C. I. AC 439(1) WOOD GREEN Borough of Wood Green. Annual Report of the Medical Officer of Health and School Medical Officer Year 1933. MALCOLM MANSON, M.C., M.A., M.D., D.P.H., Medical Officer of Health and School Medical Officer. 1934. Crusha & Son, Ltd., Tottenham, Enfield and Wood Green. WOOD 17 INDEX To the Report of the Medical Officer of Health. A. Accidents due to Traffic 9 Ambulance Service 13 B. Bacteriological Examinations 41 Baths 22 Births 6 Bye-laws 15 C. Clinics— M. & C.W. 16 School 16 Tuberculosis 17 Venereal 17 D. Day Nursery 21 Deaths 7 Disinfection 41 Drainage and Sewerage 21 F. Factory & Workshop Acts 27 Food and Drugs Acts 35 Food Inspection 33 Foster Mothers 20 H. Hospitals 10 House-to-House Inspection 26 Housing Statistics 30 I. Infantile Mortality 8 Infectious Diseases 35 Cases removed to Hospital 36 Cases attending schools 36 L. Legislation in Force 14 M. Maternity & Child Welfare— Ante-Natal Clinic 19 Centres 17 Dental Work 19 Free Food 20 Home Visiting 20 Maternity Hospital provision 12 Maternity and Nursing Homes 10 Maternal Mortality 8 Sunlight Treatment 20 Midwives 10 Mortuary 33 N. Nursing in the Home 9 P. Poor Law Relief 9 Population 6 R. Rent Restriction Acts 32 Rivers and Streams 21 S. Sanitary Inspection 23 Slaughterhouses 34 Slum Clearance 32 Social Conditions, etc. 4 Staff 3 Statistical Tables— Birth and Death Rates, etc. 43 Causes of Death 44 Infectious Diseases 47 Infantile Mortality 46 Meteorological Report 49 Tuberculosis 48 Vital Statistics, 1921-33 42 T. Tuberculosis 11, 39 V. Vital Statistics, Extract from 5 W. Water Supply 21 Z. Zymotic Mortality 8 Borough of Woob Green. PUBLIC HEALTH COMMITTEE, 1933. Councillor E. J. Anderton, L.D.S. (Chairman). The Chairman of the Council (Councillor F. W. Locke, J.P.). The Vice-Chairman of the Council (Councillor G. C. Boulton). Councillor H. Barnes. Councillor H. Tudor Rhys, J. P. Councillor S. B. Cole. Councillor J. Walker. Councillor C. W. Dennis. Councillor F. G. Gillett. Councillor F. G. Holmes. Councillor W. H. Evans. MATERNITY AND CHILD WELFARE COMMITTEE, 1933. Councillor Mrs. J. J. Bolster, J. P. (Chairman). The Chairman of the Council (Councillor F. W. Locke, J.P.). Councillor E. J. Anderton. Councillor W. E. Hill. Councillor H. Barnes. Councillor F. G. Holmes. Councillor F. G. Gillett. Councillor C. H. Nash. Councillor A. R. Harrison. Councillor H. Tudor Rhys, J. P. (to May, 1933). Councillor T. G. Wayman (from May, 1933). Co-opted Members:— Mrs. Blue. Mrs. Cole. Mrs. Duncan. Mrs. Jackson. Dr. Edith Summerskill. 2 The Committees as from December 6th, 1933:— PUBLIC HEALTH COMMITTEE. Councillor E. J. Anderton, L.D.S. (Chairman). The Mayor (Alderman S. B. Cole, J.P.). The Deputy Mayor (Alderman C. H. Nash). Alderman F. G. Holmes. Councillor F. Corbett. Alderman H. Tudor Rhys, J. P. Councillor C. W. Dennis. Councillor H. Barnes. Councillor W. G. Doyle. Councillor A. J. Blue. Councillor W. J. Knight. Councillor W. J. Payne. MATERNITY AND CHILD WELFARE COMMITTEE. Alderman Mrs. J. J. Bolster, J.P. (Chairman). Councillor E. J. Anderton, Councillor J. Burr. L.D.S. Councillor Mrs. A. Duncan. Councillor H. Barnes. Councillor F. W. Locke. Co-opted Members:— Mrs. Blue. Mrs. Cole. Dr. Edith Summerskill. 3 STAFF during 1933. *Medical Officer of Health.—Malcolm Manson, M.C., M.A., M.D., D.P.H. * Assistant Meclical Officer of Health.— Miss Gwenddolen Brooke, M.R.C.S., L.R.C.P., D.P.H. * District Sanitary Inspectors.—S. C. Stanbury, Cert. R. San. Inst., Cert. Meat and Food Inspection; G. C. Billing, Cert. R. San. Inst., Cert. Meat and Food Inspection. * Health Visitors.—Miss G. Moore, C.M. B.; Miss F. Orwin, C.M.B.; Miss F. Medd, C.M.B. *Nurse-in-Charge, Day Nursery.—Miss C. Hunt. Chief Clerk.—G. W. Jones. Assistant Clerks.— W. T. Gloster; A. Hutchings; N. F. Truscott. * Clerk for Maternity and Child Welfare.—Mrs. Wass. Each of the Health Visitors holds a General Training Certificate as does also Miss Hunt at the Day Nursery and Miss Moore and Miss Orwin hold the new Health Visitor's Certificate. *Officers in respect of whom salary contributions are made under the Public Health Acts by Exchequer Grants. 4 Town Hall, Wood Green, N.22. May 17th, 1934. To the Mayor and Members of the Council of The Borough of Wood Green. Ladies and Gentlemen, I beg to present to you my Annual Report as Medical Officer of Health for the year 1933. The year has been uneventful so far as the health of the community is concerned. The vital statistics are satisfactory and there has not been any very serious prevalence of infectious disease. I have again to express my thanks to the Chairmen of the Public Health and Maternity and Child Welfare Committees for the consideration and help I have received from them, and to the whole staff of the Health Department for their willing co-operation during the year. Your obedient servant, MALCOLM MANSON, Medical Officer of Health. 