AC 439 HOR 025 BOROUGH OF HORNSEY. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR 1933. R. P. GARROW, M.D., D.P.H. Printed by "The Hornsey Journal," Ltd., 161, Tottenham Lane, Hornsey, N.8. HOR 025 Borough of ANNUAL REPORT FOR 1933 OF THE Medical Officer of Health. INDEX. Acts In force, 12. Admissions to Hospital, 43. Allotments, 20. Ambulances, 12. Ante-natal Clinics, 34, 47. Area of Borough, 6. Attack rate, infectious disease, 44. Bacteriological examinations, 11. Bakehouses, 20, 22. Baths and Wash-houses, 23. Births and rates, 6, 13, 38, 42. Borough Nursing Association, 10, 11. Butchers, 20, 22, 28. Bye-laws in force, 12, 23. Cancer deaths, 42. Carbide, 30. Cellulose spirit, 31. Cerebro-spinal meningitis, 44. Charity expenditure, 8. Children Act, 1908, 12, 47. Cinemas, 20, 22. Cleansing station, 24. Clinics, 34, 35, 47. Committees, 1, 2, Controlled houses, 23. Conveniences, 20. Dairies, 20, 22, 25, 28. Deaths and rates, 6, 7, 38, 42. „ Causes of, 39, 40. Dental scheme and treatment, 35. Diarrhoea, 7, 42. Diphtheria, 31, 42, 43, 44. „ Immunisation, 31. Diseases of Animals Acts, 33. Disinfection, 24. „ Vans, 24. Dog nuisance, 24. Drain tests, 20, 21, 24. Drains opened, 21. Drainage, 20, 21. Dysentry, 44. Encephalitis letharglca, 43, 44. Enteric fever, 42, 43, 44. Entertainment places, 22. Erysipelas, 43, 44. Factories and workshops, 20, 22, 48. Pish shops, 22. Pish condemned, 27. " Five-year " programme, 14. Plats erected, 16. Food inspection, 25, 27. „ condemned, 26, 27. „ poisoning, 25. „ samples, 27. Foster mothers and children, 12, 47. Funds disbursed, 8. Gramophone and Loud-speaker Bye- laws, 12. Grimshaw Close, 14. Hairdressers (Sunday Closing) Act, 28, 30. Health Committee, 1. „ Services. 9, 11. Visiting, 47. Visitors, 4, 34. Home Nursing, 10. Hornsey Central Hospital, 11. Hornsey Deanery Association, 11. Hornsey Housing Trust, Ltd., 16. Hornsey Nursing Association, 10, 11. Horticultural poisons, 31. Hospital services, 9, 11. Houses controlled and decontrolled, 23. demolished, 14, 17, 18. „ erected, 16. Housing, 14. Byelaws, 23. Families rehoused, 14. " Five-year " programme, 14. House-to-house Inspections, 18, 20. Inspections, 17. Returns of work, 17. Statistics, 17. Trust, 16. Hydro-carbon, 30. Humane slaughtering. 26. Illegitimate births, 6. „ deaths, 7. Increase of Rents Act, 20. Infant deaths and rates, 7, 38, 42. „ „ Causes, 41. Infantile paralysis, 43, 44. Infectious disease— Diphtheria, 31, 42, 43, 44. Notifications, 43. Prevalence, 31. Scarlet fever, 31, 42, 43, 44. Inhabited houses, 6. Inquests, 33. Inspections made, 20. Isolation Hospital, cases admitlcd to, 43. Laboratory work, 11. Legal proceedings, 31. Library books, 24. Licences, 20, 22 , 25, 26, 30, 31. Malaria, 44. Maternal mortality, 6. Maternity and Child Welfare Committee, 2. Maternity and Child Welfare— Analysis of attendances, 47. Ante-natal, 47. Births notified, 13. Centres, 34. Children Act, 12, 47. Clinics, 34, 47. Committee, 2. Dental treatment, 3, 35. Foster children, 12, 47. Health visiting, 47. Hospital arrangements, 9, 11, 34. „ maternity cases, 34. Maternal deaths, 6. Midwife, 11, 35, 47. Milk grants, 35. Nursery school, 36. Orthopaedic scheme, 35. Sessions, 34. Staff, 3, 4, 34. Time-table, 34. Toddlers' playroom, 36. Voluntary Committees, 36. X-ray treatment, 35. Year's work, 47. Measles, 7, 42, 44. Meat inspection, 26. „ condemned, 26. Meningitis, 44. Midwlves, 4, 11, 35, 47. Milk grants, 35. licences, 25, 26. „ samples, 25. „ shops, 20, 22, 25. Mortuary, 33. Music and dancing licences, 20. North Hill flats, 14. „ (No. 15, 17 & 17a), 14. Notification of Births Act, 13. Nursing Association, 10, 11. North Road Cottages, 14. Nursing Homes, 11. North Middlesex Hospital, 34. Ophthalmia neonatorum, 32, 43, 44. Orthopaedic scheme, 35. Outworkers, 20, 22, 49. Overorowding, 14, 20, 22. Para-typhoid, 43, 44. Passageways, 20. Petroleum Acts, 20, 30. „ licences, 22, 30. Piggeries, 21. Pneumonia, 43, 44. Poisons Act, licencos, 31. Poliomyelitis, 43, 44. Polio Encephalitis, 44. Population, 6, 38. Preface, 5. Puerperal fever and pyrexia, 3, 6, 43, 44. Puerperal deaths, 6. Rag Flock Act, 20. Rateable value and produce of 1d. rate, 6. Refuse shoots, 20, 22. Regulations in force, 12, 23. Rent and Mortgage Interest (Restrictions) Act, 20, 23. Restaurants, 20, 22, 28. Rose Cottages demolished, 14. Rowlands Close, 14. Royal Northern Hospital, 34. St. James's Lane Housing area, 14. Sale of Food and Drugs Act, 27. Sanitary notices served, 18. Sanitary work, 21. Scabies, 20, 24. Scarlet fever, 31, 42, 43, 44. Shoots, refuse, 20, 22. Shops Act, 20, 28. list of, 28. Slaughter-houses, 20, 22, 26. Slaughtering byelaws, 27. Slaughtermen's licences, 26. Small-pox, 21, 31, 44. Smoke, 20. Social services, 8. Stables, 20. Staff, 3, 4, 34. Statutory notices, 18. Statistics, 6. Still-births, 6, 42. Subscriptions, Annual, 11. Tables, list of, 37. Tottenham Lane Cottages, 14. Tuberculosis, Cases of, 33, 43, 45. „ Deaths and rates, 42,45. „ Order, 33. „ Register, 33, 45, 46. „ Sanatoria and beds, 32. „ Sputums, 11. Turnpike Lane housing area, 14. Typhoid fever, 42, 43, 44. Underground tenement closed, 18. Unmarried mothers, 11. Vaccination, 32. Verminous houses, 20, 22, 24. Veterinary Inspector's report, 33. Visits by Inspectors, 20. Visiting of Children, 12, 47. Vital statistics, 6, 7, 38. „ „ England, &c„ 38. Voluntary Committees' work, 36. Ward's Cottages, 14. Water supply, 19. Whooping-cough, 7, 42. Workshops, 20, 22. X-ray treatment, 35. 1 HEALTH COMMITTEE as at 31st December, 1933. Alderman P. Everington (Chairman), 81, Mount View Rd., N.4. The Mayor, Councillor W. J. Grimshaw, J.P., 25, Sheldon Avenue, N.6. Alderman W. W. Kelland, M.A., 14, Hillside Mansions, N.6. ,, J. W. Rowlands, J.P., 25, Cholmeley Park, N.6. ,, R. Steeds, 19, Coolhurst Road, N.8. 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. ,, Mrs. C. M. Cave, 10, Wood Vale, N.10. ,, J. Edwards, 102, Turnpike Lane, N.8. ,, Mrs. M. N. Hill, 16, Bishopswood Road, N.6. ,, W. J. Lendrum, 10, Leaside Avenue, N.10. „ J. W. Shipp, 12, Berkeley Road, N.8. ,, L. J. Valette, 59, Allison Road, N.8. ,, W. V. Wall, 168, Stroud Green Road, N.4. „ C. Winkley, 72, Woodside Avenue, N.10. 2 MATERNITY & CHILD WELFARE COMMITTEE as at 31st December, 1933. Councillor E. Brooks (Chairman), 122, Crouch Hill, N.8. The Mayor, Councillor W. J. Grimshaw, J.P., 25, Sheldon Avenue, N.6. Alderman P. Everington, 81, Mount View Road, N.4. ,, W. W. Kelland, M.A., 14, Hillside Mansions, N.6. ,, R. Steeds, 19, Coolhurst Road, N.8. Councillor Mrs. J. H. Barrenger, 20, Southwood Hall, N.6. ,, A. J. Blake, 25, Danvers Road, N.8. ,, F. A. P. Boustred, 26, Lanchester Road, N.6. Mrs. C. M. Cave, 10, Wood Vale, N.10. ,, J. Edwards, 102, Turnpike Lane, N.8. ,, S. G. Goulding, Woodlands, Cranley Gardens, N.10. ,, 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. ,, L. J. Valette, 59, Allison Road, N.8. ,, W. V. Wall, 168, Stroud Green Road, N.4. ,, A. T. Willis, 62, High Street, Highgate, N.6. Selected Members: Mrs. L. J. Bond, 125, Mount View Road, N.4. Mrs. F. O. Dixon, 2, Woodside Avenue, N.6. Miss A. M. Inward, 29, Endymion Road, N.4. Mrs. F. M. Merry, 20, Etheldene Avenue, N.10. Mrs. B. Walton, " Greenacre," The Green, Ealing, W.5. 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 Jean Sutherland, M.B., Ch.B., D.P.H. ‡Assistant Medical Officer for Maternity and Child Welfare Jessie Muir, M.B., Ch.B. ‡Consultants (Puerperal Fever and Pyrexia Regulations) Dr. J. B. Banister, 129, Harley Street, W.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.R.C.P. L. Rowlands, L.D.S. †*Senior Sanitary Inspector . Henry Eastwood, M.R.San.I. M.S.I.A. Cert. R.San.I., Cert. Insp. of Meat and Foods. †*Sanitary Inspectors J. Goodman, Cert. R.San.I. J. H. Jesse, M.S.I.A. Cert. R.San.I., Cert. Insp. of Meat and Foods. J. D. Chance, M.S.I.A. Cert. R.San.I., Cert. Insp. of Meat and Foods A. E. Gooday, M.S.I.A. Cert. R.San.I., Cert. Insp. of Meat and Foods †Chief Clerk W. Gilroy, †Assistant Clerks E. Cheesman, A. wickham. D. Bryant (Temporary). 4 †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. F. R. H. Ross (part time). H.V. Cert., S.R.N., 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.B.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. Me. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the health of the Borough for the year 1933. The birth-rate of 10 85 per 1,000 of the population is the lowest ever recorded, and is now definitely lower than the deathrate of 12.2 per 1,000. According to the Registrar-General's estimate, there has been a loss of population of 920 persons between 1932 and 1933. Infant mortality remains at the low figure of 43 2 deaths of infants under one year of age per 1,000 infants born. I have the honour to be, Ladies and Gentlemen, Your obedient servant, R. P. GARROW, Medical Officer of Health. 6 STATISTICS FOR 1933. Social and Economic Statistics. Area (acres) 2,874 Population (Census 1931) 95,524 Do., Registrar-General's estimate (mid 1933) 96,070 Number of inhabited houses (end of 1933), according to Rate Books 21,588 Rateable value (General Rate) £1,006,572 Product of a penny rate £4,194 LIVE BIRTHS— Legitimate Males 530 „ Females 465 Illegitimate Males 25 „ Females 21 Total 1,041 Birth-Rate 1085 per 1,000 population (Registrar-General's estimate). STILL-BIRTHS— Legitimate Males 17 „ Females 21 Illegitimate Males 1 „ Females 2 Total 41 Rate per 1,000 total (live and still births), 39.4. DEATHS— Male 501 Female 601 Total 1,102 Death-Rate 12 2 per 1,000 population (Registrar-General's estimate). Deaths from Puerperal Causes. Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 0.92 Other puerperal causes 3 2.77 Total 4 3.69 7 Deaths of Infants under 1 Year of Age. Legitimate Males, 26, Females 13 = 39 Illegitimate „ 4,„ 2=6 Total 45 Death-Rate of Infants under 1 Year of Age. All infants per 1,000 live births 43.22 Legitimate infants per 1,000 legitimate live births 39.19 Illegitimate infants per 1,000 illegitimate live births 130.4 Deaths from Measles (all ages) 0 Deaths from Whooping-Cough (all ages) 3 Deaths from Diarrhoea (under 2 years of age) 6 8 SOCIAL AND ECONOMIC CONDITIONS IN THE AREA. The following is a list supplied by the Relieving Officer, Mr. It. Parry, of the amount disbursed from public and voluntary funds during 1933:— SUMMARY. £ s. d. Public Assistance 23,237 8 7 Old Age Pensions 8,150 0 0 Unemployed Benefit 7,161 9 3 Widows' Pensions 1,645 0 0 National Health Insurance 968 17 6 British Legion, Hornsey 696 8 0 Hornsey Parochial Charities 562 2 0 War Pensions 448 6 0 United Services Fund 423 17 0 Welfare Centres—Milk supplied by Council 402 9 0 Soldiers' and Sailors' Help Society 159 9 1 School Care Committees 128 1 10 Hornsey Coal Fund 125 4 10 Central Boot Fund 107 6 10 Distress Fund, Muswell Hill 75 2 3 Central Distress Committee, Hornsey 74 9 3 British Legion, Muswell Hill 60 5 3 Hornsey Y.M.C.A. 47 0 0 United Services, Muswell Hill 30 0 0 Ferme Park Carol Singers 17 10 0 Private Charity conducted by Mrs. James 12 0 0 Mrs. Lovell-Harrison's Special Fund 10 9 8 Hornsey Y.W.C.A. 5 0 0 Harringay Constitutional Club 4 10 0 Anonymous Private Fund 2 0 0 Muswell Hill Girl Guides 1 0 0 Grand Total £44,555 6 4 9 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. No important change or development has taken place during 1933 in the general provision of health services for the area. The needs of the population in regard to diagnosis and treatment of disease at home or in hospital are adequately provided for