I (4396) HORWSEY HOR 02 BOROUGH OF HORNSEY. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR 1931. R. P. GARROW. M.D., D.P.H. HOR 023 Borough of Hornsey ANNUAL REPORT for 1931 of the Medical Officer of Health. “The Hornsey Journal.” Ltd. 161, Tottenham Lane, Hornsey, N.8. INDEX. Acts in force, 13. Admissions to Hospital, 48. Ambulances, 14. Ante-natal Clinics, 38, 39, 40, 52. Area of Borough, 9. Attack rate, infectious disease, 49. Bacteriological examinations, 13. Bakehouses, 24. Baths and Wash-houses, 26. Births and rates, 9, 13, 16, 43, 47. Borough Nursing Association, 12. Butchers, 24. Bye-laws in force, 13, 25. Cancer deaths, 47. Carbide, 33. Cellulose spirit, 33. Census, 5, 9. Cerebro-spinal meningitis, 49. Charity expenditure, 11. Children Act, 1908, 16, 52. Cinemas, 24. Cleansing station, 36. Clinics, 15, 38, 39, 40, 52. Committees, 1, 2, 38, 39. Dairies, 24, 28. Deaths and rates, 5, 9, 43, 47. Causes of, 44, 45. Dental scheme and treatment, 41. Diarrhoea, 10, 47. Diphtheria, 13, 47, 48, 49. Diseases of Animals Acts, 37. Disinfection, 36. Drain tests, 22, 23. Drainage, 18, 23. Dysentery, 49. "Economy" Circular, 7. Encephalitis lethargica, 48, 49. Engine sidings, Hornsey, 18. Enteric fever, 13, 47, 48, 49. Erysipelas, 48, 49. Factories and workshops, 24, 53. Financial crisis, 6. Fish shops, 24. Five-year programme, 19. Food Inspection, 28, 29. „ surrendered, 29. „ samples, 30. Foster mothers and children, 16, 52. Hairdressers (Sunday Closing) Act, 33. Health Committee, 1. „ Visiting, 15. „ Visitors. 38, 39, 40. Home Nursing, 12. Hornsey Deanery Association, 14. Hornsey Nursing Association, 12. Hospital services, 13. Housing, 18, 27. Bye-laws, 25, 26. Families rehoused, 27. House-to-house Inspections, 25. Returns of work, 19. Statistics, 19. Hydro-carbon, 33. Humane slaughtering, 29. Illegitimate births, 9. „ children, 14. Infant deaths & rates, 9, 10, 43, 46, 47. „ causes, 46. Infantile paralysis, 48, 49. Infectious disease— Prevalence, 34. Diphtheria, 47, 48, 49. Notifications, 48, 49. Scarlet fever, 47, 48, 49. Inhabited houses, 9. Inquests, 37. Inspections made, 22, 24. Isolation Hospital, cases admitted to. 48. Laboratory work, 13. Legal proceedings, 34. Lodging-houses, 25, 26. Malaria, 48, 49. Maternal mortality, 9, 15. Maternity and Child Welfare Committee, 2. Maternity and child welfare— Analysis of attendances, 52. Ante-natal, 12, 38, 39, 40, 52. Births notified, 15. Centres, 38, 39. Clinics, 38, 39, 40, 52. Dental treatment, 41. Health visiting, 15. Maternal deaths, 9, 15. Midwife, 13, 40, 52. Milk grants, 11, 40. Sessions, 38, 39, 40, 52. Staff, 38, 39. Toddlers, medical inspection, 16. Time-table, 38, 39, 40. Voluntary Committees, 38, 39. X-ray treatment, 40. Year's work, 52. Measles, 10, 47, 49. Meat inspection, 28. Medical inspection of children, 16. Midwife's fees, 40. Midwives, 13, 40, 52. Milk grants, 11, 40. „ licences, 28. „ samples, 28. Mortuary, 37. North Hill flats, 19. Notification of Births Act, 16. Nursing Association, 12. Nutrition, 30. Ophthalmia neonatorum, 12, 35, 48, 49. Outworkers, 24, 53, 54. Overcrowding, 24, 26. Para-typhoid, 48, 49. Pemphigus neonatorum, 48. Petroleum Acts, 24, 33, 34. Pneumonia, 12, 48, 49. Poisons Act, licences, 33. Poliomyelitis, 48, 49. Polio Encephalitis, 49. Population, 9, 43, 47. Preface, 5. Pueperal fever and pyrexia, 3, 12, 15, 48, 49. Rag Flock Act, 22. Rateable value and produce of 1d. rate, 9. Registrar-General on Census, 5. Refuse disposal, 18. Refuse shoots, 18, 24. Regulations in force, 13. Rent and Mortgage Interest (Restrictions) Act, 22. Restaurants, 22, 24. Royal Northern Hospital, 14. Sale of Food and Drugs Act, 30. Sanitary notices served, 20. Sanitary work, 22, 23. Scarlet fever, 47, 48, 49. Shoots, refuse, 18, 24. Shops Acts, 31, 34. „ „ Summonses, 34. „ number of, 31, 32. Slaughter-houses, 28, 29. Small-pox, 23, 34, 49. Smoke, 18. Social services, 7, 11, 12. Statutory notices, 20. Staff, 3, 4, 38, 39. Still births, 9. Summersby flats, 19. Summonses, 34. Tables, List of, 42. Tonsils and adenoids, Nursing, 13. Tuberculosis, Cases of, 36, 48, 49, 50,51 „ Santorla and beds, 35 „ Deaths and rates, 47, 51 „ Sputums, 13. Typhoid fever, 47, 48, 49. Unmarried Mothers' Home, 14. Vaccination, 36. Verminous houses, 10. Veterinary Inspector's report, 37. Visits by Inspectors, 22. Visiting of Children, 15. Vital statistics, 5, 9, 43. „ „ England, &c., 43. Voluntary Committees, 38, 39. Ward's Cottages, 19. Water supply, 17. Whooping-cough, 10, 12, 47. Workshops. 53. X-ray treatment, 40. 1 HEALTH COMMITTEE As at 31st December, 1931. Alderman P. Everington (Chairman), 81, Mount View Ed., N.4. The Mayor, Alderman J. W. Rowlands, J.P., 25, Cliolmeley Park, N.6. Alderman W. W. Kelland, M.A., 14, Hillside Mansions, N.6. Councillor Mrs. J. H. Barrenger, 20, Southwood Hall, N.6. ,, A. J. Blake, 25, Danvers Road, N.8. ,, P. A. P. Boustred, 26, Lanchester 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. ,, Mrs. M. N. Hill, 16, Bishopswood Road, N.6. ,, Dr. J. D. R. Monro, “Fairport,” Fortis Green, N.10. „ J. W. Ship, 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. „ C. Winkley, 72, Woodside Avenue, N.10. 2 MATERNITY & CHILD WELFARE COMMITTEE as at 31st December, 1931. Councillor Mrs. C. M. Cave (Chairman), 10, Wood Vale, N.10. The Mayor, Alderman J. W. Rowlands, J.P., 25, Cholmeley Park, N.6. Alderman P. Everington, 81, Mount View Road, N.4. ,, W. W. Kelland, M.A., 14, Hillside Mansions, N.6. Councillor Mrs. J. H. Barrenger, 20, Southwood Hall, N.6. ,, A. J. Blake, 25, Danvers Road, N.8. ,, E. Brooks, 122, Crouch Hill, N.8. ,, J. Edwards, 102, Turnpike Lane, N.8. „ 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. Selected 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. Mrs. E. Piggott, 13, Rookfield Avenue, N.10. Mrs. B. Walton, 19, Etheldene Avenue, N.10. Miss F. E. Wood, 38, Church Crescent, N. 3 STAFF OF PUBLIC HEALTH DEPARTMENT, †*Medical Officer of Health R. P. Garkow, M.D., I).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. ‡Consultants (Puerperal Fever and Pyrexia Regulations) ... Dr. J. B. Banister, 129, Harley Street, W.1. Dr. A. W. Bourne, 14, Devonshire Street, W.1. Dr. L. H. W. Williams, 70, Harley Street, W.l. ‡Dentists (M. & C.W. Dental Scheme) Dr. B. Hamilton, L.D.S., L.R.C.S., L.R.C.P. L. Rowlands, L.D.S. ‡*Senior Sanitary Inspector Henry Eastwood, M.R.S.I., 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). A †*Health Visitors A. Glover 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. 5 To the Mayor, Aldermen and Councillors of the Borough of Hornsey. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the health of the Borough for the year 1931. The vital and mortal statistics are satisfactory, in that there was no special epidemic or cause of disease or death during the year under review. Health statistics require to be carefully interpreted with a knowledge of changes taking place in the population over fairly long periods of years. For example, it is of little interest to know that the death-rate in Hornsey was 11.2 per thousand of its population in the year 1931. It is of great interest to know that Hornsey's death-rate has risen steadily from about 8 per thousand at the beginning of this century to about 12 per thousand average in the last five years, while during the same period the death-rate per thousand of the population of England and Wales has fallen from about 18 to about 12. This falling death-rate is constantly quoted by authority as an index of the improved sanitation and health of the country generally, and the question may well be asked—Is the rising death-rate in Hornsey a sign of deterioration in municipal hygiene and public health ? The answer to this question is in the negative. The relatively low birth-rate and infant-mortality rate in the Borough for many years, together with immigration of retired people into the area, has resulted in a gradual increase in the proportion of older persons in the population. It is the increasing number of deaths in persons of advanced years that tends to raise the general death-rate. Last year, of the total 1,058 deaths, 574 (over 54 per cent.) were in persons of 65 years or over. The Census, 1931. The Census of England and Wales, taken on April 26th, 1931, revealed a population of 95,524 in Hornsey—an increase of 9 per cent, on the census population of 1921, which was only 3'6 per cent. above the population of 1911. The Registrar-General in his Preliminary Report on the Census draws special attention to 6 the remarkable increases in population in the districts composing the outer ring of London, and makes some interesting comments on the significance of this development in relation to the population of the County of London and of the country as a whole. He says:— It is too early yet to discuss whether the new orientation of population marks a definite change in the industrial structure and organisation of the country. Such national prosperity as has surmounted the current widespread depression appears to have resulted largely from enterprises located in the vicinity of the metropolis, and this has naturally attracted surplus labour from the less fortunate areas. But the movement has been somewhat precipitate: from current indexes of migration, like electoral records, etc., it appears to have been concentrated mainly in the latter half of the decennium, and further time is required to prove whether it is more than a transient phase, to be succeeded by an equally marked reaction if and when the older industries regain any of their former established positions." This movement of population is one which the new developing districts of the Home Counties can view with equanimity for decades to come, but for a fully-developed and populated district like Hornsey it is a phenomenon which gives cause for some anxiety. Any increase of population of this Borough beyond 100,000 within its present boundaries is bound to cause overcrowding on a scale which may endanger the public health. In future the census is to be taken at quinquennial intervals instead of decennially, as in the past. It will be interesting to learn from the census of 1936 whether the increasing pressure of population in the past shows any sign of abating. The Financial Crisis, 1931. The outstanding feature in the public life of England in 1931 was the "financial crisis." It is not the duty of a Medical Officer of Health to discuss economic and political upheavals, except in so far as they may affect the public health. There are certain aspects of the crisis of 1931 which bear very directly on the public health, and therefore deserve the careful attention of health authorities. The first is that famine played no part in 7 causing or precipitating the crisis. It was not, therefore, in any sense a "food crisis," due to failure of the world's harvests in any region or in regard to any of the staple foods of man. On the contrary, we have heard a great deal during the year of surplus milk at home, surplus wheat abroad—abundance of everything, together with adequate means of transport by sea and land. In these circumstances, there would appear to be no excuse for such economy in diet as would lead to a lowering of the natural defences of the body against disease. I am glad to be able to report that, in spite of straightened circumstances in many families in this Borough, I have no evidence of increased malnutrition in the population. Indeed, the general nutrition of the child population is on the up-grade, thanks to the education going on in centres and schools in favour of plain wholesome diet, and the fact that there is abundance of every kind of fresh food available at prices within the means of the great bulk of the population. The second aspect of the crisis which demands attention is the question of economy in the social services—a subject upon which much has been said and written during the year. Of particular interest to Medical Officers of Health were the representative views on Circular 1,222 (the "Economy Circular" of the Ministry of Health) obtained by The Lancet and published as anonymous contributions in that journal on September 19th and 26th and October 3rd, 1931. These were written by the administrative heads of large medical departments," with the exception of one, which was written by a contributor, who says:—" I have never been an officer of a local government authority, but I have been for many years a member of such an authority with special interest in the departments of public health (including mental deficiency and maternity and infant welfare) and education." He expresses apprehension at the possible consequences of retrenchment without discrimination, and goes on to say:—"There is much unwise expenditure now going on under the head both of education and of public health, though, speaking generally, I think that investigation would show that the unwisdom of particular items is more prevalent in the case of those authorities who have a low expenditure per head of population than in those who have a high one." 8 I venture to suggest that the most urgent need of the social services of this country is ruthless exposure of humbug of the kind contained in the passage quoted. The suggestion that there is a special direct relationship between low expenditure and unwise spending, and that economy can be effected by raising the total expenditure per bead of population, is simple nonsense. The other anonymous contributions to The Lancet's symposium on economy are obviously from practical administrators, who have helpful suggestions as to the ways and means of effecting economy now and in the future. It would be a great pity if, as a result of the crisis and Circular 1,222, economy were to become a " stunt," instead of being, as it ought to be, a matter for constant attention in every department of public life and social service. I desire to acknowledge the continued good work of the staff of the department during the year, the great help rendered by voluntary workers, and the keen desire of members of the Council to maintain the high standard of health administration in the Borough. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, It. P. GARROW, Medical Officer of Health. 