5 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (acres) 1,625 Population—Estimate supplied by the Registrar-General 54,210 Number of inhabited houses (end of 1933, according to the Rate Books) 13,105 Rateable Value, 1933 £465,779 Sum represented by a penny rate £1,875 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births— Total. M. F. Legitimate 577 302 275 Birth Rate 11.1. Illegitimate 24 13 11 Stillbirths 21 10 11 Rate per 1,000 births, 33.7. Deaths 565 276 289 Death Rate, 10.4. Deaths from puerperal causes :— Puerperal sepsis 1 Rate per 1,000 births, 1.6. Other puerperal causes — Rate per 1,000 births, Nil. Total 1 Rate per 1,000 births, 1.6. Deaths of infants under 1 year of age:— All infants 32 Rate per 1,000 live births, 53. Legitimate 30 Rate per 1,000 legitimate live births, 52. Illegitimate 2 Rate per 1,000 illegitimate live births, 83. Deaths from— Measles (all ages), Nil. Whooping Cough (all ages), 1. Diarrhoea (under 2 years of age), Nil. 6 POPULATION. The Registrar-General's estimate of population for 1933 was 54,210 and I have used this figure to calculate the birth and death rates for the year. It represents a slight decrease in the population from that of 1932, which was 54,500. As the number of births occurring during the year has been in excess of the deaths, and as almost eighty new houses have been built, this estimate, if correct, must mean that the number of people who have left the district during the year exceeds, by several hundreds, the number who have come in. The very close approximation of the birth rate to the death rate, and the fact that very little further building of new houses can be looked for in the district, would seem to indicate that the population is not likely to increase any further and that any change which may take place will be in the direction of a decrease. BIRTHS. The number of live births registered during 1933 was 601, as compared with 681 for the previous year. Of the 601, 315. were male and 286 female. The birth rate was 11.1 per 1,000 of population, as compared with 12.5 for the previous year, and establishes a new low record for the district. The Birth Rate, both for the whole country and for the 118 great towns (which include Wood Green) was 14.4, so that in 1933, just as in previous years, the Birth Rate for Wood Green was very appreciably lower than both that of the whole country and that of the great towns. The number of stillbirths registered during the year was 21, 10 male and 11 female. 7 The births registered in the district were distributed in the different Wards as follows:— Town Hall 227 Noel Park 73 Central 72 Bowes Park 67 Alexandra Park 33 472 DEATHS. The number of deaths belonging to Wood Green, after making the necessary adjustments for inward and outward transfers, was 565, 276 male and 289 female. This represents a Death Rate of 10.4 per 1,000 of population, which is slightly higher than that for the previous year, which was 10.1. This Death Rate of 10.4 compares favourably with that for the country as a whole, which was 12.3, and that for the 118 great towns, which was 12.2. Of the total deaths, 294, or 52 per cent., occurred in persons over 65 years of age. The corresponding percentage for 1932 was 49. The distribution of deaths over the year was as follows:—First quarter, 180; second, 136; third, 108; and fourth, 141; the heaviest mortality being, as usual, in the first quarter of the year, and the lowest in the third. Table III in the Appendix gives the causes of all deaths occurring in Wood Green during the year, and Table IV shows the deaths distributed both according to cause of death and age at death. The former table is supplied by the Registrar-General, while the latter has been compiled in the Health Department. It will be seen from Table III that, as in previous years, heart disease is the commonest 8 cause of death, being responsible for as many as 175 deaths, or over 30 per cent. of all the deaths. Of these deaths from heart disease, almost three-quarters occurred in persons over 65 years of age, which indicates, as I have remarked in previous reports, that in old persons heart failure is very commonly stated as the cause of death without any proof being given that organic disease of the heart necessarily existed. Cancer came second as a cause of death, with 69 deaths, and was followed by pneumonia, with 35 deaths, tuberculosis, with 32 deaths, and cerebral haemorrhage, with 25 deaths. The deaths due to influenza numbered 21. The number of deaths due to the principal zymotic diseases, enteric fever, smallpox, measles, scarlet fever, diphtheria, whooping cough and diarrhoea (in children under 2 years), was only two, diphtheria and whooping cough being responsible for one death each. The Zymotic Death Rate was 0.04 per 1,000 of population, as compared with 0.18 for the previous year. INFANTILE MORTALITY. The number of deaths occurring in children under 12 months of age was 32, and the Infantile Mortality Rate 53 per 1,000 live births. This is not so good as in the previous year when the number of infantile deaths was 28, and the Infantile Mortality Rate 41. The Rate for the whole country during 1933 was 64, and for the 118 great towns, 67. The individual causes of the infantile deaths and the age at which death took place, are shown in Table V. The table shows that of the total infantile deaths, no fewer than 13, or more than one-third occurred within one week of birth and almost two-thirds within one month of birth. MATERNAL MORTALITY. Only one mother died during the year as a result of childbirth. The death in this case was due to septic broncho-pneumonia and 9 empyema. The Maternal Mortality Rate was 1.6 per 1,000 births. The rate for the previous year was 1.4. POOR LAW RELIEF. I am indebted to the Clerk of the Middlesex County Council for the following figures, showing the particulars of outdoor relief granted to Wood Green residents during 1933:— Persons. Amount granted. 