A C439(i)HrRn8V BOROUGH OF HORNSEY. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR 1936 R. P. GARROW, M.D., D.P.H. Printed by "The Hornsey Journal." Ltd., 161, Tottenham Lane. N.8, HOR 028 Borough of bornsey ANNUAL REPORT fob 1936 of the Medical Officer of Health. INDEX. Admissions to Hospitals, 49. Ambulances, 7, 8. Ante-natal Clinics and Services, 11, 13, 53. Area of Borough, 6. Attack rate, Infectious disease, 50. Bacteriological examinations, 8. Bakehouses, 23. Baths and Wash-houses, 24. Bed-bug eradication, 28. Births and rates, 5, 6, 7, 15, 48. Blindness prevention, 40. Borough Nursing Association, 9. Butchers, 23 Bye-laws, 24. Cancer deaths, 45, 46, 48. Carbide, 30. Cellulose spirit, 30. Cerebro-spinal meningitis, 45, 46, 49, 50. Charity expenditure, 10. Children Acts, 7, 18, 53. Cinemas, 23. City of London Maternity Hospital, 13. Cleansing station, 27. Clinics, 7, 14, 53. Committees, 1, 2, Controlled houses, 24. Dairies, 23, 36. Deaths and rates, 5, 6, 7, 44, 45, 46, 48. Causes of, 45, 46. Decontrolled houses, 24. Dental scheme and treatment, 3, 16. Diarrhoea, 7, 45, 46, 48. Diphtheria, 45, 46, 48, 49, 50. immunization, 39. Diseases of Animals Acts, 4, 41. Disinfection and Dislnfestation, 27. ,, Vans, 28. Dog nuisance, 28. Drain tests. 21. Drains opened, 21. Drainage, 21. Dysentery, 49. 50. Encephalitis letharglca, 45, 46, 50 Enteric fever. 45, 46, 48. 49 50 Erysipelas, 49, 60. Factories and workshops, 23, 52. Fish shops, 23. food Inspection, 36. ,, condemned, 38. ,, samples, 38. F°od stores provided, 24, Foster mothers and Health Committee, 1. ,, Visiting, 7, 53. „ Visitors, 4, 14. Home Helps, 17. Home Nursing, 10. Hornsey Central Hospital, 10. Hornsey Deanery Association, 10. Hornsey Housing Trust, Ltd., 28. Hornsey Nursing Association, 9. Hospital services, 7, 10, 13. Houses controlled and decontrolled, 24. Housing, 29. Byelaws, 24. Families rehoused, 32. House-to-house inspections, 33. Inspections, 20. Overcrowding Survey, 31, 35. Returns of work, 20. Statistics, 31, 32, 33, 34, 35. Trust, 28. Hydro-carbon, 30. Illegitimate births, 6, 7. „ deaths, 6, 7. Immunization, Diphtheria, 39. Infant deaths and rates, 7, 47, 48. „ „ Causes, 47. Infant Life Protection, 7, 18, 53. Infantile paralysis, 45, 46, 50. Infectious disease, 39. Attack rate, 50. Diphtheria, 45, 46, 48, 49, 50. Notifications, 49, 50. Scarlet fever, 45, 46, 48, 49, 50. Inhabited houses, 6. Inquests, 41. Inspections made, 20. Isolation Hospital, cases admitted, 49. Laboratory work, 8. Library books, 27. Libraries (Shops) Act, 25. Licences, 24, 37. Malaria, 50. Maternal mortality, 7. Maternity and Child Welfare Committee, 2. Maternity cases arrangements, 13. Masseuse, 19. Maternity and Child Walfare— Analysis of attendances, 53. Ante-natal, 11, 13, 53. Births notified, 15. Centres, 5, 7, 13, 53. Children Act, 7, 18, 53. Clinics, 14, 53. Committee, 2. Maternity and Child Welfare (Cont'd) Dental treatment, 3, 16. Foster children, 7, 18, 53. Health visiting, 7, 53. Home Helps, 17. Hospital arrangements, 7, 10, 13. „ maternity cases, 13, 53 Maternal deaths, 7. Midwife, 4. 11, 53. Fee reduced, 12. Milk grants, 17. New Centre, 12. Orthopaedic scheme, 7, 19. Premises, 12. 14. Sessions, 14, 53. Staff, 4, 14. Time-table, 14. Toddlers' playroom, 18. Voluntary Committees, 18. Year's work, 53. Measles, 7, 45, 46, 48. Meat inspection, 37. Meningitis, 49. Midwives, 4, 7, 11. 53. Milk grants, 17. licences, 37. ,, samples, 36. „ shops, 36. ,, (Special Designations) Order, 1936, 36. Mortuary, 41. Music and Dancing Licences, 33. Naphtha, 30. North Middlesex Hospital, 10, 13. Notifications of Births Act, 15. Nursing Association, 9. „ Classes, 9. Nursing Homes, 10. Ophthalmia neonatorum, 40, 49, 50. Orthopaedic scheme, 7, 19. Outworkers, 23, 55. Overcrowding Survey, 31, 35. Para-typhoid, 49, 50. Pests. House, 27. Petroleum Acts, 23, 28. licences, 24. Piggeries. 21, 41. Pneumonia, 45, 46, 49, 50. Poliomyelitis. 50. Polio Encephalitis, 50. Population, 6, 44. Preface, 5. Puerperal fever and pyrexia, 3, 7, 49, 50. Rag Flock Act, 20. Rateable value and produce of Id. rate, 6. Refuse shoots, 23. Restaurants, 23. Retail Meat Dealers Act. 25. Sale of Food and Drugs Act, 38. Sanitary notices served, 21. Sanitary work, 19, 20, 21. Scabies, 20. Scarlet fever, 45 , 46 , 48 , 49 , 50. Schools, 30. Shoots, refuse, 23. Shops Acts, 25. Action, 25. „ list of, 26. Slaughter-houses, 23, 38. Small-pox, 45, 46. Smoke, 21. Social services, 10. Stables, 20. Staff, 3, 4, 14. Statutory notices, 21. Statistics, 6, 44 to 55. Still-births, 6, 48. Subscriptions, Annual, 9, 10. Sunday Trading (Shops) Act, 25. Swimming Pool, 30, 31. Tables, list of, 43. Toddlers' playroom, 18. Tuberculosis, Cases of, 51, 52. Deaths, 45, 46, 48, 51,52. „ Register, 41, 51, 52. Sanatoria and beds, 41. „ Sputums, 8. Typhoid fever, 45. 46. 48. 49, 50. Unmarried mothers, 10. Vaccination, 40. Verminous houses, 20. Veterinary Inspector, 4, 41. Visits by Inspectors, 20. Visiting of Children, 7, 18, 53. Vital statistics, 6, 7, 44. „ „ England, &c., 44. Voluntary Workers, 18. Ward boundaries, 43. Water supply, 19. Welfare Centres, 14. Whooping-cough, 7. 45. 46, 48 Workshops, 54. 1 HEALTH COMMITTEE as at 31st December, 1936. Alderman J. W. Rowlands. J.P.(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. „ J. W. Shipp, 40. Coleridge Road, N.8. ,, R. Steeds, 19, Coolhurst Road, N.8 ,, C. H. Summers by, J.P., 49, Queen's Avenue, N.10. Councillor Mrs. «T. H. Barrenger, 18, Fordington Road, N.6. ,, Elliott E. Brooks, 122. Crouch Hill, N.8. „ Mrs. C. M. Cave, 10, Wood Vale, N.10. „ J. Edwards, 102, Turnpike Lane, N.8. ,, 8. G. Goulding, Woodlands, Cranley Gardens, N.10. ,, W. J. Grimshaw, 25, Sheldon Avenue, N.6. ,, Mrs. M. N. Hill, 16, Bishopswood Road, N.6. i, G. K. M. Hutcitinson, 8, Grosvenor Gardens, N.10. ,, W. J. Lendrum, 4, Creighton Avenue, N.10. ,, F. L. Pascoe, 110, Highgate Hill, N.6. i, T. Tivendale, 12, Colnev Hatch Lane, 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, 1936. Councillor Elliott E. Brooks(Chairman), 122, Crouch Hill, N.8. Tiie Mayor, Councillor C. Winkley, J.P., 72, Woodside Avenue, N.10. Alderman W. W. Kelland, M.A., 14. Hillside Mansions, N.6. ,, J. W. Shipp, 40. Coleridge Road. N.8. ,, R. Steeds, 19, Coolhurst Road, N.8. ,, C. H. Summers by, J.P., 49. Queen's Avenue, N.10. Councillor Mrs. .T. H. Barrexger. 18. Fordington Road. N.G. Mrs. C. M. Cave, 10, Wood Vale, N.10. ,, J. Edwards, 102, Turnpike Lane, N.8. ,, S. G. Goulding, Woodlands. Cranley Gardens, N.10. ,, H. G. R. Griffin*, 12, Avenue Road. N.6. ,, W. J. Grimshaw, 25, Sheldon Avenue, N.6. ,, Mrs. M. N. Hill, 16, Bishops wood Road, N.6. ,, G. K. M. Hutchinson, 8, Grosvenor Gardens, N.10. ,, W. .T. Lendrum, 4, Creighton Avenue, N.10. ,, T. Tivendale, 12. Colnev Hatch Lane, N.10. ,, L. J. Valette, 59, Allison Road, N.8. ,, W. V. Wall, 10, Winchester Place, N.6. Selected Members: Mrs. F. 0. Dixon, 2, Woodside Avenue, N.6. Mrs. H. M. Inward, 99, Pemberton Road, N.4. Mrs. M. King, 45, Wood Vale, N.10. 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 and School Medical Officer 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., D.C.O.G. †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.l. Dr. A. W. Bourne, 14, Devonshire Street, W.l. Dr. L. H. W. Williams, 89, Harley Street, W.l. †Dentists (M.&C.W. Dental Scheme) Dr.B.Hamilton, L.D.S., L.R.C.S., L.R.C.P. (Resigned 30th April, 1936). L.Rowlands, L.D.S. (Resigned 23rd Dec., 1935). H.A.Creeke, L.D.S. (Appointed 27th April, 1936). †*Senior Sanitary Inspector, Petroleum Inspector, Shops Acts Inspector. Henry Eastwood, M.R.San.I. M.S.I.A. Cert. R.San.I. Cert. Insp. of Meat and Poods. †*Sanitary Inspectors and Shops Acts Inspectors 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 Poods. H. G. Bartram, (Resigned 30th March, 1936). M.S.I.A. Cert. R.San.I. Cert. Insp. of Meat and Poods. 4 †*Sanitary Inspectors and Shops Acts Inspectors (contd.) f Chief Clerk ... +Assistant Clerks f Health Visitors †Midwife †Mortuary Keeper †Disinfectors †Medical Services Motor Driver ‡Veterinary Inspector under W. G. Colebeck, (Resigned 30th July, 1936). M.S.I.A. Cert. R.San.I. Cert. Insp. of Meat and Foods. W. J. Wilson, (Appointed from 15th June, 1936). M.S.I.A. Cert. R.San.I. Cert. Insp. of Meat and Foods. H. Foster, (Appointed from 24th Aug., 1936). M.S.I.A. Cert. R.San.I. cert. Insp. of Meat and Poods. W. Gilroy. E. Cheesman. A. Wickham, (Resigned 30th Sept., 1936). N. Smith. W. A. Simons. (Appointed from 5th Oct., 1936). A. Glover, (Retired 15th Nov., 1936). 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. Miss E. Hart, (Appointed from 23rd Nov.. 1936). H.V. Cert., S.R.N., C.M.B. F. E. H. Ross (part time). H.V. Cert., S.R.N., C.M.B. M. Andrews, C.M.B. C. F. Catlin. W. H. Lewis. P. Hall. P. Martin. 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 on the Health of the Borough for the year ending December 31st, 1930. The births numbered 1.155 and the deaths 1.152, a state of population equilibrium. Only 40 infants under 1 year died for each 1,000 infants born. Of the total 1,152 deaths, considerably more than half, namely, 051, were in persons of 65 years or over, and of these 367 had reached the age of 75 years or over. These figures mean that Hornsey fully maintains its reputation as a healthy Borough. The year has been one of great activity in the Sanitary Inspectors' department, on account of the Housing Survey, and I desire to acknowledge the able way in which the Chief Sanitary Inspector. Mr. Eastwood, and his staff co-operated with the men engaged temporarily in carrying out this survey. Particulars of the results of this survey are contained in this Report. The Maternity and Child Welfare Department has also had a busy year, in which Health Visitors, Voluntary Workers and Medical Officers at the Centres have worked harmoniously in the interests of the expectant mother, the infant and the young child up to the age of entry into school, when further responsibility for general health and physical development passes to the Education Committee. I desire to thank the Chairman and Members of the Health and Maternity and Child Welfare Committees, and, indeed, every Member of the Council, for their continued interest in the Public Health. I am, Mr. Mayor. Ladies and Gentlemen, Your obedient servant, R. P. GARROW. Medical Officer of Health. 6 STATISTICS FOR 1936. (SECTION A.) Social and Economic Statistics. Area (acres) 2,874 Population (Census 1931) 95,524 Do., Registrar-General's estimate (mid 1936) 96,160 Number of inhabited bouses (end of 1936), according to Rate Books 22,144 Rateable value (General Rate) £l,066,403 Product of a penny rate £4,200 LIVE BIRTHS— Legitimate Males 573 ,, Females 530 Illegitimate Males 24 ,, Females 28 Total 1,155 Birth Rate 120 per 1,000 population (Registrar-General's estimate). STILL-BIRTHS— Legitimate Males 14 ,, Females 14 Illegitimate Males 1 ,, Females 2 Total 31 Rate per 1,000 total (live and still) births, 261. DEATHS— Male 522 Female 630 Total 1.152 Death Rate 1198 per 1,000 population (Registrar-General's estimate) 7 Deaths from Puerperal Causes. Puerperal sepsis Other puerperal causes Total Deaths. 1 2 3 Rate per 1,000 total (live and still) births 0.84 1.68 2.52 England and Wales. 