HOR 024 AC 439(1) BOROUGH OF HORNSEY. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR 1932. R. P. GARROW, M.D., D.P.H. Printed by "The Hornsey Journal," Limited, 161, Tottenham Lane, Hornsey, N.8. HDR 02.4 Borouob of 1born8e\\ ANNUAL REPORT FOR 1932 OF THR Medical Officer of Health 1 nnted by The Hornsey Journal," Ltd., 161, Tottenham Lane, Hornsey, N.8. INDEX. Acts In force, 11. Admissions to Hospital, 43. Allotments, 17. Ambulances, 11, 12. Ante-natal Clinics, 34, 47. Area of Borough. 7. Attack rate, infectious disease, 44. Bacteriological examinations, 11. Bakehouses, 17, 19. Baths and Wash-houses, 21. Births and rates, 7, 13, 38, 42. Borough Nursing Association, 10. Butchers, 17, 19. Bye-laws in force, 11, 20, 25. Cancer deaths, 42. Carbide, 29. Cellulose spirit, 29. Cerebro-splnal meningitis, 43, 44. Charity expenditure, 9. Children Acts, 12, 47. Cinemas, 17, 19. Cleansing station, 32. Clinics, 34, 43. Committees, 1, 2. Conveniences, 17. Controlled houses, 21. Dairies, 17, 19, 23. Deaths and rates, 7, 8, 38, 42. Causes of, 39, 40. Dental scheme and treatment, 35. Diarrhoea, 8, 42. Diphtheria, 30, 42, 43, 44. Diseases of Animals Acts, 33. Disinfection, 32. ,, Vans 33. Dog nuisance, 32. Drain tests, 17, 18. Drainage, 17, 18. Dysentry, 44. Encephalitis letharglca, 43, 44. Enteric fever, 42, 43, 44. Erysipelas, 43, 44. Factories and workshops, 17, 19, 48. Fish shops, 19. Fish condemned, 25, 26. Five-year" programme, 5, 14. Flats erected, 23. Pood inspection, 17, 26. ,, condemned, 25, 26. ,, samples, 26. Poster mothers and children, 12, 47. Hairdressers (Sunday Closing) Act, 28. Health Committee, 1. ,, Visiting, 12, 47. ,, Visitors, 34. Home Nursing, 10. Hornsey Nursing Association, 10. Horticultural poisons, 29. Hospital services, 31, 34. Houses erected, 23. „ demolished, 16. Housing, 5. Bye-laws, 20, 21. Families rehoused, 22, 23. " Five-year " programme, 5, 14. House-to-house inspections, 17, 20. Inspections, 14. Returns of work, 14. Statistics, 14. Hydro-carbon, 29. Humane slaughtering, 25. Illegitimate births, 7. „ children, deaths, 8. Infant deaths and rates, 38, 41, 42. „ „ Causes, 41. Increase of Rents Act, 17, 20. Infantile paralysis, 43, 44. Infectious disease— Prevalence, 30. Diphtheria, 30, 42, 43, 44. Notifications, 43. Scarlet fever, 30, 42, 43, 44. Inhabited houses, 7. Inquests, 33. Inspections made, 17, 19. Isolation Hospital, cases admitted to, 43. Laboratory work. 11. Legal proceedings, 29. Library books, 32. Lodging houses, 21. Malaria, 44. Maternal mortality, 12. Maternity and Child Welfare Committee, 2. Maternity and child welfareAnalysis of attendances, 47. Ante-natal, 34, 47. Births notified, 13. Centres, 33, 34. Clinics, 34, 35. Dental treatment, 35. Health visiting, 12, 47. Hospital arrangements, 34. „ maternity cases, 34. Lectures, 35, 47. Maternal deaths, 7. Midwife, 11, 34, 47. „ car allowance, 34. Milk grants, 35. Nursery school, 36. Orthopaedic scheme, 35. Sessions, 34, 47. Staff, 34. Statistics, 47. Maternity & child welfare— Time-table, 33, 34. X-ray treatment, 34. Year's work, 47. Measles, 8, 42, 44. Meat inspection, 24, 25. „ condemned, 25. Meningitis, 43, 44. Midwives, 11, 35, 47. Milk grants, 35. „ cookery lectures, 35. „ licences, 23, 24. „ samples, 23, 33. „ shops, 17, 19, 23. Mortuary, 33. North Hill Hats, 14. Notification of Births Act, 13. Nursing Association, 10. Nursery School, 36. Ophthalmia neonatorum, 30, 43, 44. Orthopsedic scheme, 35. Outworkers, 19, 49. Overcrowding, 5, 17, 19, 21. Para-typhoid, 43, 44. Passageways, 17. Pests, 17, 32. Petroleum Acts, 17, 19, 28. „ licences, 29. Piggeries, 18. Pneumonia, 43, 44. Poisons Act, licences, 29. Poliomyelitis, 43, 44. Polio Encephalitis, 44. Population, 7, 38, 42, 44. Preface. 5. Puerperal fever and pyrexia, 3, 43, 44. „ deaths, 7. Rag Flock Act, 17. Rateable value and produce of 1d. rate, 7. Refuse shoots, 14, 17, 19. Regulations in force, 11, 20, 25. Rent and Mortgage Interest (Restrictions) Act, 17, 20. Restaurants, 17, 19. Royal Northern Hospital, 34. Sale of Food and Drugs Act, 26. Sanitary notices served, 15. Sanitary work, 14, 17, 18. Scabies, 17. Scarlet fever, 30, 42, 43, 44. Shoots, refuse, 14, 17, 19. Shops Acts, 17, 26. „ Summonses, 29. ,, list of, 27, 28. Slaughter-houses, 17, 19, 24, 25. Slaughtering bye-laws, 25. Small-pox, 18, 30, 43, 44. Smoke, 17. Social services, 9. Stables, 17. Statutory notices, 15. Staff, 3, 4. Still births, 7, 42. Summonses, 29. Tables, List of, 37. Tuberculosis, Cases of, 31, 32, 43, 44, 46. „ Sanatoria and beds, 31. „ Deaths and rates, 42, 44, 45. „ Register, 46. „ Sputums, 11. Typhoid fever, 42, 43. 44. Vaccination, 30. Verminous houses, 17. Veterinary Inspector's report, 33. Visits by Inspectors, 17, 19. Visiting of Children, 12, 47. Vital statistics, 7, 8, 38. „ „ England, &c., 38. Voluntary Committees work, 36. Ward's Cottages, 14. Whooping-cough, 8, 42. Workshops, 48. X-ray treatment, 34. 1 HEALTH COMMITTEE AS AT 31st December, 1932. Alderman P. Everington (Chairman), 81, Mount View Ed., N.4. The Mayor, Alderman J. W. Rowlands, J.P., 25, Cholmeley Park, N.6. Alderman W. W. Kelland, M.A., 14, Hillside Mansions, N.6. Councillor Mrs. J. H. Barrenger, 20, Southwood Hall, N.G. ,, F. 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. ,, W. J. Grimshaw, 25, Sheldon Avenue, N.6. ,, Mrs. M. N. Hill, 16, Bishopswood Road, N.6. ,, W. J. Lendrum, 10, Leaside Avenue, 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. ,, C. Winkley, 72, Woodside Avenue, N.10. 2 MATERNITY & CHILD WELFARE COMMITTEE as at 31st Decemrer, 1932. 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.0. Councillor Mrs. J. H. Barrenger, 20, Southwood Hall, N.6. ,, F. A. P. Boustred, 26, Lanchester Road, N.6. ,, E. Brooks, 122, Crouch Hill, N.8. ,, S. G. Goulding, Woodlands, Cranley Gardens, N.10. ,, W. J. Grimshaw, 25, Sheldon Avenue, N.6. ,, Mrs. M. N. Hill, 16, Bishopswood Road, N.6. ,, W. J. Lendrum, 10, Leaside Avenue, 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. F. M. Merry, 20, Etheldene Avenue, N.10. Mrs. B. Walton, 19, Etheldene Avenue, N.10. Miss F. E. Wood, 38, Church Crescent, N.10. 3 STAFF OF PUBLIC HEALTH DEPARTMENT, †*Medical Officer of Health R. P. Garrow, M.D., D.P.H. †*Deputy Medical Officer of Health and Assistant Medical Officer of Schools and Maternity and Child Welfare Centres Edith I. L. Abbott, M.B.,B.S., D.P.H. (till June, 1932). Jean Sutherland, M.B., Ch.B., D.P.H. (from Sept., 1932). ‡ Assistant Medical Officer for Maternity and Child Welfare Jessie Muir, M.B., Ch.B. ‡Consultants (Puerperal Fever and Pyrexia Eegulations) ... Dr. J. B. Banister, 129, Harley Street, W.l. Dr. A. W. Bourne, 14, Devonshire Street, W.l. 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.E.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. 4 †Chief Clerk W. Gilory, †Assistant Clerks E. Cheesman, A. Wickham. D. Bryant (Temporary). †Health Visitors A. Glover. J. I. Macpherson, Dip. N.H.S., H.V. Cert., C.M.B E. Durnford, H.V. Cert., C.M.B. A. Godden, H.V. Cert.. C.M.B. †Midwife M. Andrews, c.m.b. †Mortuary Keeper C. F. Catlin. †Disinfectors W. H. Lewis. P. Hall. †Medical Services Motor Driver P. Martin. ‡Veterinary Inspector under Diseases of Animals Acts F. G. Buxton, M.R.C.V.S. Note:—† Whole time Officers. * Officers in respect of whom salary contribution is made under the Public Health Acts or by Exchequer Grants. ‡ Part time Officers. 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 1932. From the health point of view the year has been a remarkably good one. In spite of continued economic depression, there has been no evidence of any unusual prevalence of disease. Throughout the country as a whole the public health problem which has loomed largest in 1932 is the housing problem or the "slum problem." State and Church are equally determined that the slums which disgrace many—indeed most—of the towns and cities of England should be wiped out within a limited number of years (within five years, according to Circular 1,331, dated 6th April, 1933, from the Ministry of Health). In Hornsey, fortunately, the slum aspect of the housing problem—the need for demolition and re-housing—is relatively small and manageable. The five-years' programme submitted to the Ministry of Health in 1931 under the Housing Act, 1930, included 86 houses unfit for human habitation. Further inspections have brought this figure up to 118. Substantial progress has already been made in dealing with these condemned houses, and all of them can be disposed of within the period indicated in the Circular. There is another aspect of the housing problem which presents much greater difficulty in Hornsey—the problem created by good houses being divided into flats, or groups of rooms, or even single rooms, for occupation by separate families. This process is proceeding apace in every part of suburban London. The resulting overcrowding in some houses and the increased density of population in the areas affected are factors which may influence the prevalence of certain infectious diseases and their complications. The sanitary inspectors have given this matter constant attention throughout the year in their respective districts of the Borough. The health department, in conjunction with the 6 housing department, is doing everything possible to prevent new cases of overcrowding and to relieve those found during routine inspection of houses. Yet another aspect of housing which has received due attention is the early repair of minor sanitary defects—a most important factor in maintaining a high standard of housing. Good housing alone will not secure good health for a family or for a community. Good health demands good living, in every sense—hence the modern trend in public health effort, which assumes good environmental hygiene, such as we have in Hornsey, and emphasises the importance of personal hygiene. This is a department presided over by the Maternity and Child Welfare and Education Committees, in which much good work has been done at the Schools, the Welfare Centres, the School Clinic, and in the homes. I wish to acknowledge the untiring efforts of the Voluntary Workers at the Centres and the Care Committees attached to the schools; also the close interest of the Health Committee and the Maternity and Child Welfare Committee in the maintenance of a high standard of health. I am, Ladies and Gentlemen, Your obedient servant, E. P. GAEEOW. 7 Social and Economic Statistics. Area (acres) 2,874 Population (Census 1931) 95,524 Do., Registrar-General's estimate (mid 1932) 96,990 Number of inhabited houses (end of 1931), according to Rate Books 21,307 Rateable value (General Rate) £1,003,750 Product of a penny rate £4,182 LIVE BIRTHS- Legitimate Males527 ,, Females 528 Illegitimate Males 26 ,, Females 22 Total 1,103 Birth-Rate 1137 per 1,000 population (Registrar-General's estimate). STILL-BIRTHS— Legitimate Males 21 ,, Females 13 Illegitimate Males 1 ,, Females 3 Total 38 Rate per 1,000 total (live and still births) births, 33.3. DEATHS— Male 486 Female 625 Total 1,111 Death-Rate 1145 per 1,000 population (Registrar-General's estimate). Deaths from Puerperal Causes. Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 4 35 Other puerperal causes 2 1.75 Total 6 5.25 8 Deaths of Infants under 1 Year of Age. Legitimate Males 21, Females 23 = 44 Illegitimate ,, 5, ,, 2=7 Total 51 Death-Rate of Infants under 1 Year of Age. All infants per 1,000 live births 462 Legitimate infants per 1,000 legitimate live births 41.7 Illegitimate infants per 1,000 illegitimate live births 145.8 Deaths from Measles (all ages) 6 Death from Whooping-Congh (all ages) 3 Deaths from Diarrhoea (under 2 years of age) 7 9 SOCIAL AND ECONOMIC CONDITIONS IN THE AREA. The following is a summary of cases and cost of public and voluntary assistance disbursed in the Borough during 1932, from information collected by Mr. R. Parry, Relieving Officer:— SUMMARY. Charitable Organisations. £ s. d. Public Assistance (Out-relief) 23,820 1 6 Widows (10/-) and Old Age Pensions 8,000 0 0 Widows' (with dependent children) Pensions 1,564 0 0 National Health Insurance benefits 1,427 13 0 War Pensions 423 8 0 Earnings of Wives of Unemployed Men 402 6 0 Unemployment Insurance benefit 8,260 9 2 Hornsey United Services Fund 429 14 9 Mrs. Lovell Harrison's Fund 16 10 8 Hornsey British Legion 600 12 0 Muswell Hill United Services Fund 32 6 0 Muswell Hill British Legion 60 19 6 Muswell Hill Distress (Boot) Fund 19 17 0 Central Boot Fund (Mr. Allen) 36 5 11 Parochial Charities (Coal) 114 19 0 Hornsey Y.M.C.A 47 0 0 Mrs. Chapman 22 12 6 68th Rover Crew 1 10 0 Mr. Homewood 1 0 0 Mrs. Kingsley-Curtis 1 0 0 School Care Committee 164 13 6 Hornsey Parochial Charities 593 2 6 Hornsey Distress Committee 62 18 11 Mayor's Fund (Oakfield Villa) 403 2 11 Muswell Hill Distress Committee 71 10 0 Welfare Centres (Milk supplied by Council) 292 9 10 Total 46,930 2 8 10 NURSING IN THE HOME. (i.e., District Nursino.) The Hornsey Nursing Association continues to render invaluable service to the Borough by the home nursing of many cases of acute disease, medical and surgical. But for this service many more sick and infirm patients would require admission to Hospital. The following are some particulars of this Association:— President—The Mayor of Hornsey. Honorary Secretary— Mr. R. H. Crookall, 0, Birchington Road, N.8. Honorary Treasurer— Mr. S. M. Mason, 50, North Hill, N.6. Superintendent Nurse— Miss Ivett, 2, Ravenstone Road, N.8. Tele. 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. Pneumonia 26 308 16 4 5 - Tuberculosis 8 280 2 - 4 - Influenza 26 235 22 - 3 1 Whooping Cough 2 11 2 - - - Whooping Cough- Pneumonia complication 4 55 4 - - - Measles 13 91 12 - - 1 Measles- Pneumonia complication 1 7 1 - - - Puerperal Pyrexia - - - - - - Ophthalmia Neonatorum - - - - - - 11 MIDWIVES. There are 17 Midwives and one Municipal Midwife notified to the Middlesex County Council as practising in the Borough. The Municipal Midwife attended 161 births, and she also attends all the ante-natal clinics held at the Welfare Centres—Brook Road, Wightman Road, Church Road, Highgate, and Coldfall School. One of the conditions upon which the Council's Midwife accepts a case is that the expectant mother shall attend an ante-natal clinic. LABORATORY FACILITIES. The arrangements for the examination or analysis of materials are as previously described and meet all requirements. The specimens examined in the laboratory at the Isolation Hospital during 1932 were as follows:— Negative. Positive. Diphtheria specimens 833 53 Sputum (T.B.) ,, 194 26 Enteric Fever ,, 4 1 Other „ 8 6 1,039 86 Total 1,125 LEGISLATION IN FORCE. No new Local Acts, Special Orders, general adoptive Acts or Byelaws relating to the public health came into force in Hornsey in 1932. The Children and Young Persons Act, 1932, which amends the Children Act, 1908. and deals, inter alia, with Infant Life Protection, was passed during the year. AMBULANCE FACILITIES. No change has been made in the ambulance arrangements, which are adequate for all types of case—infectious, noninfectious, maternity, accidents, etc. The Morris "Viceroy" motor conveyance for the transport of mentally and physically defective children travelled over 11,000 miles and carried over 22,000 passengers. Prior to 1933 this vehicle was classed as an ambulance and tax-free. The Ministry of Transport has, however, laid down that a tax-free ambulance must be sent out for recumbent cases. 12 The following is a statement of the work done by the "Borough Ambulance " under the Fire Brigade:— Calls 1,009 Persons conveyed 1,006 Street accidents 343 Other cases 666 MATERNAL MORTALITY. Circular 1,167 and Memo. 156 M.C.W. from the Ministry of Health has received the M.C.W. Committee's close attention. All the services suggested in this Circular are available in the Borough and are working smoothly. As requested by Circular 1,206 of the Ministry of Health, full details of the conditions and arrangements in regard to the health visiting of children from birth to school age were set out in my Report for 1931. CHILDREN ACT, 1908, AND CHILDREN AND YOUNG PERSONS ACT, 1932, An Act, entitled the Children and Young Persons Act, 1932, was passed to amend the Children Act, 1908. The part dealing with infant life protection came into force on 1st February, 1933. The work under these Acts is carried out by the Health Visitors in their respective areas. 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 at each Centre, and the following is a summary of the register:— No. 1. No. 2. Centre— No. 3 & Sub. Total. No. of foster-mothers on the register— At the beginning of 1931 29 11 10 50 „ „end „ „ 30 7 16 53 No. of foster-children on the register— At the beginning of 1931 23 10 17 50 „ „ and „ „ 20 7 16 43 Died during the year 1 — — 1 On whom inquests were held during the year — — — — Visits to foster-children 154 82 74 310 No proceedings were taken during the year. 13 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, in addition to being registered within a period of six weeks after birth. The number of births notified under the Acts during 1932 was:— Male. Female. Total. Live births 625 599 1,224 Still births 21 21 42 646 620 1,266 The births were notified:— By Doctors 177 By Borough Midwife 147 By other Mid wives 339 By Hospitals 113 By parents 45 By others 370 1,191 The 1,077 net number of notified births belonging to Hornsey were divided among the districts of the Centres as follows:— Brook Road 537 Wightman Road 262 Highgate 252 Coldfall Sub-Centre 26 1,077 of this number there were: Live births. Still births. Occurring in the Borough and transferred to other districts 184 5 Occurring in Hospitals, etc., outside the district belonging to Hornsev 357 18 Unnotified (from Registrar's return):— Live births 73 Still births 2 75 1,266 14 REFUSE SHOOTS. The refuse shoots in Coppetts Road, Muswell Hill, and in Coolhurst Avenue have been kept under close observation during the year. That in Coolhurst Avenue, which is being levelled to form a playing field, has been a cause of trouble, owing to its slow progress, but by an arrangement come to with the owners the filling in has been expedited, and it is hoped that the work will be completed before the end of the year. The superintending of finishing off and levels, etc., has been undertaken by the Borough Engineer's Department. HOUSING. Satisfactory progress continues to be made in the five-year programme of demolition of unfit houses and the rehousing of their occupants. The block of 21 flats on the site of Ward's Cottages, North Hill, is nearing completion, and will provide accommodation for families in certain groups of condemned houses in the Highgate area. 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) 1.880 (b) Number of inspections made for the purpose 7,368 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 439 (b) Number of inspections made for the purpose 3,073 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation ... * Note.—Two houses were closed for human habitation without the service of statutory notices and utilised as storage premises in connection with businesses, one being practically rebuilt. 15 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,203 2. Remedy of Dcfects 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 926 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 94 (2) Number of dwelling-houses in which defects were remedied after service of formal notices (a) By owners 79 (b) By local authority in default of owners — 10 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 3 (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 — * Note.—Demolished without formal Demolition Order:— In 1931 5 houses and 1 small factory In 1932 17 houses 17 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 439 Special inspections 981 Re-inspections 10,323 Transfer to Council houses 13 Notifiable infectious diseases 204 Tuberculosis 70 Deaths 93 Verminous houses 21 Scabies 1 Shops Act 678 Factories, workshops and outworkers 556 Rent Restriction Act 6 Cinemas, etc. 15 Overcrowding 182 Petroleum stores 182 Rag Flock Act 4 Dairies and milkshops 42 Bakehouses 42 Slaughter-houses 324 Butchers' shops 86 Restaurant kitchens 26 Other food shops 285 Annual licences (Music and Dancing) 47 Stables 43 Urinals 15 Smoke observations 11 Refuse tips 230 Passages 35 Allotments 4 Drainage 91 Fee tests 5 House pests 43 18 Piggeries 10 Water tests applied (new drains) 63 Smoke and chemical tests applied (old drains) 40 Drains examined under Sec. 41, Public Health Act, 1875 25 Small-pox Contacts—Visits 291 15,526 SUMMARY OF SANITARY IMPROVEMENTS CARRIED OUT. Drainage. Number of houses and premises redrained 40 Repairs or amendments to existing drains 155 Drains or gullies unstopped or cleansed 98 Manholes provided 53 do. repaired 36 Intercepting traps fixed 18 New gully traps fixed 144 New soil pipes and ventilating shafts fixed 47 Soil pipes and ventilating shafts repaired 54 Fresh-air inlets provided or repaired 73 Water-Closets and Sanitary Fittings. New water-closet basins fixed 202 Water-closets unstopped, cleansed or repaired 47 New check cisterns fitted to water-closets; existing check cisterns repaired 96 New sinks provided 160 New lavatory basins provided 42 New waste-pipes fixed 109 Waste-pipes trapped, repaired or unstopped 200 Miscellaneous. Roofs repaired 265 Eaves guttering renewed, cleansed or repaired 173 Rain-water pipes provided, repaired or unstopped do. disconnected from drains 7 Damp walls remedied 290 Damp-proof courses inserted 128 19 Paving of yards repaired 205 Structural repairs of premises 1,012 Rooms cleansed, distempered or papered 1,031 Work-rooms cleansed or repaired 9 Drinking-water cisterns repaired, cleansed and covered 70 Water supply reinstated 1 do. (additional) provided 8 Baths provided or made usable 17 Windows and skylights provided or made usable 186 Floors repaired 253 Windowsills repaired 48 Stagnant water abated 1 Sanitary dustbins provided 280 Accumulations of manure and refuse removed 56 Stoves, ranges and coppers repaired or renewed 348 Sundry items 506 Overcrowding abated 42 6,702 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 33 Milk purveyors in connection with other businesses 58 Bakehouses 26 Bestaurant kitchens 37 Tea-rooms and Coffee-bars 19 Slaughter-houses 6 Butchers' shops 54 Fish shops 23 l actones, workshops and work-places 332 Outworkers' premises 129 Cinemas 7 Places of public entertainment 31 Shoots (refuse) 2 Overcrowded houses 57 Licensed petroleum stores 81 895 20 HOUSE-TO-HOUSE INSPECTIONS. Highgate— Archway Road 44 North Hill 2 Baker's Lane 2 Muswell Hill— St. James's Lane 32 Coppett's Road 6 Page's Lane 11 North Haringey— Clarendon Road 54 Denmark Road 45 Haringey Grove 25 West Hornsey— Campsbourne Road 4 Boyton Road 4 East Hornsey— Rathcoole Gardens 51 St. Mary's Road 76 Grove House Road 27 Finsbury Park— Woodstock Road 56 439 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 owner 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. 