Died at Sanatorium or other Institution. Totals. M F M F M F M F M F 3 8 13 13 Pulmonary 24 9 52 44 12 14 2 0 5 2 Non-Pulmouary 3 2 11 6 1 2 5 8 18 15 13 16 27 11 63 50 113 56 TABLE H. MATERNITY AND CHILD WELFARE WORK, 1930. Nature of Work. Centres. Totals. No. 1. No. 3. No. 3 and Sub-Centre. Number of sessions held 217 115 75 407 ,, ante natal sessions held 50 25 20 95 Number of individual Mothers seen by Doctor:— Ante-natal, New cases 177 95 54 326 ,, Old cases 391 204 113 708 Post-natal, New cases 56 20 8 79 ,, Old cases 9 8 5 22 633 327 175 1,135 Total attendances of Mothers 1,108 425 185 1,718 Number of babies attending Centres for first time 395 243 194 832 Number of individual babies on Centre registers 855 485 479 1,819 Attendance of babies at medical consultations 3,775 2,238 1,363 7,376 Babies seen by doctor 2,664 1,623 1,021 5,308 Total attendances of babies at Centres 8,155 4,417 2,791 15,363 Referred to own private doctors 34 30 4 68 Referred to hospitals 102 52 33 187 Health talks given by nurses 7 32 32 71 Total Grand First Total First Total First Total First Total Visits paid by nurses:— visits visits visits visits visits visits Visits visits To expectant mothers 87 136 65 114 58 82 210 332 To infants under one year 541 2,710 312 1,448 314 1,208 1,167 5,366 To children aged 1-5 years 60 3,221 39 1,725 68 1,508 167 6,454 Total visits paid by nurses 688 6,067 416 3.287 440 2,798 1,544 12,152 CHILDREN ACT, 1908— Visits paid to Foster Children 7 35 15 31 1 39 23 105 RECORD OF WORK OF MUNICIPAL MIDWIFE, 1930. Confinements attended 144 Ante-natal Clinics attended 75 do. visits 391 Post-natal visits 2,039 57 TABLE I.—FACTORIES, WORKSHOPS AND WORKPLACES. The following is a summary of the result of inspections made at Factories, Workshops and Workplaces during the year, with a list of Outworkers' premises, a copy of which has been forwarded to the Home Office, as required. None of the Outworkers' premises was found to be in an unwholesome condition. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 295 7 0 Workshops (Including Workshop Laundries) 513 14 0 Workplaces (Other than Outworkers' premises) 50 0 0 Total 858 21 0 DEFECTS FOUND IN FACTORIES, WORKSHOPS & WORKPLACES. Particulars. Number of Defects. Number Pound. Remedied. Referred to H.M. Inspector. of Prosecutions. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 8 8 — — Want of ventilation — — — — Overcrowding (1 0 — — Want of Drainage of floors — — — — Other nuisances 9 9 — — Sanitary accommodation insufficient 1 1 — — unsuitable or defective 10 10 — — not separate for sexes 0 0 — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). — — — — Total 20 20 — — *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. ' ' 58 TABLE I.—(contd.) OUTWORKERS, 1930. Nature of Work. Outworkers. Instances. Notices served. Prosecutions. (1) Wearing Apparel Wearing Apparel 5 0 0 0 Mackintoshes 1 0 0 0 Gaiters 2 0 0 0 Machinist 1 0 0 0 Scarves 1 0 0 0 Underclothing 4 0 0 0 Tailoring 24 0 0 0 Outfitters 1 0 0 0 Boots 5 0 0 0 Neckwear 8 0 0 0 Ladies' Neckwear 3 0 0 0 Blouses 5 0 0 0 Gowns 2 0 0 0 Dressing Gowns 1 0 0 0 Dresses Dressmaking 22 0 0 0 Costumiers 3 0 0 0 Jumpers and Costumes 2 0 0 0 Skirt making 1 0 0 0 Ladies' Wear 1 0 0 0 Infants' Millinery 3 0 0 0 Millinery 11 0 0 0 Children's Wear Children's Blouses 1 0 0 0 Girls' Tunica 1 0 0 0 Children's Frocks 7 0 0 0 Children's Outfitting 1 0 0 0 Boxes 2 0 0 0 Furs 2 0 0 0 Knitted Goods 2 0 0 0 Baby Linen 1 0 0 0 Fancy Goods 2 0 0 0 Artificial Flowers 2 0 0 0 Embroidery 5 0 0 0 Needlework 1 0 0 0 Suspensory Bandages 1 0 0 0 Picture Frames 1 0 0 0 Total 135 0 0 0 Borough of Hornsen. ANNUAL REPORT OF THE School Medical Officer FOR THE Year ending December 31st, 1930 HORNSEY EDUCATION COMMITTEE. List of Members, December 31st, 1930. Members of the Town Council— His Worship the Mayor, Councillor C. H. Summersby. Aldermen. Mr. W. G. Barrenger (Chairman), 18, Fordington Road, Highgate, N.6. Mr. F. E. Grayson, 55, Upper Tollington Park, N.4. Mr. B. H. Jenkinson, 36, Avenue Road, Highgate, N.6. Mr. W. W. Kelland, M.A., 14, Hillside Mansions, Jackson's Lane, Highgate, N.6. Mr. J. W. Rowlands, 25, Cholmeley Park, Highgate, N.6. Councillors. Mrs. J. H. Barrenger, 18, Fordington Road, Highgate, N.6. Mr. A. A. Bell, 120, Wightman Road, Harringay, N.4. Mrs. C. M. Cave, 10, Wood Vale, Muswell Hill, N.10. Mr. W. J. Grimshaw, A.C.A., Vice-Chairman, " Oaklea," 25, Sheldon Avenue, N.6. Mr. D. V. Johnson, 54, Coolhurst Boad, Crouch End, N.8. Mr. J. W. Shipp, 12, Berkeley Road, Crouch End, N.8. Mr. L. J. Valette, 59, Allison Road, Hornsey, N.8. Mr. W. V. Wall, 168, Stroud Green lioad, N.4. Mr. R. J. Owen, 278, Wightman Road, N.8. Co-optative Members— The Rev. H. C. Montgomery-Campbell, M.A., The Rectory, Hornsey, N.8. The Rev. Cliffood Wood, 52, Talbot Road, Highgate, N.6. Mr. H. Tompkins, 7, Danvers Road, Hornsey, N.8. Mrs. A. Holman, J.P., 8, Hornsey Lane, Highgate, N.6. Mrs. J. Whitehead, 2, Waverley Road, Crouch End, N.8. Mrs. W. Turner, 65, Crouch Hail Road, Crouch End, N.8. Mr. W. E. Paterson, M.A., B.Sc., 7, Donovan Avenue, N.10. Secretary to the Education Committee— A. W. Allen, Esq., M.A., Education Office, 79, Crouch End Hill, N.8, 3 MEMBERS OF THE CENTRAL CARE COMMITTEE. Six Members of the Education Committee— Councillors J. H. Barrenger, C. M. Cave and L. J. Valette, Mr. W. E. Paterson, M.A., B.Sc., Mr. H. Tompkins and Mrs. J. Whitehead. Two Representatives of the Middlesex Education Committee— Aldermen F. E. Grayson and W. W. Kelland, M.A. Three Head Teachers from among the Head Teachers of the Public Elementary Schools— Miss F. A. Barter, Miss E. M. Stoker and Mr. H. Turner. One Representative of the Hornsey Parochial Charities Trustees— Mr. J. C. Taylor. Not more than four other persons residing in the Borough who possess experience or knowledge of social work among school children or young per/sons— Miss M. H. Cole, Mr. J. H. Ford, M.A., Mr. C. Knight and Mr. G. Simmonds, B.A. Eight Representatives of Employers and employees in the area of the Authority— Councillor W. V. Wall, Mr. E. H. Bennett, Mr. A. H. Page, Mr. G. Pain, Mrs. E. Chapman, ‡Mrs. E. Cook. Mr. J. A. Newrick and Mrs. H. Tompkins. MEMBERS OF THE DISTRICT CARE COMMITTEES. Campsbourne.—Councillor C. M. Cave (ex—officio), Mrs. D. Bayne, Mrs. F. C. Carter, *Mrs. E. Chapman, ‡Mrs. E. Cook, Mrs. W. C. Hardwick, †Mr. C. Knight, Mrs. A. E. Lamble, Miss G. S. Litchfield, Mrs. E. J. Luckett, Miss M. D. Sibley, Mrs. G. C. Spencer, Miss H. M. Stone, Mr. H. Turner and Mrs. L. Whittle. Crouch End.—Councillor C. M. Cave (ex-officio), Miss F. A. Barter, Mr. J. H. Ford, M.A., †Mrs. A. M. Halford, Mrs. E. H. Hare, Mr. J. Iliffe, Miss E. Pitson, Mrs. J. Stevenson, Mrs. H. Tompkins, Mrs. W. Turner, Miss A. E. Walmsley, the Rev. W. White and *Mrs. Whitehead. * Secretary. † Chairman. ‡ Died 4/2/31. 4 Highgate.—Councillor C. M. Cave (ex-officio), Councillor J. H. Barrenger, the Rev. W. Blackshaw, M.A., Mr. T. E. Durban, Mrs. E. Farrell, †Mrs. P. Farquharson, the Rev. F. Hawkins, M.A., Mrs. A. Imber, Mr. E. R. Lewis, Mr. S. Mason, *Miss M. Owen, Miss D. F. Smith, Miss E. Towler, Mr. H. E. Williams and the Rev. C. Wood. Muswell Hill.—†Councillor C. M. Cave (ex-officio), Mr. A. H. Bex, Miss E. F. Catley, Miss M. N. Clarke, Mr. F. G. Edwards, Mrs. A. Holman, J.P., Mrs. M. Heppell, Mr. W. E. Paterson, M.A., Mrs. W. Paterson, Mr. W. Penn, the Rev. C. A. Roberts, Mr. G. Simmonds, B.A., *Mrs. E. Simmonds and the Rev. J. C. Wilcox. North Harringay.—Councillor C. M. Cave (ex-officio), Mrs. H. Betts, Mrs. W. Briggs, Mrs. N. L. Brixey, the Rev. C. Easterling, *Mrs. H. M. Hay, Mrs. G. Hodd, Mr. F. W. Jaggard, Miss R. Jones, Mrs. R. Owen, Mr. G. Pain, Miss G. M. Ryde, B.Sc., Miss E. M. Stoker, †Councillor L. J. Valette, and Mrs. L. J. Valette. * Secretary. † Chairman. 5 1 —STAFF OF SCHOOL MEDICAL SERVICE. School Medical Officer: R. P. Garrow, M.D. Assistant School Medical Officer: Edith I. L. Abbott, M.B., B.S., D.P.H. (Commenced duty 28/4/30.) Oculist: J. S. Boden, M.B., B.S. Aurist: A. R. Friel, M.A., M.D., F.R.C.S. (I.). Radiologist: J. Morison, M.D. Orthopaedic Surgeon: Mr. J. Binford Barnett, M.B., F.R.C.S. (Eng.) Resident Medical Superintendent, Royal National Orthopædic Hospital, Country Branch, Stanmore.) (Died—March, 1931.) Masseuse: Mrs. Yorke (Royal National Orthopædic Hospital). Dentists (Part-time): W. P. Beresford, L.D.S. C H. Rubra, L.D.S. S. T. Taylor, L.D.S. Nurses: M. Anscombe. L. M. Oliver. F. E. Paris. F. Ross. Clerk: H. M. Croak. Assistant Clerk: V. Powell. 