by the various public and voluntary agencies in the Borough, in London and in the County of Middlesex. Indeed, it is doubtful whether any area in any country or in any age ever enjoyed such facilities. The centres, clinics, homes, hospitals and other institutions which cater for special diseases or special groups or classes of persons are almost unlimited in number and variety. Specialisation has reached a high pitch, and the provision of hospital beds is on a correspondingly generous scale. Same interesting figures were provided recently regarding hospital provision in the metropolis in comparison with that for other populations. The number of beds provided (municipal and voluntary) for all purposes (medical, surgical, fever, mental, etc.) per 1,000 of the population is stated to be: — 9.47 in England and Wales 7.86 in Scotland 7.45 in U.S.A. 8.05 in Germany 6.87 in Berlin 19.57 in London Even when allowance is made for the fact that the voluntary hospitals of London are used by sick persons from all over the country and from abroad, it will be seen that London is provided on a scale greatly in excess of the average for this and other countries. These figures suggest that the time has arrived when it may he of some advantage for Local Authorities to distinguish between "health services" and "disease services." The Local Government Act, 1929, placed upon the major health authorities the country (Counties and County Boroughs) a heavy obligation in the direction of hospital provision. It would be unfortunate if the necessary provision for disease became confused in the public mind with measures for the promotion of health and 10 the prevention of disease. These latter measures only are entitled to the description "health services." Their object is to secure a healthy environment—houses, streets, air, food, water, sanitation—and to promote healthy habits of living amongst the people, so that fewer hospital beds should be required. NURSING IN THE HOME. Among the local organisations within the Borough which do good service and save its members from requiring hospital attention is the Borough of Hornsey Nursing Association. Inaugurated as a home nursing service for the entire Borough in 1927 and affiliated with the Queen's Institute of District Nursing, it continues to grow in importance. The following are some particulars of this Association: — President—The Mayor of Hornsey. Honorary Secretary— Mr. R. H. Crookall, 9, Birchington Road, N.8. Honorary Treasurer— Mr. S. M. Mason, 50, North Hill, N.6. Superintendent—Miss Ivett, 2, Ravenstone Road, N.8. Tele.: Mountview 6971. There is a staff of five 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. Pneumonia 16 88 10 1 5 Tuberculosis 2 362 — — 4 Influenza 28 180 26 1 1 Whooping Cough — — — — — Measles — — — — — Puerperal Pyrexia — — — — — Ophthalmia Neonatorum 2 5 — — — Other diseases in ohildren under 5 16 84 15 — — 11 There are 3,070 subscribing members of the Association, and during the year 11,048 visits were paid in 466 cases. Home Nursing Classes were conducted by Miss Ivett, the Superintendent, at Hornsey High School, under the Higher Education Committee. The Council subscribe annually a sum of 25 guineas and the Education Committee £5 to the funds of the Association for the nursing of cases. Hornsey Deanery Association.—The Council subscribe a sum of £50 a year to the Association's home for unmarried mothers in Eastern Road. Nursing Homes.— There are 24 Nursing Homes in the Borough registered with the Middlesex County Council under the Nursing Homes Registration Act. Fifteen of these are registered for the reception of maternity cases, with approximately 80 beds. Hornsey Central Hospital.—The Hospital, which has 49 beds, treated 698 cases, of which 583 were Hornsey cases. 1,314 out-patients were also treated. MIDWIVES. The Local Supervising Authority under the Midwives Act is the Middlesex County Council. There are 23 Midwives and one Municipal Midwife notified to the Middlesex County Council as practising in the Borough, 11 of whom reside outside the Borough. The Municipal Midwife attended 139 births, in addition to 89 ante-natal clinics held at the Welfare Centres—Brook Road, Wightman Road, Church Road, Highgate, and Coldfall Clinic. 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 1933 were as follows: — Negative. Positive. Diphtheria specimens 943 22 Sputum (T.B.) ,, 186 19 Enteric fever ,, 2 — Other ,, 14 6 1,165 47 Total 1,212 12 LEGISLATION IN FORCE. Byelaws relating to loud-speakers and gramophones were made by the Council during the year. AMBULANCE FACILITIES. The ambulance arrangements with the London County Council for the transport of infectious cases, and the Council's ambulance for street accidents and general ambulance services continue to be satisfactory and adequate. The "Morris Viceroy" motor conveyance, purchased in October, 1931, for the transport of mentally and physically defective children travelled 11,476 miles and carried over 22,639 passengers. The following is a statement of the work done by the Borough Ambulance under the Fire Brigade: — Calls 1,127 Persons conveyed 1,120 Street illness and accidents 384 Maternity case 1 Other cases 742 CHILDREN ACT, 1908, AND CHILDREN AND YOUNG PERSONS ACT, 1932. 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 and at each Centre. The following is a summary of the Begister:— Centre— No. of foster-mothers on the register— No. 1. No. 2. No. 3 & Sub. Total. At the beginning of 1933 30 7 16 53 end ,, ,, 20 8 10 38 No. of foster-children on the register— At the beginning of 1933 20 7 16 43 „ „ end ,, ,, 18 9 27 59 Died during the year — — — — On whom inquests were held during the year — — — — Visits to foster-children 121 101 104 326 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 1933 Male Female. Total. Live births 618 554 1,172 Still births 19 21 40 637 575 1,212 The births were notified:— By Doctors 174 ,, Borough Midwife 134 ,, other Mid wives 295 ,, Hospitals 126 ,, parents 44 ,, others 401 1,174 Unnotified (from Registrars return):— Live births 34 Still births 4 38 1,212 Of this number there were:- Live births. Still Dirths. Occurring in the Borough and transferred to other districts 180 3 Occurring in Hospitals, etc., outside the district belonging to Hornsey 390 16 The 1,029 nett number of notified births belonging to Hornsey were divided among the districts of the Centres as follows:— Brook Road 478 Wightman Road 257 Highgate 263 Coldfall Sub-Centre 31 i 1,029 14 HOUSING. The Council's scheme for the demolition of all unfit houses in the Borough and the rehousing of their occupants makes steady and satisfactory progress. The group of unfit houses on North Hill known as " Ward's Cottages " have been replaced by a block of 20 flats and one shop and were all occupied by July. These are named " Rowlands Close," after Mr. Alderman J. W. Rowlands, Deputy Mayor [Mayor 1931-1933]. " North Road Cottages," numbering 21, have been demolished, and in their place are being erected a block of 26 flats, named " Grimshaw Close," after the Mayor, Mr. Councillor J. W. Grimshaw, J.P. These flats will be ready for occupation during the summer of 1934. Demolition of unfit houses has taken place also at 15, 17 and 17a, North Hill, and at 1 and 2, Rose Cottages, Fortis Green. The two chief groups of unfit houses remaining are at Tottenham Lane and St. James's Lane, and both of these areas will be dealt with in the immediate future. An area suitable for the erection of blocks of flats has been acquired at Turnpike Lane. OVERCROWDING. During the year 7 fresh cases of overcrowding have been found and 24 cases abated. There were 40 known cases of overcrowding existing in the Borough at the end of the year. The following is a statement of overcrowding conditions extending over a period of four years:— Cases found 130 ,, abated 90 ,, unabated 40 Visits paid 750 Re-Housing.—The Borough Engineer informs me that during the year 1933, 86 families, representing 393 persons, have been re-housed, as follows:— Families. Persons. North Road Cottages 17 56 Myddelton Road 5 30 15  Families. Persons St. Mary's Road 5 23 Steeds Road 4 21 Orchard Road 3 16 Barrenger Road 2 13 11 Archway Road 2 Canon Road 2 11 Newlands Road 3 11 Alexandra Gardens 2 10 North wood Road 2 10 Nightingale Lane 2 10 Nelson Road 2 9 Campsbourne Road 2 9 Hill Road 1 8 North View Road 1 8 Coleraine Road 1 7 St. James's Lane 1 7 Clarendon Road 1 6 High Street, Highgate 1 6 Grove House Road 1 5 Harvey Road 1 5 Priory Road 1 5 Fortis Green 1 5 Muswell Hill Road 1 5 Raleigh Road 1 5 Lynton Road 1 5 Etheldene Avenue 1 4 Rathcoole Avenue 1 4 Rathcoole Gardens 1 4 Inderwick Road 1 4 The Grove 1 4 Rectory Road 1 4 Crouch End Hill 1 4 Park Road 1 4 The Campsbourne 1 4 Woodstock Road 1 4 Colney Hatch Lane 1 4 Fortis Green Avenue 1 4 Greenham Road 1 3 Muswell Hill Place 1 3 16  Families. Persons. Hornsey Park Road 1 3 Glebe Road 1 3 New Road 1 3 Bishop's Road 1 3 Birkbeck Road 1 2 Coppett's Road 1 8 86 393 The following houses and flats, etc., have been built during 1933: — Number of houses erected by private enterprise 110 Number of flats erected by private enterprise 30 Number of houses and shops converted into flats 20 Number of flats erected by the Council (Rowlands Closet 21 HORNSEY HOUSING TRUST, LTD. The Hornsey Housing Trust, Ltd., was formed in 1933 to assist in the provision of better housing at cheaper rents for certain classes of families. The Council, being in sympathy with the objects of the Trust, have decided, in pursuance of Section 70 of the Housing Act, 1925, to make advances on the security of the Society's properties up to 85 per cent. of the value of the properties on the following terms:— (1) Interest at £3 12s. 6d. per cent. (2) Term not exceeding 30 years. (3) No charges other than out-of-pocket expenses to be made by the Council. (4) Purchase price to be approved by the Council. (5) Expenditure on alterations or reconditioning not to exceed the amount required to meet the minimum requirements of the Council's byelaws. The Trust held its first Annual General Meeting on March 27th, 1934, at which the Chairman, Councillor Mrs. 17 M. N. Hill, gave an account of its work over a period of ten-and-ahalf months. HOUSING STATISTICS. The housing statistics of the year as required by the Ministry of Health are set out below:— 1. Inspection of Dwelling-houses during the Year: — (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,344 (b) Number of inspections made for the purpose 7,697 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 388 (b) Number of inspections made for the purpose 1,890 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 1,500 2. Remedy of Defects during the Year without service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,293 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 - 18 (2) Number of dwelling-houses which were rendered fit niter service of formal notices:— (a) By owners — (b) By local authority in default of owners — 13.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 63 (2) Number of dwelling-houses in which defects were remedied after service of formal notices (a) By owners 55 (b) By local authority in default of owners — 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 5 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 5 D.