INTELL LIBRARY Urban District of Wood Green. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL OFFICER FOR THE YEAR 1925. W. E. PORTER, M.D., D.P.H., (Fellow of the, Royal Institute of Public Health ), Medical Officer of Health and School Medical Officer. 1926, Crusha & Son, Ltd., Tottenham, Enfield and Wood Creen. WOOD 16 1 Wood Green Urban District Council. PUBLIC HEALTH COMMITTEE, 1925. Councillor The Rev. Winston Haines (Chairman) (Vice Chairman of the Council.) The Chairman of the Council. Councillor Anderton. Councillor Lawrie. Councillor Barnes. Councillor Locke. Councillor Cole. Councillor Tudor Rhys. Councillor Gillett. Councillor Tappenden. Councillor Walker. MATERNITY AND CHILD WELFARE COMMITTEE, 1925. Councillor Mrs. Bolster (Chairman). Councillor Barnes. Councillor James. Councillor Gillett. Councillor Locke. Councillor Ingram. Councillor Oliver. Councillor Tappenden. Co-opted Members:— Mrs. Blue. Mrs. Cole. Mrs. Duncan. Mrs. Ingram. 2 Staff. *Medical Officer of Health.—W. E. Porter, M.D., D.P.H., C.M., M.R.C.S., Fellow of the Royal Institute of Public Health, and of the Incorporated Society of Medical Officers of Health. *Chief Sanitary Inspector.—A. E. Adams, Assoc.R.San.Inst., R.P.C., Cert.R.San.Inst., Cert. Meat and Food Insp., Cert. Plumbers' Work, Cert. Building Construction, Physiology, Hygiene, etc. Assistant Inspectors.—S. C. Stanbury, Cert.R.San.Inst.,Cert. Meat and Food Insp.; G. C. Billing, Cert.R.San.Inst. Clerks.—G. W. Jones, A. E. Gooday, H.J. Bailey, L. F. Jerman. * Maternity and Child Welfare.—Lady Medical Assistant (part-time). —Miss S. Aileen F. Boyd-Mackay, M.R.C.S. (Eng.), L.R.C.P. (Lond.). *Clerk.—Mrs. Wass. * Health Visitors.—Sister Moore, Cert. Gen. Training, C.M.B., Health Visitors Diploma prescribed by the Board of Education and Ministry of Health; Sister Orwin, Cert. Gen. Training, C.M.B., Cert. for Health Visitors R.San. Inst., C.S.M.M.G., Sister Jenkins (resigned Jan., 1925); Sister Henderson, Cert. Gen. Training, Silver Medallist, C.M.B. (appointed March, 1925). * Acting Matron of Day Nursery.—Miss M. W. Jones (Certificated). * Exchequer Grants received in part payment of salaries of above Officials. 3 Public Health Department, Town Hall. To the Chairman and Members of the Urban District Council of Wood Green. Mr. Chairman, Mrs. Bolster and Gentlemen, I beg to submit ray Annual Report for the year 1925:— NATURAL AND SOCIAL CONDITIONS OF THE AREA. Area (acres) 1,625 Population—Census 1921 50,707 Estimated 1925 51,960 (Figure supplied by Registrar-General) Number of inhabited houses (1921) 10,227 Do. do. (1925) (estimated) 10,783 Number of families or separate occupiers (1921) 12,890 Do. do (1925) (estimated) 13,572 Rateable value (1921) £298,775 Do. (1925) £319,337 Sum represented by a penny rate (1921) £1,176 Do do (1925) £1,330 VITAL STATISTICS. Births—740. Total. M. F. Legitimate 723 362 361) Birth Rate, 14.24 Illegitimate 17 12 5 Deaths 507 253 254 Death Rate, 9.75. Number of women dying in, or in consequence of, childbirth:— From sepsis, 1; from other causes, 1 Total, 2. Deaths of infants under one year of age per 1,000 births:— Legitimate, 45.6; Illegitimate, 117.6. Total, 47.29. (Per 1,000 legitimate (Per 1,000 illegitimate births.) births.) 4 Deaths from:— Measles (all ages) 2. Whooping Cough (all ages), 8. Diarrhoea (under two years of age), 5. POPULATION. The population in 1921 (Census Year) was 50,707, an average of 4.95 persons per house. Since that date 556 houses have been erected in the District. Allowing a deduction of 0.8% for houses not occupied, I estimate the population for 1925 at 52,950; the Registrar-General's figure for 1925 is 51,960, showing a difference of 990. For the purposes of this report I am taking the Registrar General's figure. I give below the population for each Ward for the years 1921 and 1925:— Ward. Area in Acres. Population. Increase or decrease. 1921 (Census). 1925 Town Hall 388 11,798 11,811 13 inc. Bowes Park 265 8,013 7,990 23 dec. Alexandra Park 594 7,258 7,484 226 inc. Central 219 10,272 10,831 559 inc. Noel Park 159 13,366 13,844 478 inc. The average number of persons per acre in each Ward being as follows:— 1921. 1925. Town Hall 30.4 30.4 Bowes Park 30.2 30.1 Alexandra Park 12.2 12.6 Central 46.9 49.4 Noel Park 84.0 87.0 5 Physical Features of the District. The District of Wood Green has an area of 1,625 acres, and is situated in the County of Middlesex, to the North of London; is bounded on the North side by the Parish of Southgate, on the South almost wholly by the Borough of Hornsey, on the East by the Parish of Tottenham and on the West by Hornsey and Friern Barnet. The subsoil consists of various clays with a shallow pocket of gravel in the Muswell Hill District, beneath which are beds of London clay. The highest point is the site of the Alexandra Palace which is 300 ft. above ordnance datum, and the lowest point 56 ft. above ordnance datum at the junction of the Eastern end of the District with Tottenham. The Western portion of the District, known as the Alexandra Park District, is uneven and hilly and has the highest altitude. Roughly, the District north of Lordship Lane averages 108 feet above ordnance datum, and the portion south of that line about 70 feet above ordnance datum. Open Spaces. The open spaces situated in the various Wards of the District are as follows:— Ward. Area in Acres. Area of Open Spaces. Acres. Alexandra Park 594 171 Bowes Park 265 16 Town Hall 388 44 Noel Park 159 5 Central 219 16 6 The area of open spaces thrown open for the use of the Public during and since 1921 to the end of 1925 being:— Alexandra Park (Albert Road Recreation Ground) 13 acres. Noel Park (Recreation Ground) 4 ,, The District is well provided with open spaces; indeed, for its size I should say that we are as fortunate in this respect as any place round London and I think the Council are to be congratulated upon the efiort they have always made in this direction. Social Conditions. The inhabitants of the District are chiefly of the artisan class and those employed in commercial pursuits in London. Very few of the inhabitants generally are employed in the District, with the exception of the tradesmen and their assistants There is one very large factory in the District, namely, that of Messrs. Barratt & Company, confectioners, a large proportion of whose employees reside outside the District of Wood Green. There are no unhealthy or offensive trades carried on in the District. The only other factories of any size are those engaged in the manufacture of screws, glass bottles, metal hose, calculating machines and hosiery respectively. There is one Hospital—the Passmore Edwards Hospital, with accommodation for 55 beds—situated within the District, also four Institutions—the Fishmongers' and Poulterers' Institution, the Fullers' Almshouses, the Porters' Walter's Almshouses and the Printers' Almshouses. 7 BIRTHS. There were 740 births, as against 762 in 1924. The births were:—374 males and 366 females; of these 17 were illegitimate (viz., 12 males and 5 females). This corresponds to an annual rate of 14.24, as compared with 14.69 per thousand of the population in 1924. The birth-rate for the 105 great towns (which included Wood Green) was 18.8 per 1,000 of the population. The number of births occurring outside the District was 72 (included in the above figure). The following table gives the number of births registered within the District, and the birth-rate for each Ward:— Births Registered. BirthRate. Town Hall 204 17.2 Bowes Park 101 12.6 Alexandra Park 73 9.7 Central 150 13.8 Noel Park 140 10.1 The number of births over the number of deaths was 233. The following are the number of births and birth-rate for the five years 1921 to 1925 inclusive:— Year. No. of Births. BirthRate. No. of Births over the No. of Deaths. 1921 905 17.71 412 1922 873 17.02 349 1923 896 17.38 405 1924 762 14.69 247 1925 740 14.24 233 8 Our low birth-rate—the smallest on record—is not altogether to be deplored. What we are losing in quantity is being made up in quality, for it is much more desirable that a few healthy children are born than a number of weaklings who, not only are a misery to themselves, but a burden on society. It is estimated that, on the average, every child born this year has an expectancy of life 12 years longer than its grandfather. The following are the number of illegitimate births and the illegitimate birth-rate for the five years 1921 to 1925 inclusive:— Year. No. of Illegitimate Births. Illegitimate Birth-rate. 1921 24 .47 1922 26 .50 1923 34 .67 1924 15 .28 1925 17 .32 DEATHS. There were 286 deaths registered within the District during the year 1925. There were also 221 residents who died outside the District, making a total of 507. The annual death-rate for Wood Green was 9.75 per 1,000 of the population, as compared with 9.89 in 1924. The annual death-rate for the 105 great towns for the same period was 12.2. The following are the number of deaths and the death-rate per 1,000 of the population for each Ward:— Ward. No. of Deaths. Death-Rate. Town Hall 109 9.2 Bowes Park 86 10.7 Alexandra Park 71 9.4 Central 131 12.0 Noel Park 110 7.9 9 Where the standard death-rate of the town is the same as the standard death-rate of the Country generally, no correction is required; but when these death-rates are different, the standard death-rate for the town must be raised or lowered in a certain ratio. The factor for correction for Wood Green, given by the RegistrarGeneral, is .969, which shows a corrected death-rate of 9.447, which almost corresponds with the rate obtained from the figures supplied by the Registrar-General. The following are the number of deaths and death-rate for the five years 1921 to 1925 inclusive:— Year. No. of Deaths. Death-Rate. 1921 493 9.64 1922 524 10.21 1923 491 9.52 1924 ,515 9.89 1925 507 9.75 There were 35 deaths of infants under one year of age, which corresponds to a rate of 47.29 per 1,000 births, as against 32, or a rate of 41.99 per 1,000 births in 1924, the increase being due to Whooping Cough and Diarrhoea (including Enteritis). The following are the deaths of infants under one year of age, and the death-rate per 1,000 births for the five years 1921 to 1925 inclusive:— Year. No. of deaths of infants under 1 year of age. Death-Rate per 1,000 births. 1921 63 69.61 1922 41 46.96 1923 34 37.94 1924 32 41.99 1925 35 47.29 10 The number of deaths of children under five years of age was 54, which corresponds to a rate of 1.03 per 1,000 of the population, as against 51, or a rate of .98 per 1,000 in 1924. The following are the deaths of children under five years of age, and the death-rate per 1,000 population for the five years 1921 to 1925 inclusive:— Year. No. of deaths of children under 5 years of age. Death-Rate per 1,000 population. 1921 76 1.48 1922 58 1.13 1923 51 .98 1924 51 .98 1925 54 1.03 Zymotic Mortality. The seven principal Zymotic diseases caused 16 deaths, which corresponds to an annual rate of .30 per 1,000 of the population, as against nine deaths, or a rate of .17 per 1,000 in 1924. The following are the number of deaths from each of these diseases for the five years 1921 to 1925 inclusive:— Disease. Number of Deaths. 1921. 1922. 1923. 1924. 1925. Smallpox - - - - - Scarlet Fever 1 3 — 1 — Diphtheria 8 3 3 1 1 Enteric Fever - - - - - Measles — 2 3 3 2 Whooping Cough 4 2 1 3 8 Diarrhoea 7 5 6 1 5 Totals 20 15 13 9 16 11 Rainfall and Diphtheria. Year. Rainfall. Ins. Cases of Diphtheria notified. 1921 12.94 143 1922 22.19 44 1923 23.23 26 1924 30.89 24 1925 21.71 54 According to these figures it appears that Diphtheria was intimately connected with deficient rainfall, as many deaths from this cause (eight) occurring in 1921 as during the whole of the other four years. 1921 was a particularly dry year. There is no doubt that a wet summer, owing to the increased cleansing of the air by the rain, oftentimes prevents much infectious disease. 12 CAUSES OF, AND AGES AT DEATH DURING THE YEAR 1925. All Ages. Under 1 year. 1 and under 2 years. 2 and under 3 years. 3 and under 4 years. 4 and under 5 Years. 5 and under 10 years. 10 and under 15 years. 15 and under 20 years. 20 and under 35 years. 35 and under 45 years. 45 and under 65 years 65 years and 1 upwards. Enteric Fever - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - Measles 2 - 1 - - - 1 - - - - - - Scarlet Fever - - - - - - - - - - - - - Whooping Cough 8 2 2 2 1 1 - - - - - - - Diphtheria and Croup 1 - - - - - 1 - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - Influenza 11 - - - - - - - - 1 3 4 3 Meningococcal Meningitis - - - - - - - - - - - - - Pulmonarv Tuberculosis.. 35 - - - - - 1 1 2 16 3 1 2 Other Tuberculous Diseases 10 — — 1 2 — 2 — — — — 3 2 Cancer, Malignant Disease 74 — — — — 1 1 — — 1 9 30 32 Rheumatic Fever 5 — — — — — 1 1 — 1 — 2 — Diabetes 1 - - - - - - - - 1 - - - Cerebral Haemorrhage 28 - - - - - - - - - 1 7 20 Organic Heart Disease 95 - - - - - - - - 2 5 21 67 Arterio Sclerosis 37 - - - - - - - - - - 9 28 Bronchitis 37 2 - - - - - - - - 1 14 20 Pneumonia (all forms) 22 — 1 - - - - - - 1 1 7 12 Ulcer of Stomach or Duo denum 4 - - - - - - - - 1 2 1 - Other Respiratory Diseases 6 - - - - - 1 - - - 1 1 3 Diarrhoea, etc. (under 2 years) 5 5 - - - - - - - - - - - Appendicitis and Typhlitis - - - - - - - - - - - - - Cirrhosis of Liver 2 - - - - - - - - - - 2 — Acute and Chronic Nephritis 13 - - - - - - - - 2 1 4 6 Puerperal Fever 1 - - - - - - - - - - - - Other Diseases and Accidents of Pregnancy and Parturition 1 - - - - - - - - - - - - Congenital Debility and Malformation, Premature Birth 20 20 - - - - - - - - - - - Violence, apart from Suicide 8 - 1 - - - - - 1 1 2 3 - Suicide 4 - - - - - - - - 1 1 1 1 Other defined diseases 77 6 2 1 3 — 1 1 7 2 5 10 39 Causes ill-defined or unknown - - - - - - - - - - - - - Totals 507 35 7 4 6 2 9 3 10 3 36 129 235 13 Causes of Death during the year 1925 in the Urban Sanitary District of Wood Green. Causes of Death. Male. Female. Enteric Fever - - Smallpox — — Measles 1 1 Scarlet Fever - - Whooping Cough 3 5 Diphtheria — 1 Influenza 6 5 Encephalitis Lethargica — — Meningococcal Meningitis — — Tuberculosis of Respiratory System 18 17 Other Tuberculous Diseases 5 5 Cancer, Malignant Disease 29 45 Rheumatic Fever 3 2 Diabetes - 1 Cerebral Haemorrhage, etc. 10 18 Heart Disease 53 42 Arterio Sclerosis 23 14 Bronchitis 15 22 Pneumonia 10 12 Other Respiratory Diseases 4 2 Ulcer of Stomach or Duodenum 3 1 Diarrhoea, etc. (under two years) 2 3 Appendicitis and Typhlitis — — Cirrhosis of Liver 1 1 Acute and Chronic Nephritis 7 6 Puerperal Sepsis — 1 Other Accidents and Diseases of Pregnancy and Parturition - 1 Congenital Debility and Malformation, Premature Birth 14 6 Suicide 1 3 Other Deaths from Violence 8 — Other Defined Diseases 37 40 Causes ill-defined or unknown — — Total 253 254 14 INFANTILE MORTALITY DURING THE YEAR 1925. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 1 month. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Total under 1 year. Smallpox - - - - - - - - - - Chicken Pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Whooping Cough — — — — — 1 — — 1 2 Diarrhoea — — 1 — 1 1 — 1 — 3 Enteritis — I — — 1 — — 1 — 2 Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - — - - - - - - - Other Tuberculous Diseases - 1 2 - - - - - - - Congenital Malformations 2 1 — 5 — — — — 5 Premature Birth 10 I — — 11 — — — — 11 Atrophy, Debility and Marasmus 1 - - - 1 2 1 - — 4 Atelectasis - - - - - - - - - - Injury at Birth - - - - - - - - - - Erysipelas - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Meningitis - - - - - - - - - - Convulsions — — — 1 1 — — — — 1 Gastritis - - - - - - - - - - Laryngitis - - - - - - - - - - Bronchitis - - - - - - 1 1 — 2 Pneumonia (all forms) - - - - - - - - - - Suffocation, overlaying, etc. - - - - - - - - - - Other Causes 1 1 — — 2 2 — 1 — 5 Totals 14 4 3 1 22 6 2 4 1 35 The term "Infantile Mortality" is a proportional figure indicating the number of deaths of Infants during their first year of life, compared with a thousand births occurring during the same period. Our number this year is 47 and this, when contrasted with 79, which is the average figure in the 105 large Towns (of which we are one) shows that we are a favoured community. Infantile Mortality is considered to be a sensitive index of the general state of Health of any locality. 15 Neo-Natal Mortality refers to the toll of children who die within the first month of their existence. Comparatively these numbers are less under our control than those occurring in the other eleven months of the first year. The work of the Maternity and Child Welfare Service has done much to improve the figures of this latter group. In 1925 out of the 35 deaths of Infants in Wood Green under one year of age, 22 died before they reached the end of their first month. Total Deaths during the five years, 1921 to 1925 inclusive- Cause of Death. 1921. 1922. 1923. 1924. 1925. Enterip Fever - - - - - Smallpox - - - - - Measles — 2 3 3 2 Scarlet Fever 1 3 — 1 — Whooping Cough 4 2 1 3 8 Diphtheria 8 3 3 1 1 Influenza 14 26 11 17 1 Encephalitis Lethargica 1 1 — 1 — Meningococcal Meningitis — — — 1 — Tuberculosis of Respiratory System 34 46 29 44 35 Other Tuberculous Diseases 5 7 9 7 10 Cancer, Malignant Disease 58 64 76 65 74 Rheumatic Fever 3 1 — — 5 Diabetes 8 8 6 1 1 Cerebral Haemorrhage, etc . 24 19 27 36 28 Heart Disease 71 84 88 76 95 Arterio Sclerosis 24 20 16 28 37 Bronchitis 54 45 35 48 37 Pneumonia 35 44 28 31 22 Other Respiratory Diseases 2 9 5 3 6 Ulcer of Stomach or Duodenum 1 5 1 2 4 Diarrhoea, etc. (under two years) 7 5 6 1 5 Appendicitis and Typhlitis 1 4 6 6 — Cirrhosis of Liver 4 3 4 3 2 Acute and Chronic Nephritis 10 7 11 13 13 Puerperal Sepsis 1 — — 1 1 Other Accidents and Diseases of Pregnancy and Parturition 2 4 — 2 1 Congenital Debility and Malformation, Premature Birth 24 17 21 17 20 Suicide 6 4 1 3 4 Other Deaths from Violence 8 14 17 19 8 Other Defined Diseases 83 77 86 79 77 Causes Ill-defined or Unknown — — 1 1 — Totals 493 524 491 513 507 16 It will be seen from the preceding table that during the past five years 28 children have died of Whooping Cough and Measles. Some of them would probably have recovered if suitable Hospital accommodation had been available and I now hope, that in the near future, when our new Ward at the Isolation Hospital is opened, that we shall be able to deal with such illnesses. The public are far too apt to look upon these two ailments as trivial childish occurrences, but occasionally they become very serious indeed, when the lack of proper nursing care and insufficient housing are taken into consideration. It is just as desirable that Measles and Whooping Cough should be combated with the same energy as that taken in the case of Scarlet Fever and Diphtheria. It will also be noticed that in 1925 no deaths occurred from Enteric Fever, Smallpox or Scarlet Fever and that during the past five years there were none resulting from Enteric or Typhoid Fever or Smallpox. The following table is intended to show that the expectancy of life at the present time has increased over that of, say 20 years ago. In 1905 the percentage of deaths of persons over 65 years of age was 24.59 while for 1925 it was 46.35 as compared with the total number of deaths at all ages; thus nearly half the number of deaths during 1925 occurred over the age of 65 years, whereas in 1905 only barely a quarter. I think these figures are the most notable item in this Report. Year. Total deaths (at all ages). Deaths of Persons over 65 years of age. Percentage of deaths of persons over 65 years of age. 1905 435 107 24.59 1915 570 212 37.19 1921 493 197 39.94 1922 524 204 38.93 1923 491 213 43.37 1924 515 239 46.40 1925 507 235 46.35 17 POOR LAW. The Poor Law is administered by the Edmonton Board of Guardians (which includes Wood Green) and the Clerk to the Guardians has kindly supplied the following particulars of out- relief granted during 1925, for the Parish of Wood Green:— Kind. Cash. Total. £ s. d. £ s. d. £ s. d. Unemployed 1,323 3 6 847 8 0 2,170 11 6 Ordinary 246 16 0 5,414 18 0 5,661 14 0 £7,832 5 6 HOSPITALS. (1) Tuberculosis. These are provided by the Middlesex County Council and are dealt with from the Dispensary in Alexandra Road, just outside our boundary, but which is quite convenient for the whole of the District of Wood Green. (2) Maternity. An agreement has been entered into with the Guardians of the Edmonton Union to receive confinement cases into their Maternity Ward at the North Middlesex Hospital. Arrangements are also made with the City of London Maternity Hospital in cases of necessity. (3) Children. Special arrangements are made, where necessary for treatment, and in these cases beds have always been found for the patients. The Hospitals chiefly concerned were the Great Ormond Street Hospital for Sick Children, the North Middlesex Hospital and the Royal Northern Hospital. 18 (4) Fever. After a Public Enquiry by the Ministry of Health on the 11th day of May, 1922, the Council became one of the three constituent authorities (namely Hornsey, Finchley and Wood Green) controlling the Joint Isolation Hospital, Coppetts Road, Muswell Hill, to which cases are removed. The Hospital has accommodation for 104 patients, and an Enquiry was held on the 1st December, 1925, by the Ministry with respect to an extension to the administrative block and the erection of a special Ward to accommodate 20 beds, to be largely used for mixed infection. Sanction was obtained and tenders have been accepted, and at the time of writing this report the work has been commenced. (5) Smallpox. The Council is one of the constituent Authorities in connection with the Joint Smallpox Hospital at South Mimms. (6) Other. The Passmore Edwards Cottage Hospital situated within the District which has accommodation for 55 beds. Other general Hospitals to which patients are sent from the District are the Prince of Wales's Hospital, Tottenham; the North Middlesex Hospital, Edmonton; and the Royal Northern Hospital, Holloway; all of which are accessible by either tram or bus, together with other Hospitals in the London Area. During the year the Council made contributions of £50 to the Royal Northern Hospital, £100 to the Prince of Wales's Hospital, and £300 to the Passmore Edwards Hospital, in consequence of the number of patients dealt with at each of the above who were resident in the District. 19 Institutional Provision for:— (a) Unmarried Mothers. No provision is made at present, but individual cases are dealt with, and suitable accommodation is found for them at the North Middlesex Hospital. (b) Illegitimate Infants and Homeless Children. No special provision is made for the above, but individual cases requiring help are dealt with as they occur. AMBULANCE FACILITIES. (a) Infectious Cases. The Council have their own horse-drawn brougham, which is only used in case of emergency. As a rule an ambulance (with nurse in attendance) is sent from the Isolation Hospital for the removal of patients. (b) Non-infectious Cases. The Wood Green Motor Ambulance is kept at the Fire Station for use at any time during the whole of the twenty-four hours. We have an arrangement with the adjoining Authorities for the interchange of ambulances, should either be unavailable due to being under repair, etc., so that at no time is the District without an ambulance for urgent cases requiring removal. The number of journeys made by the Wood Green Motor Ambulance during the five years 1921 to 1925 inclusive are as follows:— Year. Number of Journeys. 1921 412 1922 865 1923 721 1924 704 1925 1,058 20 MATERNITY AND CHILD WELFARE CENTRES. Name and Situation. Day and Hour Open. Provided by Southern District— Congregational Hall, Lordship Lane Wednesday, 9.30-12 noon, and 1.30-4 p.m. The Council St. John's Hall, Brook Road Thursday, 1.30-4 p.m., (transferred to Lordship Lane Centre, January, 1925) - Western District— Trinity Hall, Trinity Road Monday, 1.30-4 p.m., Tuesday, 9.30-12 noon, and 1.30-4 p.m. - Eastern District— Congregational Hall, Lordship Lane Wednesday, 9.30-12 noon, and 1.30-4 p.m. — Congregational Hall, Arcadian Gardens Monday, 1.30-4 p.m. - Ante-Natal Clinic, Stuart Villa, Stuart Crescent Monday, 10-12 noon (transferred to Town Hall, February, 1925) — Dental Clinic, Stuart Villa, Stuart Crescent Tuesday, 1 session — Stuart Villa, Stuart Crescent To accommodate 30 Children — 21 SCHOOL CLINICS. Name and Situation. Provided by Minor Ailments— White Hart Lane Schools (5 Sessions weekly) The Education (Transferred to Stuart Villa, Stuart Crescent, Committee. January, 1925) Ophthalmic— Stuart Villa, Stuart Crescent (1 Session weekly) — (And 1 extra Session per fortnight) Dental- Stuart Villa, Stuart Crescent (4 Sessions weekly — Special Medical Examinations, 1 Conjointly; 1 or 2 Sessions Dull and Backward Children J weekly, as required. Tuberculosis— Dispensary, 10, Alexandra Road, Hornsey Middlesex Cty. Council. Venereal Diseases— Prince of Wales's Hospital, Tottenham, and Royal Northern Hospital, Holloway, both of which are within easy distance by tram or bus from this District. Professional Nursing in the Home. (a) General. A District Nurse was appointed in September, 1923, and her services have been in such demand that it was thought desirable that there should be a second. This was sanctioned by the District Nurse Committee, and another nurse was appointed in May, 1925. 22 The Nursing Service is supported by voluntary contributions from various organisations in the District and a very substantial allowance from the Charity Trustees. A small charge is made for the nurses' visits, as no part of the cost of the Service can be derived from the Rates. Both the nurses are kept well employed, and their services are much appreciated throughout the District. (b) Infectious Cases. * It has not been found necessary to appoint a special nurse for nursing patients suffering from Infectious Disease. Midwives. Before 1921, an arrangement was made for a subsidy of £1 1s. per quarter to be paid to each of two Midwives (one on the east, and one on the west side of the District) in addition to their regular fee for attendance on any case when employed by the Council. This arrangement is still in force. The number of midwives practising in the District during 1921 was 8, and during 1925 11. LOCAL ACTS. Metropolitan Commons Supplemental Act, 1882. Tottenham Local Board (Division of District) Act, 1888. Wood Green Local Board Act, 1889. Tottenham and Wood Green Sewerage Act, 1891. Wood Green Urban District Council Acts, 1903 and 1920. Alexandra Park and Palace (Public Purposes) Acts, 1900, 1903, 1905 and 1913. Middlesex County Council (General Powers) Acts, 1898, 1906, 1921 and 1925. 23 ACTS OF PARLIAMENT ADOPTED. Infectious Disease (Notification) Act, 1889. Infectious Disease (Prevention) Act, 1890. Public Health Acts Amendment Act, 1890 (Parts 2 and 3). Public Libraries Acts. Housing of the Working Classes Act, 1890 (Part 3). Baths and Wash-houses Acts. Notification of Births Act, 1907. Small Dwellings Acquisition Act. 1899. Public Health Acts Amendment Act, 1907. Part 2 (which relates to streets and buildings other than Sections 15, 16, 19, 23, 26, 27, 30 and 33). Part 3 (which relates to sanitary provisions other than Sections 39 to 44 inclusive, 46 and 47). Part 4 (which relates to infectious diseases other than Sections 52 to 59 inclusive and 67). Part 10 (miscellaneous provisions). Public Health Act, 1925 (miscellaneous provisions). The Public Health Act of 1925 embodies several of the provisions already in force in our own local Act of 1920, and contains such divergent measures as those relating to rag-and-bone dealers selling articles of food or toys, driving to a common danger, the regulation of tram and bus queues, etc. BYE-LAWS. 1 (1889).—Standing Orders for the Regulation of Proceedings and Business of the Council. 2 (1891).—Bye-laws with respect to Slaughter-houses. 24 3 (1891).-—Regulations under the Contagious Diseases (Animals) Act, 1886, and the Dairies, Cowsheds and Milkshops Order, 1885. 4 (1892).—Bye-laws for the Regulation of the "Wood Green Commons. 5 (1893).—Bve-laws with respect to New Streets and Buildings. 6 (1901).—Bye-laws with respect to New Buildings and the ations of Buildings. 7 (1923).—Regulations with respect to Allotments. 8 (1901).—Bye-laws under the Public Health Act Amendment Act, 1890, with respect to telegraph and other wires. 9 (1901).—Bye-laws for the Prevention of Nuisances arising from Snow, Filth, Dust, Ashes and Rubbish, and for the prevention of the Keeping of Animals on any Premises so as to be injurious to Health. 10 (1908).—Bye-laws under the Employment of Children Act, 1903. 11 (1908).—Bye-laws as to New Streets and Buildings (amending Bye-laws 10, 16 and 21 of the series of 1893 relating to the Construction of External and Party Walls). 12 (1908).—Bye-laws with respect to the Management, Use and Regulation of the Open-air Public Swimming Bath. 13 (1909).—Regulations with respect to the Management, Use and Conduct of the Bowling Green. 14 (1909).—Bye-laws with respect to Tents, Vans, Sheds and similar structures used for Human Habitation. 