21 The number on the register at present are classified as follows:— Decontrolled lodging-houses 130 Partly controlled 33 Fully controlled 81 Total 244 One hundred and ninety-eight houses have been dealt with under these Byelaws during the year and the following works carried out:— Byelaw No. 11 (a) liepairs to drains, etc. 1 11 (b) Means of carrying off waste water (including provision of sinks) 20 11 (e) Ventilation to passage and staircase 1 11 (f) Sash-cords and window fittings 29 15 (a) Closet accommodation 1 15 (b) Water supplies 15 15 (c) Washing accommodation 7 15 (d) Food stores 93 16 (a) Kepairs to staircase 1 16 (b) and (c) Lighting of staircase 12 21 (a) Cleansing and painting 9 22 Provision of hand-rail 9 198 Note.—In regard to washing accommodation, Byelaw 15 (c), the new baths and wash-houses erected by the Borough Council in High Street, Hornsey, were opened on the 14th April, 1932. These have proved by their use to have been a much-needed institution in the Borough, so much so that it is contemplated extending the premises by additional slipper baths and washhouse accommodation at a cost estimated at £3,000. OVERCROWDING. During the year 23 fresh cases of overcrowding have been found and 26 cases abated. According to our records there were 57 known cases of overcrowding existing in the Borough at the end of the year. 22 Re-Housing, — The Borough Engineer informs me that during the year 1932, 68 families, representing 303 persons, have been re-housed, as follows:— Families. Persons. Bryanstone Road 1 7 High Street, Hornsey 2 9 Woodstock Road 1 5 Sydney Road 1 5 Clovelly Road 1 2 Middle Lane (Alexandra Pavement) 1 4 Spencer Road 1 5 Lightfoot Road 1 3 The Grove 1 4 Archway Road 1 6 St. James's Lane 1 5 North View Road 3 14 Campsbourne Road 1 4 Baker's Lane 1 4 South View Road 1 5 Muswell Hill Road 2 7 Bathcoole Gardens 4 14 North Hill 7 27 North Road 1 5 Nelson Road 1 5 Newlands Road 1 3 Hanbury Road 1 4 Glebe Road 2 6 Southwood Lane 2 6 Inderwick Road 1 5 Coleraine Road 1 7 Myddelton Road 2 17 Park Road 1 4 Etheldene Avenue 1 4 Prince's Parade 1 4 Everington Road 1 4 Hill Road 4 29 Barrenger Road 2 10 Hawthorn Road 1 8 23  Families. Persons. Marriott Road 3 18 Woodside Cottages 1 4 Ward's Cottages 10 40 68 303 The following houses and flats, etc., have been built during 1932:— Number of houses erected by private enterprise 47 Number of flats erected by private enterprise 48 Number of houses converted into flats 19 Number of flats erected bv the Council 18 (Summersby Road) DAIRIES AND MILKSHOPS. Every dairyman or purveyor of milk must be registered with the Sanitary Authority of the district in which his dairy premises are situated; if he retails milk in the district of another Sanitary Authority he must also be registered with that Authority. At the end of the year the register showed 50 classed as dairies and 58 classed as milkshops the principal trade of which is not dairy produce. Of these dairies, however, 17 are situated outside and operate inside the Borough. The dairies and milkshops have been inspected periodically and it is pleasing to record that a high standard of cleanliness has been found to exist. These inspections have been amplified by the taking of 30 informal samples for bacteriological examination during the year, seven of which were found to be below the standard. Six of these, however, were from roundsmen operating from dairy premises outside the Borough and the Sanitary Authorities in whose districts these dairy premises were situated and registered were communicated with, after which an improvement was found. There are no cowsheds and there is only one firm actually pasteurising milk in the Borough. 24 SPECIAL DESIGNATED MILK. Producers of, and dealers in, special designated milk are required to obtain licences annually. 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) Milk 2 In my opinion it would be fairer to the public and eventually to all concerned if the Milk (Special Designations) Order, 1923, was amended so as to apply to milk which is Pasteurised and not designated as such. MEAT AND OTHER FOODS. Under the Public Health (Meat) Regulations, 1924, notice of intention to slaughter animals has to be sent by the butchers to the Town Hall. In this way the Inspectors are enabled to examine the carcase and organs of every animal killed for human consumption. The year 1932 stands out from recent years on account of the greater amount of slaughtering done and the quantity of meat surrendered and destroyed. These increases were due to the use of one slaughter-house in the Borough by an outside butcher from Ilford for a period extending from 10th of January to 19th of April inclusive. The bulk of this slaughtering took place on Sundays, and it was found necessary to keep this slaughter-house under almost continuous supervision during its use. During the year the carcases and offal of 2,033 animals have been inspected under the Regulations, and the carcases and offal of 9 sheep and 1 lamb were destroyed, in addition to the offal destroyed where the carcases were sound and wholesome. 25 STATISTICS OF SLAUGHTERING, 1932. Hornsey Butchers. Sheep & Lambs Cows Bullocks Calves Heifers Total. 1,022 0 4 0 0 1,026 Weight of unsound offal destroyed, 333 lbs. 4 ozs. Outside Butcher. Sheep & Lambs Cows Bullocks Calves Helfers Total. 908 33 27 30 9 1,007 Weight of carcases and offal destroyed, 1,446 lbs. 8 ozs. Total number of animals slaughtered 2,033 Total quantity of meat destroyed 1,779 lbs. 12 ozs. STATISTICS OF SLAUGHTERING, 1926—1932. Year. Beasts. Sheep. Swine. Calves. Total. 1926 195 2,843 27 0 3,065 1927 144 2,374 21 16 2,555 1928 58 1,526 0 1 1,585 1929 21 1,303 0 1 1,325 1930 4 1,024 0 0 1,028 1931 4 741 34 0 779 1932 73 1,930 0 30 2,033 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. The local R.S.P.C.A. Inspector has tried to encourage the use of the humane, or mechanical, killer for the slaughter of sheep and has lent instruments and cartridges to the butchers in the hope of making the method popular with them. FISH. Boxes of fish brought from the London Market are sometimes found to be unsound on arrival at their destination. These are submitted for examination, destroyed, and a "condemned" note is given, which enables the dealer to obtain a fresh supply or an allowance from the wholesaler. This arrangement is quite good and results in prompt notification. 26 The following have been condemned and destroyed:— Cod fillets 31 lbs. 8 ozs. Scotch fillets 14 lbs. 0 ozs. Prawns 7 lbs. 0 ozs. 52 lbs. 8 ozs. All diseased meat and food is destroyed at the Council's incinerator. Particular attention has been paid to all premises where food is prepared or sold in order to ensure that satisfactory standards of quality and cleanliness are maintained. Food Adulteration.—Mr. E. Robinson, Chief Officer of the Public Control Department of the Middlesex County Council, has kindly supplied me with the following information regarding samples of food taken during the year in the Borough:— Article. Samples. Adulterated. Milk 258 4 Milk, sterilised 2 - Cream, artificial 1 - Butter 1 - Meat 3 - Sausages 1 - Tripe 3 - Apples 1 - 270 4 SHOPS ACTS. Six hundred and seventy-eight 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 six instances where contraventions have occurred after verbal notices, and undertakings obtained that recurrences will not take place. 27 There are 1,230 shops in the Borough engaged in the following trades:— Grocers 114 Confectioners 102 Drapers, Costumiers, Ladies' Outfitters, etc. 80 Boots 69 Greengrocers 67 Restaurant Kitchens, Tea-rooms & Coffee-bars 56 Stationers and Newsagents 54 Butchers 54 Hairdressers and Barbers 52 Tobacconists 47 Off-licences 36 Public-houses 35 Furniture and Upholsterers 34 Dairies and Milkshops 33 Coal Merchants 32 Bakers 32 Gas, Electrical and Wireless Fittings 29 Chemists 28 Tailors and Men's Outfitters 27 Fishmongers 23 Oil and Colour Shops, General and Domestic Stores 23 Milliners 17 Watches and Jewellery 16 Ironmongery and Hardware 15 Florists 13 Builders and Decorators 11 Cycles and Motor Repairs 11 Hosiers 11 Cooked Meats 11 Saddlers and Leather Goods 9 Booksellers and Libraries 8 Cornchandlers 7 Photographers 7 Pianos and Music 7 Wardrobe Dealers and Dress Agencies 5 Carpets and Lino 5 28 Timber Merchants 5 Clothes Pressing, Cleaning and Repairing 4 Picture Frames 4 Art Needlework and Wool 4 Bazaars 4 Umbrellas 3 Toys 3 Sewing Machines 3 Opticians 3 Furriers 3 Blinds 2 Antique Shops 2 Pawnbrokers 1 Baby Carriages 1 Corsets 1 Cotton Goods (Cottons and Shirts) 1 Herbalist 1 Basket Ware 1 Cutler 1 Cork Goods 1 Arts and Crafts 1 Knitted Goods 1 1.230 Hairdressers' and Barhers' Shops (Sunday Closing) Act, 1930. This Act came into operation on the 1st day of January, 191, and provides for the compulsory closing of hairdressers' and barbers' shops on Sundays. No infringement of this Act has been observed during the year. 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. 