2,475 £15,360 11s. 4d. The amount granted in 1932 was £17,339 18s. ACCIDENTS DUE TO TRAFFIC. The Commissioner of Police of the Metropolis has kindly supplied me with the number of accidents due to traffic in Wood Green, involving personal injury, during the year 1933. There were 117 accidents in the High Road and 132 elsewhere in Wood Green, as compared with 148 and 109 respectively during 1932, and the use of a Motor Ambulance was required on 144 occasions as compared with 183 in 1932. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Professional Nursing in the Home. (a) General. The Wood Green (Urban District) Charity Trustees employ two district nurses whose services are available for sick persons in the district who are under the care of medical practitioners. The 10 Medical Officer of Health is Honorary Medical Officer to the Charity Trustees, so that there is the closest possible co-operation between the Public Health Department and the District Nursing Service. (b) Infectious Diseases. It is part of the duty of the Health Visitors to visit cases of ophthalmia neonatorum, measles, whooping cough or pneumonia occurring in young children in their areas. By arrangement with the Charity Trustees, notified cases of pneumonia are visited by the District Nurses, and nursing assistance is supplied whenever asked for. Midwives. No midwives are employed by the Council, but a subsidy of £1 1s. per quarter is paid to a midwife residing in the district, whose services are available any time the Council should desire them. During the year, 7 midwives residing in the district notified their intention to practise. MATERNITY AND NURSING HOMES. There are two Maternity Nursing Homes in the district registered by the Middlesex County Council. Supervision of these Nursing Homes and of the midwives practising in the district is in the hands of the County Council. HOSPITALS. 1. Fever. Wood Green is one of the three authorities (Hornsey, Finchley and Wood Green) which together own and control the Joint Isolation Hospital, Coppetts Road, Muswell Hill. 11 The Hospital is a good one with an excellent modern observation block, built on the cubicle system, and has accommodation for one hundred and thirty patients. The cases admitted are for the most part those of scarlet fever and diphtheria, but in case of necessity other infectious cases can also be dealt with. 2. Smallpox. The Middlesex County Council is responsible for the provision of isolation accommodation for cases of smallpox occurring in this Borough. The accommodation is provided by arrangement between the Middlesex and London County Councils at one of the London County Council Smallpox Hospitals. 3. Tuberculosis. Provision for the treatment of tuberculosis is made by the Middlesex County Council, and I am indebted to Dr. Tate, the County Medical Officer, for the following information showing the accommodation available at the different institutions during 1933. Institution. Accommodation. Type of case. Adults. Children. M. F. County Sanatorium, 129 129 56 Pulmonary—Sanatorium. Harefield 4 (for male and female alternately) 8 Pulmonary—Observation. County Sanatorium, Clare Hall, South Mimms 120 66 — Pulmonary—late sanatorium and hospital. Heatherwood Hospital, Ascot — — 25 Non-pulmonary. Victoria Home, Margate — — 6 Non-pulmonary. 12 Use is also made of many other institutions suitable for different types of tubercular patients to which cases are sent as occasion arises. 4. Maternity. Arrangements have been made with three maternity hospitals, namely the Mothers' Hospital, Clapton, the Royal Northern Hospital, Holloway, and the City of London Maternity Hospital, to admit, at an inclusive charge to the mother, maternity cases recommended by the Maternity and Child Welfare Department. 5. Children. There is no special children's hospital in this neighbourhood, but children are taken into the North Middlesex Hospital and the Royal Northern Hospital. Many children from Wood Green receive treatment also at the Great Ormond Street Hospital for Sick Children. 6. Other. The Passmore Edwards Cottage Hospital is situated in Wood Green and has accommodation for fifty-two patients. A considerable proportion of the cases dealt with belong to Wood Green. Other general hospitals to which patients are sent from Wood Green are the Prince of Wales's Hospital, Tottenham, the North Middlesex Hospital, Edmonton, and the Royal Northern Hospital, Holloway. All of these are accessible by tram or bus. During the year the Council contributed £400 to the Passmore Edwards Hospital, £100 to the Prince of Wales's Hospital, and £50 to the Royal Northern Hospital. 