—Proceedings under section 20 of the Housing Act, 1930: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — HOUSE-TO-HOUSE INSPECTIONS. Highgate— Coleridge Buildings, Archway Road 32 Townsend's Yard, High Street, Highgate 9 Kent's Yard, High Street, Highgate 6 19 Muswell Hill— Cottages off Fortis Green Road 39 Viewfield Cottages, Colney Hatch Lane 4 Muswell Hill Place 22 Willow Cottages, St. James's Lane 2 Alexandra Gardens 12 North Haringey— Clarendon Road 2 Turnpike Lane 4 South Haringey— Wightman Road 10 East Hornsey— Holland Road 13 Rectory Road 41 Canon Road 33 Hanbury Road 31 West Hornsey— The Grove, off Lynton Road 28 Park Road 21 Lavender Cottages (Park Road) 5 New Road 25 Brook Road 19 Finsbury Park— Woodstock Road 30 388 SANITARY CIRCUMSTANCES OF THE AREA. The general sanitation of the area is maintained at a high level. Drainage and sewerage, public cleansing, sanitary inspection and the abatement of nuisances are all effective in maintaining a healthy environment. The public water supply— an item of immense importance to the public health—is excellent in quality and so far unrestricted in quantity, in spite of the prolonged drought. The population of this Borough owes a great debt of gratitude to the late Sir Alexander Houston, for many years Director of Water Examination to the Metropolitan Water Board. His great scientific ability and untiring zeal in the discharge of his duties 20 are generally acknowledged to be factors in securing for the Metropolis and its surrounding districts an abundant supply of pure water. He retired from office in 1933 and died later in the year. 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 388 Special inspections 1,106 Re-inspections 9,124 Transfer to Council houses 2 Notifiable infectious diseases 285 Tuberculosis 53 Deaths 112 Verminous houses 137 Scabies 6 Shops Act 798 Factories, workshops and outworkers 548 Rent Restriction Act 22 Cinemas, etc. 19 Overcrowding 145 Petroleum stores 293 Rag Mock Act 4 Dairies and milkshops 90 Bakehouses 47 Slaughter-houses 198 Butchers' shops 70 Restaurant kitchens 40 Other food shops 296 Annual licences (Music and Dancing) 40 Stables 50 Conveniences 11 Smoke observations 22 Refuse tips 207 Passages 348 Allotments 6 Drainage 502 Drainage Fee tests 9 21 Piggeries 6 Water tests applied (new drains) 46 Smoke and chemical tests applied (old drains) 43 * Drains examined under Sec. 41, Public Health Act, 1875 5 Small-pox Contacts—Visits 43 15,101 *Authority was obtained in respect of 14 houses, but in only 5 of these cases was it necessary for the Council to open the drains. SUMMARY OF SANITARY IMPROVEMENTS CARRIED OUT. Drainage Number of houses and premises redrained 29 Repairs or amendments to existing drains 209 Drains or gullies unstopped or cleansed 119 Manholes provided 38 do. repaired 37 Intercepting traps fixed 29 New gully traps fixed 172 New soil pipes and ventilating shafts fixed 49 Soil pipes and ventilating shafts repaired 55 Fresh-air inlets provided or repaired 63 Water-Closets and Sanitary Fittings. New water-closet basins fixed 230 Water-closets unstopped, cleansed or repaired 48 New check cisterns fitted to water closets; existing check cisterns repaired 104 New sinks provided 184 New lavatory basins provided 59 New waste-pipes fixed 173 Waste-pipes trapped, repaired or unstopped 329 Miscellaneous. Roofs repaired 212 Eaves guttering renewed, cleansed or repaired 121 Rain-water pipes provided, repaired or unstopped 148 do. disconnected from drains 29 Damp walls remedied 132 Damp-proof courses inserted 75 Paving of yards repaired 136 22 Premises structurally repaired 1,146 Rooms cleansed, distempered or papered 948 Rooms disinfested of vermin 354 Work-rooms cleansed or repaired 10 Drinking-water cisterns repaired, cleansed and covered 74 Water supply reinstated 2 do. (additional) provided 10 Baths provided or made usable 43 Windows and skylights provided or made usable 88 Floors repaired 139 Window sills repaired 39 Sash cords and fittings repaired 115 Sanitary dustbins provided 240 Accumulations of manure and refuse removed 41 Stoves, ranges and coppers repaired or renewed 242 Sundry items 584 Overcrowding abated 24 6,879 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 37 Milk purveyors in connection with other businesses 62 Bakehouses 22 Restaurant kitchens 34 Tea-rooms and coffee-bars 24 Slaughter-houses 6 Butchers' shops 54 Fish shops 23 Factories, workshops and work-places 322 Outworkers' premises 127 Cinemas 7 Places of public entertainment 32 Shoots (refuse) 2 Overcrowded houses 40 Licensed petroleum stores 81 873 23 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, 1923 and 1983. The number on the register at present are classified as follows:— Decontrolled lodging-houses 160 Partly controlled 37 Fully controlled 82 Total 279 Fifty-one houses have been dealt with under these Byelaws during the year and the following works carried out:— Byelaw No. 11 (b) Means of carrying off waste water (including provision of sinks) 15 11 (f) Sash-cords and window fittings 13 15 (a) Closet accommodation 1 15 (b) Water supplies 9 15 (c) Washing accommodation 12 15 (d) Food stores 35 15 (e) Preparation and cooking of food 1 16 (a) Repairs to staircase 1 16 (b) and (c) Lighting of staircase 1 17 Artificial lighting 1 21 (a) Cleansing and painting 2 91 Note.—In regard to washing accommodation, Byelaw 15 (c), the new baths and wash-houses erected by the Borough Council in High Street, Hornsey, opened on the 14th April, 1932, were extended during the year by additional slipper baths and washhouse accommodation at a cost of £3,000. 24 DISINFECTION AND DISINFESTATION. Number of rooms fumigated after notifiable infectious disease 360 „ „ „ „ non- „ „ „ 137 „ „ „ „ T.B 51 ,, articles disinfected 5,782 ,, ,, destroyed 231 ,, verminous roams disinfected 354 CLEANSING STATION.—Thirteen adults and 15 children have been treated at the cleansing station for various reasons. There were also 3 adults from Wood Green and 1 adult from Southgate treated 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 622 On account of vermin, etc.:— Disinfestations (premises) 142 Spraying of stagnant pools 2 Spraying at bakehouse for crickets and cockroaches 1 Posting bills re Dog Nuisance in different parts of the Borough 450 Collecting and disinfecting library books:— Received. Returned. Public Libraries 160 111 School Libraries 42 16 Private Libraries 72 20 Drain tests and conveyance of drain-testing appliances 86 Visits in connection with Welfare Centres 74 Mileage run. Brown van 3,905 Blue van 2,088 25 INSPECTION AND SUPERVISION OF FOOD. The inspection of the milk supply, meat and other foods, and of places where food is prepared, is part of the routine duty of the Sanitary Inspectors, and goes on continuously throughout the year. Disease produced by eating unsound or unwholesome food is extremely rare. During the heat wave in June, 1933, however, an outbreak of food poisoning occurred at Muswell Hill, affecting over sixty persons and causing one death. There was no difficulty in tracing the trouble to brisket of beef, prepared and sold in a local cooked-meat shop. The remainder of the infected material was at once surrendered and destroyed. Scrupulous cleanliness of premises and personnel is essential in all places where food is prepared and sold, and it is the constant endeavour of the officers of the Health Department to secure a high standard of hygiene in these places. Dairies and Milksiiops. 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 60 classed as dairies and 62 classed as milkshops the principal trade of which is not dairy produce. Of these dairies, 23 are situated outside and operate also 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 24 informal samples for bacteriological examination during the year. There are no cowsheds in the Borough. Special Designated Milks. Producers of, and dealers in, special designated milk are required to obtain licences annually. 26 During the year licences were granted as follows:— Pasteurising and sale of Pasteurised Milk 1 Sale of Pasteurised Milk 18 Sale of Pasteurised Milk (Supplementary) 1 Sale of Certified Milk 4 Bottling and sale of Grade "A" (T.T.) Milk 1 Sale of Grade "A" (T.T.) Milk 5 Sale of Grade "A" (T.T.) Milk (Supplementary) 1 Sale of Grade "A" Milk 3 Sale of Grade "A" (Pasteurised) Milk 2 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 Medical Officer of Health. In this way the Inspectors are enabled to examine the carcase and organs of every animal killed for human consumption. During the year the carcases and meat offal of 845 animals have been inspected under the Regulations. Meat offal weighing in all 74 lbs. was condemned, surrendered and destroyed in the Council's incinerator. Statistics of Slaughtering, 1926-1933. 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 1933 3 842 0 0 845 There are six licensed slaughter-houses in the Borough. 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 Slaughter of Animals Act, 1933, which supersedes the Council's bye-law as to slaughtering of larger animals, also requires the holding of a licence to slaughter and stun animals in slaughter-houses. Seven persons have been so licensed, and 27 the licences remain in force for a period of three years to 31st December, 1936. All the butchers in the Borough on whose premises slaughtering takes place have undertaken to use the mechanical stunner for all animals. In these circumstances it was not considered necessary to make any alteration in the Byelaws. FISH. Fish brought from the London Market and found to be unsound on arrival at its destination is submitted for examination, condemned, surrendered and destroyed, and a " condemnment " note is given, which enables the dealer to obtain a credit from the wholesaler. This arrangement is quite good and results in prompt notification. The following fish was condemned and destroyed:— Haddocks 238 lbs. Kippers 264 lbs. Dog fish 49 lbs. Other fish 70 lbs. 621 lbs. 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. R. 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 162 3 Milk, sterilised 5 — Butter 3 — Lard 1 — 28 Sausages 5 - Fish (Hake) 21 12 Fish (Lemon Sole) 13 5 Jam 1 - Whisky 9 1 Gin 1 - 221 21 SHOPS ACTS. Seven hundred and ninety 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 two instances where contraventions have occurred after verbal notices, and undertakings obtained that recurrences will not take place. No legal action has been necessary. There are 1,252 shops in the Borough engaged in the following trades:— Grocers 118 Confectioners 105 Drapers, Costumiers, Ladies' Outfitters, etc. 84 Boots 70 Greengrocers 68 Restaurant Kitchens, Tea-rooms and Coffee-bars 62 Hairdressers and Barbers 56 Stationers and Newsagents 54 Butchers 54 Tobacconists 49 Off-licences 37 Dairies and Milkshops 37 Public-houses 35 Bakers 33 Coal Merchants 32 Gas and Electrical Fittings, and Wireless 31 Tailors and Men's Outfitters 30 Furniture and Upholsterers 30 29 Chemists 28 Fishmongers 23 Oil and Colour Shops, General and Domestic Stores 23 Watches and Jewellery 17 Milliners 15 Ironmongery and Hardware 12 Florists 14 Builders and Decorators 10 Cycles and Motor Repairs 10 Cooked Meats 10 Hosiers 9 Saddlers and Leather Goods 9 Booksellers and Libraries 8 Photographers 8 Pianos and Music 8 Corn chandlers 7 Timber Merchants 6 Wardrobe Dealers and Dress Agencies 5 Carpets and Lino 5 Clothes Pressing, Cleaning and Repairing 4 Picture Frames 4 Art Needlework and Wool 4 Bazaars 4 Antique Shops 4 Umbrellas 3 Toys 3 Opticians 3 Furriers 3 Blinds 2 Sewing Machines 2 Pawnbrokers 1 Baby Carriages 1 Corsets 1 Herbalist 1 Basket Ware 1 Cutler 1 China and Glass 1 Cork Goods 1 30 Arts and Crafts 1 Knitted Goods 1 Fishing tackle 1 Salvage and job stores 1 1,260 Hairdressers' and Barbers' Shops (Sunday Closing) Act, 1930. This Act came into operation on the 1st day of January, 1931, 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. The total number of licences for storing petroleum spirit is 81, the same as last year, but several conversions from can to bulk storage in underground steel tanks have been made, which brings the total quantity of petroleum which may be kept on licensed premises to 89,796 gallons, 4,396 gallons being kept in two-gallon cans and 85,400 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. 