TOT 17 Borough of Tottenham Annual Report ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1942 G. Hamilton Hogben Medical Officer of Health and School Medical Officer Crusha & Son, Ltd. (T.U.), Palmers Green, Wood Green, Enfield and Tottenham. 2 Public Health Department, Town Hall. N. 15. 1st December, 1943, To the Mayor, Aldermen and Councillors of the Borough of Tottenham. Mr. Mayor, Ladies and Gentlemen, This, my Annual Beport for 1942, sets out in an abbreviated, and mainly statistical form, the salient features about the health of the Borough. Vital Statistics. The population which immediately prior to the war was estimated to be 144,400, and fell in mid-year 1941 to 105,620, rose in 1942 to the figure of 110.100, and is still rising. The birth rate per 1,000 of the population was 16.5, compared with 14.7 in 1941, and the number of registered births was 1,819 or nearly 300 more than the previous year— the proportion of male to female births being 909 males to 910 females. The infant death rate was 43 per 1,000 live births as compared with 46 in 1941, or 49 for England and Wales. The maternal death rate continued to remain at a low level, being 2.6 per 1,000 births, as compared with 2.2 in 1941. The general death rate of the civilian population also showed an improvement over the previous year, being 12.2 as compared with 13.4 in 1941. Though no effort must be relaxed to improve further these figures, it is gratifying to know that in the fourth year of war, the health of the Borough was in many respects higher than at any time prior to the war. Two at least of the great social factors influencing vital statistics, namely, nutrition and employment have, by their improvement since the war, contributed materially to the better standard of public health. The third important social factor, housing, has on the other hand, deteriorated since the war; and in this area, housing must be regarded as priority number one in the task of combating disease and promoting health and well being. Infectious and Other Diseases. Though no statistics are available relating to the total amount of sickness among the population, there was a continued reduction in 1942 of notifiable infectious disease, including a slight reduction in the number of cases of tuberculosis. The number of deaths from cancer, totalling 229 (116 male, 113 female) was in excess of the figure of 194 for the previous year; the majority of deaths occurring between the ages of 65—85. 3 War-time Services in the Public Health Department. The story of the effect of air raids on the Borough, though it cannot yet be told in statistical form, is one which, on examination, emphasises the important part which extemporisation played in building up the ancillary services, particularly the machinery for carrying out First Aid Repairs to houses and the Homeless Persons Service. The provisions made nationally to deal with the effects of enemy air raids prior to August 1940, were concerned primarily with dealing with casualties and the services incidental to these functions. The special problems of building up an organisation to ensure the rapid repair of war damaged houses and the care of homeless persons, was clearly not visualised; and yet experience has shown that these two services represent, in total, the major problems arising from air raids. The Borough of Tottenham is, I think, unique in that the executive control of these two war-time services, together with those of the Casualty Service and provision of War-time Nurseries for children of working mothers, is vested in the Medical Officer of Health. (1) The Ambulance and Casualty Service in this area has followed closely the pattern laid down for such services throughout the London Region, a description of which has been given in the Annual Report in previous years. In the efficient and smooth running of this service, Mr. Stanley Brown, my Staff Officer, has rendered invaluable assistance. An opportunity is also given me here to acknowledge the valuable help rendered by the part-time medical practitioners undertaking various aspects of Civil Defence work in charge of First Aid Posts, Mobile Units, as Incident Medical Officers, and in Tube Station Shelter supervision. In the training of personnel Dr. R. H. Smythe, M. C., Sen. Asst. S.M.O. has devoted much spare time and energy to this work. (2) First Aid Repair of War Damaged Houses is a service which has been built up on an individual basis with experience as the only guide. The principle of dividing the Borough into zones has been adopted in connection with this work, and under the personal direction of the Chief Sanitary Inspector, Mr. J. B. Smith, ably assisted by all the Sanitary Inspectors, the work of assessing damage and supervising building repairs has been carried out, it is believed, with efficiency and satisfaction to all concerned. In the earliest stages, the co-operation of local builders was sought and willingly obtained, a procedure which has proved eminently successful. A survey of the resources of materials in the warehouses of these local builders was made, and these resources proved to be sufficient to provide an adequate reserve for carrying out the type of work required. 4 (3) Care of Persons rendered Homeless by Enemy Action.—This service, primarily the responsibility of the Middlesex County Council, was delegated to the Local Authority in October 1940, and the Medical Officer of Health was appointed the Executive Officer to control this service. The local problem was then reviewed objectively and buildings selected for Rest Centres were sited so as to place no geographical hardship upon any person rendered homeless and seeking shelter, food and rest. The Rest Centres were provided with protective sleeping accommodation, fitted with beds or bunks, with adequate cooking facilities, food stocks, supplies of clothing and staffed on a twenty-four hour voluntary basis. The voluntary helpers, to whom so much is owed for their able and patient service, were drawn from Church workers, the Joint War Organisation and the Women's Voluntary Services. By co-operation with the organiser of the W.V.S., Mrs. County Councillor Lynch, the work of supervision of the personnel was undertaken by Mrs. Archibald Wilson, whose initiative and energy has since contributed so much to the efficiency of the service. Contiguous with the Rest Centre Service, there was established, a Billeting and Rehousing service, and Mr. T. E. Cowan, F.C.I.S., a member of the Medical Officer of Health's School Medical Department was seconded whole-time to this service as Rehousing Officer. This appointment has since proved to have been the best possible selection for a post demanding not only ability, but a sympathetic understanding of the social needs of persons who have suffered from the unexpected stresses of losing their home and personal belongings. The three stages in the rehabilitation of the homeless were centralised in a single administrative unit along with such matters as salvage and storage of furniture, recovery of personal effects, searcher and information services, thus saving the unnecessary fatigue to the homeless of having to go from one office to another. The result of this centralisation of all services concerned with persons bombed out of their homes has, from the administrative angle, done a very great deal to speed up the stages of the final rehabilitation of the homeless. (4) War-time Nurseries.— The Maternity and Child Welfare Committee has established eight non-residential war-time nurseries and a residential nursery party in Hertfordshire, with total accommodation for 380 children of mothers engaged in war-time occupations. With considerable pre-war experience of various types of nursery provision, the Authority was able to take what might have been a more formidable task, almost in its normal stride. With the additional provision made by the Local Education Committee for the attendance of 730 children under five years of age in school infant departments with the availability of Play Centre accommodation for extended hours, and an evacuated 5 nursery party for 40 children in Rutlandshire, it may truly be said that Tottenham has made a substantial contribution to the Government's scheme for the carc of young children of war-working mothers. The Maternity and Child Welfare Committee would wish to acknowledge in particular the energetic and untiring services of the Superintendent Health Visitor, Mrs. J. Kent Parsons, M. B.E., in the work of establishing and maintaining the war-time nurseries. School Medical Service. Despite the difficulties of war conditions, a very complete medical and dental service has been maintained, and has during the year been extended to include, by delegation from the Middlesex County Council, the Minor Ailment and Orthopaedic treatment of all secondary school children in the area. This extension means that routine medical and dental inspection and all forms of treatment are now available to children attending schools provided by the Higher Education A uthority, as well as the Local Education Authority. Close attention has been paid to the nutritional standard of the children which has again showed no sign of deterioration since the war. It is gratifying to note that the percentage of children on the roll now taking milk in school is 79 per cent., and that Tottenham is among the first half dozen districts in the country with the highest proportion of children receiving a daily hot meal at school. Maternity and Child Welfare Service. The increased birth rate and ever increasing popularity of the Municipal Health Centres has kept the Health Visitors, Municipal Midwives and medical staff working at top pressure throughout the year. Two additional ante-natal sessions, making nine sessions a week, have been established during the year, and the percentage of the maternal population attending is as high as any in the country. At the close of the year it was decided to appoint two additional municipal midwives to cope with the increasing number of births. In conclusion, I wish to acknowledge the support and encouragement accorded to me by you Mr. Mayor, and the Chairmen and Members of the various Committees, and to record my indebtedness to my fellow workers, particularly the Chief Clerks, in every department of the Borough's Health Services. I have the honour to be, Your obedient Servant, G. Hamilton Hogben, Medical Officer of Health. and School Medical Officer. 