1.34 2.31 3.65 Deaths of Infants under I Year of Age. Legitimate Males 21, Females 20 = 41 Illegitimate ,, 2, ,, 4=6 Total 47 Death Rate of Infants under 1 Year of Age. All infants per 1,000 live births 400 Legitimate infants per 1.000 legitimate live births 371 Illegitimate infants per 1.000 illegitimate live births 115 4 Deaths from Measles (all ages) 3 Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under 2 years of age) 8 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (Section B). Under this heading 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)Orthopedic Treatment. 8 Past reports have set out in detail the general health services available to the population of Hornsey within the Borough and in the Metropolis. No population in England—or, indeed, anywhere—has access to a more lavish provision for the prevention of sickness, the cure of disease and the alleviation of suffering. That full advantage is taken of these services is obvious to anyone who reads the annual reports of the Voluntary Hospitals, Nursing Associations and Municipal Authorities in Greater London. LABORATORY FACILITIES. The specimens examined in the laboratory at the Isolation Hospital during 1936 were as follows: — Negative. Positive. Diphtheria specimens 961 46 Sputum (T.B.) ,, 227 33 Enteric fever ,, 7 2 Other ,, 12 3 1,207 84 Total 1,291 AMBULANCE FACILITIES. The ambulance arrangements with the London County Council for the transport of infectious cases, and the Council's ambulance for street accidents and general ambulances services arc unaltered and continue to be satisfactory and adequate. The " Morris Viceroy " motor conveyance for the transport of mentally and physically defective children, purchased in October, 1931. continues in active service, but was out of action for a period of over three weeks in June, when hired vehicles had to be used for the daily journeys. It travelled 11.299 miles and 21.119 passengers were carried ; 665 miles were covered in addition by hired vehicles. The following is a statement of the work done by the Borough Ambulance under the Fire Brigade: — Calls- Accidents and illness in street 415 Private cases 719 1,134 Persons conveyed 1,131 Mileage 7,004 Hours ambulance was engaged 881 9 NURSING FACILITIES. HORNSEY NURSING ASSOCIATION. President : The Mayor of Hornsey. Hon. Secretary: Mr. R. H. Crookall. 9. Birchington Road, N.8. Hon. Treasurer: Mr. S. M. Mason, 50. North Hill, N.6. Superintendent: Miss Ivett. 2, Ravenstone Road. N.8. Tele.: Bowes Park 3032. The work of this Association continues to grow steadily year after year. There is a staff of 7 nurses and the Superintendent. During 1936 they paid 14.345 visits to 680 patients, an increase of 230 and 38 respectively on 1935. The following is a statement of the infectious diseases nursed during the year by the Queen's District Nurses: — NAME OP DISEASE. No. of NewCases. No. of Visits. No. Convalescent. No. sent to Hospital. No. Died at Home. Pneumonia 32 342 22 — 8 Tuberculosis 14 657 7 2 1 Influenza 19 167 13 — 1 Measles 7 98 8 - — „ and Pneumonia 9 156 1 — — Mumps 2 15 2 — — Chicken Pox 1 2 1 — — Whooping Cough 2 28 2 — - Other diseases in children under 5 35 100 31 2 - Elementary School Children 59 340 59 - — A sum of 50 guineas is subscribed to the Association annually by the Council and 5 guineas by the Education Committee for this service. HOME NURSING CLASSES were again successfully conducted during the Winter Session by Miss Ivett. Superintendent of the District Nursing Association, at Hornsey High School, under the Higher Education Committee. 10 NURSING HOMES.—There are 23 Nursing Homes, with a total of 242 beds, in the Borough registered with the Middlesex County Council under the Nursing Homes Registration Act, 1927. Thirteen of these, with a total of 83 beds, are registered for the reception of maternity cases. NORTH MIDDLESEX HOSPITAL.—The number of beds at Xorth Middlesex Hospital is 950. The number of cases from Hornsey treated there in 1936 was:—Maternity 172. other cases 1.250, a total of 1,422. HORXSEY CENTRAL HOSPITAL.—The Hospital, which normally has 49 beds, has been reduced to 38, owing to the closing for rebuilding of the Children's Ward, which it is hoped will commence, early in 1937. Meantime, 6 cots are provided in the adult wards. The Hospital is provided with up-to-date X-Rav and Ultraviolet Ray Departments. There were 823 cases treated during the year, of which 678 belonged to the Borough. In addition, 1,922 out-patients were treated. The Council subscribe an annual sum of £200 to the Hospital funds. HORNSEY DEANERY ASSOCIATION.—An annual sum of £50 is subscribed by the Council to this Home for Unmarried Mothers in Eastern Road. PUBLIC ASSISTANCE AND CHARITIES. Mr. F. L. Monnington, Public Assistance Officer, has furnished the following list of sums, so far as available, expended in Hornsey in 1936 from public and voluntary sources: — Public Assistance— £ s. d. £ s. d. Hornsey, North 19,662 17 10 Hornsey, South 10,781 10 4 30,000 8 2 Education Authority— Central Care Committee (Boots) ... 174 1 0 do. (Spectacles) 14 16 3 Children's Holiday Fund—168 Children 278 10 5 11 Welfare Centre— Milk to Mothers and Children Hornsey B.L. & U.S.F. Muswell Hill B.L. & U.S.F Soldiers' and Sailors' Help Society Hornsey Fuel Fund Hornsey Distress Committee Y.M.C.A Y.W.C.A Christ Church Social Services Rotarv Club—Xmas Dinners, &c. Anonymous Mrs. Ashworth—Parcels Mrs. Lovell Harrison— Special Fund for Ex-Servicemen Hornsey Parochial Charities— Pensions 852 4 0 Hospital Nursing grants 105 0 0 Apprenticeships 101 0 0 Education Scholarships 187 13 4 £ s. d. 536 0 0 511 11 7 70 0 10 72 0 0 106 5 0 51 9 3 41 0 0 5 0 0 30 0 0 40 0 0 10 0 0 19 0 0 10 0 0 Hornsey Housing Trust—Tenants' Assistance Fund. Furniture. Removals, Convalescent Homes. &c. Hornsey Nursing Association— 698 Free Visits to necessitous poor Plaza Cinema—53 passes to Old Age Pensioners ... 745 17 4 144 3 10 Total £32,860 3 8 MIDWIFERY SERVICES. The Local Supervising Authority under the Midwives Act is the Middlesex County Council. There are 25 Midwives, including the Municipal Midwife, notified to the Middlesex County Council as practising in the Borough, 15 of whom reside outside the Borough. The Municipal Midwife attended 189 births, in addition to 88 ante-natal clinics held at the Welfare Centres—Brook Road, 12 Wightman Road. Church Road, Highgate, and Coldfall School Clinic. One of the conditions upon which the Council's Midwife accepts a case is that the expectant mother shall attend an antenatal clinic. A reduction of her fee was made in 43 necessitous cases. 1,926 births have been attended by the Borough Midwife since the appointment was first made in 1922. MATERNITY AND CHILD WELFARE. NEW MATERNITY AND CHILD WELFARE CENTRE. The Council's Maternity and Child Welfare services have been carried on successfully on the same lines as in previous years. The only change is the transfer of the Welfare Centre from the Mission Hall in Brook Road, Campsbourne, to a new Centre, built as a first floor on the School Clinic at the rear of the Town Hall, Crouch End. The building was completed at the end of 1936, but was not opened until March 1st, 1937. The Minister of Health, the Rt. Hon. Sir Kingsley Wood, P.C., M.P., was unfortunately prevented at the last moment from carrying out his promise to open the new Centre, but Sir Arthur MacNalty, Chief Medical Officer of the Ministry of Health, performed the ceremony in a speech which congratulated Hornsey on its excellent record in the past, and directed attention to the importance of safeguarding the health and physical development of the " toddler." The work of this new Centre since March 1st, 1937, is not strictly matter for recording in the present Report, which deals with the year 1936. However, as there was doubt in the minds of a few people as to the wisdom of transferring the Centre from Campsbourne to Crouch End, I am glad to be able to report that already, within a few months of opening, the new Centre is doing considerably more work than the old. There has been no falling off in attendance of mothers with their children from the Campsbourne area and there has been a great increase from the Crouch End district. 13 ANTE-NATAL AND MATERNITY SERVICES. The number of maternity cases occurring in the North Middlesex Hospital from the Borough during the year is veryconsiderable—in 1936 it was 172. An arrangement was come to with the County Council in June whereby normal cases shall, after booking at and attending the ante-natal clinic at the Hospital for the first time, attend for routine supervision at the antenatal clinic at one of our Welfare Centres until about the thirtysixth week. This arrangement is found to be a boon to mothers in that it saves them expense and the long journey to Edmonton. Another advantageous arrangement has been made with the City of London Maternity Hospital, which will come into force from the 1st April. 1937. whereby maternity cases will be admitted to the Hospital from Hornsey for the payment by the Council of £1 1s. 0d. per case. MATERNITY AND CHILD WELFARE CENTRES TIME TABLE. 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 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, Wight man Road, opened in September, 1918 Held under Lease for 99 years, from 29/9/88 Yearly ground rent £12 Lease purchased by the Council on 24/1/18 Stroud Green Finsbury Park N. & S. Haringey 1st and 3rd Tuesdays. 2—4 Dr. J Sutherland 1st and 3rd Mondays, 2—4 (Dr J. Sutherland) Every Tuesday. 10—12 and 2nd & 4th Tuesdays. 2—4 Dr. M Radford Miss A. Glover retired 15/11/36 Miss K. Hart appointed 23/11/36 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. Su' herland 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 15 NOTIFICATION OF BIRTHS ACT. 1907 & 1915. All live births and still births of seven months and over must be notified to the Medical Officer of Health within 3G hours, in addition to being registered within it period of six weeks after birth. The number of births notified under the Acts during 1936 was: — Male. Female. Total. Live births 679 653 1,332 Still births 19 17 36 698 670 1,368 The births were notified : — By Doctors 124 ,, Borough Midwife 169 ,, other Midwives 351 „ Hospitals 173 ,, parents 37 ,, others 462 1,316 Unnotified (from Registrar's return): — Live births 47 Still births 5 — 52 1,368 Of this number there were: — Live births. Still births. Occurring in the Borough and transferred to other districts 204 5 Belonging to Hornsey and occurring in Hospitals, etc., outside the district 543 20 16 The 1,159 nett number of notified births belonging to Hornsey were divided among the districts of the Centres as follows: — Brook Road 523 Wightman Road 309 Highgate 300 Coldfall Sub-Centre 27 1,159 MATERNITY AND CHILD WELFARE DENTAL SCHEME. The Dental Scheme for mothers and young children, started in 1928, continues to do good work. The cost of dentures for mothers, in excess of what the mothers are able to pay, was borne by the Voluntary Committees of the Centres until 1936. when it was taken over by the Maternity and Child Welfare Committee. The following is a record for the year of the Dental Clinic for Mothers and Children Mothers. Children. Clinics held 86 Old cases 301 107 New cases 56 97 Total attendances 357 204 Finished cases 33 103 Attendances for dentures 151 — Dentures provided 29 — Dentures repaired 3 — Teeth extracted 413 99 Fillings done 17 10 Inspections 21 68 Gas cases 77 44 Local injections 57 1 Other treatments (dressings, scaling, gum treatment, etc.) 10 73 A charge of 7s. 6d. per session is made for the use of the Dental facilities at the School Clinic by the Education Committee. 17 MILK (MOTHERS & CHILDREN) ORDERS. 1,934 applications for milk under this Order were dealt with during the year, of which 1,357 were granted and 37 refused. 