6 To the Chairman and Members of the Hornsey Education Committee. Mr. Alderman Barrenger, Ladies and Gentlemen, 1 have the honour to submit my Annual Report on the work of the School Medical Service for the year 1930. In April Dr. Edith Abbott took up the combined duties of Assistant Medical Officer for Maternity and Child Welfare and Assistant School Medical Officer, the object of this new appointment being to secure closer co-ordination in the work of preventive medicine as it applies to the school child and the pre-school child. It has been decided to appoint a whole-time dentist as from April 1st, 1931, to undertake the work now being done by three dentists working part-time. The arrangement with the Hornsey Central Hospital for the operative treatment of eases of enlarged tonsils and adenoids in school children is working satisfactorily. The orthopaedic scheme sanctioned in 1929 was begun in November, 1930, when the necessary accommodation became available at Topsfield Parade on the removal of the Education Office to 79, Crouch End Hill. Excellent work is being done. The question of building a permanent School Clinic to take the place of the unsuitable premises now occupied at Topsfield Parade has received careful attention. An ideal site for such a building has been secured at the rear of the "Town Hall site" in the Crouch End Broadway Grounds. Plans will be prepared for consideration in the near future. A considerable part of this Report is devoted to an attempt to explain Table iii of the statistical returns required by the Board of Education—the return of all "exceptional children" in the area —blind, deaf, mentally defective, epileptic and physically defective children of school age (5—16). I have also gone more or less fully into what I believe to be the most urgent problem which confronts Education Authorities in every part of the country—the problem of the delicate or physically sub-normal child. This is not in any sense a problem confined to "distressed areas." Reports of School Medical Officers indicate that it is present in every area. At the same time, I desire to direct attention to three steps taken during the year towards the solution of this difficult problem in Hornsey. 7 (1) There was a general extension throughout the schools of the scheme of the National Milk Publicity Council for the supply of 1/3 of a pint of milk daily in a sealed bottle with a straw. Towards the end of the year upwards of 2,600 school children were partaking of this milk daily at 10.30 a.m.—a most valuable practical lesson in the hygiene of food. (2) A system of monthly charting of weights and heights of all the children attending Coldfall School has been in operation since March, 1930. (3) A copy of Dr. R. W. P. Emerson's book "The Diagnosis of Health" (Constable, 1930, 10s. 6d.) has been supplied by the Education Authority to all Elementary Schools in the Borough for the use of the teaching staffs. This book is the best practical guide I know in the application of modern physiology to the solution of the problem of malnutrition and other unsatisfactory states of health. Preventive medicine in this country has too long concerned itself with the diagnosis of "the beginnings of disease." We have failed to grasp the simple truth that disease which has begun has not been prevented. Every success achieved in diagnosing "the beginnings of disease" should be recorded as a failure in prevention. We must regard the problem more from the point of view of positive health and less from the standpoint of disease. To all who are genuinely interested in this aspect of the maintenance of health I most heartily recommend Emerson's little book. I wish to express my appreciation of the helpful co-operation of all those concerned in promoting the health and physical wellbeing of the school children—the members of the Education Committee, staff of the Education Office, the Medical Profession, staff of the School Medical Service, the Head Teachers and their staffs, School Attendance Officers, Care Committees and parents. I am, Ladies and Gentlemen, Your obedient servant, R. P. GARROW. 8 The headings under which this Report is written are those suggested by the Medical Branch of the Board of Education for the guidance of School Medical Officers. 2—CO-ORDINATION. (a) With Infant and Child Welfare. An important step in securing closer co-ordination between medical supervision of the infant and pre-school children and the school child was the appointment of a whole-time Assistant Medical Officer. Dr. Edith Abbott took up the duties of this office on April 28th, 1930, and devotes three-tenths of her time to Maternity and Child Welfare, and seven-tenths to school medical work. (b) With Nursery Schools. There are no Nursery Schools in the Borough of Hornsey. The advocates of Nursery Schools believe there is need for a Nursery Class in Campsbourne and one at Coldfall. The Nursery School idea has been very freely discussed during 1930 in the literature of preventive medicine—no doubt as a result of the joint circular on the subject from the Ministry of Health and Board of Education addressed to Maternity and Child Welfare and Education Committees. (c) With Measures for the Care of Debilitated Children Under School Age. The Chief Medical Officer of the Board of Education in his Annual Report for 1929 on "The Health of the School Child" says:— "Yet more might be done in the supervision of the 'toddler' without invoking the more expensive and elaborate provisions mentioned above (i.e., Nursery Schools and Classes). There is no reason, for example, provided the Local Education Authority concurs, why, when parents are invited to routine inspection in the schools, they should not be encouraged to bring their younger children with them, and submit them for examination to the School Medical Officer." This suggestion has been adopted for trial in Hornsey. 9 The Authority's orthopaedic scheme, which came into operation towards the end of the year, is a joint scheme of the Education and Maternity and Child Welfare Committees, and applies therefore to all children from birth to school-leaving age. 3—SCHOOL HYGIENE. Muswell Hill—St. James' (Church of England). The hygiene of these school buildings has been greatly improved by work undertaken in 1930 for the better heating, lighting and ventilation of the school. The offices have been reconstructed and a hall has been provided. Crouch End and Holy Innocents' Schools. The premises of the Holy Innocents' School have been condemned by the Board of Education as being quite unsuitable for the purposes of a public elementary school. The Board have also reported that the Crouch End School buildings are unsatisfactory at the present time, but that they are capable of being altered and improved so as to fulfil modern requirements. The Education Committee's proposed Scheme for the Reorganisation of Schools provided for the discontinuance of the Holy Innocents' School and the reconstruction of the Crouch End School. The consideration of this scheme has been deferred by the Town Council pending the decision of Parliament with regard to the Education Bill for the raising of the school leaving-age. 4—MEDICAL INSPECTION. The arrangements for the routine medical inspection of the children are briefly as follows:— (1) The age groups inspected are "entrants" (age 5), "intermediates" (age 8) and "leavers" (age 12 and over). (2) The inspection covers the entire schedule of the Board of Education and includes a record of the date of inspection, standard and regularity of attendance, age, state of clothing and footgear, height, weight, nutrition, cleanliness, teeth, nose and throat, glands of neck, eyes, vision, ears, hearing, speech, mental condition, tuberculosis, rickets, deformities, spinal disease, infectious and contagious disease, heart and circulation, lungs, nervous disease and any other 10 disease or defect found by a complete and thorough examination of the child. (3) Parents are invited to attend this medical examination. A majority of the mothers and an occasional father turn up, and appear keenly interested in hearing the result of the medical survey of the child. The occasion is taken advantage of by the school doctor to offer such general advice on hygiene as the child's condition may suggest is necessary or advisable. The Head Teacher and school nurse are also present. 5—FINDINGS OF MEDICAL INSPECTION. Table ii is a statement of the defects found at medical inspection. The commonest defect is dental decay (779), followed in numerical order by defective vision and diseases of the eyes (413), deformities (199), anaemia (151) and skin diseases (138). 6—INFECTIOUS DISEASE. During October a group of cases of diphtheria occurred in connection with Crouch End Junior School. These were traced to infection from a child who had a mild illness in which no doctor was called in. Examination of this child's throat showed the presence of diphtheria bacilli. Exclusion and isolation of this carrier of the infection promptly brought the outbreak to a close. 7—FOLLOWING UP. Following up of children who are found at routine medical inspection or at the School Clinic to require treatment is done by the school nurses, who made 1,505 visits to the schools and 1,400 visits to the children's homes. Their work is effective, and accomplished with such kindness and consideration that there is no friction. 