BOROUGH OF HORNSEY. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR 1935 R. P. GARROW, M.D., D.P.H. Borough of hornsey ANNUAL REPORT FOR 1935 of the Medical Officer of Health. INDEX Admissions to Hospitals, 45. Goulding Court, 30. Allotments, 18. Grimshaw Close, 30. Ambulances, 7, 8. Ante-natal Clinics, 11, 13, 49. Hairdressers, 26. Area of Borough, 6. Health Committee, 1. Attack rate, infectious disease, 46. „ Visiting, 7, 11, 49. „ Visitors, 4, 13. Bacteriological examinations, 7, 8. Home Nursing, 2, 8, 9. Bakehouses, 18, 21, 26. Horney Central Hospital, 9. Baths and Wash-houses, 22. Horney Deanery Association, 10. Births and rates, 5, 6, 14, 40, 44. Horney Housing Trist. Ltd., 31. Blindness prevention, 39. Hornsey Nursing Association, 7, 8, 10. Borough Nursing Association, 7, 8, 10. Horticultural poisons, 25. Broadlands, 30. Hospital services, 7, 9, 45. Butchers, 18, 21, 26. Houses controlled and decontrolled, 22. Bye-laws, 19, 20, 21, 22. „ demolished, 30. „ erected, 30. Housing, 29. Cancer deaths, 41, 42, 44. Byelaws, 19, 20, 21, 22. Carbide, 25 Families rehoused, 31, 32, 33. Cellulose spirit, 24. “Five-year" programme, 29. Cerebro-spinal meningitis, 45, 46. House-to-house inspections, 17, 33. Charity expenditure, 10. Inspections, 22. Children Acts, 7, 11, 12, 16, 49. Returns of work, 22. Cinemas, 18, 21. Statistics, 17, 22, 30, 31, 33, 34. Cleansing station, 22. Trust, 31. Clinics, 11, 13, 49. Hydro-carbon, 24. Colney Hatch Lane, demolitions, 30. Committees, 1, 2. Illegitimate births, 5. Controlled houses. 22. „ deaths, 5. Conveniences, 18. Immunization, Diphtheria, 38. Infant deaths and rates, 7, 40, 43, 44. Dairies, 18, 21, 26, 36. „ „ Causes, 43. Deaths and rates, 5, 6, 7, 40. Infant Life Protection, 7, 12, 16, 49. „ Causes of, 41, 42, 44 Infantile paralysis, 45, 46. Decontrolled houses, 22. Infectious disease, 18, 38, 45. Dental scheme and treatment, 3, 12 Attack rate, 46. 15. Diphtheria, 38, 41, 42, 45, 46. Diarrhoea, 7, 41, 42, 44. Notifications, 45, 46. Diphtheria, 38, 41, 42, 44, 45, 46. Scarlet fever, 41, 42, 45, 46. „ immunization, 38. Inhabited houses, 6. Diseases of Animals Acts, 4, 40 Inquests, 40. Disinfection and Disinfestation, 22, 23. Inspections made, 17, 21, 22. „ Vans. 23. Isolation Hospital, cases admitted, 45. Dog nuisance, 23. Drain tests, 18. Kent's Cottages, 30. Drains opened, 18. Drainage, 17, 18, 19. Lavender Cottages, 30. Dysentery, 45, 46. Laboratory work, 7, 8. Library books, 23. Encephalitis lethargica, 45, 46. Licences, 18, 24, 36. Enteric fever, 8, 41, 42 44, 45, 46. Entertainment places, 18, 21. Malaria, 46. Erysipelas, 45, 46. Maternal mortality, 7. Maternity and Child Welfare mittee, 2. Factories and workshops, 18, 19. 20, Maternity cases arrangements, 11. 21, 50. Masseuse, 17. Fish shops, 21, 27. Maternity and Child welfare— “Five-year" programme, 29. Analysis of attendances, 49. Flats erected, 30. Ante-natal, 11, 13, 49. Food inspection, 18, 35. Births notified, 14. „ condemned, 37. Centres, 5, 7, 13. „ samples, 38. Children Act, 7, 12, 16, 49. Food stores provided, 20. Clinics, 11, 13, 49. Foster mothers and children, 7, 12. Committee, 2. 16, 49. Dental treatment, 3, 12, 15. Maternity and Child Welfare (Cont'd.) Rag Flock Act, 18. Foster children, 7, 12, 16, 49. Rateable value and produce of 1d. Health visiting, 7, 11, 49. rate, 6. Home Helps, 12. Refuse shoots, 18, 21. Hospital arrangements, 7, 9. Restaurants, 18, 21, 26. „ maternity cases, 9, 11. Rose Cottages, 30. Maternal deaths, 7. Rowlands Close, 30. Midwife, 4, 7, 11, 49. „ Fee reduced, 11. St. James's Lane demolition, 30. Milk grants, 12, 15, 16. St. James's Lane flats, 30. New Clinic, 5. Sale of Food and Drugs Act, 38. Nursery school, 16. Sanitary notices served, 19. Orthopaedic scheme, 7, 12, 17. Sanitary work, 17, 19, 20, 21. Outfits, 12. Scabies, 18. Premises, 5, 12. Scarlet fever, 41, 42, 44, 45, 46. Scheme, 11. Schools, 17, 28. Sessions, 13, 49. Sewerage, 17. Staff, 4, 13. Shoots, refuse, 18, 21. Time-table, 13. Shops Acts, 18, 19, 25. Toddlers' playroom, 16. „ Action, 26. Voluntary Committees, 12. „ list of, 26. Year's work, 49. Slaughter-houses, 18, 21, 36, 37. Measles, 7, 41, 42, 44, 46. Small-pox, 18, 46. Meat inspection, 36. Smoke, 17, 18. „ condemned, 37. Social services, 10. Meningitis, 45, 46. Stables, 18. Midwives, 4, 7, 11, 49. Staff, 3, 4, 13. Milk grants, 12, 15, 16. Statutory notices, 19. „ licences, 36. Statistics, 6, 40 to 51. „ samples, 23. Still-births, 6, 44. „ shops, 21. Subscriptions, Annual, 9, 10. Mortuary, 40. Summersby Road, 30. Mumps, 9. Swimming Pool, 28. Music and dancing licences, 18. 21. Tables, list of, 41. Naptha, 24. Toddlers' Playroom, 16. North Hill Court, 30. Tottenham Lane Cottages. 30. „ „ (No. 15, 17 & 17a), 30. Townsend's Yard, 30. North Middlesex Hospital, 9. Town Hall, 5. North Road Cottages. 30. Tuberculosis, Cases of, 9, 40, 45, 47. Notifications of Births Act, 14. „ Deaths. 41. 42, 44, 47. Nursery School, 16. „ Register, 40, 48. Nursing Association, 7, 8, 10. „ Sanatoria and beds. 39. „ Classes, 9. „ Sputums, 8. Nursing Homes, 9. Turnpike Lane Flats, 30 Typhoid fever, 8, 41, 42, 44, 45, 46. Ophthalmia neonatorum, 39, 45, 46. Orthopædic scheme, 7, 12, 17. Unmarried mothers, 10. Outworkers, 21, 51. Overcrowding, 18, 20, 21, 31. Vaccination, 38. „ Survey, 31. Verminous houses. 18 Para-typhoid, 46. Veterinary Inspector, 4, 40. Passageways, 18. Viewfield Cottages demolition, 30. Pests, House, 23. Visits by Inspectors, 17, 21. Petroleum Acts, 18, 21, 24. Visiting of Children, 7, 12, 16, 49. „ licences, 24. Vital statistics, 6, 7, 40. Pickering Cottages (1 & 2), 30. „ „ England, &c., 40. Piggeries, 18. Voluntary Workers, 12. Pneumonia, 9, 45, 46. Pharmacy and Poisons Act, 25. Ward's Cottages, 30. Poliomyelitis, 45, 46. Water supply, 17. Polio Encephalitis, 46. Welfare Centres, 13. Population, 6, 40. Woodside Cottages, 30. Preface, 5. Whooping-cough, 7, 41, 42, 44. Puerperal fever and pyrexia, 3, 7, 45, Workshops, 18, 19. 46. 1 HEALTH COMMITTEE as at 31st December, 1935. Alderman J. W. Rowlands (Chairman), 25, Cholmeley Park, N.6. The Mayor, Councillor C. Winkley, J.P., 72, Woodside Avenue, N.10. Alderman 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. „ E. Elliott Brooks, 122, Crouch Hill, N.8. „ Mrs. C. M. Cave, 10, Wood Vale, N.10. „ J. Edwards, 102, Turnpike Lane, N.8. „ W. J. Grimshaw, J.P., 25, Sheldon Avenue, N.6. „ Mrs. M. N. Hill, 16, Bishopswood Road, N.6. „ G. K. M. Hutchinson, 8, Grosvenor Gardens, N.10. „ W. J. Lendrum, 10, Leaside Avenue, N.10. „ J. W. Shipp, 12, Berkeley Road, N.8. „ C. H. Summersby, J.P., 49, Queen's Avenue, N.10. „ L. J. Valette, 59, Allison Road, N.8. „ W. V. Wall, 10, Winchester Place, N.6. 2 MATERNITY & CHILD WELFARE COMMITTEE as at 31st December, 1935. Councillor E. Elliott Brooks (Chairman), 122, Crouch Hill, N.8. Alderman 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. „ Mrs. C. M. Cave, 10, Wood Vale, N.10. „ J. Edwards, 102, Turnpike Lane, N.8. „ S. G. Goulding, Woodlands, Cranley Gardens, N.10. „ W. J. Grimshaw, J.P., 25, Sheldon Avenue, N.6. „ Mrs. M. N. Hill, 16, Bishopswood Road, N.6. „ G. K. M. Hutchinson, 8, Grosvenor Gardens, N.10. „ W. J. Lendrum, 10, Leaside Avenue, N.10. „ F. J. Randall, 25, Muswell Avenue, N.10. „ J. W. Shipp, 12, Berkeley Road, N.8. „ L. J. Valette, 59, Allison Road, N.8. „ W. V. Wall, 10, Winchester Place, N.6. Selected Members: Mrs. L. J. Bond, 125, Mount View Road, N.4. Mrs. F. O. Dixon, 2, Woodside Avenue, N.6. Mrs. H. M. Inward, 99, Pemberton Road, N.4. Mrs. F. M. Merry, 20, Etheldene Avenue, N.10. Mrs. B. Walton, "Greenacre," The Green, Ealing, W.5. Miss E. F. 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 Muriel Radford, M.B., B.Sc., D.P.H. ‡Consultants (Puerperal Fever and Pyrexia Regulations) Dr. J. B. Banister, 129, Harley Street, W.1. Dr. A. W. Bourne, 14, Devonshire Street, W.1. Dr. L. H. W. Williams, 70, Harley Street, W.1. ‡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, (Retired 2nd Feb., 1935) 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, (Resigned 31st May, 1935) M.S.I.A. Cert. R.San.I. Cert. Insp. of Meat and Foods. 4 †*Sanitary Inspectors (contd.) H. G. Bartram, (Appointed from 4th Feb., 1935) M.S.I.A. Cert. R.San.I. Cert. Insp. of Meat and Foods. W. G. colebeck, (Appointed from 17th June, 1935) M.S.I.A. Cert. R.San.I. Cert. Insp. of Meat and Foods. †Chief Clerk W. Gilroy. †Assistant Clerks E. Cheesman. A. Wickham. N. Smith. †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. Boss (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.R.C.V.S. Note:—† Whole time Officers. * Officers in respect of whom salary contribution is made under the Public Health Acts or by Exchequer Grants. ‡Part time Officers. 5 To the Mayor, Aldermen and Councillors of the Borough of Hornsey. Ladies and Gentlemen, I have the honour to submit my Annual Report for the year ending December 31st, 1935. The birth-rate for the year is 11.83 per 1,000 of population, as against 11.07 in the previous year, and the death-rate is 10.84, as against 11.68 in 1934. But the infant mortality rate is 48.7, against 36 4 in the previous year—largely accounted for by the deaths of 14 illegitimate infants in 1935. There was no unusual cause of sickness or invalidity in the area during the year. An important event (from the point of view of health) in the municipal history of Hornsey was the opening, on November 4th, 1935, by His Royal Highness the Duke of Kent, of the new Town Hall at Crouch End. Here the staffs of the various departments work in ideal conditions of space, lighting, cleanliness, ventilation and heating. The closer touch of the Health and Education Departments with the School Clinic has been of great assistance in the work, and a further gain in this direction will be effected when the new Maternity and Child Welfare Centre completes the Clinic building in 1936. I have the honour to be, Ladies and Gentlemen, Your obedient servant, R. P. GARROW, Medical Officer of Health. 6 STATISTICS FOR 1935. (SECTION A.) Social and Economic Statistics. Area (acres) 2,874 Population (Census 1931) 95,524 Do., Registrar-General's estimate (mid 1935) 95,330 Number of inhabited houses (end of 1935), according to Rate Books 22,095 Rateable value (General Rate) £1,036,572 Product of a penny rate £4,116 LIVE BIRTHS— Legitimate Males 570 „ Females 510 Illegitimate Males 33 „ Females 16 Total 1,128 Birth Rate 11.83 per 1,000 population (Registrar-General's estimate). STILL-BIRTHS— Legitimate Males 21 ,, Females 15 Illegitimate Males — ,, Females — Total 36 Rate per 1,000 total (live and still) births, 31.9. DEATHS— Male 466 Female 568 Total 1.034 Death Rate ... 10.84 per 1,000 population (Registrar-General's estimate). 7 Deaths from Puerperal Causes. Deaths. Rate per 1,000 total (live and still) births. England and Wales. Puerperal sepsis 2 1.72 1.68 Other puerperal causes 1 0.86 2.42 Total 3 2.57 4.10 Deaths of Infants under 1 Year of Age. Legitimate Males 24, Females 17 = 41 Illegitimate „ 10, „ 4 = 14 Total 55 Death Rate of Infants under 1 Year of Age. All infants per 1,000 live births 48.7 Legitimate infants per 1,000 legitimate live births 36.4 Illegitimate infants per 1,000 illegitimate live births 291.7 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 0 Deaths from Diarrhœa (under 2 years of age) 15 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (Section B). Under this beading the Minister of Health asks for an account of any developments or changes during the year in— 1.—(a) Laboratory Facilities. (b) Ambulance Facilities. (c) Nursing in the Home. (d) Clinics and Treatment Centres. (e) Hospitals: Public and Voluntary. 3.—(i) Midwifery and Maternity Services. (ii) Institutional Provision for Mothers and Children. (iii) Health Visitors. (iv) Infant Life Protection. (v) Orthopædic Treatment. These services are all fully organised, and no developments or changes have been found necessary. 8 LABORATORY FACILITIES. The specimens examined in the laboratory at the Isolation Hospital during 1935 were as follows:— Negative. Positive. Diphtheria specimens 1,115 58 Sputum (T.B.) „ 203 12 Enteric fever „ 11 0 Other „ 11 2 1,340 72 Total 1,412 AMBULANCE FACILITIES. The ambulance arrangements with the London County Council for the transport of infectious coses, 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 11,042 miles and carried 20.287 passengers. The following is a statement of the work done by the Borough Ambulance under the Fire Brigade:— Calls 1,073 Persons conveyed 1,058 Street illness and accidents 414 Other cases 659 Mileage 6,923 Hours ambulance was engaged 849 NURSING FACILITIES. HORNSEY NURSING 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. 9 The work of this Association continues to grow steadily year after year. During 1935 an additional nurse was appointed, making a staff of six nurses and the Superintendent. They paid 14,115 visits to 630 patients. The following is a statement of the infectious diseases nursed during the year by the Queen's District Nurses:— NAME OF DISEASE. No. of New Cases. No. of Visits. No. Convalescent. No. sent to Hospital. No. Died at Home. Pueumonia 30 588 17 4 5 Tuberculosis 8 444 3 2 2 Influenza 12 163 10 2 — Mumps 2 25 1 — — Other diseases in children under 5 40 178 38 — — Elementary School Children 58 287 49 4 — A sum of 50 guineas is subscribed to the Association annually by the Council and £5 by the Education Committee for this service. HOME NURSING CLASSES, conducted by Miss Ivett, the Superintendent, at Hornsey High School, under the Higher Education Committee, continue to be a success. NURSING HOMES.