13 Other Institutions. (а) Unmarried Mothers. (b) Illegitimate Infants and Homeless Children. No provision is made for either of these classes of case, but an endeavour is made to assist individual cases as they arise. AMBULANCE FACILITIES. (а) Infectious Cases. By arrangement between the Joint Isolation Hospital Committee and the London County Council, cases of infectious disease are removed to hospital in ambulances belonging to the London County Council. (b) Non-Infectious and Accident Cases. The Council provides a Motor Ambulance for the conveyance of non-infectious, sick and accident cases, which is housed at the Fire Station and is available at all hours. During the year a new Ambulance was purchased by the Council to replace the old Talbot Ambulance which had done almost seven years' service. The new Ambulance has a Lomas body on a 20-h.p. Austin chassis and is fitted with one wheeled and two other stretchers and also a patent lowering mechanism for the top stretcher. During the year the Ambulance was used on 1,298 occasions, 127 being cases of street accident (20 of which were for neighbouring authorities) and 38 cases of illness in the street. The total mileage for the year was 10,970. The sums received from various users amounted in all to £22 7s. 6d. (c) Maternity Cases. The Council's Ambulance is also used when necessary to carry maternity cases to hospital. 14 LEGISLATION IN FORCE IN THE BOROUGH. 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, 1925 and 1930. Adoptive Acts. Infectious Diseases (Prevention) Act, 1890. Public Health Acts (Amendment) Act, 1890, Parts 2 and 3. Public Libraries Acts. Baths and Wash-houses Acts. Small Dwellings Acquisitions Act, 1899. Public Health Acts (Amendment) Act, 1907. Part 2—Streets and Buildings—Sections 17, 18, 20, 21, 22, 24, 25, 28, 29, 31 and 32. Part 3—Sanitary Provisions—Sections 34, 35, 36, 37, 38, 45, 48, 49, 50 and 51. Part 4—Infectious Diseases—Sections 60, 61, 62, 63, 64, 65, 66 and 68. Part 10—Miscellaneous—Sections 92, 93, 94 and 95. Public Health Act, 1925. Part II—Sections 17, 18, 19, 23, 24, 25, 26, 27, 30, 31, 35. Part III—Section 43. Part IV—Sections 45, 46, 47, 48, 49, 50. Part V—Sections 53 and 55. 15 Byelaws. (1891)—Bye-laws with respect to slaughter-houses. (1891)—Regulations under the Contagious Diseases (Animals) Act, 1886, and the Dairies, Cowsheds and Milkshops Order, 1885. (1892)—Bye-laws for the regulation of the Wood Green Commons. (1901)—Bye-laws under the Public Health Act (Amendment) Act, 1890, with respect to telegraph and other wires. (1901)—Bye-laws for the prevention of nuisances arising from Snow, Filth, Dust, Ashes and Rubbish, and for the prevention of keeping any animals on any premises so as to be injurious to health. (1908)—Bye-laws with respect to the management, use and regulation of the Open-Air Public Swimming Bath. (1909)—Regulations with respect to the management, use and conduct of the Bowling Green. (1909)—Bye-laws with respect to Tents, Vans, Sheds and similar structures used for human habitation. (1910)—Regulations with respect to Dairies, Cowsheds and Milkshops (in substitution for the Regulations made in 1891). (1923)—Rules with respect to Allotments. (1924)—Standing Orders for the regulation of Proceedings and Business of the Council and Committees. (1926)—Bye-laws as to the Employment of Children generally and Street Trading by persons under the age of 16 years. (1927)—Bye-laws with respect to New Streets and Buildings. (1931)—Bye-laws under the Housing Act, 1925, for the Regulation of Houses let in Lodgings. 16 CLINICS AND TREATMENT CENTRES. MATERNITY AND CHILD WELFARE CENTRES. The days and hours of the Maternity and Child Welfare Centres were as follows:— Name and Situation. Day and Hour Open. Provided by The Welfare Centre, White Hart Lane, N.22 Monday, 2 p. m. to 4 p. m. The Council. Child Welfare Clinics Wednesday, 2 p.m. to 4 p.m. Friday, 10 a.m. to 12 noon „ Ante-Natal Clinics Tuesday, 3 p. m. to 4 p. m. Friday, 2 p.m. to 4 p.m. „ Post-Natal Clinic Tuesday, 2 p.m. to 3 p.m. ,, The Pavilion, Albert Road Recreation Ground, N.22— Child Welfare Clinic Thursday, 10 a.m. to 12 noon „ SCHOOL CLINICS. Name and Situation. Provided by Minor Ailments— Stuart Villa, Stuart Crescent, N. 22 (5 sessions The Education weekly) Committee. Ophthalmic— The Child Welfare Centre, White Hart Lane (1 session weekly and 1 extra session per fortnight) „ Aural— The Child Welfare Centre, White Hart Lane (1 session per fortnight) „ 17 Name and Situation. Provided by Dental— Stuart Villa, Stuart Crescent (5½ days weekly) The Education Committee. Speech Defects— Stuart Villa, Stuart Crescent (2 sessions per week) „ Artificial Sunlight Treatment.—Provided at the North Middlesex Hospital, under an agreement with that hospital, at a charge of 1s. per child visit. Tuberculosis Dispensary. —A dispensary is provided by the Middlesex County Council at No. 10, Alexandra Road, Hornsey. Treatment Centres for Venereal Diseases.