8—MEDICAL TREATMENT. The scheme of treatment undertaken by the Authority includes:— (a) The treatment of minor ailments, sores, skin diseases, blepharitis, etc., is done by the school nurses each evening at the School Clinic at Crouch End and each morning at the Centres at Brook Boad, Highgate, Coldfall and Wightman Boad. 11 (b) Cases requiring operation for the removal of adenoids and enlarged tonsils are referred by the School Medical Officer to the Hornsey Central Hospital. Every child operated on is kept in Hospital overnight or until the surgeon is of opinion it is safe for the patient to return to its home, where it is visited by a school nurse. (c) Cases with signs or symptoms suggestive of tuberculosis are sent to the Tuberculosis Officer of the County Council (Dr. Dobson). (d) Skin disease, and (e) External eye disease are included under the minor ailments treated daily by the school nurses under the supervision of the School Medical Staff. (f) Defects of vision are treated by the School Oculist (Dr. J. S. Boden), who devotes two sessions per week to this work. (g) Ear disease (otorrhœa) and defective hearing are treated by the Aural Specialist (Dr. A. R. Friel), who reports on his department of the work as follows:— "The outstanding event of the Aural Clinic in the present year has been the opportunity of examining the cases of deafness in school children which have been detected by Dr. Crowden, of the London School of Tropical Medicine and Hygiene, in a systematic testing he undertook of all the children in the Elementary Schools. This has been rendered possible by the use of an apparatus called an audiometer. It is a gramophone with a large number of headphones attached to it. Each headphone has only one earpiece, which is placed over the ear to be examined. Twenty-four children can be tested at once. The gramophone speaks 12 series of numbers; each series has three numbers, and each number three units. Thus the first series might be 836, 512, 791. The numbers are spoken with an intensity the same as a man speaking a few feet from the listener. The second series is spoken as if the man were at a greater distance, and so on to the last series. A child with sharp hearing and ordinary intelligence can write down correctly all the numbers of the 12 series. The numbers he cannot hear he cannot write down, and this failure gives a measure of his deafness. The percentage of children who were 12 discovered to have defective hearing in one or both ears was 6.5. These children were then sent to the Aural Clinic for examination. An endeavour was made to discover what was keeping them deaf, and also to determine whether something could be done for them. "Some of the patients showed extensive damage to the drum and middle ear by suppuration. This might be still present or have completely ceased. In those cases in which it was present treatment was given to arrest it and put a stop to further damage. Other cases of deafness showed inflammation in the nose and obstruction of the eustachian tube. Where the obstruction was due to congestion or to chronic catarrh of recent or moderate duration the treatment devised by Dr. Gautier, of Paris, and known as diastolisation, was given. "The introduction of the audiometer—an American instrument—into the schools as a routine method of testing quickly and accurately the hearing of large numbers of children is an important innovation and advance. It makes it possible to detect cases of slight deafness which might easily be overlooked. The doctors of the School Medical Service, as well the patients, are indebted to Dr. Crowden for the trouble he took in bringing the instrument forward and testing all the children. To know of the existence of a defect is the first step in remedying it." 13 TABULAR STATEMENT OF WORK OF AURAL CLINIC. Nature of Disease. Total. Cured. Lost sight of. Still under treatment. Needing or attending hospital. Acute suppurativa otitis media 11 11 — — — Chronic suppurative otitis media due to— (a) Tympanic sepsis 14 13 — 1 — (b) Tympanic sepsis + granulations 5 3 — 2 — (c) Tympanic sepsis + polypus 1 1 — — — (d) Tympanic sepsis + Cholecystectomy in tympanum 1 1 — — — Tympanic conditions + rhinitis 3 2 — 1 — + inflamed tonsils 1 1 — — — + external otitis 1 1 — — — Attic disease 4 — — 4 — Mastoid disease 12 1 — 5 6 External otitis 13 13 — — — Not diagnosed 1 1 — — — 67 48 0 13 6 (h) Dental defects are treated by three part-time dentists, who devote a total of ten sessions per week to this work. A wholetime School Dentist is about to be appointed in their place to commence duty on April 1st, 1931. (i) Crippling Defects—the orthopaedic scheme. The most important development in the treatment of school children during the year was the inauguration of an orthopaedic scheme jointly with the Maternity and Child Welfare Committee. Briefly the scheme includes:— (1) A local Orthopaedic Clinic equipped in the premises at 6, Topsfield Parade, recently vacated as an Education Office and now forming part of the School Clinic. 14 Here the Orthopaedic Surgeon, Mr Barnett, Resident Medical Superintendent of the Royal National Orthopaedic Hospital's Country Branch Hospital at Stanmore, conducts a clinic monthly for the examination of cases referred to him by the School Medical Officer. Here, also the Orthopædic Masseuse, Mrs. Yorke, conducts two sessions weekly for the treatment by massage, electricity and remedial exercises of those children for whom Mr. Barnett prescribes such treatment. This Clinic opened on November 7th. (2) An Orthopaedic Hospital. Cases considered by the Orthopaedic Surgeon to require operation or other treatment which can only be satisfactorily carried out in Hospital are admitted under his care to the Orthopaedic Hospital at Stanmore. 9—OPEN-AIR EDUCATION. The arrangements for sending delicate children away to residential schools and homes have been fully set out in a memorandum prepared by the Secretary of the Education Committee for the information of Members of the Care Committees, Head Teachers and others interested. This statement is reproduced here:— "Memorandum with regard to Holiday Homes and Schools of Recovery. Holiday Homes. The Children's Holiday Fund was established some years ago with the object of providing holidays for children who would not otherwise get them owing to the poverty of their parents. Since the 1st January, 1926, the number of children sent away through this Fund has been as follows:— 1926 81 1927 92 1928 83 1929 106 1930 102 15 Children have been sent at different times to all the undermentioned Holiday Homes, but the greater number of places are reserved at the Middlesex King Edward VII. Memorial Home, which was formerly situated at Heme Bay. Name. Address. Age and Sex of Children. Charge. The Middlesex King Edward VII. Memorial Home. Collington Manor, Bexhill. For boys and girls between 9 and 14 years of age. 35/- for two weeks, including railway fares. Arthur's Home (Shaftesbury Society). Aldwick Road, Bognor. For girls between 7 and 12 years of age." 10/- per week plus railway fares (4/2 return). The Princess Christian Holiday Home (Shaftesbury Society). Englefield Green, near Windsor. For boys between 7 and 12 years of age 10/- per week plus railway fares (1/2 return). The Herne Bay Home for Little Children (Shaftesbury Society). "Batesholme," Grand Drive, Heme Bay. For boys and girls between 5 and 7 years of age. 10/- per week plus railway fares (3/11 return). The usual holiday period is two weeks, and the children are selected by the School Medical Officer from among those recommended by the District Care Committees, Head Teachers or School Nurses. The School Attendance Officers interview the parents and obtain their signature to a form of consent, together with an undertaking to pay some small contribution towards the cost of the holiday. The amount of the contribution is approved by the Chief School Attendance Officer after receiving the visiting officer's report as to the family circumstances. Before they actually begin the holiday the children are again examined by the School Medical Officer or School Nurse in order to ensure that they are clean in person and clothing and free from infectious disease. On the day of departure the children assemble at the School Clinic and are taken to the London railway terminus by a school guide. During the period of the holiday the School Attendance Officers make personal ca}ls in order to collect the parents' contributions, and the amounts received are paid in to the Holiday Fund. 16 In a few urgent cases the children are sent to the Holiday Homes during the winter months, but the majority of the children are sent away between April and October. Full advantage is taken of the school holiday periods. In order to ensure that a sufficient number of places will be available for Hornsey children during the summer, it is necessary to book accommodation at the Holiday Homes months ahead. It is proposed, therefore, that the Children's Holiday SubCommittee should meet in March each year and allocate among the various schools the approximate number of holiday places available, having regard to the amount of the funds in hand on the 31st March. The Honorary Secretaries of the District Care Committees would then be informed of this allocation and invited to submit from time to time the names of the necessitous children from their respective districts recommended for holidays. This list would be prepared after consultation with the Head Teachers concerned and forwarded to the Secretary for Education. The children thus recommended would be examined in due course by the School Medical Officer, and lists of the children finally selected would be forwarded to the District Care Committees and the Head Teachers, together with particulars as to the place and time of the holiday in each case. Schools of Recovery. The Education Authority have entered into arrangements by which delicate children may be sent to the following Schools of Recovery for lengthy periods with the object of setting them up into a condition of permanent good health:— The Ogilvie Home and School, Clacton-on-Sea (for boys and girls between 7 and 12 years of age). The Russell-Cotes Home and School, Parkstone, Dorset (for boys and girls between 6½ and 14 years of age). The Middlesex King Edward VII. Memorial Home and School, Bexhill (for boys and girls between 9 and 14 years of age). N.B.