—There are 25 Nursing Homes in the Borough registered with the Middlesex County Council under the Nursing Homes Registration Act, 1927. Fourteen of these are registered for the reception of maternity cases. NORTH MIDDLESEX HOSPITAL.—The number of beds at North Middlesex Hospital is 1,016. The number of cases from Hornsey treated there in 1935 was:—Maternity 163, other cases 1,163. HORNSEY CENTRAL HOSPITAL.—The Hospital, which has 49 beds, treated 778 cases, of which 128 were Hornsey cases. 1,521 out-patients were also treated. The Council subscribe an annual sum of £200 to the Hospital funds. 10 HORNSEY DEANERY ASSOCIATION.—A sum of £50 is subscribed annually by tbe Council to the Home for Unmarried Mothers in Eastern Road. PUBLIC ASSISTANCE AND CHARITIES. Mr. Parry, Public Assistance Officer, has furnished the following list of sums expended in Hornsey in 1935 from public and voluntary sources:— £ s. d. Public Assistance 31,221 11 1 Education Authority— Spectacles 289 13 11 Care Committee—Milk 236 11 6½ Central Boot Fund— 320 pairs @ 7/- 112 0 0 428 pairs repaired @ 8/- 64 4 0 112 pairs plimsolls @ 2/- 11 4 0 Children's Holiday Fund— 174 Children 256 18 5 Welfare Centre— Milk to Mothers and Children 440 12 0 Hornsey B.L. & U.S.F. 716 7 3 Musweil Hill B.L. & U.S.F. 170 10 0 Hornsey Distress Committee (77 cases) 95 4 5 Hornsey Fuel Fund 112 0 0 Y.M.C.A. 38 7 6 Y.W.C.A. 10 0 0 Hornsey Parochial Fund 571 9 6 Ferme Park Carol Singers' Fund 35 15 7 Ferme Park Benevolent Fund 49 15 0 Anonymous 8 0 0 Dr. and Mrs. Pearman 3 0 0 Jubilee Old Folks' Treat 168 14 6 Muswell Hill Distress Fund 7 4 0 Mrs. Ashworth—80 parcels @ 4s. 6d. 18 0 0 Mrs. Lovell Harrison—Special Fund 10 0 0 Total £34,647 2 8½ 11 MIDWIFERY SERVICES. The Local Supervising Authority under the Midwives Act is the Middlesex County Council. There are 19 Midwives, including the Municipal Midwife, notified to the Middlesex County Council as practising in the Borough, 9 of whom reside outside the Borough. The Municipal Midwife attended 165 births, in addition to 86 ante-natal clinics held at the Welfare Centres—Brook Road, Wightinan 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. A reduction of her fee was made in 43 necessitous cases. 1,737 births have been attended by the Borough Midwife since the appointment was first made in 1922. MATERNITY AND CHILD WELFARE. The work of the Maternity and Child Welfare Department comprises:— (1) The regular visiting by the Health Visitors of infants and children up to 5 years of age in their homes, and the giving of advice to mothers in regard to infant hygiene and feeding. (2) Medical consultations at the four centres, as set out in the accompanying table. Children from birth up to the age of 5 years are seen by the doctors. There is no gap in the medical supervision of the children between the age of 2 years and 5 years, when they enter school. The supervision is continuous for those mothers who desire it, but, of course, there is no compulsion on any mother to bring a child to a centre if she does not wish to do so. (3) Ante-natal consultations, at which expectant mothers are advised regarding their health and assisted to make arrangements for the expected confinement. (4) Maternity service rendered by the whole-time Municipal Midwife. 12 (5) Provision of milk to expectant and nursing mothers and children up to 5 years of age in necessitous cases. (6) Dental treatment for expectant and nursing mothers and children up to 5 years of age at the School Clinic. (7) Orthopædic treatment (clinic and hospital) for children up to 5 years of age. (8) Supervision of foster-mothers by the Health Visitors, who are appointed Infant Life Protection Visitors in their respective areas. (9) Provision of home helps in special cases. (10) Provision of maternity outfits in certain cases. In all these services the Medical Officers, Health Visitors and Midwife are ably assisted by voluntary workers at the four centres. I desire to express the sincere thanks of the official staff to these ladies for their unfailing support. 13 Centre Conditions of Tenancy. District Served. Sessions and Doctor. Health Visitor. Ante-natal. Children. No. 1 Brook Road Mission Hall, opened in October, 1916 10 years' lease,from 29/9/26 Yearly rent £90 E. & W. Hornsey N. Haringey Crouch End Thursdays, 2-4 p.m. Dr. J. Sutherland 2nd and 4th Mondays ,2-4 p.m. (Dr. J. Sutherland) Wednesdays, 10-12 and 2-4 Thursdays, 10-12 Dr. M. Radford Mrs. E. Durnford Miss A. Godden No. 2 22, wightman Road, opened in september,1918 Held under Lease for 99 years, from 29/9/88 Yearly ground rent £90 Lease purchased by the Council on 24/1/18 Stroud Green Finsbury Park N. & S. Haringey 1st and 3rd Tuesdays, 2-4 Dr. M. Radford * 1st and 3rd Mondays (Dr. J. Sutherland) Tuesdays, 10-12 and 2-4 Dr. M. Radford Miss A. Glover No. 3 Mission Hall, Church Road, Highgate, opened in October, 1925 21 years'lease, from 24/6/25 Yearly rent £90 Highgate Muswell Hill 2nd Fridays, 10-12 Dr. J. Sutherland Fridays, 2-4 (Dr. R. P. Garrow) Miss J. Macpherson No. 3 Sub-Centre Coldfall School, opened in September, 1928 School Clinic Premises Council's Muswell Hill Housing Estate 4th Fridays, 10-12 Dr. J. Sutherland 1st and 3rd Fridays, 10-12 (Dr. J. Sutherland) Miss F. Ross (part-time) 14 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 1935 was:— Male. Female. Total Live births 668 587 1,255 Still births 20 15 35 688 602 1,290 The births were notified:— By Doctors 135 „ Borough Midwife 149 „ other Midwives 363 „ Hospitals 161 „ parents 27 „ others 419 1,254 Unnotified (from Registrar's return):— Live births 34 Still births 2 36 1,290 Of this number there were:— Live births. Still births. Occurring in the Borough and transferred to other districts 181 2 Belonging to Hornsey and occurring in Hospitals, etc., outside the district 503 23 The 1,107 nett number of notified births belonging to Hornsey were divided among the districts of the Centres as follows:— 15 Brook Road 492 Wightman Road 317 Highgate 268 Coldfall Sub-Centre 80 1,107 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 42 Old cases 156 146 New cases 55 68 Finished cases 33 46 Total attendances 111 214 Attendances for dentures 67 — Gas cases 36 40 Teeth extracted 241 58 Fillings done 46 3 Dentures provided 12 — Inspections 18 79 Other treatments (dressings, scaling, gum treatment, etc.) 14 70 Finished cases 33 46 MILK (MOTHERS AND CHILDREN) ORDERS. One thousand two hundred and seventy-two applications for milk under this Order were dealt with during the year, of which 1,261 were granted and 11 refused, as follows:— 1 pint milk daily free 1,066 2 pints „ „ „ 88 1 pint „ „ half-price 41 2 pints „ 11 1 lb. dried milk weekly free 51 1½ lbs. „ „ „ „ 2 2 lbs. „ „ „ „ 2 Not granted 11 1,272 16 The number last year was 1,029. The total of the accounts paid to 31st December amounted to £440 12s. 4d. The cost per pint is 3d. from May to September and 3½d. from October to March, from which price a discount of 5 per cent. is deducted from milk purveyors' accounts. 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 23. There are 26 between the ages of 2 and 5 on the rolls and the total attendances made during the year was 3,707. INFANT LIFE PROTECTION. 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 Register:— Centre— No. 1. NO. 2. NO. 3. & Sub. Total. No. of foster-mothers on the register— At the beginning of 1935 15 10 14 39 „ „ end „ „ 16 18 11 45 No. of foster-children on the register— At the beginning of 1935 20 8 36 64 „ „ end „ „ 20 16 15 51 Died during the year — — 3 3 On whom inquests were held during the year - - - — Visits to foster-children— 1st Visits 25 27 6 58 Total Visits 194 168 116 478 no proceedings were taken during the year. 17 ORTHOPÆDICS. The Surgeon attends monthly and the Masseuse three times weekly for the treatment of elementary school children and children under five. The following are the statistics for the year:— Surgeon. Masseuse. Sessions held 10 137 Children treated—New cases 26 — Old cases 76 — „ attendances 102 316 The cost, which is divided proportionately between the Education and Maternity and Child Welfare Committees, was £25 11s. 1d. for the treatment of children under five years for the year to 31st March, 1936. SANITARY CIRCUMSTANCES OF THE AREA. (Section C). The Minister of Health requires information on extensions or developments regarding— (1) Water supply. (2) Drainage and sewerage. (3) Rivers and streams—Prevention of pollution. (4) Closet accommodation. (5) Public cleansing. (6) Sanitary inspection of the area. (7) Smoke abatement. (8) Schools. All these essential services are fully developed and maintained at the highest possible level of efficiency. SANITARY INSPECTION. 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 241 Special inspections 1,331 Re-inspections 7,572 18 Transfer to Council houses 9 Notifiable infectious diseases 306 Tuberculosis 48 Deaths 62 Scabies 3 Verminous houses 86 Shops Acts 1,112 Factories, workshops and outworkers 512 Rent Restriction Act 3 Cinemas, etc. 12 Overcrowding 186 Petroleum stores 348 Rag Flock Act 2 Dairies and milkshops 34 Bakehouses 49 Slaughter-houses 72 Butchers' shops 33 Restaurant kitchens 24 Other food shops 269 Annual licences (Music and Dancing) 39 Stables 12 Piggeries 4 Conveniences 12 Smoke observations 1 Sidings 3 Refuse tips 16 Passages 78 Allotments 2 Drainage 309 Drainage Fee tests 3 Water tests applied (new drains) 99 Smoke and chemical tests applied (old drains) 30 Drains examined under Sec. 41, Public Health Act, 1875 17 Small-pox Contacts—Visits 3 12,942 19 NOTICES. The Notices given during the year are as follows:— Under the— Verbal Preliminary Statutory Public Health and Housing Acts 216 746 71 Housing Bye-Laws — 65 — Shops Act, 1934 25 43 - 231 854 71 No legal proceedings in connection with the repair or demolition of unfit dwelling-houses have been necessary during the year. SUMMARY OF SANITARY IMPROVEMENTS CARRIED OUT. Drainage. Number of houses and premises redrained 65 Repairs or amendments to existing drains 152 Brains or gullies unstopped or cleansed 107 Manholes provided 51 do. repaired 46 Intercepting traps fixed 66 Petrol interceptor chamber provided 1 New gulley traps fixed 145 New soil pipes and ventilating shafts fixed 55 Soil pipes and ventilating shafts repaired 52 Fresh-air inlets provided or repaired 50 Water-Closets and Sanitary Fittings. New water-closet buildings 5 New water-closet basins fixed 181 Water-closets unstopped, cleansed or repaired 47 New check cisterns fitted to water-closets; existing check cisterns repaired 87 New sinks provided 164 New lavatory basins provided 98 New waste-pipes fixed 205 Waste-pipes trapped, repaired or unstopped 326 Waste-pipes diverted into proper drain 20 20 Miscellaneous. Roofs repaired 300 Eaves guttering renewed, cleansed or repaired 176 Rain-water pipes provided, repaired or unstopped 102 do. disconnected from drains 7 Damp walls remedied 145 Damp-proof courses inserted 60 Paving of yards repaired 140 Premises structurally repaired 980 Rooms cleansed, distempered or papered 776 Rooms disinfested of vermin 100 Work-rooms cleansed or repaired 28 Drinking-water cisterns repaired, cleansed and covered 66 Water supply reinstated 4 do. (additional) provided Baths provided or made usable 70 Windows and skylights provided or made usable 188 Sub-floor ventilation 41 Floors repaired 175 Dry rot abated 3 Window sills repaired 87 Sash cords and fittings repaired 126 Sanitary dustbins provided 121 Accumulations of manure and refuse removed 49 Stoves, ranges and coppers repaired or renewed 240 Sundry items 414 Food stores provided 26 Overcrowding abated 24 6,398 Factories and Workshops. Defects Remedied. Sanitary accommodation—Insufficient 1 Unsuitable or defective 17 Not separate for sexes 5 Workrooms cleansed or repaired 29 52 21 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 milksliops 36 Milk purveyors in connection with other businesses 76 Bakehouses 34 Catering trades 79 Slaughter-houses 6 Butchers' shops 56 Fish shops 24 Factories, workshops and work-places 305 Outworkers' premises 128 Cinemas 7 Places of public entertainment 32 Shoots (refuse) 2 Overcrowded houses 41 Licensed petroleum stores 85 911 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 confirmed on 13th May, 1030, and will require amendment at a later date to comply with certain standards laid down in the Housing Act, 1935. They do not apply to any lodging-house 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 1933. 