—Treatment centres are provided at the Prince of Wales's Hospital, Tottenham and the Royal Northern Hospital, Holloway, both of which are within a few miles of this district. MATERNITY AND CHILD WELFARE. The number of live births registered during 1933 as belonging to Wood Green was 601, according to the information supplied by the Registrar-General. The number of births registered in the district during the year was 472. Of the births belonging to Wood Green, 582 were notified under the Notification of Births Act, a percentage of 96.8. The number of stillbirths registered was 24 and the number notified was 20. Child Welfare Centres. Maternity and Child Welfare Clinics were held at the Centre in White Hart Lane on Monday afternoons, and Wednesday mornings and afternoons, and at the Pavilion in the Albert Road Recreation Ground on Thursday mornings, throughout the year. 18 The attendances at the Centres during the year are shown in the following table:— January 1,169 February 1,191 March 1,266 April 1,034 May 1,620 June 1,085 July 1,550 August 956 September 1,171 October 1,607 November 1,314 December 1,055 Total 15,018 The attendances in 1932 were 14,480. The attendances at the Centre held in the Albert Road Pavilion numbered 2,178 as compared with 2,072 in 1932. The number of individual children brought to the Centres during the year was 1,361, of whom 692 were infants under 12 months of age, and 669 of from 1 to 5 years of age. The number of children seen by Dr. Brooke at the Centres during the year was 1,294. 668 of these were infants under 12 months of age, who made 1,973 attendances, while 626 were children of from 1 to 5 years of age, and their attendances numbered 1,496. Of the 32 infantile deaths which occurred during the year, in only 2 cases had the baby attended one of the Welfare Centres. 19 Ante-Natal Clinic. An Ante-Natal Clinic was held at the White Hart Lane Welfare centre every Friday afternoon and for one hour on Tuesday afternoons. The number of expectant mothers seen by Dr. Brooke was 282 and the total attendances made numbered 1,010. The remainder of the Tuesday afternoon Clinic was allotted to Post-Natal cases, the number seen being 135 and the attendances 174. Maternity Hospital Provision. Agreements are still in force with three hospitals, namely, the Mothers' Hospital, Clapton, the Royal Northern Hospital, Holloway, and the City of London Maternity Hospital, for the admission of cases from the Wood Green Centres. 17 cases were sent to these maternity hospitals during the year. Dental Clinic. Expectant and nursing mothers and children under school age in need of dental treatment can obtain such treatment from the Dental Surgeon at Stuart Villa on Tuesday afternoons, when recommended by the Medical Officer at the Child Welfare Centres. Increasing use continues to be made of this provision, both by mothers and by children under school age. The following is a record of the work done during the year:— Extractions (with local anaesthetic) 25 „ (with gas) 630 Fillings 283 Scalings 24 Inspections, impressions, advice, etc. 466 Dentures provided 36 20 Light Treatment. By arrangement with the Middlesex County Council, mothers and children are sent, as occasion arises, to the North Middlesex Hospital for artificial sunlight treatment. Home Visiting. During the year the Health Visitors made a total of 7,139 home visits to mothers and children. 2,539 of these visits were to babies under 1 year of age, 4,147 to children of from 1 to 5 years, and 453 were ante-natal visits to expectant mothers. Free Food. Free food, consisting mostly of dried milk, Virol and malt and cod liver oil, was issued during the year to necessitous, expectant and nursing mothers attending the Centres, at a cost of £111 14s. 7d. Cows' milk was issued similarly at a cost of £131 11s. 5d. Free dinners were also supplied to necessitous mothers at the Feeding Centre in White Hart Lane at a cost of £3 8s. Children Acts, 1908 to 1932. The Health Visitors have continued to act as Infant Life Protection Visitors during the year. The number of foster-mothers and foster-children on the register at the end of the year was 15 and 16 respectively. Day Nursery. The work of the Day Nursery has been carried on as in previous years at Stuart Villa. The accommodation here is far from satisfactory, but in spite of this very useful work continues to be done. 21 The following table shows the attendances made at the Day Nursery throughout the year, and the corresponding figures for the previous year:— 1933. 1932. January 367 354 February 382 399 March 483 390 April 348 449 May 404 222 June 459 379 July 440 566 August 442 172 September 393 454 October 428 605 November 418 378 December 478 413 5,042 4,781 SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The whole district is in the area supplied by the Metropolitan Water Board and every house has a constant supply. Rivers and Streams. There are two watercourses in the district-—the Muswell Stream and the Moselle Brook. Both of these are culverted, so that there are no open streams in the area. Drainage and Sewerage. All premises in the district are now connected up to the Council's sewers. There is a dual system of drainage, the soil 22 drains being connected to the main sewers which carry the sewage to a pumping station situated in Tottenham. Here 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 are 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 surfacewater sewers through which the surface-water flows into the Moselle and Muswell Brooks, and by these is carried finally into the River Lea. BATHS. Good use was made during 1933, both of the Public Baths in Western Road, and to a lesser extent, of the Open-Air Swimming Pond on the racecourse at Alexandra Park. Progress was also made with the Council's project for providing a modern open-air bath on a central site in Durnsford Road. The Council's proposals were approved by the Ministry of Health after a public enquiry, and work on the new bath is already at an advanced stage. The total attendances at the present baths for 1933 and the three preceding years are shown below:— Western Road Baths. Open-Air Bath. Adults. School Children. Adults. Children. 