—This institution is available as a school of recovery during the winter months only. During their stay at these Schools of Recovery the children are taught by trained certificated teachers, and the schools are recognised by the Board of Education as public elementary 17 schools. The names of children sent to these schools should therefore be temporarily removed from the registers of the schools previously attended. The children are selected by the School Medical Officer from among the cases noted by the doctors at the routine medical inspections or referred to him for special examination by the School Nurses or Head Teachers. The minimum period of a child's stay at a School of Recovery is six weeks, but this period is considerably extended if the resident Medical Officer so advises. The parents are required to contribute towards the expenses incurred by the Local Education Authority in respect of the child's maintenance. Convalescent Homes. A small number of delicate children are also sent away to Convalescent Homes each year by the various District Care Committees at their own expense. Education Office 12th December, 1930. 79, Crouch End Hill, N.8." 10—PHYSICAL TRAINING. There is no Area Organiser of Physical Training, but organised games and sports are played at all the schools and at the Playing Fields at Redston Road, Newlands Road and at Rokesly Avenue. The Coldfall Playing Fields will be taken into use during 1931. Mr. L. W. Gilbert, Hon. Secretary of the Hornsey Schools' Sports Association, has kindly furnished me with the following report:— "The activities of the Hornsey Schools' Sports Association have been continued, and in some respects extended, during the past year. Netball, tennis, athletics, cricket, football and swimming continue to play their parts, some fourteen separate competitions being organised. It is particularly pleasing to be able to record that the number of individual scholars taking part in the competitions has probably been greater during the past year than during any previous year in which the Association has been organised on its present basis. 18 Keenness, enthusiasm and good sportsmanship continue to show themselves. Hornsey's boys and girls continue to be trained to be good losers as well as good winners, and the games, played on those days of fresh air in the rain and the sun, are still doing what they can to contribute to the health and happiness of young Hornsey." 11—PROVISION OF MEALS. There are no arrangements for the provision of meals to school children, but there has been a gratifying extension of the scheme of the National Milk Publicity Council, which provides the school child with one-third of a pint of milk in a bottle with a sterile straw through which to drink the milk. The cost is one penny per bottle. Towards the end of the year upwards of 2,600 children were partaking of this daily ration of milk, all but a very small minority paying for it. 12—SCHOOL BATHS. The swimming bath at South Harringay School is available for children from all the elementary schools in the Borough between May and September. During these months it is visited by 2,000 per week. The Council's open-air swimming pool in Park Road is available to school children on special terms. Hornsey children also make use of the swimming bath of the Islington Borough Council in Hornsey Road. , Campsbourne.—In my last Annual Report I mentioned the provision of spray baths opened in June 1929 at Campsbourne School. This is proving to be a great boon, and might with advantage be extended to other schools. 13-16—CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. The closest co-operation exists of parents, teachers, School Attendance Officers and Care Committees, not only in facilitating the work of medical inspection, following up and treatment, but in everything that promotes the health and physical well-being 19 of the school children. The mothers come to medical inspection in a high proportion of pases; the Head Teachers are always present at medical inspection; the Chief School Attendance Officer attends the School Medical Officer's special clinic weekly; Head Teachers, the School Medical Officer and Chief School Attendance Officer attend the monthly meetings of the Care Committees. 17—BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN—TABLE III. Ascertainment of Exceptional Children.—The School Medical Officer has no more difficult or responsible duty than the ascertainment of children who are defective within the meaning of Part V. of the Education Act, 1921. Table III. at the end of this Report is the annual return of these ''exceptional children" in the form prescribed by the Board of Education. In order to assist members of the Education Authority to appreciate fully the importance of this table, I have appended to it certain "Notes on Table III." which the Board furnish to School Medical Officers to guide them in the work of compiling the table. Particular attention is directed to the following considerations:— (1) The table represents the number of defective children on the last day of the calendar year. (See note a.) (2) The definitions of blind, deaf, defective and epileptic children should be very carefully borne in mind. (See note a.) In each category the defect (physical or mental) is of such a degree as to render the child "incapable of receiving proper benefit from the instruction in the ordinary public elementary schools." (3) Note (c) make it quite clear that none of the children in Table III. (except children suffering from epilepsy which is not severe) should, in fact, be attending public elementary schools. They are children who, in the opinion of the School Medical Officer, are so defective as to be "incapable of receiving proper benefit from the instruction in the public elementary schools," and should therefore be admitted to Special Schools. The form of the table, with its headings and sub-headings, together with the 20 explanatory notes, indicates that the Board's intention is that Table III. should be the basis upon which the Authority considers the need for provision of Special Schools for the different categories of mentally and physically defective children in its area. For this reason alone the table is, in a sense, the most important of the tables compiled annually by School Medical Officers and submitted by them to their Authorities and to the Board. Blind.—There is generally no difficulty in determining whether a child is "totally blind or so blind that he can only be appropriately taught in a school or class for totally blind children." There is also no room for doubt that a blind child requires education in a Special School for blind children. The chief causes of total blindness are (1) congenital defects of the eyes and (2) the condition called "Ophthalmia neonatorum," which if not adequately treated, destroys the newborn infant's eyes in a few days. The more effective prevention, and the more adequate treatment of this condition when it occurs, is causing a steady diminution of the numbers of totally blind children. The sub-group, "partially blind," includes two classes of visual defects:— (a) Children suffering from some disease or defect of the eye, such as scarring of the cornea, which so interferes with vision that the child cannot read ordinary school books. There can be no doubt about the wisdom of sending such children to a special school or class for the partially blind. (b) Children whose eyes show the error of refraction, called myopia—that is, short-sighted children or myopes. Myopia is a defect of the eyes which may appear in early childhood, and tends to increase during school life. In rare cases (malignant myopia) it leads to partial or total blindness. Special schools or classes for partially blind children may include children of class (a) only or class (b) only, or (a) and (b) together. Classes for myopes are sometimes called "sight-saving classes" on the ground that the special education provided tends to retard the progress of the myopia. That, indeed, is the object 21 of the myope class. The sight-saving class regime is based on the theory that the eye-strain involved in reading and other close work tends to accelerate the progress of the myopia. This