22 The numbers on the register at present are classified as follows:— Decontrolled lodging-houses 301 Partly controlled 43 Fully controlled 91 Total 435 Seventy-nine houses have been dealt with under these Bye aws during the year and the following works carried out:— Byelaw 11 (a) Repairs to drains 2 11 (b) Means of carrying off waste water (including provision of sinks) 15 11 (f) Sash-cords and window fittings 5 15 (a) Closet accommodation 5 15 (b) Water supplies 5 15 (c) Washing accommodation 43 15 (d) Food stores 106 15 (e) Preparation and cooking of food 1 17 Artificial lighting 5 22 Handrails 1 188 Note.—In regard to washing accommodation, Byelaw 15 (c), the baths and wash-houses erected by the Borough Council in High Street, Hornsey, opened on the 14th April. 1932, and extended during 1934 by additional slipper baths and wash-house accommodation, are still verv popular and are satisfying a longfelt want, particularly in the immediate neighbourhood. disinfection and disinfestation. Number of rooms fumigated after notifiable infectious disease 384 „ „ „ „ non- „ „ „ 88 „ „ „ „ T.B. 48 ,, articles disinfected 5,711 „ „ destroyed 243 ,, verminous rooms disinfested 267 23 CLEANSING STATION.—Eight adults and five children have been treated at the cleansing station for various reasons. The following work has been carried out by the disinfecting staff during the year:— On account of vermin, etc.:— Disinfestations (premises) 154 Spraying for cockroaches (4), wasps' nests (4), silverfish (2), ants (3), flies (5) 18 Collecting and disinfecting library books:— Received Returned Destroyed Public Libraries 126 126 — School Libraries 47 37 10 Private Libraries 84 39 45 Conveyance of drain-testing appliances 35 Visits in connection with Welfare Centres 102 Mileage run. Green van 3,225 Blue van 3,259 Samples taken to laboratory for analysis:— Milk 12 Water 2 dog nuisance. The posting of handbills was discontinued in May and metal plates substituted, so made as to be affixed to lamp columns. One hundred and fifty-six of these have been affixed in various parts of the Borough. These plates are lasting well, whereas the handbills were repeatedly defaced or torn down. The plates will be added to as requests are received, while the handbills will be used to supply requests from shopkeepers and others. 24 petroleum inspector's report. The following is a Report of the Petroleum Inspector for the year 1935:— PETROLEUM ACTS, &c. Since the coming into force of the Petroleum (Consolidation] Act, 1928, which defined Petroleum Spirit as "Petroleum, which when tested in a prescribed manner gives off an inflammable vapour at a temperature of less than 73 deg. Fahrenheit," there have been a number of fresh Regulations and Orders, namely:— Petroleum Spirit (Motor Vehicles, Ac.) Regulations of 1929. Petroleum (Carbide of Calcium) Order of 1929. Petroleum Spirit (Conveyance) Regulations of 1932. Cellulose Solutions Regulations of 1932. The quantity of petroleum stored under licence, apart from quantities stored under proper conditions which do not necessitate a licence, has now reached the enormous total of 101,27.5 gallons. 97,700 gallons is stored in underground steel tanks find 3,575 gallons kept in properly sealed two-gallon cans. The total number of licences issued is 85. The premises licensed were inspected from time to time find contraventions of the conditions attached to the licences 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. Hydro-Carbon. There is one licence issued for the storage of 100 gallons of hydro-carbon. Naphtha. There is one licence issued for the storage of 2,000 gallons of naphtha. Cellulose Spirit. Two premises are licensed solely for the storage of cellulose spirit and the total quantity kept on these premises is 50 gallons. 25 Carbide of Calcium. There is one premises licensed for the storage of Carbide of Calcium and the quantity stored under licence is 10 cwts. Horticultural Poisons. There are two licences in force for the sale of horticultural poisons under the Poisons and Pharmacy Act. Under the Pharmacy and Poisons Act, 1933, the registration and control of the sale of Horticultural Poisons will be transferred to the County Council, dating from the 1st of May, 1936. H. EASTWOOD, Chief Sanitary Inspector and Petroleum Inspector. SHOPS ACTS. The whole series of Shops Acts have for their main object the comfort and welfare of the worker. The Shops Act, 1934, came into operation on the 30th December, 1934. Its main provisions, put very briefly, are:— (1) Curtailment of hours of labour of young persons, including restriction on night employment. (2) Suitable and sufficient means of ventilation of shops. (3) Suitable and sufficient means to maintain a reasonable temperature. (4) Proper lighting. (5) Where meals are taken by assistants in the shop, suitable and sufficient facilities for doing so. (6) Suitable and sufficient sanitary conveniences, including washing facilities. The working of this Act has necessitated entirely new record forms and fresh information from shopkeepers; moreover, the r.ither complicated provisions of the Act have often involved considerable explanation. 26 The following are the particulars of action taken during the year under the provisions of the Shops Act, 1934, relating to ventilation and temperature of shops and to sanitary conveniences : — Complied Notices. with. Ventilation 1 1 Temperature 4 3 Sanitary accommodation 19 16 Washing facilities 27 23 Meal facilities17 15 One thousand one hundred and twelve 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, 1912-1930, have, generally speaking, been well observed. Legal action has been necessary in one case only (when the proprietor of a grocery and newspaper shop was fined £2 Os. Od. and £2 2s. Od. costs at Highgate Police Court on March 22nd. There are 1,387 shops in the Borough engaged in the following trades: — Grocers 133 Confectioners 95 Drapers, Costumiers, Ladies' Outfitters, etc. 94 Boots 70 Greengrocers 70 Restaurant kitchens, Tea-rooms and Coffee-bars 79 Hairdressers and Barbers 62 Stationers and Newsagents 65 Butchers 56 Tobacconists 55 Off-licences 41 Dairies and Milkshops 36 Public-houses 37 Bakers 34 Coal Merchants 33 Gas and Electrical Fittings and Wireless 45 Tailors and Men's Outfitters 33 Furniture and Upholsterers 37 Chemists 27 27 Fishmongers 24 Oil and Colour Shops, General and Domestic Stores 21 Watches and Jewellery 17 Milliners 12 Ironmongery and Hardware 16 Florists 15 Builders and Decorators 10 Cycles and Motor Repairs 11 Cooked Meats 12 Hosiers 7 Saddlers and Leather Goods 10 Booksellers and Libraries 7 Photographers 5 Pianos and Music 9 Corn chandlers 7 Timber Merchants 6 Wardrobe Dealers and Dress Agencies 6 Carpets and Lino 6 Clothes Pressing, Cleaning and Repairing 6 Picture Frames 5 Art Needlework and Wool 13 Bazaars 3 Antique Shops 6 Umbrellas 4 Toys 4 Opticians 4 Furriers 3 Blinds 1 Sewing Machines 2 Pawnbrokers 1 Baby Carriages 1 Corsets 2 Herbalist 4 Cutlery 1 China and Glass 7 Cork Goods 1 Builders' Merchants 5 Eggs and Jams 1 28 Animal Pets 1 Stamps and Albums 1 Funeral Furnishers 1 Sports Dealers 2 Arts and Crafts 1 Knitted Goods 1 Fishing tackle 1 Salvage and job stores 1 Flower and Bulb Merchant 1 1,387 open-air swimming pool. The Swimming Pool, which was opened in June, 1929, was one of the first of its kind in the country, and has never ceased to be a great attraction to ratepayers of the Borough and visitors from other areas. It has been found necessary to increase the dressing-room accommodation. Other improvements have been carried out. including flood-liirhting, which extends the hours of usefulness of the Pool. The Pool is open all the year and during 1935 was used by 150.677 persons, and 1.124 season-tickets were issued. The satisfactory condition of the water is maintained by a system of filtration, aeration and chlorination. schools. The sanitary condition of the public elementary schools is the subject of periodic inspection. Crouch End Elementary School lias just been modernised and brought up to date, including entirely new offices and sanitary accommodation, and the Highgate Elementary School is about to be treated in the same way. There are two School Swimming Baths, which are used for teaching scholars swimming. 29 housing. The five-year programme initiated in 1930 for the closing and demolition of unfit houses and the rehousing of their occupants in modern flats has continued steadily and is nowcompleted. No serious difficulty or opposition has been encountered in the carrying through of this programme, the various steps of which are set out in the accompanying table:— 30 SITE. Number of Unfit Houses. Date of Demolition. Development of Site. "Churchyard Bottom" or Woodside Cottages (1st section) 9 1930 18 Council flats built re-named "Summersby Rd." "Ward's Cottages," North Hill 16 1932 21 Council flats built re-named "Rowlands Close" North Road Cottages, Highgate 21 1933 24 Council flats built re-named "Grimshaw Close" 15, 17 & 17a, North Hill 3 1933 Private Development block of 14 flats built in 1934, named , " North Hill Court" 1 and 2 "Pickering Cottages," at rear of above 2 1934 1 and 3 Rose Cottages, Fortis Green 2 1934 nil. St, James's Lane 26 1934 27 Council flats now erected Turnpike Lane 4 1934 33 Council flats built and named "Goulding Court" Colney Hatch Lane 4 1934 —35 To be developed privately Tottenham Lane IS 1935 Road widening and private development North Hill, "Bartholomew Terrace" 4 1935 Private development in flats built in 1935, and named "Broadlands" Highgate Village, "Townsend's Yard" 9 1935 Private development Highgate Village, "Kent's Cottages" 6 1935 do. "Lavender Cottages," off Park Road, Crouch End, N.8 5 Closed Adapted for builders stores "Aldbury," "Maismore," "Laurelhurst" "The Lodge" St. James' Lane, Muswell Hill 4 1935 Developed in connection with an adjoining factory Summersby Road, formerly "Churchyard Bottom" or Woodside Cottages (final section) 7 1935 Council flats 31 overcrowding. OFFICIAL SURVEY UNDER THE HOUSING ACT, 1935. This survey was commenced on December 30th, 1935, and completed on March 21st, 1936. Among 11,120 houses visited, 177 were found to be overcrowded by 188 families. Six years ago the Health Committee called for a quarterly report on cases of overcrowding found in the ordinary routine work of the Health Department. The relatively low incidence of overcrowding in the Borough revealed by the recent survey is largely due to the fact that the problem of overcrowding has received constant attention during the last six years. I desire to acknowledge, too, the valuable assistance rendered bv the Hornsey Housing Trust, Ltd., in dealing with difficult cases not eligible for Council houses and unable to find suitable accommodation privately. During these six years 186 cases of overcrowding were reported and 145 cases were abated. During 1935 families to the number of 122, representing 489 persons, have been rehoused in the following streets:— Families. Persons. Northwood Road 3 10 North Road 1 4 North Hill 5 16 Summersby Roa 2 6 Kenwood Road 1 3 Bishops Road 1 3 Archway Road 3 11 Barnard Hill 1 5 Coldfall Avenue 2 7 Barrenger Road 1 8 Coppetts Road 1 4 Grovehouse Road 1 5 Waldegrave Road 1 5 Beresford Road 1 5 Seymour Road 2 6 32 Hampden Road 2 11 Fairfax Road 1 2 Wightman Road 1 3 Lothair Road 1 3 Sydney Road 2 7 Turnpike Lane 2 8 Clarendon Road 1 3 Haringey Grove1 5 Burghley Road 2 6 Coleraine Road 1 6 Endvmion Road 1 4 Victoria Terrace 1 5 Mount Pleasant Road 1 4 Ennis Road 1 3 Osborne Road 1 3 Nelson Road 3 11 The Broadway, N.8 1 2 Topsfield Parade 1 4 Middle Lane 1 3 Tottenham Lane 6 25 Rathcoole Avenue 1 5 Glebe Road 1 4 Enfield Road 1 3 St. Mary's Road 3 10 Inderwick Road 1 5 Birkbeck Road 1 4 Park Road 15 51 Edison Road 2 6 St. Ann's Road 1 6 Pembroke Road 1 6 The Campsbourne 2 8 Campsbourne Road 2 10 Mvddleton Road 5 20 Nightingale Lane 1 4 Boyton Road 1 5 High Street, N.8 2 8 North View Road 4 16 Hawthorn Road 4 16 Crouch End Hill 2 9 33 Families. Persons. Newlands Road 1 3 St. James's Lane 5 18 Hillfield Park 1 6 Prince's Avenue (Garage) 1 2 Hill Road 4 22 Southwood Lane 1 2 Steeds Road 4 26 HOUSE-TO-HOUSE INSPECTIONS. The number of these inspections is as follows: — Ward. Road. Highgate North Hill 12 North Road 2 Southwood Lane 6 Baker's Lane 2 Muswell Hill St. James's Lane 3 Colney Hatch Lane 1 East Hornsey Birkbeck Road 30 Birkbeck Mansions 52 St. Mary's Road 2 Enfield Road 33 West Hornsey Boyton Road (part of) 40 North Haringey Lyttelton Road 14 Finsbury Park Mount Pleasant Road 44 241 34 HOUSING STATISTICS. (Section D). 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 spected for housing defects (under Public Health or Housing Acts) 2,205 (b) Number of inspections made for the purpose 8,073 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 241 (b) Number of inspections made for the purpose 960 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,553 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 1,160 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 1 35 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (а) By owners 1 (b) By local authority in default of owners — B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 55 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 54 (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 4 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 4 D.