31 Cellulose Spirit. Three premises are licensed solely for the storage of cellulose spirit and the total quantity kept on these premises is SO gallons. Horticultural Poisons. There are three 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. The Petroleum Spirit (Conveyance) Regulations, 1932, came into operation on the 1st of February, 1933. LEGAL PROCEEDINGS. No legal proceedings were taken during the year. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. There is, fortunately, nothing of an unusual nature to report regarding the incidence of infectious diseases. There was no case of small-pox in the Borough, in spite of the fact that the mild form of this disease (Variola Minor) continues to smoulder in the metropolitan area. There was an average incidence of scarlet fever, which continues to be of a mild type. This infection is, indeed, so mild that many cases must be missed during the year, because the patients are not ill enough to cause alarm and no doctor is called in. Diphtheria also remains at a low incidence and fatality— only 44 cases and 2 deaths occurring during the year. Tn these circumstances there is no public demand for immunisation against diphtheria and scarlet fever, and not very strong ground for urging the desirability of protection against these infections. It should always be borne in mind, however, that medical science does not fully understand the factors which control variations in the incidence and severity of diseases, and it may happen that diphtheria or scarlet fever or both may not continue indefinitely to let us off so lightly. 32 VACCINATION. The Public Vaccinators inform me that they have performed vaccination of persons in the Borough during 1933 as follows:— Dr. E. Buckler 75 Dr. T. E. Pearman 208 OPHTHALMIA NEONATORUM. Seven cases of ophthalmia neonatorum were notified. Four were treated in St. Margaret's (L.C.C.) Hospital, Kentish Town, one in a nursing-home and two were nursed at home. Cases Vision unimpaired. Vision impaired. Total blindness. Deaths. Notified. Treated At home. In hospital or nursing home. 7 2 5 7 0 0 0 TUBERCULOSIS. Sanatorium provision for all forms of Tuberculosis in Hornsey is made by the Middlesex County Council. There are 539 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 Heatherwood Hospital, Ascot — — 25 Non-pulmonary Victoria Home. Margate — — 6 ,, 33 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 Eegister at the end of 1933 was 718, an increase of 34 on the total for last year. Dr. Dobson, the Middlesex Tuberculosis Officer for Hornsey, lias kindly supplied the following particulars of Hornsey cases of Tuberculosis on his Eegister:— New Tubercular cases 69 Transfers into district not included in above 22 New Non-tubercular cases, including contacts 133 Tubercular cases under supervision during the year 344 Cases undiagnosed at end of year 1 Tubercular cases on Eegister at 1st Jan., 1934 268 MORTUARY. Sixty bodies were received at the mortuary and inquests held on 18 of them. DISEASES OF ANIMALS ACT. Mr. F. G. Buxton, the Veterinary Inspector, reports that during the year he inspected 337 pigs and 50 sheep and issued removal licences in respect of 43 pigs, 8 sheep and 1 pigeon. No action was necessary under the Tuberculosis Order, 1925. 34 MATERNITY AND CHILD WELFARE. CENTRES. No. 1 Centre.—St. Mary's Mission Hall, Brook Road, serving East and West Hornsey, Croucli 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, Wigiitman Road, serving Stroud Green, Finsbury Park and South Haringay areas. Health Visitor: Miss A. Glover. Clinics:— 1st and 3rd Mondays, 3-4 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. Clinics:— Fridays: 2-4 p.,m. (Dr. Garrow). 2nd Fridays (Ante-natal): 10-12 a.m. (Dr. Sutherland). Sub-Centre at Col-dfall 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. North Middlesex Hospital. During 1933, 132 maternity cases and 1,140 other 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. 35 Midwifery. The Municipal Midwife attended 139 births. A reduction of her fee was made in 44 necessitous cases. 1,425 births have been attended by the Borough Midwife since the appointment was first made in 1922. X-Ray Treatment. One expectant mother was sent to University College Hospital from the Ante-natal Clinic for examination. Milk (Mothers and Children) Orders. One thousand one hundred and twenty-nine applications for milk under this Order were dealt with during the year, of which 1,107 were granted and 22 refused. The number last year was 932. The total of the accounts paid to 31st December amounted to £403 0s. 9d. Orthopædic 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 Orthopasdic 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:— Mothers. Children. Clinics held 46 43 Old cases 144 108 New cases 38 74 Total attendances 182 182 Attendances for dentures 55 — Gas cases 78 73 Local injections 6 — Teeth extracted 306 174 Fillings done 36 5 Dentures provided 12 — Inspections 19 47 Cases finished 28 62 Other treatments (dressings, scaling, gum treatment, etc.) 26 45 36 Voluntary Committees. It would not be possible to carry on the work at the Centres so effectively were it not for the work of the ladies who so generously give their time and services and collect funds for voluntary assistance to mothers and babies. Their help given in this direction includes holidays at convalescent homes, surgical instrument, massage, dental treatment, home helps, etc. The Fathers' and Mothers' Committee also do valuable work in providing funds as the outcome of their social gatherings. Toddlers' Playroom. The Toddlers' Playroom, started in November, 1931, and conducted at no expense to the Council by Miss Benn at the Highgate Centre, continues to be a success. The Playroom is open each morning from Monday to Friday and the maximum attendance is 18. There are 21 between the ages of 2 and 5 on the rolls and the total attendances made during the year was 2,809. 37 LIST OF TABLES TABLE A.—Vital Statistics, 1911-33. TABLE B.—Causes of, and ages at, death in 1933. TABLE C.—Summary of causeR of death, 1931-1932. TABLE I).—Infant Mortality in 1933. Causes of and ages at death. TABLE E.—Births, Deaths, Infant Deaths, and Deaths from certain diseases, 1901-1933. TABLE F.—Cases of Infectious Disease notified in 1933. TABLE G.—Cases of Infectious Disease notified, 1911-1933. TABLE H.—(1) Notification of, and deaths from, Tuberculosis, 1933. ,, (2) Tuberculosis Register, 1933. TABLE I.—Work done at the Maternity and Child Welfare Centres and by Municipal Midwife, 1933. TABLE J.—Inspection of Factories, Outworkers, etc., 1933. 38 TABLE A. BOROUGH OP HORNSEY VITAL STATISTICS, 1911.1933. Year. Estimated Mid-Year Population. Birth Kate per 1,000 Population. Death Rate per 1,000 Population. Infant Mortality per 1,000 Births. 1911 84,592 (Census). 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 (Census). 16.7 11.0 49 1922 88,007 15.4 11.2 54 1923 88,326 14.4 10.6 51 1924 88,661 13.4 10.4 41 1925 89,064 13.6 10.6 43.6 1926 89,850 13.4 10.3 47.2 1927 90,000 l3.3 11.2 38.3 1928 90,250 12.1 12.1 61.3 1929 90,500 Regr..Gen.'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 1933 96,070 10.85 12.2 43.2 ENGLAND and WALES (Rates in 1933) 14.4 12.3 64 118 County Borough and Great Towns, including London (Rates in 1933) 14.4 12.2 67 132 Smaller Towns Populations 25,000 to 50,000 (Rates in 1933) 14.5 11.0 56 London (Rates in 1933) 13.2 12.2 59 39 TABLE B.-CAUSES OF. AND AGES AT, DEATH,1933 (NEW CLASSIFICATION). Total. All Ages. 0—l 1-2 2-5 5-15 15—25 25—35 35-45 45-55 55—65 65—75 76 & over M F M F M F M F M F M F M F M F M F M F M F M F 1. Typhoid and paratyphoid fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 4. Whooping cough 3 2 1 ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 5. Diphtheria 2 1 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 6. Influenza 45 20 25 2 ... ... ... ... ... 1 ... ... 1 ... 1 ... ... 5 3 3 4 ... 7 7 9 6 7. Encephalitis lethargica 3 1 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... 1 7 8. Cerebrospinal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 9. Tuberculosis of respiratory system 44 25 19 ... ... ... ... ... ... ... ... 4 4 5 4 5 2 6 3 3 3 1 2 1 1 9 10. Other tuberculous diseases 20 11 9 1 ... 2 1 1 ... ... 1 1 2 2 3 1 1 1 ... ... 1 1 ... ... ... 10 11. Syphilis 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 12. General paralysis of the insane, tabes dorsalis 4 4 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... 1 ... ... ... 12 13, Cancer, malignant disease 171 75 96 ... ... ... ... ... ... ... ... ... ... ... 2 4 10 9 16 23 24 20 20 19 24 13 14. Diabetes 22 8 14 ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 ... ... ... 3 5 7 2 1 14 15. Cerebral haemorrhage, etc. 51 23 28 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 1 4 2 9 11 6 13 15 16. Heart disease 280 117 163 ... ... ... ... ... ... ... ... ... 2 ... 2 2 4 7 5 24 27 44 35 38 88 16 17. Aneurysm 5 2 3 ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... 1 ... 2 2 ... ... ... 17 18. Other circulatory diseases 53 22 31 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 2 2 7 9 10 20 18 19. Bronchitis 31 13 18 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 1 ... ... 3 6 6 11 19 20. Pneumonia (all forms) 80 34 46 4 ... 1 ... ... 2 ... ... ... 1 2 2 2 1 4 3 7 7 9 11 5 19 20 21. Other respiratory diseases 6 3 3 ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... 1 ... ... ... 1 ... 1 21 22. Peptic ulcer 10 8 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 ... 2 1 2 ... 22 23. Diarrhoea, etc. 10 4 6 3 2 1 ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 23 24 Appendicitis 8 6 2 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... 3 1 ... 1 ... ... 24 25. Cirrhosis of liver 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 25 26. Other diseases of liver, etc. 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 ... ... 26 27. Other digestive diseases 27 10 17 ... ... ... 1 1 ... ... ... ... 1 1 ... 1 ... 4 4 1 4 1 3 ... 3 27 28. Acute and chronic nephritis 27 13 14 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 4 2 2 4 7 5 1 28 29. Puerperal sepsis 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 29 30. Other puerperal causes 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... 30 31. Congenital debility, premature birth, malformations, etc. 27 17 10 17 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 32. Senility 22 5 17 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 16 32 33. Suicide 16 12 4 ... ... ... ... ... ... ... ... 1 1 1 ... 1 1 5 ... 4 2 ... ... ... ... 33 34. Other violence 39 22 17 1 1 1 ... ... ... 1 ... 2 ... 4 ... 