theory is not, however, universally accepted. The other school of thought on myopia regards it as an inherited condition of the eyes which progresses to a degree determined more or less by the hereditary factor, and influenced not so much by the amount of close work done as by the general health of the myope. A firm believer in, and clear exponent of, this latter view is Mr. T. Harrison Butler, Surgeon to the Birmingham and Midland Eye Hospital and School Oculist, Coventry Education Authority. He writes in the Annual Report of the School Medical Officer, Coventry, 1929 (page 145), as follows:— "I cannot here go into the vexed question of the cause of myopia. I do not believe that the use of the eyes has anything to do with it. I constantly find a history of myopia in the forebears, and believe that the true cause is a hereditary weakness in the scleral coat of the eye, which is aggravated by malnu[???]tion and toxic influences of all kinds. I find that not only do [???]requently obtain actual evidence of hereditary short-sight, but the final degree of short-sight can often be foretold by a study of the myopia of the relations. If, for example, the mother has seven degrees of myopia it is probable that her myopic child will reach approximately this figure." He furnishes graphs showing an increase in the incidence of myopia in elementary and secondary school children in Coventry following the industrial troubles of 1926, and says:— "There can be little doubt that the variation of the curves represents an alteration in general health conditions. The myopic curve is a nutrition curve. During the boom period after the war wages were high, and the nutrition of working-class children was good. The year 1926 began the period of increasing unemployment, with the inevitable result, diminishing comfort in the home, insufficient and improper food for many children." (The italics are Mr. T. Harrison Butler's.) The same authority, writing on "Ophthalmic School Clinics" in "Public Health," 1929 (page 251), says:— "High degrees of astigmatism and myopia, and, in older children, hypermetropia, result in defective vision. A child who 22 cannot see well will not develop along exactly the same lines as one with full acuity. He cannot see his friends across the street and does not develop the wish to recognise them. As time goes on he becomes what the Americans call a "bad mixer," introspective and, perhaps, 'even more selfish than the majority of his fellows. Visual defects and the absence of binocular vision associated with squint do not tend to proficiency in ball games, and here again fall social intercourse is hindered. On the other hand, the myope, enjoying a contracted sphere of clear vision, is more likely to cultivate his brain than his muscles, and, unless his education has been stunted in a myope school, may become one of the world's thinkers." These conflicting views are quoted so that members of the Authority may appreciate the difficulty of deciding whether a child should attend an ordinary elementary school or a special school. Deaf.—No difficulty arises in determining whether a child is totally deaf or deaf and dumb, and no one doubts the advisability of sending such children to special schools for the deaf. The question is not so easy in regard to the partially deaf. It must always be a matter of difficulty to settle the degree of deafness which should determine the admission of a child into a special school or class for partially deaf children. Loss of hearing has been the subject of an extensive investigation in Hornsey elementary school children during 1930 by Dr. Crowden, Lecturer in Physiology at the London School of Hygiene and Tropical Medicine. Mentally Defective.—The accurate ascertainment and correct classification of all the mentally defective children in the area is not an easy matter, but this subject has been actively pursued in Hornsey for many years, and I believe the figures presented in Table III. under this heading are correct, in spite of the fact that they do not correspond with the average incidence of mentally defective children in the country as a whole. The number of uneducable mentally defective children notified to the Middlesex County Council during the year 1930 is four, and the total number of defectives so notified in the last 10 years and still alive is 25. 23 The educable mentally defective children (i.e., the feebleminded) are provided with special education at Oak Lodge, the joint special school for Hornsey, Finchley and Wood Green. The uneducable defectives are cared for at the Occupation Centre, Staffordshire Hall, Wood Green. Epileptics.—The diagnosis of epilepsy depends usually on a history provided by parents or teachers that a child has fits of a particular character. Attacks of major epilepsy, or severe fits ("grand mal") are regarded as ground for exclusion of a child from the ordinary elementary school and admission to a special school for epileptics. Children subject to slight attacks or "petit mal" are regarded as suitable for attendance at the ordinary elementary school. Physically Defective Children.—The last of the notes on Table III. (note h) says: — "The exact classification of the physically defective is admittedly a matter of difficulty. Valuable information, however, will be obtained if School Medical Officers will record these defective children as accurately as possible under the selected sub-headings, taking care that no child is entered under more than one sub-heading." Although there are five sub-divisions of the physically defective, they might be considered as falling naturally into three groups, namely:— (a) Tubercular children, (b) Cripple children, (c) Delicate children. (a) Tubercular Children.—The main facts about tuberculosis in children are now well known. Two forms of the disease infect man—the human infection and the bovine. These may attack any organ or tissue of the body producing pulmonary tuberculosis or consumption, and non-pulmonary tuberculosis or, as it is sometimes called, "surgical tuberculosis" (bones, joints, glands, etc.) The important fact to bear in mind about tuberculosis from the point of view of school medicine is the widespread nature of the infection throughout urban communities. Tests carried out with tuberculin on children at different ages show a progressive increase of positive reactions from infancy onwards, until at school-leaving age 24 about 90 per cent. of adolescents show evidence of "tuberculisation," or infection with tubercle bacilli. Only a small proportion of these ever develop tuberculosis. Thus, though the disease, tuberculosis, is steadily diminishing in its incidence on the community, there is no evidence that the infective agent is any less disseminated throughout the populations of towns. The ultimate eradication of this great scourge may, indeed, be through a naturally acquired racial immunity—a state of "universal tuberculisation with tuberculosis." If this modern conception of tuberculosis is correct, it indicates that further progress will be achieved, not so much by attempts to prevent children being infected as by taking measures to ensure the development of a sound and permanent immunity response to tuberculisation. Of these the most important is sound nutrition. Definite cases of tuberculosis in children of school age are now few and far between. The total of 8 cases entered in Table III. has been arrived at after careful consideration of the records in consultation with Dr. Dobson, Tuberculosis Officer of the Middlesex County Council. (b) Cripple Children.—Under this heading are included all children with any physical defect of body, or limbs, or heart severe enough to make attendance at an ordinary elementary school a matter of difficulty or danger for the child. The present number of cripples is 14, of whom 3 are at Certified Residential Cripple Schools, 4 at Certified Day Cripple Schools, and 7 at other Institutions. In addition to these there is a number of children in the elementary schools who are technically crippled, but whose crippling defect does not call for special school provision. Examples of these are—healed tubercular disease of bones or joints, leaving stiffness of a joint, or possibly some shortening of a leg, causing the child to walk with a limp; old infantile paralysis, leaving a weak arm or leg: or accidents causing loss of a limb, and so on. These children are kept under special observation by the School Medical Staff, get such treatment as may be required under the orthopaedic scheme, and do perfectly well in the ordinary elementary school. 25 (c) Delicate Children.—Lastly we come to the sub-heading of Table III., "Delicate Children"—which is perhaps the cause of more confusion and misunderstanding than all the other categories together. What exactly is a "delicate child"? The definition given in the table is "pre or latent tuberculosis, malnutrition, debility, anaemia, etc." What is "pre or latent tuberculosis"? We have learned that a large proportion—up to 90 per cent.