1 pint milk daily free 1,021 2 pints ,, ,, 229 3 pints „ ,, 4 1 pint ,, ,, half-price 40 2 pints ,, „ ,, 26 llb. dried milk weekly free 36 1½lbs. „ ,, ,, ,, 1 Not granted 37 1,394 The number last year was 1.272. The total of the accounts paid to 31st December amounted to £536. 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. HOME HELPS. The Hornsey Home Helps Society was started by the Voluntary Workers in 1930 and. in spite of the great difficulties connected with this form of voluntary social service, has continued to show increased work each year. I am indebted to the Hon. Secretary, Mrs. Inward, for the following report on the work of the Society for 1936: — " I have much pleasure in presenting to you a report of the Home Help Service for 1936. The number of Mothers served:—66. No. 1 Centre 20 No. 2 21 No. 3 14 Not attached to any Centre 11 66 The number of Helps on books:—8. There is great difficulty in obtaining really efficient Helps owing to the uncertainty of the date of confinement and long hours of service. 18 Mothers recommend Helps to friends, who often offer them permanent work at higher wages. The full fee is paid by Mothers who can afford, otherwise the Centre pays the balance of fee, also fares and employees' share of the National Health Insurance and postage. Enclosed is Auditor's statement of accounts. H. M. Inward, Hon. Sec. and Treasurer." VOLUNTARY COMMITTEES. Assistance to mothers and children attending the Centres has been rendered by the Voluntary Committees during the year:— Sent for holidays 8 Sent to Convalescent Homes 2 Dentures provided 8 Spectacles provided 5 Home Helps provided 26 Surgical instruments provided 1 TODDLERS' PLAYROOM AT HIGHGATE. The Toddlers' Playroom, started in November. 1931, under Miss Benn, has a morning session from 9—12 on five days per week (Monday to Friday). There are 25 children between the ages of 2 and 5 years on the roll, who made a total of 3,331 attendances during the year. INFANT LIFE PROTECTION. CHILDREN ACT. 1908, AND CHILDREN & 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. The number of requests for foster-mothers is much in excess of the number available and requests are often received from Societies and Authorities outside the Borough. 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; — 19 No. of foster-mothers on the register— At the beginning of 1930 ,, ,, end ,, No. of foster-children on the register— At the beginning of 1936 ,, ,, end „ Died during the year On whom inquests were held during the year Visits to foster-children— 1st Visits Total Visits Centre— No. 3 No. 1. No. 2. & Sub. Total. 26 18 11 55 21 16 15 52 20 16 15 51 24 16 19 59 - 1 - 1 21 24 5 50 198 236 80 514 No proceedings were taken during the year. ORTHOPAEDICS. The Surgeon attends monthly and the Masseuse three times weekly for the treatment of elementary school children and children under five years. The following are the statistics for the year for children under five. Surgeon. Masseuse. Sessions held 10 141 Children treated—New cases 28 - Old cases 61 - ,, attendances 89 387 The cost, which is divided proportionately between the Education and Maternity and Child Welfare Committees, was £21 12s. l1d. for the treatment of children under five years for the year to 31st March, 1937. SANITARY CIRCUMSTANCES OF THE AREA. (Section C.) The Minister of Health requires information on extensions or developments regarding— Water supply. Drainage and sewerage. Rivers and streams—Prevention of pollution. Closet accommodation. Public cleansing. 20 Sanitary inspection of the area. Shops. Smoke abatement. Swimming baths and pools. Eradication of bed bugs. 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:— Visits. House-to-house inspections 130 Special inspections 1,392 Re-inspections 7,133 Transfer to Council houses 4 Notifiable infectious diseases 212 Tuberculosis 30 Deaths 56 Scabies 5 Verminous houses 88 Shops Acts 568 Factories, workshops and outworkers 208 Rent Restriction Act 3 Cinemas, etc 12 Overcrowding 184 Petroleum stores 202 Rag Flock Act 2 Dairies and milkshops 30 Bakehouses 39 Slaughter-houses 46 Butchers' shops 33 Restaurant kitchens 20 Other food shops 98 Offensive trades (fish frying) 10 Annual licences (Music and Dancing) 33 Stables 12 21 Piggeries 2 Conveniences 10 Smoke observations 14 Sidings 2 Refuse tips 6 Passages 29 Allotments 2 Drainage 252 Drainage Fee tests. Water tests applied (new drains) 61 Smoke and chemical tests applied (old drains) 45 Drains examined under Sec. 41, Public Health Act, 1875 2 Small-pox .Contacts—Visits 2 10,982 NOTICES. The Notices given during the year are as follows: — Under the Verbal Preliminary Statutory Public Health and Housing Acts 269 860 86 Housing Bye-Laws — 42 27 Shops Act, 1934 7 35 — Increase of Rents Act — 1 — 276 938 113 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 27 Repairs or amendments to existing drains 73 Drains or guillies unstopped or cleansed 111 Manholes provided 45 do. repaired 49 22 Intercepting traps fixed 40 New gulley traps fixed 114 New soil pipes and ventilating shafts fixed 50 Soil pipes and ventilating shafts repaired 44 Fresh-air inlets provided or repaired 100 Water-Closets and Sanitary Fittings. New water-closet buildings 22 New water-closet basins fixed 247 Water-closets unstopped, cleansed or repaired 45 New check cisterns fitted to water-closets; existing check cisterns repaired 110 New sinks provided 19G New lavatory basins provided 84 New waste-pipes fixed 161 Waste-pipes trapped, repaired or unstopped 230 Waste-pipes diverted into proper drain 23 Baths provided or made usable 67 Urinals cleansed 14 Miscellaneous. Roofs repaired 327 Eaves, guttering renewed, cleansed or repaired 154 Rain-water pipes provided, repaired or unstopped 118 do. disconnected from drains Damp walls remedied 110 Damp-proof courses inserted Paving of yards repaired 133 Premises structurally repaired 1,073 Rooms cleansed, distempered or papered 780 Rooms disinfested of vermin 97 Work-rooms cleansed or repaired 14 Drinking-water cisterns repaired, cleansed and covered ... 64 Water supply reinstated 4 do. (additional) provided 7 Windows and skylights provided or made usable 183 Sub-floor ventilation 26 Floors repaired 26 Window sills repaired 95 23 Sash cords and fittings repaired 156 Sanitary dustbins provided 113 Accumulations of manure and refuse removed 50 Stoves, ranges and coppers repaired or renewed 206 Sundry items 963 Food stores provided 39 6,669 Factories and Workshops. Defects Remedied. Sanitary accommodation—Insufficient 4 Unsuitable or defective 8 Not separate for sexes 10 Workrooms cleansed or repaired 14 36 PREMISES INSPECTED PERIODICALLY. The following premises were inspected periodically during the year and any matters requiring attention were dealt with: — No. in District. Dairies and milkshops 36 Milk purveyors in connection with other businesses 77 Bakehouses 33 Catering trades 82 Slaughter-houses 6 Butchers' shops 54 Fish shops 23 Factories, workshops and work-places 314 Outworkers' premises 158 Cinemas 8 Places of public entertainment 32 Shoots (refuse) 2 Offensive trades (fish frying) 10 Licensed petroleum stores 85 920 24 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. The Byelaws were confirmed on 13th May, 1930, and will be superseded in 1937 by amended byelaws confirmed on 5th May, 1937, and made necessary by the new standards laid down in the Housing Act, 1936. The present byelaws 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 (Restriction) Acts. 19:20. 1923 and 1933. The numbers on the register at present are classified as follows:— Decontrolled lodging-houses 355 Partly controlled 53 Fully controlled 103 Total 511 Forty-two houses have been dealt with under these Byelaws during the year and the following works carried out: — Byelaw 11 (f) Sash-cords and window fittings 5 15 (b) Water supplies 4 15 (c) Washing accommodation 16 15 (d) Food stores 53 15 (e) Preparation and cooking of food 5 17 Artificial lighting 5 88 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 very popular and are satisfying a long felt want, particularly in the immediate neighbourhood. 25 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 proceeded satisfactorily. Three new Shops Acts come into operation next year, namely:— The Shops Act, 1936, which applies to premises and places where the business of lending books or periodicals is carried on for the purposes of gain. The Retail Meat Dealers' Shops (Sunday Closing) Act, 1936. The Shops (Sunday Trading Restriction) Act, 1936. 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:— Compiled Notices. with. Temperature 7 7 Sanitary accommodation 2 2 Washing facilities 10 10 Meal facilities 7 7 26 Five hundred and and sixty-eight visits have been paid to shops during the year, and, apart from a number of minor infringements, which were dealt with, the provisions of the Shops Acts, 1912-34, have, generally speaking, been well observed. There are 1,366 shops in the Borough engaged in the following trades:— Shops. Antiques 5 Bakers 28 Butchers 54 Builders and Builders' Merchants 15 Carpets and Lino 6 Catering 81 Chemists 26 China and Glass 7 Cleaners and Dyers 7 Coal Merchants 31 Confectioners 94 Cooked Meats 8 Corn Chandlers 7 Drapers, Ladies' Outfitters, Milliners, etc. 125 Electrical, Radio and Gas Fittings 41 Fishmongers 23 Florists 14 Footwear 67 Furniture 37 Greengrocery 71 Grocers 128 Hairdressers 64 Herbalists and Health Food Stores 4 Household and Domestic Stores, Oil and Colour Shops, and Bazaars 23 Ironmongers 14 Watches, Jewellery and Pawnbroker 17 Leather Goods and Saddlers 9 Milkshops 36 Music, etc. 8 Newsagents, Stationers, Bookshops and Libraries 76 27 Motors, Motor-cycles and Cycles 22 Off-licences 40 Opticians 4 Photographers 7 Pictures and Picture Framing 4 Public Houses 37 Tailors, Gentlemen's Outfitters and Hosiers 36 Tobacconists 56 Timber Merchants 6 Wardrobe Dealers 6 Sewing Machines 2 Sports Goods, Toys and Games 6 Umbrellas 4 Miscellaneous 10 1,366 DISINFECTION AND DISINFESTATION. Number of rooms fumigated after notfiable infectious disease 297 „ „ ,, ,, non- ,, ,, ,, 115 „ „ „ „ T.B. 69 „ „ disinfected after death 31 „ articles disinfecte 4,413 „ „ destroyed 273 „ verminous rooms disinfested 223 CLEANSING STATION.—Eight adults and nine 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.:— Disinfestation (premises) 143 Spraying for cockroaches (8), wasps' nests (1), ants (4), flies (2) 15 Collecting and disinfecting library books: — Received Returned Destroyed Public Libraries 151 151 — School Libraries 24 24 — Private Libraries 54 28 24 23 Conveyance of drain-testing appliances 53 Visits in connection with Welfare Centres 119 Mileage run. Eed van 4,283 Blue van 2,361 Samples taken to laboratory for analysis:— Milk 18 Water 2 ERADICATION OF BED BUGS. The number of Council houses infested and disinfested was 15. The number of other houses infested and disinfested was 128. The methods employed consist of easing of the architraves, skirtings, stripping of walls, etc., including in bad cases the opening up of the floors of infested rooms and spraying with an insecticidal fluid. The beds and bedding are examined and dealt with. If badly infested, the bedsteads are destroyed. Bedding is treated at the Council's steam disinfector. The belongings of tenants to be moved into Council houses or Hornsey Housing Trust dwellings are examined, and where considered necessary treated as previously described. The work of disinfestation is carried out by the Local Authority. DOG NUISANCE. One hundred and eighty-one metal plates are afiixed to lamp columns in various parts of the Borough. During the year 25 more have been fixed and 20 replaced. PETROLEUM INSPECTOR'S REPORT. The following is a Report of the Petroleum Inspector for the year 1936:— 29 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, &c.) Regulations of 1929. Petroleum (Carbide of Calcium) Order of 1929. Petroleum Spirit (Conveyance) Regulations of 1932. Cellulose Solutions Regulations of 1932. The Petroleum (Transfer of Licences) Act, 1936, came into operation in August, 1936, and enables a petroleum-spirit licence to be transferred by endorsement of the licence or otherwise. The quantity of petroleum stored under licence, apart from quantities stored under proper conditions which do not necessitate a licence, totals 97,218 gallons. 