9 STATISTICS FOR 1931. Social and Economic Statistics. Area (acres) 2,874 Population (Census 1931) 95,524 Do., Registrar-General's estimate (mid 1931) 95,590 Number of inhabited houses (end of 1931), according to Rate Books 21,122 Rateable value (General Rate) £990,460 Product of a penny rate £4,127 Live births— Legitimate Males 550 ,, Females 539 Illegitimate Males 30 ,, Females 20 Total 1,139 Birth-Rate 119 per 1,000 population. Still-births— Legitimate Males 25 ,, Females 14 Illegitimate Males 3 ,, Females 2 Total 44 Rate per 1,000 total (live and still births) births, 37.2. Deaths— Male 462 Female 596 Total 1,058 Death-Rate11.2 per 1,000 population. Number of women dying in, or in consequence of, child-birth: — From Sepsis 2 ,, other causes 3 Deaths of Infants under 1 Year of Age. Legitimate Males 28, Females 23 = 51 Illegitimate 4, 5 = 9 Total 60 10 Infant Death-Rate per 1,000 live births. All infants per 1,000 live births 52.6 Legitimate infants per 1,000 legitimate live births 44.7 Illegitimate infants per 1,000 illegitimate live births 80.0 Deaths from Measles (all ages) 0 Deaths from Whooping-Cough (all ages) 2 Deaths from Diarrhoea (under 2 years of age) 2 11 SOCIAL AND ECONOMIC CONDITIONS IN THE AREA. I am indebted to Mr. Parry, Relieving Officer, for the following summary of cases and cost of relief and assistance (public and voluntary), so far as he knows it, during the year 1931: — Number of Cases. Cost. Out-relief Public Assistance £ s.. d. 1,177 17,590 8 11 267 Old Age Pensions 6,942 0 0 21 Widows' Pensions 966 15 6 20 Disability Pensions and Reserve Pay 145 4 6 86 National Health Insurance benefit 170 3 6 30 Wives of Unemployed (earnings) 140 2 3 43 Hornsey Central Distress Committee 32 0 6 15 Fund administered by Mrs. LovellHarrison 16 15 6 53 Boot Fund administered by the Director of Education. Hornsey 21 15 8 503 Hornsey British Legion 1,274 5 6 106 United Services Fund, Hornsey 541 12 7 57 Muswell Hill British Legion 105 9 10 17 United Services Fund, Muswell Hill 43 12 0 40 Hornsey Parochial Charity 805 14 0 505 Hornsey Coal Charity 117 0 0 245 Hornsey Y.M.C.A.—Coals and Parcels 31 7 0 3,185 Education Authority—Milk for necessitous children 320 0 0 Hornsey Borough Council—Milk for mothers and children 280 0 0 Care Committee, Hornsey Schools— Spectacles, etc. 67 12 5 Mayor's Fund—Milk for necessitous children 130 7 2 Unemployment benefit to cases in receipt of Out-relief 3,248 6 3 Incorporated Soldiers' and Sailors' Help Society and grants from Regimental Associations (per Mrs. French) 83 10 1 Cost 33,074 3 2 12 NURSING IN THE HOME. (i.e., District Nursing). Nursing in the home of medical and surgical cases under the care of medical practitioners, as well as the public health nursing of certain infectious diseases and other special conditions, is efficiently carried out for the entire area by the Borough of Hornsey Nursing Association—a voluntary institution affiliated to the Queen's Institute of District Nursing. The following are some particulars of this Association: — President—The Mayor of Hornsey. Honorary Secretary—Mr. R. H. Crookall, 9, Birchington Road, N.8. Honorary Treasurer—Mr. S. M. Mason, 50, North Hill, N.6. Superintendent—Miss Ivett, 2, Ravenstone Road, N.8. Tel. Mountview 6971. There is a staff of four trained nurses in addition to the Superintendent. The income is derived from: — (1) Voluntary subscriptions and donations. (2) Provident contributions of members. (3) Patients' payments. (4) Public authorities (for services rendered). The following is a statement of the infectious diseases nursed during the year: — NAME OF DISEASE. No. of New Cases. No. of Visits. No. Convalescent. No. Sent to Hospital. No. Died. Private Nurse Whooping Cough Pneumonia complication 2 69 2 — — — Mastoid complication 1 95 — 1 for further operation — — Bronchitis and Chickenpox complication 1 16 1 — — — Puerperal Fever 2 6 — 2 — — Pneumonia 18 256 8 2 6 2 Ophthalmia Neonatorum 1 5 — — — — 13 For the Education Committee the Nursing Association attended 4 children suffering from threadworms, 7 after tonsils and adenoids operation, and 1 child suffering from otorrhœa and 1 from rheumatism. For the Public Assistance Committee of Middlesex County Council the Association paid 595 visits to 8 old and 11 new cases during the year. MIDWIVES. There are 16 midwives in private practice and one Municipal Midwife. The latter attended 145 births, and she also attends all the ante-natal clinics held at the four centres—Brook Road, Wightman Road, Church Road, Highgate, and Coldfall. One of the conditions upon which the Council's midwife accepts a case is that the expectant mother should attend an ante-natal clinic. LABORATORY FACILITIES. The arrangements for the examination or analysis of materials are as previouslv described and meet all requirements. The specimens examined in the laboratory during 1931 were as follows: — Negative. Positive. Diphtheria specimens 973 6'2 Sputum (T.B.) ,, 196 22 Enteric ,, 1 0 Other ,, 17 3 1,187 87 Total 1,274 LEGISLATION IN FORCE. No new Local Acts, Special Orders, general adoptive Acts or Byelaws relating to the public health came into force in Hornsev in 1931. HOSPITALS. The Hospital services, public and voluntary, within and Without the area, available for the inhabitants were detailed in my report for 1930. 14 A noteworthy addition to these is the magnificent new St. David's wing of the Royal Northern Hospital, Holloway, in the Borough of Islington. This is a block of wards and rooms for paying patients—a much-needed institution in North London. The terms of admission and of medical and surgical attention may be obtained on application to the Secretary of the Hospital. Generally speaking, the hospital provision for the area is adequate. At all events, no case has come to my notice of a person requiring admission to hospital for whom no hospital bed could be found. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS AND HOMELESS CHILDREN. The County Council of Middlesex, in the exercise of their duties taken over from the late Guardians of the Poor, provide institutional care for these cases. The Hornsey Deanery Association for Preventive and Rescue Work at Beacon Lodge, Eastern Road, Fortis Green, is carrying on good work in this field. AMBULANCE FACILITIES. Adequate ambulance facilities for all types of case— infectious, non-infectious, maternity, accidents, etc.—exist in the area, and no change has taken place in these arrangements in 1931. The special Guy ambulance, used mainly for the transport of physically and mentally defective children for the Education Committee—was replaced by a larger and more suitable Morris Viceroy motor ambulance coach in October, 1931. This vehicle travels about 12.000 miles a year and carries over 20,000 passengers. The following is a statement of the work done by the " Borough Ambulance " under the Fire Brigade: — Calls. Persons. Street accidents in Borough 203 208 Sudden accidents and illness in street 151 140 Maternity cases 28 28 Private cases 696 697 1,078 1,073 15 CLINICS AND TREATMENT CENTRES. These have been set out in tabular form in previous reports and no additions or alterations have been made during the year. MATERNAL MORTALITY. The Medical Officer of Health is directed by Circular 1,206 to "describe any special arrangements made for the investigation of maternal deaths and cases of puerperal fever or puerperal pyrexia.'' While the arrangements for rendering help to medical practitioners in cases of puerperal fever or puerperal pyrexia are complete and satisfactory, there are no special arrangements for the investigation of cases beyond the report form which a medical practitioner may, at his own option and discretion, complete and return to the Medical Officer of Health for forwarding to the Ministry of Health. I am also asked to give particulars of action taken by the Local Authority in the light of Circular 1,167 and Memorandum 156/M.C.W. These have received careful consideration, and I am glad to be able to report that the full scheme outlined in the Memorandum is in operation in the Borough. HEALTH VISITING. (a) Health Visiting of Infants up to 1 Year. Infants are visited once a month for the first three months, and then every second month till they reach the age of 1 year. Special difficulties in feeding and management may require more frequent visits in certain cases. (b) Health Visiting of Children between 1 and 5 Years. Circular 1,206 asks specifically for comment on the adequacy of the arrangements for the visiting of children between the ages of 1 and 5 years. This request is no doubt prompted by the desire of the Ministry to direct the attention of health authorities to the need for more active measures to safeguard the health of the pre-school child. This important aspect of preventive medicine is receiving more attention in Hornsey, with a view to reducing the number of defects found at medical inspection of school entrants. 16 Routine visiting averages twice yearly during this period and mothers are urged to bring the children for examination at the Centres. The invitations to parents to attend medical inspection of their children in school also offers medical inspection of the pre-school children. It is essential to see the toddler stripped in order to make any estimate of his progress, or to offer useful advice in individual cases. The home visiting of these children by health visitors provides an occasion to emphasise the supreme importance of good fresh food, adequate rest, fresh air, exercise and suitable clothing for the growing child. CHILDREN ACT, 1908. The supervision of foster-children under Part I. of this Act was transferred from the late Guardians to the Borough Council in 1930, and is carried out by the health visitors in the course of their routine visiting. These children are visited once a month, or oftener where necessary. Foster-mothers are encouraged to bring the children to the centres for periodical medical examination. A register of foster-mothers and foster-children is kept by the Medical Officer of Health and at each Centre, and the following is a summary of the register: — No. 1. Centre No. 2. No. 3. & Sub. Total. No. of foster-mothers on the register— At the beginning of 1931 17 8 9 34 „ „ end „ „ 29 11 10 50 No. of foster-children on the register— At the beginning of 1931 15 6 5 26 „ „ end „ „ 23 10 17 50 Died during the year 1 – – 1 On whom inquests were held during the year ... – – – – No proceedings were taken during the year. 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. 17 The number of births notified under the Acts during 1931 was: – Male. Female. Total. Live births 666 635 1,301 Still births 25 15 40 691 650 1,341 The births were notified: — By parents 68 By doctors 236 By Borough Midwife 128 By other midwives 440 By Hospitals 140 By others 271 1,283 Unnotified (from Registrar's return): — Live births 56 Still births 2 58 1,341 Of this number there were: — Live births. Still births. Occurring in the Borough and transferred to other districts 195 3 Occurring in Hospitals, etc., outside the district belonging to Hornsey 369 17 The 1.143 net number of notified births belonging to Hornsey were divided among the districts of the Centres as follows: — Brook Road 539 Wightman Road 281 Highgate 290 Coldfall Sub-Centre 33 SANITARY CIRCUMSTANCES OF THE AREA. The "sanitary circumstances" of an area include considerations of supreme importance to the public health, e.g., a Pure water supply. So perfect is the service of the Metropolitan Water Board that water has long ago ceased to be 18 ciated with disease and epidemics in the minds of those who live within its area of supply. Again, drainage and sewerage throughout this district are so complete and effective that sewage disposal has ceased to be a factor in the genesis of disease. Smoke abatement is a problem which is practically confined to a small area in the north-eastern corner of the Borough to the leeward of the engine-sheds at Hornsey Station on the London and North Eastern Railway. There the coaling and firing of engines produces smoke, to the serious discomfort of residents in Wightman Road and the roads passing east from it. The collection of house refuse has been improved by the replacement of the older dust-carts by improved modern vehicles. REFUSE SHOOTS. There are two refuse shoots within the Borough—one, belonging to the Council, situated at the extreme north-western corner of the area, in close proximity to the Council's Coldfall housing estate; the other, at the open space which is being levelled to form a playing-field to the south of Coolhurst Avenue, near the centre of the borough. During 1931 complaints have been received from residents in these districts in regard to nuisances arising in connection with the shoots. In common with many other similar deposits in the London area, these became infested with crickets, which invaded the neighbouring houses. Another cause of complaint was rat-infestation of the dumps. Every effort has been made and is being made to control these pests, and to so improve the nature of the material being deposited as to prevent recurrence of trouble from the same causes. Efforts are also being made to accelerate the levelling up and finishing off of the Coolhurst shoot. HOUSING. The favourable position of Hornsey in regard to the housing of its population has frequently been commented upon in annual reports of the Medical Officer of Health. In last year's report I indicated the need for dealing with a few small groups of old houses in an advanced state of senile decay—numbering in all less than a hundred dwellings. 19 I am glad to be able to report that a good start has been made in the effort to clear out all these old unfit habitations in the first five-yearly programme under the Housing Act, 1930. Two blocks of flats in all have been erected in Summersby Road, adjoining Queen's Wood, and the tenants of Ward's Cottages and two other unfit houses in North Hill have been rehoused in the new flats. The total number of families rehoused in this operation is 18. Plans have been passed for a block of 21 flats to be erected on the site on North Hill which will be rendered available when the empty houses are demolished. These new flats will be occupied in their turn by families now in condemned houses in other parts of the Borough; and so the process of demolition and building should proceed till the Borough can claim to have no house within its area that is not in all respects fit for human habitation. In addition to this process of rehousing, there has been continuous effort all the year to effect repair of houses in need of it; to deal with houses let in lodgings; and to prevent overcrowding. The housing statistics of the year as required by the Ministry of Health are set out below: — HOUSING STATISTICS. 