6 STATISTICAL SUMMARY, ETC. Area of the District in acres 3,014 Registrar-General's estimate of civilian population, mid-year 1942 110,100 Rateable Value £971,032 Sum represented by a penny rate £3,800 Births and Deaths Registered live births:— Total. Males. Females. Legitimate 1,740 869 871 Illegitimate 79 40 39 1,819 909 910 Birth Rate per 1,000 estimated population 16.52 Stillbirths Total. Males. Females. Legitimate 40 25 15 Illegitimate 4 2 2 44 27 17 Stillbirth Rate per 1,000 total (live and still) births 23.62 Deaths Males 701 Females 648 Total 1,349 Death Rate per 1,000 estimated population 12,25 Maternal Deaths:— Deaths Rate per 1,000 total (live and still) births. Puerperal sepsis 1 0.54 Other puerperal causes 4 2.15 5 2.69 Death Rate of Infants under one year of age:— All infants per 1,000 live births 43.43 Legitimate infants per 1,000 legitimate live births 41.95 Illegitimate infants per 1,000 illegitimate live births 75.95 Deaths from Cancer (all ages) (males 116, females 113) 229 ,, Diphtheria 3 ,, Measles 1 ,, Whooping Cough — ,, Diarrhoea (under 2 years) 8 7 Table of Deaths during the year 1942 in the Borough of Tottenham, classified according to Diseases. Cause of Death Males Females Totals Typhoid and Paratyphoid Fevers — — — Measles 1 — 1 Scarlet Fever — — — Whooping Cough — — — Diphtheria 1 2 3 Influenza 3 5 8 Encephalitis Lethargica 1 3 4 Cerebro- Spinal Fever 1 1 2 Tuberculosis of Respiratory System 42 38 80 Other Tuberculous Diseases 6 6 12 Syphilis 10 6 16 General Paralysis of the Insane Tabes Dorsalis - - - Cancer, Malignant Disease 116 113 229 Diabetes 2 8 10 Cerebral Haemorrhage, etc. 49 54 103 Heart Disease 133 149 282 Other Circulatory Diseases 45 38 83 Bronchitis 72 42 114 Pneumonia (all forms) 35 43 78 Other Respiratory Diseases 12 3 15 Peptic Ulcer 16 5 21 Diarrhoea (under 2 years') 3 5 8 Appendicitis 6 2 8 Other Digestive Diseases 16 17 33 Acute and Chronic Nephritis 23 18 41 Puerperal Sepsis — 1 1 Other Puerperal Causes — 4 4 Congenital Debility, Premature Birth, Malformations 26 27 53 Road Traffic Accidents 9 3 12 Other Violent Causes 13 16 29 Suicide 6 1 7 All Other Causes ... 54 38 92 701 648 1,349 Infantile Deaths in Ages and Sexes during the year 1942. Cause of Death. 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. Total deaths under 1 year. Males. Females. T.B. Meningitis — — — — — — — 1 1 1 — Meningitis — — — — — — 1 — — 1 1 — Bronchitis — — — — — 2 — — — 2 1 1 Pneumonia 2 — — 2 4 1 3 — 1 9 2 7 Diarrhoea and Enteritis — — — 1 1 4 2 2 1 10 3 7 Premature Births, congenital Malformation, etc. 34 8 3 2 47 4 2 - - 53 26 27 Injury at Birth 2 — — — 2 — — — — 2 2 — Other Causes 1 — — — 1 — — — — 1 — 1 Totals 39 8 3 5 55 11 8 2 3 79 36 43 8 Table of Cases of Infectious Disease coming to the knowledge of the Medical officer of Health during the year I 912 in the Borough of Tottenham, classified according to Diseases and Ages. Notifiable Disease. Males. Females Under one. 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 & over. Total Cases Removed to Isolation Hospital by Council Scarlet Fever 166 129 1 5 11 21 38 . 171 32 3 9 4 134 Diphtheria 39 36 1 1 2 6 4 39 9 5 4 2 2 — 74 Pneumonia 60 49 1 1 3 2 1 14 4 5 11 18 32 17 — Erysipelas 8 14 - - - - - - - 1 2 4 12 3 5 Puerperal Pyrexia — 12 - - - - - - - - 10 2 — — 5 Dysentery 7 1 — — 2 — — 1 3 2 — — - — 4 Ophthalmia Neonatorum — 1 1 - - - - - - - - - - - - Cerebro- Spinal Meningitis 6 10 — 1 1 — 1 3 — 3 3 1 2 1 6 Poliomyelitis 1 1 - - - - - - 1 1 — — — — 2 Encephalitis Lethargica 1 — — — — — 1 — — — — -— — — — Enteric 1 — — — — — — — — — 1 — — — — Food Poisoning 5 6 — — — — — — — — 4 2 4 1 — Whooping Cough 49 54 10 19 12 11 10 37 2 — 1 1 — — 12 Measles 364 348 25 44 55 63 129 378 14 1 2 1 — — 36 Pulmonary Tuberculosis 96 68 — — — 2 — 2 4 18 86 23 24 5 — Other forms of Tuberculosis 10 11 - - 1 1 2 4 2 5 4 - 2 - - Totals 813 740 39 71 87 106 186 649 71 44 137 58 78 27 278 6 10 INFECTIOUS AND OTHER DISEASES. Scarlet Fever. 295 oases of Scarlet Fever were notified during the year, compared with 103 in 1941, 103 in 1940, 335 in 1939, and 186 in 1938. Less than 50 per cent.—namely, 134—of these oases were removed to Isolation Hospital. Diphtheria. The number of cases notified was 75, compared with 73 in 1941, 28 in 1940, 60 in 1939, and 221 in 1938. There were 3 deaths from this disease. Immunisation is carried out by two doses alum precipitated toxoid; 0.2 c.o., foillowed 3 weeks later by 0.5 o.c. Total attendances 9,689 Schick Tests 1,970 Cases completed during the year:— Over 5 years of age, 1,171. Under 5 years of age, 1,794.-2,965. Estimated Percentage of Child Population Immunised at 31st December, 1942:— Aged under 5 years, 60 per cent. Between 5 and 15 years, 50 per cent. Diabetes. With the approval of the Ministry of Health, Insulin was supplied to 11 patients suffering from Diabetes. The cost of this amounted to £52 12s. 8d. Laboratory Facilities. The following is a statement of the examinations made during the year:— Swabs. Negative. Positive. Total. Diphtheria Contacts, Discharged cases, Convalescent Home cases etc. 630 19 649 Medical Practitioners 421 31 452 1,051 50 1,101 11 Specimens of Sputa examined for Tuberculosis : — Positive 81 Negative 14 95 Faeces examined for Dysentery 1 (Negative) Ambulance Facilities. There is no change to record in the constitution and administration of the Borough Ambulance Service. Five motor ambulances are available for accident and non-infectious cases, and there are two buses for conveying children to Special Schools. These buses are also used for transporting meals to the various School Feeding Centres. A Utility Van is also available for conveying school meals. Total mileage for the year—Ambulance Vehicles and buses . . 44,408 Total mileage for the year—Utility Van 8,351 Number of Accident and Hospital Cases conveyed 3,695 Number of Maternity Cases conveyed 154 Number of occasions on which the Oxygen Resusci- tator was used . 4 Water Supply. The Borough water supply, controlled by the Metropolitan Water Board, has been satisfactory in all respects. Sanitary Conditions and Housing. The repair of war damage continued to occupy a considerable portion of the Sanitary Inspectors' time, but a full report of this work since the commencement of the "blitz" period! in 1940 cannot, for security reasons, be given at present. The Health Committee have given continuous thought to the housing situation in the Borough, and have expressed considerable concern at the conditions arising from the acute shortage of suitable accommodation available to meet the increasing needs of the District. 12 The Council's Housing Estates at present comprise :— White Hart Lane Estate 787 houses. Bromley Road Estate 28 houses. Weir Hall Estate 306 houses. Weir Hall Estate . 40 flats for aged persons. Scotland Green Estate 36 houses. 4 1,197 (including 40 flats). In the three years 1941, 1942 and 1943, only 50 vacancies have occurred on these Estates, and it has only been possible, therefore, to deal with but a fraction of the many urgent cases registered on the existing application list, which now totals over a thousand names. The urgency of the housing problem was apparent midway through 1942;, when there were 650 applications registered. Representations were made to the Ministry of Health by deputations appointed by the Council. The subjects of such discussions were:— (а) the immediate housing needs with particular reference to requisitioning for general housing purposes; and (b) future requirements, taking into consideration the post-war slum clearance programme. Little progress in the solution of this problem has been made so far, although the Ministry of Health Circulars 2845 and 2871, issued in August and October, 1943, will enable the Council to secure a limited number of properties for general housing needs. The ma.in problem—namely, rehousing the hundreds of families created and extended since the war—remains untouched, and it will need vigorous action in the future to provide this urgent requirement for new homes. Inspections Carried out by the Sanitary Inspectors, and Defects, etc., Remedied. House to House Inspections 100 Infectious Diseases 523 Complaints 4,041 Drains Tested 652 13 Drains Defective 307 Re-Inspections 6,849 Factories 458 Workplaces 66 Outworkers 193 Dairies, etc 132 Slaughter-Houses 19 Bakehouses 107 Public House Urinals 97 Stables and Mews 43 Food Premises 702 Appointments and Interviews 1,185 Other Visits 1,822 War Damage Visits 10,920 Visits to Requisitioned Houses (for homeless persons) in connection with general maintenance 2,012 Drains Reconstructed 76 Drains Repaired 154 Drains found stopped 203 Soil Pipes repaired or renewed 72 Gullies renewed 76 Fresh-air-inlets renewed 50 W.C. cisterns and pans repaired or renewed 472 Waste pipes repaired or renewed 262 Defective dustbins reported 102 Rain-water-pipes repaired or renewed 197 Roofs repaired or renewed 812 Gutters repaired or renewed 404 Drinking water cisterns repaired or renewed 47 Number of Houses where water provided from main 12 Yard paving repaired or renewed 102 Sinks repaired or renewed 45 Floors repaired or renewed 259 Floors ventilated 88 Window frames and sashes repaired or renewed 309 Window frames and sashes painted 11 Coppers repaired or renewed 55 14 Fireplaces, Stoves and Ovens repaired or renewed 304 Food Stores provided or repaired 14 Number of Houses where damp proof courses inserted 59 Number of Houses pointed 38 Number of Houses rendered 216 Number of Houses where walls and ceilings made good and cleansed 1,319 Stairs repaired 66 Doors repaired 47 Water supply reinstated 44 Common Staircases lighted 1 Miscellaneous defects remedied 398 Accumulation of refuse removed 55 Notices Served. Informal 2,427 Statutory— Housing Act, 1936, Section 9 251 Public Health Act., 1936, Section 24 42 Public Health Act, Section 39 35 Public Health Act, 1936, Section 83 . 