15 (1909).—Bye-laws with respect to Houses let in Lodgings or occupied by persons of more than one family. 16 (1910).—Regulations with respect to Dairies, Cowsheds and Milkshops (in substitution for the Regulations made in 1891). 17 (19211.—Bye-laws as to the Employment of Children. 25 WATER SUPPLY. The District is supplied with a constant service of water by the Metropolitan Water Board (New River District), water being laid on to each house. The whole of the houses on the Noel Park Estate have their supply direct from the main service pipe without any storage cisterns. We are gradually getting the remaining houses in the District to take a supply direct from the main service pipe for dietary purposes. The number of houses which have been provided with water for dietary purposes direct from the main service during the years 1921 to 1925 inclusive, is 951. There is no supply of water in the District other than from the Metropolitan Water Board. Watercourses. There are two watercourses in the District, viz., the Muswell Stream and the Moselle Brook. The former takes the surface water from the Muswell Hill District of Hornsey and Wood Green, and pursues a meandering course from Hornsey on the West side of the District to Pymmes Brook, Southgate on the North side of the District. The Moselle Brook also takes surface water from Hornsey and Wood Green, entering the District on the South side, flowing under the High Road and leaving the District on the East side through Tottenham. The culverting of these two streams was completed during 1925, which had been the subject of report by the Medical Officer of Health for some years past, and it is very satisfactory to be ableto report that the work has now been completed. The transition from open ditches to culverted streams will be a great asset to the District, not only from a Public Health point of view, but for the prevention of the flooding of certain roads which used to take place during heavy rainfall, and has been the subject of numerous complaints from ratepayers almost since the 26 time the District was separated from that of Tottenham, and it is one of the outstanding improvements which have been effected during the past few years. Drainage and Sewerage. All the premises in the District, with the exception of twofactories at the extreme Eastern boundary of the District, a Church Hall in the Town Hall Ward and four cottages in the Bowes Park Ward, are connected to the Council's sewers, there being no cesspools. The system of drainage is dual, the soil drains being connected to the main sewers, which are continued through Tottenham to a pumping station in that district, from which the sewage is pumped into the London County Council's sewers, by arrangement with that Council. The pumping station and main sewer in Lordship Lane is under the control of a Joint Drainage Committee, consisting of representatives from Tottenham and Wood Green. The surface-water drains discharge into the Council's surface water sewers, which flow into the Moselle and Muswell Brooks and finally discharge into the River Lea. The public soil sewers are periodically flushed and cleaned by the Surveyor's staff, a gang of men being continually employed throughout the year at that work. Closet Accommodation. Practically the whole of the District is provided with water carriage system, and each house provided with water closet accommodation, there being no privies, earth closets or slop closets, with the exception of the factories, Church Hall and cottages previously mentioned. 27 Scavenging. The Dust Destructor was erected during 1907, on the "Moat House" site in Western Road, at a cost of £9,475, including the buildings, furnaces, engine, dynamo and electric lighting. There are six cells in two units of 3 each, each unit capable of destroying 45 tons of refuse in 24 hours, and is sufficient for dealing with the whole of the refuse of the District. Refuse is collected from each house in the District once each week by means of horse-drawn vans, and all premises are provided with galvanised iron dustbins with proper covering. Trade refuse is collected from shop premises once each week, a charge being made for removal of any refuse over and above three to seven basketfuls, according to the establishment concerned. A bathroom and mess-room are provided for the workmen in connection with the Destructor. The steam generated is utilised for heating the water for the baths, working a disinfecting apparatus and providing electric light for the baths and depot. Baths. A spacious, covered-in Swimming Bath (100 ft. by 30 ft.) is provided adjacent to the Destructor Works in Western Road. In addition, there are Slipper Baths for men and women, which are open on week-days from 6.30 a.m. to 9 p.m., and 6.30 a.m. to 9.30 a.m. on Sunday in the summer; and 7.30 a.m. to 9 p.m. on weekdays, and 7.30 a.m. to 9.30 a.m. on Sundays in winter. Arrangements have been made with the Education Committee for school children to be admitted to the Swimming Bath at a reduced fee. An Open-air Swimming Pool is also provided on the racecourse, Alexandra Park. 28 The following are the attendances at the Swimming Baths for the year 1925, which have been kindly supplied by the Surveyor:— Month. / Western Road Baths. Slipper Baths. School Children Open Air Bath. Adults. School Children. Adults. Children. School Children. 1925. January 7,943 196 334 — — — February 6,863 208 287 — — — March 7,966 318 314 — — — April 10,031 49 129 — — — May 19,648 5,091 184 448 791 57 June 20,670 4,243 139 2,288 1,733 79 July 20,219 3,257 — 2,161 1,979 72 August 15,582 654 — 1,302 939 9 September 11,600 2,693 — 751 169 — October 11,604 130 — 646 1 — November 7,093 592 — 526 — — December 5,343 214 — 456 — — Totals 144,562 17,645 1,387 8,578 5,612 217 SMOKE ABATEMENT. Observations have been kept on chimneys of the various factories in the District, and only on one occasion was black smoke found to be emitted to any extent. A warning letter was sent, and we have had no cause to complain since that date. As I have previously stated, there are very few large factories in the District, and it is the private houses which are the greatest delinquents in the matter of the emission of smoke. Although the use of gas fires and cookers has increased within the last few years, there is still the open fireplace to be dealt with, and the remedy for domestic smoke appears to be in the direction of a reliable smokeless fuel. From time to time, we read of schemes for combating the smoke nuisance, but until some authoritative smokeless fuel is produced at a cost within the reach of the average householder, or until some improvement can be effected in the 29 existing extravagant method of using coal, I am afraid we cannot expect freedom from the emission of smoke from the household grate. SCHOOLS. A statement as to the Sanitary Conditions and Water Supply to Schools in the District will be found in my report to the Members of the Education Committee, as School Medical Officer, which is attached to this report, so that I need hardly duplicate the remarks already made. HOUSING. General Housing Condition's in the Area. There are no courts or alleys in the District such as exist in most of the large towns throughout the country. There is a small block of old houses just off the High Road which might perhaps be described as a "court," but there is plenty of through ventilation, the area in front is well-paved and drained, and in spite of overcrowding in several of the houses, the health of the inmates is not affected any more than the rest of the District. It is sometimes alleged that mortality rates bear a direct proportion to the density of population, but where houses are built in a satisfactory manner—the roads being wide, and the general sanitary condition good—there is not much difference in figures between a well-ordered working-class area and a middle-class one. I take, for comparison, two areas in Wood Green:— Noel Park Ward.—87 persons to the acre; Death-rate, 7.9 per 1,000 population. Alexandra Park Ward.—12.6 persons to the acre; Death-rate, 9.4 per 1,000 population. Noel Park, therefore, would appear to be a very healthy part of the District in which to live. 30 There have been no important changes in the character of the population during the period under review, and so far as one can anticipate, the District will always remain a kind of dormitory to London. During the year under review, the Council received sanction from the Ministry of Health to erect 30 houses—at a rental of about 18s. per week—on the Housing Estate in White Hart Lane, to deal with cases of overcrowding brought to their notice by this Department. They have also under consideration the desirability of erecting further houses or flats on this Estate. The Artisans, Labourers and General Dwellings Company are also contemplating the building of 15 or more houses on their Noel Park Estate, which are to be let at a rental and not for sale. What appears to me to be really necessary is a better provision for the accommodation of the bona fide working classes at reasonable and economic rents. Some kind of communal dwellings arranged in flats of self-contained suites of rooms; and such buildings might be constructed on four sides of a square in order to get through ventilation for each tenement, with a large open garden space in the centre. The London County Council have adopted something of this kind near the Eastern side of our boundary in Lordship Lane, and such a scheme might very well be considered. At the time of writing this, our own Council have built 20 houses in Rivulet Road, and 10 more are in the course of construction, which are of satisfactory design and sufficiency; but they seem to me not to meet the case of many of our applicants, who are unable to afford the rent required, and yet who need them badly. It is somewhat strange, but according to our own figures together with those of the Registrar-General, the population of this District has increased but little during the last 10 years, as will be seen by the figures given below; and yet during that time a large number of houses have been built, showing that overcrowding is gradually being overcome by increased accommodation. 31 Registrar-General's estimated population for the years:— 1915 1921 1922 1923 1924 1925 50,545 51,100 51,290 51,540 51,840 51,960 Overcrowding. During the year 1925, 26 special cases of overcrowding were brought to the notice of the Public Health Committee, but this figure does not, of course, cover to any extent all the overcrowding which exists in the District. During the course of house inspection, it is found that the condition of some of the houses is such that remedial increase of accommodation is very pressing—not only is the air space and ventilation insufficient, but occasionally the proper separation of the sexes in bedrooms cannot be maintained. In most, if not in all cases, there is not sufficient bathing provision to keep the household reasonably clean. Whilst we are trying to raise, and are raising, the standard of cleanliness in the Schools, many of the mothers must be hard-pressed to keep up with the requirements of the children. One cannot expect people to be clean in person and clothing unless there is a bath in every house, and this should be a sine qua non in any scheme of building that is adopted. Houses which were built for, and originally occupied by, one family are now tenanted by two or even three; and this practice of taking a larger house than is required—or than the occupier can afford—and then to let off two or more rooms, often causes overcrowding. The price asked for these rooms is frequently exorbitant and more than pays for the total rental and rates of the house, and, unfortunately, this system is looked upon by some as a means of livelihood. The causes of overcrowding are complex, and people 32 crowd together not only because there is a shortage of houses but also because there is a shortage of money to meet the higher rents required. The Housing Committee are taking active steps to select the most suitable cases for the occupation of the houses that are in course of construction as they become completed. This is a difficult matter, because in many of the instances, the people who most need more accommodation are not able to pay the rental required. The reasons mentioned above make it exceedingly difficult to get repairs done with the same promptitude as they were carried out in pre-war days, and I find that more time has to be given to property owners for the purpose of carrying out repairs required. In the case of owners of large blocks of property, repairs are carried out over a period according to agreed arrangements. There is also the difficulty of dealing with the owner who, instead of spending the increased rent on his property, is in such circumstances that he makes use of it for other purposes, and allows the property to become in a state of disrepair. Where the sole income is obtained from house property, there is a certain difficulty in getting the owner to undertake repairs; but so far, by allowing a little latitude, we have been able to get the work done. Generally speaking, there is very much more anxiety and worry in getting repairs executed to property for the reasons given above at the present time, and it is much more difficult to deal with owners of what one might term "poor-class property." Unhealthy Areas. No information or complaints have been received, nor has it been necessary to make any representations with respect to any unhealthy areas in the District. 33 Fitness of Houses. The general standard of housing in the District is good. There are, however, two or three small areas where the housing conditions are certainly not all that could be desired, due in some measure to the manner in which the houses were erected, and will always be more or less a trouble to this Department with respect to repairs being required. Many of the tenants in the areas referred to do not tend to maintain the property in a sanitary condition. The general character of the defects found during the course of house inspection is dirty walls and ceilings, unpaved area spaces and general internal defects—many of which are due, of course, to lack of proper management and supervision of owners. The general excuse is that the increase in rent allowed by the Rent Restriction Act is not sufficient to keep the property in a reasonable state of repair, and that building material—without taking into consideration the cost of labour—has increased to a greater extent since 1914. Generally speaking, there are very few cases in this District of waste or neglect by tenants; but, of course, these do occur as in every other District, and it is very difficult to know how to deal with tenants of this class. At various conferences, suggestions have been made, but no practical solution appears to have been arrived at with respect to tenants who have no regard for the premises in which they reside. The existing bye-laws, up to the present, have worked satisfactorily, and I make no recommendation for their revision. HOUSING STATISTICS FOR THE YEAR 1925. Number of new houses erected during the year:— (a) Total (including numbers given separately under (b)) 126 (b) With State assistance under the Housing Acts— (i) By the Local Authority — (ii) By other bodies or persons — 34 1.