93,900 gallons is stored in underground steel tanks and 3,318 gallons kept in properly scaled two-gallon cans. The total number of licences issued is 80. The Superintendent of the Fire Brigade is furnished with a list of all annual renewals of licences and of new installations. The premises licensed were inspected from time to time and contraventions of the conditions attached to the licences dealt with. All plans relating to new petrol installations are 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. A noteworthy feature during the year has been the changeover from hand-operated to electrically-operated petrol pumps. The Borough Electrical Engineer is notified in every case so that the wiring can be inspected. There is a greater tendency to the spilling of petrol from electrically operated pumps, owing to the operator's attention being more intent on the dial than on the tank and nozzle, and I have found it necessary to insist on adequate supplies of sand near these pumps in addition to foam fire extinguishers required by regulations. 30 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 for the storage of cellulose spirit ans. the total quantity kept on these premises is 50 gallons. Carbide of Calcium. There is one premises licensed for the storage of Carbide of Calcium and the quantity stored under licence is 10 ewts. H. EASTWOOD, Chief Sanitary Inspector and Petroleum Inspector. OPEN-AIR SWIMMING POOL. The Swimming Pool, which was opened in June, 1029, was one of the first of its kind in the country, and has never ccased to be a great attraction to ratepayers of the Borough and visitors from other areas. Since the opening many improvements and additions have been made, including— Children's paddling pool. Sun-bathing facilities, Floodlighting, Increased dressing-room accommodation. The Pool is open all the year and during 1936 was used by 100,494 persons, and 1,014 season-tickets were issued. The satisfactory condition of the water is maintained by a system of filtration, aeration and chlorination, and regular inspections are made by the Medical Officer of Health. SCHOOLS. The sanitary conditions of the public elementary schools is the subject of periodic inspection. The Highgate Elementary School is now in course of being modernised. including all sanitary arrangements. The remaining older schools not yet dealt with will be treated in the same way as occasion permits. 31 In addition to the public Swimming Pool, there are two schools with Swimming Baths, which are used for teaching scholars swimming. HOUSING. Housing Act. 1935.—Overcrowding Survey. The preliminary overcrowding survey (Form A) was commenced at the end of December, 1935, and was completed on the 21st March, 1666. A temporary staff of 17 men was engaged on the work for varying periods, working in all an aggregate of 17 weeks. The estimate of this preliminary survey work was given as £.300 and the actual cost was £2293 4s. 4d.. including cards, filing cabinets and printing (£53 12s. 3d.). 11,120 houses, which is almost exactly 50 per cent. of the inhabited houses in the Borough, were visited by the Enumerators, and only 188 families in 177 houses were found to be overcrowded. 30 of the 177 houses were on the Council's Housing Estates. The proportion of overcrowded houses to those enumerated is therefore 106 per cent. The following tables give in detail the result of the survey:— WARD. (See note on page 43). Number of Families. Enumerated. Uncrowded. Overcrowded. For Review within 2 years, i.e. to April, 1938. Highgate 1,635 1,604 31 5 Muswell Hill 737 721 16 2 Crouch End 304 299 5 1 West Hornsey 2,539 2,498 41 10 East Hornsey 2,922 2,896 26 9 North Harringay 2,693 2,683 10 2 South Harringay 2,081 2,075 6 5 Stroud Green 2,122 2,118 4 1 Finsbury Park 2,734 2,685 49 6 TOTALS 17,767 17,579 188 41 32 The "appointed clay" under the Act for Hornsey was fixed as 1st January, 1937. The work of measuring of houses for " permitted numbers (Form B) was commenced in December, 1936, and is approaching completion at the time of writing, but the details of the result will he furnished in the Report for 1937. At the end of 1936, however, the 188 overcrowded cases, representing 995 persons, were reduced by 47, leaving, with one additional case discovered, a total of 142 overcrowded cases. During the year 1936 83 families, representing 397 persons, were re-housed as follows:— Families. Persons. Newland Road 1 3 North View Road 3 22 South View Road 3 21 Nightingale Lane 1 4 Hillfield Avenue 2 n / High Street, Hornsey 2 7 Campsbourne Road 3 11 Myddelton Road 2 7 Boyton Road 2 9 Hawthorn Road 1 5 Priory Avenue 1 5 Rectory Gardens 1 8 The Campsbourne 1 5 Brook Road 1 5 Linzee Road 1 4 Eastfield Road 1 4 Grovehouse Road 1 4 Birkbeck Road 1 4 Glebe Road 1 5 Montague Road 1 4 Spencer Road 1 5 Rathcoole Gardens 3 16 Hanbury Road 1 2 Enfield Road 1 6 Inderwick Road 2 10 Hornsey Park Road 1 4 Clarendon Road 1 4 Raleigh Road 1 4 33 Wightnian Road Families. Persons. 1 4 Cavendish Roud 1 3 Perth Road 1 7 Victoria Road 1 3 Stroud Green Road 1 4 Cornwall Road 1 5 Ossian Road 1 6 Park Road 1 4 The Grove 1 6 Topsfield Road 1 4 Glasslyn Road 1 3 St. James's Lane 2 10 Pages Lane 1 3 Everington Road 3 18 Hill Road 2 14 Steeds Road 3 21 Marriott Road 2 15 Stution Parade, Colney Hateh Lane 1 5 Archway Road 3 12 Holmesdale Road 1 4 Northwood Road 1 4 Talbot Road 1 5 Southwood Lane 1 3 North Road 3 10 North Hill 5 16 Yeatman Road 2 13 HOUSE-TO-HOUSE INSPECTIONS. The number of these inspections is as follows:— Ward. Road. Stroud Green Rathcoole Gardens 64 Central Hornsey Boyton Road 60 Highgate Campsbourne Road 6 North Hill 4 Muswell Hill Queen's Cottages 2 136 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) ... '2,285 (6) Number of inspections made for the purpose 7,050 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 136 (6) Number of inspections made for the purpose 680 (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 1.667 2. Remedy of Dcfects during the Year without service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 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 35 (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (a) By owners — (b) By local authority in default of owners — B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 86 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 80 (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 — 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 — 4. Housing Act, 1935. Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 177 (ii) Number of families dwelling therein 188 (iii) Number of persons dwelling therein 995 (b) Number of new cases of overcrowding reported during the year 1 36 (c) (i) Number of cases of overcrowding relieved during the year 47 (ii) Number of persons concerned in such cases 257 INSPECTION AND SUPERVISION OF FOOD. The inspection of food and supervision of places where food is prepared or 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 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 66 classed as dairies and 77 classed as milkshops the principal trade of which is not dairy produce. Of the dairies, 30 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 18 informal samples for bacteriological examination during the year. There are no cowsheds in the Borough. Milk (Special Designations) Order, 1936. Circular 1,535. This Order, which came into force on 1st June, 1036. revokes the Orders of 1923 and 1924 and prescribes the following amended special designations for milk:— PASTEURISED Milk has been heated at 145° Fahr. for 30 minutes to destroy any disease germs. TUBERCULIN TESTED Milk comes from cows that have passed the tuberculin test for freedom from tuberculosis, 37 Tuberculin Tested Milk (Pasteurised) is Tuberculin Tested Milk which is also Pasteurised. Tuberculin Tested Milk (Certified) is Tuberculin Tested Milk which is bottled on the farm. ACCREDITED milk conies from cows that have passed a veterinary inspection, but not a test for tuberculosis. The old designations— Certified Grade A (Tuberculin Tested) Grade A are abolished. Special Designated Mii.k Licences. Producers of, and dealers in, special designated milk are required to obtain licences annually. During the year licences under the old designations were in force as follows:— Sale of Pasteurised Milk 21 „ „ „ ,, (Supplementary) 3 ,, ,, Certified Milk 3 ,, ,, ,, (Supplementary) 1 „ „ Grade A (T.T.) Milk 4 „ ,, ,, ,, ,, ,, (Supplementary) 2 „ „ „ „ Milk 3 „ ,, ,, ,, (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. During the year the carcases and meat offal of 285 animals have been inspected under the Regulations. Meat offal weighing 371/2 lbs. was condemned, surrendered and destroyed. 38 Statistics of Slaughtering, 1926-1936. Year. Beasts. Sheep. Swine Calves. Total. 1926 195 2,843 27 0 3,065 1927 144 2,374 21 16 2,555 1928 56 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 1936 0 285 0 0 285 There are six licensed slaughter-houses in the Borough. Articles of food brought from 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: — Fish 22 lbs. Prawns 12 lbs. All diseased meat and food is destroyed at the Council s mcinerator. FOOD ADULTERATION. Mr. R. Robinson, Chief Officer of the Public Control Department of the Middlesex County Council, has kindly supplied tne with the following information regarding samples of food taken during the year in the Borough: — Article. Samples. Adulterated. Milk 173 5 ,, Sterilised 2 — Butter 3 — Lard 2 — Cream Pastries 1 — Hake 8 3 Prawns 1 — Fish Paste 3 — Meat Paste 3 — 39 Article. Samples. Adulterated Sausages 5 2 Cocoa 1 — Sugar 1 — Almonds, ground 1 — Arrowroot 3 — Mustard 2 — Pepper 2 — Cinnamon 1 — Gin 3 2 Rum 2 — Whisky 5 2 222 14 INFECTIOUS DISEASE. Table G gives the incidence of infections disease in the Borough for the last 26 years. The total number of notifications in 1936 is well below the average. It is indeed the lowest in the last 10 years, with the exception of one year—1932. The cases were generally of mild type, from which recovery is generally complete without complications. Nearly one-third of the cases are nursed at home, a policy which is encouraged where home conditions make isolation and nursing safe. The majority of hospital cnses are admitted to the Hornsey, Finchley and Wood Green Joint Isolation Hospital at Coppetts Road. Muswell Hill, where they receive medical and nursing attention of the highest order. Certain infections of a special nature are admitted to hospitals under the London County Council, e.g., Puerperal Fever and Puerperal Pyrexia cases go to the North-Western Hospital, Hampstead; Ophthalmia Neonatorum is treated at St. Margaret's Hospital, Kentish Town. I desire to acknowledge the great value of such highly specialised units in the treament of these conditions. DIPHTHERIA IMMUNISATION. A clinic for Diphtheria Immunisation was arranged during the year, to be held at one of the Welfare Centres on each Saturday during each month. The demand was at first so considerable that it was not possible to cope with it at the Saturday morning clinics, and special clinics were therefore held at Highgate Council and St. Michael's Schools. 