1. Inspection of Dwelling-houses during the Year: — (1) (a) Total number of dwelling-houses spected for housing defects (under Public Health or Housing Acts) 2,045 (b) Number of inspections made for the purpose 9,106 (2) (c) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 382 (b) Number of inspections made for the purpose 2,499 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — 20 (4) Number of dwelling-houses (exclusive of those referred to tinder the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,046 Minor defects, including dust-bins. etc. 255 1,301 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 745 Including minor defects as above 191 936 3. Action under Statutory Powers during the Year: — A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which notices were served requiring repairs — (2) Number of dwelling-houses which were dered fit after service of formal notices: — (a) By owners — (b) By local authority in default of owners — B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 71 (2) Number of dwelling-houses in which defects were remedied after service of formal notices — (а) By owners 61 (b) By local authority in default of owners — 21 C.— Proceedings under sections 19 and 21 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which Demolition Orders were made — (2) Number of dwelling-houses demolished in pursuance of Demolition Orders — D.—Proceedings under section 20 of the Housing Act, 1930: (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — E.—Proceedings under section 3 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which notices were served requiring repairs — (2) Number of dwelling-houses which were dered fit after service of formal notices:— (a) By owners — (b) By local authority in default of owners — (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — F.—Proceedings under sections 11, 14 and 15 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which Closing Orders were made — (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit — (3) Number of dwelling-houses in respect of which Demolition Orders were made — (4) Number of dwelling-houses demolished in pursuance of Demolition Orders — 22 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 visits made, the notices served and the sanitary improvements carried out are recorded in the following tables:— Visits. House-to-house inspections 382 Special inspections 1,220 Re-inspections 9,454 Transfer to Council houses 5 Notifiable infectious diseases 366 Tuberculosis 77 Deaths 120 Verminous houses 10 Scabies 1 Shops Act 725 Factories, workshops and outworkers 600 Rent Restriction Act 7 Cinemas, etc. 22 Overcrowding 140 Petroleum stores 298 Rag Flock Act 4 Dairies and milkshops 86 Bakehouses 57 Slaughter-houses 186 Butchers' shops 95 Restaurant kitchens 32 Other food shops 204 Annual licences (Music and Dancing) 32 Stables 46 Urinals 12 Smoke observations 8 Refuse tips 142 Passages 20 Allotments 5 Drainage 43 Fee tests 9 23 Water tests applied (new drains) 32 Smoke and chemical tests applied (old drains) 49 Drains examined under Sec. 41, Public Health Act, 1875 0 Small-pox Contacts—Visits 41 14,530 SUMMARY OF SANITARY IMPROVEMENTS CARRIED OUT. Drainage. Number of houses and premises redrained 24 Repairs or amendments to existing drains 120 Drains or gullies unstopped or cleansed 61 Manholes provided 50 do. repaired 40 Intercepting traps fixed 24 New gully traps fixed 134 New soil pipes and ventilating shafts fixed 49 Soil pipes and ventilating shafts repaired 35 Fresh-air inlets provided or repaired 50 Water-Closets and Sanitary Fittings. New water-closet basins fixed 113 Water-closets unstopped, cleansed or repaired 92 New check cisterns fitted to water-closets; existing check cisterns repaired 95 New sinks provided 161 New waste-pipes fixed 93 Waste-pipes trapped, repaired or unstopped 187 Miscellaneous. Roofs repaired 282 Eaves guttering renewed, cleansed or repaired 206 Rain-water pipes provided, repaired or unstopped 158 do. disconnected from drains 2 Damp walls remedied 173 Damp-proof courses inserted 65 24 Paving of yards repaired 191 Structural repairs of premises 813 Rooms cleansed, distempered or papered 827 Work-rooms cleansed or repaired 22 Drinking-water cisterns repaired, cleansed and covered 74 Water supply reinstated 3 do. (additional) provided 7 Baths provided or made usable 19 Windows and skylights provided or made usable 135 Floors repaired 151 Windowsills repaired 50 Stagnant water abated 2 Sanitary dustbins provided 255 Accumulations of manure and refuse removed 38 Stoves, ranges and coppers repaired or renewed 204 Sundry items 350 Overcrowding abated 17 5,372 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 32 Milk purveyors in connection with other businesses 43 Bakehouses 30 Restaurant kitchens 33 Slaughter-houses 6 Butchers' shops 55 Fish shops 26 Factories, workshops and work-places 354 Outworkers' premises 165 Cinemas 7 Places of public entertainment 29 Shoots (refuse) 2 Overcrowded houses 56 Licensed petroleum stores 79 25 HOUSE-TO-HOUSE INSPECTIONS. Highgate. North wood Road 40 Holmesdale Road 56 North Hill 5 Archway Road 12 Muswell Hill. Muswell Hill Place 44 St. Winifred's Crescent 8 Margaret Cottage 1 Rose Cottages 3 West Hornsey. Campsbourne Road 126 East Hornsey. Spencer Road 36 Fixsbury Park. Ennis Road 33 Osborne Grove 18 382 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 lodginghouse 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 lodging-house 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 has been found that the byelaws have materially assisted in the campaign for better housing conditions amongst families living in divided houses. A register is in process of compilation showing the number of "lodging-houses" to which the byelaws can be wholly or partly applied. 26 The number on the register at present are classified as follows:— Decontrolled lodging-houses 90 Partly controlled 33 Fully controlled 70 Total 193 One hundred and thirteen houses have been dealt with under these byelaws during the year and the following works carried out:— Byelaw No. 11 (b) Means of carrying off waste water (including provision of sinks) 24 11 (f) Sash-cords and window fittings 35 15 (a) Closet accommodation 2 15 (b) Water supplies 21 15 (c) Washing accommodation 8 15 (d) Food stores 147 16 (a) Repairs to staircase 1 16 (b) and (c) Lighting of staircase 2 22 Provision of hand-rail 1 Total 241 Note.—In regard to washing accommodation, Byelaw 15 (c), the new baths and wash-houses erected by the Borough Council in High Street, Hornsey, and opened on the 14th of April, 1932. should prove extremely helpful, particularly to the residents in the tenement property situated in the East and West Hornsey Wards and also to the residents in the North Haringey Ward. OVERCROWDING. During the year 26 cases of overcrowding have been found and 17 cases abated. According to our records there were 50 known cases of overcrowding existing in the Borough at the end of the year. 27 Rehousing.—During the year 1931, 44 families, representing 228 persons, have been rehoused, as follows: — Families. Persons. Campsbourne Road 2 11 Campsbourne (The) 2 13 Boyton Road 1 6 Myddelton Road 1 6 Brook Road 1 3 Grove House Road 1 6 Haringey Road 1 5 Rathcoole Gardens 1 7 Inderwick Road 2 7 The Grove, Crouch End 1 5 Harvey Road 1 5 Osborne Grove 1 7 Woodstock Road 1 7 Nelson Road 1 4 Tottenham Lane 1 6 Muswell Hill Place 1 4 Crouch Hill 1 3 Crouch Hall Road 1 5 Fortis Green 1 5 Upper Tollington Park 1 3 Ridge Road 1 5 Langdon Park Road 1 4 Archway Road (Coleridge Buildings) 1 5 North Hill 3 13 North Road Cottages 1 4 Woodside Cottages 1 3 South View Road 2 13 North View Road 1 6 Victoria Parade 1 4 Beechwood Road 1 2 Marriott Road 1 11 Hill Road 4 24 Steeds Road 1 5 Yeatman Road 1 6 Kenwood Road 1 5 44 228 28 INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. Dairies and Milkshops. At the end of the year there were 32 dairies within the Borough and 43 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 7 Grade "A" Milk 3 ,, Grade "A" (Pasteurised) 2 Nineteen samples of milk were taken from roundsmen's barrows and sent for bacteriological examination. In sixteen instances the results varied from 1,900 to 59,233 organisms per cubic centimetre, as compared with the limit of 100,000 organisms allowed for pasteurised milk. In two samples taken from one dairyman whose premises are situated outside the Borough the bacterial counts were 566,500 and 639,500, and in another sample taken from a dairyman whose premises are in the Borough the bacterial count was 369,500. The local authority in whose district the outside dairy was situated, the dairyman and the farmers supplying the milk were communicated with, after which fresh samples were taken and found to come well within the limit allowed. (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. 29 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 741 sheep, 4 bullocks and 34 pigs have been inspected under the Regulations, and offal amounting to 42 lbs. 2 ozs. 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. 1931. Licensed 7 5 5 6 Slaughtering of Animals during the last Six Years. The table below is interesting as showing a steady decrease in the number of animals slaughtered in the Borough during the last six 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 1931 4 741 34 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, or heifer. One infringement of this Byelaw was reported and the offender cautioned. Unsound Food. — Unsound food was surrendered and destroyed as follows:— lbs. ozs. Lungs 13 6 Liver 28 12 Fish.— Witches 49 0 Smoked fillets 28 0 Chat haddocks 112 0 231 2 30 Adulteration, &c.—List of samples taken in Hornsey and examined during the year by the Middlesex County Council: — Article. Taken. Adulterated. Milk 190 1 Milk, sterilised 2 — Bread 1 — Flour 1 — Meat 41 1 Minced beef 17 — Sausages 29 — Seasoning 2 — Whisky 1 — Rum 1 — Gin 3 1 288 3 NUTRITION. Dissemination of Knowledge. Under the above heading information is sought by the Ministry as to the means adopted for securing the education of the public in the knowledge of food and dietetics. It is clear that, however perfect may be the inspection and supervision of the food supply of a community, unless the individual members of families thereof take a diet sufficient in quantity, quality and variety, the private health and therefore the public health must suffer. Indeed, I have no hesitation in asserting that in this Borough the bulk of the defects and disabilities found in infancy and childhood up to school-leaving age are, directly or indirectly, nutritional in origin. I have no doubt that the digestive disorders of middle life are also largely dependent on errors of diet. Much has been said and written about disease conveyed by milk, meat and other foods, but I can quite honestly say that T never see them. So sound and wholesome is the food supply in this area that food has practically ceased to be a cause of disease in the positive sense. I do, however, see ample evidence of disease, defective development, and poor physique, due to want of sufficient milk, meat and other natural foods in the diet. 31 The measures adopted for improving this state of affairs is the constant preaching of the gospel of good food by every officer in the health services of the Council who comes into personal contact with the mothers and children — medical and dental officers, health visitors and school nurses. SHOPS ACTS. The Shops Acts, 1912-13, and the Shops (Hours of Closing) Act, 1928, may be cited together as the Shops Acts, 1912 to 1928. Seven hundred and twenty-five 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 thirteen instances where contraventions have occurred after verbal notices, and undertakings obtained that recurrences will not take place. There are 1,213 shops in the Borough engaged in the following trades: — Grocers 118 Confectioners 95 Boots 73 Drapers and Costumiers 71 Greengrocers 67 Butchers 55 Restaurant Kitchens 51 Stationers and Newsagents 50 Hairdressers and Barbers 50 Tobacconists 48 Tailors and Outfitters 42 Furniture and Upholsterers 36 Public-houses 35 Off-licences 35 Dairies and Milkshops 32 Coal Merchants 30 Chemists 28 Bakers 27 Fishmongers 24 32 Oil and Colour Shops, General and Domestic Stores 23 Gas, Electrical and Wireless fittings 23 Milliners 19 Ironmongers and Hardware 17 Watches and Jewellery 16 Florists 12 Builders and Decorators 11 Cycles and Motor Repairs 11 Hosiers 10 Cooked Meats 10 Pianos and Music 9 Photographers 8 Saddlers and Leather Goods 8 Corn Chandlers 6 Books 6 Wardrobe Dealers and Dress Agencies 5 Picture Frames 5 Carpets and Lino 5 Clothes Pressing (Cleaning and Repairing 4 Bazaars 4 Timber Merchants 4 Art Needlework and Wool 3 Umbrellas 3 Toys 3 Sewing Machines 3 Opticians 3 Blinds 2 Antique Shops 2 Furriers 2 Pawnbrokers 2 Baby Carriages 1 Corsets 1 Cotton Goods (Cottons and Shirts) 1 Herbalist 1 Basket Ware 1 Cutler 1 Cork Goods 1 1,213 33 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. One infringement of the Act has been reported and the responsible person cautioned. 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° Fahrenheit. The total number of licences for storing petroleum spirit is 79, and the quantity of petroleum which may be kept on licensed premises is 84,896 gallons, 5,226 gallons being kept in two-gallon cans and 79,670 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 has been carefully supervised and tanks and pipe lines for bulk storage installations tested. Carbide of Calcium. There are two premises licensed for the storage of Carbide of Calcium and the quantity stored under licence is 1 ton 10 cwts. 50 lbs. Hydro-carbon. There is 1 licence issued for the storage of 100 gallons of hydrocarbon. Cellulose Spirit. One licence solely for the storage of 50 gallons of cellulose spirit has been issued. Horticultural Poisons. There are three licences in force for the sale of horticultural poisons under the Poisons and Pharmacy Act. 34 The Petroleum Spirit (Motor Vehicles, &c.) Regulations and the Petroleum (Carbide of Calcium) Order, 1929, came into force in December, 1929. LEGAL PROCEEDINGS. Legal proceedings have been taken on three occasions. (1) Under the Public Health Act of 1875 for the abatement of a nuisance. The defendant was ordered to carry out the work within 28 days and to pay £1 9s. 0d. costs. (2) Under the Shops (Hours of Closing) Act, 1928, for not being closed for the serving of customers at the prescribed time. Two cases. The defendants were fined £2 and £1 respectively. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The incidence of the acute infectious diseases (notifiable) is set out in Table F, page 48. The numbers are well under the average for recent years. Small-Pox. — No case of small-pox occurred in Hornsey during 1931, in spite of the prevalence of this disease in many parts of London and the Home Counties. Early in 1932, however, three cases of Variola minor occurred. The story of how this mild infection was introduced into the Borough is interesting. The first case was a girl of 14 years, who, about Christmas, paid a visit to friends in an adjoining Metropolitan borough. On January 7th she had headache and feverishness, and on the 14th her illness was diagnosed as smallpox. The suspected source of infection was telephoned to the Medical Officer of Health of the Metropolitan Borough, and he found, on visiting the address, that a son of the family was recovering from a missed case of mild small-pox!—and that the father was coming out in a small-pox eruption, and just ready to send to the small-pox hospital!! Fortunately the Hornsey contacts accepted the advice to get protected by vaccination, and only two further cases occurred. These were in relatives of the first case living in another house, containing four families, totalling 16 persons. But for the good sense of these people in regard to vaccination the community might have been put to the unnecessary trouble and expense of an outbreak of this mild small-pox. 35 This incident is liable to be repeated at any time so long as mild small-pox is out of control in London. The history of small-pox in England in the last ten years is one of the most interesting chapters in the annals of epidemic diseases, and has led to a revision of official medical views on the relationship of Variola major and Variola minor. The subject is, however, too long and difficult to discuss here. No vaccinations were performed by the Medical Officer of Health, all contacts being referred to the public vaccinator. Ophthalmia Neonatorum.—Three cases of ophthalmia neonatorum were notified. Two were treated in St. Margaret's (L.C.C.) Hospital, Kentish Town, and one was treated at home. Cases Vision unimpaired. Vision impaired. Total blindness. Deaths. Notified. Treated At home. In hospital. 3 1 2 3 0 0 0 Tuberculosis.—Sanatorium provision for all forms of tuberculosis in Hornsey is made by the Middlesex County Council. There are 555 beds available solely for Middlesex under the Middlesex County Council scheme for the treatment of tuberculosis in sanatoria, allotted as follows: — Accommodation. TYPE OF CASE. Adults Child'n M. F. County Sanatorium, 129 129 56 Pulmonary—Sanatorium Harefield – – 8 ,, —observation County Sanatorium, Clare Hall, South Minims 120 66 — ,, late sanatorium and hospital County Council Hospital— Dispensary Hounslow 9 7 – ,, observation Heatherwood Hospital, Ascot – – 25 Non-pulmonary Victoria Home, Margate — — 6 ,, 36 Middlesex patients were also treated in 48 other institutions during 1931. The total number of cases on the Tuberculosis Register at the end of 1931 was 625, an increase of 22 during the year. Dr. Dobson, the Middlesex Tuberculosis Officer for Hornsey, has kindly supplied the following particulars of Hornsey cases of tuberculosis on his register:— New Tubercular cases 72 New non-Tubercular cases 130 Undiagnosed cases 1 Total 203 Transfers in (Tubercular), not included in above 12 Cases supervised at or from the dispensary during 1931 (all Tubercular) 311 Tubercular cases still on the Register on 1st Jan., 1932 222 Undiagnosed 1 DISINFECTION. Number of rooms fumigated after notifiable infectious disease 472 ,, ,, ,, ,, non ,, ,, 179 ,, ,, ,, ,, T.B. 77 ,, articles disinfected 8,208 ,, ,, destroyed 173 ,, verminous rooms disinfected 110 CLEANSING STATION. Seven adults and 67 children have been treated at the cleansing station for various reasons. There were also 3 adults and 5 children belonging to Wood Green treated. These were paid for by Wood Green at an agreed charge per treatment. 37 MORTUARY. Seventy-five bodies were received at the mortuary and an inquest held on 26 of them. DISEASES OF ANIMALS ACT. Mr. F. G. Buxton, the Veterinary Inspector, reports that during the year he inspected 406 pigs and 27 sheep and issued 7 removal licences. No action was necessary under the Tuberculosis Order, 1925. 38 MATERNITY AND CHILD WELFARE. Personnel.—There were no changes in the official personnel at the Welfare Centres during the year. CENTRES. No. 1 Centre.—St. Mary's Mission Halt,, 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 Treasurer), 19, Etheldene Avenue, N.10. Miss Bligh, 25, Summerland Mansions, N.10. Mrs. Borrowson, 36, Cascade Avenue, N.10. Miss Creswell, 35, Birchwood Avenue, N.10. Mrs. Danks, 97, Wood Vale, N.10. Mrs. Eason, 13, Woodberry Crescent, N.10. Miss Faulkner, 9, Aubrey Road, N.8. Mrs. A. M. L. Harvey, 1, Etheldene Avenue, N.10. Mrs. Howey, 4, Firs Avenue, N.10. Mrs. Hume, 5, Prince's Avenue, N.10. Mrs. Lower, 1, Cranmore Way, N.10. Mrs. Merry, 20, Etheldene Avenue, N.10. Mrs. Moore, 18, Buckingham Avenue, Whetstone, N.20. Mrs. Price, 35, Park Way, Friern Lane, N.ll. Mrs. Bertram Smith, 31, Connaught 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). 39 No. 2 Centre.—No. 22, Wightman Road, serving Stroud Green, Finsbury Park and South Haringey areas. Voluntary Committee: Mrs. J. H. Barrenger (Chairman), 20, Southwood Hall, N.6. Miss A. M. Inward (Hon. Sec. and Treasurer), 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. Swinstead, 15, Avenue Road, N.6. Health Visitor: Miss A. Glover. Clinics: — 1st, 3rd and 5th Mondays, 2-4 p.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. Dixon (Hon. Secretary), 56, Talbot Road, N.6. Miss Reavely (Hon. Treasurer), 79, Gower Street, W.C.I. Miss Benn, 25, Connaught Gardens, N.10. Mrs. Compton, 73, Addison Road, Kensington, W.14. Miss Grant, " Tregarthen," Cranley Gardens, N.10. Miss Groser, 36, Wood Lane, N.6. Mrs. Hill, 16, Bishopswood Road, N.6. Miss Hodgson, " Belle Vue," Church Road, 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. 40 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 I. on page 52 gives a statistical record of the work done at the Centres and by the Borough Midwife. Midwifery. The Municipal Midwife attended 145 births. A reduction of her fee was made in 32 necessitous cases. Eleven hundred and twenty-five births have been attended by the Midwife since the appointment was first made in 1922. X-Ray Treatment. Three expectant mothers were sent to University College Hospital from the Ante-natal Clinic for examination. Milk—Mothers and Children Order. Six hundred and eighty-one applications for milk under this Order were dealt with during the year, of which 664 were granted and 17 were refused. 41 Dental Clinic. The following is a record for the year of the Dental Clinic for Mothers and Children which was started in 1928: — 1931. Individual cases treated 104 Total attendances made 417 Teeth extracted 241 Gas cases 92 Inspections 65 Local injections 26 Fillings 174 Dentures provided 10 ,, repaired 1 Attendances for dentures 74 Other treatments, scaling, gum treatment, etc. 67 Cases finished 86 42 LIST OF TABLES. TABLE A.—Vital Statistics, 1909-1931. TABLE B.—Causes of, and ages at, death in 1931. TABLE C.—Summary of causes of death, 1921-1930. TABLE D.—Infant Mortality in 1931. Causes of and ages at death. TABLE E.—Births, Deaths, Infant Deaths, and Deaths from certain diseases, 1901-1931. TABLE F.—Cases of Infectious Disease notified in 1931. TABLE G.—Cases of Infectious Disease notified 1909-1931. TABLE H.—(1) Notification of, and deaths from, Tuberculosis, 1931. ,, (2) Tuberculosis Register, 1931. TABLE I.—Work done at the Maternity and Child Welfare Centres and by Municipal Midwife, 1931. TABLE J.—Inspection of Factories, Outworkers, etc., 1931. 43 TABLE A. BOROUGH OF HORNSEY VITAL STATISTICS, 1909-1931. Year Estimated Mid-Year Population. Birth Kate per 1,000 Population. Death Kate per 1,000 Population. Infant Mortality per 1,000 Births. 1909 82,378 18.3 9.6 57 1910 83,401 16.7 8.8 69 1911 84,592 17.5 9.6 78 1912 84,840 16.8 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 88,326 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 13.3 11.2 38.3 1928 90,250 12.1 12.1 61.3 1929 90,500 Regr -General 88,450 13.8 12.7 54.05 1930 88,450 13.7 11.8 41.35 1931 Census. 95,524 11.9 11.2 52.6 ENGLAND and WALES (Rates in 1931) 15.8 12.3 66 107 County Borough and Great Towns, including London (Rates in 1931) 16.0 12.3 71 159 Smaller Towns (Rates in 1931) 15.6 11.3 62 London (Rates in 1931) 15.0 12.4 65 44 TABLE B.-CAUSES OF, AND AGES AT.DEATH .1931 All Agse??? 5—15 15 25 25 35 36-45 45 56 65-75 75&over M !F M F M F M F M F M F M F M F M F M F M F M F 1 1. Typhoid and paratyphoid fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3. Scarlet Fever ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4. Whooping cough ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 5. Diphtheria 2 3 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 3 3 ... 2 3 8 6 6. Influenza 7 16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 7. Encephalitis Iethargica ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 8. Cerebro spinal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 2 ... 1 1 ... 1 9 9. Tuberculosis of respiratory system 21 31 ... ... ... ... ... ... ... ... 2 4 4 ... ... ... 8 1 ... 3 ... ... ... ... 10 10. Other tuberculous diseases 3 2 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 11 11. Syphilis 1 3 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 12 12. General paralysis of the insane, 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 21 ... 33 13 13. Cancer, malignant disease 72 107 ... ... ... ... 1 ... ... ... ... 1 ... 4 2 9 ... 14 24 25 28 5 11 3 14 14. Diabetes 4 12 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 3 2 1 3 ... 30 15 15. Cerebral haemorrhage, etc. 17 52 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 3 9 3 37 9 80 16 16. Heart disease 110 150 ... ... ... ... ... ... ... ... 1 ... 1 5 2 3 8 11 22 ... 37 ... 38 ... 17 17. Aneurysm 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 5 1 4 8 18 18 18. Other circulatory diseases 25 29 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 8 1 8 5 10 9 19 19. Bronchitis 15 15 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 2 6 4 16 20 20. Pneumonia (all forms' 28 40 1 6 1 2 2 ... ... ... ... ... ... 1 4 ••• 6 4 1 2 7 3 ... ... 21 21. Other respiratory diseases 5 6 ... ... ... 1 ... ... ... ... ... ... ... ... 1 ••• 1 ... 1 ... 1 ... 2 3 22 22. Peptic ulcer 7 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 2 ... ... ... 23 23. Diarrhoea, etc. 2 3 1 1 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... ... ... ... 24 24 Appendicitis 3 4 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 2 ... ... 1 1 ... ... 25 25. Cirrhosis of liver 2 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 26 26. Other diseases of liver, etc. 3 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 1 5 2 3 27 27. Other digestive diseases 10 10 l ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 2 3 5 4 3 5 28 28. Acute and chronic nephritis 19 15 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 4 3 5 ... ... ... ... ... 29 29. Puerperal sepsis ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 30 30. Other puerperal causes ... 3 ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 31 31. Congenital debility, premature birth, malformations, etc. 24 16 24 16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 11 32 32. Senility 8 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 33 33. Suicide 9 2 ... ... ... ... ... ... ... ... ... ... 1 4 ... 2 ... 1 1 1 4 3 4 34 34. Other violence 16 13 2 ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 3 2 1 13 4 12 7 34 35. Other defined diseases 44 41 2 4 ... ... 1 ... ... ... ... 3 3 4 2 7 5 3 5 7 ... ... ... ... 36 36. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 462 596 32 28 1 5 5 2 6 8 10 8 15 32 23 26 49 62 92 81 116 113 113 113 Special causes included in 35 above Small-pox Poliomyelitis Polioencephalitis 45 TABLE C. CAUSES OF, AND AGES AT, DEATH DURING THE TEN YEARS, 1921-1930 CAUSES OF DEATH All Ages. Registrar-General's returns. 1930 1929 1928 1927 1928 1925 1924 1923 1922 1921 All causes—Certified Uncertified 1 Enteric Fever. ... ... 1 1 1 ... ... 1 ... ... 1 2 Small-pox ... ... ... ... ... ... ... ... ... ... 2 3 Measles 4 ... 7 ... 8 1 2 4 3 1 3 4 Scarlet Fever 1 ... 2 1 ... ... 1 ] 3 3 4 5 Whooping Cough ... 14 1 ... 3 8 2 1 7 2 5 6 Diphtheria 4 8 6 6 1 1 2 6 6 13 6 7 Influenza 10 65 16 54 17 20 22 14 47 24 7 8 Encephalitis Lethargica 1 2 3 1 2 3 2 1 ... 3 8 9 Meningococcal Meningitis ... ... 2 1 ... ... ... ... ... ... 9 10 Tuberculosis of Respiratory System 53 57 60 57 59 48 55 47 60 74 10 11 Other Tuberculous Diseases 13 16 12 7 8 7 7 11 13 12 11 12 Cancer, Malignant Disease 159 147 134 138 147 143 146 136 143 136 12 13 Rheumatic lever 2 1 4 2 2 3 3 2 4 5 13 14 Diabetes 11 13 9 19 7 13 9 10 14 8 14 15 Cerebral Hemorrhage, etc 82 57 49 43 60 68 53 60 54 68 15 16 Heart Disease 231 263 188 200 160 163 141 126 116 122 16 17 Arterio-sclerosis 43 63 73 55 41 60 46 44 44 40 17 18 Bronchitis 41 45 48 58 47 61 71 55 65 72 18 19 Pneumonia 'all forms) 54 64 58 60 55 64 67 68 67 46 19 20 Other Respiratory Diseases 14 18 10 12 10 16 16 9 20 23 20 21 Ulcer of Stomach or Duodenum 8 13 13 12 9 7 6 8 8 4 21 22 Diarrhoea (under 2 years) 7 2 2 3 2 3 1 5 3 15 22 23 Appendicitis 16 5 9 13 13 6 9 7 11 7 23 24 Cirrhosis of Liver 4 8 4 8 4 6 4 6 6 11 24 25 Acute and Chronic Nephritis 36 34 31 31 31 25 35 32 36 24 25 26 Puerperal Sepsis 2 0 2 1 2 ... 1 1 2 ... 26 27 Other accidents and diseases of Pregnancy and Parturition 3 5 1 3 2 3 2 5 3 4 27 28 Congenital Debility and Malformation, Premature Birth 19 36 42 27 31 26 29 38 36 34 28 29 Suicide 15 13 10 6 33 4 10 12 12 11 29 30 Other Deaths from Violence 29 25 30 23 6 27 20 22 22 21 30 31 Other Defined Diseases 188 161 173 167 171 170 175 196 190 185 31 32 Causes Ill-defined or Unknown ... ... ... ... 1 ... 1 ... ... ... 