— of adolescents undergo the process of tuberculisation or infection with tubercle bacilli. Every such child who is not manifestly suffering from tubercular disease may, in a sense, be regarded as in the state of "pre or latent tuberculosis." But clearly that is not the intention so far as Table III. is concerned, otherwise a majority of the children in the elementary schools would be suitable candidates for special schools. It is now generally considered that "pre or latent tuberculosis" is a meaningless term which should disappear entirely from the literature of medicine as did "struma" and "scrofula," two terms in common use before Koch's discovery of the bacillus of tuberculosis in 1882. Almost equally vague and indefinable are the terms "malnutrition, debility, ana?mia, etc.," although, in practice, it is not difficult to detect the unsatisfactory state of health which these terms are intended to indicate. The important thing to recognise about this considerable group of children is that the causes of their condition are chiefly inadequate rest and insufficient or improper food. If these causes were removed the condition of a majority of the "delicates" would be satisfactory. Therefore, to classify them as "physically defective" is misleading. It is true that the term "physically defective" may be used in the wide sense to include all children the subjects of physical defect or defective physique. But the meaning usually attached to physically defective is the condition of being handicapped or crippled by some obvious physical deformity. It would be less confusing to classify this group in a separate table as physically sub-normal children. I have referred to them as a considerable group of children —they represent from 5 per cent. to 10 per cent. at least of 26 the elementary school children in all areas, the exact percentage depending on the standard of nutrition and physique taken as normal or satisfactory. The number entered in Table III. is 9, all of whom were at Certified Residential Open-air Schools on December 31st, 1930. The explanation of this apparent contradiction is that, though I am fully aware of the existence of "delicates" in considerable numbers in the elementary schools, I am unable to say that these children are "so physically defective as to be incapable of receiving proper benefit from the instruction in ordinary elementary schools." Indeed, I do not believe that the provision of special schools is the best method of dealing with the general problem of malnutrition and debility and anaemia in school children. The best way is sound feeding. Just as modern developments in orthopaedics and their application in properly organised schemes to school children have rendered the school for cripple children unnecessary, except in the very large cities, so I believe that a nutrition campaign would so improve the physique of the children as to render special schools for delicate children unnecessary. A Nutrition Campaign. The principles upon which a nutrition campaign should be conducted are— (1) That the most important factors in the maintenance of good health and sound physical development are:—(a) Good food; (b) adequate rest; (c) exercise; (d) fresh air. (2) That the most important of these are good food and adequate rest, and if these are secured for the growing child he will naturally take sufficient exercise, and in doing so will get plenty of fresh air. (3) That good food means fresh milk, eggs and butter, fresh meats of all sorts (including beef, mutton, veal, liver, fish, fowl), bread and other cereal foods, fresh fruits and vegetables, including such raw vegetables as carrot, turnip, radish, etc. (4) That it is unnecessary and indeed undesirable that the diet of healthy persons, and more particularly of children, should include patent or proprietary or tinned foods, or food extracts, or concentrated vitamins. 27 This campaign should be directed towards the expectant mother, the nursing mother, the infant, the toddler and the school child right on to late adolescence or the end of the growing period. The immense volume of recent work on growth and nutrition in relation to diet and health all points in the same direction. It would be impossible in the course of a short report to summarise or quote from the important researches published in recent years, but there is one volume which deserves to be specially studied by all who are interested in the practical application of the newest knowledge of nutrition to the problems of preventive medicine. It is "The Diagnosis of Health," by W. R. P. Emerson (Constable, 1930). A copy of this book has been furnished to every elementary school in the borough for the use of the teaching staffs. The system described by Emerson for the cure of malnutrition amongst school children is the formation of "Nutrition Classes" in the ordinary schools. The organisation and procedure of the nutrition class is outlined in Chapter XI. of his book. Remarkable results were obtained by this system; e.g., in Rochester, N.Y., fifteen hundred children in public, private and parochial schools—under weight and in many cases still losing weight—were enabled in their own homes and while carrying on their regular school work, to make an average gain of more than three times the amount expected of children of their age. I do not suggest that the exact methods adopted by Emerson in America are suitable for conditions of school life in England, but I am convinced that equally striking results would follow the adoption of a nutrition programme modified to suit local conditions. I believe that malnutrition in children attending the elementary schools of this Borough could be practically abolished by a concerted effort of the kind indicated. I am equally convinced that without such an effort malnutrition will remain the chief physical defect in the elementary school population. A successful nutrition campaign would bear fruit in many directions and be a contribution to the solution of many problems in preventive medicine, for example:— (1) It would practically eliminate the weak, thin, pale, anæmic, debilitated child. 23 (2) It would abolish rickets and the deformities of the chest and limbs resulting from this food-deficiency disease. (3) It would help materially in the formation of sound teeth resistent to decay. (4) It would be an important factor in the control and eradication of tuberculosis. (5) It would increase the resistance of the community to infection of various kinds and reduce complications and sequel® of infectious diseases. (6) External eye diseases—blepharitis—and septic conditions of the skin would be diminished in incidence and more readily cured. (7) It would be a big factor in abolishing rheumatic infection, with its serious train of heart complications and sequelae. (8) By assisting in full skeletal development in girls it would tend to reduce difficult labour and by increasing the natural resistance to infection it would prevent puerperal fever. In both of these ways it would reduce maternal mortality and morbidity. (9) Recent observations already quoted in this report suggest that myopia is a condition which, in its progress, is sensitive to the state of the nutrition of the myope. (10) Recent work on the relation of adenoids and enlarged tonsils to rickets suggests that nutrition is an important factor in enlargement of tonsils and adenoids. (11) Mens sana in corpore sano—a well-nourished body is essential to mental health. In these and possibly in other ways a successful nutrition campaign would be in the strictest and best sense "preventive medicine," and would contribute materially to an improvement of the public health. A splendidly successful beginning has been made by the adoption of the National Milk Publicity Council's scheme for the distribution of one-third of a pint of pasteurised milk daily to each child who pays one penny for it. This is not so much a scheme for the feeding of school children or the provision of school meals as a lesson in the hygiene of food and dietetics. The daily bottle of milk consumed by over 2,600 children in the elementary schools teaches—(1) That cows' milk is a good food 29 for growing children; (2) that cold milk taken slowly does not chill the stomach; (3) that the milk supply of Hornsey as delivered in bottles is a safe food. I desire to acknowledge the great value of the extra work willingly undertaken by the head teachers and their staffs in supervising the daily milk distribution; the help rendered by the Care Committees in regard to necessitous children; and the invaluable service rendered by His Worship the Mayor in raising a special milk fund to enable the Care Committees to see that no child has to go without his daily milk in school because of inability of his parents to pay for it. Summary and Conclusions regarding Table III. I have gone somewhat fully into the return of exceptional children set out in Table III. at the end of this Report. Unless the various categories of defective children who make up the numbers in this return are clearly defined and thoroughly understood, the table may be a very misleading one both to the Education Authority and to the Board of Education. I have also discussed the ways in which some classes of defectives may be dealt with—more particularly the class of physically defective children described as " delicate." The special school as a means of dealing with this class has three serious objections:—(1) It is limited in its scope by the number of places provided in the special school; (2) its results are obtained without the efforts or co-operation of the mothers; (3) it involves a relatively heavy expenditure of public money. On the other hand, a nutrition campaign is unlimited in scope and should embrace not only every delicate or subnormal child, but all children. It should aim at securing the intelligent interest and co-operation of the parents, and more particularly of the mother. Its main object is to secure a more effective spending of private money on the family food budget rather than the expenditure of public funds in the extension of social services. 