1 2 1 2 2 1 5 3 4 8 34 35. Other defined diseases 86 41 45 2 1 ... ... ... ... l 4 3 1 2 2 3 4 1 4 8 9 10 10 11 10 35 36. Causes ill-defined or unknown 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 36 Totals 1102 501 601 30 15 6 2 4 4 7 6 13 15 22 20 27 30 54 50 92 94 125 137 121 228 Special causes included in 35 above Small pox Poliomyelitis Polioencephalitis 40 TABLE C.—CAUSES OP, AND AGES AT, DEATH. 1931 AND 1932 (NEW CLASSIFICATION). All Ages 1931 All Ages 1932 M F M F 1. Typhoid and paratyphoid fever ... ... ... ... 2. Measles ... ... 3 3 3. Scarlet Fever ... 1 ... ... 4. Whooping cough ... 2 1 2 5. Diphtheria 2 3 ... 4 6. Influenza 7 16 11 20 7. Encephalitis lethargica ... 1 ... ... 8. Cerebro-spinal fever ... ... ... 1 9. Tuberculosis of respiratory system 21 31 23 31 10. Other tuberculous diseases 3 2 3 6 11. Syphilis 1 3 ... ... 12. General paralysis of the insane, tabes dorsalis 3 ... 4 3 13. Cancer, malignant disease 72 107 66 94 14. Diabetes 4 12 3 10 15. Cerebral haemorrhage, etc. 17 52 25 40 16. Heart disease 110 150 109 181 17. Aneurysm 2 ... 4 1 18. Other circulatory diseases 25 29 24 22 19. Bronchitis 15 15 21 8 20. Pneumonia (all forms) 28 40 32 34 21. Other respiratory diseases 5 6 9 8 22. Peptic ulcer 7 4 8 3 23. Diarrhoea, etc 2 3 4 4 24. Appendicitis 3 4 9 5 25. Cirrhosis of liver 2 1 5 2 26. Other diseases of liver, etc. 3 1 3 I 27. Other digestive diseases 10 10 7 14 28. Acute and chronic nephritis 19 15 12 14 29. Puerperal sepsis ... 2 ... 4 30. Other puerperal causes ... 3 ... 2 31. Congenital debility, premature birth, malformations, etc. 24 16 15 17 32. Senility 8 11 10 24 33. Suicide 9 2 9 2 34. Other violence 16 13 25 18 35. Other defined diseases 44 41 48 47 36. Causes ill-defined or unknown ... ... ... ... Totals 462 596 486 625 1,058 1,111 Special causes included in 35 above Small-pox Poliomyelitis Polioencephalitis A Table of causes, etc., of death under previous classification for 1921-30 appeared in Report for 1932. 41 TABLE D.—INFANT MORTALITY, 1933. 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. 9-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Premature Birth 6 2 1 9 9 Marasmus — 1 3 1 5 1 — — — 6 Gastric Enteritis — — 1 1 2 3 — — — 5 Pneumonia — 1 — — 1 1 — 1 2 5 Atelectasis 2 — — — 2 — — — — 2 Congenital Heart 1 — — — 1 1 — — — 2 Asthenia 2 — — — 2 — — — — 2 Inattention at Birth 2 — — — 2 — — — — 2 Inanition 1 — — — 1 — — — — 1 Icterus Neonatorum 1 — — — 1 — — — — 1 Melina neonatorum 1 — — — 1 — — — — 1 Bronchitis — — — — — — — 1 — 1 Tubercular Meningitis — — — — — — — 1 — 1 Inspessation 1 — — — 1 — — — — 1 Intra Cranial Hæmorrhage 1 1 — — 2 — — — — 2 Cerebral Hæmorrhage 1 — — — 1 — — — — 1 Suprarenal Hæmorrhage 1 — — — 1 — — — — 1 Jaundice — 1 — — 1 — — — — 1 Epilepsy — — — — — — — 1 — 1 Total 20 6 5 2 33 6 0 4 2 45 42 TABLE. E. BIRTHS, DEATHS, INFANT DEATHS. AND DEATHS FROM CERTAIN DISEASES, 1901-1933. YEAR. 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 1,661 ... 589 130 15 19 1 1 8 1 62 46 20 1904 1,659 ... 690 145 18 17 21 l 7 2 49 54 23 1905 1,567 ... 696 106 9 10 6 3 8 2 65 58 16 1906 1,603 ... 769 136 18 4 22 6 13 5 65 47 13 1907 1,524 ... 766 116 5 19 3 4 9 4 76 50 19 1908 1,485 ... 752 95 12 11 3 3 9 2 84 53 16 1909 1,508 ... 787 87 12 12 0 3 10 0 75 57 26 1910 84,592 1,393 ... 737 84 1 10 0 4 8 3 88 41 18 1911 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 87,691 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 2 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 1933 96,070 1,041 41 1,102 45 0 3 6 0 2 0 171 44 20 43 TABLE F.- INFECTIOUS DISEASES NOTIFIED, 1933. WARDS. AGES Total Admitted to Joint Hospital. Admitted to other Hospitals. In Nursing Home. Nursed at Home. Registered Deaths DISEASE Highgate Muswell Hill. Crouch End West Hornsey East Hornsey North Haringey South Haringey Stroud Green Finsbury Park. 0— 1 l— 5 5— 15 15— 25 25— 45 45— 65 65 and over Scarlet Fever 58 57 15 28 27 20 13 13 10 — 46 123 47 23 2 — 241 186 4 — 51 — Diphtheria 6 7 — 11 8 3 2 2 5 2 8 22 7 5 — — 44 40 3 — 1 2 Typhoid 1 — — — — — — — — — — — — — 1 — 1 1 — — — — Para Typhoid 1 1 — — — — — — — — — — 1 1 — — 2 — 2 — — — Pneumonia 8 11 3 8 8 1 5 7 6 — 4 3 1 18 15 16 57 3 10 2 42 80 Erysipelas 8 11 1 7 1 5 — 9 4 — 1 3 2 12 22 6 46 29 3 — 14 — Puerperal Fever — 2 — 1 1 — — — — — — — 1 3 — 4 — 4 — — 3 Puerperal Pyrexia 1 2 1 1 1 3 — 1 — — — — 4 6 — — 10 — 8 2 — — Ophthalmia Neonatorum 3 1 1 2 — — — — 7 — — — — — — 7 — 4 1 2 — Poliomyelitis 1 — — — — — — — 1 — 2 — — — — — 2 1 — — 1 — Encephalitis Lethargica — 1 — 1 — — — — — — — 2 — — — — 2 1 1 — — 3 84 95 21 58 48 32 20 32 26 9 61 153 63 68 40 22 416 261 39 5 1ll Tuberculosis : Pulmonary 9 17 6 10 24 17 6 11 17 — — 2 25 60 27 3 117 44 NonPulmonarv 8 10 3 4 5 5 2 2 2 2 4 8 6 17 2 2 41 20 Total Excluding T.B. Admitted to Joint Isol. 53 58 12 42 33 15 12 20 16 Hospital Other Hptls 6 7 2 5 5 5 2 3 4 Nursing Homes — 2 — 1 1 — — 1 — Nursed at Home 25 28 7 10 9 12 6 8 6 Note.—The following 62 cases were also admitted to the Isolation Hospital in addition to the above : —8 Tonsillitis, 7 Measles, 7 Chicken-pox, 7 Whooping Cough, 5 Whooping Cough and Pneumonia, 4 Influenza, 3 found not to be Typhoid, 2 German Measles, 2 found not to be Diphtheria, 2 Laryngitis, 1 Pharyngitis, 1 Septic Mouth, 1 Septic Throat, 1 Local Sepsis, 1 Cold, 1 Rheumatism, 1 Appendicitis, 1 Colic, I Gastritis, 1 Lymphangitis, 1 Myalgia, 1 Otitis Media, 1 Sprained Ankle, 1 Injury to Ankle, 1 found not to be Scarlet Fever. 44 TABLE G.-.NOTIFICATIONS OF INFECTIOUS DISEASE, 1911-1933. Year. Population. Estimated Scarlet Fever. Diphtheria or Croup. Typhoid Fever. Para Typhoid. Puerperal Fever. Puerperal Pyrexia. Erysipelas. Cerebral Spinal Meningitis. Polio-Myelitis. Ophthalmia Neonatorum. Malaria. Dysentery. Encephalitis Lethargica. Polio-Encephalitis. Pneumonia. Small-pox. Measles. German Measles. Total Attack rate per 1,000 population. 1911 84,592 (Census) 179 133 6 — 2 — 40 — — — — — — — — 1 — — 361 4.2 1912 84,840 138 88 9 — 3 — 39 1 1 — — — — — — — — — 279 3.2 1913 86,122 206 115 10 — 2 — 26 — — — — — — — — — — — 359 4.2 1914 85,456 346 101 9 — 1 — 24 — — 11 — — — — — — — — 492 5.7 1915 85,800 182 105 18 — 5 — 35 9 3 1 — — — — — — — — 358 4.1 1916 86,147 103 77 8 — 1 — 32 2 6 9 — — — — — — 207 281 726 2.7 * 1917 86,450 132 66 4 — 1 — 28 4 — 1 — — — — — — 1,227 881 2,344 2.7 * 1918 86,942 89 67 8 — 2 — 23 1 3 2 — — — — — — 796 119 1,110 2.3 * 1919 87.100 203 87 6 — 4 — 42 4 1 5 21 2 5 — 112 — 224 285 1,001 5.7 * not now notifiable 1920 87,410 245 149 6 — 2 — 27 1 3 8 10 2 4 — 98 — 555 6.3 1921 87,691 591 189 2 — 2 — 36 — 2 6 1 1 6 — 42 — 878 10.1 (Census) 286 123 1 — 2 — 24 — — 10 1 — 1 — 104 — 552 6.2 1922 88,007 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 90,500 249 129 3 2 3 8 30 3 1 5 2 — — 1 163 — 599 6.6 1930 88,450 346 115 5 4 4 15 36 1 1 1 — — — — 61 3 592 6.6 1931 'R.-Gen.'s Estimate) 95,524 (Census) 247 116 — 1 7 9 32 — 1 3 1 — 2 — 86 — 505 5.3 1932 96,990 R.-Gen.'s Estimate) 123 70 2 3 4 14 28 2 2 2 — — 1 — 52 5 308 3.2 1933 96,070 241 44 1 2 4 10 46 — 2 7 — — 2 — 57 — 416 4.3 * Excluding Measles and German Measles. 45 TABLE H.— (1) NOTIFICATIONS OF, AND DEATHS FROM, TUBERCULOSIS, 1933. AGE PERIODS. New Cases. Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 — 1 — — 2 — — — 1 — 1 — 5 — — 3 1 — — 2 1 5 — 15 2 — 5 3 — — 1 — 15 — 25 6 19 3 3 4 4 1 1 25 —35 15 19 4 9 5 4 1 2 35 — 45 20 6 2 2 5 2 2 3 45— 55 11 5 2 — 6 3 1 1 55 — 65 7 4 — — 3 3 1 — 65 and over 1 2 1 1 2 3 1 1 Totals 62 55 22 19 25 19 11 9 Wards ;— Highgate 3 6 3 5 5 2 1 3 Muswell Hill 7 10 8 2 3 3 5 — Crouch End 3 3 2 1 1 — 2 2 West Hornsey 6 4 3 1 3 3 1 1 East Hornsey 15 9 2 3 4 3 1 1 North Haringey 12 5 2 3 2 1 1 — South Haringey 4 2 1 1 2 1 — — Stroud Green 5 6 — 2 3 2 — 1 Finsbury Park 7 10 1 1 2 4 — 1 Totals 62 55 22 19 25 19 11 9 46 TABLE H.-(2) TUBERCULOSIS REGISTER, 1933. Pulmonary. Non-Pulmonary. Total. Male. Female. Male. Female. Male. Female. (a) Number of Cases on Register at commencement of 1933 265 270 75 74 340 344 (b) Number of Cases notified for first time during year under Regulations 45 38 10 11 55 49 (c) Cases restored to Register during 1933 1 3 — — 1 3 (d) Cases added to Register otherwise than by notifications under Regulations: (1) Transferred from other districts 11 10 2 3 13 13 (2) From Death Returns 5 4 10 5 15 9 (e) Number of Cases removed from Register during 1933 52 46 16 10 68 56 (f) Number of Cases remaining on Register at end of 1933 275 279 81 83 356 362 Cases removed from the Register shown 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 2 0 3 4 19 18 Pulmonary 19 16 52 46 9 8 Non-Pulmonary 1 0 4 1 0 3 1 2 10 4 16 10 3 0 7 5 19 21 10 10 29 20 68 56 47 TABLE I. MATERNITY AND CHILD WELFARE WORK, 1933. Nature of Work. Centres. Totals. No. 1. No. 2. No, 3 and Sub-Centre. Number of sessions held 197 122 93 415 ,, ante natal sessions held 50 25 23 98 Number of individual Mothers seen by Doctor:— Ante natal, New cases 195 76 73 344 ,, Old cases 337 123 103 563 Post-natal. New cases 40 24 3 67 ,, Old cases 9 14 — 23 581 237 179 997 Total attendances of Mothers 659 292 253 1,204 Number of babies attending Centres for first time : Under 1 year 345 191 150 686 1-5 years 81 56 74 211 Number of individual babies on Centre registers: Under 1 year 301 253 128 682 1—5 years 663 206 341 1,210 Babies seen by Doctor 2,289 1,322 915 4,536 Attendances of babies at medical consultations 3,202 2,072 1,110 6,384 Total attendances of babies at Centres : Under 1 year 5,416 2,522 1,734 9,672 1—5 years 3,460 1,041 962 5,463 Referred to own private doctors 15 11 2 28 Referred to hospitals 148 42 2 192 Health talks given by nurses — 31 — 31 Visits paid by nurses: — First visits Total visits First visits Total visits First visits Total visits Grand First visits Totals Total visits To expectant mothers 92 184 91 151 48 76 231 411 To infants under one year 487 2,364 313 1,351 278 1,075 1,078 4,790 To children aged 1—5 years 112 3,465 73 1,667 60 1,534 245 6,666 Total visits paid by Nurses 691 6,013 477 3,169 386 2,685 1,554 11,867 CHILDREN ACTS— Visits paid to Foster Children 8 121 9 101 2 104 19 326 RECORD OF WORK OF MUNICIPAL MIDWIFE, 1933. Confinements attended 139 Ante-natal Clinics attended 89 do. visits 574 Post-natal visits 1,885 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) 170 2 0 Workshops (Including Workshop Laundries) 200 4 0 Workplaces (Other than Outworkers' premises) 12 0 0 Total 382 6 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 cleanlines 18 18 — — Want of ventilation — — — — Overcrowding — — — — Want of Drainage of floors — — — — Other nuisances 8 8 — — Sanitary accommodation insufficient unsuitable or defective 15 15 — — 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 Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). 5 Total 41 41 5 — *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, 1933. Nature of Work. (1) Premises. Outworkers. Instances. Notices served. Prosecutions. Wearing Apparel 96 103 0 0 0 Books 7 7 0 0 0 Gaiters 1 1 0 0 0 Furs 3 3 0 0 0 Carnival Hats 2 3 0 0 0 Table and Bed Linen 8 8 0 0 0 Curtains 1 1 0 0 0 Cellophane Covers 1 1 0 0 0 Boxes 1 1 0 0 0 Umbrellas 1 1 0 0 0 Artificial Flowers 2 2 0 0 0 Brushes 1 1 0 0 0 Chemists' Suudries 1 1 0 0 0 Jewel Cases 1 1 0 0 0 Bead Stringing 1 1 0 0 0 Total 127 135 0 0 0 - Borough of hbornsey. ANNUAL REPORT OF THE School Medical Officer FOR THE Year ending December 31st, 1933 3 To the Chairman and Members of the HORNSEY EDUCATION COMMITTEE. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the work of the School Medical Service for the year ending December 31st, 1933. 1 am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, R. P. GAKROW, School Medical Officer. 