—Proceedings under section 20 of the Housing Act, 1930 (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — inspection and supervision of food. The inspection of food and supervision of places where food is prepared and sold was carried out by the Sanitary Inspectors throughout the year. No outbreak of food poisoning occurred during the year, and, indeed, the food supply is now generally so 36 wholesome and free from contamination, and the methods of handling so good, that disease or infection resulting from the ingestion of food is a rare occurrence. Dairies and Milkshops. Every dairyman or purveyor of milk must be registered with the Sanitary Authority of the district in which his dairy premises are situated; if he retails milk in the district of another Sanitary Authority he must also be registered with that Authority. At the end of the year the register showed 64 classed as dairies and 76 classed as milkshops the principal trade of which is not dairy produce. Of the dairies, 28 are situated outside and operate also inside the Borough. The dairies and milkshops have been inspected periodically and a high standard of cleanliness has been found to exist. These inspections have been amplified by the taking of 12 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. During the year licences were granted as follows: — Pasteurising and sale of Pasteurised Milk 1 Sale of Pasteurised Milk 16 Sale of Pasteurised Milk (Supplementary) 1 Sale of Certified Milk 3 Sale of Grade "A" (T.T.) Milk 4 Sale of Grade "A" (T.T.) Milk (Supplementary) 1 Sale of Grade "A" Milk 4 Sale of Grade "A" (Pasteurised) Milk 1 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. 37 During the year the carcases and meat offal of 321 animals have been inspected under the Regulations. Meat offal weighing 15 lbs. was condemned, surrendered and destroyed in the Council's incinerator. Statistics of Slaughtering, 1926-1935. 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 1934 2 624 0 0 626 1935 0 321 0 0 321 There are six licensed slaughter-houses in the Borough. Articles of food brought from the London markets and found to be unsound on arrival at their destination are submitted for examination, condemned, surrendered and destroyed, and a ''condemnment" note is given, which enables the dealer to obtain credit from the wholesaler. This arrangement is quite good and results in prompt notification. The following were condemned and destroyed: — Skate wings 106 lbs. Prawns 8 lbs. 8 ozs. All diseased meat and food is destroyed at the Council's incinerator. FOOD ADULTERATION. \ 38 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 170 — ,, Sterilised 14 — Butter 5 — Cream 1 1 Cream Pastry 4 1 Hake 6 — Lemon Sole 6 — Minced Beef 5 — Sausages 4 — Arrowroot 3 — Mustard 3 2 Pepper 1 — Sweets 1 — Gin 2 1 Whisky 1 — 226 5 INFECTIOUS DISEASE. (Section F). The common infections (Diphtheria, Scarlet Fever, Measles, Whooping Cough, Mumps, Chicken-pox) were of average incidence and very moderate severity during the year. DIPHTHERIA IMMUNISATION. Immunisation against diphtheria has been available for those requesting it at the School Clinic on Saturday mornings. It has been decided in 1936 to hold an immunisation session weekly at the four Maternity and Child Welfare Centres in rotation on Saturday mornings. VACCINATION. The Public Vaccinators inform me that they have performed vaccination of persons in the Borough during 1935 as follows: — Dr. E. Buckler 79 Dr. R. Anderson 208 39 PREVENTION OF BLINDNESS. (SECTION 66, PUBLIC HEALTH ACT, 1925.) All cases of ophthalmia neonatorum likely to cause blindness or permanent damage to the eyes are admitted to St. Margaret's Hospital (Kentish Town) of the London County Council, where they receive the most efficient treatment. The doctors in practice and the midwives all know of this excellent arrangement and the result is that year after year we have a record of no blindness resulting from this dangerous infection. Six cases of ophthalmia neonatorum were notified. Four were treated in St. Margaret's (L.C.C.) Hospital and two were nursed at home. Cases Vision unimpaired. Vision impaired. Total blindness. Deaths. Notified. Treated At home. In hospital or nursing home. 6 2 4 6 0 0 0 TUBERCULOSIS. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925, and SECTION 62, PUBLIC HEALTH ACT, 1925. No occasion has arisen in the course of the year to put these powers into action. Sanatorium provision for all forms of Tuberculosis in Hornsey is made by the Middelsex County Council. There are 512 beds available solely for Middlesex under the Middlesex County Council scheme for the treatment of Tuberculosis in sanatoria, namely: — Harefield Sanatorium 326 beds Clare Hall „ 186 ,, Pulmonary cases in excess of these numbers and nonpulmonary eases are maintained by the County Council in sanatoria and hospitals in various parts of the country. 40 The total number of cases on the Tuberculosis Register at the end of 1935 was 740, viz., pulmonary 560, non-pulmonary 180, an increase of 2 on the total for last year. Dr. Dobson, the Middlesex Tuberculosis Officer for Hornsey, has kindly supplied the following particulars of Hornsey cases of Tuberculosis on his Register: — New tubercular cases 64 Transfers into district not included in above 28 New non-tubercular cases, including contacts 144 Tubercular cases on Dispensary Register 361 ,, ,, removed or lost sight of 49 ,, ,, cured 12 ,, ,, died 42 Cases undiagnosed at end of year 1 Tubercular cases on register at 31st Dec., 1935 258 MORTUARY. Twenty-four bodies were received at the mortuary and inquests held on 21 of them. DISEASES OF ANIMALS ACT. Mr. F. G. Buxton, the Veterinary Inspector, reports that during the year he inspected 432 pigs and issued 52 licences under the Diseases of Animals Acts. No action was necessary under the Tuberculosis Order, 1025. 41 LIST OF TABLES. TABLE A.—Vital Statistics, 1911-35. TABLE B.—Causes of, and ages at, death in 1935. TABLE C.—Summary of causes of death, 1931-1934. TABLE D.—Infant Mortality in 1935. Causes of, and ages at, death. TABLE E.—Births, Deaths, Infant Deaths, and Deaths from certain diseases, 1901-1935. TABLE F.—Cases of Infectious Disease notified in 1935. TABLE G.—Cases of Infectious Disease notified, 1911-1935. TABLE H.—(1) Notification of, and deaths from, Tuberculosis, 1935. (2) Tuberculosis Register, 1935. TABLE I.—Work done at the Maternity and Child Welfare Centres and by Municipal Midwife, 1935. TABLE J.—Inspection of Factories, Outworkers, etc., 1935. 42 TABLE A. BOROUGH OP HORNSEY VITAL STATISTICS, 1911-1935. Year. Estimated Mid-Year Population. Birth Rate per 1,000 Population. Death Rate per 1,000 Population. Infant Mortality per 3,000 live 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 10.5 51 1924 88,661 13.4 10.4 41 1925 89,064 13.6 10.6 43.6 3926 89,850 13.4 10.3 47.2 1927 90,000 13.3 11.2 38.3 1928 90,250 12.1 12.1 61.3 1929 90,500 Regr.-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 Bstimate 96,990 11.37 11.45 46.2 1933 96,070 10.85 12.2 43.2 1934 95,306 11.07 11.68 37.91 1935 95,330 11.83 10.84 48.7 ENGLAND and WALES (Rates in 1935) 14.7 11.7 57 121 County Borough and Great Towns, including London (Rates in 1935) 14.8 11.8 62 140 Smaller Towns Populations 25,000 to 50,000 (Rates in 1935) 14.8 11.2 55 London (Rates in 1935) 13.3 11.4 58 Table b Total All Ages. 0-1 1-2 2-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75 & over 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 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 2. Measles 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3. Scarlet Fever o ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 4. Whooping cough 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 5. Diphtheria 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 6. Influenza 15 7 8 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 4 2 ... 2 ... 1 4 6 7. Encephalitis lethargica 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 7 8. Cerebro-spinal fever 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 9. Tuberculosis of respirutory system 54 27 27 ... ... ... ... ... ... ... 1 5 3 5 9 3 11 8 1 3 2 2 ... 1 ... 9 10. Other tuberculous diseases 14 6 8 ... ... ... ... 1 1 ... 4 3 1 ... 1 1 ... 1 ... 1 ... ... ... ... 10 11. Syphilis 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... 11 12. General paralysis of the insane, tabes dorsalis 4 4 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 2 ... ... ... ... ... 12 13. Cancer, malignant disease 170 78 92 ... ... ... ... ... ... ... ... 1 ... ... ... 3 6 5 15 17 27 30 31 22 13 13 14. Diabetes 16 5 11 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... 1 4 2 ... 6 14 15. Cerebral haemorrhage, etc. 36 12 24 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 3 4 4 6 4 10 15 16. Heart disease 271 103 168 ... ... ... ... ... 1 ... ... ... 1 ... ... 1 3 7 11 15 16 33 43 47 93 16 17. Aneurysm 5 4 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... ... ... ... 1 17 18. Other circulatory diseases 45 24 21 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 3 4 10 15 8 18 19. Bronchitis 27 13 14 ••• ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 2 2 4 9 7 19 20. Pneumonia (all forms) 66 29 37 3 1 ... 1 ... 1 ... ... ... ... ... 3 ... 2 4 3 7 3 6 5 9 18 20 21. Other respiratory diseases 8 6 2 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 1 ... ... ... 2 ... 21 22. Peptic ulcer 15 11 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 1 5 1 2 1 ... ... 22 23. Diarrhoea, etc. 16 13 3 12 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 23 24 Appendicitis 7 2 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 1 3 ... ... ... ... 24 25. Cirrhosis of liver 3 0 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... 25 26. Other diseases of liver, etc. 4 1 3 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 3 ... ... 26 27. Other digestive diseases 23 11 12 ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... 2 ... 2 4 5 3 ... 4 27 28. Acute and chronic nephritis 32 16 16 ... ... ... 1 ... ... ... ... ... ... 1 2 1 ... 2 ... 5 2 5 6 2 5 28 29. Puerperal sepsis 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 29 30. Other puerperal causes 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 30 31. Congenital debility, premature birth, malformations, etc. 31 18 13 15 13 ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 31 32. Senility 21 5 16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 16 32 33. Suicide 11 4 7 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 ... ... 1 3 3 ... ... 33 34. Other violence 15 22 ... 1 ... ... 1 ... 1 1 3 ... ... 1 1 1 2 1 1 3 2 3 4 11 34 35. Other defined diseases 45 46 3 3 ... ... ... ... 1 2 1 1 3 1 2 2 3 8 12 14 6 6 14 9 35 36. Causes ill-defined or unknown 2 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 36 Totals 1,034 466 568 34 21 1 3 4 3 2 9 16 5 13 19 19 30 47 56 85 89 111 127 l34 206 Special causes included in 35 above Small-pox Poliomyelitis Polioencephalitis 43 44 TABLE C.—CAUSES OF, AND AGES AT, DEATH, 1931-1934 (NEW CLASSIFICATION). All Ages 1931 All Ages 1932 All Ages 1933 All Ages 1934 M F M F M F M F 1. Typhoid and paratyphoid fever ... ... ... ... ... ... ... ... 2. Measles ... ... 3 3 ... ... 4 1 3. Scarlet Fever ... 1 ... ... ... ... 1 1 4. Whooping cough ... 2 1 2 2 1 1 1 5. Diphtheria 2 3 ... 4 1 1 2 2 6. Influenza 7 16 11 20 20 25 5 3 7. Encephalitis lethargica ... 1 ... ... 1 2 1 ... 8. Cerebro-spinal fever ... ... ... 1 ... ... 1 ... 9. Tuberculosis of respiratory system 21 31 23 31 25 19 27 32 10. Other tuberculous diseases 3 2 3 6 11 9 7 ... 11. Syphilis 1 3 ... ... ... 1 ... 1 12. General paralysis of the insane, tabes dorsalis 3 ... 4 3 4 ... 6 ... 13. Cancer, malignant disease 72 107 66 94 75 96 64 112 14. Diabetes 4 12 3 10 8 14 6 7 15. Cerebral hemorrhage, etc. 17 52 25 40 23 28 23 35 16. Heart disease 110 150 109 181 117 163 111 174 17. Aneurysm 2 ... 4 1 2 3 3 18. Other circulatory diseases 25 29 24 22 22 31 31 43 19. Bronchitis 15 15 21 8 13 18 14 16 20. Pneumonia (all forms) 28 40 32 34 34 46 34 39 21. Other resniratory diseases 5 6 9 8 3 3 6 2 21. Peptic ulcer 7 4 8 3 8 2 11 2 23. Diarrhœa, etc. 2 3 4 4 4 6 4 1 24. Appendicitis 3 4 2 5 6 2 2 6 25. Cirrhosis of liver 2 1 5 2 1 ... 5 1 26. Other diseases of liver, etc. 3 1 3 1 1 2 3 4 27. Other digestive diseases 10 10 7 14 10 17 15 13 28. Acute and chronic nephritis 19 15 12 14 13 14 18 9 29. Puerperal sepsis ... 2 ... 4 ... 1 ... 2 30. Other Puerperal causes ... 3 ... 2 ... 3 ... 1 31. Congenital debility, Premature birth, malformation, etc. 24 16 15 17 17 10 14 14 32. Senility 8 11 10 24 5 17 8 16 33. Suicide 9 2 9 2 12 4 14 6 34. Other violence 16 13 25 18 22 17 24 18 35. Other defined disease 44 41 48 47 41 45 53 34 36. Causes ill-defined or unknown ... ... ... ... ... 1 ... ... Totals 462 596 486 625 501 601 515 699 Special causes included in 35 above 1,058 1 1,111 1,102 1,114 Small-Pox Poliomyelitis Polioencephalitis A Table of causes, etc., of death under previous classification for 1921-30 appeared in Report for 1932. 45 TABLE D.