32 Total 1050 1130 1000 1009 926 956 938 928 995 968 46 TABLE D.—INFANT MORTALITY, 1931. CAUSES OF DEATH. Deaths from stated causes at various Ages under One Year of Age. Total Deaths under One Year Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under Weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Premature Birth 15 1 1 17 - 17 Injury at Birth 1 — — — 1 — — — — 1 Inattention at Birth 1 — — — 1 — — — 1 Congenital Heart 2 — 1 — 3 1 — 4 Spina Bifida — — 1 1 — — 1 Atrophy, Debility and Marasmus — 2 — — 2 1 1 — — 4 Atelectasis 2 — — — 2 — — — — 2 Inanition 2 — — — 2 — — — — 2 Imperforate Anus 1 — — — 1 — — — 1 Abdominal Distention 1 1 Intestinal Obstruction 1 1 1 Streptococcal Meningitis — — — - — 1 — 1 Pyaemia — — — 1 1 1 — — — 2 Lues — — — — — — 1 — — 1 Pneumonia — 1 — 1 3 2 2 1 9 Whooping Cough — — — — — — — — 1 1 Diarrhœa — — — 1 1 2 Convulsions 1 1 1 2 Hæmorrhage 1 1 2 1 3 Tetanus Neonatorum — — 1 1 — 1 Erysipelas — — — — — — — — 1 1 Burns — — — 1 1 Operation — — — — — — — — 1 1 Total 26 6 4 i 37 11 6 2 4 60 47 TABLE. E. BIRTHS DEATHS. INFANT DEATHS, AND DEATHS FROM CERTAIN DISEASES, 1901-1931. YEAR. Population Census. Total Births Total Deaths Total Infant Deaths (under one year) Deaths frem 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 1 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 1 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 65 47 13 1807 1,524 766 116 5 19 3 4 9 4 76 50 19 1908 1,485 752 95 12 11 3 3 9 2 84 53 16 1909 1,508 787 87 12 12 0 3 10 0 75 57 26 1910 1,393 737 97 1 10 0 4 8 3 88 41 18 1911 84,592 1,479 812 116 20 15 35 1 6 1 103 55 23 1912 1,385 840 105 5 2 13 3 2 2 114 43 17 1913 1,425 824 81 12 8 12 0 4 3 96 55 14 1914 1,529 781 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 1 136 47 11 1924 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 58 6 1928 1,191 995 73 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 1931 95,524 1,139 1,058 60 0 2 5 1 5 0 179 52 5 48 TABLE F.-INFECTIOUS DISEASES NOTIFIED, 1931. DISEASE WARDS ACES Total Admitted to Joint Hospital. Admitted to other Hospitals. Nursed at Horn*. Registered Deaths Highgate Muswell Hill. Crouch End West Hornsey East Hornsey North Haringey South Haringey Stroud Green Finsbury Park. 0— 1 1— 5 5— 15 15— 25 25— 45 45— 65 65 and over Scarlet Fever 43 53 26 42 39 15 7 15 11 0 37 139 43 27 1 0 247 198 4 45 1 Diphtheria 10 26 14 34 16 5 1 4 6 1 15 78 14 7 1 0 116 106 7 3 5 Para Typhoid 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 0 0 1 0 Erysipelas 4 4 2 2 6 1 2 7 4 3 2 1 3 8 11 4 32 16 3 13 0 Ophth. Neon 0 0 0 1 0 1 1 o 0 3 0 0 0 0 0 0 3 0 2 1 0 Pneumonia 6 14 8 13 7 14 9 5 10 5 4 5 11 23 23 15 86 2 26 58 88 Pueiperal Fever 3 0 0 0 1 1 1 1 0 0 0 0 3 4 0 0 7 0 6 1 5 Puerperal Pyrexia 2 5 0 1 1 0 0 0 0 0 0 0 3 6 0 0 9 0 5 4 0 Poliomyelitis 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 Encephalitis Lethargica 0 0 0 1 0 0 0 1 0 0 0 0 1 0 1 0 2 1 1 0 1 Malaria emphigus 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 Neonatorum 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 68 102 53 94 70 33 21 34 31 13 58 224 78 76 38 19 506 Tuberculosis Pulmonary 11 16 3 11 21 19 10 10 10 0 0 0 26 57 23 5 111 53 NonPulmon ary 3 1 2 2 0 3 2 4 1 0 2 3 3 5 4 1 18 5 Total . 82 119 58 107 91 55 33 48 42 13 60 227 107 138 65 25 635 323 56 127 Admitted to Joint Isol. Hospital 40 71 32 73 50 14 6 21 16 Other Hptls (except T.B.) 11 7 7 7 5 6 4 4 5 Note.—The following 41 oases were also admitted to the Isolation Hospital iu addition to the above, making a total of 547:—6 tonsillitis, 6 sepsis, 3 measles, 2 influenza, 2 mumps, 2 rheumatism, 2 gastritis, 2 conjunctivitis, 1 chicken pox, 1 whooping cough, 1 mastoids 1 glandular fever, 1 qoinsieB, 1 appendicitis, 1 cellulitis, 1 colitis, 1 impetigo, 1 lymphangitis, 1 paratitis, 1 post pharyngeal abscess, 1 synovitis, 1 found not to be para-typhoid fever, 1 found not to be diphtheria and 1 for observation. Of these 41 cases 27 were members of the hospital staff. 49 TABLE G. NOTIFICATIONS OF INFECTIOUS DISEASE, 1909-1931. Year. Population. Scarlet Fever. Diphtheria or Croup. Enteric Fever. Para Typhoid. Puerperal Fever. Puerperal Pyreiia. Erysipelas. Cerebral Spinal Meningitis. Polio-Myelitis. Ophthalmia Neonatorum. Malaria. Dysentery. Encephalitis Lethargica. Polio-Encephalitis. Pneumonia. Small-pox. Measles. German Measles. j Total Attack rate per 1,000 population. 1905 82,378 221 151 4 - - - - - - - - - - - - - - - 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 86,122 206 115 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 1923 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 1926 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 — — — 693 6.5 1929 89,450 249 129 8 2 8 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 1931 95,524 (Census) 247 116 0 1 7 9 32 0 1 3 1 - 2 - 86 - - - 635 6.6 » Excluding Measles and German Measles. 50 TABLE H. (1).—NOTIFICATIONS OF, AND DEATHS FROM, TUBERCULOSIS, 1931. AGE PERIODS New Cases. Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 — 1 - - - - - - - - 1 - 6 - - - 2 - - - 1 5 — 15 1 2 __ - 15 — 25 12 14 2 1 2 4 1 - 25 — 35 14 23 1 2 4 8 — — 36 — 45 12 8 1 1 4 3 — — 45 - 55 7 11 1 1 8 11 1 1 55 - 65 4 1 — 2 2 3 — — 65 and over 2 3 1 — 1 2 — - Totals 51 60 7 11 21 31 3 2 Wards;— Highgate. 4 7 1 2 2 8 — — Muswell Hill 7 9 1 — 2 4 — — Crouch End 2 1 1 1 — 1 1 1 West Hornsey 5 6 1 1 5 6 — . — East Hornsey 12 9 - — 3 4 — — North Haringey 7 12 — 3 2 2 — 1 South Haringey 4 6 2 5 1 — Stroud Green 5 5 3 1 1 5 — — Finsbury Park 5 5 1 1 1 1 - Totals 51 60 7 11 21 31 3 2 51 TABLE H. (2).—TUBERCULOSIS REGISTER, 1931. No. of cases at commencement of 1931. No. of case* added to register during 1931. No. of cases removed from register during 1931. No. of cases on register at end of 1931. (1) (2) (3) (4) Pul. Non.-Pul. Pul. Non.-Pul. Pul. Non.-Pul. Pul. Non.-Pul. Males 237 69 50 7 47 7 240 69 Females 236 61 61 11 49 4 248 68 473 130 111 18 96 11 488 137 Totals 603 129 107 625 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 1 10 18 10 Pulmonary 18 14 47 49 10 15 0 0 4 4 Non-Pulmonary 3 0 7 4 0 0 1 10 22 14 10 15 21 14 54 53 52 TABLE I. MATERNITY AND CHILD WELFARE WORK, 1931. Nature of Work. Centres. Totals. No. 1. No. 2. No. 3 and Sub-Centre. Number of cessions held 199 117 83 399 „ ante natal sessions held 51 26 23 100 Number of individual Mothers seen by Doctor Ante-natal, New cases 186 92 76 354 ,, Old cases 438 223 115 776 Post natal. New cases 84 30 5 119 „ Old cases 37 7 1 45 745 352 197 1,294 Total attendances of Mothers 1,125 447 198 1,770 Number of babies attending Centres for first time: Under 1 year 300 203 168 671 1—5 years 63 41 61 165 Number of individual babies on Centre registers 873 490 510 1,873 Attendances of babies at medical consultations 3,532 2,169 1,291 6,992 Babies seen by Doctor 2,457 1,551 1,064 5,072 Total attendances of babies at Centres : Under 1 year 4,964 2,838 1,846 9,648 1 5 years 3,132 1,677 1,005 5,814 Referred to own private doctors 24 24 10 58 Referred to hospitals 109 43 10 162 Health talks given by nurses 31 15 46 Visits paid by nurses: — First Total visit* First Total First Total Grand First Totals Total visits To expectant mothers 94 185 55 107 53 95 202 387 To infants under one year 521 2,685 290 1,506 308 1,140 1,119 5,331 To children aged 1-5 years 73 3,599 42 1,835 70 1,435 185 6,869 Total visits paid by Nurses 688 6,469 387 3,448 431 2,670 1,506 12,587 CHILDREN ACT, 1908— Visits paid to Foster Children 18 81 9 86 11 70 38 237 RECORD OF WORK OF MUNICIPAL MIDWIFE, 1931. Confinements attended 145 Ante-natal Clinics attended 77 do. visits 446 Post-natal visits 1,963 53 TABLE J.—FACTORIES, WORKSHOPS AND WORKPLACES. The following is a summary of the result of inspections made at Factories, Workshops and Workplaces during the year, with a list of Outworkers' premises, a copy of which has been forwarded to the Home Office, as required. None of the Outworkers' premises was found to be in an unwholesome condition Premises. Number of Inspections. Written Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 164 6 0 Workshops (Including Workshop Laundries) 271 3 0 Workplaces (Other than Outworkers' premises) 50 0 0 Total 485 9 0 DEFECTS FOUND IN FACTORIES, WORKSHOPS & WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:-* Want of cleanliness 22 22 — — Want of ventilation — — — — Overcrowding — — — — Want of Drainage of floors Other nuisances — — — — Sanitary accommodation insufficient unsuitable or fective 4 4 - - not separate for sexes 1 1 — — 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 27 27 — — Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Act6. 54 TABLE J.— (Contd.) OUTWORKERS, 1931. Nature of Work. Outworkers. Instances. Notices served. Prosecutions. (1) Wearing Apparel Wearing Apparel 13 0 0 0 Gloves 1 0 0 0 Gaiters 2 0 0 0 Machinist 1 0 0 0 Scarves 1 0 0 0 Underclothing 5 0 0 0 Drapery 1 0 0 0 Tailoring 29 0 0 0 Outfitters 1 0 0 0 Hoots 6 0 0 0 Neckwear 9 u 0 0 Blouses 8 0 0 0 Gowns 3 0 0 0 Dressing Gowns 1 0 0 0 Dresses Dressmaking 25 0 0 0 Costumiers 2 0 0 0 Jumpers and Costumes 2 0 0 0 Skirt making 1 0 0 0 Dress Designing 1 0 0 0 Infants' Millinery 1 0 0 0 Millinery 14 0 0 0 Children's Wear Children's Blouses 1 0 0 0 Girls' Tunics 1 0 0 0 Children's Frocks 9 0 0 0 Children's Outfitting ,, Raincoats 2 1 0 0 0 0 0 0 Boxes 2 0 0 0 Furs 7 0 0 0 Umbrellas 1 0 0 0 Knitted Goods 2 0 0 0 Baby Linen 2 0 0 0 Fancy Goods 2 0 0 0 Artificial flowers 3 0 0 0 Embroidery 4 0 0 0 Needlework 2 0 0 0 Brushes 1 0 0 0 Chemists' Sundries 1 0 0 0 Picture Frames 1 0 0 0 Total 169 0 0 0 Borough of Hornsen. ANNUAL REPORT of thr SCHOOL MEDICAL OFFICER for the Year ending December 31st, 1931. HORNSEY EDUCATION COMMITTEE. List of Members, December 31st, 1931. Members of the Town Council— His Worship the Mayor, Alderman J. W. Rowlands, J.P. Aldermen. Mr. W. G. Barrenger, 18, Fordington Road, Highgate, N.8. Mr. F. E. Grayson, 55, Upper Tollington Park, N.4. Mr. B. H. Jenkinson, 36, Avenue lload, Highgate, N.6. Mr. W. W. Kelland, M.A., 14, Hillside Mansions, Jackson's Lane, Highgate, N.6. Councillors. Mr. D. V. Johnson (Vice-Chairman), 54, Coolhurst Road, N.8. 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 (Chairman), "Oaklea," 25, Sheldon Avenue, N.6. 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 Road, N.4. Mrs. M. N. Hill, 16, Bishopswood Road, N.6. Co-optative Members— The Rev. H. C. Montgomery-Campbell, M.A., The Rectory, Hornsey, N.8. 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. Mr. J. W. Ford, M.A., 5, Woodlands Gardens, 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. Gave and L. J. Valette, Mr. J. H. Ford, M.A., 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 persons— Miss M. M. Cole, Mr. C. Knight, Mr. G. Simmonds, B.A., and Mrs. W. Turner. Eight Representatives of Employers and employees in the area of the Authority— Councillor W. V. Wall, Mr. E. H Bennett, Mrs. N. Brixey, Mrs. E. Chapman, Mr. J. A. Ne'wrick, Mrs. D. M. Johnson, Mr. G. Pain, Mrs. H. Tompkins. members of the district care committees. Campsbourne.—Councillor L. J. Valette (ex-officio), Mrs. P. Kayne, Mrs. F. C. Carter, *Mrs. E. Chapman, Mrs. W. C. Hardwick, IMr. 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, Mrs. L. Whittle, Mrs. Durrant and Mrs. Gardiner. Crouch End.—Councillor L. J. Valette (ex-officio), Miss F. A. Barter, Mr. J. H. Ford, M.A., tMrs. A. M. Halford, Mrs. E. H. Hare, Mr. J. Iliffe, Miss E. Pitson, Mrs. J. Stevenson, Mrs. H. Tompkins, Miss A. E. Walmsley, Mrs. J. Whitehead, *Mrs. E. M. Freeborough, Miss F. E. Gee and Miss B. Curtis. * Secretary. †Chalrman. 4 Highgate.—Councillor L. J. Valette (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 and the Rev. C. Wood. Muswell Hill.—Councillor L. J. Valette (ex-officio), †Councillor C. M. Cave, Mr. A. H. Bex, Miss E. F. Catley, Miss M. N. Clarke, Mr. F. G. Edwardes, Mrs. A. Holman, J.P., Mrs. M. Heppell, Mr. W. E. Faterson, M.A., Mrs. W. Paterson, Mr. W. Penn, the Rev. C. A. Roberts, Mr. G. Simmonds, B.A., *Mrs. E. Simmonds and the Rev. W. B. Williams. North Harringay.—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., Mrs J. T. Searle, Miss E. M. Stoker, tCouncillor Valette, Mrs. Easterling and Mrs. Valette. * Secretary. t Chairman. 5 1 - staff of school medical service. School Medical Officer: R. P. Garrow, M.D., D.P.H. Assistant School Medical Officer: Edith I. L. Abbott, M.B., B.S., D.P.H. 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: H. J. Seddon, F.R.C.S. (Eng.) (Resident Medical Superintendent, Royal National Orthopaedic Hospital, Country Branch, Stanmore.) Masseuse: Mrs. Yorke (Royal National Orthopaedic Hospital). Dentist: Hetty C. Hamilton, L.D.S., L.R.C.S., L.R.C.P. (Edin.). 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. Councillor Grimshaw, Ladies and Gentlemen, I have the honour to submit the following Annual Report on the work of the School Medical Department for the year ending December 31st, 1931. Although addressed to the Education Committee of the Borough, this Annual Report is also for the information of the Board of Education. The form of the Report and the tables attached thereto are more or less prescribed by the Board of Education in a Schedule entitled "Suggestions for the arrangements of Annual Reports of School Medical Officers." This Schedule indicates, by means of twenty-four main headings and a certain number of sub-headings and explanatory notes, the information desired by the Board. This plan has obvious advantages from the administrative and statistical points of view, but it has also certain disadvantages. The chief disadvantage is the monotonous repetition entailed in describing year after year the arrangements made and methods adopted in carrying out medical inspection and treatment; in securing the co-operation of parents, teachers, school attendance officers and voluntary bodies; in following up children suffering from defects; in ascertaining and dealing with children who are defective within the meaning of Part V. of the Education Act, 1921; in reviewing the findings of medical inspection; and so on. Arrangements and methods do not change so rapidly as to necessitate a yearly description. In this Annual Report I have therefore omitted many of the details given annually for many years and confined myself to a brief account of the scheme of medical inspection and treatment and the ascertainment of mentally and physically defective children. The Scheme of Medical Inspection. Medical inspection of the elementary school children was carried out in all the schools in accordance with the Board of Education schedule of medical inspection. The boys' departments are inspected by the School Medical Officer and the girls' and infants' departments by the Assistant School Medical Officer. A notice is sent to the parents of each child with an invitation to 7 attend at the time of inspection, and to bring any child under school age for medical examination if desired. A majority of the mothers accept this invitation and take a keen interest in the physical condition of their children. Children under school age to the number of 63 were inspected at the request of parents. The usual three age groups were examined, "entrants," age 5; "intermediates," age 8; and "leavers," age 12. Having regard to the age of entry into Secondary Schools—age 11 +— medical inspection would serve the general educational scheme better if four age groups were inspected, namely ages 5, 8, 11 and 14.