1930 133,351 33,200 11,018 3,708 1931 137,395 32,294 8,259 2,485 1932 142,947 40,984 10,695 5,693 1933 133,744 42,783 14,751 9,365 23 SANITARY INSPECTION OF THE AREA. The information given in this section is a brief record of the activity of the Sanitary Inspectors during the year. Inspections:— Inspection of dwelling-houses:— Initial Inspections under Public Health Acts 443 Re-inspections 818 Complaints investigated 124 Inspections under the Housing (Consolidated) Regulations, 1925 333 Inspections under the Housing Acts 135 Re-inspections 823 Inspections of Houses let in lodgings 52 Re-inspections 201 Total 2,929 Inspections under Rent Restrictions Acts 41 Grand Total 2,970 Enquiries in connection with Infectious Disease:— Smallpox 23 Scarlet Fever 353 Diphtheria 50 Tuberculosis 82 Meningitis 1 Enteric — Other Diseases — Total 509 Inspections of Registered Premises, etc.:— Factories 11 Workshops 137 Workplaces:— Butcher Shops 751 Dairies 210 Fried Fish Shops 124 1,085 Slaughter-houses 76 Outworkers 97 Total 1,406 24 Miscellaneous Inspections:— Urinals 161 Passageways 111 Cinemas, and other places of entertainment 39 Ice Cream premises 32 Stalls—day and night visits 678 Smoke from factory chimneys 8 Total 1,029 Total Inspections during the year 2,435 Action Taken:- Issued. Completed. Verbal intimations 24 24 Preliminary Notices:— Under Public Health Act, 1875, Section 94 120 124 Under Public Health Act, 1875, Section 36 64 54 Under Housing Act, 1930, Section 17 125 120 Under Housing Act, 1925, Section 5 16 16 Under Infectious Disease (Prevention) Act, 1890, Section 5 185 185 Under the Wood Green Urban District Council Act, 1920, Section 77 19 19 Under Factory and Workshop Act, 1901, Section 99 1 1 Under Bye-laws regulating houses let in lodgings 40 24 570 543 Statutory Notices:— Under Public Health Act, 1875, Section 94 9 11 Under Public Health Act, 1875, Section 36 5 3 Under Public Health Act (Amendment) Act, 1890, Section 22 1 1 Under Public Health Act (Amendment) Act, 1907, Section 25 2 1 Under Public Health Act (Amendment) Act, 1907, Section 37 1 — Under Housing Act, 1930, Section 17 36 42 Under Infectious Disease (Prevention) Act, 1890, Section 5 14 14 Under the Wood Green Urban District Council Act, 1920, Section 77 1 1 Under Byelaws regulating houses let in lodgings 1 1 70 74 25 Work Carried out:— Drainage Works:— Drains reconstructed 6 Drains repaired 6 Drains unblocked and cleansed 16 Soil and vent shafts repaired or provided 23 Fresh air inlets repaired or provided 11 Sink and bath wastes repaired 48 Inspection chambers repaired 12 Interceptors repaired 7 Drains tested 91 210 Water Closets:— New water-closets provided 2 New water-closet pans provided 45 Water-closets repaired 24 Foul water-closets cleansed 29 Flushing apparatus repaired or provided 28 128 Cleansing:— Premises limewashed 1 Premises otherwise cleansed 2 Rooms cleansed after disinfection 199 Premises disinfested 3 Accumulations of manure removed 3 Accumulations of refuse removed 4 Keeping of animals discontinued 8 220 Dampness:— Roofs repaired, etc. 91 Eaves gutters repaired or provided 46 Rainwater pipes provided or repaired 24 Damp-proof courses provided 5 Walls rendered 23 Dampness otherwise remedied 41 230 House repairs:— Floors repaired—wood 21 Floors repaired—concrete 7 Coppers repaired 38 Ceilings redecorated 589 Walls redecorated 576 General repairs 623 1,854 26 Miscellaneous:— Food stores repaired or provided 29 Yard paving repaired 34 Dustbins provided 97 Water supply taken from mains 4 Baths, sinks and lavatory basins fixed 59 Gullies fixed 11 234 Total works carried out during the year 2,876 HOUSE-TO-HOUSE INSPECTION. NUMBER OF HOUSES INSPECTED, 1933. Road. No. of Houses. No. of Rooms. Families. Persons per room. Adults. Children. Brook Road 16 96 107 14 1.26 Chapmans Terrace 4 20 16 2 0.90 Commerce Road 11 51 52 9 1.19 Cross way 14 70 57 19 1.08 Croxford Gardens 20 100 84 33 1.17 Finsbury Cottages 9 36 44 12 1.55 Gospatrick Road 41 205 166 49 1.04 James Gardens 20 100 78 37 1.15 Lawton Road 11 66 79 22 1.53 Neville Place 19 77 70 13 1.07 Perth Road 21 105 88 32 1.14 Redvers Road 6 33 24 2 0.78 Ringslade Road 6 26 20 8 1.07 Rivulet Road 67 335 311 82 1.17 St. Michaels Road 42 257 160 26 0.72 Wellesley Road 16 78 70 13 1.06 Western Road 3 19 21 2 1.21 White Hart Lane 7 35 33 7 1.14 Totals 333 1709 1480 382 1.08 27 FACTORIES, WORKSHOPS, WORKPLACES, LAUNDRIES, AND HOMEWORK. 1.