40 The following statement shows the number of injections and the number of completed cases, i.e., receiving three injections each, at the end of the year. Total injections. Completed Cases. Brook Road Centre 386 65 Wightman Road Centre 95 23 Highgate Centre 197 62 Coldfall Sub-Centre 164 36 Highgate Council School 657 210 St. Michael's School 142 38 1,641 434 VACCINATION. The Public Vaccinators inform me that they have performed vaccination of persons in the Borough during 1936 as follows:— Dr. E. Buckler 89 Dr. B. Anderson 251 children, 3 adults 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. One of these cases was still in hospital at the end of the year, but has since been discharged with vision unimpaired. Cases Vision unimpaired. Vision impaired. Total blindness. Deaths. Notified. Treated At home. In hospital or nursing home. 6 2 4 6 0 0 0 41 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 Middlesex County Council. There are 570 beds available solely for .Middlesex under the Middlesex County Council scheme for the treatment of Tuberculosis in sanatoria, namely:— Harefield Sanatorium, Uxbridge 378 beds Clare Hall Sanatorium, South Minims 186 ,, Victoria Home, Margate 6 ,, Pulmonary cases in excess of these numbers and nonpulmonary cases are maintained by the County Council in sanatoria and hospitals in various parts of the country. The total number of cases on the Tuberculosis Register at the end of 1936 was 756, viz., pulmonary 570, non-pulmonary 186, an increase of 16 on the total for last year. A table showing the history of Tuberculosis cases during the year will.be found on pp. MORTUARY. Thirty-one bodies were received at the mortuary and inquests held on 27 of them. DISEASES OF ANIMALS ACT. Mr. F. G. Buxton, the Veterinary Inspector, reports that during the year he made 23 visits to piggeries and inspected 491 pigs. Fifty-two removal licences were issued under the Diseases of Animals Acts. No action was necessary under the Tuberculosis Order, 1925. 43 LIST OF TABLES. TABLE A.—Vital Statistics, 1911-36. TABLE B.—Causes of, and ages at, death in 1936. TABLE C.—Summary of causes of death, 1931-1935. TABLE D.—Infant Mortality in 1936. Causes of, and ages at, death. TABLE E.—Births, Deaths, Infant Deaths, and Deaths from certain diseases, 1901-1936. TABLE F.—Cases of Infectious Disease notified in 1936. TABLE G.—Cases of Infectious Disease notified 1911-1936. TABLE H.—(1) Notification of, and deaths from, Tuberculosis, 1936. ,, (2) Tuberculosis Register, 1936. TABLE I.—Work done at the Maternity and Child Welfare Centres and by Municipal Midwife, 1936. TABLE J.—Inspection of Factories, Outworkers, etc., 1936. Note.—The boundaries and names of certain Wards in the Borough were altered by an Order in Council dated 24th July, 1936, but for the purposes of the Report for 1936 the Wards remain unaltered. 44 TABLE A. BOROUGH OP HORNSEY VITAL STATISTICS, 1911.1936. Year. Estimated Mid.Year Population. Birth Kate per 1,000 Population. Death Kate per 1,000 Population. Infant Mortality per 1,000 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 88,325 14.4 10.5 51 1924 88,661 13.4 10.4 41 1925 89,064 13.6 10.6 43.6 1926 89,850 13.4 10.3 47.2 1927 90,000 13.3 11.2 38.3 1928 90,250 12.1 12.1 61.3 1929 90,500 Regr..Gcn.'s Estimate. 88,450 13.8 12.7 54.05 1930 88,450 13.7 11.8 41.35 1931 Census 95,524 Regr-Gen's Estimate 11.9 11.2 52.6 1932 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 1936 96,160 12.0 11.98 40.0 ENGLAND and WALES [Rates in 1936) 14.8 12.1 59 122 County Borough and Great Towns, including London (Rates in 19361 14.9 12.3 63 143 Smaller Towns Populations 25,000 to 50,000 (Rates in 1936) 150 11.5 55 London (Rates in 1936) 13.6 12.5 66 45 —46 * s— .55 M. .65 eo— .75 75 & Total. All M 1 F —X K 1 M —9 F i— 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 2 1 1 1 1 1 2 2. Measles 3 2 1 1 J. 1 3 3. Scarlet Fever 1 1 4 4. Whooping cough ... 2 1 i 1 1 1 5 5. Diphtheria ... 1 1 i 2 6. Influenza 13 6 7 1 1 1 2 2 1 1 6 7. Encephalitis lethargica ... 4 2 2 1 1 1 1 1 I 8. Cerebro.spinal fever 1 1 8 9 Tuberculosis of respiratory system 58 36 22 6 2 7 9 5 4 4 4 13 i 1 2 9 10. Other tuberculous diseases 5 4 1 1 1 1 1 1 10 11. Syphilis 1 1 ... ... 1 11 12. General paralysis of the insane, tabes dorsalis 4 3 1 2 i 1 12 13. Cancer, malignant disease 181 8< 98 2 1 2 15 14 20 33 26 32 19 17 13 14. Diabetes 19 6 13 1 1 1 2 2 4 2 6 14 15. Cerebral haemorrhage, etc. 52 18 34 1 1 i •t 6 8 3 14 6 10 15 16. Heart disease 332 137 195 1 5 8 4 7 28 27 50 46 54 102 16 17. Aneurysm ... 10 7 3 1 1 2 1 3 1 17 18. Other circulatory diseases 65 23 42 1 • 2 1 5 8 17 11 20 18 19. Bronchitis .. 33 16 17 1 3 1 1 1 4 4 8 10 19 20. Pneumonia (all forms) ... 58 31 27 3 3 1 1 1 1 1 2 2 3 4 3 1 12 5 4 9 20 21. Other respiratory diseases 8 1 7 2 1 5 21 22. Peptic ulcer JO 8 2 1 1 1 1 I 3 2 22 23. Diarrhoea, etc. 10 4 6 3 5 1 1 23 24 Appendicitis 11 7 4 1 1 1 i 4 1 1 24 25. Cirrhosis of liver ... 4 3 1 1 1 1 25 26. Other diseases of liver, etc. 10 4 6 2 1 2 1 2 2 26 27. Other digestive diseases ... 31 15 16 2 1 2 1 6 4 1 3 3 27 28. Acute and chronic nephritis 35 13 22 ... 1 1 2 3 i 2 3 3 5 2 9 28 29. Puerperal sepsis ... 1 1 1 29 30. Other puerperal causes ... 2 ... 2 1 1 30 31. Congenital debility, premature birth, malformations, etc. 25 13 12 12 12 1 31 32. Senility 24 10 14 1 1 1 i 8 12 32 33. Suicide 9 5 4 2 3 2 2 33 34. Other violence 42 17 25 1 2 4 2 ? 1 2 2 1 3 2 5 4 ii 34 35. Other defined diseases ... 85 44 41 1 3 1 1 1 2 1 4 2 4 1 6 13 9 5 10 13 5 35 36. Causes ill.defined or unknown . 36 Totals 1,152 522" 63d ~23~ 24 3 r 6 2 6 6 12 —6 ~W 30 23 49 49 ioT 110 135 149 143 224 Special causes included in 35 above Small.pox Poliomyelitis Polioencephalitis ... . 46 TABLE C.—CAUSES OP, AND AGES AT, DEATH, 1931.1935 (NEW CLASSIFICATION) All Ages 1931 All Ages 1932 All Ages 1933 All Ages 1934 All Ages 1935 M F M F M F M F M F 1. Typhoid and paratyphoid fever ... ... ... ... ... ... ... ... 1 ... 2. Measles ... ... 3 3 ... ... 4 1 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 ... 1 6. Influenza 7 16 11 20 20 25 5 3 7 8 7. Encephalitis lethargica ... 1 ... ... 1 2 1 1 ... 8. Cerebro.spinal fever ... ... ... 1 ... ... 1 ... ... ... 9. Tuberculosis of respiratory system 21 31 23 31 25 19 27 32 27 27 10. Other tuberculous diseases 3 2 3 6 11 9 7 ... 6 8 11. Syphilis 1 3 ... ... ... 1 ... 1 3 ... 12. General paralysis of the insane, tabes dorsalis 3 ... 4 3 4 ... 6 ... 4 ... 13 Cancer, malignant disease 72 107 66 94 75 96 64 112 78 92 14. Diabetes 4 12 3 10 8 14 6 7 5 11 15. Cerebral hæmorrhage, etc. 17 52 25 40 23 28 23 35 12 24 16. Heart disease 110 150 109 181 117 163 111 174 103 168 17. Aneurysm 2 4 1 2 3 3 4 1 18. Other circulatory diseases 25 29 24 22 22 31 31 43 24 21 19. Bronchitis 15 15 21 8 13 18 14 10 13 14 20. Pneumonia (all forms) 28 40 32 34 34 46 34 39 29 37 21. Other respiratory diseases 5 6 9 8 3 3 6 2 6 2 22. Peptic ulcer 7 4 8 3 8 2 11 2 11 4 23. Diarrhœa, etc. 2 3 4 4 4 6 4 1 13 3 24. Appendicitis 3 4 2 5 6 2 2 6 2 5 25. Cirrhosis of liver 2 1 5 2 1 5 1 0 3 26.Other diseases of liver, etc. 3 1 3 1 1 2 3 4 1 3 27. Other digestive diseases 0 10 7 14 10 17 15 13 11 12 28.. Acute and chronic nephritis 19 15 12 14 13 14 18 9 16 16 29. Puerperal sepsis ... 2 ... 4 ... 1 ... 2 2 30. Other puerperal causes ... 3 ... 2 ... 3 ... 1 ... i 31. Congenital debility, premature birth, malformations, etc. 24 16 15 17 17 10 14 14 18 13 32. Senility 8 11 10 24 5 17 8 16 5 13 33. Suicide 9 2 9 2 12 4 14 6 4 16 34. Other violence 16 13 25 18 22 1 7 24 18 4 7 35.Other defined diseases 44 41 48 47 41 45 53 34 45 46 36. Causes ill-defined or unknown ... ... ... ... ... 1 ... ... 1 1 Totals 462 596 486 625 501 601 515 599 466 568 1,058 1,111 1,102 1,114 1,034 Special causes included in 35 above Small.pox Poliomyelitis Polioencephalitis A Table of causes, etc., of death under previous classification for 1921.30 appeared in Report for 1932. 47 TABLE D.—INFANT MORTALITY, 1936. 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 2 ... 1 17 2 4 1 ... 24 Gastro Enteritis ... ... ... ... ... 2 2 3 1 8 Pneumonia ... ... ... 1 2 1 1 2 ... 6 Whooping Cough ... ... ... ... ... ... ... 1 ... 1 Status Lymphaticus ... ... ... ... ... ... 1 ... ... 1 Miliary T B. ... ... ... ... ... ... ... 1 ... 1 Meningitis ... ... ... ... ... 1 ... ... ... 1 Intracranial Hemorrhage 1 ... ... ... 1 ... ... ... ... 1 Spina Bifida ... ... ... ... ... 1 ... ... ... 1 Hydrocephalus ... ... ... ... ... ... ... ... 1 1 Asphyxia ... ... ... ... ... ... 1 ... ... 1 Other Diseases ... ... ... ... ... ... 1 ... ... 1 Total 15 2 1 2 20 7 10 8 2 47 TABLE I-E. BIRTHS. DEATHS, INFANT DEATHS, AND DEATHS FROM CERTAIN DISEASES. 1901-1930 YEAR. Population Census. Total Live Births Total Still Births Total Deaths Total Infant Deaths (under one year) Deaths from Measles Deaths from Whooping Cough Deathsfrom 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 l 8 1 62 46 20 1904 1,6511 ... 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 60 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 1,211 ... 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 0 15 0 1 1 170 54 14 1936 96,160 1,155 31 1,152 47 3 2 8 1 1 2 181 58 5 48 49 TABLE F.-INFECTIOUS DISEASES NOTIFIED. 1936 DISEASE High gate Muswell Bill. WARDS (see notes on page 43. AGES Total Admitted to Joint Hospital. Admitted to other Hospitals. In Nursing Home. Nursed at Home. Registered Deaths. Crouch End West Hornsey East Hornsey North Haringey South Haringey Stroud Green Finsbury Park. 0— 1 1— 5 515 15— 25 2545 45— 65 65 and over Scarlet Fever 21 40 13 35 9 14 10 13 3 l 24 81 29 14 8 1 158 120 12 0 26 1 1 Diphtheria 8 8 2 9 9 0 4 13 0 9 33 12 3 1 0 58 53 3 0 2 2 Typhoid 0 2 0 1 1 0 0 0 1 1 0 2 0 0 4 1 0 0 3 Para Typhoid 0 1 1 0 0 0 0 0 0 0 0 0 0 2 0 0 2 1 1 0 0 Pneumonia 6 14 6 8 4 5 6 6 3 1 7 8 5 15 16 6 58 1 13 0 44 58 Erysipeals 7 4 3 4 8 2 2 3 6 0 0 0 2 13 13 11 39 15 6 1 17 Puerperal Fever 0 2 0 1 0 0 0 1 0 - - - 0 4 0 - 4 0 2 1 1 3 Puerperal Pyrexia 0 3 0 0 0 2 1 1 1 - - - 2 6 0 - 8 0 7 1 0 Ophthalmia Neonatorum 0 1 0 2 2 0 0 1 0 6 - - - - - 6 0 4 0 2 - encephalo. myelitis 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 Cerebro.Spinal Meningitis 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 0 1 0 0 1 Dysentery 0 0 0 2 0 0 0 0 0 0 1 1 0 0 0 0 2 0 2 0 0 42 76 25 62 33 28 19 30 26 8 42 124 50 61 38 18 341 191 52 3 95 Tuberculosis: Pulmonary 25 22 8 14 7 13 7 17 11 1 1 3 28 52 34 5 124 NonPulmonary 5 2 1 4 0 2 1 1 1 0 2 4 3 6 2 0 17 Total, 72 100 34 80 40 43 27 48 38 9 45 131 81 119 74 23 482 Admitted to Joint Isol. 24 41 10 43 18 16 7 15 17 191 Hospital Other Hptls 12 8 5 4 6 3 3 7 4 52 Nursing Homes 1 2 0 0 0 0 0 0 0 3 Nursed at Home 5 25 10 15 9 9 9 8 5 95 Excluding T.B. The following 66 cases were treated in the Isolation Hospital in addition to the above :—10 Measles, 5 Measles and Pneumonia, 1 Measles and Pneumonia and Whooping Cough, 1 Measles and Croup, 1 Measles and Mastoid, 1 Measles and Otitis Media, 3 German Measles, 1 Chicken Pox, 1 Mastoid, 4 Whooping Cough, 4 Whooping Cough and Pneumonia, 1 Whooping Cough and Rheumatism, 1 Rheumatism, 11 Tonsilitis, 1, Pharyngitis. 