—INFANT MORTALITY, 1935. CAUSES OF DEATH. Deaths from stated causes at various Ages under One Year of Age. Total Deaths under One Year Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Premature Birth 14 1 3 — 18 1 — — 19 Gastro Enteritis — — 3 1 4 2 3 2 1 12 Pneumonia 1 — 1 — 2 1 — 1 1 5 Icterus Neonatorum 1 1 — — 2 — — — — 2 Status Lymphaticus — — - — — — 1 — — 1 Nephritis - — — — — - - — 1 1 Jaundice — — — 1 1 — - — — 1 Mastoiditis — - — — — — — — 1 1 Hasmorrhage 3 — — — 3 — — — — 3 Spina Bifida - — 1 — 1 — — — — 1 Erysipelas — — — — — 1 — - — 1 Empyema — — — 1 1 — - - - 1 Other Diseases 5 1 — — 6 — 1 - - 7 Total 24 3 8 3 38 5 5 3 4 55 40 TABLE E. BIRTHS, DEATHS, INFANT DEATHS, AND DEATHS FROM CERTAIN DISEASES, 1901-1935. 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 l,561 ... 589 130 15 19 1 1 8 1 62 46 20 1904 1,659 ... 690 145 18 17 21 1 7 2 49 54 23 1905 1,567 ... 696 106 9 10 6 3 8 2 65 58 16 1906 1,603 ... 769 136 18 4 22 6 13 5 65 47 13 1907 1,524 ... 766 116 5 19 3 4 9 4 76 50 19 1908 1,485 ... 752 95 12 11 3 3 9 2 84 53 16 1909 1,508 ... 787 87 12 12 0 3 10 0 75 57 26 1910 1,393 ... 737 84 1 10 0 4 8 3 88 41 18 1911 84,592 1,479 ... 812 116 20 15 35 1 6 1 103 55 23 1912 1,385 ... 840 105 5 2 13 3 2 2 114 43 17 1913 1,425 ... 824 81 12 8 12 0 4 3 96 55 14 1914 1,529 ... 791 88 1 4 21 1 7 1 82 44 10 1915 1,394 ... 1,007 112 37 7 23 3 11 2 99 58 19 1916 1,404 ... 928 64 0 5 8 0 11 1 106 84 20 1917 1,038 ... 906 73 14 6 3 0 6 0 113 58 25 1918 1,037 ... 1,094 64 6 13 7 2 8 0 130 76 13 1919 1,188 ... 992 76 0 0 6 2 3 1 119 66 11 1920 1,707 ... 903 93 4 7 7 3 20 2 119 61 12 1921 87,691 1,468 ... 968 72 1 2 15 3 13 0 136 74 12 1922 1,372 ... 992 72 3 7 3 3 7 0 143 60 13 1923 1,217 ... 928 64 4 1 5 1 4 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 1,139 44 1,058 60 0 2 5 1 5 0 179 52 5 R.-Gen.'s Estimate 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 1934 95,306 1.055 35 1,114 40 5 2 2 2 4 0 176 59 7 1935 95,330 1,128 36 1.034 55 1 1 0 15 0 1 1 170 54 14 47 TABLE F.-INFECTIOUS DISEASES NOTIFIED, 1935. DISEASE W A R D S . AGES Total Admitted to Joint Hospital. Admitted to other Hospitals. In Nursing Home. Nursed at Home. Registered Deaths Highgate Muswell Hill. Crouch End West Hornsey Bast Hornsey North Haringey South Haringey Stroud Green Finsbury Park. 0—1 1-5 5—15 15—25 25—45 45—65 65 and over Scarlet Fever 24 ' 57 22 49 26 9 29 16 13 1 36 136 34 33 5 0 245 178 19 0 48 0 Diphtheria 5 10 8 21 15 11 4 6 3 0 18 55 6 4 0 o 83 78 3 0 2 1 Typhoid 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 1 0 0 1 Pneumonia 2 12 2 1 9 10 2 2 4 3 7 3 6 8 11 6 44 1 7 1 35 66 Erysipelas 3 5 6 0 4 2 2 3 0 0 1 1 0 3 14 6 25 7 1 0 17 0 Puerperal Fever 0 0 0 0 0 0 0 1 1 — — — - 2 — — 2 0 2 0 0 3 Puerperal Pyrexia 1 1 0 3 0 3 1 0 0 — — 2 7 — — 9 0 8 1 0 Ophthalmia Neonatorum 1 0 0 1 2 1 1 0 0 6 - - - - — — 6 0 4 0 2 0 Poliomyelitis 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 Encephalitis Lethargica 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 1 Cerebro-Spinal Meningitis 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 Dysentery 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 2 0 1 1 0 Tuberculosis: 37 85 39 76 57 37 39 28 22 10 62 197 50 57 31 13 420 265 48 2 105 Pulmonary 24 IS 4 IS 15 17 7 11 12 0 4 3 33 54 23 3 120 NonPulmonary 3 5 0 4 1 2 2 2 2 0 4 8 2 4 2 1 21 Total 64 105 43 95 73 56 48 41 36 10 70 208 85 115 56 17 561 Admitted to Joint Isol. 21 50 20 64 38 16 26 16 14 Hospital Other Hptls 5 5 5 S 7 8 3 5 5 Nursing Homes 0 0 0 0 0 1 0 1 0 Nursed at Home 11 30 14 7 12 12 10 6 3 Excluding T.B. Note.-The following 38 cases were also admitted to the Isolation Hospital in addition to the above: 9 Tonsillitis, 6 Local Sepsis, 4 Whooping cough and Pneumonia, 2 Colic, 2 Measles, 2 Whooping Cough, 1 Abscess, 1 Chicken Pox, 1 Ecthyma, 1 Gastritis, 1 Influenza, 1 Mumps, 1 Peristitis, 1 Quinsy, 1 Rheumatism, 1 Sprained ankle, 1 Ulcer and 2 for Observation. 48 table G.-NOTIFICATIONS OF INFECTIOUS disease. 1911-1935. 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 85,122 206 115 10 - 2 - 26 - - - - - - - - - - - 359 4.2 1914 85,456 346 101 9 - 1 - 24 - — 11 - - - - - - - - 492 5.7 1915 85,800 182 105 18 - 5 - 35 9 3 1 - - - - - - - - 358 4.1 1916 86,147 103 77 8 - 1 - 32 2 6 9 - - - - - - 207 281 726 2.7* 1917 86,450 132 66 4 - 1 - 28 4 - 1 - - 1,227 881 2,344 2.7* 1918 86,942 89 67 8 - 2 - 23 1 3 2 - - - - - — 796 119 1,110 2.3* 1919 87,100 203 87 6 — 4 - 42 4 1 5 21 2 5 — 112 — 224 285 1,001 5.7* 1920 87,410 245 149 6 - 2 - 27 1 3 8 10 2 4 - 98 - not now notifiable 555 6.3 1921 87,691 (Census 591 189 2 — 2 - 36 — 2 6 1 1 6 — 42 — 878 10.1 1922 88,007 286 113 1 — 2 - 24 — — 10 1 — 1 - 104 — 552 6.2 1923 88,325 126 133 1 — — - 24 2 — 6 4 — 2 - 75 — 373 4.2 1924 88,661 215 40 3 — 1 - 26 — 1 1 - - 11 - 61 — 359 4.0 1925 89,064 126 53 10 — 1 - 26 2 2 4 1 1 7 - 60 — 293 3.3 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 (R..Gen.'s Estimate) 346 115 5 4 4 15 36 1 1 1 — — — — 61 3 592 6.6 1931 95,524 (Census) 247 116 - 1 7 9 32 1 3 1 — 2 — 86 — 505 6.3 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 1934 95,306 283 63 1 — 4 14 36 — 3 10 1 — 41 — 456 4.7 1935 95,330 245 83 1 — 2 9 25 1 1 6 — 2 1 — 44 — 420 4.4 *Excluding Measles and German Measles. 49 TABLE H.-(1) NOTIFICATION OF, AND DEATHS FROM, TUBERCULOSIS. 1935. AGE PERIODS. New Cases. Deaths Pulmonary Nan-Pulmonary Pulmonary Non-Pulmonary M F M F M p M F 0 — 1 - - - - - - - - 1 — 5 2 2 3 1 - — 1 1 5 — 15 1 2 2 6 - 1 — 4 15 — 25 19 14 2 - 6 2 3 - 25-35 16 17 1 1 5 10 1 - 35 — 45 8 13 1 1 3 11 1 1 45 - 55 11 5 1 1 7 1 — 1 55 — 65 3 4 - - 3 2 — 1 65 and over 3 — 1 — 3 — — — Totals 63 57 11 10 27 27 6 8 Wards;— Highgate 11 13 - 3 2 3 — 2 Muswell Hill 5 10 3 2 6 9 2 2 Crouch End 2 2 - - 2 - - — West Hornsey 7 8 3 1 5 4 2 1 East Hornsey 10 5 1 - 3 4 1 - North Haringey 12 5 1 1 5 4 — 1 South Haringey 6 1 - 2 1 2 - 1 Stroud Green 4 7 2 - 1 - 1 - Finsbury Park 6 6 1 1 2 1 - 1 Totals 63 57 11 10 27 27 6 8 50 TABLE H.-(2) TUBERCULOSIS REGISTER, 1935. Pulmonary. Non-Pulmoiiry. Total. Male. Female. Male. Female. Male. Female. (a) Number of Cases on Register at commencement of 1935 285 271 93 89 378 360 (b) Number of Cases notified for flrst time during year under Regulations 40 28 3 5 43 33 (o) Cases restored to Register during 1935 2 2 0 1 2 3 (d) Cases added to Register otherwise than by notifications under Regulations : (1) Transferred from other districts 14 21 2 1 16 22 (2) Prom Death Returns 7 6 6 3 13 9 (e) Number of Cases removed from Register during 1935 58 58 10 13 68 71 (f) Number of Cases remaining on Register at end of 1935 290 270 94 86 384 356 Cases removed from the Register snown under (c) are accounted for as follows:— Found not to be T.B Cured. Removed to another area. Died at Home. Died at Sanatorium or other Institution. Other Reasons. Totals. M F M F M F M F M F M F M F Pulmonarv - 2 4 7 17 17 11 14 25 15 1 3 58 58 Non-pulmonary - - 3 1 2 5 1 5 6 — - 10 13 51 TABLE I. MATERNITY AND CHILD WELFARE WORK, 1935. Nature of Work. Centres. No. 1. No. 2. No. 3 and Sub-Centre. Totals. Number of sessions held 185 102 70 357 ,, ante natal sessions held 50 24 23 97 Number of individual Mothers seen by Doctor:— Ante-natal, New cases 171 66 55 292 ” Old cases 327 123 128 578 Post-natal, New cases 33 10 6 49 „ Old cases 4 4 2 10 535 203 191 929 Total attendances of Mothers 7il 232 191 1,164 Number of babies attending Centres for first time : Under 1 year 338 216 142 696 1-3 years 79 43 29 151 3-5 24 18 19 61 Number of individual babies on Centre registers: Under 1 year 288 232 135 655 1—5 years 730 269 137 1,136 Babies seen by Doctor 2,513 1,567 941 5,021 Attendances of babies at medical consultations 3,497 2,167 1,087 6,751 Total attendances of babies at Centres: Under 1 year 4,851 2,677 1,214 8,742 1-3 years 3,028 1,023 677 4,728 3-5 „ 935 307 232 1,474 Referred to own private doctors 63 23 1 87 Referred to hospitals 131 26 6 163 viisits paid by nurses:— First visits Total visits First visits Total visits First visits Total visits Grand First visits Totals Total visits to expectant mothers 97 183 89 149 50 100 236 432 to infants under one year 465 2,520 334 1,575 266 1,065 1,065 5,160 To children aged 1-5 years 163 3,757 74 1,694 71 1,810 308 7,26l Total visits paid by Nurses 726 6,460 497 3,418 387 2,975 1,509 12,853 CHILDREN ACTS— Visits paid to Foster Children 25 194 27 168 6 116 58 478 RECORD OF WORK OF MUNICIPAL MIDWIFE, 1935. Confinements attended 165 Ante-natal Clinics attended 86 do. visits 609 Post-natal visits 2,205 52 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 126 1 0 Workshops (Including Workshop Laundries) 193 6 0 Workplaces (Other than Outworkers'premises) 10 0 0 Total 319 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 cleanliuess 29 29 — — Want of ventilation - - — — Overcrowding — — — — Want of Drainage of floors — — — — Other nuisances — — — — Sanitary accommodation insufficient 1 1 — — unsuitable or defective 17 17 — - not separate for sexes 5 5 - - 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 52 62 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. 53 TABLE J.—(contd.) OUTWORKERS, 1935. Nature of Work. (1) Premises. Outworkers. Instances. Notices served. Prosecutions. Wearing Apparel 95 103 0 0 0 Boots 4 4 0 0 0 Embroidery 5 5 0 0 0 Furs 3 4 0 0 0 Carnival Hats 3 4 0 0 0 Church Needlework 1 1 0 0 0 Curtains 1 1 0 0 0 Cellophane Covers 1 1 0 0 0 Boxes 4 4 0 0 0 Artificial Flowers 2 2 0 0 0 Laundry 1 1 0 0 0 Cushions 1 1 0 0 0 Jewel Cases 3 3 0 0 0 Bead Stringing 1 1 0 0 0 Art Needlework 1 1 0 0 0 Silk Tassels 1 1 0 0 0 Dolls Clothes 1 1 0 0 0 Total 128 138 0 0 0 Borough of Hornsey ANNUAL REPORT OF THE School Medical Officer FOR THE Year ending December 31st 1935 3 HORNSEY EDUCATION COMMITTEE. List of Members, 31st December, 1935 APPOINTED BY HORNSEY. Members of the Town Council— Aldermen. Mr. W. G. Barrenger, J.P., 20, Southwood Hall, Highgate. N.6. Mr. B. H. Jenkinson, 36, Avenue lload, Highgate, N.G. Mr. W. W. Kelland, M.A., 14, Hillside Mansions, Jackson's Lane, N.6. Mr. J. W. Rowlands, J.P., 25, Cholmeley Park, N.6. Councillors. Mr. D. V. Johnson, 54, Coolhurst Road, Crouch End, N.8 (Chairman). Mrs. C. M. Cave, 10, Wood Vale, Muswell Hill, N.10 (ViceChairman). Mr. S. H. Baker, 33, Coolliurst Road, N.8. Mr. A. A. Bell, 120, Wightman Road, Harringay, N.4. Mr. W. J. Grimshaw, J.P., 25, Sheldon Avenue, Highgate, N.6. Mr. G. K. M. Hu'j i'chinson, 8, Grosvenor Gardens, N.10. Mr. W. J. Lendrum, 10, Leaside Avenue, N.10. Mr. J. W. Palmer, 30, Crescent Road, Crouch End, N.8. Mr. L. J. Valette, 59, Allison Road, Harringay, N.8. Mr. W. V. Wall, 10, Winchester Place, N.6. Co-optative Members— The Rev. E. S. Duval, M.A., The Rectory, Hornsey, N.8. Mr. F. C. Ellerton, 14, Bancroft Avenue, N.2. Mr. J. H. Ford, M.A., 5, Woodland Gardens, Muswell Hill, Mrs. A. Holman, J.P., 8, Hornsey Lane, Highgate, N.6. Mr. W. E. Paterson, M.A., B.Sc., 7, Donovan Avenue, N.10. Mrs. G. M. Reid, B.A., 60a, Shepherds Hill, N.6. Mr. H. Tompkins, 7, Danvers Road, N.8. Director of Education— A. W. Allen, M.A., Education Office, Town Hall, Broadway, N.8. 4 MEMBERS OF THE CENTRAL CARE SUB-COMMITTEE. Six members of the Education Committee— Councillors Mrs. C. M. Cave, G. K. M. Hutcliinson, L. J. Valette and W. V. Wall, Mrs. G. M. Reid, B.A., and Mr. H. Tompkins. Four Head Teachers of Elementary Schools nominated by the Hornsey Head Teachers' Association— Miss F. A. Barter, Mr. F. W. Jaggard, Miss H. M. Stone and Mr. H. Turner. The Chairman or Hon. Secretary of each of the six District Care Committees as may be nominated by the District Care Committee— Mrs. H. M. Durrant, Mrs. J. Faraday, Mrs. W. A. Grimshaw, Mrs. H. M. Hay, Mr. G. A. Henderson and Mrs. E. Simmonds. Four other persons residing in the Borough who possess erjicricnce or knowledge of social work among school children or young persons— Mr. W. P. Bannister, M.A., Mrs. N. Brixey, Mrs. D- M. Johnson and Mrs. E. M. Tompkins. MEMBERS OF THE DISTRICT CARE COMMITTEES. Campsbourne.—Councillor L. J. Valette (ex-officio), Mrs. D. M. Johnson, Mrs. G. M. Reid, B.A., Mr. H. Tompkins, tMr. H. Turner, Miss G. S. Litchfield, Miss D. F. Smith, Miss M. DSibley, Mr. J. W. T. Harris, *Mrs. H. M. Durrant, Mrs. E. Gardiner, Mrs. W. C. Hardwick, Mrs. A. E. Larnble and Mrs. L. Whittle. Crouch End.—Councillor L. J. Valette (ex-officio), Mrs. E. M. Tompkins, *Mr. G. A. Henderson, Mrs. G. M. Beid, Mr. J. Iliffe, Miss F. A. Barter, Miss A. E. Walmsley, fMrs. A. M. Halford, Mrs. E. H. Hare, Miss F. Milborrow, Bev. L. G. Pilkington, Mrs. E. R. Byrne and Mrs. J. Stevenson. * Secretary. † Chairman 5 Harringay.—fCouncillor L. J. Valette (ex-officio), Mr. W. P. Bannister, M.A., Mrs. N. L. Brixey, *Mrs. H. M. Hay, Miss (1. M. Rvde, B.Sc., Miss B. Jones, Mr. G. F. Sliaw, M.A., Mr. J. H. Spilman, B.Sc., Miss H. M. Stone, Councillor Mrs. J. H. Bnrrenger, Mrs. H. Betts. Mrs. C.' Easterling, Mrs. Hawkins, Mr. G. Pain, Mrs. R. Owen and Mrs. L. J. Valette. Higiigate.—Councillor L. J. Valette (ex-officio), *Mrs. W. J. Grimshaw, Mr. T. E. Durban, Miss R. Spalding, Mr. E. R. Lewis, Miss E. Towler, Mrs. E. Farrell. |Mrs. G. Farquharson, Bev. F. Hawkins, M.A., Mrs. A. Iniber, Miss Dow and Mr. S. Mason. Muswell Hill. — Councillor L. J. Valette (ex-officio), 'Councillor Mrs. C. M. Cave, *Mrs. E. Sirnmonds, Mr. G. Simnionds, B.A., Miss M. Clarke, Mr. I. T. Plant, Miss E. F. Catley, Mr. F. G. Edwardes, Mrs. M. Heppell, Mrs. A. Hohnan, J.P., Councillor F. J. Randall and Rev. A. Dunn. Stroud Green.