* This could be done in Hornsey without additional staff or expense. I wish to express my appreciation of the interest taken by the Head Teachers in the health and physical development of the children. Their presence at medical inspection along with the child's parent ensures co-operation of school and home in measures taken to remedy defects. Defects of growth, nutrition, posture and development are often things of insidious onset and demand medical measures applied conscientiously for prolonged periods—indeed, during the whole developing period of school life and after. Without the closest co-operation of the Head Teachers and their staffs and the intelligent interest of the parents, medical inspection would be a futile affair. It is a pleasure to record that in this Borough it is an increasingly effective agency in promoting the public health, thanks largely to the teachers. Scheme of Medical Treatment of School Children. The ultimate goal of the School Medical Branch of Preventive -Medicine is the diagnosis of health and the maintenance of health which implies full growth and physical development of all children. We are still, alas, far from realising these ideals. Routine medical inspection reveals numerous failures in prevention in the form of disease, deformity, defective development and stunted growth. Many of the defects found have their origin in errors of hygiene, and particularly in dietetic errors in infancy and early childhood. * The suggested inspection of four age groups has been adopted and it is now in operation for 1932 and subsequent years. 8 Medical and surgical treatment in various forms is provided by private family doctors, hospitals and other institutions, and by the Education Authority at the School Clinic. The Authority's scheme of treatment is set out in tabular form on page 12. (a) Minor Ailments. It is not possible to define a minor ailment or draw any clear distinction between an ailment which is minor and one which is major. A condition Which appears trifling to-day may by to-morrow show signs of becoming a serious illness. But, generally speaking, the minor ailments treated by the Clinic Nurse include sores, cuts, skin diseases, inflamed eyelids, etc. The prompt and efficient treatment of these conditions is not only essential in the interest of the children treated, but also in the interest of the general hygiene of the Schools. (b) Throat Operations. These operations were transferred from the School Clinic to the Hornsey Central Hospital in 1929, and the new arrangements are working satisfactorily. (c) Defective Vision. It is unnecessary to stress the great importance of routine testing of the vision of school children, followed by complete examination at the Clinic of those found to have defective vision, and the prescription of glasses to correct the defects. This work is done by the School Oculist, working two sessions per week. (d) Ear Disease and Defective Hearing. An important and effective branch of treatment is that carried out by the School Aurist, Dr. Friel, each Saturday morning. The purpose of this work is the cure of ear discharge and the relief of deafness of varying degree. Conservative methods are employed with such success that the more radical surgical procedures in the nose and throat are becoming less necessary. 9 The following is Dr. Friel's Report of his work:— TABLE SHOWING RESULTS OF TREATMENT OF DISCHARGING EARS. Cause of suppuration. Total. Cured. Lost sight of. Still under treatment. Needing hospital treatment. I Acute inflammation of the Middle Ear 25 18 1 3 3 II. Chronic inflammation of the Middle Ear due to— (a) Tympanic sepsis 14 13 1 — — (4) T.S. + Granulations 4 4 — — — (c) T.S. + Rhinitis 2 2 — — — (d) T.S. + External Otitis 1 — 1 — — (e) Attic disease 4 1 — 3 — (f) Mastoid disease 5 1 — 2 2 III. Inflammation of the external canal 5 4 — 1 — Totals 60 43 3 9 5 "The table shows the number of suppurating ears treated at the Clinic and gives information as to the nature of the disease found to be responsible, and also gives a summary of the results of treatment. The last column, marked 'hospital,' shows the number of ears which need operation or which have already been operated upon. A number of children in whom an operation on the ear was desirable have attended the Clinic but have not been sent to hospital. The reason is that operation does not always hold out a reasonable prospect of the discharge being cured and the deafness not being increased. After the operation has been performed and the child allowed to return home a long attendance as an out-patient is necessary. Parents in poor circumstances and with a large or a young family cannot keep 10 up this prolonged attendance. From the child's point of view it is, therefore, often better to allow him to remain as he is for the present. A longer stay in hospital with the more efficient after-treatment which he would receive would lead to quicker healing than subsequent irregular attendance at an out-patient department. It is very desirable that certain wards in a hospital should be set aside for the treatment of school children suffering from mastoid disease to which patients from several adjacent areas could be sent. The wards should be under the care of an aurist responsible to the Local Authorities for the treatment. It would be a beneficial and economical arrangement, enabling children to be sent out to their work in the world without the disability of a chronic discharge from the ear. A. R. F." (e) The Dental Scheme. The most important change in the School Medical Service in 1931 affected the dental department. The part-time system of dental service employing three dentists doing a total of 10 sessions of work weekly was abandoned, and a whole-time dentist doing 11 sessions of work weekly was appointed. Dr. Betty C. Hamilton commenced the duties of this post in April. Her scheme is to do a dental inspection of all the scholars in a school and then to provide the necessary treatment at the School Clinic of the children who require it and whose parents consent. All the elementary schools are dealt with in similar fashion, and, when the tour of schools is completed, it is repeated in the same order. One whole-time dentist is not able to complete the dental inspection and treatment of all the elementary schools in a year. The tour of the schools will occupy about 15-16 months. (f) The Orthopædic Scheme. The scheme of treatment for crippling defects and deformities started in 1929 is a joint arrangement between the Maternity and Child Welfare and Education Committees. This service is provided very effectively by arrangement with the Royal National Orthopaedic Hospital. It comprises: — (a) A monthly session at the School Clinic by the Orthopaedic Surgeon. 11 (b) Two weekly sessions at the School Clinic by the Orthopaedic Masseuse. (c) Hospital treatment at the country branch of the E.N.O.H. at Stanmore. (d) Provision of surgical appliances, splints, etc. The Orthopaedic Surgeon and Masseuse are on the staff of the R.N.O.H. and therefore are in touch with both ends of the work—at the School Clinic and at the Hospital—thus securing continuity of treatment and supervision. The scheme is working smoothly and is a very valuable and economical extension of the work of the School Medical and Child Welfare Services. The accommodation at the Clinic is cramped and unsuitable, with the result that there are cases on the waiting list. The new School Clinic will enable more work to be undertaken without extra cost (g) Stammering. Miss Bains conducts a class twice weekly for the cure of stammering and other defects of speech. In 1931 16 children were under treatment at the beginning of the year; 4 children were admitted to the class, and 10 children were discharged, leaving under treatment 10 children at the end of the year. It is of the utmost importance that children with defects of speech should have the advantage of this specialist treatment as soon as the defect is recognised. Valuable results are obtained in relieving children of defects of speech which, if they become fixed and permanent, are distressing to the person affected and to his or her friends, colleagues and associates. (h) Ringworm. The treatment by X-rays of ringworm of the scalp is provided by arrangement with a private practitioner who specialises in this work. The number of cases requiring this treatment has diminished steadily and is now nearly nil per annum. (i) Medical Consultative Clinic. Ample opportunity is provided at the School Clinic and the Infant Welfare Centres for medical examination and advice (but no medicine or medical treatment) to be given to any elementary school child who presents any condition which appears to the teacher or parent to prevent the child from obtaining full benefit from the education provided. 12 School Medical Service Scheme of Treatment. Condition treated. Where treated. By whom. When. (a) Minor ailments including skin disease and external eye disease. School Clinic. Clinic Nurse (Miss Paris). Daily at 4 p.m. Throat Operations: (b) Tonsils and Adenoids Hornsey Central Hospital. Surgical Staff of the Hospital. As required. (c) Defective Vision. School Clinic. School Oculist (Dr. Boden). Two sessions weekly, Tuesday afternoons, Thursday mornings. (d) Ear Disease and defective hearing. School Clinic. School Assistant (Dr. Friel). One session weekly, Saturday morning. (e) Dental Defects. School Clinic. School Dentist (Dr Betty C. Hamilton). Full time, Eleven sessions weekly. (f) Crippling defects. School Clinic. Orthopaedic Surgeon (Mr. Seddon). Masseuse (Mrs. Yorke). One session monthly, 1st Friday afternoon in each month. Two sessions weekly, Monday and Friday afternoon*. (g) Stammering. Sehool Clinic. Special Teacher (Miss Bains). Two sessions weekly, Monday and Wednesday afternoons. (h) Ringworm. Address : Haddon Court, Sonthwood Lawn Rd., N 6. Private doctor by arrangement with Education Authority (Dr. J. Morison) Each case as required. (i) Conditions requiring medical consultation. School Clinics and Infant Welfare Centres. S.M.O. and A.S.M.O. Seven sessions or part sessions weekly. 13 blind, deaf, defective and epileptic children. In my Annual Report for 1930 attention was called to the very important questions of the ascertainment of, and special provision made for, children who are defective within the meaning of Fart V. of the Education Act, 1921. These are known officially as "exceptional children," and the Board of Education requires a return of these as on the 31st of December each year under the headings set out in Table III. at the end of this Report. The form of this table has recently been revised by the Board with a view to securing greater uniformity of returns. The revised table gives a better and fuller classification of tubercular children and omits the objectionable and meaningless term "pre-tuberculosis." The separation of children with severe heart disease from crippled children is also an advantage. On the other hand, there appear to be two respects in which the revised form of Table III. presents difficulties to the Medical Officer desirous of making an accurate and clear-cut return, viz., (1) The table is essentially a statement of the number of children in the area between the ages of 5 and 16 years who are so defective as to be unsuitable for a place in an ordinary elementary school. That is to say, it is a statistical statement of the needs of the Authority for special schools for defectives of one kind or another. But the foot notes to the table make it clear that exception to this rule is made in four groups: (a) children suffering from minor epilepsy, (b) certain classes of tubercular children, (c) certain cripples, (d) some delicate children (rheumatics). (2) The second difficulty is the new definition of delicate children, viz.: "All children (except those included in other groups) whose general health renders it desirable that they should be specially selected for admission to an Open-air School." This definition is not confined to diagnosis—but has farreaching implications in treatment and policy. It commits the School Medical Officer to the view that an Open-air School is the correct or the best method of dealing with delicate children. The Medical Officer who returns any considerable 14 number of children attending Public Elementary Schools as delicate in Table III. is, in effect, asking his Authority to provide an Open-air School for delicate children. If he believes, as I do, that there are other methods, more effective and less expensive, of tackling this problem his duty is to make a nil return of delicates. This is the course I have adopted. Ascertainment of Defectives. Efforts to secure complete ascertainment of all exceptional children have been made throughout the year. In this work I have to acknowledge the help of the Head Teachers, Attendance Officers, School Nurses, Tuberculosis Officer and voluntary Social Workers. Summary of the position in regard to Exceptional, Children. Blind.—There is only one totally blind child —a girl age 7 years—who is being educated at the Royal Normal College for the Blind at Upper Norwood. Partially Blind.—Seven children (4 boys and 3 girls) are attending the Myopic Centre at Wood Green. All of them are suffering from defects of vision of such a degree as to render them unfit for the ordinary elementary school methods of education. Deaf and Partially Deaf.