29 The total number of licences for storing petroleum spirit is 81, and the quantity of petroleum which may be kept on licensed premises is 86.940 gallons, 4,740 gallons being kept in two-gallon cans and 82,200 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 is one premises licensed for the storage of Carbide of Calcium and the quantity stored under licence is 10 cwts. Hydro-carbon. There is one licence issued for the storage of 100 gallons of hydro-carbon. Cellulose Spirit. Two premises are licensed solely for the storage of cellulose spirit and the total quantity kept on these premises is 70 gallons. Horticultural Poisons. There are four licences in force for the sale of horticultural poisons under the Poisons and Pharmacy Act. The Petroleum Spirit (Motor Vehicles, &c.) Regulations and the Petroleum (Carbide of Calcium) Order, 1929, came into force in December, 1929. Tiie Petroleum Spirit (Conveyance) Regulations, 1932, came into operation on the 1st of February, 1933. LEGAL PROCEEDINGS. Legal proceedings have been taken on two occasions. Under the Shops (Hours of Closing) Act, 1928, for not being closed for the serving of customers at the prescribed time:—Two cases. One defendant was fined 10/-, and the other was dismissed under the Probation of Offenders' Act. 30 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Nothing of an unusual nature is to be recorded in regard to infectious and epidemic diseases during the year. The common infections, like diphtheria, scarlet fever, etc., were relatively low in numbers and mild in character. No death occurred from scarlet fever and only four from diphtheria. Five cases of the mild form of Small-Pox (Variola Minor), now endemic in London, occurred in the early part of the year. The incidence of cases of notifiable infectious disease has been very low during the year; in fact, the total number of cases notified is the lowest this century. The average during the ten years previous to 1932 was 479 cases, compared with 308 for 1932. Scarlet fever is lower than it has been since 1918 and diphtheria since 1925. Details in regard to notifiable infectious diseases will be found in Table F on page 43. VACCINATION. The Public Vaccinators inform me that they have performed vaccination of persons in the Borough during 1932 as follows:— Dr. E. Buckler 152 Dr. T. E. Pearman 203 OPHTHALMIA NEONATORUM. Two cases of ophthalmia neonatorum were notified. One was treated in St. Margaret's (L.C.C.) Hospital, Kentish Town, and one in a nursing-home. Cases Vision unimpaired. Vision impaired. Total blindness. Deaths. Notified. Treated At home. In hospital or nursing home. 2 0 2 2 0 0 0 31 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 Mimms 120 66 — ,, late sanatorium and hospital County Council Hospital — Dispensary Hounslow (Closed Dec. 1932) 9 7 — ,, observation Heatherwood Hospital, Ascot — — 25 Non-pulmonary Victoria Home, Margate — — 6 „ A number of Tuberculosis patients were maintained by the County Council in other Institutions approved by the Ministry of Health. The total number of cases on the Tuberculosis Register at the end of 1932 was 684, an increase of 59 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:— Total number of new Tubercular cases 86 Transfers in not included in above 31 Total number of new Non-tubercular cases, including contacts 106 Total number of Tubercular cases under supervision during the year 344 Tubercular cases removed, transferred or lost sight of 40 Tubercular cases removed from Register as recovered 10 32 Tubercular cases died in 1932 47 Tubercular cases still on the Register 247 Undiagnosed cases on 31st December, 1932 nil DISINFECTION. Number of rooms fumigated after notifiable infectious disease 250 „ „ „ „ non- „ „ „ 418 „ „ „ „ T.B. 82 ,, articles disinfected 4,892 ,, ,, destroyed 202 ,, verminous rooms disinfected 134 CLEANSING STATION.—Eight adults and 6 children have been treated at the cleansing station for various reasons. There was 1 child belonging to Wood Green treated, paid for by Wood green at an agreed charge per treatment. DISINFECTING STATION.—The following work has been carried out by the disinfecting staff during the year:— Disinfection of rooms and removal of bedding for treatment 550 Returning bedding after disinfection 407 On account of vermin, etc:— Disinfestations 80 Spraying of stagnant pools 2 do. shoots 3 Destruction of wasps nests 3 Spraying at Town Hall for cockroaches do. bakehouse for crickets and cockroaches 2 Posting 1,200 bills re Dog Nuisance in different parts of the Borough 7 Collecting and disinfecting library books:— Received. Returned. Public Libraries 81 54 School Libraries 23 17 Private Libraries 16 16 Drain tests and conveyance of drain-testing appliances 72 Visits in connection with Welfare Centres 60 33 Taking of milk samples for analysis 3 Wasted calls 34 Mileage run. Brown van 3,875 Blue van 2,020 MORTUARY. Seventy-five bodies were received at the mortuary and an inquest held on 20 of them. DISEASES OF ANIMALS ACT. Mr. F. G. Buxton, the Veterinary Inspector, reports that during the year he inspected 393 pigs and 2 sheep and issued 2 removal licences. A post-mortem examination was made of 3 sheep. No action was necessary under the Tuberculosis Order, 1925. MATERNITY AND CHILD WELFARE, CENTRES. No. 1 Centre.—St. Mary's Mission Hall, Brook Road. serving East and West Hornsey, Crouch End and North Haringey areas. Health Visitors: Mrs. E. Durnford and Miss A. Godden. Clinics:— 2nd and 4th Mondays: 2-4 p.m. (Dr. Sutherland). Wednesdays: 10-12 a.m. and 2-4 p.m. (Dr. Muir). Thursdays: 10-12 a.m. and (Ante-natal) 2-4 p.m. (Dr. Muir). No. 2 Centre.—No. 22, Wightman Road, serving Stroud Green, Finsbury Park and South Haringey areas. Health Visitor: Miss A. Glover. Clinics:— 1st, 3rd and 5th Mondays, 2-4 p.m. (Dr. Sutherland). 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. Health Visitor: Miss J. Macpherson. 34 Clinics:— Fridays: 2-4 p.m. (Dr. Garrow). 2nd Fridays (Ante-natal): 10-12 a.m. (Dr. Sutherland). 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. Sutherland). 4th Friday (Ante-natal): 10-12 a.m. (Dr. Sutherland). Table I. on page 47 gives a statistical record of the work done at the Centres and by the Borough Midwife. Maternity. During 1932, 192 maternity cases were admitted to the North Middlesex Hospital from Hornsey. An arrangement has been made with the Royal Northern Hospital whereby expectant mothers attending the Welfare Centre Ante-natal Clinics can be admitted for an inclusive fee of £4 4s. 0d. Midwifery. The Municipal Midwife attended 161 births. A reduction of her fee was made in 59 necessitous cases. Twelve hundred and eighty-six births have been attended by the Midwife since the appointment was first made in 1922. In view of the increasing call upon the Midwife's services and her difficulty in making all her visits, the Council in May made her a car allowance. X-Ray Treatment. Only one expectant mother was sent to University College Hospital from the Ante-natal Clinic for examination. Milk—Mothers and Children Orders. Nine hundred and thirty-two applications for milk under this Order were dealt with during the year, of which 91G were granted and 16 were refused. The total of the accounts paid to 31st December amounted to £292 9s. l0d. 35 Milk Cookery Lectures. A course of Milk Cookery Lectures was conducted at Brook Road Centre by the National Milk Publicity Council. Unfortunately they were not as well attended as was hoped and the experiment was not extended to the other Centres. Orthopedic Treatment. A joint (Maternity and Child Welfare and Education Committees) scheme for the early diagnosis and treatment and prevention of crippling conditions in children from birth to schoolleaving age has been in operation for about four years, and is giving highly satisfactory results at relatively small cost. The local centre of this scheme is at the School Clinic, and hospital cases are admitted to the country branch of the Royal National Orthopaedic Hospital at Stanmore. Dental Clinic. The following is a record for the year of the Dental Clinic for Mothers and Children which was started in 1928: — 1932. Mothers. Children. Clinics held 47 35 Old cases 86 62 New cases 34 34 Total attendances 202 116 Attendances for dentures 16 — Gas cases 35 40 Local injections 14 — Teeth extracted 184 60 Fillings done 60 16 Dentures provided 5 — Dentures repaired 5 — Inspections 21 32 Cases finished 27 24 Other treatments (dressings, scaling, gum treatment, etc.) 17 29 36 Voluntary Committees. The Hon. Secretaries of the Voluntary Committees inform me that the following benefits have been dispensed out of voluntary funds:— Brook Road Centre. — Two mothers sent to convalescent homes and 4 to holiday homes. Highgate Centre.—Eleven mothers to holiday homes, 1 child to convalescent home, 2 mothers supplied with home helps during confinement, and 15 children supplied with surgical instruments. Nurseky School. The Nursery School started in November, 1931, and conducted at no expense to the Council by Miss Bonn at Highgate Centre, continues to be a success. There are about 20 between the ages of 2 and 5 on the rolls and the total attendances made during the year was 2,719. 37 LIST OF TABLES. TABLE A.—Vital Statistics, 1911-32. TABLE B.—Causes of, and ages at, death in 1932, and summary of causes of death, 1931. TABLE C.—Summary of causes of death, 1921-1930. TABLE D.—Infant Mortality in 1932. Causes of and ages at death. TABLE E.—Births, Deaths, Infant Deaths, and Deaths from certain diseases, 1901-1932. TABLE E.—Cases of Infectious Disease notified in 1932. TABLE G.—Cases of Infectious Disease notified 1909-1932. TABLE H.—(1) Notification of, and deaths from, Tuberculosis, 1932. „ (2) Tuberculosis Register, 1932. TABLE I.—Work done at the Maternity and Child Welfare Centres and by Municipal Midwife, 1932. TABLE J.—Inspection of Factories, Outworkers, etc., 1932. 38 TABLE A. BOROUGH OF HORNSEY VITAL STATISTICS, 1911.1932. Yaar. Estimated Mid-Year Population. Birth Rate per 1,000 Population. Death Rate per 1,000 Population. Infant Mortality per 1,000 Births. 1911 84,592 17 .5 9.6 78 1912 84,840 16.3 9.9 75 1913 85,122 16.7 9.7 56 1914 85,456 17.8 9.2 57 1915 85,800 15.5 12.2 80 1916 86,147 16.0 11.5 46 1917 86,450 11.3 10.9 70 1918 86,942 11.7 13.8 61 1919 87,100 13.6 11.4 64 1920 87,410 19.3 10.3 54 1921 87,691 16.7 11.0 49 1922 88,007 15.4 11.2 54 1923 88,326 14.4 10.5 51 1924 88,661 13.4 10.4 41 1925 89,064 13.6 10.6 43.6 1926 89,850 13.4 10.3 47.2 1927 90,000 13.3 11.2 38.3 1928 90,250 12.1 12.1 61.3 1929 90,500 Regr..Gcn.'s Estimate. 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 1932 Regr..Gen.'s Estimate 96,990 11.37 11.45 46.2 ENGLAND and WALES (Rates in 1932) 15.3 12.0 65 118 County Borough and Great Towns, including London (Rates in 1932) 15.4 11.8 69 126 Smaller Towns (Rates in 1932) 15.4 10.8 58 London (Rates in 1932) 14.2 12.3 66 39 TABLE b.-CAUSES OF, AND AGES AT, DEATH, ??? AND ??? Total. All Ages. 0-1 1—2 2—5 5—15 15—25 25 35 35 45 45—55 55—65 65-75 75 & over All Ages 1931 M F M F M F M F M F M F M F M F M F M F M F M F M F Typhoid and paratyphoid fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2. Measles 6 3 3 ... ... 1 1 ... 1 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 4. Whooping cough 3 1 2 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 2 5. Diptheria 4 ... 4 ... ... ... 1 ... ... ... 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 5 2 3 6. Influenza 31 11 20 ... ... ... ... ... ... 1 1 1 2 1 2 2 ... 2 1 ... 1 2 3 2 10 6 7 16 7. Encephalitis lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 ... 1 8. Cerebro-spinal fever 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 ... ... 9. Tuberculosis of respiratory system 54 23 31 ... ... ... ... ... ... ... ... 3 5 6 12 7 7 2 3 5 2 ... 2 ... ... 9 21 31 10. Other tuberculous diseases 9 3 6 ... ... ... ... 1 l ... 1 1 2 ... ... ... 1 1 ... ... ... ... 1 ... ... 10 3 2 11. Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 1 3 12. General paralysis of the insane, tabes dorsalis 7 4 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 1 1 ... ... 1 ... ... 12 3 ... 13. Cancer, malignant disease 160 66 94 ... ... ... ... ... ... ... ... 1 1 3 ... 5 8 2 17 20 23 26 22 8 23 13 72 107 14. Diabetes 13 3 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 7 1 2 14 4 12 15. Cerebral haemorrhage, etc. 65 25 40 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 3 2 6 5 18 14 13 15 17 52 16. Heart disease 290 109 181 ... ... ... ... ... ... ... ... ... 2 ... 