—Inspection. Including Inspections made by the Sanitary Inspectors. Premises. Inspections. Notices. Prosecutions. Factories— (Including Factory Laundries) 11 1 — Workshops— (Including Workshop Laundries) 137 7 — Workplaces— (Other than Outworkers' Premises) 1085 4 — Total 1233 12 — 2—Defects Found. Particulars. Found. Remedied Referred to H.M. Inspectr Prosecutions. Nuisances under the Public Health Acts— Want of Cleanliness 6 6 — — Want of Ventilation — — — — Overcrowding — — — — Want of Drainage of floors — — — — Other Nuisances 4 4 — — Sanitary Accommodation- Insufficient 1 1 — — Unsuitable or Defective 3 3 — — Not separate for Sexes — — — — Offences under the Factory and Workshop Acts— Illegal Occupation of ground Bakehouse - - - - Other offences (excluding ces relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health tories and Workshops fer of Powers) Order, 1921) - - - - Total 14 14 — — 28 3.—Homework. Nature of Work. Outworkers' Lists under Section 107 of Factory and Workshop Act, 1901. Received twice in the year. Received once in the year. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. The making, cleaning, washing, altering, ornamenting, finishing and repairing of wearing apparel 15 - 33 27 - 52 The making-up, ornamenting, finishing and repairing of table linen, or other household linen, and any process incidental thereto 1 - 1 1 - 2 The making of curtains and furniture hangings and any process incidental thereto - - - 1 - 2 The making or filling of cosaques, Christmas crackers, Christmas stockings or similar articles or parts thereof 1 - 1 1 - 2 The making of boxes or other receptacles or parts thereof made wholly or partially of paper, cardboard, chip or similar material 1 - 1 - - - The making of artificial flowers 1 — 1 1 — 1 The making or repairing of umbrellas, sunshades, parasols, or parts thereof - - - 1 - 1 Total 19 — 37 32 — 60 29 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.) Class. Number. Wearing Apparel 45 Dining Rooms 16 Laundries 2 Bakehouses 17 Carpentry and Joinery 7 Mechanical Repairs 10 Upholstery 9 Other Workshops 27 Total 133 5.—Other Matters. Factory and Workshop Acts:— Matters notified to H.M. Inspector of Factories - Underground Bakehouses (S.101):— Certificates granted during the year — In use at the end of the year 1 Public Health Acts:— Matters notified by H.M. Inspector of Factories 3 Defects remedied following H.M.I.'s notifications 4 30 HOUSING STATISTICS. 1.—Inspection of Dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 945 (b) Number of inspections made for the purpose 2,787 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 333 (b) Number of inspections made for the purpose 690 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (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 419 2.—Remedy of Defects during the year without service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 365 3.—Action under Statutory Powers during the year:— (A) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 36 31 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners 42 (b) By Local Authority in default of owners — (B) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 18 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 16 (b) By Local Authority in default of Owners — (C) Proceedings under Sections 19 and 21 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of houses demolished in pursuance of Demolition Orders Nil (D) Proceedings under Section 20 of the Housing Act, 1930— (1) Number of separate tenements or underground rooms in respect of which closing orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 32 Rent Restriction Acts. Seven Certificates were granted under the above heading during the year 1933. NEW HOUSES BUILT DURING 1933. I am indebted to the Borough Surveyor for the following information relating to new houses erected in Wood Green during 1933— Number of houses erected during 1933 65 Number of flats erected during 1933 10 Number of houses built by the Council Nil Number built by other bodies and persons 75 Number built with State assistance Nil SLUM CLEARANCE. In June, 1933, I submitted a detailed report to the Health Committee on the condition of nineteen houses on the west side of the High Road, known as Neville Place, and recommended that the Council should proceed to deal with these as a clearance area under Section I of the Housing Act, 1930. The Committee agreed with the recommendation and attempts have been made since then to obtain a suitable site on which the tenants of this property may be rehoused in the event of the recommendation being carried out. It is, unfortunately, extremely difficult to find such a site in Wood Green owing to the district being practically entirely built up, and it has not been possible yet to obtain the consent of the Ministry of Health to such proposals as have been made. It is hoped that the further efforts that are being made at the moment to solve the difficulty of rehousing will be successful. 33 PUBLIC MORTUARY. Bodies deposited during the year 36 Inquests held 12 Post-mortem examinations 30 For lodgment only 2 Causes of death:— Natural causes 23 Accidental 4 Misadventure 1 Suicide 6 INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The greater part of the milk supply in this borough is in the hands of large firms and combines, who supply the milk in bottles filled at their depots outside the borough. (1) No cattle are kept in the borough. (2) The following licences for the sale of milk under special designations have been granted during the year:— Licences in respect of shop or other premises (not being the establishment at which the milk is produced or bottled) at or from which the milk is sold. Certified. Grade A Grade A (Tuberculin Tested). Grade A (Pasteurised). Pasteurised. 