—There are 10 children (6 boys and 4 girls) attending the Day School for Deaf Children at Tottenham. Mentally Defective. Twenty-nine Hornsey children (18 boys and 11 girls) attend the Joint Special Day School for Mentally Defective Children at Oak Lane, Finchley (Oak Lodge School). Ascertainment of these children is part of the routine work during every year. When a child in school presents special educational difficulties the question of mental deficiency is raised by the Head Teacher, who reports on a special form to the Secretary for Education. This report is passed to the School Medical Officer, who examines the child at school with the Head Teacher. The result of a careful consideration of all the evidence available may be that the child (a) remains at the elementary school, or (b) is certified as an educable feeble-minded child and is transferred to the Special School, or (c) is certified as an uneducable mentally 15 defective child and is notified to the Local Mental Deficiency Authority (Middlesex County Council). Four children (1 boy and 3 girls) were so notified as imbecile during the year. All the feeble-minded children attending the Special School at Oak Lane are examined twice a year (June and December) by the School Medical Officer. Mentally defective children of poor physical condition and unsatisfactory health who are transferred to Oak Lodge School often make remarkable progress physically within a few months. The Head Teacher (Miss Wyldes) attributes this to the good food provided at the mid-day meal in school—an opinion with which I am in complete agreement. No corresponding improvement is observed in the mental development of these children. They respond to the special educational methods employed by improving in attainment, but they remain mentally defective. Epileptics. Two girls have been ascertained to be suffering from major epilepsy—one is at a residential institution and one is at home. Seven children (3 boys and 4 girls) attending schools have attacks of minor epilepsy . Tubercular Children. The ascertainment of the tubercular groups of physically defective children has been carried out in co-operation with Dr. Dobson, Tuberculosis Officer of the Middlesex County Council, and I am indebted to him for the trouble he has taken in the matter. The virtual disappearance of tuberculosis as a cause of physical defect and crippling among school children is largely due to the pasteurization of the milk supply. Delicate Children. I have already discussed the official definition of delicate children and explained my nil return of "delicates" in public elementary schools. Six children (3 boys and 3 girls) are entered on Table III. as attending certified residential open-air schools. Six places are reserved at the Russell-Cotes Open-air School of Recovery at Parkstone, Dorset, for Hornsey children, and batches of 3 boys and 3 girls are sent there for six weeks at a time. In the course of a year 16 48 children (selected by the School Medical Officer in consultation with the Head Teachers) spend a pleasant six weeks at Parkstone, and resume their places in the elementary schools on their return. The batch of six who happen to be at Parkstone on the last day of the calendar year are entered in Table III. not because they are more or less delicate than the batches who precede and succeed them, but because they were, on the 31st of December, at a certified residential open-air school. Cripples. Table III. includes 11 cripples—a boy and 2 girls at Residential Cripple Schools, 3 boys at Day Cripple Schools and 5 girls at home. All of these are under appropriate orthopaedic treatment. In addition, there are children with various crippling defects of minor degree who are quite able to attend elementary schools and receive orthopaedic treatment at the School Clinic or elsewhere. Heart Disease. Only two children are known to be suffering from heart disease of such severity as to render them unsuitable for an elementary school—.a girl at a special Heart Hospital, and a boy at home. In this connection it should be noted (Table II.) that routine medical inspection of 2,285 school children during the year revealed only 2 cases of organic heart disease. Compared with certain other districts in which rheumatism is such a menace to the child population as to warrant a special antirheumatic campaign, Hornsey is singularly fortunate in this low incidence of heart disease which is the gravest sequel of rheumatism. Special Provision for Defectives. The general position in regard to "exceptional children" is satisfactory, in that they are adequately provided for in accordance with their special needs. a permanent school clinic. The most urgent need of the School Medical Service is a permanent School Clinic built and equipped with proper facilities for carrying out the work of the Medical, Dental, Nursing and Specialist Staffs. 17 Fortunately this can be secured without adding to the cost of the service. An ideal site has been obtained in a quiet, central position at Crouch End, with approaches from the Broadway, from Weston Park, and from Haringey Park. Plans prepared by the Borough Engineer and Architect are now under consideration, and it is hoped that building operations will commence in time to enable the new Clinic to be occupied in the autumn of 1932.* general summary and review—the need for a nutrition campaign. The impression left on one's mind by the year's work in the schools is that a majority of the children are well cared for and of sound physique. The standard of cleanliness is very high. There remains, however, a minority of the children whose general physique leaves much to be desired. They show diseases and defects of one kind or another due in the main to errors of nutrition and poor mothercraft generally. These children strip badly—they are thin, pale, soft, badly shaped, and frequently show structural defects of the bones—evidence of rickets in infancy and early childhood. They are frequently the victims of "nerves" and are educationally as unsatisfactory as they are physically. It cannot be too strongly emphasised that, in the main, the problem presented to the Education Committee and to the Maternity and Child Welfare Committee by this class of child is a nutrition problem. An adequate diet of plain, wholesome foods for the expectant mother, the infant, the pre-school child and the school child is the first consideration. Everything possible is being done in this direction by both Committees by way of education and, in necessitous cases, by the supply of food. An average of 2,500 children took one-third of a pint of milk daily in the schools throughout the year. About 90% of these paid for their milk. For the remaining 10% the cost was defrayed by the Authority. Just as half a loaf * Building commenced April, 1932, and the new Clinic will be ready for occupation September, 1932. 18 is better than no bread, so is a third of a pint better than no milk—and the improvement noted in some of the children after partaking of their morning bottle of milk in school is very striking. But it would be idle to pretend that one-third of a pint of milk is an adequate daily supply for growing boys or girls. They require at least one pint of milk daily—twice as much at home as they get at school. Other fresh natural foods equally necessary for full growth and development and resistance to disease are eggs, butter, bread, meats of various kinds, including liver, and abundance of fruit and vegetables. After diet, rest comes next in order of importance for growing children. An extra hour in bed at night is equal to 15 days' complete rest in the year. The young school child who goes to bed at 9 to 10 p.m. instead of at 6 p.m. is losing six to eight week's rest per annum. No wonder that some of these little ones look tired and old! After diet and rest, I would glace physical exercises next in order of value in promoting growth and establishing sound physique—especially exercises designed to improve shape, posture and breathing capacity. For the class of children I have in mind I suggest that a portion of the school time now being devoted to shaping their minds would be profitably devoted to shaping their bodies. I desire to acknowledge with thanks the good work of the staff of the School Medical Service throughout the year, the hearty co-operation of the Education Office and the teaching staffs, the devoted service of the Care Committees, and the constant interest of the Education Committee in all that promotes the physical welfare of the elementary school children. I wish particularly to thank the Education Committee for the favourable consideration given to the provision of a new School Clinic where more work of better quality can be carried out at (I hope) less cost to the community. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, R. P. GARROW. 19 list of tables. TABLE I.—Number of children inspected. ,, II. (a).—Defects found by medical inspection. „ II. (b).—Number of individual children found to require treatment (including uncleanliness and dental diseases). ,, 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 treated as minor ailments). 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. 20 TABLE I. RETURN OF MEDICAL INSPECTIONS (see note a). (a)—Routine Medical Inspections. Number of Code Group Inspections— (see note b). Entrants 963 Intermediates 973 Leavers 349 Total 2,285 Number of other routine Inspections (see note c). 178 (b)—Other Inspections. Number of special Inspections (see note d). 1,289 Number of re-inspections (see note e). 2,362 Total 3,651 21 NOTES ON TABLE I. (a) The return refers to a complete calendar year. (b) This heading relates solely to the routine medical inspection of the three ordinary age groups, i.e., to medical inspection carried out:— (i) In compliance with Article 17 of the Consolidated tions relating to Special Services—Grant Regulations No. 19; (ii) on the school premises (or at a place specially sanctioned by the Board); (iii) for the purpose of making a report on each child on the lines of the approved Schedule set out in Circular 582. (c) Under this heading may be recorded routine inspections, if any, of children who do not fall under the three code age-groups, e.g., routine inspections of a fourth age-group or of other groups of children, as distinct from those who are individually selected on account of some suspected Ill-health for "Special" Inspection. (d) A Special Inspection is a medical inspection by the School Medical Officer himself or by one of the Medical Officers on his staff of a child specially selected or referred for such inspection, i.e., not inspected at a routine medical inspection as defined above. Such children may be selected by the Medical Officer during a visit to the School or may be referred to him by the Teachers, School Nurses, Attendance Officers, Parents, or otherwise. It is immaterial for the purpose of this heading whether the children are inspected at the School or at the Inspection Clinic or elsewhere. If a child happens to come before the School Medical Officer for special Inspection during a year in which it falls into one of the routine groups, its routine inspection should be entered in Part A of Table I. and its special inspection in Part B. The inspection to be recorded under the heading of special inspections should be only the first Inspection of the child so referred for a particular defect. If a child who has been specially inspected for one defect is subsequently specially inspected for another defect, such subsequent inspection should be recorded as a Special Inspection and not as a Re-inspection. (e) Under this heading should be entered the medical inspections of children who as the result of a routine or special inspection come up later on for subsequent re-Inspection, whether at the School or at the Inspection Clinic. The first inspection in every case will be entered as a routine or special inspection as the case may be. Every subsequent inspection of the same defect will be entered as a re-inspection. Care should be taken to see that nothing is included under the head of special inspections or re-inspections except such inspections as are defined above. Attendances for treatment by a Nurse, or for examinations by anyone other than a Doctor on the staff of the School Medical Service, should not be recorded as medical inspections. If, however, at any such attendance a child is also examined by one of the Authority's Medical Officers, this should be recorded as a special inspection or re-inspectlon as the case may be, even if treatment is also given; but such attendance may also of course be recorded as an attendance for treatment. 22 TABLE II. (A)—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER. DEFECT OR DISEASE. Routine Inspections. Special Inspections- No. of Defects. No, of Defects. Requiring treatmen Requiring to be kept under observation, but not requiring treatment. Requiring treatment. Requiring to be kept .under observation, but not requiring treatment. (2) (3) (4) (5) Malnutrition- 45 ... ... ... Uncleanliness (See Table IV., Group V.) Skin Ringworm, scalp ... ... 5 ... „ body ... ... 4 ... Scabies ... ... 9 ... Impetigo ... ... 47 ... Other Diseases (Non-tuberculous) ... 1 72 ... Eye Blepharitis 1 ... 5 ... Conjunctivitis ... ... 31 ... Keratitis ... ... ... ... Corneal Opacities 1 ... ... ... Defective Vision (excluding Squint) 169 31 111 ... Squint 24 2 35 ... Other Conditions 4 ... 102 ... Ear Defective Hearing 10 ... 9 ... Otitis Media 2 0 20 ... Other Ear Diseases 4 ... 33 ... Nose and Throat Enlarged Tonsils only 2 14 11 ... Adenoids only ... ... 1 ... Enlarged Tonsils and Adenoids 2 4 12 ... Other conditions 7 ... 75 ... Enlarged Cervical Glands (Non-Tuberculous) ... 1 8 0 Defective Speech 2 ... ... ... Teeth Dental Diseases (see note a) (See Table IV., Group IV.) 665 ... 9 0 Heart and Circulation Heart Disease: Organic ... 2 ... ... Functional ... ... ... ... Anaemia 10 ... 78 ... Langs Bronchitis 17 ... 3 0 Other Non-Tuberculous Diseases ... ... ... ... Tuberculosis Pulmonary: Definite ... ... ... Suspected ... ... ... ... Non-Pulmonary: Glands ... ... ... ... Spine ... ... ... ... Hip ... ... ... ... Other Bones and Joints Skin ... ... ... ... Other Forms ... ... ... ... Nervous SysteM Epilepsy ... 2 ... ... Chorea ... 1 1 ... Other Conditions ... ... ... ... Deformities Rickets 5 ... ... ... Spinal Curvature 9 ... ... ... Other Forms 135 ... ... ... Other Defects and Diseases 4 5 624 ... 