6 3 3 6 11 17 21 39 54 44 84 16 110 150 17. Aneurysm 5 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 1 1 ... ... 17 2 ... 18. Other circulatory diseases 46 24 22 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 3 3 9 6 10 13 18 25 29 19. Bronchitis 29 21 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 4 ... 8 2 7 6 19 15 15 20. Pneumonia (all forms) 66 32 34 3 2 4 ... ... ... ... 1 1 ... 2 ... 3 2 5 2 4 4 7 11 3 12 20 28 40 21. Other respiratory diseases 17 9 8 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 1 4 1 ... 5 21 5 6 22. Peptic ulcer 11 8 3 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 3 1 1 1 1 ... 1 ... 22 7 4 23. Diarrhoea, etc. (under 2 years) 8 4 4 3 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 23 2 3 24 Appendicitis 7 2 5 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 1 1 1 1 ... ... 24 3 4 25. Cirrhosis of liver 7 5 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 l 2 1 ... ... 24 2 1 26. Other diseases of liver, etc. 4 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 ... 26 3 1 27. Other digestive diseases 21 7 14 1 ... ... ... ... l ... ... ... ... 1 ... ... 1 ... 1 1 4 2 3 2 4 27 10 10 28. Acute and chronic nephritis 26 12 14 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 4 2 3 5 5 28 19 15 29. Puerperal sepsis 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... 29 ... 2 30. Other puerperal causes 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 30 ... 3 31. Congenital debility, premature birth, malformations, etc. 32 15 17 13 17 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 31 24 16 32. Senility 34 10 24 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 8 21 32 8 11 33. Suicide 11 9 2 ... ... ... ... ... ... ... ... 1 1 1 1 3 ... 1 ... 2 ... 1 ... ... ... 33 9 2 34. Other violence 413 25 18 1 ... 1 ... 1 l 2 4 3 l 4 ... ... ... 4 1 4 2 3 2 2 7 34 16 13 35. Other defined diseases 915 48 47 2 1 1 1 ... l 1 ... 1 3 5 4 o 2 6 11 5 7 13 8 12 9 35 44 41 36. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 36 ... ... Totals 1111 186 625 26 25 7 5 2 6 7 11 14 18 24 29 29 28 46 56 80 82 130 151 121 214 462 596 Special causes included in 35 above 1,058 Small-pox Poliomyelitis Polioencephalitis 40 TABLE C. CAUSES OF, AND AGES AT, DEATH DURING THE TEN YEARS 1921-1930 (OLD CLASSIFICATION). CAUSES OF DEATH All Ages. Registrar-General's returns. 1930 1929 1928 1927 1926 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 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 63 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 Fever 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 Haemorrhage, 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 6 3 15 22 23 Appendicitis 16 5 9 13 6 6 9 7 11 7 23 24 Cirrhosis of Liver 4 3 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 2 1 2 1 1 2 26 27 Other accidents aud 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 41 TABLE D.—INFANT MORTALITY, 1932. 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 4 Weeks. 1-3 Month3. 3-6 Months. 6-9 Months. 9-12 Months. Premature Birth ... 12 1 - 1 14 1 1 - - 16 Atelectasis 5 - - 5 - - - - 5 Inanition 1 - - - 1 - - - - 1 Asphyxia 1 - - - 1 - - - - 1 Intra Cranial Haemorrhage 1 - - - 1 - - - - Tetanus Neonatorum - - 1 - 1 - - - - 1 Pneumonia - - 1 - 1 3 - - 1 5 Bronchitis - - - 1 1 - - - - 1 Spina Bifida - - - 1 1 - - - - 1 Marasmus - - - - - 1 1 - - 2 Gastric Enteritis - - - - - 2 3 1 1 7 Meningitis - - - - - 1 - - - 1 Peritonitis - - - - - 1 - - -- 1 Strangulated Hernia - - - - - 1 - - - 1 Hydrocephalus - - - - - 1 - - - I Congenital Heart - - - - - - 1 - - 1 Whooping Cough and Pneumonia - - - - - - - 1 1 2 Acidosis - - - - - - - 1 1 Uraemia - - - - - - - - 1 1 Pink's Disease - - - - - - - I 1 Total 20 1 2 3 26 11 6 2 6 51 42 BIRTHS. DEATHS. INFANT DEATHS. AND DEATHS FROM CERTAIN DISEASES. 1901-1932.  Population Census. Total Live Births Total Still Births Total Deaths Total Infant Deaths (under one year) Deaths from Measles Deaths from Whooping Cough Deaths from | Diarrhoea (under two years) Deaths from Scarlet Fever Deaths from Diphtheria Deaths from Typhoid Fever. Deaths from Cancer. Deaths from Tuber culosis (Pulmonary Deaths from Tuberculosis (Non-Pulmonary) 1901 72,056 1,511 597 127 8 14 6 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 l 8 1 62 46 20 1904 1,659 690 145 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 1H07 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 58 16 1909 1,508 787 87 12 12 0 3 10 0 75 57 26 1910 1,393 737 84 1 10 0 4 8 3 88 41 18 1911 84,592 1.479 812 116 20 15 35 1 6 1 103 55 23 1912 1,385 840 105 5 2 13 3 2 2 114 43 17 1913 1,425 824 81 12 8 12 0 4 3 96 55 14 1914 1,529 791 88 1 4 21 1 7 1 82 44 10 1915 1,394 1,007 112 37 7 23 3 11 2 99 58 19 1916 1,404 928 64 0 5 8 0 11 1 106 84 20 1917 1,038 906 73 14 6 3 0 6 0 113 58 25 1918 1,037 1,094 64 6 13 7 2 8 0 130 76 13 1919 1,188 992 76 0 0 6 2 3 1 119 66 11 1920 1 707 903 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 1,217 928 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 53 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 n 0 7 0 143 58 15 1930 1,209 45 1,047 50 4 0 10 2 4 0 156 57 7 1931 95,524 R.-Gen.'s Estimate 1,130 44 1,058 60 0 2 5 1 5 0 179 52 5 1932 96,990 1,103 38 1,111 51 6 3 8 0 4 0 160 54 9 43 TABLE-F WARDS. AGES Admitted to Joint Hospital. Admitted to other Hospitals. In Nursing Home. Nursed at Home. Registered Deaths Excluding T.B. DISEASE Highgate Muswell Rill. Crouch End West Hornsey East Hornsey North Haringey South Haringey Stroud Green Finsbury Park. 0l 15 515 1525 2545 4565 65 and over Total Small Pox - 1 - - 4 - - - - 1 - 1 2 1 - 5 - 4 - - - Scarlet Fever 20 25 11 12 23 14 4 7 7 - 25 61 26 9 2 - 123 89 5 - 29 - Diphtheria 7 10 4 8 15 8 5 12 1 - 15 30 16 8 1 - 70 61 6 - 3 4 Typhoid 1 - - - - - - 1 - - - - - 2 - - 2 2 - - - - Para Typhoid 2 - - - - - 1 - - - 1 2 - - 3 1 1 - 1 - Pneumonia 3 11 3 12 7 4 5 3 4 - 4 7 9 12 11 9 52 10 11 - 11 66 Erysipelas 3 3 5 6 5 3 1 1 1 - 1 2 2 6 13 4 28 15 - - 13 - Puerperal Fever - 1 - 2 1 - - - - - - - 1 3 - - 4 - 4 - - 4 Puerperal Pyrexia 3 4 1 1 1 2 1 1 - - - - 5 9 - - 14 - 13 1 - - Ophthalmia Neonatorum - 1 - - - - - - - - - - - - - - 2 - 1 1 - - Poliomyelitis - 1 - - - - - - - - - - - - - 2 1 - - 1 - Meningitis - - - - 1 — - - 1 - 1 - 1 - - - 2 2 - - - 1 Encephalitis Lethargica - 1 - - - — - - - - - - - 1 - 1 - - - 1 - 39 58 24 41 57 31 16 27 15 3 48 101 63 51 29 13 308 75 Tuberculosis : Pulmonary 20 25 5 17 18 13 15 20 13 - - 3 39 69 32 3 146 54 9 NonPulmonary 5 3 2 2 7 4 1 4 - 1 3 12 7 5 - 28 Total 64 86 31 70 82 48 32 51 28 4 51 116 109 125 61 16 482 181 45 2 80 138 Admitted to Joint Isol. Hospital 19 38 11 23 36 18 8 18 10 Other Hptls. 12 6 3 7 8 3 2 3 1 Nursing Homes - 2 - - - - - Nursed at Home 8 12 10 11 13 10 6 6 4 Note.—The following 97 cases were also admitted to the Isolation Hospital in addition to the above:—16 Measles, 11 Measles and Pneumonia. 14 Tonsilitis, 9 Influenza, 3 Chicken-pox, 3 Mastoid, 3 Gastro-Enterltis, 2 Gastritis, 2 Laryngitis, 1 Pharyngitis, 1 Bad Throat, 1 Quinsey, 1 German Measles, 1 Whooping Cough, 1 Whooping Cough and Pneumonia, 1 Measles, Whooping Cough and Pneumonia, 1 Adenitis, 1 Colic, 1 Rheumatism, 1 Mental derangement, 1 Sepsis, 4 Local sepsis, 2 Septio fingers, 1 Septic toe, 1 Injury to face and hand, 1 Injury to hand, 1 Injury to wrist, 1 Injury to knee, 2 Vaccination, 4 found not to be Enterio Fever, 1 Enteric found to be Appendicitis, 1 found not to be Cerebrospinal meningitis, and 3 for observation. 44 TABLE G. NOTIFICATIONS OF INFECTIOUS DISEASE, 1909-1932.  Population. Scarlet Fever. Diphtheria or Croup. Enteric Fever. Para Typhoid. Puerperal Fever. Puerperal Pyrexia. Erysipelas. Cerebral Spinal Meningitis. Polio Myelitis. Ophthalmia Neonatorum. Malaria. Dysentery. Encephalitis Lethargica. Polio Encepha itis. Pneumonia. Small-pox. Measles. German Measles. Total Attack rate per 1,000 population. 1909 82,378 221 151 4 - 1 - 37 - - - - - - - - - - - 414 5.0 1910 83,401 173 105 10 - I - 30 - - - - - - - - - - - 319 3. 1911 84,592 179 133 6 - 2 - 40 - - - - - - - - - - - 361 4. 1912 84,840 138 88 9 - 3 - 39 1 1 - - - - - - - - - 279 3.2 1913 85,122 206 115 10 - 2 - 26 - - - - - - - - - - - 359 4. 1914 85,456 346 101 9 - 1 - 24 - - 11 - - - - - - - - 492 5. 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 - - - - - - - - 1,227 881 2,344 2.7 * 1918 86,942 89 67 8 - 2 - 23 1 3 2 - - - - - - 796 119 1,110 2.3 * 1919 87,100 203 87 6 - 4 - 42 4 1 5 21 2 5 - 112 - 224 285 1,001 5.7 * not now notifiable 1920 87,410 245 149 6 - 2 - 27 1 3 8 10 2 4 - 98 - 555 6.3 1921 87,691 591 189 2 - 2 - 36 - 2 6 1 1 6 - 42 - 878 10.1 1922 88,007 286 133 1 - 2 - 24 - - 10 1 - 1 - 104 - 552 6.2 1923 88,325 126 133 1 - - - 24 2 - 6 4 - 2 - 75 - 373 4.2 1924 88,661 215 40 3 - 1 - 26 - 1 1 - — 11 - 61 - 359 4.0 1925 89,064 126 53 10 - 1 - 26 2 2 4 1 1 7 - 60 - 293 3.3 1926 89,850 140 116 4 - 4 6 22 - 2 8 - — 6 - 56 - 364 4.0 1927 90,000 179 92 6 1 1 14 34 2 3 5 1 - - - 89 - 427 4.7 1928 90,250 328 104 4 - 3 22 24 4 1 6 1 - 2 - 94 - 593 6.5 1929 88,450 249 129 3 2 3 8 30 3 1 5 2 - - 1 163 - 599 6.6 1930 88,450 '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 - 1 7 9 32 - 1 3 1 - 2 - 86 - 505 5.3 1932 96,990 R.-Gen.'s Estimste) 123 70 2 3 4 14 28 2 2 2 - - 1 - 52 5 308 3.2 * Excluding Measles and German Measles. 45 TABLE H. (1) .NOTIFICATIONS OP, AND DEATHS FROM, TUBERCULOSIS, 1932. AGE PERIODS. New Cases. Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 - 1 - - - 1 - - - - 1 - 5 - - 1 2 - - 1 1 5-15 1 2 6 6 - - - 1 15 -25 13 26 4 3 3 5 1 2 25 -35 16 28 - 3 6 12 - - 35 -45 14 11 1 1 7 7 - 1 45 - 55 12 5 - - 2 3 1 - 55 - 65 9 6 - - 5 1 - 1 65 and over 1 2 - - - 3 - - Totals 66 80 12 16 23 31 3 6 Wards :— U ighgate 10 10 3 2 3 1 - - Muswell Hill 10 15 . - 8 3 2 - 3 Crouch End 3 2 - 2 1 2 - 1 West Hornsey 8 9 2 - 3 4 - - East Hornsey 8 10 5 2 7 5 1 2 North Haringey 7 6 1 3 2 6 - - South Haringey 4 11 - 1 - 4 1 - Stroud Green 9 11 1 3 2 3 1 - Finsbury Park 7 6 - - 2 4 - - Totals 66 80 12 l6 23 31 3 6 46 TABLE 11. (2). TUBERCULOSIS REGISTER, 1932. Pulmonary. Non-Pulmonary. Total. Male. Female. Male. Female. Male. Female. (a) Number of Cases on Register at commencement of 1932 240 248 69 68 309 316 (b) Number of Cases notified for first time during year under Regulations 52 52 9 9 61 61 (c) Cases restored to Register during 1932 1 1 0 0 1 1 (d) Cases added to Register otherwise than by notifications under Regulations: (1) Transferred from other districts 13 22 2 4 15 26 (2) From Death Returns 0 5 1 3 1 8 (e) Number of Cases removed from Register during 1932 41 58 6 10 47 68 (f) Number of Cases remaining on Register at end of 1932 265 270 75 74 340 344 Cases removed from tne Register snown under (c) are accounted for as follows: — Found not to be T.B. 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 M F 1 3 1 5 21 20 Pulmonarv 9 12 41 58 9 18 0 0 0 3 3 2 Non-Pulmonarv 3 2 6 10 0 3 1 3 1 8 24 22 9 21 12 14 47 68 47 TABLE I. MATERNITY AND CHILD WELFARE WORK, 1932. Nature of Work. Centres. Totals. No. 1. No. 2. No. 3 and Sub-Centre. Number of sessions held 197 122 73 392 ,, ante natal sessions held 50 27 24 101 Number of individual Mothers seen by Doctor:— Aute-natal, New cases 228 91 59 378 ,, Old cases 322 127 104 553 Post natal, New cases 61 39 1 101 „ Old cases 14 9 - 23 625 266 164 1,055 Total attendances of Mothers 903 344 156 1,403 Number of babies attending Centres for first time : Under 1 year ... 