1 Laryngitis, 2 Quinsy, 1 Influenza, 1 Epilepsy, 3 Colic, 1 Gastritis, 1 Cerebral Aneurysm, 1 Gonorrheal Vaginitis, 1 Local Sepsis, 1 Abscess Axilla, 1 Septicaemia, 1 Removal of Toe Nail, 1 Injured Side, 4 for Observation. 50 TABLE G. NOTIFXCATIONS Of' INFECTIOUS DISEASES. 1B11.1B3G Year. Population. Estimated Scarlet Fever. Diphtheriaor Croup. Typhoid Fever. Para Typhoid. 1 Puerperal Fever Puerperal Pyrexis. Erysipelas. , Cerebro Spinal Meningitis. Polio-Myelitis. Ophthalmia Neonatorum. Malaria. Dysentery. Encephalitis Lethargica. Polio-Encephalitis. Pneumonia. Small-pox. Measles. German Measles. | Total Attack rate per 1,000 population. 1911 84,592 (Census) 179 133 6 - 2 - 40 - - - - - - - - 1 - - 361 4.2 1912 84,840 138 88 9 - 3 - 39 1 1 - - - - - - - - - 279 3.2 1913 86,122 206 115 10 - 2 - 26 - - - - - - - - - - - 359 4.2 1914 85,456 346 101 9 - 1 - 24 - - 11 - - - - - - - - 492 5.7 1916 86,800 182 105 18 - 5 - 35 9 3 1 - - - - - - - - 368 41 1916 86,147 103 77 8 - 1 - 32 2 6 9 - - - - - - 207 281 726 2.7 * 1917 86,450 132 66 4 - 1 - 28 4 - 1 - - - - - - 1,227 881 2,344 2.7 * 1918 86,942 89 67 8 - 2 - 23 1 3 2 - - - - - - 796 119 1,110 2.3 * 1919 87,100 203 87 6 - 4 - 42 4 1 5 21 2 5 - 112 - 224 285 1,001 5.7 * not now notifiable 1920 87,410 245 149 6 - 2 - 27 1 3 8 10 2 4 - 98 - 555 6.3 1921 87,691 (Census) 591 189 2 - 2 - 36 - 2 6 1 1 6 - 42 - 878 10.1 1922 88,007 286 123 1 - 2 - 24 - - 10 1 - 1 - 104 - 552 6.2 1923 88,325 126 133 1 - - - 24 2 - 6 4 - 2 - 75 - 373 4.2 1924 88,661 215 40 3 - 1 - 26 - 1 1 - - 11 - 61 - 359 4.0 1925 89,064 126 53 10 - 1 - 26 2 2 4 1 1 7 - 60 - 293 3 3 1926 89,850 140 116 4 - 4 6 22 - 2 8 - - 6 - 56 - 364 40 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 - 91 - 693 6.5 1929 90,500 249 129 3 2 8 8 30 3 1 5 2 - - 1 163 - 599 6.6 1930 88,450 (R..Gen.'s Estimate) 346 115 5 4 4 15 36 1 1 1 - - - - 61 3 592 6.6 1931 95,524 (Census) 247 116 - 1 7 9 32 - 1 3 1 - 2 - 86 - 505 5.3 1932 96,990 (R..Gen.'s 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 1936 96,160 158 58 4 2 4 8 39 1 - 6 - 2 - 1 58 - 341 3.5 * Excluding Measles and German Measles. 51 TABLE H.-(1) NOTIFICATION OF. AND DEATHS FROM. TUBERCULOSIS, 1936. AGE PERIODS. New Cases. Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 — 1 1 0 0 0 0 0 1 0 1 — 5 0 1 1 1 0 0 1 1 5 — 15 3 0 2 2 0 0 0 0 15 — 25 17 11 1 2 5 2 0 0 25 — 35 22 12 1 5 8 9 0 1 35 — 45 9 9 0 0 4 6 0 0 45-65 14 7 0 1 6 4 0 0 55 — 65 12 1 1 0 9 1 1 0 65 and over 2 3 0 0 2 2 0 0 Totals 80 44 6 11 34 24 3 2 Wards (see note ou page 43): H ighgate 14 11 2 3 4 5 0 0 Muswell Hill 12 10 0 2 4 6 0 0 Crouch End 6 2 0 1 4 2 0 1 West Hornsey 10 4 2 2 2 2 1 0 East Hornsey 7 0 0 0 9 4 0 0 North Haringey 7 6 1 1 7 2 2 0 South Haringey 4 3 0 1 1 0 0 0 Stroud Green 14 3 0 1 0 0 0 1 Finsbury Park 6 5 1 0 3 3 0 0 Totals 80 44 6 11 34 24 3 2 52 TABLE H.-(2) TUBERCULOSIS REGISTER. 1936 Pulmonary. Non-Pulmonary. Total. Male. Female. Male. Female. Male. Female. (a) Number of Cases on Register at commencement of 1936 290 270 94 86 384 356 (b) Number of Cases notified for first time during year under Regulations 53 23 4 5 57 28 (c) Cases restored to Register during 1936 1 3 1 0 2 3 (d) Cases added to Register otherwise than by notifications under Regulations : (1) Transferred from other districts 16 10 1 3 17 13 (2) From Death Returns 9 9 0 3 9 12 (e) Number of Cases removed from Register during 1936 61 53 7 4 68 57 (f) Number of Cases remaining on Register at end of 1936 308 262 93 93 401 355 Cases removed from the Register shown under (c) are accounted for as follows:- Found not to be T.B Cured. Removed to another area. Died at Home. Died at Sanatorium or other Institution. Cases closed by T.B.O. Total*. M F M F M F M F M F M F M F 1 0 2 4 21 20 Pulmonary 20 16 3 1 61 53 14 12 0 0 3 1 2 0 Non-Pulmonary 2 3 0 0 7 4 0 0 53 TABLE I. MATERNITY AND CHILD WELFARE WORK, 1936. Nature of Work. Centres. No. 1. No. 2. No. 3 and Sub-Centre. Totals. Number of sessions held 194 99 70 363 " ante natal sessions held 51 24 24 99 Number of individual Mothers seen by Doctor:— Ante natal, New cases 167 70 72 309 ,, Old cases 385 145 136 666 Post-natal, New cases 44 15 6 65 ,, Old cases 4 17 3 24 600 247 217 1,064 Total attendances of Mothers 847 284 217 1,348 Number of babies attending Centres for first time : Under 1 year 312 192 149 653 1—3 years 64 31 33 128 3.5 „ 19 10 22 51 Number of individual babies on Centre registers: Under 1 year 306 176 121 603 1—5 years 652 304 321 1,277 Babies Been by Doctor 2,507 1,458 838 4,803 Attendances of babies at medical consultations 3,434 2,010 988 6,432 Total attendances of babies at Centres: Under 1 year 4,893 2,490 1,379 8,762 1—3 years 2,686 714 502 3,902 3-5 " 862 189 211 1,262 Referred to own private doctors 86 27 8 121 Referred to hospitals 164 19 6 189 Visits paid by nurses:- First visits Total visits First visits Total visits First visits Total Grand First Totals Total To expectant mothers 120 197 77 134 63 97 260 428 To infants under one year 504 1.915 334 1,688 299 860 1,137 4,463 To children aged 1-5 years 135 3,460 63 1,497 97 1,663 295 6,620 Total visit paid by Nurses 759 5,572 474 3,319 459 2,620 1,692 11,511 CHILDREN ACTS— Visits paid to Foster Children 21 198 24 236 5 80 50 514 RECORD OP WORK OF MUNICIPAL MIDWIFE, 1936. Confinements attended 189 Ante.natal Clinics attended 88 do. visits 649 Post-natal visits 2,476 54 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 41 0 0 (Including Factory Laundries) Workshops 85 4 0 (Including Workshop Laundries) Workplaces 10 0 0 (Other than Outworkers' premises) Total 116 4 0 DEFECTS FOUND IN FACTORIES, WORKSHOPS 4 WORKPLACES. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (») Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts:—* Want of cleanliness 11 11 - - Waut of ventilation 3 3 - - Overcrowding - - - - Want of Draiuage of floors - - - - Other nuisances - - - - Sanitary accommodation insufficient 4 4 - - unsuitable or de. fective 8 8 - - Dot separate fur sexes 10 10 - - 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). - - 3 - Total 36 36 3 - Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 55 TABLE J.— (contd.). OUTWORKERS 1936. Nature of Work. (1) Premises. Outworkers. Instances. Notices served. Prosecutions. Wearing Apparel 117 125 0 0 0 Boots 5 5 0 0 0 Embroidery 5 5 0 0 0 Furs 4 5 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 2 2 0 0 0 Artificial Flowers 3 3 0 0 0 Laundry 1 1 0 0 0 Cushions 2 2 0 0 0 Jewel Cases 3 3 0 0 0 Bead Stringing 1 1 0 0 0 Art Needlework 7 7 0 0 0 Dolls Clothes 3 3 0 0 0 Leather Goods 2 2 0 0 0 Coat Hangers 1 1 0 0 0 Photography 1 1 0 0 0 Total 163 173 0 0 0 Borough of bornsey ANNUAL REPORT OF THE School Medical Officer FOR THE Year ending December 31st 1936 3 HORNSEY EDUCATION COMMITTEE. List of Members, 31st December, 1936 APPOINTED BY HORNSEY. Members of the Town Council— Aldermen. Mr. W. G. Baurenger, J.P., 20, Southwood Hall, Highgate. N.6. Mr. B. H. Jenkinson, 36, Avenue Road, Highgate, N.6. 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 Yale, Muswell Hill, N.10 (ViceChairman). Mr. S. H. Baker, 33, Coolhurst Road, N.8. Mr. H. G. R. Griffin, 12, Avenue Road, N.6. Mr. W. J. Grimshaw, J.P., 25, Sheldon Avenue, Highgate, N.6. Mr. G. K. M. Hutchinson, 8, Grosvenor Gardens, N.10. Mr. W. J. Lendrum, 4, Creighton 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 Hillr 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. Hutchinson, 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. G. Simmonds, 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. M. L. Easterling, Mrs. J. Faraday, Mrs. J. I. Grimshaw, Mr. G. A. Henderson and Mrs. E. Simmonds. Four other persons residing in the Borough who possess experience 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, Mr. H. Turner, Miss F. Regis, Miss D. F. Smith, Miss M. D. Sibley, Mr. J. W. T. Harris, *Mrs. H. M. Durrant, Mrs. E. Gardiner, Mrs. G. T. Arnold, Mrs. A. E. Lamble and Mrs. L. Whittle. Crouch End.—Councillor L. J. Valette (ex-officio), Mrs. E. M. Tompkins, *Mr. G. A. Henderson, Mrs. G. M. Reid, Mr. J. Iliffe, Miss F. A. Barter, Miss A. E. Walmsley, †Mrs. E. H. Hare, Miss D. Holt, Miss F. Milborrow, Mrs. E. R. Byrne and Mrs. J. Stevenson. * Secretary. † Chairman. 5 Harringay.— †Councillor L. J. Valette (ex-officio), *Mrs. M. L. Easterling, Mr. W. P. Bannister, M.A., Mrs. N. L. Brixey, Miss G. M. Ryde, B.Sc., Mr. G. F. Shaw, M.A., Mr. J. H. Spilman, B.Sc., Miss H. M. Stone, Mr. L. A. Wilson, Councillor Mrs. J. H. Barrenger, Mrs. H. Betts, Mrs. Hawkins, *Mrs H. M. Hay, Mr. G. Pain and Mrs. L. J. Valette. Highgate.—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, Rev. F. Hawkins, M.A., Mrs. A. Imber, Miss Dow and Mr. S. Mason. Muswell Hill.— Councillor L. J. Valette (ex-officio), †Councillor Mrs. C. M. Cave, *Mrs. E. Simmonds, Mr. G. Simmonds, B.A., Miss M. Clarke, Mr. I. T. Plant, Miss E. F. Catley, Mr. F. G. Edwardes, Mrs. M. Heppell, Mrs. A. Holman, J.l'., Councillor F. J. Randall and Rev. E. J. A. Dunn. Stroud Green.—Councillor L. J. Valette (ex-officio), Mrs. N. L. Brixey, *Mrs. J. Faraday, (Councillor W. V. Wall, Mr. F. W. Jaggard, Miss E. M. Cockhill, Miss R. Jones, Mrs. J. Ashworth, Mrs. A. Cole, Miss M. Freeman, Mrs. K. Knowles, Mrs. R. Wootton and Mrs. M. Wall. *Secretary. † Chairman 6 STAFF OF SCHOOL MEDICAL SERVICE. School Medical Officer: R. P. Garrow, M.D., D.P.H. Assistant School Medical Officer: Jean Sutherland, M.B., Ch.B., D.P.H., D.C.O.G. Dentist: Betty C. Hamilton, L.D.S., L.R.C.S., L.R.C.P. (Edin.), (resigned 30th April, 1936) Winifred M. Hunt, L.D.S. (appointed 18th May, 1936, started 24th August, 1936). Oculist: J. S. Boden, M.B., B.S. Aurist: A. R. Friel, M.A., M.D., F.R.C.S. (I.). Radiologist: J. Morison, M.D. Orthopaedic Surgeon . H. J. Seddon, F.R.G.S. (Eng.) (Resident Medical Superintendent, Royal National Orthopaedic Hospital, Country Branch, Stanmore). Masseuse: Mrs. Yorke (Royal National Orthopaedic Hospital). Nurses: M. Anscombe. L. M. Oliver. F. E. Paris. F. Ross. Clerk: H. M. Croak. Assistant Clerks: H. Powell. J. Lane, Temporary (appointed on staff, 25th Jan., 1937) 7 To the Chairman and Members of the EDUCATION COMMITTEE. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit my Annual Report as School Medical Officer for the year ending December 31st, 1936. The only change in staff during the year was the resignation of Dr. Betty C. Hamilton, Dental Surgeon, on April 30th, and the appointment in her place on May 18th of Miss Winifred Hunt, L.D.S. The work of routine medical and dental inspection in the schools and the schemes of treatment—medical, aural, ophthalmic, dental and orthopaedic—at the School Clinic have been carried out as in former years and the results of these activities are furnished in statistical tables at the end of this Report. Nutrition. Figures have little meaning in themselves, and only become intelligible when compared with figures of former years and the statistics of other districts. For example, the nutrition table shows that in 1936 (as in 1935) there were no children suffering from bad malnutrition. The percentage found with "slightly subnormal nutrition" was 3 per cent. in 1936, as compared with 6 per cent. in 1935. The examinations were done in all the schools in both of these years by the same persons, namely, Dr. Jean Sutherland in the Girls' and Infants' Departments and by myself in the Boys' Departments. There can be no doubt whatever that, as a result of the steady advocacy of good fresh foods at home, together with the increasing use of milk in the schools, the general standard of nutrition is rising. The nutrition campaign, launched some years ago, is giving results which are obvious to medical officers, teachers and all who have opportunities for close observation of the physical condition of the child population. Still better results will follow in many children when it is more fully appreciated that vitaminconcentrates are not substitutes for good food in growing children. Research in nutrition during recent years has been directed almost entirely to the discovery of vitamins and their properties. 