—Unfit dwelling-houses:— Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 714 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 714 (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 3 2.—Remedy of defects without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 596 3.—Action under Statutory Powers:— A. Proceedings under Section 3 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 3 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By Owners 3 (b) By Local Authority in default of Owners — 35 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by Owners of intention to close — B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 118 (2) Number of dwelling-houses in which defects were remedied— (a) By Owners (including those outstanding from 1924) 94 (b) By Local Authority in default of Owners — C. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of representations made with a view to the making of Closing Orders — (2) Number of dwelling-houses in respect of which Closing Orders were made — (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit — (4) Number of dwelling-houses in respect of which Demolition Orders were made — (5) Number of dwelling-houses demolished in pursuance of Demolition Orders — 36 NUMBER OF HOUSES INSPECTED, 1925. HOUSE-TO-HOUSE INSPECTION. Road. No. of Houses. No. of Rooms. Families. Persons per Room Adults. Children. Alexandra Road 58 320 239 42 0.87 Clarence Road 5 34 20 9 0.85 Dagmar Road 55 250 203 42 0.98 Finsbury Cottages 9 36 49 12 1.69 Hornsey Park Road 91 559 467 108 1.03 Mayes Road 124 727 597 139 1.01 Moselle Avenue (part of) 185 683 583 169 1.10 Nightingale Road 118 667 525 100 0.93 Park Ridings 69 423 322 52 0.88 Totals 714 3699 3005 673 0.99 During the years 1921 to 1925 inclusive, 2,643 houses and 13,616 rooms have been inspected under the system of House-toHouse Inspection. Rent Restriction Acts. Five certificates under the above were granted during 1925, two of which were subsequently cancelled on completion of the necessary repairs. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The greater part of the Milk Supply in this District is in the hands of one combine, who have installed new plant and otherwise are taking measures to ensure a satisfactory standard of cleanliness and purity. 37 (i) No cattle are kept in the District of Wood Green. (ii) The following licences for the sale of milk under special designations have been granted during the year:— Certified 2 Pasteurised 1 Grade "A"—Tuberculin Tested 1 All the firms concerned are outside this District. (iii) It has not been necessary to refuse or revoke registration of any retailer. (iv) Bacteriological examinations of graded and other milk are not carried out by the Council, but by the County Authority. (6) Meat. The occupier of the licensed slaughter-house in the District has given notice of the times of slaughtering, and arrangements are made for the inspection of all carcases by the Chief Inspector or his Assistant, who both hold the Certificate of the Royal Sanitary Institute for Meat Inspection. In the remaining slaughter-houses, only one notice of slaughtering (sheep) has been received. Almost the whole of the meat consumed in the District is purchased from the London markets, and has, presumably, been inspected. The Public Health (Meat) Regulations came into operation on the 1st April, 1925, and are a valuable addition to our Sanitary provisions. They deal with the cleanly condition and transport of meat in the markets, shops and stalls, and especially affect the housekeeper, in that a person selling meat or exposing or offering the same for sale, must protect it from mud, filth or dust being 38 splashed or blown upon it; that the counter or slab on which it is laid is kept clean, and that knives or other implements used in connection therewith shall be clean, and that it shall be protected from contamination by flies. There are only three or four stalls within the District from which meat is sold, the remaining meat retailers having the usual butchers' shops. On the 5th March, 1925, I called a meeting of all the butchers in the District, and supplied each with a copy of the Public Health (Meat) Regulations, 1924, and an interesting discussion took place; but with few exceptions, no difference has been made in the shops with a view to complying with the Regulations. I was hoping that I should have been able to persuade the tradesmen in question to have kept their meat behind glass, but the explanation of the regulations given by the Ministry of Health has been quoted from time to time against this suggestion. Sufficient time has now elapsed for something to have been done in the direction of covering meat exposed for sale in butchers' shops, and I am contemplating taking some action in the Local Petty Sessions with respect thereto. There are no public slaughter-houses in the District. Private Slaughter-houses. In 1920. In January, 1925. In December, 1925. Registered 3 3 3 Licensed 1 1 1 4 4 4 39 Meat which has been inspected and found unfit for human consumption is removed to the Refuse Destructor and burnt. A list of meat and other food surrendered as unsound is given below:— Meat:— Part of Forequarters and Lungs of Bullock. Weight, 40 lb. Small portion of Veal and Ham Paste. Weight, 2¼ oz. Lungs of Bullock. Weight about 8 lb. Fish:— 5 stone of Skate. 1 box of Kippers. 12 boxes of Tinned Sardine and Anchovy Paste. Weight, 16 cwt. 1 box of Smoked Codling. Fruit:— 26 boxes of Apples. 25 boxes of Apples. Weight, 3½ cwt. 20 boxes of Pears. The small portion of Veal and Ham Paste referred to above was brought to the office by the purchaser, who stated it had a "bad taste." The same was sent to the County Analyst, but nothing deleterious could be found therein. (c) Other Foods. All premises where food is prepared, stored or exposed for sale are regularly inspected from time to time, and defects remedied where necessary. Although no serious defects have been found, I am of opinion that all places where food is prepared or stored should be licensed by the Local Authority; or, at any rate, they should be required to be registered. (d) No cases of food poisoning have been reported during the year. 40 SALE OF FOODS AND DRUGS ACT. The Middlesex County Council being the Authority for taking samples under the above Act, Mr. R. Robinson, Chief Officer of the Public Control Department, has kindly supplied the following figures of samples taken during the year:— Article No. of samples taken. Adulterated. Milk 171 6 Cream 1 — Butter 7 — Arrowroot 3 — Brawn 1 — Cinnamon 4 3 Coffee 2 — Cornflour 1 — Jam 3 — Mustard 3 — Pepper 3 — Rum 1 — Sugar 2 — Whisky 4 2 206 11 Number of Prosecutions 3 Number of Convictions 2 Fines and Costs imposed £5 16 0 The figures given for adulterated samples include some adulterated informal samples in respect of which no proceedings could be taken. INFECTIOUS DISEASE. Owing to the prevalence of Smallpox in the provinces, Chickenpox was made notifiable in October, 1921, for a period of six months, and again from June, 1922, for periods of 12 months up to the present time. 41 Printed instructions giving information with respect to Measles, Whooping Cough and Chicken-pox are distributed by the Health Visitors on their visits to homes, and are also available at the Child Welfare Centres. At the end of 1921 and the beginning of 1922, a serious epidemic of Scarlet Fever occurred in the District, and our Hospital was quite inadequate to deal with the number of cases. Consequently, the Council made an arrangement with the London Fever Hospital to admit any cases of Scarlet Fever and Diphtheria which required urgent removal. Careful enquiry was made into each case, but no common source of infection could be traced. Upon the receipt of a Notification of Infectious Disease, an early investigation of the case is made as to the probable source of infection and the surroundings of the patient and family. If removal is desirable or requested, a message is sent to the Joint Isolation Hospital, and an ambulance, with a nurse in attendance, is sent for the conveyance of the patient. When cases are treated at home, a leaflet is left, with full instructions as to the isolation, etc., of the patient, and a card, which the medical practitioner returns to the Public Health Department on the recovery of the patient. Following on the removal or recovery of patients, the premises are disinfected with Formaldehyde Gas or Formalin Spray—whichever is convenient—and the bedding, etc., removed from the house for disinfection in a Washington Lyons Disinfector. Day and Sunday Schools, and the Librarian of the Public Library, are notified of the existence of Infectious Disease in every case, and are again notified when disinfection has been carried out. The Education Committee have instructed the Head Teachers of the various Schools under their control that no child is to return to School until Notification of Disinfection has been received from the Public Health Department; while we find the Superintendents of the Sunday Schools most anxious and willing to assist us in this direction. 42 A supply of Diphtheritic Anti-toxin is kept at the Council Offices, also at the residences of the Medical Officer of Health and Chief Sanitary Inspector, where it can be obtained at any time. During 1925, 47 tubes (94,000 units) were supplied. Specimens for examination are sent to the Medical Superintendent at the Joint Isolation Hospital. A list of the material and results obtained is given below. We have had very few cases of Encephalitis Lethargica during the past five years. In 1924, there were 6 cases. Although careful enquiry was made into all the cases during the period referred to, no source of infection could be traced, and no second case has occurred in any one house. The number of cases of Pneumonia for the past five years has not been excessive, having regard to the population. We have had no cases of Malaria in the District since 1922. The following table shows the prevalence of Notifiable and Infectious Disease since 1921:— 1921. 1922. 1923. 1924. 1925. Diphtheria 143 44 26 24 54 Scarlet Fever 418 248 91 85 88 Enteric Fever 1 1 — — — Cerebro-Spinal Fever — — — 2 — Puerperal Fever 2 — 1 — 2 Pneumonia 34 36 27 34 36 Erysipelas 24 14 15 16 8 Ophthalmia Neonatorum 5 8 3 4 2 Malaria 3 1 — — — Encephalitis Lethargica 2 1 2 6 1 Poliomyelitis 1 — 1 1 — Smallpox 1 — 1 — — Tuberculosis:— Pulmonary Male 24 29 24 26 39 Female 29 26 20 31 19 Non-Pulmonary Male 6 2 3 4 9 Female 3 5 13 4 8 Total 696 415 227 237 266 Chicken Pox 28 131 203 272 116 43 The use of the Schick and Dick tests in Diphtheria and Scarlet Fever respectively, or the recently developed artificial methods of immunization against these diseases, have not been made. No vaccinations have been performed by me in my capacity as Medical Officer of Health. The mortality from Influenza for the past five years has been as follows:— 1921. 1922. 1923. 1924. 1925. 14 26 11 17 11 The Director of Education forwards to this Department information of illness amongst children of school age which comes to the knowledge of the School Attendance Officers during their enquiries, and investigation is made where necessary. The number of such during the year was:— Whooping Cough 14 Measles and German Measles 90 Miscellaneous 17 121 Pathological and Bacteriological specimens for examination were sent to the Clinical Research Association in 1921 and 1922, and to the Medical Superintendent of the Joint Isolation Hospital since the latter date. The following are the number dealt with:— 1921. 1922. 1923. 1924. 1925. Positive. Negative. Total. Diphtheria 390 190 115 164 45 338 383 Pulmonary Tuberculosis 89 98 112 88 7 126 133 Enteric 3 1 — — — 1 1 Ringworm 4 10 6 1 2 2 4 Coli — — 1 — — — — Urine — — 1 — — — — Totals 486 299 235 253 54 467 521 44 CANCER. There were 30 deaths from Cancer of persons between the ages of 45 and 65 years, being 40.5 per cent. of the total deaths from Cancer; and 32 over 65 years of age, being 43.2 per cent. of the total. Year. Population. Total deaths of persons over 65 years of age. Deaths from Cancer of persons over 65 years of age. 1921 50,707 197 23 1922 51,290 204 27 1923 51,540 213 37 1924 51,840 239 38 1925 51,960 235 32 Death-Rate from Cancer, per 1,000 population . General Death-Rate, Per 1,000 population- 1901 .. 0.64 11.55 1911 .. 0.87 11.28 1921 .. 1.13 9.64 1922 .. 1.24 10.21 1923 .. 1.47 9.52 1924 .. 1.24 9.89 1925 .. 1.42 9.75 45 DEATHS FROM CANCER, 1925. MALE. FEMALE. Total. Organ affected. 2535 yrs. 3545 yrs. 4555 yrs. 5565 yrs. 65 and over. 2535 yrs. 3545 yrs. 4555 yrs. 5565 yrs. 65 and over. Bladder - 1 - - - - - - - 2 3 Bowel - - - 1 - - - - - 2 3 Brain - - - - - 1 - - - - 1 Breast - - - - - - 1 5 — 2 8 Caecum - - - - - - - - - 2 2 Cervix - - - - - - 1 - - 1 2 Colon - - - 1 - - 2 - - 1 4 Ilium - - - - - - - 1 - - 1 Intestine - — — 1 1 — — — — — 2 Kidney - — — 1 — — — — 1 — 2 Larynx - - - - - - - - - - 2 Liver - - - - 1 - - - - - 1 Lung - 1 - - - - - - - - 1 Maxillary - - - - - - - - - 1 1 Neck - - - - 2 - - - - - 2 Nose - - - - - - - - - 1 1 Oesophagus - - - - - - - - - 1 1 Omentum - - - - - - - - - 1 1 Ovaries - - - - - - - 1 - - 1 Pelvis - - - - - - - 1 - - 1 Prostate - — — 1 2 — — — — — 3 Pylorus - - - - - - - 1 - - 1 Rectum - - 1 - - - 1 1 1 — 4 Sigmoid - - - 1 - - - - - - 1 Stomach 1* 1 — — 3 — — 2 2 — 9 Tongue - — 1 1 — — — — — — 2 Tonsil - - - 1 - - - - - - 1 Uteri - - - - - 1† 1 1 1 1 5 Vulva - - - - - - - - - 1 1 Miscellaneous — — — 2 2 — — — — 3 7 Totals — 3 2 10 13 1 6 12 6 19 74 *4 years of age †5 years of age 46 NOTIFIABLE DISEASES DURING THE YEAR 1925. Disease. Total Cases Notified. Cases admitted to Hospital. Total Deaths. Smallpox - - - Scarlet Fever 88 76 — Diphtheria 54 49 1 Enteric Fever - — — Puerperal Fever 2 2 1 Pneumonia 36 — 22 Cerebro-Spinal Fever — — — Erysipelas 8 3 — Ophthalmia Neonatorum 2 — — Malaria — — — Encephalitis Lethargica 1 1 - Poliomyelitis — — — Chicken-Pox 116 — — CASES OF INFECTIOUS DISEASES IN WARDS, 1925. Town Hall. Noel Park. Central. Bowes Park. Alex. Park. Totals. Diphtheria 15 22 11 5 1 54 Erysipelas 1 2 3 2 — 8 Scarlet Fever 19 18 26 7 18 88 Enteric Fever - - — - — - Puerperal Fever — 1 1 — - 2 Ophthalmia Neonatorum — — — 2 - 2 Phthisis 19 17 10 9 3 58 Other Tuberculous Diseases 3 3 5 3 3 17 Cerebrospinal Fever — — - - - — Pneumonia 8 10 9 4 5 36 Malaria — - - - - - Encephalitis Lethargica — 1 — — - 1 Poliomyelitis — — — — — — Chicken-Pox 20 28 22 15 31 116 Smallpox — — — — — — Totals 85 102 87 47 61 382 Cases of Tuberculosis coming to our knowledge other than by Notification:— Phthisis Other Tuberculous 5 — 2 3 2 12 Diseases — 1 1 — — 2 47 INFECTIOUS DISEASES IN AGE GROUPS. 