7 Public Health Act, 1936, Section 94 20 Public Health Act, 1936, Section 56 1 Repair of Houses by the Council. Work carried out in default:— £ s. d. Section 9, Housing Act, 1936. 21 premises: Cost 543: 4: 10 Section 39, Public Health Act, 1936. 5 premises: Cost 41 : 1 : 8 Work carried out for maintenance of public sewers :— Section 24, Public Health Act, 1936 30 premises: Cost 268: 4: 0 15 Housing Act, 1936, Section 11. Demolition Orders with respect to 2 houses, namely Nos. 6 and 7, Railway Terrace, were made under this Section. Housing Act, 1936, Section 12. A Closing Order under this Section was made with respect to part of the premises No. 13, Railway Terrace. Disinfection Work. There was a considerable increase in the amount of disinfection work undertaken during the year. This was due mainly to the greater use made of this Service by private firms in the Borough. Complete details are as follows:— Rooms disinfected after Diphtheria, Scarlet Fever, Tuberculosis, etc. 899 Number of houses where bedding was disinfected after the occurrence of infectious disease 806 Wards or School Rooms disinfected 35 Verminous rooms (including disinfestation process) 356 Miscellaneous rooms 21 Other Blankets. Pillows. Overlays. Articles. Private Firms 6,723 3211 261 127 Civil Defence Fire Watchers, etc. 1,982 344 525 728 Library Books, 240. Houses disinfected on Council's Estates—51 houses. (109 rooms). Milk (Special Designations) Orders, 1936 and 1938. These designations may only be used under licence from the local authority. In 1942 the following licences were granted:— Pasteurised Milk:— Pasteurisers' Licences 3 Dealers' Licences 15 Supplementary Licences 4 Tuberculin Tested Milk:— Bottlers' Licences 1 Dealers' Licences 8 Supplementary Licences 3 Accredited Milk Licence: 1 16 Shops Acts, 1912—1938. The Shops Acts are administered by two whole-time officers. By means of systematic visitation of shops throughout the Borough, effective administration of the Shops Acta is secured, and the necessary information obtained for the purpose of keeping up to date a register of all shops in the Borough. Regular visits and investigations are made on the days of the Weekly Half Holiday, and in the evening to ensure that the provisions of the Acts and the various closing orders made thereunder are complied with. Many shopkeepers are desirous of having the earlier evening closing hours imposed under the Defence Regulations made permanent by legislation after the war. In the administration of the Acts and closing orders, 4,772 inspections have been made. Most of the offences have been minor irreguilarities, and the non-exhibition of statutory notices in respect of which 30'1 verbal warnings and notices were issued. Shops (Sunday Trading Restriction) Act, 1936. Regular investigations and inspections have been made in connection with this Act, and it is pleasing to be able to state that very few shops open on Sunday in Tottenham. The conditions relating to the employment of assistants on Sunday, and the compensatory holidays in lieu thereof, are being complied with. Shops Act, 1934, and Young Persons Employment Act, 1938 The provisions of the Acts relating to the employment of shop workers have been effectively applied during the course of routine visitation of shops, and it has been ascertained that. the conditions of employment have improved as a result, in respect both of the hours of employment of young persons and the arrangements made for the health and comfort of shop workers generally. Shopkeepers are desirous of taking reasonable measures to comply with the requirements of all the Shops Acts, and are ready to obtain and act upon the advice and instructions given by the Shops Inspector. Owing to so many older shop assistants being engaged on work in connection with the war, the number of young persons employed at present is above the normal. 17 It is gratifying to record that with the co-operation of shopkeepers, the Acts generally have been well observed. During 1942 five warning notices were issued in respect of contraventions of the above Acts. Tuberculosis. The County Council are responsible for the treatment of Tuberculosis. 185 notifications were received under regulations during 1942. Pulmonary, 164; other than Pulmonary, 21. Cases remaining on the register at the end of the year were— Pulmonary, 548 ; Non-Pulmonary, 160. The Tottenham Tuberculosis Officer has his premises at 140, West Green Road. The days and hours of attendance at the dispensary are:— Monday to Saturday—10 a.m.—12.0 noon. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary . Pulmonary. NonPulmonary. Males Females Males Females Males Females Males Females Under 1 year - - - - - - 1 — 1 to 5 years — 9 2 2 — — 2 2 5 to 15 ,, 4 2 2 4 — — — — 15 to 25 ,, 26 27 4 2 6 12 1 1 25 to 35 ,, 26 25 1 2 12 14 2 1 35 to 45 ,, 17 6 — — 4 6 — — 45 to 55 ,, 12 2 1 - 7 3 — — 55 to 65 ,, 8 2 — 1 8 2 — 1 65 years and upwards 3 2 — — 5 1 — 1 Totals 96 68 10 11 42 38 6 6 18 Organs affected (New Cases): — Males. Females. Lung 96 68 Glands 2 2 Spine 3 2 Kidney 1 — Knee — 2 Hip 2 2 Thumb 1 — Meninges 1 1 Skin — 2 The deaths represent a death rate of 0.8 per 1,000 population. In 2'3.9 per cent, of the fatal cases no previous notification had been received. There was, however, no suggestion of wilful neglect or refusal to notify, and accordingly no proceedings were taken. School Medical Service. Staff- In the appendix a new table (VII) will be found, giving particulars of the Medical, Dental and Nursing Staff. The return of a number of Children from Reception Area6 during 1941 caused much additional work. Dr. Webster's post as Part-time Medical Officer, therefore, became whole time from February, 1942 (1/20 being reserved for Maternity and Child Welfare work). In November, 1940, Mr. A. E. Fisher, one of the dental surgeons, temporarily gave up his Tottenham duties to join the Dental Branch of the R.A.F.V.R. Many children were at that time evacuated, and the burden of dental work placed upon the other two dentists was manageable; but a whole-time temporary assistant dental surgeon, Miss E. MoRaith, L.D.S., took up duties on October 26th, 1942, when the growth of school population by numbers of children returning from Reception Areas made this step necessary. I regret to have to report the death of Miss B. Johnson, L.D.S., on June 2nd. Miss M. C. Dixon, L.D.S., took up the permanent position from September 7th. Medical Inspections— Despite the difficulties of war conditions, the members of the Staff have maintained a very complete service. Medical, dental 19 and cleanliness inspections have not fallen behind those of a normal year. The routine medical inspections of the three age groups, and in addition of children who could not be medically inspected in 1941, has been completely carried out during the year under review. This factor, coupled with the large number of new entrants to schools, augments the figure of children examined well beyond that of the previous year. Summary of medical inspection work :— (A) Routine Medical Inspection : Entrants 21,630 2nd Age Group 1,242 3rd Age Group 1,551 Other routine inspections 571 Total 5,994 (B) Special Inspections (and re-inspections): After a routine school medical inspection, children requiring particular attention are carefully watched and are re-examined at schools and; clinics. Early appointments are given to the eye, ear, nose, throat, orthopaedic and other clinics so that specialists may examine the children. Close attention is given to nutrition and cleanliness; we refer to the nutrition clinic any sub-normally nourished children, and their progress is constantly noted. If the medical officers recommend medicinal foods, e.g., Cod liver oil and malt, these are supplied. Physical Welfare in War-time The statistical tables for the year register progress, especially of secondary school children. Medical inspections show them to be of better physique than in previous years; the numbers who have school meals are constantly increasing. A good example of this progress is the monthly measurement of heights at a secondary school; this year's entrants were found to be more than half-inch taller than those of last year. Stamina is on the up grade particularly among children having dinners at school. 