8 Various substances, notably, Cod Liver Oil and Cod Liver Oil and Malt, known to be rich in vitamins, have been the subject of health propaganda and advertisement. Proprietary substances claiming to be still richer in vitamins have been produced by the manufacturing chemists, the climax of which is a vitamin concentrate with thirteen thousand times the potency of cod liver oil! Parents would do well to avoid all foods for their children (or for themselves) which are claimed to be super-charged with vitamins, and use only the ordinary fresh foods to be obtained from milkman, grocer, baker, butcher, poulterer, fishmonger, fruiterer and greengrocer. If such foods are taken in sufficient quantity and variety there is no need, summer or winter, for children to be given even "oil and malt." From my experience of the slightly subnormal children from better homes, I suggest that the "oil and malt" mentality, which is now almost universal in this country, is one of the chief hindrances to sound nutrition and good physique in this class of child. Physical Education. After nutrition, the factor which most concerns the acquisition of a good physique is sound physical training, or, as I prefer to think of it, physical education. The Press to-day— medical, scholastic and lay—is devoting a great deal of attention to the campaign for a fitter nation. Games, athletics and gymnastics are all useful in this way, but I suggest that there should be more constant attention during school hours and at home to the importance of maintaining good posture with a view to developing a good shape or figure. The child should "stand tall," with chin down and in, shoulders down and back, chest forward and abdomen retracted. Deep breathing a few times in a good posture should be performed in the bath at night and repeated many times during the day. The average posture and physique of the boys are poorer than those of the girls. It would be a good thing if fathers could take more interest in the development of their boys. Hundreds of boys with the makings of first-class physiques are of poor shape and development because their interest in this direction has not yet been roused. Boys need male influence from a very early age if they are to develop into boys and not effiminate males. 9 It is never too early to start this process. Immediately the boy gets on his feet, assumes the "erect posture" which distinguishes him from all other mammals and becomes a "toddler," father would do well to see him as often as he can in his bath. A very little effort and trouble taken at this stage would, I am certain, prevent some of the pathetic figures seen amongst the male school entrants at age 5. Child Guidance. "Child guidance" stands almost on a par with "nutrition" and physical training as matters of public interest. The term came to us from America some ten years ago and in its stricter sense means the thorough investigation and treatment of children who show departures from normal behaviour. The subjects of child guidance are referred to as "problem children." The investigation and treatment are carried out by a child-guidance team, consisting of a psychologist, a psychiatrist and a social worker—all highly trained in their special branches and all working in close co-operation. The child-guidance movement has made considerable progress in this country and some education authorities have established special child-guidance clinics staffed with specialist teams. The same movement has undoubtedly influenced practice in many districts where special clinics have not been established. There is need for all workers amongst children—parents, doctors, teachers, social workers, school nurses—aye, even members of education and maternity and child welfare authorities—to become more "psychologically minded." An education authority, with its staff of teachers, doctors and nurses, is in the wider sense a child-guidance council. In its Annual Report for 1936 the Child Guidance Council says:—"Experience in many districts shows that the more closely the clinic (i.e., the child-guidance clinic) is linked with the existing educational and medical services, the more successful its work. This is important, as it foreshadows a time when routine psychological study is recognised to be as necessary a part of every community and educational system as medical inspection." 10 The ultimate goal is that the educational and medical services should he the child-guidance services. General. I desire to acknowledge with thanks the good work of my colleagues, whole-time and part-time, on the staff of the school medical service; the generous co-operation of the Education Department; the willing assistance at all times of the teaching staffs; the help of the school-attendance officers. Our sincere gratitude is due also to the members of the Central Care SubCommittee and the District Care Committees, who continue year after year to contribute voluntary service of the greatest possible value to the children, and to the members of the Education Committee for their keen interest in the work as a whole. I am, Ladies and Gentlemen, Your obedient servant, R. P. GARROW, School Medical Officer. 11 School Medical Service Scheme of Treatment. Condition treated. Where treated. By whom. When. (a) Minor ailments including skin disease and external eye disease. School Clinic. Clinic Nurse (Miss Paris). Daily at 4 p.m. Throat Operations : (6) Tonsils and Adenoids Hornsey Central Hospital. Surgical Staff of the Hospital. As required. (c) Defective Vision. School Clinic. School Oculist (Dr. J. S. Boden). Two sessions weekly Tuesday afternoons, Thursday mornings. (d) Ear Disease and defective hearing. School Clinic. School Aurist (Dr. A. R. Friel) One session weekly, Saturday morning. (e) Dental Defects. School Clinic. School Dentist Miss W. M Hunt (started 24th Aug., 1936) Full time. Eleven sessions weekly. (f) Crippling defects. School Clinic. Orthopædic Surgeon (Mr. H J. Seddon). One session monthly, 4th Monday morning in each month. Masseuse (Mrs. Yorke). Three sessions weekly Monday, Wednesday & Friday afternoons. (g) Stammering and other speech defects. School Clinic. Special Teacher (Miss Bains) resigned 30/9/36. Miss Bennett appointed 1/10/36 Two sessions weekly, Monday and Thursday afternoons. (h) Ringworm. Address : Haddon Court, Southwood Lawn Rd., N 6. Private doctor by arrangement with Education Authority (Dr. J. Morison) Each case as required. (i) Conditions requiring medical consultation. School Clinics and Infant Welfare Centres. S.M.O and A.S.M.O. Seven sessions or part sessions weekly. 12 TABLE I. RETURN OF MEDICAL INSPECTIONS, 1936, ATTENDING PUBLIC ELEMENTARY SCHOOLS (see note a). (a)—Routine Medical Inspections. Number of Inspections in the prescribed Groups— (see note b). Entrants 856 Second Age Group 1,313 Third Age Group 426 Total 2,595 Number of other routine inspections (see note c). 580 Grand Total 3,175 (b)—Other Inspections. Number of special inspections (see note d). 1,889 Number of re-inspections (see note e). 3,199 Total 5,088 (c)—Children Found to Require Treatment. Number of individual children (see note f) found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Prescribed Groups: Entrants 20 Second Age Group 90 Third Age Group 39 Total (Prescribed Groups) 149 Other Routine Inspections 50 Grand Total (see note g) 199 13 NOTES ON TABLE I. (a) The return refers to a complete calendar year. (b) This heading relates solely to the routine medical inspection of the three ordinary age groups, i.e., to medical inspection carried out:— (i) In compliance with Article 17 of the Consolidated Regulations relating to Special Services—Grant Regulations No. 19. (ii) on the school premises (or at a place specially sanctioned by the Board); (iii) for the purpose of making a report on each child on the lines of the approved Schedule set out in Circular 582. (c) Under this heading may be recorded routine inspections, if any, of children who do not fall under the three 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) A Special Inspection is a medical inspection by the School Medical Officer himself or by one of the Medical Officers on his staff of a child specially selected or referred for such inspection, i.e., not inspected at a routine medical inspection as defined above. Such children may be selected by the Medical Officer during a visit to the School or may be referred to him by the Teachers, School Nurses, Attendance Officers, Parents, or otherwise It is immaterial for the purpose of this heading whether the children are inspected at the School or at the Inspection Clinic or elsewhere. If a child happens to come before the School Medical Officer for special inspection during a year in which it falls into one of the routine groups, its routine inspection should be entered in Part A of Table I. and its special inspection in Part B. The inspection to be recorded under the heading of special inspections should be only the first inspection of the child so referred for a particular defect. If a child who has been specially inspected for one defect is subsequently specially inspected for another defect, such subsequent inspection should be recorded as a Special Inspection and not as a Re-inspection. (e) Under this heading should be entered the medical inspections of children who as the result of a routine or special inspection come up later on for subsequent re-inspection, whether at the School or at the Inspection Clinic. The first inspection in every case will be entered as a routine or special inspection as the case may be. Every subsequent inspection of the same defect will be entered as a re-inspection. Care should be taken to see that nothing is included under the head of speoial inspections or re-inspections except such inspections as are defined above. Attendances for treatment by a Nurse, or for examinations by anyone other than a Doctor on the staff of the School Medical Service, should not be recorded as medical inspections. If, however, at any such attendance a child is also examined by one of the Authority's Medical Officers, this should be recorded as a special inspection or re-inspection as the case may be, even if treatment is also given; but such attendance may also of course be recorded as an attendance for treatment. (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. 14 TABLE II. (A) RETURN OP DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1936. DEFECT OR DISEASE. Routine Inspections. Special Inspections No. of Defects. No, of Defects. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. (1) (2) (3) (4) (5) Skin (1) Ringworm, scalp ... ... ... ... (2) „ body ... ... 3 ... 13) Scabies 2 ... 19 ... (4) Impetigo 1 ... 41 (5) Other Diseases (Non-tuberculous) 2 ... 