336 176 146 658 1-5 years 86 44 50 180 Number of individual babies on Centre registers: Under 1 year 295 199 116 610 1-5 years .. 625 249 361 1,235 Attendances of babies at medical consultations 3,325 2,089 1,044 6,458 Babies seen by Doctor 2,411 1,391 814 4,616 Total attendances of babies at Centres : Under 1 year 5,107 2,126 1,765 8,998 1-5 years 3,069 1,175 848 5,092 Referred to own private doctors 18 37 3 58 Referred to hospitals 134 51 6 191 Health talks given by nurses - 26 1 27 Grand Total Visits paid by nurses: — First visits Total visits First visits Total visits First visits Total visits First visits Total visits To expectant mothers 95 167 80 140 70 118 245 425 To infants under one year 509 2,454 287 1,368 287 1,090 1,083 4,912 To children aged 1-5 years 99 3,266 66 1,825 61 1,589 226 6,680 Total visits paid by Nurses 703 5,887 433 3,333 418 2,797 1,554 12,017 CHILDREN ACTS— visits paid to Foster Children 20 154 8 82 1 74 29 310 RECORD OF WORK OF MUNICIPAL MIDWIFE, 1932. Confinements attended 161 Ante-natal Clinics attended 75 do. visits 507 Post-natal visits 2,119 48 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. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries) 137 8 0 Workshops (Including Workshop Laundries) 253 6 0 Workplaces (Other than Outworkers' premises) 50 0 0 Total 440 9 0 DEFECTS FOUND IN FACTORIES, WORKSHOPS & WORKPLACES. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts:— Want of oleanlines 4 4 - - Want of ventilation - - - - Overcrowding Want of Drainage of floors - - - - Other nuisances 5 5 - - Sanitary accommodation insufficient - - - - unsuitable or defective - - - - not separate for sexes - - - - 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 bohedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). - - - - Total 9 9 - - *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901 as remediable under the Public Health Acts. 49 TABLE J-(contd.) OUTWORKERS, 1931. Nature of Work. (1) Outworkers. Instances. Notices served. Prosecutions. Wearing Apparel Wearing Apparel 12 0 0 0 Gloves 1 0 0 0 Gaiters 2 0 0 0 Machinist 1 0 0 0 Underclothing 3 0 0 0 Drapery 2 0 0 0 Tailoring 18 0 0 0 Outfitters 2 0 0 0 Boots 6 0 0 0 Neckwear 9 0 0 0 Blouses 4 0 0 0 Gowns 3 0 0 0 Dresses Dressmaking 20 0 0 0 Costumiers 1 0 0 0 Jumpers and Costumes 2 0 0 0 Skirt making 1 0 0 0 Dress Designing 1 0 0 0 Infants' Millinery 2 0 0 0 Millinery 8 0 0 0 Children's Wear Girls' Tunics 1 0 0 0 Children's Frocks 7 0 0 0 Children's Outfitting 2 0 0 0 Raincoats 1 0 0 0 Cellophane Covers 1 0 0 0 Boxes 1 0 0 0 Furs 2 0 0 0 Umbrellas 1 0 0 0 Knitted Goods 2 0 0 0 Fancy Goods 1 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 Jewel Cases 1 0 0 0 Total 129 0 0 0 Borough of Thornsey. ANNUAL REPORT OF THE School Medical Officer FOR THE Year ending December 31st, 1932 HORNSEY EDUCATION COMMITTEE. List of Members, December 31st, 1932. Members of the Town Council— His Worship the Mayor, Alderman J. W. Rowlands, J.P., 25, Cholmele.y Park, Higligate, N.6. Aldermen. Mr. W G. Barrenger, 20, Southwood Hall, Higligate, N.8. Mr. B. H. Jenkinson, 36, Avenue Road, Highgate, N.6. Mr. W. W. Kelland, M.A., 14, Hillside Mansions, Jackson's Lane, Highgate, N.6. Councillors. Mr. W. J. Grimshaw (Chairman), " Oaklea," 25, Sheldon Avenue, N.6. Mr. D. V. Johnson (Vice-Chairman), 54, Coolhurst Road, N.8. Mrs. J. H. Barrenger, 20, Southwood Hall, 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. R. J. Owen, 278, Wightman Road, N.8. Mr. J.W. Palmer, 30, Crescent Road, Crouch End, N.8. Mr. J. W. Shipp, 12, Berkeley Road, Crouch End, N.8. Mr. L. J. Valette, 59, Allison Road, Hornsey, N.8. Mr. W. V. Wall, 168, Stroud Green Road, N.4. Co-optative Members— The Rev. H. C. Montgomery-Campbell, M.A., The Rectory, Hornsey, N.8. Mr. J. H. Ford, M.A., 5, Woodlands Gardens, N.10. Mrs. A. Holman, J.P., 8, Hornsey Lane, Highgate, N.6. Mr. W. E. Paterson, M.A., B.Sc., 7, Donovan Avenue, N.10. Mr. H. Tompkins, 7, Danvers Road, Hornsey, N.8. Mrs. W. Turner, 65, Crouch Hall Road, Crouch End, N.8. Mrs. J. Whitehead, 2, Waverley Road, Crouch End, N.8. Director of the Education Committee— A. W. Allen, Esq., M.A., Education Office, 79, Crouch End Hill, N.8. 5 MEMBERS OF THE CENTRAL CARE COMMITTEE. Six Members of the Education Committee— Councillors J. H. Barrenger, C. M. Cave and L. J. Valette, Mrs. W. Turner, Mr. H. Tompkins and Mrs. J. Whitehead. Two Representatives of the Middlesex Education Committee— Alderman W. W. Kelland, M.A., and Rev. F. M. Tapply, M.A. Three Head Teachers from among the Head Teachers of the Public Elementary Schools— Miss F. A. Barter, Miss H. M. Stone 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— Mr. J. H. Ford, M.A., Mrs. D. M. Johnson and Mr. G. Simmonds, B.A. Eight Representatives of Employers and eviployees in the area oj the Authority— Councillor W. V. Wall, Mr. E. H. Bennett, Mrs. N. Brixey Mrs. E. Chapman, Mr. G. Pain, Mrs. H. Tompkins, Mr. R. James and Mr. H. Townsend. MEMBERS OF THE DISTRICT CARE COMMITTEES. Campsbourne.—Councillor L. J. Valette (ex-officio), *Mrs. K- Chapman, Mrs. W. C. Hardwick, Mrs. A. E. Lamble, Miss £j. S. Litchfield, Mrs. E. J. Luckett, Miss M. D. Sibley, Miss IX P. Smith, Mr. H. Turner, Mrs. L. Whittle, Mrs. Durrant. Mrs. Gardiner and Mrs. D. M. Johnson. Crouch End.—Councillor L. J. Valette (ex-officio), Miss F A. Barter, Mr. J. H. Ford, M.A., fMrs. A. M. Halford, Mrs. E 11. Hare, Mr. J. Iliffe, Miss E. Pitson, Mrs. J. Stevenson, Mrs H. Tompkins, Miss A. E. Walmsley, Mrs. J. Whitehead, *Mrs -V W. Findlay, M.A., Miss F. E. Gee and Miss B. Curtis. *Secretory. † Chairman. 4 Highgate.—Councillor L. J. Valette (ex-officio), Councillor J. H. Barrenger, Mr. T. E. Durban, Mrs. E. Farrell, fMrs. P. Farquharson, the Rev. F. Hawkins, M.A., Mrs. A. Imber, Mr. E. R. Lewis, Mr. S. Mason, *Miss M. Owen, Miss R. Spalding, Miss E. Towler, the Rev. C. Wood and Mrs. C. M. Cave. Muswell Hill.—Councillor L. J. Valette (ex-officio), ^Councillor C. M. Cave, Miss E. F. Catley, Miss M. N. Clarke, Mr. F. G. Edwardes, Mrs. A. Holman, J.P., Mrs. M. Heppell, Mr. 1. T. Plant, the Rev. C. A. Roberts, Mr. G. Simmonds, B.A., *Mrs. E. Simmonds, the Rev. W. B. Williams, Mir. H. Townsend and Mr. F. J. Randall. North Harringay.—Mrs. H. Betts, Mrs. W. Briggs, Mrs. N. L. Brixey, the Rev. C. Easterling, *Mrs. H. M. Hay, Mrs. G. Hodd, Miss R. Jones, Mrs. R. Owen, Mr. G. Pain, Miss G. M. Ryde, B.Sc., Miss H. M. Stone, † Councillor Valette, Mrs. Easterling, Mrs. Valette and Mr. J. H. Spilman, B.Sc. * Secretary † 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. (till June, 1932). Jean Sutherland, M.B., Ch.B., D.P.H. (from September, 1932). 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, Staninore). Masseuse: Mrs. Yorke (Royal National Orthopaedic Hospital). Dentist: Betty 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. Ladies and Gentlemen, I have the honour to submit my Annual Report on the School Medical Service for the year ending December 31st, 1932. The outstanding event of the year was the transfer of the School Clinic from temporary premises in Topsfield Parade to the new building at The Broadway, Crouch End. A full description of the new Clinic, with photographs and plan, will be found later in this Report. An event of great importance in its ultimate effect on the physical condition of the school children was the appointment of a Special Committee on Public Education in Hornsey, which issued its Report in October, 1932. Among the many important aspects of education considered by this Committee was the subject of " Physical Training and Organised Games." In regard to Physical Training, the Special Committee's recommendations are: — 1.—That the Head Teachers of all Schools be instructed to arrange for some part of every school day to be devoted to the physical training of the children, as distinct from organised games. 2.—That arrangements be made for appropriate remedial exercises to be given by specially-qualified teachers to all children in the schools suffering from minor physical deformities who are recommended by the School Medical Officer for special treatment. 3.—That the Local Education Authority offer every facility for the younger members of the teaching staff to obtain special training in order that they may be able to undertake the physical training of the children in accordance with the best modern methods. 4.—That the Head Teachers of all Schools be requested to see that special attention is paid to the correct posture of the children during the whole time they are in school. 7 Already in January, 1933, evening classes for the instruction of teachers in modern methods of physical training have been started in Stroud Green School—a class for women teachers on Monday evenings and a class for men teachers on Tuesday evenings. It is hoped that these classes may be repeated periodically, and that the teachers taking part in them will be able in their respective schools to create a desire for the cultivation of good posture and sound body mechanics. There is a big field for useful work in this direction in the elementary schools. REVIEW OF THE YEAR'S WORK. At the end of this Report will be found the statistical tables setting out the work of the year in the form required by the Board of Education. Table I. gives the number of routine and special inspections and re-inspections carried out by the medical staff. The routine inspections at different ages numbered 3,074, special inspections 1,293, and re-inspections 3,608—a total of 7,975. This volume of work is considerably in excess of that of previous years—chiefly because of the inspection of the group of children eligible for admission to secondary schools, i.e., age 10-11, in addition to the usual three " code groups," 5, 8 and 12-14. Table II. is a statement of the number and nature of the defects found in the course of medical inspection, and the number of individual children found to require treatment. It is extremely difficult to present in figures a true picture of the physical condition of the children from which comparisons may be made between successive years in an attempt to gauge progress. The general impression gained by the handling of considerable numbers of children throughout the year is, on the whole, favourable. In some respects the indications are indeed most pleasing. For example, the standard of general cleanliness is very high, as also of clothing and footgear. Certain infectious skin diseases have practically disappeared, e.g., ringworm. Tubercular conditions of glands, bones and joints are extremely rare; affections of the heart, lungs and other vital organs are quite uncommon. 