20 Nutrition and School Meals. We have found that there are no apparent signs of deterioration in children's health although meat, fats, eggs, fruit, etc., are very limited. But the effect of lacking these foods is to a great extent neutralised by school meals and milk in schools. There is no doubt in fact that a satisfactory standard of nutrition has been reached only because families have made great use of these services. The Director of Education has kindly supplied me with the following statistics of school meals provided during the year. Provision of Solid Meals. The success of this scheme, on a sliding scale of payment is shown by the figures below :— Month. Free. On Payment. January 428 2429 February 468 2568* March 493 2785* April 544 2918 May 566 3057* June 537 3099* July 527 2614* August 430 1926* September 559 3139 October 395 2341* November 472 3173 December 444 3078* *Month during which school holidays occurred. Board of Education figures show Tottenham among the first half dozen areas of the Country with the highest proportion of children receiving a daily hot meal at school. Parents who wanted their children to take meals on Saturdays and school holidays were served by the British Restaurant service which the Education Committee organises jointly with the school meals scheme. Provision of Milk. Children taking milk both free and on payment numbered 80 per cent. of those attending school. The teaching staff voluntarily helped in the provision of milk during school holidays. 21 Cleanliness. School nurses examine children regularly for uncleanliness and vermin. Children are watched both at school and at home. Treatment by a Lethane compound has been found useful. In the appendix the number of unclean children and the manner in which they were dealt with is shown. Scabies. Children and relatives treated were in larger numbers earlier in the year, but numbers diminished later, despite a vigilant search ; and probably scabies is now decreasing in this area. Ultra Violet Light Treatment. 203 children were given ultra violet ray treatment, the total number of attendances being 2965. The work is done at the Municipal .Medical Centre, Park Lane, by agreement with the Maternity and Child Welfare Committee, so that we make use of the ultra violet ray apparatus installed for treatment of children under five. The improvement in health of children after this treatment is marked, and Medical Officers send increasing numbers to the sunlight clinic. We are therefore installing additional lamps at the Medical Centre, Lordship Lane; school nurses will give the treatment. Exposures are systematically reduced in length, so that the patient will be gradually separated from his artificial aid and the risk of the so-called '' negative phase " be reduced. Diphtheria Immunisation. National and local propaganda for immunisation has been vigorous. The number of sessions in Tottenham has been doubled; each section of the Borough is now conveniently near a weekly clinic. The drive has been helped by head teachers, who have given details, and underlined at school assembly the fact that it. is vitally important to be protected against diphtheria. Similarly, at school medical inspections, minor ailments land even nutrition clinics, the medical staff has tried as much as possible to talk to parents in person; this is the best way of all to get parents to consent. Copies of the Minister of Health's "Urgent Letter to Parents" (which "must be returned whether signed or not") have 22 been distributed to all children who are not immunised. As a result all special immunisation sessions were full most of the year, and a doctor has held part sessions at schools where many children applied for treatment. Nearly every patient immunised in 1942 was an objector in earlier years because more than 5,000 children of school age were already completely immunised prior to 1942. Every patient has a final Schick test performed to assure that treatment has been effectual. About 5 per cent. still prove Schick positive: the dose is increased with a further test three months later. Every child has finally become negative. Only one patient has developed diphtheria after being fully immunised, and this was a mild case. Bacteriological Examinations. Culturing and examination of Swabs from suspected diphtheria patients has continued in the Council's laboratory; contacts or exhospital patients have been tested as before by the "three negative swab" method, and the virulence test for chronic carriers has been undertaken where necessary by the Pathologist at the Prince of Wales's General Hospital. Infectious Diseases. By early 1942 so many school children had returned from evacuation that I decided to include again an infectious disease table in this report. Mumps, chicken pox and scarlet fever seemed to have increased, but oases have been exceptionally mild, and probably some were so slight that they were not detected. Certainly this occurred with scarlet fever in a few schools, where nothing could be found until the child was actually desquamating. Milk supplies were examined and were not a cause of these cases. The great reduction in Diphtheria is remarkable. It may be only temporary, but we have reason to hope that immunisation is responsible, especially when whole families are afflicted except, the immunised members. Weekly lists of infections supplied by Head Teachers have continued to be most helpful, especially with diseases not notifiable. From these lists home visits of great value have been made by the School Nurses. 23 Infectious Diseases in school children:— Notified Cases: Scarlet Fever 199 Whooping Cough 40 Diphtheria 44 Measles 381 Pneumonia 19 Cerebro-Spinal Meningitis 2 Poliomyelitis 1 Pulmonary T.B. 6 Non-Pulmonary T.B. 6 Total 698 Infectious Diseases not Notifiable. Mumps 717 Chicken Pox 611 Care of Teeth. The senior dental officer, Mr. V. Sainty, L.D.S., reports that the year has been difficult for the dental service, for reasons given earlier in this report; but three dental clinics were again operating full time by the end of the year. Despite the handicaps, 3,219 children were treated, as against 3,284 in 1941. Children in the war-time nurseries are inspected by the dentist every three months, so that these children as well now receive regular attention. Taking into account the pre-school supervision at toddlers' clinics and nursery classes, there will probably be great improvement among entrants at infants' schools. Constant attention is given to the dental condition of all Tottenham children throughout school life; a great improvement in their dental condition is noticeable. The major part of clinical treatment deals with conservation of the teeth and correction of maloclusion of the dentition. Cases in need of orthodontic treatment have the opportunity to have irregularities corrected, the result being an improvement both from the viewpoint of mastication and a?sthetically. Treatment was also given to 771 (expectant and nursing mothers, including, if necessary, the supply of dentures: the figure is an increase of 100 over that of 1941. 24 Orthopaedic Clinic. 136 children needing treatment for some crippling defect were found on routine and special inspections. Surgical appliances were supplied, a.nd repairs and replacements made in 54 instances. The Orthopaedic Sturgeon attends regularly, and prescribes treatment which is carried out by the masseuse. Children requiring surgical treatment are admitted to the Royal National Orthopaedic Hospital at Stanmore, which also supplies them with surgical appliances. The number of new cases and in particular the number of treatments given lias increased. The type of case remains the same except for foot defects. This is due to the admission of secondary school children to clinics. Spinal defects have not increased, which probably testifies to the efficient physical training given at these schools. Diagnosis of New Cases at the Orthopaedic Clinic Congenital Deformities 23 Birth Injuries — Ricketty Deformities 4 Knock-knees 16 Structural Curvature of Spine 3 Postural Defects of Spine 14 Flat Feet 56 Infantile Paralysis 3 Sequelae of acute fevers — Fractures T.B. Joints 1 Bone Diseases other than T.B. 5 Other conditions 4 Osteomyelitis — Non-Orthopaedic 2 133 Ophthalmic Clinic. 75.7 errors of refraction, including 51 sufferers from squint, were found. Spectacles were prescribed and obtained for 553 eases. The Ophthalmic Surgeon has three sessions weekly at the Lordship Lane centre, where children are treated for all eye defects not 25 handled by the Minor Ailments Clinic. An optician attends each session, and spectacles are fitted the following week to the Surgeon's satisfaction. Individual cases are given special appointments for re-examination in three to twelve months. Special attention is paid to squint, and those attending Toddlers' Clinics are particularly observed. Cases thus discovered are referred to the specialist. Health Visitors and School Nurses co-operate in the work of early detection of cases. Co-operation with Voluntary Bodies. Much useful service has, as always, been rendered to the School Medical Department by the Invalid Children's Aid Association and the National Association for the Prevention of Cruelty to Children, and thanks are due to both these voluntary organisations. Child Guidance. Children having difficulties in educational progress and behaviour are referred to the Tavistock Clinic of the Institute of Medical Psychology, Hampstead, iand to the Department, of Psychological Medicine at Guy's Hospital. A report is made as to the best method of treatment for each individual case. Nursery Classes. At Lancasterian Infants' School three groups of children attend, of ages from two to four and a half years. The children are there all day. Attendance is excellent. All children have onethird of a pint of milk in the morning and in the afternoon and an excellent dinner at midday. The health of these children ia very good. A medical officer carries out a routine inspection every second week, and visits the school