—Councillor L. J. Valette (ex-officio), Mrs. N. L. Brixey, *Mrs. J. Faraday, fCouncillor W. V. Wall, Mr. P. W. Jaggard, Miss E. M. Cockhill, Miss E. Pitson, Mrs. J. Ashworth, Mrs. A. Cole, Miss M. Freeman, Mrs. K. Knowles, Mrs. B. Wootton and Mrs. M. Wall. *Secretary. † Chairman 6 STAFF OF SCHOOL MEDICAL SERVICE. School Medical Officer: It. 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. II. Friel, M.A., M.D., F.R.C.S. (I.). Radiologist: J. Morison, M.D. Orthopaedic Surgeon: H. J. Seddon, F.R.C.S. (Eng.) (Resident Medical Superintendent, Royal National Orthopeedic 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. 7 To the Chairman and Members of the EDUCATION COMMITTEE. Mr. Chairman, 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, 1935. The work of Medical Inspection of four age groups in all the elementary schools of the Borough was carried through during the year by myself and my colleague, Dr. .Tean Sutherland. The findings of this routine medical inspection, together with the findings of dental inspection and treatment by the School Dentist, Dr. Betty Hamilton, of cleanliness inspections by the school nurses, and the figures relating to the various schemes of treatment carried out at the School Clinic, are contained in the statistical tables in this Report. Tn many respects these figures afford grounds for satisfaction and gratitude. Nutrition. For example, the nutrition survey, set out in Table IIb. in the form required by the Board of Education, shows that amongst 3.182 children inspected, only 6 per cent, showed "slightly subnormal nutrition," and not one wan classified as of "bad nutrition. This is due, no doubt, in large part, to the generally favourable economic circumstances of the population of the district. I suggest, however, that it is, in some degree, the result of the preaching of the gospel of good food which has been undertaken by your medical officers, school nurses and teaching staffs for some years. Another factor is the generous view taken by the Education Committee of its opportunities under the School Milk Scheme. The problem of nutrition in relation to public health is now attracting widespread attention throughout the world. It has passed the stage of being a medical problem and is attracting the attention of statesmen and economists. Another pleasing feature of The situation is that we are beginning to think of the problem in terms of "optimum nutrition." In the past it has been considered far too much from the point of view of "malnutrition." This change of viewpoint and spread of interest in nutrition are the surest signs of sound progress in public health and national well-being. 8 Defective Children. Another favourable feature in the statistical returns to which I desire to draw attention is the relatively small numbers recorded under the different categories of Table III. For example, there is only one totally blind child—a girl attending the Residential School for the Blind at Brighton;—only four partially blind children, attending the Myopic School at Wood Green, only one totally deaf child and four partially deaf. These happy results are attributable largely to the soundness of modern methods of dealing with ophthalmia neonatorum (inflammation of the eyes of the new-born), which is by far the commonest cause of total blindness, and of treating the common infectious diseases, such as measles, whooping cough and scarlet fever, the ear complications of which are the chief causes of deafness. The group of mentally defective children requiring special education is not subject to much variation in numbers and remains at about 30 to 35; and epilepsy (numbering 6) is an inherited condition which also remains fairly constant in numbers. Coming to the physically defective, the numbers are so striking as to require some explanation. There is a nil return under tuberculosis, which means that we have not ascertained any boy or girl to be suffering from any tubercular condition in such a stage as to be definitely diagnosed and to require treatment in a sanatorium or elsewhere, thus rendering the child unfit to attend an ordinary elementary school. There are, doubtless, many children in the elementary school population who have been infected with the tubercle bacillus and who are reacting mildly to it, children who are, in fact, undergoing the process of tuberculisation," or natural vaccination against tuberculosis. Again, the nil return under the heading of delicate children is an expression of the belief that there are better methods of dealing with a physically sub-normal school child than sending him or her to a special school. The more I see of this type of child, the more I feel that there is no greater dis-service an Education Authority may do to any child than send him to a "special" school (of any kind) if he is at all fit to attend an "ordinary" school. 3 There are two distinct types of children commonly described as "delicate" — first, the children of large families of poor parents; these victims of poverty are underfed and overcrowded, and when they get such conditions as measles, whooping cough, etc., they tend to develop complications like broncho-pneumonia, from which they make imperfect recovery. The numbers of this type are diminishing in every part of the country, and, as our nutrition statistics show, they practically do not exist as a problem in this Borough. It is obvious to any person that the good food and rest in healthy surroundings which are provided at special schools for delicate children may transform this type of child into a strong, healthy boy or girl. The same result may be obtained if the poverty at home can be remedied and the parents educated in the needs of growing children in regard to rest and food. The second type of child to which the label " delicate becomes attached presents a striking contrast to the poor child just described. His parents may be, comparatively, " in easy street." If he is not an only child, he has, at the most, one brother or sister, separated from him by five years or more. Often the story is that " he has been delicate from birth." This early discovery was, possibly, made by the child's grandmother. He has been under the doctor—or attending the out-patients' department of a children's hospital — for one complaint after another ever since. He is well clothed, of immaculate cleanliness, and when stripped for examination he is found to be thin, soft, round-shouldered and of poor, undeveloped physique. He is very quiet while mother takes off his clothes and puts them on again (without his help), and he takes his medical examination without evincing the slightest emotion or interest in the proceedings. Clearly he has been through the same process so many thousands of times that he is bored! This second type of "delicate" child is on the increase in recent years. When further inquiry is made as to his health, mother often answers It's his nerves." In offering advice to the parents of such children I believe the first essential step is to persuade them to abandon the terms nerves" and "delicate." There is nothing more calculated to interfere with the proper physical, moral and mental development of a child than to be brought up on "delicate" lines. 10 The number of children suffering from severe heart disease is three. One of these attends an elementary school and is doing very well. The other two are in hospital. The general position, then, with regard to defective children is that they are relatively few in numbers, and all of them who require special school or institutional care are receiving it. Physical Education. The education of the child's body is now receiving the attention it merits. In January, 1936, the Board of Education issued Circular 1,445 on " Physical Education," and in April a Special Committee of the British Medical Association on Physical Education issued its report. It is some years now since the first appointments of organisers of physical training were made in Hornsey jointly with adjoining authorities. These appointments, and the keen interest and enthusiasm which has developed amongst the teaching staffs, is already bearing fruit in improved physique of the school children. There is still room," however, for vast improvement in posture, breathing capacity and general physical development of many of the boys and girls. Voluntary Workers. This Annual Report is not intended to be an exhaustive account of all the activities of the School Medical Service during the year. The work of the various departments—medical, dental, aural, ophthalmic, orthopaedic, nursing and clerical—is all on a fairly settled basis and runs smoothly. To describe the whole in detail each year would mean unnecessary repetition. I cannot, however, close without acknowledging the support and assistance which every branch of the work receives from the Director of Education and his staff, the teaching staffs of the schools, and the large and enthusiastic band of voluntary workers who compose the six District Care Committees and the Central Care Committee. Their work on behalf of the school children is invaluable. 11 I desire also to acknowledge gratefully the keen interest of members of the Education Committee in all that pertains to the health and physical well-being of the elementary school children of the Borough. I have the honour to be, Ladies and Gentlemen, Your obedient servant, R. P. Garuow, School Medical Officer. 12 School Medical Service Scheme of Treatment. Condition treated. Where treated. By whom. When. (a) Minor ailments including skin disease and external eye disease. School Clinic. Clinic Nurse (Miss Paris). Daily at 4 p.m. Throat Opwutions: (b) Tonsils and Adenoids Hornsey Central Hospital. Surgical Staff of the Hospital. As required. (c) Defective Vision. School Clinic. Sohool 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. (c) Dental Defects. School Clinic. School Dentist (Dr Betty C. Hamilton). Full time, Bleven sessions weekly. (f) Crippling defects. School Clinic. Orthopaedic Surgeon (Mr. Seddon). Masseuse (Mrs. Yorke). One session monthly, 4th Monday morning in each month. Three sessions weekly, Monday, Wednesday & Friday afternoons. (g) Stammering and other speech defects. Sehool Clinic. Special Teacher (Miss Bains). Two sessions weekly, Monday and Wednesday afternoons. (h) Ringworm. Addbess : Haddon Court, South wood Lawn Rd., N.6. Private doctor by arrangement with Education Authority (Dr. Morison) Each case as required. (i) Conditions requiring medical consultation . Sohool Clinics and Infant Welfare Centres. S.M.O. and A.S.M.O. Seven sessions or part sessions weekly. 13 TABLE I. RETURN OP MEDICAL INSPECTIONS, 1935, ATTENDING PUBLIC ELEMENTARY SCHOOLS (see note a). (a)—Routine Medical Inspections. Number of Inspections in the prescribed Groups— (see note b). Entrants 836 Second Age Group 1,186 Third Age Group 498 Total 2,520 Number of other routine inspections 662 (see note c). Grand Total 3,182 (b)—Other Inspections. Number of special inspections 1,700 (see note d). Number of re-inspections 3,406 (see note e). Total 5,106 14 NOTES ON TABLE I. (a) The return refers to a complete calendar year. (b) This heading relates solely to the routine medical inspection of the three ordinary age groups, i.e., to medical inspection carried out:— (i) In compliance with Article 17 of the Consolidated tions relating to Special Services—Grant Regulations No. 19. (ii) on the school premises (or at a place specially sanctioned by the Board); (iii) for the purpose of making a report on each child on the lines of the approved Schedule set out in Circular 582. (c) Under this heading may be recorded routine inspections, if any, of children who do not fall under the three prescribed age-groups, e.g., routine inspections of a fourth age-group or of other groups of children, as distinct from those who are individually selected on account of some suspected ill-health for " Special " Inspection. (d) 14 Special Inspection is a medical inspection by the School Medical Officer himself or by one of the Medical Officers on his staff of a child specially selected or referred for such inspection, i.e., not inspected at a routine medical inspection as defined above. Such children may be selected by the Medical Officer during a visit to the Sohool or may be referred to him by the Teachers, School Nurses, Attendance Officers, Parents, or otherwise. It is immaterial for the purpose of this heading whether the children are inspected at the School or at the Inspection Clinic or elsewhere. If a child happens to come before the School Medical Officer for special inspection during a year in which it falls into one of the routine groups, its routine inspection should be entered in Part A of Table I. and its special inspection in Part B. The inspection to be recorded under the heading of special inspections should be only the first inspection of the child so referred for a particular defect. If a child who has been specially inspected for one defect is subsequently specially inspected for another defect, such subsequent inspection should be recorded as a Special Inspection and not as a Re-inspection. . (e) Under this heading should be entered the medical inspections of children who as the result of a routine or special inspection come up later on for subsequent re-inspection, whether at the Sohool or at the Inspection Clinic. The first inspection in every case will be entered as a routine or special inspection as the case may be. Every subsequent inspection of the same defect will be entered as a re-inspection. Care should be taken to see that nothing is included under the head of special inspections or re-inspections except such inspections as are defined above. Attendances for treatment by a Nurse, or for examinations by anyone other than a Doctor on the staff of the School Medical Service, should not be recorded as medical inspections. If, however, at any such attendance should be also examined by one of the Authority's Medical Officers, this be recorded as a special inspection or re-inspection as the case may be even if treatment is also given; but such attendance may also of course ecorded as an attendance for treatment. (f)No individual child should be counted more than once, even if it is found to be suffering from more than one defect (g)This total should not exceed the total of column 2 of Part A. of Table II. on Form 8 b.M. 15 TABLE II. (A) RETURN OP DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1935. 