8 Perhaps most important of all, in view of the straitened economic circumstances of many families, is the fact that the general nutrition of the children has quite definitely improved in recent years. The departures from health which maintain a relatively high incidence are dental decay, defective vision and defects of posture and general physique. Too many of the children have poor shapes, a condition caused by lack of muscular tone, displaying itself in round shoulders, flat chest and large abdomen. Many of these children carry with them varying degrees of bony deformities chiefly affecting the ribs—pigeon breast, and sunken lower ribs forming a groove across the lower chest known as Harrison's Sulcus. These departures from normal shape are evidence of rickets in infancy—a condition caused by lack of fresh elements in the diet, together with an excess of starchy foods, such as bread, potatoes and such milk puddings as rice and sago. Table III. classifies in 85 different categories those children who are so physically or mentally defective as to be incapable of receiving proper benefit from the education provided in the ordinary elementary schools. As in former years, I have given special attention to the completion of accurate records of these "exceptional children." Their number is relatively small and they are all provided for in ways suited to their special physical and educational requirements. I have explained in a previous report the difficulty in making any return of " delicate children. Table IV. gives details of the treatment carried out during the year under the Authority's scheme of treatment, as set out in tabular form below:— 9 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 Aurist (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). One session monthly, 1st Friday afternoon in each month. Masseuse (Mrs. Yorke). Two sessions weekly, Monday and Friday afternoons. (g) Stammering and other speech defects. School Clinic. Special Teacher (Miss Bains). Two sessions weekly, Monday and Wednesday afternoons. (h) Ringworm. Address: Haddon Court, Southwood Lawn Rd., N.6. Private doctor by arrangement with Education Authority (Dr. 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. 10 AURAL CLINIC. Report by Dr. A. R. Friel, Aural Surgeon:— "The event of the year 1932 was the transfer of this Clinic to the new School Clinic in Crouch End Broadway. This Clinic is well equipped and comfortable to work in. It is designed for a Clinic in which there are various departments— general, dental, etc.—and no one who has worked in it would like to go back to an ordinary house adapted for the purpose. The room allotted to ear work is convenient and is wired to provide current for light, heating a steriliser, working a motor, and in addition, a spare plug for other apparatus as required. Hot and cold water are laid on to a large sink and to a handbasin. The plugs are of a safety type, designed to prevent accidents to little fingers which might poke their way into places not intended for them. "The treatment during the year has been carried out on the same lines as in previous years. All children sent from the Infant Welfare Centres, as well as from the Schools, suffering with otorrhœa, are treated. In addition, many school children are sent up with deafness resulting from suppuration in the ear, as well as the sequel to chronic colds." Discharging ears classified as to the nature of the disease. Results of treatment summarised:— Cause of suppuration. Total. Cured. Lost sight of. Still under treatment. Needing hospital treatment. I Acnte inflammation of the Middle Ear with suppuration 20 19 — 1 - II. Chronic inflammation of the Middle Ear with suppuration due to— (a) Tympanic sepsis 13 12 — 1 - (b) T.S. + Granulations 4 3 — 1 - (e) T.S. + Polypus 2 1 — 1 - (d) Attic disease 8 4 1 2 1 (e) Mastoid disease 3 — — 1 2 III. Inflammation of the external auditory canal 2 2 - — - IV. Not diagnosed 1 1 — — - Totals 53 42 1 7 3 A. R. Friel, M.D, 11 With reference to the dental treatment, summarised in Table IV., Dr. Betty C. Hamilton, School Dental Officer, furnishes the following observations:— "During the year 1932 there was a slight increase compared with previous years in the number of children whose parents consented to have their children's teeth treated at the School Clinic. A certain proportion of the remainder attend a private dentist, and those who can afford private treatment are encouraged to do so. "The opening of the new School Clinic has made dental work much more easily organised, although the time lost during the removal from the old Clinic to the new caused a certain delay in the round of inspection and treatment. "The Head Teachers have given their help In reducing the number of special inspections of casual applicants for treatment, and emphasis is placed on the necessity of accepting full treatment at the time of inspection. "The number of actual attendances during 1932 is less than in previous years; but it is now considered advisable to complete the dental treatment of each child in as few visits as possible, considering the nature of the work and the wellbeing of the child. "It will be noted that there is an increase in the number of permanent teeth filled. The decrease in 1931 and 1932 in the number of temporary teeth filled is balanced by the figures under 'Other operations—temporary teeth,' which relates to nitrate of silver treatment by Howe's method. "The number of anaesthetics given for extraction is not less than in 1931, but it is worthy of note that nitrous oxide gas is now the invariable anaesthetic, and it has been found better to arrange where necessary for two administrations of nitrous oxide on two different occasions rather than to submit the child to ethyl chloride anaesthesia, with its prolonged recovery period. "The other operations performed on permanent teeth consist partly of orthodontic work, which is a service given by the Hornsey school dentists for some years, and for which there is a demand, and partly of cleaning and scaling operations and the treatment of incipient gum disease." BETTY C. HAMILTON, School Dental Surgeon. THE NEW SCHOOL CLINIC. After thirteen years in temporary, more-or-less unsatisfactory shop premises at Topsfield Parade, Crouch End, the School Medical Department moved in October, 1932, into its permanent headquarters—the new School Clinic, built in the eastern corner of the site purchased for municipal purposes and lying between the private gardens of houses in Weston Park and Haringey Park. It has access from both these roads and also from The Broadway, Crouch End. The situation is ideal in its quietness and central position. 12 General Description of the Building. — The building is finished in red brick, with artificial Portland stone dressings, and presents a modest but pleasing appearance. The somewhat unusual cruciform shape (see accompanying plan) was to some extent determined by the necessity for making the best possible use of a small triangular site. This general lay-out has resulted in a very convenient and economical arrangement of the accommodation. The front entrance faces west, and has some 150 yards of open space between it and Crouch End Broadway. On either side of the front entrance are the lavatories—boys on the left and girls on the right—both entered from the main waiting hall only. The waiting hall is a spacious, well-lit and well-ventilated room, 40 feet in length and 20 feet wide. The south end of the hall can be divided as occasion requires by a movable partition and used for special purposes (e.g., stammering class, remedial exercises, lectures, etc.), while the remainder of the waiting hall is used for children and their parents waiting attention by doctor or dentist. Directly opposite the entrance to the waiting hall is a corridor 66 feet long and 5 feet wide, giving access to nine rooms—four on the right side (south) and five on the left side (north). The corridor is exceptionally well lit from both ends, two roof lights, and fanlights above all the doors. Boom I.—The first room on the right is the office and store room. In addition to its outside windows to the south, the office has sliding windows into the main waiting hall and corridor, giving the clerk a view of all children in these parts of the building. Boom 2.—The second room on the south, the largest in the building (excepting the waiting hall) is the orthopaedic room, 26 by 12 feet. It is also used as the school oculist's room. A special feature is the cork flooring, which is warm, soft and insulating for children stripped and undergoing treatment by massage and electricity. Another feature is the arrangement of French windows, occupying the entire south side and enabling it to be converted into an open-air room, and the adjoining paved courtyard to be used by children doing remedial exercises in the open when weather conditions permit. 13 Room 3.—Room 3 is a small dressing room for children being prepared for examination by the Orthopædic Surgeon in Room 2 or by the Medical Officer in Room 4. It has doors opening into both of these rooms. Room 4.—The end room on the south side is the doctors' consulting room, in which the School Medical Officers see children referred for advice by Head Teachers at the request of parents. Room 5.—The end room on the north side of the corridor is the dentist's operating room, which has a large bay window with glass roof, giving exceptionally good natural lighting (north). Room 6.—Opening out of the dentist's operating room is the recovery room, fitted with ample mouth-washing facilities, a water-closet, and a folding couch for any child requiring rest in the recumbent position. Room 7.—Room 7 is the treatment room, of the same size, shape and lighting as the dental room. It also opens into the recovery room, so that it could be adapted and equipped if required as a second dental room. Rooms 8 & 9.—Room 8 is the doctors' and dentist's retiring room and Room 9 is the school nurses' room. Each of these has a lavatory and water-closet. All cupboard accommodation required is provided in the dividing walls between rooms, thus reducing the need for movable furniture, which restricts working space. Equipment.—The equipment throughout has been designed with a view to providing the most efficient, up-to-date and economical service in all departments of the work. Floors.—The flooring throughout is buff magnesite on concrete, except in the orthopædic room, where cork is used for warmth, softness and insulation. Walls.—In the main hall and corridor there is a 4ft. 6in. dado of blue magnesite. Elsewhere the plastered walls have been left to dry out thoroughly before being painted. 14 Lighting.—The natural lighting of the main hall, lavatories, corridors and all rooms is exceptionally good. There is not a dark corner in the building. The artificial lighting is by electricity and our best thanks are due to Mr. Staniland, the Borough Electrical Engineer, and his staff for the really beautiful and efficient installation provided, and for the trouble they have taken over the sterilisers and other electrical apparatus in use at the Clinic. Heating.—The central heating of the building is by means of a low-pressure system, with coke-fired sectional boiler in the basement. The hot-water supply is obtained by means of a domestic boiler, also coke-fired. Both boilers can be converted to automatic oil firing if desired at a later date. Pram Shelter.