23 TABLE II. (continued). (B)—NUMBER OF INDIVIDUAL CHILDREN (see note b) FOUND AT ROUTINE MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UNCLEANLINESS AND DENTAL DISEASES). Group Number of Children. Percentage of Children found to require Treatment (see note d). Inspected (tee note c). Found to require Treatment. (1) (2) (3) (4) Code Groups:— Entrants 963 76 8 Intermediates 973 232 24 Leavers 349 77 22 Total (code groups) 2,285 385 17 Other routine inspections 178 35 20 NOTES ON TABLE II. (a) The figures to be included in this space should refer to the findings of the Medical Officer and not those resulting from dental inspection in the schools by the School Dentist. The findings of the School Dentist should be recorded in Table IV., Group IV. (b) No individual child should be counted more than once in this part of Table II., i.e., under B., even if it is found to be suffering from more than one defect. (c) The figures in this column will of course be the same as those given in Table I. A. (d) The figure in this column will be the percentage of the figure in column (3) of that in column (2). 24 TABLE III. RETURN OP ALL EXCEPTIONAL CHILDREN IN THE AREA (see note a). No child should be entered under more than one heading. Boys. Girls. Total. 1. Children suffering from the following types of Multiple Defect, i.e., any combination of Total Blindness (see note (b) (1)), Total Deafness (see note (d) (1)), Mental Defect, Epilepsy, Active Tuberculosis, Crippling (as defined in penultimate category of the Table), or Heart Disease The actual combination of defects and the type of School, if any, attended should be indicated on a separate sheet Blind (including partially blind (see note b). (i) Suitable for training in a School for the totally blind. 2 At Certified Schools for the Blind 1 1 3 At Public Elementary Schools (see note c) 4 At other Institutions 5 At no School or Institution (ii) Suitable for training in a School for the partially blind. 6 At Certified Schools for the Blind or Partially Blind 4 3 7 7 At Public Elementary Schools (see note c) 8 At other Institutions 9 At no School or Institution Deaf (i n cluding deaf and dumb and and partially deaf (see note d) (i) Suitable for training in a School for the totally deaf or deaf and dumb. 10 At Certified Schools for the Deaf 6 4 10 11 At Public Elementary Schools (see note c) 12 At other Institutions 13 At no School or Institution (ii) Suitable for training in a School for the partially deaf. 14 At Certified Schools for the Deaf or Partially Deaf 15 At Public Elementary Schools (see note c) 16 At other Institutions 17 At no School or Institution Mentally Defective Feebleminded. (See note e) 18 At Certified Schools for Mentally Defective Children 18 11 29 19 At Public Elementary Schools (see note c) 20 At other Institutions 21 At no School or Institution 1 1 Notified to the Local Mental Deficiency Authority during the year. 22 Details should be given on Form 307 M 1 3 4 25 TABLE III. (continued). Boys. Girls. Total. Epileptics. Suffering from severe epilepsy. (Sec note f). 23 At Certified Schools for Epileptics 1 1 24 At Certified Residential Open Air Schools 25 At Certified Day Open Air Schools 26 At Public Elementary Schools (see note c) 27 At other Institutions 28 At no School or Institution 1 1 Suffering from epilepsy which is not severe. (See note g). 29 At Public Elementary Schools 3 4 7 30 At no School or Institution Physically Defective (see note i). Active pulmonary tuberculosis (including pleura and intrathoracic glands). 31 At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 32 At Certified Residential Open Air Schools 33 At Certified Day Open Air Schools 34 At Public Elementay Schools (see note h) 35 At other Institutions 36 At no School or Institution Quiescent or arrested tuberculosis (including pleura and intrathoracic glands). 37 At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 38 At Certified Residential Open Air Schools 39 At Certified Day Open Air Schools 40 At Public Elementary Schools ... 41 At other Institutions 42 At no School or Institution 1 1 Tuberculosis of the peripheral glands. 43 At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 44 At Certified Residential Open Air Schools 45 At Certified Day Open Air Schools 46 At Public Elementary Schools (see note h) 47 At other Institutions 48 At no School or Institution Abdominal tuberculosis. 49 50 At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board At Certified Residential Open Air Schools 51 At Certified Day Open Air Schools 52 At Public Elementary Schools (see note h) 53 At other Institutions 54 At no School or Institution 26 TABLE III. (continued). Boys. Girls. Total Physically Defective (continued). (See note i). Tuberculosis of bones and joints (not including deformities due to old tuberculosis). 55 At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 1 1 56 At Public Elementary Schools (see note h) 57 At other Institutions 58 At no School or Institution 1 1 Tuberculosis of other organs (skin, etc.). 59 At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 60 At Public Elementary Schools (see note h) 61 At other Institutions 62 At no School or Institution Delicate Children, i.e., all children (except those included in other groups) whose general health renders it desirable that they should b e specially selected for admission to an Open Air School. (See note j.) 63 At Certified Residential Cripple Schools 64 At Certified Day Cripple Schools 65 At Certified Residential Open Air Schools 3 3 6 66 At Certified Day Open Air Schools 67 At Public Elementary Schools 68 At other Institutions 69 At no School or Institution Crippled Children (other than those with active tuberculous disease) who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life. 70 At Certified Hospital Schools 71 At Certified Residential Cripple Schools 1 2 3 72 At Certified Day Cripple Schools 3 3 73 At Certified Residential Open Air Schools 74 At Certified Day Open Air Schools 75 At Public Elementary Schools (see note k) 76 At other Institutions (see note k) 77 At no School or Institution (see note k) 5 5 27 TABLE III. (continued). Boys. Girls. Total. Physically Defective (continued). (Set note i). Children with heart disease, i.e., children whose defect is so severe as to necessitate the provision of educational facilities other than those of the public elementary school. 78 At Certified Hospital Schools 1 1 79 At Certified Residential Cripple Schools 80 At Certified Day Cripple Schools 81 At Certified Residential Open Air Schools 82 At Certified Day Open Air Schools 83 At Public Elementary Schools (see note c) 84 At other Institutions 85 At no School or Institution 1 1 NOTES ON TABLE III. (a) This Table should include 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 and certain classes of tuberculous and crippled children) 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. In areas other than Counties or County Boroughs children ascertained by the Tuberculosis Officer of the County should be included. 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. 28 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 category should in fact be attending public elementary schools. When the heading is retained, it is merely because at present the insufficiency of Spcial School accommodation makes it impossible to do better for some of these children than to allow them to attend the ordinary school, or because there is some other reason which accounts for the temporary attendance of the children at the ordinary school. (d) 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 should exclude all children who have been notified to the Local Authority under the Mental Deficiency Act. (f) 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) Children with "open" tuberculosis should of course be promptly excluded from public elementary schools. (i) The exact classification of physically defective children 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. (j) Delicate children suffering from rheumatism should be included in this category, even though it may be considered undesirable to send them to an Open School. (k) The total under this heading should be followed by a figure in brackets indicating the number of these children who should be receiving Special School education. 29 TABLE IV. RETURN OP DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER. (See note a.) TREATMENT TABLE. Group I—Minor Ailments (excluding Uncleanllness, for which see Group V.). DISEASE OR DEFECT. Number of Defects treated or under treatment during the year. Under the Authority's Scheme (see note b). Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm-Scalp 5 5 Ringworm-Body 4 4 Scabies 9 9 Impetigo 100 100 Other Skin Disease 79 79 Minor Eye Defects (External and other, but excluding cases falling in Group II). 8 8 Minor Ear Defects (See note c). 8 8 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 335 335 Total 548 S48 30 TABLE IV. (continued.) Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). DEFECT OR DISEASE. Number of Defects dealt with. Under the Authority's Scheme (see note b). Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme, Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report). 429 57 486 Other Defect or Disease of the Eyes (excluding those recorded in Group 1.). 131 131 Total 560 57 617 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 471 (b) Otherwise — Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 465 (b) Otherwise — Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme, in Clinic or Hospital (see note b). By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 21 22 82 104 31 Group IV.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist : Routine Age Groups Aged: 5 213 6 441 7 450 8 384 9 408 10 414 11 405 12 248 13 154 14 86 15 39 Total 3242 Specials (see note d) 949 Grand Total 4191 (b) Found to require treatment 3045 (c) Actually treated 2114 Retreated 572 (2) Half-days devoted to:— Inspection 25 Treatment 397 Total 422 (3) Attendances made by children for treatment 4391 (4) Fillings:— Permanent Teeth 1747 Temporary Teeth 810 Total 2557 (5) Extractions:— Permanent Teeth 403 Temporary Teeth 3067 Total 3470 (6) Administration of general anæsthetics for extractions 1332 (7) Other operations:— Permanent Teeth 423 Temporary Teeth 694 Total 1117 Group V.—Uncleanliness and Verminous Conditions. (See note e.) (i.) Average number of visits per school made during the year by the School Nurses—55. (ii.) Total number of examinations of children in the Schools by School Nurses—27,950. (iii.) Number of individual children found unclean—397. (iv.) Number of children cleansed under arrangements made by the Local Education Authority—135. (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921—Nil. (b) Under School Attendance Byelaws—Nil. NOTES ON TABLE IV. (а) The Table should deal with all defects treated during the year, however they were brought to the Authority's notice, i.e., whether by routine inspection, special inspection, or otherwise, during the year in Question or previously. (b) This heading should include all cases that received treatment under definite arrangements or agreements for treatment made by the Local Education Authority and sanctioned by the Board of Education under Section 80 of the Eduoation Act, 1921. Cases which, after being recommended for treatment or advised to obtain it, actually received treatment by private practitioners, or by means of direct application to Hospitals, or by the use of hospital tickets supplied by private persons, etc., should be entered under other headings. 32 (c) If any treatment is given for more serious diseases of the ear (e.g., operative treatment in hospital) it should not be recorded here but in the body of the School Medical Officer's Annual Report. (d) The heading "Specials" in this Table relates to all children inspected by the School Dentist otherwise than in the course of the routine inspection of children in one of the age groups covered by the Authority's approved scheme, namely, to children specially selected by him, or referred by Medical Officers. Parents, Teachers, etc., on account of urgency. The number inspected in each age group should be separately shown, as well as the total, but under "Specials" only the total number should be given. (e) A statement as to the arrangements made by the Local Education Authority for cleansing verminous children and a record of the cases in which legal proceedings were taken, should be included in the body of the School Medical Officer's Report. N.B.—Groups I.—V. above cover all the defects for which treatment is normally provided as part of the School Medical Service. Particulars as to the measures adopted by the Authority for providing treatment for other types of defect (e.g., for orthopaedic treatment) or for securing improvement in types of defect which do not fall to be treated under the Authority's own scheme and for which the Authority neither incur expenditure nor accept any responsibility, together with a statement of the effect of the measures taken, should be included in the body of the School Medical Officer's Report. It is convenient for such particulars to follow the headings of Table II. 33 TABLE V. LIST OF SCHOOLS IN THE BOROUGH. School. Department. Authorized accommodation. Average No. on the Rolls for qr. ended 31/12/31. Head Teacher. Muswell Hill Junr. Mixed 200 139 Miss E. Catley St. Michael's Mixed 196 135 Mr. E. R. Lewis „ Junr. Mixed 168 100 Miss E. Towler Highgate Mixed 328 278 Mr. T. E. Durban „ Junr. Mixed 264 154 Miss D. F. Smith North Harringay Boys' 380 413 Mr. F. W. Jaggard „ „ Girls' 380 333 Miss G. M. Ryder, B.Sc. „ „ Junr. Mixed 416 356 Miss E. Stoker South Harringay Mixed 440 451 Mr. G. F. Shaw, M.A. „ „ Infants' 240 182 Miss R Jones Stroud Green Boys' 350 338 Mr. H. D. Chrismas, B Sc. „ „ Girls' 350 343 Miss F. M. Hodgkins „ „ Infants' 352 264 Miss E. Pitson St. Mary's Mixed 428 440 Mr. J. W. Harris „ Infants' 232 255 Miss M. D. Sibley Crouch End Boys' 456 331 Mr. J. Iliffe „ „ Girls' 450 304 Miss F. Barter „ „ Junr. Mixed 411 261 Miss A. Walmsley Holy Innocents' Infants' 101 85 Miss F. Gee St. James' Junr. Mixed 240 265 Mr. W. Penn Campsbourne Boys' 388 364 Mr. H. Tumor „ Girls' 388 308 Miss G. Litchfield „ Infants' 400 300 Miss H. Stone Coldfall Mixed 440 522 Mr. G. Simmonds, B.A. „ Infants' 400 275 Miss M. Clarke Totals 8,398 7,196