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. (i) (2) (3) (4) (5) Skin - (1)ingworm, scalp - ... ... ... ... (2) ,, body ... ... 8 ... (3) Scabies' 1 ... 21 ... (4) Impetigo 3 ... 31 ... (5) Other Diseases (Non-tuberculous) 6 ... 100 ... TOTAL (Heads 1 to 5) 10 ... 160 ... Eye 6) Blepharitis - 11 ... 7 ... 7) Conjunctivitis 1 ... 20 ... 8) Keratitis 1 ... ... ... 9) Corneal Opacities - ... ... ... ... 10) Other Conditions (excluding Defective Vision and Squint ... ... 22 ... TOTAL (Heads 6 to 10) 13 ... 49 ... U) Defective Vision (excluding Squint) 191 17 163 ... [12) Squint - 18 2 31 ... Ear (13) Defective Hearing 8 ... 4 ... (14) Otitis Media 8 ... 13 ... (15) Other Ear Diseases ... ... 36 ... Nose and Throat (16) Chronic Tonsillitis only - 5 7 1 ... (17) Adenoids only . ... ... ... ... (18) Chronic Tonsillitis and Adenoids ... ... ... ... (19) Other conditions 7 ... 51 ... (20) Enlarged Cervical Glands (N on-Tuberculous) 2 ... ... ... (21) Defective Speech ... ... ... ... Heart and Circulation Heart Disease : ... ... ... ... (22) Organic ... 7 ... ... (23) Functional ... ... ... ... (24) Ansemia ... ... ... ... Lungs (25) Bronchitis .... ... ... ... (26) Other Non-Tuberculous Diseases ... ... ... ... Tuberculosis Pulmonary ; ... ... ... ... (27) Definite ... ... ... ... (28) Suspected Non-Pulmonary : ... ... ... ... (29) Glands ... ... ... ... (30) Bones and Joints ... ... ... ... (31) Skin ... ... ... ... (32) Other Forms - ... ... ... ... Nervous System (33)Epilepsy .... ... ... ... ... (34) Chorea ... 1 1 ... (35) Other Conditions ... ... ... ... Deformities (36) Rickets 2 ... ... ... (37) Spinal Curvature 5 ... ... ... (38) Other Forms 236 10 6 ... (39) other Defects and Diseases (excluding Uncleanliness and Dental Diseases 3 ... 868 ... TOTALS - 508 44 1383 ... 16 TABLE 11 (continued). (B) CLASSIFICATION OP THE NUTRITION OP CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. (See Administrative Memorandum No. 124, dated 31st December, 1934.) AGE GROUPS Number of Children Inspected. I A (Excellent) B (Normal) C (Slightly sub-normal D (Bad) No % No. % No. % No. % Entrants 847 297 36% 495 58% 55 6% — Second Age group 1,174 610 52% 477 41% 87 7% — Third Age-Group 498 299 60% 160 32% 39 7.8% — Other Routine Inspections 063 477 72% 167 25% 19 3% — TOTAL 3,182 1,683 53% 1299 41% 200 6% — TABLE III. BLIND CHILDREN. A blind child Is defined by Section 69 of the Education Act, 1921, as one who is "too blind to be able to read the ordinary school books used by children." This definition covers some children who are totally, or almost totally, blind and can only be appropriately taught in a school for blind children, and others who have partial sight and can be appropriately taught in a school for partially sighted children. Only the first class should be included in this section. At Certified Schools for the Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 1 PARTIALLY SIGHTED 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 sighted. 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 Sighted. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 4 — — — 4 17 DEAF CHILDREN. A deaf child is defined by Section 69 of the Education Act, 1921, as one who is "too deaf to be taught in a class of hearing children in an elementary school." This definition covers some children who are totally, or almost totally, deaf and can only be appropriately taught in a school for deaf children, and others who have partial hearing and can be appropriately taught in a school for partially deaf children. Only the first class should be included in this section. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 — — - 1 PARTIALLY DEAF CHILDREN. Enter in this Section only children who can appropriately be taught only 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. — 4 — — - 4 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. The following Table should include all such children except those who have been notified to the Local Authority under the Mental Deficiency Act In accordance with Article 3 of the Mental Deficiency (Notification of Children) Regulations, 1928. Particulars relating to these children should be entered in the return of notified children—Form 307 M. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 84 — — — 34 18 EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. In this part of the Table only those children should be included who are epileptio 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 Publio 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. — 4 — 2 6 PHYSICALLY DEFECTIVE CHILDREN. A.—Tuberculous Children. 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. Only children diagnosed as tuberculous and requiring treatment for tuberculosis at a sanatorium, a dispensary, or elsewhere should be recorded in this category. 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 conforms to the description of a crippled child given at the head of Section C below. All other tuberculous children who are regarded as being no longer in need of treatment should be recorded as delicate children, provided the Medical Officer is prepared to certify under Section 55 of the Education Act, 1921, that they are Incapable by reason of physical defect of receiving proper benefit from the instruction in the ordinary Publio Elementary Schools. 1.—Children Suffering From Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) At Certified Special Schools. At Public Elementary Schools t At other Institutions. At no School or Institution. Total. — — — — Nil. 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. — — — — Nil. † It is essential that tuberculous children who are, or may be, a source of infection to others should be promptly excluded from Public Elementary Schools. 19 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. Sucn 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 under Section 55 of the Education Act, 1921, that they are incapable by reason of physical defect of receiving proper benefit from the instruction in the ordinary Publio Elementary Schools. At Certified Special Schools. At Public Elementary Schools. At other Institutions At no School or Institution. Total. 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 unaDle 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, and in whose case the Medical Officer would be prepared to certify under Section 55 of the Education Act, 1921, that they are incapable by reason of such physical defect of receiving proper benefit from the instruction in the ordinary Publio Elementary Schools. At At At Certified Public no School Special Elementary or Total Schools. Schools. Institution. 7 17 4 4 32 D. CHILDREN WITH HEART DISEASE. This section should be confined to children in whose case the Medioal Officer would be prepared to certify, under Section 55 of the Education Act, 1921, that they are incapable by reason of such physical defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools. At At At Certified Public no School Special Elementary other or Total Schools. Schools. Institutions. Institution 1 2 3 20 CHILDREN SUFFERING FROM MULTIPLE DEFECTS. Information is only required in respect of children suffering from any combination of the following types of defect:— Blindness (excluding partially sighted children). Deafness (excluding partially deaf children). Mental Defect (Feeble-minded). Severe Epilepsy. Active Tuberculosis. Crippling (as defined in Section C above). Heart Disease. The clinical condition causing the defect need not be specified; It will, for example, be sufficient to enter In Coloum 1, Blind and Feeble-minded. Deaf, Crippled and Heart. Should there be no children suffering from Multiple Defects, please enter " Nil." Combi- At At At At nation Certified Public other no School — . . of Special Elementary Institutions. or Defect. Schools. Schools. Institution. — — — — — Nil 21 TABLE IV. YEAR ENDED 31st DECEMBER, 1935. TREATMENT TABLE. (see note a). Group I.—Minor Ailments (excluding Uncleanliness, for which see Batch4-610 Number of Defects treated or under treatment during the year. DISEASE OH DEFECT. (1) Under the Authority's Scheme (see note b). (2) Otherwise. (3) Total. (4) Skin— Ringworm-Scalp (i) X-Ray Treatment. If noue, indicate by dash. — — — (ii) Other Treatment. — — Ringworm-Body 8 — 8 Scabies 21 — 21 Impetigo 31 — 31 Other Skin Disease I00 — 100 Minor Eye Defects (External and other, but excluding oases falling in Group 11). S3 33 Minor Ear Defects (See note c). 53 — 58 Miscellaneous ... (e.g., minor iujuries, bruises, sores, chilblains, etc.) 288 288 Total 534 — 534 22 TABLE IV. (continued.) Group II—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). Number of Defects dealt with Under the Authority's Scheme ( ee note b) Otherwise. Total. Errors of Refraction (in eluding Squint). (Operations for squint should be recorded separately in the body of the School Medical Officer's Report!. 402 19 421 Other Defect or Disease of the Eyes (excluding those recorded in Group 1.). 33 — 33 Total 435 19 454 Under the Authority's Scheme. Otherwise. Total. No. of Children for whom spectacles were (a) Presoribed 443 — 443 (i) Obtained .. 440 — 440 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme, in Clinic or Hospital (see note b)- By Private Practitioner or Hospital, apart from the Authority's {Scheme. Total. (i) (»> (3) (4) (5) (') (>i) j (.iii) (iv) (') 1 (>i) (i») (iv) (i) 1 (") (»i) (iv) 13 13 41 £4 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids, (iv) Other defects of the nose and throat. 23 Group IV.—Orthopedic and Postural Defects. (see note d). Under the Authority's Scheme (See note b). to Otherwise. .2) Total number treated. (see note e-)[/$$$] Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. (1) (2) (3) (1) !2) 13) Number of children treated. 8 123 131 TABLE V—DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist: — (a) Routine age-groups : AGE 5 6 7 8 1 9 10 11 12 13 14 15 TOTAL Number 184 342 317 414 453 398 426 385 331 320 153 3723 (b) Specials (see note (/)) 462 (c) TOTAL (Routine and Specials) 4.165 (2) Number found to require treatment 2,586 (3) Number actually treated 2,481 (4) Attendances made by children for treatment 4,872 (5) Half-days devoted to :— (7) Extractions Inspection 30 Permanent Teeth 372 Treatment . 415 Temporary Teeth 2957 TOTAL 445 Total 3329 (8) Administration of general anesthetics for extractions 1695 (S) Fillings;—(See note g) Permanent Teeth 2366 (9; Other operations:— Permanent Teeth 639 Temporary Teeth 2 Temporary Teeth 1140 Total 2308 Total 1779 TABLE VI.