4 HORNSEY EDUCATION COMMITTEE. List of Members, December 31st, 1933. Members of the Town Council— His Worship the Mayor, Councillor W. J. Grimshaw, J.P., 25, Sheldon Avenue, N.6 (Chairman). Aldermen. Mr. W. G. Barrenger, 20, Southwood Hall, Highgate, 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. Mr. J. W. Rowlands, J.P., 25, Cholmeley Park, N.6. Councillors. 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. 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. Mr. G. K. M. Hutchinson, 1, Sandringham Gardens, N.8. 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. G. Reid, B.A., 79, Middle Lane, N.8. Director of Education— 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. G. Reid, B.A. Two Representatives of the Middlesex Education Committee— Alderman W. W. Kelland, M.A., and Kev. 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— Mrs. D. M. Johnson, Mr. G. Simmonds, B.A., Mr. W. P. Bannister, M.A. (Hornsey County School), Mrs. H. M. Haig. Eight Representatives of Employers and Employees in the area of the Authority— Councillor W. V. Wall, Mr. E. H. Bennett, Mrs. N. Brixey, Mrs. E. Chapman, Mr. G. Pain, Mrs. H. Tompkins and Mr. H. Townsend. MEMBERS OF THE DISTRICT CARE COMMITTEES. Campsbourne.—Councillor L. J. Valette (ex-officio), *Mrs. E. Chapman, Mrs. W. C. Hardwick, Mrs. A. E. Lamble, Miss G. S. Litchfield, Mrs. E. J. Luckett, Miss M. D. Sibley, Miss D. F. Smith, †Mr. H. Turner, Mrs. L. Whittle, Mrs. Durrant, Mrs. Gardiner, Mrs. D. M. Johnson, Mrs. G. Reid, B.A., and Mr. J. W. T. Harris. Crouch End.—Councillor L. J. Valette (ex-officio), Miss F. A. Barter, †Mrs. A. M. Halford, Mrs. E. H. Hare, Mr. J. Iliffe, Miss E. Pitson, Mrs. J. Stevenson, Mrs. H. Tompkins, Miss A. E. Walmsley, *Mrs. N. W. Findlay, M.A., Miss F. E. Gee, Miss B. Curtis, the Bev. F. M. Tapply, M.A., and Mr. F. W. Jaggard. * Secretary. †Chairman. 6 Highgate.—Councillor L. J. Valette (ex-officio), Councillor Mrs. J. H. Barrenger, Mr. T. E. Durban, Mrs. E. Farrell, †Mrs. P. Farquharson, the Rev. F. Hawkins, M.A., Mrs. A. Imber, Mr. E. R. Lewis, Mr. S. Mason, *Miss M. Owen, Miss R. Spalding, Miss E. Towler, the Rev. C. Wood and Councillor Mrs. C. M. Cave. Muswell Hill.—Councillor L. J. Valette (ex-officio), †Councillor Mrs. C. M. Cave, Miss E. F. Catley, Miss M. N. Clarke, Mr. F. G. Edwardes, Mrs. A. Holman, J.P., Mrs M. Heppell, Mr. I. T. Plant, Mr. G. Simmonds, B.A., *Mrs. E. Simmonds, the Rev. W. B. Williams, Mr. 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 L. J. Valette, Mrs. Easterling, Mrs. Valette and Mr. J. H. Spilman, B.Sc. * Secretary. ‡ Chairman. 7 1 —STAFF OF SCHOOL MEDICAL SERVICE. School Medical Officer: R. P. Garrow, M.D., D.P.H. Assistant School Medical Officer. Jean Sutherland, M.B., Ch.B., D.P.H. Dentist: Betty C. Hamilton, L.D.S., L.R.C.S., L.R.C.P. (Edin.), 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. Orthopædic Surgeon: H. J. Seddon, F.R.C.S. (Eng.) (Resident Medical Superintendent, Royal National Orthopaedic Hospital, Country Branch, Stanmore). Masseuse: Mrs. Yorke (Royal National Orthopaedic Hospital). Nurses: M. Anscombe. L. M. Oliver. F. E. Paris. F. Ross. Clerk: H. M. Croak. Assistant Clerk: H. Powell. 8 School Hygiene. A new Infants' School is in course of construction at Rokesly Avenue. When this is opened Holy Innocents' School, which has for some years been regarded as unfit, will be closed. Plans have been passed by the Committee and approved by the Board of Education for the reconstruction of Crouch End School. This work will be undertaken when the building at Rokesly Avenue is complete.* These changes represent important advances in the hygienic conditions of the elementary schools in the area, and it is particularly gratifying to note that the reconstruction at Crouch End School includes a suite of baths similar to those which have been such a success at Campsbourne School. Every facility provided for personal cleanliness is a definite contribution to the public health. Medical Inspection. Four age groups of school children are inspected, namely, infants, age 5; intermediates, age 8; the scholarship group, age 11, and leavers, age 14. In addition, parents are informed on the notice of medical inspection that pre-school children can be examined if desired. Findings of Medical Inspection. The nature and number of defects found are given on Table II. at the end of this Report. There is an all-round improvement in the condition of the elementary school population, especially in regard to cleanliness, which reaches a high standard, also in regard to nutrition, skin disease, dental decay, and diseases of heart and lungs. There are signs also of improvement in posture and physique as a result of the re-awakening of interest in physical education throughout the schools. Following Up and Treatment. The arrangements for dealing with defects found have been set out in previous reports. The Authority's scheme of treatment is shown in the table on page 9:— Note.—*Rokesly School will be officially opened by H. Ramsbotham, Esq., O.B.E., M.C., M.P., Parliamentary Secretary to the Board of Education, on May 12th, 1934. 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. Orthopædic Surgeon (Mr. Seddon). Masseuse (Mrs. Yorke). One session monthly, 1st Friday afternoon in each month. 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. Dr. Friel reports on the Special Aural Clinic:— "The Session for the Ear Clinic is on Saturday morning, when the patients are examined and treated. In addition to this, treatment is given by the nurses during the week for catarrh of the nose, which is a fruitful cause of defective hearing. As It would be difficult for many of the children to attend at this Clinic during the week the treatments called Diostalisation and Politzerlsation are given at other centres also—Coldfall School, where Miss Ross is in charge; Brook Road, with Miss Anscombe: Wightman Road, with Miss Glover, and Hlghgate, with Miss Maopherson. At the Central Clinic Miss Oliver carries out the treatments. "The majority of the patients attending during recent years were suffering from chronic middle ear catarrh, nasal catarrh and nasal obstruction." The following table indicates the nature of the causes and the results obtained in those suffering from chronic ortorrhœa:— Total (Bars). Cured. Lost Sight of. Still under treatment. Hospital. Acute Suppurative Otitis Media 39 34 3* 2 — Chronic Suppurative Otitis Media Due to (1) Tympanic sepsis 9 9 — — — (2) T.S & Granulations 5 3 1‡ 1 — (3) T.S. & Polypus 3 1 — 2 — Tympanic Condition & Rhinitis 2 2 — — — Attic Disease 5 2 1‡ 2 — External Otitis 5 5 — — — Totals 68 56 5 7 — *One left district. *Two refused to attend. †Refuses to attend ‡ Left School. A. R. Friel. 11 Dr. B. C. Hamilton reports as follows on the working of the Dental Scheme:— "There has been a general increase during 1933 in the number of children dentally inspected and in the number of operations, both radical and conservative, performed at the School Clinic. The fillings in permanent teeth continue to increase In number and it is very satisfactory to see that this most important part of preventive dentistry is becoming increasingly popular with parents and children. Every effort is made to encourage early conservative work on the permanent teeth where necessary, to avoid extensive restoration or extraction at a later date. "During the year the Senior Schools have all been visited by the Dental Board's Demonstrator, and children of eleven years old and upwards have been given a short talk on the structure and care of the teeth, followed by an exhibition of models of the teeth and jaws. It has been noticed that this has tended to increase the number of acceptances of clinic treatment and to improve the attitude of the children towards dental work. "The help of the Head Teachers in organising the Dental Service on a time-saving basis and In encouraging an early acceptance of treatment has been very valuable, particularly in making unnecessary a large number of casual inspections. These casual inspections consist of those children who have been absent from school at the time of the dental inspection and of those for whom for some reason Intermittent advice or treatment is desired; but the casual inspection of those who have omitted to take advantage of conservative treatment offered, and who later apply for radical treatment on account of pain, unnecessarily delays the routine of inspection and treatment, and every effort by the Head Teachers and the nurses is mads to avoid this. "A general improvement in the teeth of the school children continues to be noticeable and the number of very septic conditions and infected mouths becomes smaller each year. It is hoped that early conservative treatment, advice on oral hygiene and Improvement in general health of school entrants will continue to decrease the need for dental treatment." b. c. hamilton. Infectious Disease. The year 1933 was a "quiet" year so far as infectious diseases are concerned. No outbreak was specially associated with any of the schools. Open-Air Education. In fine weather playground classes are held at several of the schools. School journeys and camps are becoming more popular. 12 Physical Training. There is no Organiser of Physical Training in the area, but great interest is taken in all the elementary schools in physical education, organised games, good posture, etc. Children believed to have some weakness (e.g., heart) are referred by the Head Teachers to the Medical Officers for report as to fitness to take part in these school activities. The question of the appointment of organisers of physical training for boys and girls is now under consideration jointly with adjoining districts. Meals. No school meals are provided. The National Milk Publicity Council's scheme for the supply of milk to children in the schools daily has been in operation for over four years and works smoothly. This measure is undoubtedly a factor in the improved nutrition of many of the children. Co-operation of Parents, Teachers, School Attendance Officers and Voluntary Bodies. The close co-operation between these agencies, which has always been a feature of the work in this Borough, continues without a hitch. The Central Care Committee, with its five District Care Committees, does an immense amount of useful work yearly amongst the school children. Blind, Deaf, Defective and Epileptic Children. The present position in regard to children who are so blind or deaf or mentally or physically defective or epileptic as to be unsuitable for education in ordinary elementary schools is given in Table III. All children found to require special school accommodation are certified and sent to special schools. Nursery Schools. There are no nursery schools or nursery classes under the Education Authority. Health Education. The Dental Board of the United Kingdom sent a lecturer to the senior schools, with good results. (See Keport of the School Dental Officer.) 