18—NURSERY SCHOOLS. There are no nursery schools in the Borough. 30 19.—SECONDARY SCHOOLS. Medical inspection of children attending Secondary Schools in the Borough is delegated by the Middlesex County Council to the Hornsey Education Authority. The work is carried out by private practitioners in the boys' departments, and in the girls' departments by the Assistant School Medical Officer, all under the general supervision of the School Medical Officer, who submits the results to the County School Medical Officer. No provision is made for treatment. 20 —CONTINUATION SCHOOLS. No provision is made for medical inspection or treatment of pupils in attendance at Continuation Schools. 2 1—EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. The Juvenile Employment Office is in the Education Offices at 79, Crouch End Hill. The Juvenile Employment Committee meets there on the same evenings as the Central Care Committee. Both of the Committees are attended by the School Medical Officer, whose advice is available on medical matters. The district being almost purely residential, there are no conditions of employment detrimental to the health of children and young persons in the area. 22—SPECIAL ENQUIRIES. Dr. Crowden, Lecturer in Physiology in the London School of Hygiene and Tropical Medicine, conducted a very interesting and instructive special enquiry into loss of hearing in the Elementary Schools of the Borough by means of the gramophone audiometer. 23—MISCELLANEOUS. Medical examination of new teachers is carried out by the School Medical Officer at the time of their appointment. Occasionally also he furnishes a report at the request of the Committee in the case of prolonged absence of a teacher from duty on account of ill-health. Scholarship candidates are specially examined medically if there is any reason to doubt their physical fitness to undertake secondary education. 31 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 1.—Minor ailments (excluding uncleanliness). Group 11.—Defective vision and squint (excluding minor eye defects). Group 111.—Treatment of defects of nose and throat. Group IV.—Dental defects. Group V.—Uncleanliness and verminous conditions. ,, V.—List of Schools in the Borough. ,, VI.—Return of children inspected at each school. 32 TABLE I.—RETURN OP MEDICAL INSPECTIONS, 1930. (a) Routine Medical Inspections. Number of Code Group inspections— Entrants 1.016 Intermediates 1.304 Leavers 454 Total 2.774 Number of other routine inspections 177 (b) Other Inspections. Number of special inspections 1.292 Number of re-inspections 2.490 Total 3.782 33 TABLE II. (A)—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1930. Defect or Disease. Routine Inspections Special Inspections. No. of Defects. No of Defects. Requiring treatment. Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment. (1) (2) (3) (4) (5) Malnutrition – 38 1 – Uncleanliness 76 – – – (See Table IV, Group V). Skin Ringworm, scalp — — 1 – ,, body — — 2 – Scabies — — 14 – Impetigo – — 39 – Other Diseases (Non-tuberculous) 1 2 72 – Eye Blepharitis 6 — 8 – Conjunctivitis – — 24 – Keratitis – — 1 – Corneal Opacities – — — – Defective Vision (excluding Squint) 155 – 97 – Squint 17 — 35 – Other Conditions 3 — 73 – Ear Defective Hearing 4 — 1 – Otitis Media 10 — 20 – Other Ear Diseases — — 23 – Nose and Throat Enlarged Tonsils only 2 33 30 – Adenoids only — 2 – – Enlarged Tonsils and Adenoids 1 7 12 – Other Conditions 8 5 54 – Enlarged Cervical Glands (Non-tuberculous) – 4 1 – Defective Speech 1 1 – Teeth—Dental Diseases 779 – 3 – (See Table IV., Group IV.) Heart and Circulation Heart Disease Organic — 1 – 2 Functional — 16 – 7 Anaemia — 46 105 – Lungs Bronchitis — 7 3 – Other Non-tuberculous Diseases — 2 4 — Tuberculosis Pulmonary: Definite – – — – Suspected – 1 2 – Non-Pulmonary: Glands – 1 — – Spine — – — – Hip — — — – Other Bones and Joints — — — – Skin – — — – Other forms – — – – Nervous System Epilepsy — — 2 – Chorea — — 3 – Other conditions — 1 12 – Deformities Rickets 1 2 2 – Spinal Curvature 1 3 – – Other Forms 33 147 10 – Other Defects and Disease 2 16 576 – 34 TABLE H—(oontd.). (B)—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) (3) (4) Code Groups:— Entrants 1,016 33 3.2 Intermediates 1,304 135 10.4 Leavers 454 46 10.1 Total (code groups) 2,774 214 7.7 Other rontine inspections 177 28 15.8 35 TABLE III.—RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. (See Note A.). Boys Girls Total Blind (including partially blind). (See note b) (i) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind – 2 2 Attending Public Elementary Schools (see note c) – – – At other Institutions — — — At no School or Institution — — — (ii) Suitable for training in a School or Class for the partially blind Attending Certified Schools or Classes for the Blind 4 3 7 Attending Public Elementary Schools (see note c) At other Institutions — — — At no School or Institution — — — » Deaf (including deaf and dumb and partially deaf). (See note d) (i) Suitable for trainin g in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf ... 3 5 8 Attending Public Elementary Schools (see note c) — — – At other Institutions — — — 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 (see note c) — — – At other Institutions — — — At no School or Institution — — — Mentally Defective. Feebleminded (cases not notifiable to the Local Control Authority.) (See note e) Attending Certified Schools for Mentally Defective Children 14 16 30 Attending Public Elementary Schools (see note c) – – – At other Institutions — — — At no School or Institution — — — Notified to the Local Control Authority during the rear. Feeble-minded 1 – 1 Imbeciles 2 1 3 Idiots – – – Epileptics Suffering from severe epilepsy. (See note f) Attending Certified Special Schools for Epileptics – – – In Institutions other than Certified Special Schools – – – Attending Public Elementary Schools (see note c) – – – At no School or Institution 1 2 3 Suffering from epilepsy which is not severe (See note g) Attending Public Elementary Schools (see note c) 3 4 7 At no School or Institution – – – 36 TABLE III —(contd). Boys Girls. Total Physically Defective Infectious pulmonary and glandular tuberculosis. (See note h) AtSanatoria or Sanatorium Schools approved by the Ministry of Health or the Board – – – At other Institutions — — — At no School or Institution — — — Non-infectious but active pulmonary and glandular tuberculosis. (See note h) AtSanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 – 1 At Certified Residential Open Air Schools – – – At Certified Day Open-air Schools – – – At Public Elementary Schools (see note) 3 – 3 At other Institutions – 1 1 At no School or Institution – — – Delicate children (eg , pre-or latent tuberculosis, malnutrition, debility, anaemia, etc ) (See note h) At Certified Residential Open-air Schools 5 4 9 At Certified Day Open-air Schools – – – At Public Elementary Schools (see note c) – – – At other Institutions – – – At no School or Institution – – – Active nonpulmonary tuberculosis. (See note h) At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board At Public Elementary Schools (see note c) At other Institutions At no School or Institution 1 – 1 – – – 2 – 2 — – — Crippled children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease. (See note h) At Certified Hospital Schools – – – At Certified Residential Cripple Schools 2 1 3 At Certified Day Cripple Schools 4 – 4 At Public Elementary Schools (see note c) — – — At other Institutions 2 5 7 At no School or Institution — — — 37 "NOTES ON TABLE III." (a) This Table is a return of all children in the area for whom the Local Education Authority are responsible and who (except in the case of children suffering from epilepsy which is not severe) have been ascertained to be blind, deaf, defective or epileptic within the meaning of Part V. of the Education Act, 1921. It is the statutory duty of every Local Education Authority formally to ascertain all defective children in their area irrespective of the actual provision now made for their Instruction in Special Schools. It is assumed that every Authority will have a complete list of such children compiled from returns made continuously during the year and kept constantly up to date. In order to secure