on any other necessary occasion. A School Nurse attends each morning to dress minor injuries and sores, to carry out general cleanliness inspections and to super vise the health side of nursery nurture. Nursery Classes: Number on roll 110 (average) Attendance 86% Infectious illness 9% Number taking meals 87% 26 BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. We operate the model regulations of the Board of Education, which work satisfactorily, to detect these children. Our sources of information are parents, attendance officers, teachers, school nurses, health visitors, other authorities where address has been changed, hospitals and institutions. We thus have very complete knowledge, and hardly any exceptional children in the district are not known to the Department. Blind and Partially Blind Children. There were 4 blind and 6 partially blind children at the end -of 1942, accommodated at:— Royal London Hospital for the Blind, Dorton, near Aylesbury 3 London Lodge School 1 White Oak, Swanley 1 Special Day School, Walthamstow 5 Deaf Children. Of 33 children too deaf to be taught at an elementary school 22 are attending at the Special Day School and the remainder at the Committee's Evacuation School at Rustington. Mentally Defective Children. Children certified by the Medical Officers as mentally defective are accommodated at:— Oak Lodge Special Day School, Finchley 33 St. Joseph's, Dunmow 1 Banstead M.D. School 2 Low Grade mental defectives are referred to the County Council. Epileptic Children. Two children are being treated at Lingfield Epileptic Colony and one is awaiting admission. Physically Defective Children. The Committee's special open-air school at Hayling Island for delicate children had temporarily to be closed in August, 1940. Since that time children have been placed in other suitable accommodation on recommendation by the Medical Officers, and 36 cases were dealt with this year. 27 CERTIFIED SPECIAL SCHOOLS. School for the Deaf. Numbers at the Rustington evacuated school decreased steadily because those leaving were not replaced by younger entrants; these latter attended the day school in the Borough. A proposal was therefore made to close the Rustington school entirely. At the same time, tine local temporary quarters at West Green School became more crowded. Finally the remainder of the school was taken over from the National Fire Service. We can now, therefore, use the amplifier to full capacity in a quiet room reserved for this and for audiometer testing in the school. Speech training sessions have been further extended, and more stammerers benefit than ever before. We hope that early in 1943 the building specially made for these children will again be available, when it will be easier to give them all the special care they require. All children are medically inspected and re-insipected, and where necessary referred to the Aural Clinic. Oak Lodge School for Mentally Defective Children. Mentally defective children who are educable are provided for at the special day school at Oak Lodge, Finchley. This is managed by a joint Board of Finchley, Wood Green and Hornsey. Finchley A.R.P. Service occupied a part of the building at the beginning of the war; this cramped the space and made it difficult to cater for the educational needs of the children. In the middle of this year, I am pleased to say, the A.R.P. service vacated the premises. Older boys will now be instructed in boot repairing a.nd will resume the woodwork classes. 53 Tottenham children were attending at the end of the year. There is, unfortunately, no accommodation for children certified mentally defective at the school; but after the war we hope to provide special premises for these children. Special Day School for Partially Sighted Children. Lordship Lane Myopic Class (Wood Green administration) was closed. Children now attend by arrangement at the Walthamstow School for Blind and Myopic Children at Hale End Road. Such children have to be selected and certified by the Ophthalmic 23 Surgeon. 5 Tottenham children were attending at the end of the year. Special School for Physically Defective Children. Physically defective children attend a special school accommodated temporarily at West Green School 45 children were attending at the end of the year. THE AURAL CLINIC, 1942. Mr. F. P. M. Clarke, Aural Surgeon, reports that the number of children referred to the Aural Clinic during the year was considerably in increase of the previous year. The number of pre-sohool children attending has steadily increased, which is a move in the right direction, for the earlier that any defects are detected and promptly treated, the less will be the number of these ailments when the child reaches school age. This can be seen in the cases of Acute Otorrhoea.. There were 16 pre-school children treated for Acute Purulent otitis. 12 of these were cured and three remained under treatment at the end of the year; while there was only one case of Chronic Otorrhoea amongst the pre-school age. We think it advisable to add a short note here on the Suction method of Treatment used in acute purulent otitis. A day or two after the acute attack and pain have passed off, and when the discharge becomes thick, there is a tendency for the opening or perforation in the drum membrane to became closed up, with a consequent stasis of pus in the middle ear. A mild suction with a suitable instrument, applied daily, will help to keep the perforation open and empty the middle ear of discharge, allow free drainage, thus allay the irritation set up by the discharge, of the delicate tissues of the middle ear, will facilitate healing, and allow the entry into the middle ear of the antiseptic medicament used. When the external and middle ear are emptied by suction, a vacuum is produced which brings forward any pus that is present in the middle ear. In this way the pus has little chance of becoming stagnated in the mid ear and its various tracts, which sometimes lead even to the petrous pyramid. If this treatment is carefully carried out, the benefits to the patient will soon become very obvious. After the suction, a 1 or 2 per cent. solution of carbolized glycerin is dropped into the ear and repeated every two or three hours. If pain is troublesome, a warm suction douche 29 (Fowler) gives marked relief. A 1 or 2 per cent. solution of carbolic acid in sterile cod-liver oil gives equally good results as in glycerin—a, point to note in the present scarcity of glycerin. We use this method invariably with satisfactory and speedy results. The chronic cases which have remarkably diminished in the last few years, we treat by zinc ionisation. A number of these cases in the present Returns are ''old mastoid" cases, operated on same years previously, and did not heal up after the operation; granulations have developed and more bone has become necrosed. These are the most intractable conditions one has to deal with. The number of cases treated for nose and throat defects, such as sinusitis, rhinitis, nasal catarrh (often accompanied by deafness), enlarged tonsils and adenoids, nasal respiratory insufficiency, etc , has been nearly doubled. This is the correct attitude towards these ailments, and the school medical officers make a particular note of these in their regular routine examinations. The early detection and correction of naso-pharyngeal defects in children will prevent an enormous amount of the consequent permanent incapacity, especially deafness, found in later adult- life. The audiometer, both the Gramophone and Pure Tone, are of great value in detecting incipient deafness and checking up on the progress of treatment. Diastolisation has been employed in the majority of nasal cases, frequently in association with oscillation vibration. It is especially indicated in cases of rhinitis and deafness due to this. For sinus conditions, we have used considerably Proetz " Displacement " method and find the results very satisfactory. We have increased the number of "enlarged tonsil" cases treated by the Suction method—described in previous reports. •Continued satisfactory results confirm our opinion of the great value of this method. The high percentage of "enlarged tonsils" successfully treated by Suction, as against operation, will be quite surprising to people who have only one formula for "tonsils and adenoids"—remove them. We preserve a reasonable balance, and do not 'allow the pendulum to swing altogether to one side, as there are quite definitely some cases where removal is the treatment best suited, and we have sent for operation in the course of the year 26 such cases, but this is a relatively small number out of 139 referred for treatment. 30 The decision to allocate two special sessions a week (treatment clinics), with the same nurses, for carrying out the treatment prescribed at the Aural Clinic, has proved to be one of the main factors in the practical, efficient and successful working of the Clinic. This treatment is carried out, always, by the same nurses, having special experience in the work, who attend the Aural Clinic, and therefore are in regular touch with the patients. This arrangement leaves no break in the continuity of treatment, which is all important. Under war conditions the attendance has, on tine whole, been very good. A certain number, however, who attended the Aural Clinic for examination and for whom appropriate treatment was prescribed and arranged for, failed to attend for same. In the ''Follow Up" of these cases it was found that in many instances the people lived a considerable distance from the clinic and were busy with housework and could not find the time to bring the younger children. Others were engaged on essential war work; some declined the treatment, while others just simply let it drift as they did not think it was urgent. SUMMARY. Total number of new cases examined and prescribed for (700) are as follows:— Acute Otitis (school children) 134 Acute Otitis (pre-school children) 16 Chronic Otorrhoea—without complications (school) 43 Chronic Otorrhoea—with complications (school) 39 Chonic Otorrhoea. (pre-schooi) 1 Nose and Throat conditions (school) 347 Nose and Throat conditions (pre-school) 53 Miscellaneous 67 Ear cases treated by Zinc lonisation 83 Nasal cases treated by Diastolisation 2'14 Nasal cases treated by Proetz "Displacement" 41 Enlarged Tonsils treated by conservative tonsil suction 110 Ear cases referred to hospital 12 "Tonsils" (unsuitable for conservative treatment) referred to hospital for operation 26 Children examined at the Aural Clinic and treatment arranged, but failed to attend. 