13 JUVENILE RHEUMATISM: A COMPARATIVELY RARE DISEASE IN HORNSEY. A condition of early life which is attracting much attention in recent years is rheumatic infection, with its occasional disastrous sequel in heart disease. Formerly the concern of the family physician and the paediatrist (children's specialist), juvenile rheumatism has now become the subject of special supervisory schemes by public authorities—chiefly education authorities, because school age is the age of highest incidence of the disease. In these circumstances it is desirable to call attention to the favourable position of this district in regard to rheumatic infection of young people. The Nature of Juvenile Rheumatism. The cause of this infection is not known with the same certainty as is the cause of some other infections of childhood, e.g., diphtheria, meningitis, etc., but it is believed to be caused by hæmolytic streptococci, which gain entrance to the body by the throat. The initial illness may be a tonsillitis, followed, after a period of two to three weeks, by signs of acute rheumatism or rheumatic fever. If the cause is obscure, the same cannot be said about the clinical manifestations of this infection. The signs and symptoms make one of the most striking pictures seen amongst the acute specific infections of childhood. They may be classified under five headings:— (1) Constitutional.—The raised temperature (100° to 105° F.), coated tongue, thirst, perspiration, anaemia and loss of flesh all testify to the general constitutional effect of the rheumatic poison. (2) Articular (Joints).—The most characteristic feature of acute rheumatic infection is the inflammation of one or more of the joints, which become swollen, tender and hot to touch, and painful when moved. (3) Cardiac.—On account of the permanent damage sometimes done, the most important manifestations of acute rheumatic infection are those affecting the heart. Any or all of the tissues of the heart may be involved in rheumatic cavities—the sac in which the heart lies (pericarditis), the muscle wall of the heart (myocarditis), or the lining membrane of the heart (endocarditis). This 14 last condition, affecting the folds of the lining membrane which form the valves of the heart, results frequently in permanent damage to these valves, i.e., valvular disease of the heart (organic heart disease). (4) Nervous.—Rheumatic infection of the nervous system manifests itself in chorea, the condition commonly known as "St. Vitus Dance," which, like acute articular rheumatism, may be accompanied by rheumatic carditis. (5) Cutaneous.—Occasionally in the course of rheumatic infection there appears on the skin of the trunk a peculiar erythema, believed to be an expression of the rheumatic poison, and, lastly, but very rarely, there may appear small lumps or nodules under the skin in the region of joints and tendons. These are known as " rheumatic nodules." Sub-Acute forms of Juvenile Rheumatism. It must be remembered that rheumatic infection in childhood does not always manifest itself as an acute illness. The onset may be insidious—the child may gradually lose weight, become pale and languid, soft in flesh, unlit for food, sleep badly, become "nervous" and complain of vague pain and stiffness of limbs and body. In the course of such an illness the heart may be involved, resulting in permanent damage to its valves. From this short summary of signs and symptoms it will be readily understood that juvenile rheumatism (unlike rheumatism of middle and later life) is a "specific infection," that is to say, a disease caused by a specific organism. Unequal distribution of Juvenile Rheumatism. One of the most puzzling features of juvenile rheumatism is the extraordinary difference in its prevalence in adjoining districts. In one district it is so common as to be a menace to child life, while in a neighbouring district it may not be causing special anxiety. For example, in the course of an inquiry into juvenile rheumatism in Bristol and Bath and the counties of Gloucester and Somerset, it was found that in the city of Bristol the incidence was five times as high as in the surrounding counties or in Bath City. A similar or even more striking difference would appear 15 to exist between London and Hornsey. London would appear, from recent reports on the subject, to be a hotbed of juvenile rheumatism. In Hornsey the incidence of this disease is relatively low. What is the explanation? Three possibilities must be considered—first, that the difference is real; second, that it is false; third, that it is partly real and partly false. In support of a real difference, there is a good deal to be said. Hornsey has definite advantages in altitude, clear air, sunshine, open spaces, good housing, and good social and economic conditions, all of which favour robust child-life, and therefore a low incidence of juvenile rheumatism. In support of a false difference, there is something to be said which concerns diagnostic standards. I have already indicated the general range of signs and symptoms of acute rheumatic infection in childhood. It must not, however, be assumed that all cases show all or even a majority of these features. Cases differ greatly in clinical character and severity. But before a sick child is diagnosed as suffering from acute or sub-acute rheumatism, some of these symptoms in some degree should be present. I emphasise this point because it would appear that acute rheumatism is frequently diagnosed in children on very slender evidence. For example, it has become fashionable to regard any pains in the limbs of a growing child (so-called "growing pains") as acute or sub-acute rheumatism. Some of the more advanced experts go further and diagnose certain debilitated children as rheumatic without any sign or symptom other than the debilitated state. I would urge that the only sound basis for deciding whether a debilitated child is or is not suffering from rheumatism is the presence or absence of the signs of rheumatism. In regard to the puzzling difference in incidence, therefore, as between one district and another (e.g., Hornsey and London), I believe that the difference may be partly real, but is largely false, in the sense that it merely represents a difference in standards of diagnosis. Diminishing incidence of Juvenile Rheumatism. Whatever may be said about differing incidence in different districts, there is, happily, no doubt that the general prevalence of the disease is less now than formerly. Juvenile rheumatism is definitely a declining disease. 16 I have discussed this question with doctors in practice who are the first to see cases of rheumatic infection in children. They are unanimous that "rheumatic fever" is becoming a very rare disease. In certain metropolitan boroughs the disease has been notifiable for a number of years. The numbers notified have diminished each year. What is the explanation of this decline in the incidence of juvenile rheumatism in recent years? Various answers have been offered, e.g., it may be that the phenomenon is a phase in the natural periodicity of the disease. We know that some diseases occur in cycles. During one generation or century a disease may appear to increase in numbers and severity, and in a subsequent period gradually decline without any obvious reason. Juvenile rheumatism may be a "periodic disease." On the other hand, it has been claimed by the advocates of tonsillectomy that the recent decline in juvenile rheumatism is a direct result of the common practice of removing children's tonsils. The explanation which I favour is that rheumatic infection, like tuberculosis, is a disease in which the general resistance of the child to infection is the most important factor in determining not only the frequency of infection, but also the severity of the disease and the incidence of complications. If this is correct, then it can be claimed that the decline in juvenile rheumatism is just one of the results of the vastly-improved conditions of child-life to-day as compared with a generation ago—better care during infancy and childhood, better habits of rest and exercise, better economic circumstances, better housing, better nutrition, All of these improved conditions of life are closely related to better education and general enlightenment, and as these are progressive, there is reason to hope that juvenile rheumatic infection may be entirely eliminated, or, at any rate, cease to be a grave menace to the health of the juvenile population. It would therefore seem that the incidence of juvenile rheumatism may be taken as an inverse index of the efficiency of preventive medicine in an area; a means of estimating the social and environmental conditions of a community; a measure of the effectiveness of the agencies of social amelioration within its boundaries. 17 LIST OF TABLES. TABLE I. Return of Medical Inspections. TABLE II. Return of Defects found by Medical Inspection. TABLE III. Return of all Exceptional Children in the Area. TABLE IV. Return of Defects Treated. TABLE V. List of Elementary Schools in the Borough. 18 TABLE I. RETURN OF MEDICAL INSPECTIONS. (a) Routine Medical Inspections. Number of Inspections In the prescribed Groups— Entrants 904 Second Age Group 1,942 Third Age Group 220 Total 3,066 Number of other Routine Inspections 175 (b)—Other Inspections. Number of Special Inspections 1,505 Number of Re-Inspections 3,272 Total 4,777 19 TABLE II. (A)—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1933. 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 - 147 ... ... ... Skin . Ringworm, scalp ... ... ... ... ,, body ... ... ... ... Scabies ... ... 13 ... Impetigo 3 ... 29 ... Other Diseases (Non-tuberculous) 6 ... 77 ... Eye Blepharitis 1 ... 16 ... Conjunctivitis ... ... 30 ... Keratitis ... ... ... ... Corneal Opacities ... ... ... ... Defective Vision (excluding Squint) 162 18 131 ... Squint 12 1 38 ... Other Conditions 1 ... 57 ... Ear Defective Hearing 9 ... 15 ... Otitis Media 7 • •• 11 ... Other Ear Diseases 3 ... 32 ... Nose and Throat Chronic Tonsillitis only ... 10 6 ... Adenoids only ... ... ... ... Chronic Tonsillitis and Adenoids ... ... ... ... Other conditions 20 2 51 ... Enlarged Cervical Glands (Non-Tuberculous) ... ... ... ... Defective Speech ... ... ... ... Heart Heart Disease: and Circulation Organic ... 7 ... ... Functional ... 16 ... ... Anaemia 8 2 3 ... Longs Bronchitis 1 ... 7 ... Other Non-Tuberculous Diseases ... ... ... ... Tuberculosis Pulmonary; Definite ... ... ... ... Suspected ... ... ... ... Non-Pulmonary: Glands ... ... ... ... Bones and Joints ... ... ... ... Skin ... ... ... ... Other Forms ... ... ... ... Nervous System Epilepsy ... ... ... ... Chorea ... 1 1 ... Other Conditions 3 2 5 ... Deformities Rickets 3 ... ... ... Spinal Curvature ... ... ... ... Other Forms 302 110 12 ... Other Defects and Diseases (excluding Uncleanliness and Dental Diseases 7 8 604 ... 