—UNCLEANLINESS AND VERMINOUS CONDITIONS (see note h). (i ) Average number of visits per school made during the year by the School Nurses 45 (il.) Total number of examinations of children in the schools by School Nurses 30.08R 1 ' Number of individual children found unclean (see note i) 280 (IV) Number of children cleansed under arrangements made by the Local Education Authority 279 (V) umber of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 0 (b) Under School Attendance Byelaws 0 24 NOTES ON TABLE IV. (a) The Tables should deal with all defects treated during the year, however they were brought to the Authority's notice, i.e., whether by routine inspection, special inspection, or otherwise, during the year in question or previously. (b) This heading should include all cases that received treatment under definite arrangements or agreements for treatment made by the Local Education Authority and sanotioned by the Board of Education under Section 80 of the Education Act, 1921. Cases which, after being recommended for treatment or advised to obtain it, actually received treatment by private practitioners, or by means of direct application to hospitals, or by the use of hospital tickets supplied by private persons, etc., should be entered under other headings. (c) If any treatment is given for more serious diseases of the ear (e.g., operative treatment in hospital) it should not be recorded here but In the body of the Sohool Medical Officer's Annual Report. (d) Postural defects which received non-residential treatment otherwise than at an orthopaedic clinic should not be recorded in this Table. (e) A child may be recorded in more than one category and therefore the total number of children treated will not necessarily be the same as the sum of the figures in the separate categories. (/) The heading " Specials" in this Table relates to all children Inspected by the School Dentist otherwise than in the course of the routine inspection of children in one of the age groups covered by the Authority's approved scheme, namely, to children specially selected by him, or referred by Medical Officers, Parents, Teachers, etc., on account of urgency. The number Inspected in each age group should be separately shown, as well as the total, but under "Specials" only the total number should be given. (<7) Temporary fillings, whether in permanent or temporary teeth, should be recorded as other operations. (H) A statement as to the arrangements made by the Local Eduoation Authority for cleansing verminous children and a record of the cases in which legal proceedings were taken, should be included in the body of the School Medical Officer's Report. (i) (i) All cases of uncleanliness, however slight, should be recorded. (li) The return should relate to individual children and not to instances of uncleanliness. N B-—The above Tables cover all the defects for which treatment is normally provided as part of the School Medical Service. Particulars as to the measures adopted by the Authority for providing treatment for other types of defect or for securing improvement in types of defect which do not fall to be treated under the Authority's own scheme and KiWht0il the Authorlty neither incur expenditure nor accept any responsibility, together with a statement of the effect of the measures taken, should be included in the body of the School Medical Officer's Report, t is convenient for such particulars to follow the headings of Table II. (Form 8 b.M.). 25 TABLE VII. LIST OF SCHOOLS IN THE BOROUGH School. Department. Authorized accommodation. Average No. on the Holls For qr. ended 31/12/3S. Head Teacher. C&mpsbourne Junr. Mixed 388 241 Mr H Turner „ Senr. Girls' 388 355 Miss G. S. Litchfield Infants' 400 248 Miss D. F. Smith Coldfall Mixed 520 564 Mr. G. Simmonds, B.A. Infants' 400 254 Miss M. N. Clarke Crouch End Senr. Boys' 360 300 Mr. J. Iliffe Junr. Mixed 400 416 Miss F. A. Barter Rokesly Infants' 480 406 Miss A E. Walmsley Highgate Mixed 328 299 Mr. T. E. Durban Infants' 264 146 Miss R. Spalding Harringay Senr. Boys' 312 254 Mr. G. F. Shaw, M.A. North Harringay Junr. Mxd. 448 447 Mr. J. H. Spilman, B Sc. Infants' 446 294 Miss H. M. Stone Harringay Senr. Girls' 320 237 Miss G. M. Ryde, B Sc. South Harringay Infants' it Junr. Mxd. 340 305 Miss R. Jones Stroud Green Senr. Mixed 350 419 Mr. F. W. .laggard Junr. Mixed 416 307 Miss E. M. Cockliill Infants' 352 272 Miss E. Pitson Muswell Hill Junr. Mixed 200 137 MissE. F. Catley St. Mary's Mixed 580 561 Mr. J. W. T. Harris Infants' 240 249 Miss M. D. Sibley St. Michael's Mixed 196 113 Mr. E. R. Lewis Infants' 168 87 Miss E. Towler St. James' Junr. Mixed 240 242 Mr. I. T. Plant Totals 8,536 7,153 26 APPENDIX I. REPORT by Mr. A. R. FRIER, Aural Surgeon. It is interesting to notice the change in the complaints treated at the Aural Clinic from the time when it was begun in in 1921. It was opened then for children suffering from chronic otorrlirea, and equipment was provided for treating suitable cases by zinc ionization. Every ear was examined to ascertain what was keeping up the suppuration, and if this was found to be sepsis in an accessible position, the ear was treated at the ( linic. If it was found to be sepsis in an inaccessible position, such as the mastoid, the parent was told that an operation was needed in hospital. It was left to the parent to decide which hospital to take the child. Also it was impressed on the mother that there was not much difficulty in having the operation done, but that the after-attendance would impose a severe strain on her and that if, owing to distance or to the care of a number of young children, her attendance could not be regular, it would be better to defer the operation till the child was older and able to go on its own. Very few mothers of children in elementary schools have maids and if the mother has to leave home for several hours regularly the work of the home becomes disorganised, meals unsatisfactory, and the health and comfort of all the members suffer. The actual time spent on dressing the ear is not great, but the delay in waiting for this is often great. It leads to irregular attendance, and an unhealed mastoid operation means more suffering than a mastoid which has not been operated upon. When the cases at the Clinic of long-standing otorrhoea had heen disposed of, there was opportunity for every child to be treated within a few days if he suffered from discharge from the ear. It was then easy to treat, and in the majority of cases ceased in a short time. Opportunity was then available for children — babies and todrllers—attending at infant welfare centres to be treated at the School Aural Clinic. Lifelong ear trouble often begins in the Pfe-sehool age. Measles, scarlatina and colds are attended with inflammation of the nose. Little children who suffer from these r,ften get their noses blocked by the inflammation and by the discharge, which cannot escape freely either by the nostrils or 27 into the throat. The result is that the inflammation persists and extends up the eustachian tube into the ear. Owing to the importance of treating inflammation of the nosu and to the introduction of a reasonable and efficient method of treatment by Dr. Gautier, of Paris, called diastolisation, much attention is paid to the nose at the Clinic, and the treatment is carried out there during the week by the nurses, or at other centres (Brook lioad. Coldfall School, Wightman lload and Highgate Infant Welfare Centres), or in many cases by an intelligent mother at home. The results have been good. Not only are the conditions in the nose and ear relieved, but mouth breathing is unnecessary, and the general health is improved, :ts an ample supply of air can now be taken into the chest. The following table gives a summary of the conditions treated and the results obtained:— Total (Bars). Cured. Lost Sight of. Still under treatment Hospital. Acute Suppurative Otitis Media 18 IS 2 — 1 Chronic Suppurative Otitis Media Due to (1) Tympanic sepsis 16 12 2 2 (2) T.S. & Granulations 5 4 - 1 - (3) T S. & Polypus 1 — 1 - - (4» T.S. Rhinitis 1 — — _ 1 Attic Disease 3 — 2 1 - Mastoid Disease 1 — — — 1 External Otitis 4 3 1 — - Not Diagnosed 1 — — 1 Totals 50 34 8 4 4 A. R. FRIEL, Aural Surgeon. 28 APPENDIX II. REPORT by Mr. TT. -T. SEDDON, Orthopeedic Surgeon. The follow ing are notes of Hornsey cases admitted to tlie lloyal National Orthopaedic Hospital's Country Branch at Stanmore, Middlesex, during the year: — (1) Girl, aged 6i, was re-admitted on 8.3.35 with rapidlyincreasing lateral curvature of the spine, due to infantile paralysis. The date of the original attack is not known, but it must have occurred very early in life, as the child had never walked or crawled. She was first admitted on 21.11.32 and remained in hospital for eighteen months. During this period the condition of the legs improved considerably, but there was little change in the condition of the abdominal muscles, which were also affected. It is the weakness of these muscles that has led to the development of the spinal curvature, and we are afraid that nothing can he done to correct this deformity. The child's legs are not vet strong enough to enable her to walk and we are proposing to transfer her to a Children's Home. It is possible that she may learn to walk in two or three years' time, and if this proves to be the case we shall consider admitting her again to see if surgical treatment can improve her condition still further. (2) Girl, age 13, was admitted on 8.7.35 for correction of a deformity of the knee. This child also had infantile paralysis early in life, which left her with a flail foot and a weakness of the muscles controlling the knee. The foot was dealt with in 1934 and a satisfactory result was obtained. However, the weakness of the knee still compelled her to wear a walking instrument; an operation was performed on 12.7.35 to enable her to walk without the instrument. The child was discharged on 22.11.35 ana her condition since then has been satisfactory. (3) Boy, age Ifi, suffered from infantile paralysis in 1927, which left him with partial paralvsis of the left leg and the right foot. He was admitted on 1.10.34. and a stabilising operation was performed on each foot. He was discharged on 4.4.35. 1 lir right foot is excellent, but there is still a residual weakness "f the left knee, which makes an instrument necessary. It is possible that we may be able to deal with this at a later date "s in the last case. 29 Although epidemics of infantile paralysis are rare in this country, sporadic cases appear not infrequently. A certain number recover completely, but a large proportion are left with a more or less extensive paralysis, which may be a permanent handicap. Fortunately much can be done to help these children by early treatment of the paralysed muscles, and by late operations, most of which aim at stabilising the joints at which there is deficient muscular control. So far, no entirely satisfactory method of preventing the paralysis has been discovered. Serum treatment is still of doubtful value, and vaccination against the disease has not yet gone beyond the experimental stage. (4) Girl, age 12, was admitted on 1.7-35 for amputation of a deformed right fifth toe. She was discharged on 25.7.35. (5) Girl, age 14. had an acute infection of the right knee at the age of two. Several operations were performed at another hospital and she was left with a stiff flexed knee. When seen at the Clinic it was found that she had developed a curvature of the spine, due to the deformity of the leg. She was admitted on 25.7.35, and an operation was performed which gave her a straight leg; in this way the curvature of the spine has been corrected. She was finally discharged on 29.11.35. (6) Girl, age 6\, was born with a right congenital club foot. She had been treated elsewhere early in life and the deformity had been corrected apart from a turning in of the forefoot. This is not a serious residual deformity, but it gives the gait an awkward appearance, and may cause the child to stumble when walking. She was admitted on 7.8.35 and an operation was performed which resulted in complete correction of the deformity. She was discharged in plaster on 30.10.35, re-admitted for her final treatment on 9.12.35, and discharged on 3.2.36. (7) Girl, age 8, injured the right elbow at the age of three. She recovered with a good range of flexion and extension, but pronation and supination were abolished as a result of fusion between the upper ends of the radius and ulna. An attempt was made to correct this bv operation in 1931, but without success. Later, the parents were anxious that something more should be done, and the child was readmitted on 30.10.35. After complete 30 investigation, including exploration of the joint, it was found that the bones could not be freed sufficiently to allow of restoration of pronation and supination. She was discharged on 1.1.36. In reviewing the patients from tbe Hornsey area who have been treated in hospital, one finds that there are grounds for a certain amount of satisfaction. In four cases the patient's condition has been improved, and in one case (the girl age 6A) it is safe to say that the child was completely cured. There is, however, no doubt that a considerable part of operative orthopfedic surgery is concerned with making the best of a badlydeformed limb rather than with complete restoration of function. The most encouraging part of the work today is the preventive treatment carried out at the Clinic. The fact that only seven patients out of 123 have been admitted during the year is in itself encouraging. To take one example of the value of Clinic work: large numbers of children with knock-knees are seen at the Hornsey Clinic, but they are being sent to us before the deformity has become at all marked. It is not many years since operative correction was frequently necessary for the cure of this condition; it is now possible to deal with almost every case by alteration to the shoes, exercises and sometimes the application of splints. The need for operation has almost gone. As the early manifestations of crippling diseases become more widely known it is certain that severe residual deformity will become increasingly rare. H. J. SEDDON, Orthopadic Surgeon.