1925. All ages. Under 1 year. 1 to 5 years. 5 to 15 years. 15 to 25 years. 25 to 45 years. 45 to 65 years. 65 and upwards Diphtheria 54 - 9 37 4 4 - - Erysipelas 8 - — — 2 2 3 1 Scarlet Fever 88 - 15 55 10 8 — - Enteric Fever — - — — — — — — Puerperal Fever 2 — — — — 1 1 — Ophthalmia Neonatorum 2 2 - - - - - - Phthisis 58 — — 5 13 27 10 3 Other Tuberculous Diseases 17 - 2 2 3 7 3 - Cerebro Spinal Fever — — — — — — — - Pneumonia 36 — 5 9 4 5 8 5 Malaria - - - - - - - - Encephalitis Lethargica 1 — — — — — 1 — Poliomyelitis — — — — — — — — Chicken-Pox 116 1 34 65 13 2 1 — Smallpox — — — — — — — — Totals 382 3 65 173 49 56 27 9 Cases of Tuberculosis coming to our knowledge other than by Notification:— Phthisis Other Tuberculous 12 — — — 1 9 2 — Diseases 2 - 1 - - - 1 - 48 SCARLET FEVER AND DIPHTHERIA. Patients attending the Elementary Scarlet Fever. Diphtheria. Schools under the Education Committee 42 28 Trinity County School — 1 Glendale Avenue County School — — Private Schools in the District 2 6 Schools outside District 3 2 Not attending School 8 — Over School age 19 9 Under School age 14 8 88 54 46.6 per cent. of the total number of Scarlet Fever cases notified did not attend School. 21.5 per cent. of the total were patients over School age. 31.4 per cent. of the total number of Diphtheria cases notified did not attend School. 16.6 per cent. of the total were patients over School age. Scarlet Fever. 88 cases were reported, as against 85 in 1924, most of which were of a mild type. Number of houses where 1 case occurred 78 „ „ 2 cases „ 5 Diphtheria. 54 cases were notified as against 24 in 1924. Number of houses where 1 case occurred .. 45 „ „ 3 cases 1 „„ 6 1 (Residential School) 49 Cases of Infectious Disease removed to Isolation Hospital Joint Isolation Hospital. Ward. Scarlet Fever. Diphtheria. Erysipelas. Total. Town Hall 18 12 1 31 Bowes Park 7 5 1 13 Alexandra Park 10 — — 10 Central 26 8 — 34 Noel Park 15 21 — 36 76 46 2 124 Error in Diagnosis (included above) 1 Southgate Isolation Hospital. Ward. Scarlet Fever. Diphtheria. Erysipelas. Total. Central — 2 1 3 Enfield Isolation Hospital. Ward. Scarlet Fever. Diphtheria. Erysipelas. Total. Noel Park — 1 — 1 One death occurred in the Enfield Isolation Hospital on the day of admission, of a child aged 2 years, removed from the Noel Park Ward suffering from Pertussis and Diphtheria; the cause of death being Pertussis and Diphtheria. 50 INFECTIOUS DISEASES (NOTIFICATION AND PREVENTION) ACTS. Number of articles dealt with at the Disinfecting Station:— Articles disinfected after Infectious Disease 1361 ,, ,, ,, Cancer 231 ,, ,, ,, Tuberculosis 105 ,, ,, ,, Measles and German Measles 21 ,, ,, ,, Scabies 61 ,, ,, ,, Mumps 11 ,, ,, ,, Erysipelas 15 1805 Articles destroyed 172 1977 Number of rooms disinfected:— After ordinary Infectious Disease 183 After Cancer 19 After Tuberculosis 38 Miscellaneous 36 276 51 TUBERCULOSIS. Age Periods. New Cases. Deaths. Pulmonary. .Nonpulmonary . Pulmonary. Non pulmonary. M. F. M. F. M. F. M. F. 0 - - - - - - - - 1 - - 2 1 — — 2 1 5 1 1 — 2 1 — — 2 10 2 1 — — — 1 — — 15 3 3 1 — 1 1 — — 20 6 2 1 1 2 2 — — 25 10 10 2 2 2 10 - — 35 10 6 1 2 1 2 — — 45 11 1 — 1 6 1 — 2 55 — — 3 — 3 — 1 — 65 and upwards 3 — — — 2 — 2 — Totals 46 24 10 9 18 17 5 5 The number of deaths from Tuberculosis during the year was:— Pulmonary 35, equal to a rate of .67 per 1,000 of the population; Non-pulmonary 10, equal to a rate of .19 per 1,000 of the population; making a total of 45, or a rate of .86 per 1,000 of the population, as compared with a rate of .98 per 1,000 in 1924. The following table shows the organs affected in the cases of Tuberculosis notified during the year:— Male. Female. Lungs 39 19 Abdomen 1 1 Cervical Glands — 1 Hip 1 — Ileum — 1 Ileum and Sacrum — 1 Meninges 1 1 Neck — 1 Peritoneum 2 2 Radius 1 — Shoulder 2 — Spine 1 — 52 The Wards were affected as follows:— Ward. Male. Female. Town Hall 12 10 Bowes Park 8 4 Alexandra Park 2 4 Central 13 2 Noel Park 13 7 Public Health (Prevention of Tuberculosis) Regulations, 1925. There has been no necessity to take any action under these regulations, no employee in the milk trade suffering from Tuberculosis having come to our notice. Public Health Act, 1925, Section 62. No action has been necessary under this Section for the compulsory removal to Hospital of any person suffering from Tuberculosis. MATERNITY AND CHILD WELFARE. Ante-Natal Clinic. The work of this Department is being conducted with much acceptance by Dr. Aileen Boyd-Mackay, who was appointed in March, 1921, as Assistant Medical Officer in respect of Maternity and Child Welfare work. One session each week is devoted to Ante-Natal work. The number of expectant mothers visiting this Clinic is slowly increasing, and in addition to the interview with, and examination by, the Doctor, advice upon infant clothing is given and a specimen set of the style recommended is kept there. Medical supervision and help at this particular time of a woman's life is most valuable, and is often productive of much more safety and comfort than if matters are left to chance. All those who desire or need this assistance are welcome. Dr. BoydMackay also holds two sessions each week at the Maternity and Child Welfare Centres. 53 During the year 1925 she has seen 118 expectant mothers at the Ante-Natal Clinic, with a total attendance of 401; and 421 infants and 246 children at the Centres, with a total of 2,584 attendances. A list of the Centres and times of attendance appears earlier in this Report. The'Health Visitors attend the various Centres for the purpose of weighing the children and infants and giving advice as to feeding, etc., all special cases being referred to Dr. Boyd-Mackay. One cannot leave this subject without mentioning the valuable assistance rendered by the Voluntary Helpers, who give their time each week to assisting in the work generally at the Maternity and Child Welfare Centres, and I desire to here acknowledge the good work they do. Arrangements have been made, with the consent of the Ministry of Health, for the admission of maternity cases—both normal and complicated—to the North Middlesex Hospital. During the year 1925, 18 cases were dealt with. Attendances at Centres, 1921-1925 inclusive. 192. 1922. 1923. 1924. 1925. January 1,376 922 1,176 1,057 1,245 February 1,437 1,179 1,154 1,126 974 March 1,453 1,415 1,447 1,445 1,009 April 1,627 957 1,104 1,018 856 May 1,101 1,047 1,049 1,189 1,177 June 1,221 921 1,409 1,292 881 July 1,450 1,332 1,078 985 1 146 August 1,091 1,041 1,062 1,104 1,068 September 1,260 1,440 1,428 1,091 1,045 October 1,599 1,197 1,098 1,099 1,357 November 1,059 1,031 1,158 1,326 1,048 December 1,187 1,249 1,017 683 781 15,861 13,731 14,180 13,415 12,587 54 The diminution in these figures is accounted for by the falling Birthrate, the particulars of which are shown under the heading of Births during this period. 1925. 1924. Number of Infants visiting Centres 521 595 Number of Children visiting Centres (1—5 years) 531 687 Number of Ante-Natal Cases visiting Centres (for advice only) 93 112 The number of Still-Births during the year was:— Attended by Medical Practitioners 12 12 Attended by Midwives 2 9 In Hospital 8 4 OPHTHALMIA NEONATORUM. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At Home In Hospital. 2 2 — 2 (complete recovery) — — — Maternity and Child Welfare. Number of Births Registered within the District 740 Number of Births Notified within the District 619 Percentage of Births Notified 86.6 Enquiries into Deaths of Children (under 1 year of age) 30 Enquiries into cases of Ophthalmia Neonatorum 13 Special Visits (Pneumonia, Bronchitis, etc.) 690 Number of Visits paid to Homes (Infants) 2,570 Number of Visits paid to Homes (1—5 years) 3,061 Number of Visits paid to Ante-Natal Cases in their Homes 228 55 Dental Clinic. The Dental Surgeon, Mr. H. W. Gwyther, L.D.S., R.C.S., attends at Stuart Villa, on Tuesdays, for one session, to advise and treat expectant and nursing mothers and children who are referred to him by Dr. Boyd-Mackay and the Health Visitors. The following have been dealt with by him during the years 1921—1925 inclusive:— 1921. 1922. 1923. 1924. 1925. New Dentures provided 6 6 6 5 5 Extractions 55 101 114 131 114 Fillings — — 6 34 20 Impressions — — 6 8 6 Inspections — — 13 9 7 Repairs, scalings, etc. 7 40 12 14 8 Free Food. The following amount of food was granted, free of cost, to necessitous mothers attending the Centres:— Glaxo 337 lbs. Cow and Gate 609 Trufood (Full Cream) 232 „ ,, (Humanised) 245 „ Virol 572½ ,, Vitmar 263 ,, Lactagol 188 ,, Groats 349 ,, Malt and Oil 575 ,, Value of above £229 19 6 Cows' Milk—Expenditure £13 0 3½ 56 The value of food granted free of cost for the preceding four years was as follows:— 1921. 1922. 1923. 1924. £ s. d. £ s. d. £ s. d. £ s. d. Dried Milks, etc. 209 11 11 123 5 6 191 17 11 195 14 4 Cows' Milk 204 3 6 45 13 5 33 3 1 15 11 H Attendances at Day Nursery, Stuart Villa. 1925. 1924 January 374 318 February 376 337 March 455 425 April 340 310 May 446 415 June 325 448 July 418 396 August 276 414 September 457 404 October 578 396 November 452 474 December 374 361 4,871 4,698 The average number of children attending each day was 19.3, as against an average of 18.6 for the year 1924. SANITARY ADMINISTRATION. Houses inspected (systematic inspection) 714 Complaints with respect to Alleged Nuisances 232 Visits to Infectious Cases 295 Visits to Houses where Tuberculosis has occurred 75 Visits to Slaughter-houses 50 Rooms Disinfected 276 Articles Disinfected 1805 Letters Written 2508 Letters Received 1641 57 SANITARY WORK, 1925. Inspections— Number of Premises Inspected on Complaint 232 Number of Premises Inspected in connection with Infectious Diseases 247 Number of Premises under Periodical Inspection 444 Houses Inspected from House-to-House (H.T.P., etc., Act, Sect. 17) 714 Total Number of Inspections and Re-inspections made 8156 Action Taken (Other than under H.T.P. etc., Act)— Cautionary or Intimation Notices given 1139 Statutory Orders Issued 166 Summonses Served 5 Convictions Obtained 3 Bakehouses— Number in District 19 Number of Inspections made 78 Slaughter-houses— Number on Register 4 Number of Inspections made 50 Cowsheds— Number on Register (not in use) 1 Dairies and Milkshops— Number on Register 49 Number of Inspections made 160 Unsound Food— Meat (including organs) seized and surrendered. Approximate weight in pounds) 48 Fish seized and surrendered. (Approximate weight in pounds) 1890 Fruit and Vegetables seized and surrendered. (Approximate weight in pounds) 1456 Method of Disposal: Burnt in Destructor. 58 Water Supply and Water Service— Draw-Taps placed on Mains 195 Percentage of Houses supplied on Constant System 100% Drainage and Sewerage op Existing Buildings— Water Closets Repaired, Supplied with Water, or otherwise Improved 154 Percentage of Houses provided with Water Closets 100% Drains—Unstopped, Repaired, Trapped, etc., Waste Pipes, Rain Water Pipes Disconnected, Repaired, etc. 358 New Soil Pipes or Ventilating Shafts Fixed 12 Disconnecting Traps or Chambers Inserted 2 Reconstructed 1 Percentage of Houses Draining into Sewers 100% Disinfection— Rooms Disinfected—Ordinary Infectious Diseases 183 Phthisis 38 Rooms Stripped and Cleansed 41 Articles Disinfected or Destroyed—Ordinary Infectious Diseases 1872 Phthisis 105 Dust— New Bins Provided 304 Removed from each house once per week- Number of Complaints of Non-Removal received 5 Method of Disposal: Destructor. Sundry Nuisances Abated— Accumulations of Refuse 13 Foul Pigs and Other Animals 5 Dampness 298 Yards Re-paved or Repaired 150 Other Nuisances 3231 Drains Tested— New Houses 125 New Flats 2 59 SCAVENGING. Removal of House Refuse by Horses and Vans. 1921. 1922. 1923. 1924. 1925. Number of loads removed 6,477 7,227 7,973 7,889 7,743 Weight of refuse removed (tons) 6,377 7,497 8,416 9,361 9,532 Average weight of load 19.5c. 1t. 3q. 1t. 1c. 1t. 3c. 1t. 4c. Average number of carts employed per day 7.5 8.22 9.22 9.4 9.3 Number of visits paid by Foremen to carts on District 9,776 5,767 7,569 7,749 7,843 PUBLIC MORTUARY. Bodies deposited during the year 22 For lodgment only 1 Inquests held 21 Post-mortem examinations 13 Causes of death:— Natural 13 Accidental 6 Suicide 2 LEGAL PROCEEDINGS, 1925. Nature. Result. (1) Non-compliance with Notice under Order for work to be Public Health Act, 1875, re 53, done within 14 days, Woodside Road and costs. 60 Nature. Result. (2) Non-compliance with Notice under Case adjourned; work Public Health Act, 1875, re 64, completed; withdrawn Park Ridings (3) Non-compliance with Notice under Order for work to be Public Health Act, 1875, re 32, done within 14 days, Victoria Road and costs. (4) Non-compliance with Notice under Work done; with- Public Health Act, 1875, re 25, drawn Commerce Road (5) Non-compliance with Notice under Order for work to be Public Health Act, 1875, re 5, done within 7 days, Western Road and costs. HIGH ROAD TRAFFIC. The unsatisfactory condition of the High Road, with respect to traffic, still continues, and I give below a list of accidents which have occurred during the year, involving slight and serious personal injury:— January 8 February 5 March 7 April 7 May 12 June 9 July 4 August 19 September 9 October 12 November 5 December 5 102 As against 67 last year. 61 In 31 of the above cases, the Council's Motor Ambulance was called to give assistance in removing injured persons. Three of the cases are known to have been fatal. The danger that pedestrians run is becoming a serious factor in life, and certainly behoves more care on the part of the Authorities concerned in the promulgating of arrangements for the safety of the public. More supervision should be kept with regard to the speed limit of motor vehicles, especially when passing stationary tramcars. Roadside classes to teach children to cross the road safely have been proposed (in Bradford), and all engaged in instructing the young have opportunities in school hours of giving advice on this subject. RAINFALL, 1925. Month. Total Rainfall, inches. Maximum Rainfall. No. of Wet Days. Inches. Date. January 1.84 0.46 1st 12 February 3.09 0.79 12th 15 March 0.53 0.13 1st 10 April 1.49 0.32 30th 15 May 1.54 0.29 23rd 19 June 0.09 0.07 24th 2 July 2.90 1.03 22nd 14 August 1.76 0.46 23rd 16 September 2.23 0.48 19th 19 October 2.57 0.73 19th 13 November 1.44 0.52 2nd 13 December 2.23 0.41 22nd 15 Total 21.71 163 Maximum Rainfall22nd July 1.03 inches. Maximum Rate of Rainfall 20th July 0.30 inches (fell at rate of 1.8 inches per hour). 