109 ... TOTAL (Heads 1 to 5) 5 ... 172 ... Eye (6) Blepharitis 3 ... 7 ... (7) Conjunctivitis 1 ... 17 ... (8) Keratitis ... ... ... ... (9) Corneal Opacities ... ... ... ... (10) Other Conditions (excluding Defective Vision and Squint ... ... 18 ... TOTAL (Heads 6 to 10) 4 ... 42 ... (11) Defective Vision excluding Squint) 142 10 168 ... (12) Squint 10 4 48 ... Ear (13) Defective Hearing 4 2 4 ... (14) Otitis Media 7 ... 9 ... (15) Other Ear Diseases ... ... 26 ... Nose and Throat (16) Chronic Tonsillitis only 3 1 1 ... (17) Adenoids only ... ... ... ... (18) Chronic Tonsillitis and Adenoids ... ... ... ... (19) Other conditions 5 1 53 ... (20) Enlarged Cervical Glands (Non-Tuberculous) ... ... 4 ... (21) Defective Speech 3 ... ... ... Heart and Circulation Heart Disease: ... (22) Organic ... 4 ... ... (23) Functional ... ... ... ... (24) Anæmia ... ... ... ... Lungs (25) Brouchitis ... ... ... ... (26) Oilier 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 (35) Other Conditions ... ... ... ... Deforraitie (36) Rickets ... ... ... (37) Spinal Curvature 8 1 ... ... (381 Other Forms - - - 11 248 2 ... (39)Other Defects and Diseases (excluding Uncleanliness and Dental Diseases 1 ... 804 ... TOTALS - 203 289 1333 ... 15 TABLE II (continued.). (B) CLASSIFICATION OF THE NUTRITION OF 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. A (Excellent) B (Normal) c (Slightly sub-normal D (Bad) No. % No. % No. % No % Entrants 856 258 30% 571 67% 27 3% — Second Age-group 1,313 465 35% 788 60% 60 6% — Third Age-Group 426 206 48% 208 49% 12 3% — Other Routine Inspections o co 342 59% 226 39% 12 2% — TOTAL 3,175 1,271 40% 1.793 56% 111 3% — 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 At At At Schools for the Public other no School or Total. Blind Elementary Schools. Institutions. Institution. 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 At Certified At At At Schools for the Schools for Public other no School Total for the Blind. the Partially Elementary. or Sighted. School.. Institutions. Institution. — 3 — — — 3 16 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 At At At Schools Public no School Total for the Elementary others or ToUl- Deaf. Schools. Institutes. Institution. — — — — Nil. PARTIALLY DEAF CHILDREN. Enter in this Section only children who can appropriately be taught only in a school for the partially deaf. At Certified At Certified At At Schools Schools for Public no School . for the the Partially Deaf. Elementary At other or Deaf. Schools. Institutions. 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. 31 - 1 - 32 17 EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. In this part of the Table only those children should be included who are epileptic within the meaning of the Act, i.e., children who, not being idiots or imbeciles, are unfit by reason of severe epilepsy to attend the ordinary Public Elementary Schools. For practical purposes the Board are of opinion that children who are subject to attacks of major epilepsy in school should be recorded as "severe" cases and excluded from ordinary Public Elementary Schools. At Certified At At At Public no School or Special Elementary other Total. Schools. Schools. Institutions. Institution. 3 - - - 3 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 At At Certified Public other At no School Special Elementary Institutions. or Total. Schools. Schools. † Institution. - - 1 -1 II. Children Suffering From Non-pulmonary Tuberculosis. (This category should include tuberculosis of all sites other than those shown in (I) above.) At At At At Certified Public other no School Total Special Elementary Institutions. or Schools. Schools.† Institutions. Institution. 3 - - - 3 † 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. 18 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 At Public At other At no School Total. Special Elementary Institutions or Schools. Schools. Institution. - - - - Nil. C. CRIPPLED CHILDREN. This Section should be confined to children (other than those diagnosed as tuberculous and in need of treatment for that disease) who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life, i.e., children who generally speaking are unable to take part, in any complete sense, in physical exercises or games or such activities of the School curriculum as gardening or forms of handwork usually engaged in by other children, 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 Public Elementary Schools. At At At Certified Public no School Total Special Elementary At other or Schools. Schools. Institutions. Institution. 8 25 - 2 35 D. CHILDREN WITH HEART DISEASE. This section should be confined to children 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 Total Special Elementary At other Institutions. Schools. Schools. Institutions. institution. 2 - - - 2 19 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." CombiAt At At At nation Certified Public other no School of Special Elementary Institutions. or total. Defect. Schools. Schools. Institution. 20 TABLE IV. YEAR ENDED 31st DECEMBER, 1936. treatment table. (see note a). Group I.—Minor Ailments (excluding Uncleanllness, for which see Group VI.). DISEASE OR DEFECT. Number of Defects treated or under treatment during the year. Under the Authority's Scheme (see note b). Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm-Scalp (i) X-Ray Treatment. If none, indicate by dash. - - - (ii) Other Treatment. — - - Ringworm-Body 3 — 3 Scabies 19 — 19 Impetigo 41 — 41 Other Skin Disease 109 — 109 Minor Eye Defects (External and other, but excluding cases falling in Group II). 43 - 43 Minor Ear Defects (See note c). 33 — 33 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 306 - 306 Total 554 — 554 21 TABLE TV. (continued.) Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Aliments—Group I.). Number of Defects dealt with Under the Authority's Scheme (see note b) Otherwise. Total. Errors of Refraction (including Squint). (Operations for squint should be recorded separately in the body of the School Medical Officer's Report). 457 14 471 Other Defect or Disease of the Eyes (excluding those recorded in Group 1.). 34 — 34 Total 491 14 505 Under the Authority's Scheme. Otherwise. Total. No. of Children for whom spectacles were (a) Prescribed 451 — 451 (4) Obtained 446 — 446 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme, in Clinic or Hospital (see note b). By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 10 10 52 62 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids. (iv) Other defects of the nose and throat. 22 Group IV.—Orthopædic and Postural Defects. (see note d). Under the Authority's Scheme. (See note b). (1) Otherwise. (2) Total number treated. (see note e.) Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. (1) (2) (3) (1) (2) (3) Number of children treated. 10 170 180 TABLE V.—DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist:— (a) Routine age-groups: AGE 5 6 7 8 9 10 11 12 13 14 15 TOTAL Number 156 324 273 241 308 336 386 355 320 321 54 3,074 (b) Specials (see note (f)) 785 (c) TOTAL (Routine and Specials) 3,859 (2) Number found to require treatment 2,449 (3) Number actually treated 2,336 (4) Attendances made by children for treatment 4,459 (5) Half-days devoted to:— (7) Extractions:— Inspection 25 Permanent Teeth 492 Treatment 380 Temporary Teeth 2,801 Total 405 Total 3,293 (8) Administration of general anæstheties for extractions 1,419 (6) Fillings:—(See note g) (9) Other operations:— Permanent Teeth 2,258 Permanent Teeth 323 Temporary Teeth 14 Temporary Teeth 1,162 Total 2,272 Total 1,485 TABLE VI.—UNCLEANLINESS AND VERMINOUS CONDITIONS (see note h). (i) Average number of visits per school made during the year by the School Nurses 51 (ii.) Total number of examinations of children in the schools by School Nurses 28,788 (iii.) Number of Individual children found unclean (see note i) 305 (iv.) Number of children cleansed under arrangements made by the Local Education Authority 349 ('•) Number of cases In which legal proceedings were taken:— (a) Under the Education Act, 1921 0 (b) Under School Attendance Byelaws 0 23 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 sanctioned by the Board of Education under Section 80 of the Education Act, 1921. Cases which, after being recommended for treatment or advised to obtain it, actually received treatment by private practitioners, or by means of direct application to hospitals, or by the use of hospital tickets supplied by private persons, etc., should be entered under other headings. (c) If any treatment is given for more serious diseases of the ear (e.g., operative treatment in hospital) it should not be recorded here but in the body of the School Medical Officer's Annual Report. (d) 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. (f) 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. (g) 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 Education Authority for cleansing verminous children and a record of the cases in which legal proceedings were taken, should be included in the body of the School Medical Officer's Report. (i) (i) All cases of uncleanliness, however slight, should be recorded. (11) The return should relate to individual children and not to instances of uncleanliness. NB.—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 for which the Authority neither incur expenditure nor accept any responsibility, together with a statement of the effect of the measures taken, should be included in the body of the School Medical Officer's Report. It is convenient for such particulars to follow the headings of Table II. (Form 8 b.M.). 24 TABLE VII. LIST OF SCHOOLS IN THE BOROUGH. School. Department. Authorized accommodation. Average No. on the Rolls for qr. ended 31/12/36. Head Teacher. Campsbourne Junr. 388 329.6 Mr. H. Turner ,, Girls' 388 208.4 Miss L. Regis „ Infants' 400 219.3 Miss D. F. Smith Coldfall Mixed 520 550.6 Mr. G. Simmonds, B.A. ,, Infants' 400 271.4 Miss M. N. Clarke Crouch End Boys' 456 295.4 Mr. J. Iliffe ,, ,, Girls' 450 429.4 Miss F. A. Barter Rokesly Infants' 411 423.2 Miss A, E. Walmsley Highgate Mixed 328 292.9 Mr. T. E. Durban ,, Infants' 264 1301 Miss R. Spalding Harringay Senr. Boys' 380 248.5 Mr. G. F. Shaw, M.A. North Harringay Junr. Mxd 380 409.4 Mr. J. H. Spilman, B. Sc. ,, ,, Infants' 416 269 Miss II. M. Stone Harringay Senr. Girls' 440 228.7 Miss G. M Ryde, B.Sc. South Harringay Infants' & Junr. Mxd. 240 311.2 Miss R. Jones Stroud Green Senr. Mixed 350 386 Mr. F. W. Jaggard ,, ,, Junr. Mixed 416 304.7 Miss E. M. Cockhill ,, ,, Infants' 352 275.7 Miss E. Pitson Muswell Hill Junr. Mixed 200 157.9 Miss E. F. Catley St. Mary's Mixed 580 566 Mr. J. W. T. Harris ,, Infants' 240 246.3 Miss M. D. Sibley St. Michael's Mixed 196 102.6 Mr. E. R. Lewis ,, Infants' 168 89.9 Miss E. Towler St. James' Junr. Mixed 240 244.4 Mr. I. T. Plant Totals 8,603 6,990.6 25 REPORT OF DR. A. R. FRIEL, M.A., M.D., F.R.C.S., School Aurist. The following table gives a summary of the conditions treated and the results obtained:— Total (Ears). Cured. Lost Sight of. Still under treatment. Hospital. Acute Suppurative Otitis Media 21 17 1 2 1 Chronic Suppurative Otitis Media Due to (1) Tympanic sepsis 15 14 — 1 — (2) T.S. & Granulations 3 1 1 1 — (3) Tympanic conditions and Rhinitis 1 1 - - - (4) Tympanic conditions & Inflamed Tonsils - - - - - Attic Disease 3 — 1 2 — Mastoid Disease 3 2 — — — External Otitis 3 3 — — — Not Diagnosed 1 1 — — — Totals 51 40 3 7 1 A. R. FRIEL, Aural Surgeon.