—It frequently happens that mothers who accompany their school children to the Clinic for treatment also bring the younger members of the family. For their convenience a pram shelter has been provided near the entrance. The Borough Engineer and Surveyor, Mr. W. H. Adams, F.R.I.B.A., was the architect, and I wish to express to him and his staff the sincerest thanks of the School Medical Service for the way in which all our requirements have been provided for in the new building. In all departments—medical, dental, orthopaedic, etc.—more work is being done here under infinitely more comfortable conditions for staff and children than was possible in the old premises, and it is a matter of interest in connection with the present campaign for "wise spending" that the cost of these services, including annual capital charges on the building (which cost £5,000), is not increased. The Assistant School Medical Officer, Dr. Edith Abbott, resigned on June 30th to get married and the vacancy was filled in September by the appointment of Dr. Jean Sutherland, formerly Assistant Medical Officer of Health and School Medical Officer for Stockton-on-Tees. There were no other changes in the staff. 15 I desire to acknowledge the immense amount of time and trouble taken by the Head Teachers and their staffs in the efforts to improve the standard of health throughout the schools; the assistance and support of the Director of Education, and his staff; the hard work of the District Care Committees and the Central Care Committee; and the keen interest of the Education Committee in these concerted efforts to improve the physique of the children. I have the honour to be, Ladies and Gentlemen, Your obedient servant, R. P. GARROW. School Medical Officer. GROUND FLOOR PLAN. Hornsey School Clinic, Interior View of Main Waiting Hall and Corridor taken from Entrance Vestibule. Hornsey School Clinic Exterior, taken from Broadway Gardens. 17 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 I.—Minor ailments (excluding uncleanliness). Group II.—Defective vision and squint (excluding minor eye defects treated as minor ailments). Group III.—Treatment of defects of nose and throat. Group IV.—Dental defects. Group V.—Uncleanliness and verminous conditions. „ V.—List of Schools in the Borough. 18 TABLE I. RETURN OF MEDICAL INSPECTIONS (see note a) (a)—Routine Medical Inspections. Number of Code Group Inspections— (see note b). Entrants 932 Intermediates 1,406 Leavers 570 Total 2,908 Number of other routine Inspections (see note c) 166 (b)—Other Inspections. Number of special inspections (see note d). 1,293 Number of re-inspections (see note e). 3,608 Total 4,901 19 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 Regulations 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-inspection 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. 20 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 treatment. 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 47 ... 2 ... Uncleanliness (See Table IV., Group V.) Skin Ringworm, scalp ... ... ... ... „ body ... ... 5 ... Scabies 3 ... 4 ... Impetigo 1 ... 25 ... Other Diseases (Non-tuberculous) 3 ... 64 ... Eye Blepharitis 2 ... 8 ... Conjunctivitis 3 ... 13 ... Keratitis ... ... 2 ... Corneal Opacities ... ... ... ... Defective Vision (excluding Squint) 149 12 87 ... Squint 17 ... 34 ... Other Conditions 10 ... 117 ... Ear Defective Hearing 4 ... 10 ... Otitis Media 4 0 6 ... Other Ear Diseases 5 ... 32 ... Nose and Throat Enlarged Tonsils only 5 8 3 ... Adenoids only ... ... ... ... Enlarged Tonsils and Adenoids 1 1 1 ... Other conditions 24 ... 50 ... Enlarged Cervical Glands (N on-Tuberculous) 2 ... ... 0 Defective Speech 9 ... ... ... Teeth Dental Diseases (see note a (See Table IV., Group IV.) 1073 ... 3 0 Heart and Circulation Heart Disease: Organic ... 4 ... ... Functional ... ... ... ... Anæmia 5 ... 20 ... Lungs Bronchitis ... ... 10 0 Other Non-Tuberculous Diseases ... ... 1 ... culosis Pulmonary: Definite ... ... ... ... Suspected ... ... ... ... Non-Pulmonary: Glands ... ... ... ... Spine ... ... ... ... Hip ... ... ... ... Other Bones and Joints Skin ... ... ... ... Other Forms ... ... ... ... Nervous System Epilepsy ... ... ... ... Chorea ... ... 5 ... Other Conditions ... ... ... ... Deformities Rickets 3 ... ... ... Spinal Curvature ... 1 ... ... Other Forms 411 23 20 ... Other Defects and Diseases 8 2 749 ... 21 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 (1) Number of Children. Percentage of Children found to require Treatment (see note d). (4) Inspected (see note c). (2) Found to require Treatment. (3) Code Groups:— Entrants 932 219 23% Intermediates 1,406 318 23% Leavers 570 103 18% Total (code groups) 2,908 640 22% Other routine inspections 166 33 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). 22 TABLE III. RETURN OF 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 (including 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 1 1 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 6 3 9 15 At Public Elementary Schools (sit 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 19 10 29 19 At Public Elementary Schools (see note c ) 20 At other Institutions 21 At no School or Institution Notified to the local Mental Deficiency Authority during the year. 22 Details should be given on Form 307 M 4 4 23 TABLE III. (continued). Boys. Girls. Total. Epileptics. Suffering from severe epilepsy. (Sec note f). 23 At Certified Schools for Epileptics 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 Suffering from epilepsy which is not severe. (See note g). 29 At Public Elementary Schools. 4 2 6 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 Tuberculosis of the peripheral glands. 43 At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 3 1 4 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 At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 50 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 24 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 be 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 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 1 1 71 At Certified Residential Cripple Schools 1 1 72 At Certified Day Cripple Schools 3 1 4 73 At Certified Residential Open Air Schools 74 At Certified Day Open Air Schools 75 At Public Elementary Schools (see note k) 13 (1) 15 (0) 28 (1) 76 At other Institutions (see note k) 77 At no School or Institution (see note k) 1 1 25 TABLE III. (continued). Boys. Girls. Total. Physically Defective (continued). (See 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 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 (set note c) 84 At other Institutions 85 At no School or Institution 2 2 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 inoapable 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 rt V. of the Act may be provided for defective children. 26 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 lor 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 publio 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. 27 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER. (See note a.) TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.). DISEASE OR DEFECT. (1) Number of Defects treated or under treatment during the year. Under the Authority's Scheme (see note b). (2) Otherwise. (3) Total. (4) Skin— Ringworm-Scalp — — Ringworm-Body 5 5 Scabies 7 7 Impetigo 66 66 Other Skin Disease 73 73 Minor Eye Defects (External and other, but excluding oases falling in Group II). 10 10 Minor Ear Defects (See note c). 56 56 Miscellaneous (e.g., minor injuries, braises, sores, chilblains, etc.) 400 400 Total 617 617 28 TABLE IV. (Continued.) Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Aliments—Group I.). DEFECT OR DISEASE. (1) Number of Defects dealt with. Under the Authority's Scheme (see note b). (2) Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. (3) Otherwise. (4) Total. (5) Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report). 449 64 513 Other Defect or Disease of the Eyes (excluding those recorded in Group 1.). 133 133 Total 582 64 646 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 477 (b) Otherwise — Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 461 (b) Otherwise — Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. (4) Total number treated. (5) Under the Authority's Scheme, in Clinic or Hospital (see note b). (1) By Private Practitioner or Hospital, apart from the Authority's Scheme. (2) Total. (3) 1 1 74 75 29 Group IV.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist: Aged: 5 153 6 307 7 377 8 405 9 476 11 528 12 494 13 304 14 178 15 130 Routine Age Groups Total 3819 Specials (see note d) 486 Grand Total 4305 (b) Found to require treatment 2978 (c) Actually treated 2101 Retreated 725 (2) Half-days devoted to:— Inspection 36 Total 431 Treatment 395 (3) Attendances made by children for ment 3857 (4) Fillings:— Permanent Teeth 2083 Total 2312 Temporary Teeth 229 (5) Extractions Permanent Teeth 425 Total 3200 Temporary Teeth 2775 (6) Administration of general anaesthetics for extractions 1392 (7) Other operations:— Permanent Teeth 605 Total 1524 Temporary Teeth 919 Group V.—Uncleanliness and Verminous Conditions. (See note e.) (i.) Average number of visits per school made during the year by the School Nurses—57. (ii.) Total number of examinations of children in the Schools by School Nurses—28,799. (iii.) Number of Individual ohildren found unolean—317. (iv.) Number of children cleansed under arrangements made by the Local Education Authority—119. (v.) Number of cases in which legal proceedings were taken: — (a) Under the Education Act, 1921— (b) Under School Attendance Byelaws— NOTES ON TABLE IV. (a) 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 Education 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. 30 (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. 31 TABLE V LIST OF SCHOOLS IN THE BOROUGH. School. Department. Authorized accommodation. Average No. on the Rolls for qr. ended 31/12/32. Head Teacher. Campsbourne Boys' 388 379 Mr H. Turner „ Girls' 388 307 Miss G.S. Litchfield „ Infants' 400 311 Miss D.F. Smith Coldfall Mixed *440 567 Mr. G. Simmonds, B.A. „ Infants' 400 292 Miss M.N. Clarke Crouch End Boys' 456 343 Mr. J. Iliffe „ „ Girls' 450 316 Miss F.A. Barter „ „ Infants' 411 367 Miss A.E. Walmsley Highgate Mixed 328 334 Mr. T.E. Durban „ Infants' 264 119 Miss R. Spalding North Harringay Boys' 380 427 Mr. J.H. Spilman, B.Sc. „ „ Girls' 380 328 Miss G.M. Ryde, B.Sc. „ „ Infants' 416 372 Miss H.M. Stone South Harringay Mixed 440 434 Mr. G.F. Shaw, M.A. „ „ Infants' 240 183 Miss R. Jones Stroud Green Senr. Mixed 350 365 Mr. F.W. Jaggard „ „ Junr. Mixed 416 359 Mr. A.B. Coleman „ „ Infants' 352 268 Miss E. Pitson Muswell Hill Junr. Mixed 200 154 Miss E.F. Catley St. Mary's Mixed 428 431 Mr. J.W.T. Harris „ „ Infants' 232 255 Miss M.D. Sibley St. Michael's Mixed 196 143 Mr. E.R. Lewis „ „ Infants' 168 95 Miss E. Towler St. James' Junr. Mixed 240 256 Mr. I.T. Plant Holy Innocents' Infants' 101 66 Miss F.E. Gee Totals 8,464 7,471