uniformity, Authorities are requested to make up this Table from their list of defective children as it stands on the last day of each calendar year. Children who are living in residential schools in the area but who come from other areas should not be included in this Table; but children should be included who are living in residential schools outside the area and who are being maintained there by the Authority. For the purpose of this Table, no child should be included whose defect has not been ascertained by the School Medical officer or a medical member of the Authority's staff. The definitions of defective children as given in the Act are as follows and must be very carefully borne in mind. A blind child is a child who is too blind to be able to read the ordinary school books used by children. A deaf child is a child who is too deaf to be taught in a class of hearing children in an elementary school. Mentally and physically defective children are children who, not being imbecile and not being merely dull and backward, are defective, that is to say, children who by reason of mental or physical defect are incapable of receiving proper benefit from the instruction in the ordinary public elementary schools, but are not incapable by reason of that defect of receiving benefit from instruction in such special classes or schools as under Part V. of the Act may be provided for defective children. Epileptic children are children who, not being idiots or Imbeciles, are unfit by reason of severe epilepsy to attend the ordinary public elementary schools. (b) For the purpose of this return the Board require that children who are blind within the meaning of the Act should be divided into two categories, i.e., (1) those who are totally blind or so blind that they can only be appropriately taught in a school or class for totally blind children, and (2) those who, though they cannot read ordinary school books, or cannot read them without injury to their eyesight, have such power of vision that they can appropriately be taught in a school or class for the partially blind. It should be understood that children who are able by means of suitable glasses to read the ordinary school books used by children without fatigue or injury to their vision, should not be included in this Table. (c) It should be understood that none of the children in this Table (except children suffering from epilepsy which is not severe) should in fact be attending public elementary schools. When the heading is retained, it is merely because at present the insufficiency of Special School accommodation makes it impossible to do better for some defective children than to allow them to attend the ordinary school. No space is left for the entry of children with infectious pulmonary tuberculosis attending public elementary schools, as these children should of course be promptly excluded from such schools. id) Children who are deaf within the meaning of the Act should be classified for the purpose of this Table as (1) totally deaf or so deaf that they can only be appropriately taught in a school or class for the totally deaf, and (2) partially deaf, i.e.. those who can appropriately be taught in a school or class for the partially deaf. (e) This category includes only those children for whose education and maintenance the Local Education Authority are responsible, and who are not eligible for notification to the Local Control Authority under the Mental Deficiency Act. (/) In this part of the Table only those children should be included who are epileptic within the meaning of the Act. For practical purposes the Board are of opinion that children who are subject to attacks of major epilepsy in school should be recorded as "severe" cases and excluded from ordinary public elementary schools. (g) In this part of the Table should be entered the remainder of the epileptic children in the area. i.e., children whose disease is of such a kind as not to unfit them for attendance at an ordinary public elementary school. (h) The exact classification of physically detective is admittedly a matter of difficulty. Valuable information, however, will be obtained if School Medical Officers will record these defective children as accurately as possible under the selected sub-headings, taking care that no child is entered under more than one sub-heading. 38 TABLE IV. (A)—RETURN OP DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1930. TREATMENT TABLE Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.). DISEASE OR DEFECT. Number of defects treated or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. 1 (2) (3) (4) Skin— Ringworm, Scalp 1 – 1 Ringworm, Body 2 – 2 Scabies 14 – 14 Impetigo 90 – 90 Other Skin Diseases 98 – 98 Minor Eye Defects (External and other, but excluding cases falling in Group II). 23 – 23 Minor Ear Defects 20 – 20 Miscellaneous (e.g., minor injuries, bruises sores, chilblains, etc.) 464 – 464 Total 712 – 712 39 TABLE IV.—(contd.). Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. (1) Number of defects dealt with. Under the Authority's scheme. (2) Submitted to refraction by private practitioner or at hospital.apart from the Authority's scheme. (3) Otherwise. (4) Total. (5) Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report). 363 56 — 419 Other Defects or Diseases of the eyes (excluding those recorded in Group 1). 114 — — 114 Total 477 56 — 633 Total number of children for whom spectacles were prescribed (a) Under the Authority's scheme 407. (4) Otherwise—0. Total Number of children who obtained or received spectacles (a) Under the Authority's scheme 380. (4) Otherwise—0. Group III.—Treatment of Defects of Nose and Thi oat. Number of Defects. Received Operative treatment. Received other forms of treatment. (4) Total number treated (5) Under the Authority's scheme, in clinic or hospital. (1) By private practitioner or hospital, apart from the Authority's scheme. (2) Total. (3) 34 0 34 62 96 40 TABLE IV.—(contd.). Group IV.—Dental Dejects. (1) Number of Children who were— (a) Inspected by the Dentist:— Aged Routine Age Groups 5 258 6 405 7 408 8 371 9 327 10 451 11 300 12 254 13 313 14 195 15 89 Total 3.371 Specials 850 Grand Total 4,221 (b) Found to require treatment 2,927 (c) Actually treated 1,908 (d) Re-treated during the year as the result of periodical examination 526 (2) Half-days devoted to.. Inspection 21 Treatment 394 Total 415 (3) Attendances made by Children for treatment 5,398 (4) Fillings Permanent teeth 1,469 Temporary teeth 942 Total 2,411 (5) Extractions Permanent teeth 470 Temporary teeth 3,804 Total 4,274 (6) Administration of general anaesthetics for extractions 1,464 (7) Other operations Permanent teeth 471* Temporary teeth 47 Total 518 * This figure chiefly represents attendances for regulation work. Group V.—Uncleanliness and Verminous conditions. (i.) Average number of visits per school made during the year by the School Nurses—60. (ii.) Total number of examinations of children in the schools by School Nurses—28,393. (iii.) Number of individual children found unclean—477. (iv.) Number of children cleansed under arrangements made by the Local Education Authority—169. (v.) Number of cases In which legal proceedings were taken— (a) Under Education Act, 1921—Nil. (b) Under School Attendance Byelaws—Nil. 41 TABLE V. LIST OF SCHOOLS IN THE BOROUGH. School. Department. Authorized accommodation. Average No. on the Rolls for yr. ended 31/12/30. Muswell Hill Junr. Mixed 200 126 St. Michael's Mixed 196 127 „ Junr. Mixed 168 128 Highgate Mixed 328 239 „ Junr. Mixed 264 162 North Harriugay Boys' 380 376 „ „ Girls' 380 332 „ „ Junr. Mixed 416 409 South Harringay Mixed 440 437 „ „ Infants' 240 221 Stroud Green Boys' 350 360 „ „ Girls' 350 336 „ „ Infants' 352 279 St. Mary's Mixed 428 425 „ Infants' 232 254 Crouch End Boys' 456 299 „ „ Girls' 450 263 „ „ Junr. Mixed 411 317 Holy Innocents' Iufants' 101 103 St. James' Junr. Mixed 240 305 Campsbourne Boys' 388 348 „ Girls' 388 319 „ Infants' 400 342 Coldfall Mixed 440 432 „ Infants' 400 288 Totals 8,398 7,227 42 TABLE VI.—ROUTINE MEDICAL INSPECTION, 1930. 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 13 6 11 7 4 7 9 8 5 7 1 2 — — — — — — — — — — 43 37 80 St. Michael's 21 7 12 7 6 9 12 13 15 — 8 — 2 3 7 4 4 11 — 1 — — 86 55 141 Highgate 1G 18 15 21 10 5 24 18 16 18 4 5 2 3 10 11 9 12 — — 1 — 107 111 218 North Harringay 47 36 27 34 9 6 44 39 9 27 6 7 1 1 27 28 4 11 28 6 6 10 208 204 412 South Harringay 25 23 13 22 7 6 29 27 16 9 3 7 — 2 11 9 6 9 7 9 3 1 120 124 244 Stroud Greeu 36 25 17 14 9 8 53 36 7 17 5 12 3 6 28 23 2 18 19 15 4 12 183 186 369 St. Mary's 33 30 36 24 13 18 42 45 33 34 5 5 1 2 8 19 17 12 — 5 1 5 189 199 388 Crouch End 33 32 18 12 9 6 57 45 8 8 3 4 1 2 18 21 5 3 16 7 1 4 169 144 313 Holy Innocents' 16 7 14 6 3 4 — — — — — — — — — — — — — — — 33 17 50 St. James' 11 9 11 12 7 5 7 15 13 15 3 5 — 1 5 8 3 4 — — — 60 74 134 Campsbourne 51 43 15 7 7 4 67 60 4 6 2 4 1 4 25 26 2 3 4 3 — 1 178 161 339 Coldfall 46 34 23 20 5 8 35 34 8 8 — 1 1 — 17 11 2 1 2 3 2 2 141 122 263 Total 348 270 212 186 88 86 379 340 134 149 40 52 12 24 156 160 54 84 76 48 18 35 1,517 1,434 2,951 1,016 1,304 454 177