75 Total number of pre-school children seen at the Clinic 70 4 TABLE A. ACUTE OTITIS MEDIA. (i) CHILDREN OVER 5. Diagnosis. Total (Ears). Tonsils and Adenoids. Treatment. Cured. Result. Referred to Hospital for Operation. Did not attend for or Declined Treatment. Zinc lonisation. Antiseptic Treatment. Tonsils and Adenoids | Conservative: Nasal: Diastolisation. Tonsils and Adenoids J Operation. Improved. Still under Treatment or Observation. Left or Treatment Lapsed. Acute Non-Suppurative Otitis Media 25 *(6) 2 Operation before Clinic — 2 — — 2 — — — — — 23 No Operation. — 23 — — 23 — — — — — Acute Non-Suppurative Otitis Media with Nasal Conditions: Enlarged Tonsils and Adenoids 17 *(1) 3 Operation before Clinic — 3 3 — 3 — — — — — 14 No Operation — 14 10 1 10 1 2 1 — — Acute Suppurative Otitis Media 63 *(H) 14 Operation before Clinic — 14 2 — 11 — — 2 — 1 49 No Operation 11 45 2 2 47 — — 2 — — Acute Suppurative Otitis Media with Nasal conditions : Enlarged Tonsils and Adenoids 29 *(5) 8 Operation before Clinic 1 8 7 — 7 — — 1 — — 21 No Operation 3 18 13 — 17 — 2 — 1 1 Totals 134 *(23) 15 127 37 3 120 1 4 6 1 2 (II) CHILDREN UNDER 5. Acute Non-Suppurative Otitis Media 6 — Operation before Clinic — — — — — — — — — — 6 No Operation — 6 — — 5 — — 1 — — Acute Supperative Otitis Media 6 1 Operation before Clinic — 1 — — 1 — — — — — 5 No Operation — 5 — — 4 — 1 1 — — Acute Suppurative Otitis Media with Nasal Conditions : Enlarged Tonsils and Adenoids 4 *(1) 2 Operation before Clinic — — — — — — — — — — 2 No Operation — 4 4 — 2 — 2 — — — Totals (under 5) 16 *(1) — 16 4 — 12 — 3 2 — — Grand Totals 150 *(24) 15 143 41 3 132 1 7 8 i 2 * The figures in brackets indicate the number of cases with Bi-lateral Otorrhoea, TABLE B. CHRONIC SUPPURATIVE OTITIS MEDIA. DIAGNOSIS. Totals (Ears). DIAGNOSIS. Tonsils and Adenoids Treatment. Result. (Children over 5.) Chronic Tympanic Sepsis Complicated by:— Granulations: Simple Polypii. Mastoid Disease. Enlarged Tonsils and Adenoids. Nasal Catarrh: Rhinitis: Sinusitis. External Otitis: Eczema. Primary (Ear) Collateral (Nose and Throat) Cured. Improved. Still under Treatment or Observation. Left or Lapsed Treatment. Referred to Hospital for Operation. Did not attend for, or Declined Treatment. Old Operation. No Operation. Zinc lonisation. Antiseptic Treatment or Cautery. Tonsils and Adenoids Conservative: Nasal:Diastolisation. Tonsils and Adenoids Operation. SCHOOL. Granulations: Simple Polypll 1 — 1 — — — — Operation before Clinic 1 1 — — 1 — — — — — — — — — — No Operation — — — — — — — — — — Mastoid Disease IS *(4) — 16 2 — — — Operation before Clinic 14 9 — — 6 2 3 — 7 — — — — — — — No Operation — — — — — — — — — — Enlarged Tonsils and Adenoids 5 — — — — — — Operation before Clinic — — — — — — — — — — — — — 4 1 — No Operation 4 2 2 — 3 — — 2 Nasal Catarrh : Rhinitis : Sinusitis 12 — 1 2 — 5 — Operation before Clinic 4 6 4 — 3 1 — — 2 2 — -— — — 4 — No Operation 4 2 3 — 3 — 1 — — External Otitis: Eczema 3 — — — — — 2 Operation before Clinic 2 — — — — 2 — — — — — — — — 1 No Operation — 1 — — 1 — — — — — Totals 39 — 18 4 4 10 3 29 21 9 — 17 3 5 3 9 2 Chronic Suppurative Otitis Media solely 43 Children over 5 years 19 Operation before Clinic 18 1 — — 15 — — 2 1 1 24 No Operation 21 1 — — 18 — 2 2 1 1 Total—School Aoe 82 — 18 4 4 10 3 68 23 9 - 50 3 7 7 11 4 PRE-SCHOOL. Chronic Suppurative Otitis Media solely — Children under 5 years — Operation before Clinic — — — — — — — — — — — No Operation — — — — — — — — — — Chronic Suppurative Otitis Media with Nasal Conditions: Tonsils and Adenoids 1 Children under 5 years 1 Operation before Clinic — 1 — — — — — 1 — — — No Operation — — — — — — — — — — Grand Totals 83 68 24 9 — 50 3 7 8 11 4 * The figures in brackets indicate the number of cases with Bi-lateral Otorrhoea, with the exception of Mastoid Disease:— Ma wid Disease—Bi-lateral Otorrhoea. (a) Post-Operation 3 (6) No Operation Nil. TABLE C. NOSE AND THROAT CONDITIONS. (I) CHILDREN (Over 5). Diagnosis. Primary. Totals. Tonsils and Adenoids. Secondary Conditions. Treatment. Result. Deafness. Nasal Catarrh. Enlarged Tonsils and Adenoids. Diastolisation. Antiseptic Treatment. Probsts Displacement. Tonsils and Adenoids. i Cured. Improved. Still under Treatment or Observation. Left or Treatment lapsed. Referred to Hospital for Operation. Declined or did not Attend for Treatment.| Conservative Treatment. Operative Treatment. a b c D E F g H i j K L M N o p Q Sinusitis: Rhinitis 45 Operation before Clinic 17 1 10 — 10 16 15 — — 5 7 2 2 1 No Operation 28 — 17 6 18 22 21 3 — 8 2 8 4 2 4 Nasal Obstruction: Rhinitis.. 53 Operation before Clinic 22 7 — — 18 9 2 — — 12 4 2 2 — 2 No Operation 31 1 2 6 24 10 1 4 — 16 4 2 5 2 2 Nasal Catarrh 110 Operation before Clinic 30 7 — — 27 2 — — — 18 3 3 5 — 1 No Operation 80 16 — 8 63 12 1 6 — 46 7 9 10 1 15 Enlarged Tonsils and Adenoids 139 Operation before Clinic — — — — — — — — — — — — — — — No Operation 139 3 50 — 29 13 1 79 26 56 7 12 13 21 30 Totals 347 35 79 20 189 84 41 92 26 161 34 31 39 28 55 (ii) PRE-SCHOOL (Under 5). a b c D E F G H I j K l M N O p Q Nasal Conditions: Sinus Rhinitis .. 20 Operation before Clinic — — — — — — — — — — — — — — — No Operation 20 — — — 12 I — — — 9 2 — — 1 9 Enlarged Tonsils and Adenoids 17 Operation before Clinic — — — — — — — — — — — — — — — No Operation 17 — 2 — 1 — — 7 7 2 4 — 1 6 3 Enlarged Tonsils and Adenoids with Nasal Conditions: 16 Operation before Clinic — — — — — — — — — — — — — — — No Operation 16 — 8 — 12 4 — 11 1 3 3 2 5 1 2 Total: Pre- School 53 53 — 10 — 25 5 — 18 8 14 9 2 6 8 14 Grand Totals 400 35 89 20 214 89 41 110 34 175 43 33 45 36 69 31 TABLE D. MISCELLANEOUS CASES. Diagnosis . Total. Treatment. Result . Wax 14 Removed Cured. Epistaxis 3 Treated Cured. Furuncle 4 Treated Cured. Referred for Special Examination, Audiometer Tests, ReDeaf Classes 43 Report: Recommendation : Advice Unclassified 3 Treated Total 67 ELEMENTARY SCHOOLS. Table I.—Medical Inspections of Children attending Public Elementary Schools—Year ended 31st December, 1942. A.—Routine Medical Inspections. (1) No. of Inspections in the prescribed Groups:— Entrants 2,630 Second Age Group 1,242 Third Age Group 1,551 Total 5,423 (2) No. of other Routine Inspections 571 Grand Total 5,994 B.—Other Inspections. No. of Special Inspections and Re-Inspections 22,422. Table II.—Classification of the Nutrition of Children Inspected during the year in the Routine Age Groups. No. of Children Inspected. A. (Excellent). B. (Normal). C. (Slightly Sub-Normal). D. (Bad). No. % No. % No. % No. % 5,994 703 11.8 4716 78.4 557 9.5 18 3 .32 Table III. Group I.— Treatment of Minor Ailments (excluding uncleanliness .) Total number of defects treated or under treatment during the year under the Authority's Scheme 5,654 Group II.— Treatment of Defective Vision and Squint. Under the Authority's Scheme. Errors of Refraction (including Squint) 757 Other defects or diseases of the eyes (excluding those recorded in Group I) 10 Total 767 Under the Authority's Scheme. No. of Children for whom spectacles were: (a) Prescribed 553 (b) Obtained 553 Group III.—Treatment of Defects of Nose and Throat. Under the Authority's Scheme. Received Operative Treatment 136 Received other forms of treatment 306 Total number treated 442 Table IV.—Dental Inspection and Treatment. (1) No. of children inspected by Dentist:— (a) Routine Age Groups 5,874 (b) Specials 1,013 (c) Total (Routine and Specials) 6,887 (2) No. found to require treatment 4,999 (3) No. actually treated 2.646 (4) Attendances made by Children for treatment 4.846 (5) Half days devoted to:— Inspection 37½ Treatment 531½ Total 569 (6) Fillings:— Permanent Teeth 1,311 Temporary Teeth 457 Total 1,768 (7) Extractions:— Permanent Teeth 911 Temporary Teeth 3,826 Total 4,767 33 (8) Administrations of general Anaesthetics for Extractions 314 (9) Other Operations:— Permanent Teeth 392 Temporary Teeth 508 Total 900 (10) Attendances for Orthodontic Treatment 668 Table V.— Verminous Conditions. (1) Average No. of visits per school made during the the School Nurses or other authorised persons year by 18.8 (2) Total number of examinations of children in the by School Nurses or other authorised persons Schools 86,172 (3) No. of individual children found unclean (4) No. of individual children cleansed under Section 87 (2) and 1,157 (3) of the Education Act, 1921 71 (5) No. of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 42 (6) Under School Attendance Byelaws — SECONDARY SCHOOLS. Number of Pupils Inspected 1st January, 1942, to 31st December, 1942. Routine Medical Inspection. Total. Age 9 10 11 12 13 14 15 16 17 Boys 10 9 86 186 133 52 93 3 — 572 Girls Totals — 1 107 89 83 50 55 13 1 399 10 10 193 275 216 102 148 16 1 971 TECHNICAL SCHOOLS. Number of Pupils Inspected 1st January, 1942, to 31st December, 1942. Routine Medical Inspection. Total. Age 12 13 14 15 16 Boys — 8 1 9 Girls — — — 26 7 33 Totals — — 34 8 42 34 Table II. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups— Secondary and Technical Schools. Number of Children Inspected. A B C D No. % No. % No. % No. % 1,013 205 20.23 735 72.65 72 7.1 1 .09 Table III.—(Group II.) Under the Authority's Scheme. Treatment of Defective Vision and Squint:— Errors of Refraction (including Squint) 157 Other defects or disease of the eyes 4 Total 161 No. of Children for whom Spectacles were:— (a) Prescribed 153 (6) Obtained 153 Table IV.—Dental Inspection and Treatment. (1) No. of Children Inspected by the Dentist— (a) Routine Age Groups— Age 9 10 11 12 13 14 15 16 17 Total. Number 9 12 187 360 313 360 274 85 27 1,627 (6) Specials 39 (c) Total (Routine and Specials) 1,666 (2) Number found to require treatment 962 (3) Number actually treated 573 (4) Attendances made by children for treatment 1,464 (5) Half-days devoted to:— Inspection 13½ Treatment 150½ Total 164 (6) Fillings:— Permanent Teeth 995 Temporary Teeth — Total 995 (7) Extractions:— Permanent Teeth 201 Temporary Teeth 48 Total 249 35 (8) Administrations of general anaesthetics for extractions 44 (9) Other Operations:— Permanent Teeth 274 Temporary Teeth 39 Total 313 SCHOOL MEDICAL AND DENTAL STAFF. Table VII.—School Medical and Dental Staff. Name of Officer. Proportion of whole time devoted to School Medical Service. Public Health. School Medical Officer:— G. Hamilton Hogben, M.R.C.S., L.R.C.P., D.P.H. Administrative - Deputy School Medical Officer:— B. Broadbent, M.A., M.B., B.Ch., D.P.H. (Shortly to be called up for Military Service) l/6th 5/6th Assistant School Medical Officers:— R. H. Smythe, M.C., L.R.C.S., L.R.C.P. Whole time - Nora A. M. Webster, M.B., Ch.B., D.P.H. (Temporary appointment). 19/20ths l/20th Senior Dentist:—V. Sainty, L.D.S. (England). Dentists:— A. E. Fisher, B.D.S., joined dental branch R.A.F.V.R. (November, 1940). Miss C. M. Dixon, L.D.S. (England) (commenced 7.9.42). Miss E. M. McRaith, L.D.S. (England) (commenced 26.10.42). (Temporary appointment). Note.—2/3rds of the services of one Dental Unit is apportioned to the Maternity and Child Welfare Committee. The whole of the school medical and dental inspection and treatment of secondary school children is undertaken for the Higher Education Authority. School Nursing Staff. (Excluding Specialist Nurses such as Orthopaedic Nurses). Number of Officers Aggregate of time given to S.M.S. work in terms of whole time Officers. School Nurses 8 Whole time. District Nurses - - Nursing Assistants* - - Dental Attendants 3 See Note above under Dentists. *This term refers to untrained assistants described in paragraph 3 of Circular 1604. 36 MATERNITY AND CHILD WELFARE DEPARTMENT. STATISTICAL INFORMATION. Birth Rate (per 1,000 population) 16.52 Number of deaths under one year of age 79 Number of still births registered 44 Infantile death rate per 1.000 live births 43.43 Number of maternal deaths 5 Maternal death rate per 1,000 total births 2.69 CO-ORDINATION. Co-operation with the School Medical Service for specialist and dental sessions; and co-operation with all hospital as well as Social Service Associations in the area has remained a constant source of help. Maternity Hospital Service. This Las continued to function as heretofore. The facilities provided by the Mothers' Hospital, Clapton, and the North Middlesex Hospital have proved adequate, and were distributed as follows:— The Mothers' Hospital, Clapton:— Under the Council's Scheme 65 Own arrangements 10 North Middlesex County Hospital 154 Other outside Institutions 109 Evacuated for Confinement under the L.C.C. Scheme 486 THE HEALTH VISITORS' DEPARTMENT. During the year the health visitors have been fully occupied in their duties of safeguarding the health of the mothers and of the children under five. Their work has included the home visitation of:— 1. Expectant and nursing mothers; and children up to five years of age for many special, as well as routine reasons. 37 2. Foster mothers; and daily minders. 3. Defects found at toddler, and infant welfare clinics. 4. Ante-natal cases in attendance at the clinics; and those mothers wishing to evacuate for their confinements. In April, 1942, two extra ante-natal sessions were started—one at Lordship Lane Centre and one at The Chestnuts Welfare Centre. In August two new War-time nurseries, Parkhurst and Downhills were opened and a health visitor has visited these nurseries daily. Visual Education by films, charts and cookery demonstrations were held at Park Lane Municipal Health Centre during the year and were much appreciated. Baby bathing demonstrations have continued during the year for "school leavers." A health visitor was seconded during 1942 to Bengeo House for three weeks, and to Braunston Nursery School for three weeks. Health visitors have acted as lecturers to the students at the various war-time nurseries, preparing for the examination of the National Society of Childrens Nurseries, and have also given demonstrations of the various phases of the maternity and child welfare work at the centres. DETAILS OF HOME VISITING BY HEALTH VISITORS. Expectant Mothers. Children under 1 year. Over 1 yr. Totals. First Visits. Re-visits. First Visits. Re-visits. Re-visits. 1,293 2,592 1,728 6,127 11,789 23,529 Other visits Infantile Deaths 42 Still Births 56 Ophthalmia Neonatorum 2 Pneumonia - Infectious Diseases 525 Special visits: Mothers 1,398 Children 658 Total 26,210 38 ANTE-NATAL CLINICS. Centre. Sessions Attendances. Cases Total. PostNatal from 1941 New 1942 Lordship Lane Municipal Medical Centre 141 2,732 118 579 697 181 The Chestnuts, St. Ann's Road 186 3,694 231 810 1,041 185 Park Lane Municipal Medical Centre 102 1,951 94 388 482 152 Totals—1942 429 8,377 443 1,777 2,220 518 Totals—1941 336 5,989 - - 1,436 349 I am indebted to Dr. Rickards for the following report on the Maternity Clinics:— "With the rising birth rate the volume of work undertaken at the ante-natal clinics shows a corresponding increase, and the two additional weekly sessions sanctioned by the Committee have been of the utmost value to the service. During 1942 an increase of 784 patients attended the clinics, the numbers being at the Chestnuts 1,041 in 1942, compared with 616 in 1941, at Lordship Lane 697, compared with 468, and at Park Lane 482, compared with 352. There has also been an increase in post-natal patients. I believe this figure represents a record in the percentage of the maternal population attending. Throughout the year the health visitors and midwives have been most conscientious in their assistance with this vast increase in the work, and there has been co-operation throughout the service. The Mothers' Hospital, Clapton, and the North Middlesex Hospital continue to work closely with the clinics and are most helpful in admitting abnormalities—486 patients have been evacuated under the L.C.C. scheme. It is gratifying to find with an increased birth rate a reduction in the number of still births. This may be due, in part, to experiments which have been carried out with Wheat Germ oil. This preparation has been given to all mothers with a history of miscarriages and premature births, and though sufficient patients have not been treated to make a convincing case, some remarkable results have been recorded." 39 INFANT WELFARE CENTRES. Centre. Sessions. Attendances Infant weighings New Cases Weighings Attendances Over 1 year. New Cases. Examined by Doctor. Lordship Lane Municipal Medical Centre 258 5,139 420 2,180 70 1,501 The Chestnuts, St. Ann's Road 261 6,841 648 2,850 66 2,355 Park Lane Municipal Medical Centre 104 3,604 290 1,097 18 853 Town Hall 52 812 82 124 9 - Totals—1942 675 16,396 1,440 6,251 163 4,709 Totals—1941 658 10,748 1,207 6,309 381 4,853 1 am indebted to Dr. King for the following report on the Infant Welfare Centres:— "The increased numbers of young mothers with first babies attending the Welfare Clinics during the past year has been gratifying and reflects favourably upon the work of the Health Visitors. The Special Clinics—Eye, Dental, Orthopaedic, Throat and Ear, have dealt with numerous children, infants as well as toddlers, referred to them, and have saved mothers many hours necessary for travelling to and waiting in hospital departments. In spite of war-time conditions, my impression is that the general standard of health among children attending the clinics is good." TODDLERS CLINICS, 1942. Clinics for children between 2 and 5 years old were held once a fortnight at each of the three Health Centres. As no babies attend these clinics and the children are seen chiefly by appointment there is practically no waiting, and this is much appreciated by the mothers. During the age period of 2—5 years, a child is changing and growing very rapidly and a variety of problems in handling occurs, 40 consequent to the rapid emotional development. It is also the period in which the risk of exposure to infectious disease is increased because the child can run about and mix with others. The aim of these clinics is to provide parents with help in the handling of their children whenever this is sought, and, by general health supervision, to prevent disease where possible, and also to assist towards full recovery after illness so that children do not pass on with, for example, chronic infection of the ear, nose or throat, or with emotional disturbances which will hamper their adjustment to school life. It is found that mothers welcome the opportunity of discussing the various problems incident on bringing up children of these ages, especially so at present, when many of them are bearing the whole responsibility of the care of the family while their husbands are serving in the Forces. A total of 570 children were under the supervision of the Toddlers Clinics during 1942. of these 55 per cent. were found to have some defect or to require special care. The relative frequency of defects found is set out below. It is interesting to note that infections of the ear, nose and throat, and nervous disorders of sufficient degree to make the mother complain about them spontaneously, were of equal incidence. The percentage of children who were already immunised on first attendance at these Clinics was 63 per cent. DEFECTS. Infection of Ear Nose and Throat Nervous Disorders . Dental Defects. Visual Defects. Conval. after Infectious Disease. Malnutrition. Family historyof Tuberculosis. 