20 TABLE II (continued). (B)—NUMBER OP INDIVIDUAL CHILDREN POUND AT ROUTINE MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UN CLEANLINESS AND DENTAL DISEASES). Group Number of Children. Percentage of Children found to require Treatment Inspected Found to require Treatment. (li (2) (3) (4) Prescribed Group:— Entrants 904 54 6% Second Age Groups 1,942 196 10% Third Age Group 220 68 31% Total (prescribed group) 3,066 318 10% Other routine inspections 175 24 14% 21 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. It is assumed that every Authority will have a complete list of all exceptional children In their area 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 exceptional 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 deject has not been ascertained by the School Medical Officer, by a medical member of the Authority's staff, or by the Tuberculosis Officer. Tuberculous children in areas other than Counties or County Boroughs who have been ascertained by the County Tuberculosis Officer should not appear in the Table for the County but in the Table for the appropriate area. The definitions of defective children as given in the Education Act, 1921, are as follows and must be very carefully borne in mind. A blind child is a child who is too blind to be able to read the ordinary school books used by children. A deaf child Is a child who Is too deaf to be taught In a class of hearing children in an elementary school. Mentally and Physically Defective children are children who, not being imbecile and not being merely dull and backward, are defective, that is to say, children who by reason of mental or physical defect are incapable of receiving proper benefit from the instruction in the ordinary public elementary schools, but are not incapable by reason of that defect of receiving benefit from instruction in such special classes or schools as under Part V. of the Act may be provided for defective children. Epileptic children are children who. not being idiots or imbeciles, are unfit by reason of severe epilepsy to attend the ordinary public elementary schools. No child should be entered under more than one heading in this form. CHILDREN SUFFERING FROM MULTIPLE DEFECTS. Information Is only required in respect of children suffering from any combination of the following types of defect:— Blindness (NOT Partial Blindness). Deafness (NOT Partial Deafness). Mental Defect. Epilepsy. Active Tuberculosis. Crippling (as defined in the penultimate category of the Table). Heart Disease. The actual combination of defects should be stated on a separate sheet, together with the type of school attended, e.g., in the case of a mentally defective epileptic child, the return should show whether the School attended is a school for mentally defective or for epileptic children. State here the number of children suffering from any combination of the above defects Boys Girls Total* Nil. *Should there be no such children please enter "NIL." 22 BLIND CHILDREN. A blind child Is a child who Is too blind to be able to read the ordinary school books used by children. Enter in this Section only children who are so blind that they can only be appropriately taught in a school for blind children. At Certified Schools for the Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Boys 1 Girls 1 PARTIALLY BLIND CHILDREN. Enter in this Section only children 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 for the partially blind. 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. At Certified Schools for the Blind. At Certified Schools for the Partially Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Boys 5 8 Girls 3 DEAF CHILDREN. A deaf child is a child who is too deaf to be taught In a class of hearing children in an elementary school. Enter in this Section only children who are so deaf that they can only be appropriately taught in a school for the deaf. ]At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Boys 5 8 Girls 3 23 PARTIALLY DEAF CHILDREN. Enter In this Section only children who can appropriately be taught in a school for the partially deaf. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Boys Nil. Girls MENTALLY DEFECTIVE CHILDREN. Feeble-minded Children. Mentally Defective children are children who, not being Imbecile and not being merely dull or backward, are Incapable by reason of mental defect 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 Special Schools for mentally defective children. 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. Details of such children should be given on Form 307M. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Boys 19 29 Girls 10 EPILEPTIC CHILDREN. Children Suffering From Severe Epilepsy. In this part of the Table only those children should be Included who are epileptic within the meaning of the Act, i.e., children, who, not being idiots or Imbeciles, are unfit by reason of severe epilepsy to attend the ordinary Public Elementary Schools. 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. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Boys Nil. Girls 24 PHYSICALLY DEFECTIVE CHILDREN. Physically Defective children are children who, by reason of physical defect, are incapable of receiving proper benefit from the instruction In the ordinary Public Elementary Schools, but are not Incapable by reason of that defect of receiving benefit from instruction in Special Schools for physically defective children. 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. A. TUBERCULOUS CHILDREN. In this category should be placed only cases diagnosed as tuberculous and requiring treatment for tuberculosis at a sanatorium, a dispensary, or elsewhere. Children suffering from crippling due to tuberculosis which is regarded as being no longer in need of treatment should be recorded as crippled children, provided that the degree of crippling is such as to interfere materially with a child's normal mode of life. All other cases of tuberculosis regarded as being no longer in need of treatment should be recorded as delicate children. 1.—Children Suffering from Pulmonary. Tuberculosis. (Including pleura and intra-thoracic glands.) At Certified Special Schools. At Public Elementary Schools.† At other Institutions. At no School or Institution. Total. Boys 2 2 Girls II.—Children Suffering From Non-pulmonary Tuberculosis. (This category should include tuberculosis of all sites other than those shown in (I) above.) At Certified Special Schools. At Public Elementary Schools.! At other Institutions. At no School or Institution. Total. Boys 2 Girls 1 1 †It it essential that tuberculous children who are, or may be, a source of infection to others should be promptly excluded from Public Elementary Schools. 25 B. DELICATE CHILDREN. This Section should be confined to 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. Such children should be included irrespective of the actual provision of Open Air Schools in the area, or of the practicability in present circumstances of sending the children to Residential Schools. At the same time it should be remembered that children should not be regarded as suitable for admission to an Open Air School unless the Medical Officer would be prepared to certify that they are incapable by reason of physical defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools. At Certified Special Schools. At Public Elementary Schools. At other Institutions At no School or Institution. Total. Boys Girls Nil. C. CRIPPLED CHILDREN. This Section should be confined to children (other than those diagnosed as tuberculous and in need of treatment for that disease) who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life, i.e., children who generally speaking are unable to take part, in any complete sense, In physical exercises or games or such activities of the School curriculum as gardening or forms of handwork usually engaged in by other children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no Behool or Institution. Total. Boys 3 9 31 Girls 2 17 D. CHILDREN WITH HEART DISEASE. This Section should be confined to children whose defect is so severe as to necessitate the provision of educational facilities other than those of the Public Elementary School. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Boys Nil. Girls 26 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1833. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V ). DISEASE OR DEFECT. Number of Defects treated or under treatment during the year. Under the Authority's Scheme Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm-Scalp. (Show separately in brackets the number which ware treated by X-Rays) — — Ringworm-Body — — Scabies 13 13 Impetigo 63 53 Other Skin Disease 81 81 Minor Eye Defects (External and other, but excluding oases (ailing in Group II). 48 48 Minor Ear Defects 42 42 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 431 431 Total 668 668 27 TABLE IV. (continued.) Group II.—Dffective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). DEFECT OR DISEASE. Number of Defects dealt with. Under the Authority's Scheme By private practitioner or at hospital apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (in eluding Squint). (Operations for squint should be recorded separately in the body of the School Medical Officer's Report). 452 75 527 Other Defect or Disease of the Eyes (excluding those recorded in Group 1.). 57 57 Total 509 75 584 Total number of children for whom spectacles were prescribed («) Under the Authority's Scheme 473 (i) Otherwise — Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 460 (4) 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 (1) by Private Practitioner or Hospital, apart from the Authority's Scheme. (2) Total. (3) 2 2 66 68 28 Group IV.—Orthopædic and Postural Defects. Under the Authority's Scheme (1) Otherwise. (2) Total number treated. Residential treatment with education. (1) Residential treatment without education. (2) Non-residential treatment at an orthopedic clinic. (3) Residential treatment with education. (1) Residential treatment without education. (2) Non-residential treatment at an orthopaedic clinic. (3) Number of children treated. 12 229 241 Group V.—Dental Defects. (1) Number of Children who were: — (2) Half-days devoted to: — (a) Inspected by the Dentist : Inspection 37 Total 459 Routine Age Groups Aged : Total 5738 Treatment 422 s 342 6 642 (3) Attendances made by children for treatment ... 4934 7 644 8 631 (4) Fillings:— 9 582 Permanent Teeth 3266 Total 3283 10 651 Temporary Teeth 17 11 667 12 606 (5) Extractions 13 612 Permanent Teeth 524 Total 3697 14 324 15 37 Temporary Teeth 3173 Specials 254 (6) Administration of general anæstheties for extractions 1581 Grand Total. 5992 (b) Found to require treatment (7) Other operations:— 4236 (c) Actually treated 2879 Permanent Teeth 849 Total 2017 Retreated 1303 Temporary Teeth 1168 Group VI.—Uncleanliness and Verminous Conditions. (1.) Average number of visits per school made during the year by the Scnool Nurses—44. (11.) Total number of examinations of children In the Schools by School Nurses—28,802. (iii.) Number of individual children found unclean—355. (iv.) Number of children cleansed under arrangements made by the Local Education Authority—178. (v.) Number of cases in which legal proceedings were taken: — (а) Under the Education Act, 1921 — (b) Under School Attendance Byelaws — 29 TABLE V. LIST OF SCHOOLS IN THE BOROUGH School, Department. Authorized accommodation. Average No. on the Rolls for qr. ended 31/12/33. Head Teacher. Campsbourue Boys' 388 399 Mr H. Tumor „ Girls' 388 311 Miss G. S. Litchfield „ Infants' 400 302 Miss D. F. Smith Coldfall Mixed 520 599 Mr. G. Simmonds, B.A. „ Infants' 400 268 Miss M. N. Clarke Crouch End Boys' 456 368 Mr. J. Iliffe „ „ Girls' 450 324 Miss F. A. Barter „ „ Infants' 411 336 Miss A E. Walmsley Highgate Mixed 328 343 Mr. T. E. Durban „ Infants' 264 127 Miss R. Spalding North Harringay Boys' 380 446 Mr. J. H. Spilman, B.Sc. „ „ Girls' 380 338 Miss G. M. Ryde, B.Sc. „ „ Infants' 416 354 Miss H. M. Stone South Harringay Mixed 440 437 Mr. G. F. Shaw, M.A. „ „ Infants' 240 215 Miss R. Jones Stroud Green Senr. Mixed 350 407 Mr. F. W. Jaggard „ „ Junr. Mixed 416 322 Miss E. M. Cockhill „ „ Infants' 352 275 Miss E. Pitson Muswell Hill Junr. Mixed 200 148 Miss E. F. Catley St. Mary's Mixed *580 469 Mr. J. W. T. Harris „ Infants' 240 255 Miss M. D. Sibley St. Michael's Mixed 196 139 Mr. E. R. Lewis „ Infants' 168 104 Miss E. Towler St. James' Junr. Mixed 240 245 Mr. I. T. Plant Holy Innocents' Infants' 101 63 Miss F. E. Gee Totals 8,704 7,594