62 The following table shows the total rainfall in inches for the years:— 1920 24.84 1921 12.94 1922 22.19 1923 23.23 1924 30.89 1925 21.71 In conclusion I desire to acknowledge the interest taken by the whole Council in the work of this Department, and especially that of the two Committees with which I am more immediately concerned. I am also much indebted to the Chief Sanitary Inspector, Mr. Adams, whose years of experience are invaluable, and to all his Assistants, without whose help the preparation of this report would have been impossible. I remain, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, W. E. PORTER. 63 APPENDICES. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—Inspection. Including Inspections made by the Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Prosecutions. Inspections. Written Notices. Factories— (Including Factory Laundries) Workshops— (Including Workshop Laundries) 1 198 7 Workplaces— (Other than Outworkers' premises included in Part 3 of this report) 143 - - Total 341 7 — 64 2—Defects Found. Number of Defects. Number of Prosecutions. Found. Remedied Referred to H.M. Inspectr Nuisances under the Public Health Acts— Want of Cleanliness 16 16 - Want of Ventilation — - - - Overcrowding — — - — Want of Drainage of floors — — - — Other Nuisances 5 5 - - Sanitary Accommodation— Insufficient — — - - Unsuitable or Defective — — - - Not separate for Sexes — — - - Offences under the Factory and Workshop Act— Illegal Occupation of Underground Bakehouse (s. 101) - - - - Other 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) - - - - Total 21 21 — — 65 3.—Homework. Nature of Work. Outworkers' Lists, Section 107. Lists received from Employers. Sending twice in the yr. Sending once in the yr. Lists. Outworkers. Lists. Outworkers. Contr'ct'rs Workmen. Contr'ct'rs Workmen. Wearing Apparel— making, etc. 62 — 165 — — — Lace, lace curtains and nets 3 — 3 - - - Electro-plate — — — — - — Umbrellas, etc... 2 - 2 — — — Artificial flowers 9 - 9 — — — Paper, etc., boxes, paper bags 1 - 1 — — — Brush making 2 — 2 — — — Chemists' Sundries 2 — 2 — — — Stuffed toys - - — - — — Fancy Goods 3 - 4 - — — Lamp Shades 1 — 1 - — — Talle Linen — — - - - — Total 78 — 182 — — — 60 4.—Registered Workshops. Workshops on the Register (S.131) at the end of the year. Important Classes of Workshops, such as Workshop Bakehouses, may be enumerated here:— Dressmakers 7 Milliners 3 Blouse Makers 7 Dining Rooms 15 Laundries 3 Bakehouses 19 Other Workshops (various) 80 Total number of Workshops on Register 134 5.—Other Matters. Matters Notified to H.M. Inspector of Factories:— Failure to affix Abstract of Factory and Workshop Act (S .133) 1901 - Action taken in matters referred to by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Act (S .5.) 1901 - Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspector 1 Other - Underground Bakehouses (S.101):— Certificates granted during the year — In use at the end of the year 1 Wood Green Education Committee SCHOOL MEDICAL SERVICE. ANNUAL REPORT, 1925 Education Department, 10, Stuart Crescent, Wood Green, N.22. To the Chairman and Members of the Education Committee. Sir, Ladies and Gentlemen, I have the honour of presenting the Annual Report on the School Medical Service in the Elementary Schools of Wood Green for the year 1925. 1.—STAFF. Medical Officer.—Mr. W. E. Porter, M.D. and C.M. Edin., M.R.C.S. Eng., and D.P.H., Cantab. Assistant Medical Officer.—Miss Aileen S. Boyd-Mackay, M.R.C.S. Eng., L.R.C.P. Lond. Ophthalmic Surgeon.—Mr. J. S. Boden, M.B., B.S., Lond., M.R.C.S. Eng., L.R.C.P. Lond. Dental Surgeon.—Mr. H. W. Gwyther, L.D.S., R.C.S. Eng. Nurses.—Miss D. F. Jarvis, Cert. General Training ; Miss M. Fairbarns, Cert. General Training, C.M.B. Director of Education.—Mr. C. H. Jarvis, M.A., LL.D. Chief Administrative Officer.—Mr. G. Stone. Medical Clerks.—Miss H. F. Snell and Miss P. Allistone. Medical Visitation Officer.—Mrs. E. Rudd. 2.—CO-ORDINATION. (a) At the Infant Welfare Centres, cards are kept with notes made about each child, and at the commencement of School life these are handed over for use in the Education Office. 1 The system of interchange of information from one administrative body to the other is proving most useful, and is being carried out automatically. (b) We have no Nursery Schools in Wood Green, but there are about 160 Infants attending the Council Schools under five years of age. This number, I understand, will be diminished in the future on account of economic reasons. Those children who have good homes and sensible parents are, undoubtedly, better kept away from School until they are five years old; but there are many instances where these Infants would suffer exceedingly in care, attention, light and cleanliness if they were kept out of School until reaching that age. Each case will have to be dealt with on its merits, and where—in the opinion of the Education Committee—such children would be better at School, no reason of economy should weigh against their inclusion, as under such conditions it is only their natural right in a well-organised community. (c) The care of debilitated children under School age comes under the duties of the Staff of Health Visitors, and Dr. BoydMackay adds notes about these cases to the cards mentioned above. 3.—SCHOOL MEDICAL SERVICE. All the provided Schools in this District, with one exception, are well-placed as regards space around them, and the playgrounds are ample. The one exception is the Alexandra School, which is situated too close to an adjacent building, but is well open on the front aspect and opposite a large common. The ventilation in most of the classrooms is satisfactory, but there are many in which it might be improved. Up till now, our Schools have not been built on plans which fulfil proper cross-ventilation in each apartment. Electricity is gradually replacing gas in lighting the Schools, and is a great improvement if the lights are put in the right places. The scholars are so seated in most of the rooms that the window light comes from the left or back of the pupils. There are a few classrooms in which the window space is not sufficient unless it is a bright, sunlit day, and where deficient light in the afternoons during the Autumn Term is very trying. Warming is carried out by means of hot-water pipes and open fire-places, suitably protected. Equipment is, so far as I can see, 2 fully up to the modern standard. I have not seen any slates and slate pencils for years. Sanitation has received much attention during the past year, offices having been extended and modernised; and, on the whole, a sufficiency of accommodation is provided. A good supply of water for drinking and washing is laid on. Many of the desks have had to be replaced by larger ones, as of late years we have found that the size of the children has slightly increased. Great care has been taken to fit the children with suitable desks and seats. The blackboards are renovated as required, and are in good order. Schools and cloakrooms are kept clean by the several caretakers. I sometimes find the windows of the cloakrooms shut when they ought to be open. The general arrangements of the Schools in relation to the health of the scholars appears to be satisfactory. Arrangements made for drying clothes, Not applicable in this boots, etc. District, as all the Warming-up of meals children live in Supervision of children during meals close proximity to Service of meals the Schools. One is often told by parents who have lived in other Districts in London, that their children thrive much better in this neighbourhood, due, no doubt, to our plentiful open spaces and the height we live above the sea level. Wood Green is certainly a bracing place wherein to live, in spite of its clay subsoil. The following alterations and additions have been made to the Elementary Schools during the year:— White Hart Lane School .. Practical Instruction Centre built. Noel Park School Removal of Galleries on which the desks stood, so that the Floors are now level in two Infants' Classrooms. Myopic Cloakroom, addition of Lavatory Basins. 3 Bounds Green School New Lavatory Basins fitted throughout. Removal of Galleries in two Infants' Classrooms. Practical Instruction and Science Room built. New Window provided in one Infants' Classroom. Alexandra School Infants' and Boys' Urinal paired. Play-sheds re-roofed. Galleries in two Infants' Classrooms removed. St. Paul's School New Classroom provided. Lordship Lane School Muswell Hill School Minor repairs where necessary. St. Michael's School 4.—MEDICAL INSPECTION. In the Infants' Department each child is medically inspected during its first term, and in nearly every case the mother or guardian is present. In the great majority of instances, this work goes on quietly, and the child takes it as a matter of course. We present the figures in model Tables, advised by the Board, which have lately undergone some revision. A considerable number of the children inspected are found to require treatment. But, in addition, there are many who show slight defects, and these are noted and kept under observation. There has been an improvement in the physical condition of the children of late years, and there is no doubt that our standard of child life is rising; and as time goes on, medical inspection and treatment of School children will prove to be a valuable asset in our national life, for truly it has been said, "The new objective in preventive medicine is the production of fitness." The decreasing birth-rate is making a difference to our numbers, and we must look all the more to improving the quality of the child leaving School and going out into the world. 5.—FINDINGS OF MEDICAL INSPECTIONS. (a) Personal Cleanliness. Undoubtedly, children are cleaner than they used to be. One 4 of our School Nurses spends most of her time in going round the classes examining each one as regards its condition in this respect. Hence, many of the more troublesome children are persuaded to adopt better habits, and those of one class are encouraged to vie with another in their personal appearance. One nit in a child's head is now sufficient to separate it from the number of "clean" scholars. Girls are especially improving, and the custom of "bobbing" the hair is an advantage to them. Among the boys, their hands chiefly show their environment; and the Teachers are getting more particular on this point, thus ensuring a betterment. The attainment of cleanliness is very desirable, even at some cost, for without it comfort is absent; and when a child is uncomfortable, it does not get the full benefit of its schooling. (6) Minor Ailments. We see all the sorts of disease that children can suffer from at our Clinic. Small injuries, cuts, bruises, running ears, skin eruptions, etc. Automatically, those who have been found to be delicate and to have defects are brought to Stuart Villa to be advised, treated and kept under observation. All children on the School Roll who have not a perfectly clean bill of health come under our purview at this Centre, and I am pleased to say that more parents are taking advantage of this Clinic as time goes on. (c) Nose and Throat Defects. I regret to report that I consider that the number of children suffering from enlarged Tonsils and Adenoids is increasing. It is difficult to say why; but I hope that every year more Infants will be taken to the Maternity and Child Welfare Centres, and that a larger proportion of them will be treated before they reach School age. Mothers are repeatedly told at these Centres that "dummies" are harmful and dirty, and that there is a considerable ground for believing that if they do not actually cause some of the disease, they certainly aggravate it. We have always a number of children in the Schools whose parents either do not, or will not, heed the advice given them on this subject, and, unfortunately, the child is the one to suffer and to be retarded in its education; and moreover, if left untreated long enough, to grow up deaf and therefore in an impaired physical condition. 5 These unfortunate conditions of the nose and throat have apparently been increasing since the middle of last century; and if they are not actually a new trouble, it is strange that they had been so much overlooked in Medical literature before about 1850. (d) Tuberculosis. A register of all children suffering from Tuberculosis in any form is kept, and these are seen at regular intervals and kept under observation and treatment. Fortunately, Pulmonary Tuberculosis is rare in School children. Only those Tubercular children who are certified to be free from infection are allowed in the Schools. Those children who are suspected of the disease at Medical Inspection are sent on to the Tuberculosis Medical Officer for further advice and treatment, and we are kept fully informed of their welfare. There are several children attending the Schools who have in the past suffered from this disease, but who are now recovered and doing well. (e) Skin Diseases. Impetigo (sores) is the chief trouble—largely caused, and always aggravated, by dirt. We have always a case or two in attendance. Ringworm, fortunately, has been almost absent during the past year, and Scabies has been very much less frequent than it was a few years ago. (f) Eye Diseases. Many of the slight affections of the eyes and eyelids are attended to at our Daily Clinic; and should any case be of a serious nature, the child is seen by our Ophthalmic Surgeon, who is in attendance once or twice a week on regular and stated occasions. (g) Vision. Every child who is found at Medical Inspection to be seriously deficient, is referred to the Ophthalmic Surgeon, and, in the majority of cases, eventually supplied with suitable glasses. Children's spectacles have to be kept under observation by Teachers and Nurses, as well as by the Doctor. Sometimes the frames get bent or the glass broken, and not infrequently get lost. Our senior School Nurse attends to all eye cases seen by the School Medical Officer and the Ophthalmic Surgeon, and such children are kept under regular care and treatment. 