11% 11% 6% 4% 4% 4% 2% Note: Nervous Disorders=Over excitable or overtired. Disturbances of sleep. Feeding difficulties. Enuresis. Retarded mental development from any cause. WAR-TIME NURSERIES. Nurseries. Children Places. Opened Attendances, 1942. Total. Days Open. Av. Daily Attendance Saturdays & Other ½-Days January to March. April to June. July to September. October to December. Total. Attendances, No. of ½-days Average. Under 2 Over 2 Municipal Day Nursery Park Lane equipped for: Under 2 yrs. of age 20 Over 2 yrs. of age 30 50 1940 April 10 1,007 1,652 958 1,779 1,147 1,484 1,150 1,634 4,262 6,549 10,811 256 42.2 1,205 51 23.6 Wartime Day Nursery Vale Road School for: Under 2 yrs. of age 30 Over 2 yrs. of age 30 60 1941 April 28 1,593 1,696 1,718 1,565 2,219 1 ,565 1,539 1,812 7,069 6,638 13,707 256 53.5 883 51 17.3 Wartime Day Nursery Lordship Lane for: Under 2 yrs. of age 15 Over 2 yrs. of age 25 40 1942 Sept. 28 - - - - - - 841 1,030 841 1,030 1,871 64 29.2 219 12 18.3 Wartime Day Nursery Downhills School for: Under 2 yrs. of age — Over 2 yrs. of age 40 40 1942 Aug. 10 - - - - - 936 - 2,131 - 3,067 3,067 99 30.9 255 19 13.4 Wartime Day Nursery Parkhurst School for: Under 2 yrs. of age — Over 2 yrs. of age 40 40 1942 Aug. 10 - - - - - 878 - 2,159 - 3,037 3,037 99 30.7 210 19 11.0 Total under 2, 65 Over 2, 165 230 Total = 268 - 2,600 3,348 2,676 3,314 3,366 4,863 3,530 8,766 12,172 20,321 32,493 - - 2,772 - - Evacuated Nursery, Bengeo, Hertford for: 38 In residence 31.12.41 37 Discharged during 1942 includes 6 school age 23=14:X22 admitted=36 in residebce 31.12.42. Age on Admission. Under 1 yr. Over 1 and Under 2. Over 2 and Under 3. Over 3 and Under 4. Over 4 and Under 5. Total. Bengeo House 1 8 7 12 8 36 Park Lane 17 24 19 21 5 86 Vale Road 25 35 36 18 8 122 Lordship Lane 7 12 10 14 3 46 Downhills - - 26 34 7 67 Parkhurst - - 25 25 12 62 Total 50 79 123 124 43 419 41 The number of children under 5 years of age who attended the special Clinics are as follows:— SPECIAL CLINICS FOR CHILDREN UNDER 5. Clinic. No. of Consultations . Treatments. Minor Ailments 77 38 Dental 178 293 Orthopaedic 72 390 Ophthalmic 136 48 Ear, Nose and Throat 126 274 Artificial Sunlight:— Under 5 years 567 Treatments 2,738 Over 5 years 484 1,051 „ 2,494 5,232 Immunisation:— Final Schick Tests 1,003 Immunised 1,417 CHILD LIFE PROTECTION. The Health Visitors, as Infant Life Protection Officers, have, during the year, paid 79 visits to the 26 foster-mothers in the area in respect of 27 foster children. HOSPITAL TREATMENT FOR CHILDREN UNDER 5 YEARS. Thirty children have been referred to the North Middlesex Hospital for consultation and treatment of tonsils and adenoids, more especially where operation is required. Orthopaedic Treatment. Orthopaedic Hospital, Stanmore.—One case admitted during the year. Surgical instruments have been supplied to 4 children, including one in-patient. Convalescent Home Treatment. The Invalid Children's Aid Association have co-operated with the Child Welfare Clinics, and have sent away 39 children under five years of age for convalescent treatment. Three mothers only have availed themselves of convalescent home treatment during 1942, owing to the increased difficulty in finding suitable accommodation for such cases. 42 BREAST FEEDING. As the result of the health visitors' enquiries, it was ascertained that infants have been fed as follows:— Breast fed 1,024 Part Breast-fed, plus milk 528 Dried milk or condensed milk Bottle feeding—Cow's milk 51 Dried milk 72 Other artificial foods 3 Feedings unknown 137 Total 1,815 WAR-TIME NURSERIES. Three additional war-time day nurseries were opened during the year; one situated adjacent to the Lordship Lane Municipal Welfare Centre, with accommodation for 40 children under five years of age; and one at Downhills and Parkhurst Schools for 40 children each, aged two to five years. *At the end of the year a further three War-time Nurseries were in course of construction. The Local Education Authority has an evacuated Nursery School at Braunston Manor, Rutland, and a Nursery Class at Lancasterian School accommodating 48 and 80 children respectively. Approximate number of children under 5 in Infant Departments of schools is 731, and during the year six Play Centres have been established for children of Women Workers. MIDWIFERY SERVICE. The Midwifery Service was even busier in 1942 than for the previous year; although for the greater part of the year the number of Municipal Midwives was the same, namely eight. An additional Midwife was added to the service during the latter part of the year. This arduous work has been carried out with unfailing cheerfulness and efficiency in spite of "black-out" and other war-time drawbacks. 43 RECORD OF WORK. Excluding Work in Reception Areas. Cases. Attended by Total. Municipal Midwives. District Nursing Association. Number of Deliveries 872 4 876 Number of Cases Attended as Maternity Nurse 71 7 78 954 Primipara Cases 327 3 330 Multipara 616 8 624 954 Ante-natal Visits 1,505 63 1,568 Nursing Visits 14,487 198 14,685 16,253 Deaths of Mothers at Home None None None Mothers Admitted to Hospital:— (a) During Pregnancy 20 1 21 (b) „ Labour— 5 - 5 (c) „ Puerperium 1 - 1 27 Ante-natal Clinic Attendances—see Clinic figures - 31 - PUERPERAL PYREXIA. The following table shows the final result in each of the 12 cases of Puerperal Pyrexia notified during the year:— Doctors' Cases. Mid wives' Cases. Occurred in Hospitals outside District. Total. Final Results. Recovered Died. 2 2 8 12 11 1 MATERNAL MORTALITY. A special report has been forwarded to the Ministry of Health for the five maternal deaths recorded. 44 The Registrar-General's records show that the maternal death, rate was:— Deaths from Puerperal Sepsis 1 From other Puerperal Causes 4 Total 5 Maternal death rate per 1,000 live and still births 2.69 MATERNITY AND NURSING HOMES. The number of Nursing Homes on the register at the beginning of the year was 1. No applications for registration were received. Hospitals exempt from registration 1 (The Prince of Wales's General Hospital). Number on the register at the end of the year 1 HOME HELPS. Assistance was granted towards the services of Home Helps to 182 mothers; an increase of fifty for the year. At the Town Hall a list of suitable women who are prepared to act in this capacity is supplied to expectant mothers, and in necessitous cases the cost of the home help has been defrayed by the Maternity and Child Welfare Committee. Accouchement Bags have been available at the Centres and loaned in suitable cases. Maternity outfits have been provided:— 585 at cost price; part cost 55; and free 92. OPHTHALMIA NEONATORUM. Only one case was notified. One case of Discharging Eye was also reported. Both these cases made a satisfactory recovery - EVACUATION OF EXPECTANT MOTHERS. The evacuation scheme for the expectant mother remained very popular, the numbers increasing from 373 in 1941, to 484 in 1942. 45 Tlie scheme has worked harmoniously, and the staff of the L.C.C. Evacuation Department has always been most courteous -and willing to assist in every possible way. An increased number of children have been evacuated for short-term stays in connection with this scheme—some to Bengeo House and others to other country areas; these latter arranged with the co-operation of the local branch of the W.V. S. On several occasions health visitors have been lent to the L.C.C. to accompany parties of evacuating mothers. DENTAL TREATMENT FOR MOTHERS AND CHILDREN. The number of expectant and nursing mothers who have received dental treatment during 1942 was 771. Of these 630 were ante-natal and 141 post-natal, all of whom were rendered dentally fit by fillings where preservation was possible; and otherwise, by extraction under local or general Anaesthesia. 162 mothers were supplied with artificial dentures, 54 of whom were in the scale for free dentures, and 108 contributed part of the cost. Treatment of Toddlers and Infant Welfare Children continued as in previous years and led to 178 consultations with 293 treatments. ASSISTED MILK SUPPLY. The National Scheme for the provision of cow's milk or National dried milk has continued with the provision of full cream dried milk of a suitable kind where recommended by the infant welfare doctor; and in other cases "Humanised" dried milk has been supplied at cost price ; or free in necessitous cases. Extra Clothing Coupons. Coupons for expectant mothers were distributed under the Board of Trade scheme. Total, 2,007. 46 DISTRIBUTION OF FRUIT JUICES AND COD LIVER OIL. Distribution of fruit juices and cod liver oil was undertaken at the Centres as follows:— Centre. Bottles. Cod Liver Oil. Fruit Juice. Puree. The Chestnuts 3,061 6,574 2,004 Lordship Lane 2,295 4,705 1,674 Park Lane 1,887 3,994 1,102 Town Hall 2,057 3,264 1,159 Total 9,300 18,537 5,939