6 The provision of suitable lenses has cured numbers of headaches, thus allowing the children much increased ability to receive instruction. (h) Ear Diseases. A discharging ear not only adversely affects the child so afflicted, but sometimes his neighbour as well, because of the odour. It is, in most cases, secondary to a diseased condition of the throat and nose, and is, moreover, the precursor of deafness in after-life, so that every effort is made to cure the complaint. We have, during the year, many cases of this kind, and some of them are very intractable if operative treatment is not adopted. Unfortunately, very little notice is taken of this trouble by many parents. Scarcely a session of Medical Inspection passes but that we have a deaf mother visiting us. Deafness is such a serious hajidicap to our safety in life—and so much impairs social intercourse, work and pleasure—that it behoves all parents who have a child suffering from this defect to see to it that suitable treatment is obtained without delay. Childhood is the one time of life that earache is specially prevalent. The teeth may be at fault sometimes, but more often it is due to the condition of the back of the nose and throat. (i) The Care of the Teeth. There is no department of the School Medical Service that is making, and still more is going to make, such an improvement in the general health of the community. A sound and regular set of teeth in a clean mouth is a possession beyond all price; and those parents who do not, and will not, trouble to take the advantages offered to them at the Dental Clinic at Stuart Villa, are foolish and standing in the way of their children's bodily welfare. Of course, if they prefer the services of a private Dentist, well and good -a course which allows the time of our excellent Surgeon Dentist to be otherwise employed. The majority of both boys and girls now leave our Schools with their mouths in a very satisfactory condition. (j) Crippling Defects. A register is kept, and frequently revised, of all cases of paralysis, lameness, spinal curvature and the like, and each child 7 so suffering is examined at stated times during the year. Most of these cases are suitable for instruction in Open-Air Schools, and I look forward to the time when such provision will be made. Fresh air, sunlight, warmth and good food are the chief adjuncts to any special treatment for defects of this kind. (k) Clothing. Dr. Boyd-Mackay remarks that there is rather a tendency in the present day to under clothe the legs of young children—a practice which leads to the so-called "growing pains" so often noticed in early life, and which are often rheumatic in character. 6.—INFECTIOUS DISEASE. A Table of periods of exclusion is set forth in the handbook of School Regulations; and, in addition, I have issued information to the Teachers on the early symptoms and signs of the common infectious diseases of childhood, so that immediate exclusion may be made when suspicion is excited. 7.—FOLLOWING-UP. Medical Inspection may be said to be only the beginning of improvement in a child's oondition, and is of little value unless the remarks and advice of the Examiner are noted and carried out. The sensible parent who is anxious about its child's welfare, will take a hint at once and see that defects are ameliorated or remedied. It is with the careless, uneducated and stubborn parents that our Visitation Officers and Nurses have so much difficulty. Through the Clerks in the Education Office, every defect is attended to', and measures taken to ensure its being made good, veritable clearinghouse for the various ills that children are suffering from, the cases are automatically reported to the Dentist, Eye Surgeon, Nose and Throat Department or Feeding Centre, as the case may be. I have two full-time School Nurses. One is employed daily at the Minor Ailment Clinic, and assists me at my Medical Inspection and the Ophthalmic Surgeon at his Clinic. The other helps the Dentist on two days a week, and specialises in inspecting the children with respect to personal cleanliness in all the Schools. 8.—MEDICAL TREATMENT. (a) Minor Ailments. Treatment of Minor Defects is provided at the Minor Ailments' Clinic on Monday, Tuesday, Thursday, Friday and Saturday 8 mornings, on production of a Clinic Attendance Card, which can be obtained from the Head Teachers, the School Nurses or Visitation Officers. When not in use, the card is retained by the Head Teacher until the completion of the child's treatment at the Clinic. The attendances of the children at the School Clinics are recorded in the Clinic Attendance Register, also by entering the exact times of arrival and departure. (b) Tonsils and Adenoids. Surgical treatment for the above is provided at the North Middlesex Hospital by arrangement with our Committee. Both the Surgeon and Anaesthetist who carry out the operation are specially qualified to do this work, and are well skilled by experience . Operations are performed in the morning and the children remain in Hospital until the late afternoon, when they are all seen by the Medical Officer, and only those sufficiently recovered and able to travel by Ambulance to their own homes are allowed to leave. In any case of doubt, the child is detained in Hospital until the next day, or longer, if thought desirable. All the arrangements are made to ensure the welfare and safety of the children concerned. (c) Tuberculosis. Cases of this disease are referred to the Tuberculosis Medical Officer, who arranges Sanatorium, Hospital or Dispensary Treatment, as required. (d) Skin Diseases. Most of such cases are treated at the Stuart Villa Minor Ailments' Clinic by the School Medical Officer, Impetigo being the most common. (e) External Eye Disease. These are seen by the School Medical Officer, and referred to the Ophthalmic Surgeon when necessary. (f) Vision. The Department for this matter is under the charge of the Ophthalmic Surgeon. Refraction work and special vision examinations are carried out weekly at the Eye Clinic. Head Teachers receive notice from the Education Office of all children in their respective Departments who have been ordered to wear glasses so 9 that they may assist in ensuring that this advice is carried out, and they are requested to report any cases in which the instructions of the Ophthalmic Surgeon are not being followed. (g) Ear Disease and Hearing. Otorrhoea, Deafness, Impetigo and Wax in the Ear, etc., are all attended at the Minor Ailments' Clinic. (h) Dental Defects. Arrangements are made at the annual Dental Inspection in each School for the examination of the following groups of children:— (a) 6 years of age; (b) 7 years of age; (c) 10 years of age. Dental Treatment is provided on Tuesdays and Thursdays at the Dental Clinic. At the Dental Clinic, the times of arrival and departure are noted by the Nurse on the Appointment Card or Form. On returning to School, the child hands to the Head Teacher the record of attendance at the Clinic, and any necessary adjustment in the Class Register is made accordingly. (i) Crippling Defects and Orthopaedics. These are treated at Special Departments of the North Middlesex, Royal Northern and Prince of Wales's Hospitals, the Orthopaedic and Children's Hospital, at Great Ormond Street. 9.—OPEN-AIR EDUCATION. (a) Playground Classes. Such classes are held at Muswell Hill, Bounds Green and other Schools when the season and weather allow. (b) School Journeys. School journeys have not been undertaken in this district up to the present, but a proposal from the Bounds Green Boys' Department for a visit by 40 boys is receiving consideration by the Committee. (c) School Camps. A School-children's Camp was held at Hatfield Park—under the auspices of the J.O.C.—during the summer vacation, when 80 boys were given 14 days' enjoyment. Sleeping and dining tents were provided, together with a field kitchen as in former years; and altogether, the Camp was a great success, and the boys derived considerable benefit from their change of air. 10 Eighty girls have also been sent by the J.O.C. to King Edward VII Memorial Home, Heme Bay during the summer, where they have been carefully housed and fed, and have derived much physical benefit. (d) Open-Air Classrooms. We have, at present, no Open-Air Classrooms in the Public Elementary Schools. (e) Day Open-Air Schools. We have none at present, but proposals are being discussed for the inclusion of 50 Wood Green children in the new Day Open-Air School which the Borough of Hornsey are contemplating building in the near future, and which would be easily available from this District—the children being conveyed there and back by Ambulance. (f) Residential Open-Air Schools. There are none in this area, but we have 4 places allotted to Wood Green at The Russell Cotes' School of Recovery, at Parkstone, such boys staying there for 6 weeks. Seventeen boys and 1 girl have visited this School, and much benefit has been derived. 10.—PHYSICAL TRAINING. In the Council Schools, we have no Special Instructors. Various Teachers have qualified themselves for such work, and their services are being used for the Physical Exercises, which are given in both Boys' and Girls' Departments. A number of voluntary clubs meeting in the Schools during the evening, provide very considerably for the physical and social welfare of the scholars. 11.—PROVISION OF MEALS. There is no branch of educational work which is rendering more humane service than the feeding of poor children who are not getting sufficient quantity and quality of food at home. It is an undoubted fact that a child is not in a suitable condition to receive instruction unless he is adequately nourished. Older people may be expected to look after themselves, but those of tender years deserve our sympathy and help; and money used in this direction is well spent. During the year, meals have been provided at our Feeding Centre, where the food is good, well-cooked and served. The 11 children have as much as is good for them; and, from my close observations of them at their midday meal, they certainly enjoy it. As a result they look brighter and better, increase in weight, and the Teachers testify to the improvement shown. The cases are very carefully selected after enquiry and consideration, through the recommendations of the Teachers, Visitation Officers, Nurses and Doctors. An old Army hut makes a very good dining centre, with accommodation for some 120 children at a time. 12.—SCHOOL BATHS. There is a large enclosed pool (100ft. long by 30ft. broad), containing water varying from 3ft. 6in. to 7ft. deep. This Bath is very popular, and large numbers of children are being taught to swim, and many—both boys and girls—are becoming expert at it. A Festival Meeting is held once a year, when races and exhibitions of diving and swimming take place. The children are instructed in swimming by various Teachers, and are always under official supervision whilst at the Bath. There is also an Open-Air Swimming Pool, and this is in much demand during the summer. For some 18 months, an experiment was tried of allowing children to have Cleansing Baths after school hours at the price of Id., but this was given up as sufficient applicants were not forthcoming. 13.—CO-OPERATION OF PARENTS. Previously to Medical Inspection in the Infants' Department, a notice is sent to the mother asking her to attend the School at the appointed time, in order to see the Doctor when he examines her child. In the great majority of cases, this is done and much good accrues from the interview; defects are pointed out, and treatment is suggested and advised. A good many parents also attend subsequent Medical Inspections, and they are always welcome. In a small number of cases the parents do not come, and they are often specially those whom we wish to see, in order to have a personal opportunity of persuading them to attend to much-needed treatment. In these instances, my Medical Visitation Officer calls at the child's house. 14.—CO-OPERATION OF TEACHERS. I have to acknowledge with pleasure the growing interest that Teachers are taking in Medical Inspection and the welfare of their boys and girls. So much more can be done when their sympathy 12 and help has been obtained, both in bringing before the notice of the School Medical Officer children who have attracted their attention in the classroom, and also in seeing that, as far as possible, advice given is being followed up. Dr. Boyd-Mackay adds her testimony to their very valuable assistance. 15.—CO-OPERATION OF SCHOOL ATTENDANCE OFFICERS. Each and every Visitation and Attendance Officer has a part in co-operating in the administration of the School Medical Service. The work of these officials is very acceptable. 16.—CO-OPERATION OF VOLUNTARY BODIES. I am very much indebted to the Care and After-Care SubCommittee of the Education Committee for the great interest shown in the School Medical Service. Exceptional cases of distress are brought to their notice and dealt with sympathetically. The help of other Societies which aid weak and ill children is obtained in suitable instances, and there is a close relationship between our Education Committee and the various social activities which are grouped together under the name of the Juvenile Organisations' Council, by whose influence and under whose control a great deal of real benefit is found for the children in many ways—but more especially in the provision of means to allow Country Holiday Camps to have been carried on for the past 4 years. I am pleased to add that a suggestion in my last report of sending both boys and girls to breathe the seaside air has been adopted, and I am glad to know that during the coming summer both 80 boys and 80 girls (specially selected) are to be given a fortnight's enjoyment at Dymchurch, on the Kentish coast. 17.—BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. (a) Such children are picked out at the routine Medical Inspections and also at the Special Clinics regularly held, and notes are taken of them at the time. Lists of delicate and otherwise abnormal children are kept for reference. (b) We have 24 children in our Myopic Class, which is a better term than "a School for the Partially Blind," but possibly not so good as the one which has been recently suggested, viz., "The Sight-Saving Department." (The stigma attached to any Special 13 School is a very real reason of many parents in refusing to allow their children to obtain the advantages therein.) The children in this Centre are all short-sighted or have some other defect of sight which makes it necessary to take general care of their eyes, especially while they are growing. About two-thirds of the children are simply short-sighted, while the other third suffer from defects due to accident, congenital causes and scarred eyes, from disease in infancy. All of these, however, see too well to be provided for in a School for the Blind; while their weak eyes would be liable to be strained if they were forced to do ordinary School work. There are two small classes, under the skilled supervision of a Lady Teacher and her assistant, and individual attention is given. Books, pens and pencils are forbidden; large, printed sheets and blackboards, together with crayons, take their place. Each child has its own desk and miniature blackboard, and does its writing at arm's length. The teaching is specialised and interesting, and it is wonderful how much can be attained. The class is under the management of the Wood Green Local Education Authority, but children are received from the neighbouring Districts of Hornsey (6) and Tottenham (10). (c) Deaf and Dumb School. This belongs to the Tottenham Local Education Authority, and we send 9 boys and 2 girls. The teaching here is even more intricate than in the Myopic Class, and depends upon the fact that the children are taught to both appreciate the sound of the voice by means of lip-reading, and then, by constant practice, to make sounds required in speech associated with certain words and things. Great success is attained in time, but only by continued, personal, and patient training by the Teachers. It is hard work. (d) Mentally Defective Children. I have carefully examined 37 children sent to me as dull and backward by the Head Teachers of the various Schools, and have reported thereon. In most cases, it has been found that the retention in ordinary classes is advisable—that is to say, they are more likely to fit themselves for life by mixing with ordinary children 14 than by being segregated in a Special School. Any children who are, without any doubt whatsoever, unfit for the usual School curriculum, are recommended for our Joint Special School, at Finchley. Wood Green sends to this School 10 boys and 3 girls. They are conveyed there and back in an Ambulance, under supervision, and a hot meal at midday is supplied. 1 visit this School, at Finchley, on official occasions at intervals of six months, but in addition to that, keep myself closely in touch with the arrangements under which the children are taught. The chief improvement which most of the children show whilst at this Special School is in general behaviour and handwork; the addition made to their scholastic attainments is small, and not in proportion to the time and trouble that is spent by kind and sympathetic Instructors. I cannot speak too highly of the way in which Miss Wyldes conducts her work here, and of the interest she takes in it; but I am not sure that the present-day methods of dealing with such children are economic. The after-care of children attending these Special Schools is under the supervision of the Medical Visitation Officers and Teachers, controlled by the Care Committee; but this branch of the work is still in its infancy, and further co-operation and organisation is required. (e) I have ascertained that of 46 children who have attended but have now left our Special School at Finchley:— 16 are engaged as messengers, factory workers, assistants to milk roundsmen, dressmakers, gardeners, window-cleaners, shopkeepers, etc. 4 are in domestic service. 4 are in Institutions. 5 have gone to other Schools. 4 are at home. 2 have died. 4 are "in and out" of situations. 2 have gone into the country. 2 have gone abroad. 1 was excluded as Tubercular; and the destinations of two are unknown. (f) There are 7 epileptic children on our rolls, and all are being cared for in their own homes and kept under our supervision. 15 18.—NURSERY SCHOOLS. There are none in this District. 19.—EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. In connection with the employment of children and young persons during the past year, revised Bye-laws have been submitted to the Authorities at the Home Office, for which we are at present awaiting sanction. Under these regulations, we shall have absolute control of the conditions and hours concerning the part-time employment of every child under 14 years of age in attendance at School, and also the power to revoke the licence of anyone whose health may be suffering in consequence of neglect of these provisions. This, in itself, is a step in the right direction to the improvement of the physical condition of the rising generation. 20.—SECONDARY SCHOOLS. By arrangement with the County Authority, I also conduct Medical Inspection of the children attending the two Secondary Schools in Wood Green, and the services of the Staff of the Education Office are available for dealing with the administrative work arising therefrom. Consequently, there is a very close coordination between the Elementary and Secondary School Medical Service. 21 — Special medical examinations have been made during the year of all candidates for the Teaching profession and members of the Office Staff, and also of children proceeding to Convalescent Homes, both before going and after their return. 22.—CONCLUSION. It is with pleasure that I desire to acknowledge the valuable help I have received during the whole of the year and especially in connection with the compilation of this report, from the Director of Education,the Administrative Officer and the rest of the Office Staff. I remain, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, W. E. PORTER, School Medical Officer. 16 TABLE I.-RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections. Age. Entrants. 3 4 5 6 Other Ages. Total. Boys 9 63 212 87 - 351 Girls 21 54 223 60 — 3o8 Totals 30 117 435 127 — 709 Intermediates (8 to 9 Years). Age. 8 Other Ages. Total. Boys 298 103 401 Girls 260 95 355 Totals 558 198 756 Leavers. Age. 12 13 14 Other Ages. Total. Boys 177 112 9 4 302 Girls 191 100 8 12 311 Totals 368 212 17 16 613 Number of other Routine Inspections Boys 12 Girls 31 43 17 A.—ROUTINE MEDICAL INSPECTIONS—Continued. Grand Total. Entrants. Intermediates. Leavers. Other Routine Inspections. Totals. Boys 351 401 302 12 1066 Girls 358 355 311 31 1055 Totals 709 756 613 43 2121 B.—OTHER INSPECTIONS. No. of Special Inspections. No. of Re-Inspections. Boys 481 1369 Girls 371 1235 Totals 852 2544 18 TABLE II. A RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DEC., 1925. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Detects. 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) Malnutrition ... 36 ... 2 Uncleanliness (See Table IV., Group V.) 17 11 ... ... Skin RingwormScalp ... 1 2 1 Body ... ... ... ... Scabies 1 1 12 ... Impetigo 4 6 45 ... Other Diseases (non-Tuberculous) 2 30 19 2 Eye Blepharitis 1 6 10 ... Conjunctivitis ... ... 7 ... Keratitis ... ... ... ... Corneal Opacities 1 ... ... 1 Defective Vision (excluding Squint) 123 34 10 1 Squint 8 18 3 ... Other Conditions 1 5 5 4 Ear Defective Hearing 2 27 3 ... Otitis Media ... 5 ... ... Other Ear Diseases 2 21 32 4 Nose and Throat. Enlarged Tonsils only 44 248 73 36 Adenoids only 12 71 19 7 Enlarged Tonsils and Adenoids 56 71 39 13 Other Conditions 2 7 4 ... Enlarged Cervical Glands (Non-Tuberculous) ... 75 1 2 Defective Speech 1 15 ... 1 Teeth—Dental Diseases (See Table IV., Group IV.) 362 186 90 2 19 TABLE II—continued. Defects 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) Heart and Circulation. Heart Disease— 1 Organic ... 22 ... 5 Functional ... 3 ... 1 Anæmia ... 32 3 1 Lungs Bronchitis ... 38 16 6 Other Non-Tuberculous Diseases ... 23 18 1 Tuberculosis Pulmonary— Definite ... ... 1 ... Suspected ... 4 1 3 Non-Pulmonary— Glands ... 2 1 2 Spine ... ... ... ... Hip ... ... 2 ... Other Bones and Joints ... ... ... ... Skin ... ... ... ... Other Forms ... ... ... 2 Nervous System. Epilepsy ... 2 1 ... Chorea ... 8 4 1 Other Conditions ... 43 ... 2 Deformities. Rickets ... 148 2 1 Spinal Curvature 18 1 2 Other Forms 1 13 6 1 Other Defects and Diseases 7 41 117 15 20 B.—NUMBER OF INDIVIDUAL CHILDREN FOUND AT ROUTINE MEDICAL INSPECTION TO REQUIRE TREATMENT (excluding Uncleanliness and Dental Diseases). Group. (1) Number of Children. Percentage of Children found to require Treatment. (4)[/#33] Inspected. (2) Found to require Treatment. (3) Code Groups— Entrants 709 38 54 Intermediates 756 99 13 Leavers 613 98 16 Total (Code Groups) 2078 235 113 Other Routine Inspections 43 6 14 21 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA ON 31ST DECEMBER, 1925. Boys. Girls. Total. Blind (including partially blind). (i) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind ... ... ... Attending Public Elementary Schools ... ... ... At other Institutions ... ... ... At no School or Institution ... ... ... (ii) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind 6 2 8 Attending Public Elementary Schools 2 ... 2 At other Institutions ... ... ... At no School or Institution ... ... ... Deaf (including deaf and dumb and partially deaf). (i) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 5 ... 5 Attending Public Elementary Schools ... ... ... At other Institutions ... ... ... At no School or Institution 1 ... 1 (ii) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf 4 2 6 Attending Public Elementary Schools ... ... ... At other Institutions ... ... ... At no School or Institution ... ... ... Mentally Defective. Feebleminded (cases not notifiable to the Local Control Authority). Attending Certified Schools for Mentally Defective Children ... 10 3 13 Attending Public Elementary Schools 5 2 7 At other Institutions 2 1 3 At no School or Institution 1 1 2 Notified to the Local Control Authority during the year. Feebleminded 1 ... 1 Imbeciles 1 ... 1 Idiots ... 1 1 Epileptics. Suffering from severe epilepsy Attending Certified Special Schools for Epileptics ... ... ... In Institutions other than Certified Special Schools ... 1 1 Attending Public Elementary Schools ... 1 1 At no School or Institution ... ... ... Suffering from epilepsy which is not severe. Attending Public Elementary Schools 2 1 3 At no School or Institution 2 ... 2 22 Return of all Exceptional Children in the Area—Continued. Boys. Girls. Total. Physically Defective. Infectious pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 2 ... 2 At other Institutions ... ... At no School or Institution 1 ... 1 Non-infectious but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board ... 1 I At Certified Residential Open Air Schools ... ... ... At Certified Day Open Air Schools ... ... ... At Public Elementary Schools 1 1 2 At other Institutions At no School or Institution I 1 2 Delicate children (e.g., preor latent tuberculosis, malnutrition, debility, anaemia, etc.). At Certified Residential Open Air Schools ... ... ... At Certified Day Open Air Schools ... ... ... At Public Elementary Schools 58 24 82 At other Institutions ... ... ... At no School or Institution 1 1 2 Active non-pulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 1 ... 1 At Public Elementary Schools 2 1 3 At other Institutions ... ... ... At no School or Institution 1 ... 1 Crippled children (other than those with active tuberculosis disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease. At Certified Hospital Schools At Certified Residential Cripple Schools ... ... ... At Certified Day Cripple Schools ... ... ... At Public Elementary Schools 17 13 30 At other Institutions 1 1 2 At no School or Institution 3 1 4 23 TABLE IV. Return of Defects Treated death the Year Ended 31st December, 1925 TREATMENT TABLE. Group I —Minor Ailments (excluding Uncleanliness, for which see Group V). Disease or Defect. (1) Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin— Ringworm—Scalp 4 3 7 Ringworm—Body 3 — 3 Scabies 13 — 13 Impetigo 177 2 179 Other skin disease 4 — 4 Minor Eye Defects (external and other, but excluding cases falling in Group II.) 48 2 50 Minor Ear Defects.. 53 3 56 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 439 20 459 Totals 741 30 771 24 Group II.—Defective Vision and Squint (excluding Minor Eye Defects t2reated as Minor Ailments—Group I). Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by Private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint). (Operations for Squint should be recorded separately in the body of the Report) 507 21 528 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 46 4 50 Total 553 21 4 578 Total number of Children for whom spectacles were prescribed— (a) Under the Authority's Scheme 259 (b) Otherwise 21 Total number of Children who obtained or received spectacles— (a) Under the Authority's Scheme 236 (b) Otherwise 21 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. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 78 57 135 6 141 25 Group IV.— Dental Defects. (1) Number of Children who were— (2) Half-days devoted to.— (a) Inspected by the Dentist— Aged: Inspection 24 Total 175 Treatment 151 Routine Age Groups 5 — Total 1860 6 483 7 497 (3) Attendances made by children for treatment 2626 8 31 9 4 10 820 (41 Fillings:— 11 25 Permanent Teeth 296 Total 512 12 — Temporary Teeth 216 13 — 14 - Specials 736 (5) Extractions:— Permanent Teeth 275 Total 3423 Grand Total 2596 Temporary Teeth 3148 (b) Found to require treatment 2021 (6) Administrations of general amæsthetics for extractions 19 (c) Actually treated 1673* (d) Re-treated during the year as the result of periodical examination 135 (7) Other operations:— Permanent teeth 17 Temporary teeth — * In addition there were 131 eases treated by private dentists—balance of 217 represents objections. Group V.—Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses 59. (ii) Total number of examinations of children in the schools by School Nurses .. 30071. (iii) Number of individual children found unclean .. 414. (iv) Number of children cleansed under arrangements made by the Local Education Authority Nil (v) Number of cases in which legal proceedings were taken. (a) Under the Education Act, 1921 Nil (b) Under School Attendance Bye-laws Nil 26