2 1 4 1 15 Supplementary Licences to sell milk from premises which are outside the area of the Licensing Authority. Certified. Grade A (Tuberculin Tested). Grade A (Pasteurised). Pasteurised. 1 2 1 2 34 All the firms concerned produced and bottled this graded milk at premises outside this borough. (3) It has not been necessary to refuse or revoke registration of any retailer. (b) Meat. There is only one licensed slaughterhouse in the district, and the occupier has given notice of the times of slaughtering, so that all animals killed on the premises may be examined by the Sanitary Inspector before being disposed of. There are no public slaughterhouses in the district. (c) Other Foods. The premises of fishmongers, fruiterers and greengrocers and all other premises where food is prepared and sold have been visited regularly during the year, and where defects have been discovered the requisite steps have been taken to have them remedied. The undermentioned foodstuffs were condemned as unfit for human consumption during the year:— lbs. 2 sheep carcases 96 3 pigs' heads 28 Pork 10 Beef 12 Corned Beef 7,200 Various cooked meats 30 Fish (cod) 35 Fruit (peaches) 10 7,421 The total weight condemned during the year was 3 tons 6 cwt. 1 qr. 1 lb. 35 SALE OF FOOD AND DRUGS ACTS. The Middlesex County Council is the Authority for taking samples under the above Acts, and Mr. R. Robinson, Chief Officer of the Public Control Department, has kindly supplied the following figures concerning samples taken in Wood Green during 1933:— Articles. No. of samples taken. Adulterated. Milk 126 1 Milk, sterilised 12 — Butter 1 — Gin 1 — Hake 10 3 Lemon Sole 2 1 Sole 1 — Whisky 3 — 156 5 Number of Prosecutions 4 Number of Convictions 4 Fines and Costs imposed £12 11s. 6d. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. The prevalence of notifiable infectious disease throughout the district was rather greater in 1933 than in the previous year, the total number of notifications received being 362, as compared with 266 in 1932. The increase was due almost entirely to the increased incidence of scarlet fever. The number of cases removed to hospital or sanatorium was 311. The following table shows the number of cases of infectious disease admitted to the Joint Isolation Hospital from the various Wards in the district:— 36  Town Hall. Noel Park. Central. Bowes Park. Alex. Park. Totals. Joint Isolation Hospital. Scarlet Fever 45 41 26 21 41 174 Diphtheria 8 4 *8 2 1 23 Erysipelas 4 2 3 1 2 12 Mumps — — — — 1 1 Whooping Cough.. 1 1 1 — — 3 Pneumonia — — — — 1 1 Measles 2 — 2 — — 4 Glandular Fever — — — — 1 1 Totals 60 48 40 24 47 219 * In one case the diagnosis of diphtheria was not confirmed. The wards in the above table are those for the old Urban District of Wood Green, the re-division of the district into three wards only taking effect in November. The distribution of the cases of scarlet fever and diphtheria notified, as far as school attendance is concerned, is shown in the following table:— Scarlet Fever. Diphtheria. Patients attending the Elementary Schools under the Education Authority 98 9 Glendale County School 1 2 Trinity County School 2 — Private Schools 4 — Schools outside district 6 1 Under School age 49 6 Over School age 32 6 192 24 37 Scarlet Fever. The incidence of scarlet fever was very much greater during 1933 than during the previous year, the number of cases notified in 1933 being 192, as compared with 110 in 1932. 176 of these cases were removed to hospital. The disease generally was of a mild type, and for the second year in succession no deaths occurred from scarlet fever. Diphtheria. 24 notifications of diphtheria were received as compared with 34 in the previous year. 23 of these cases were removed to the Joint Isolation Hospital, where in one case the diagnosis was not confirmed. All these cases recovered. Two other cases of diphtheria belonging to Wood Green were admitted to hospitals outside the district, and of these, one, unfortunately, died after operation for laryngeal obstruction. Immunisation against diphtheria has been carried on steadily throughout the year, for the most part among the children attending the infant departments of the elementary schools. An increasing number of children under school age have also been immunised. The total number of children who had received a full course of protective injections by the end of 1933 had almost reached 2,000, and of these, over 1,500 had been subsequently Schick-tested and found immune five months after the course of injections had been completed. Of this number not one had since contracted diphtheria. Smallpox, Enteric Fever, Cerebro-Spinal Fever. No cases of any of these diseases occurred in the district during the year. Anterior Poliomyelitis. One case of this disease occurred in a child of 4 years. The child was removed to hospital where he made a slow recovery. 38 Pneumonia. Thirty-nine notifications of pneumonia were received. All cases notified were visited by the District Nurses, under the arrangement made between the Council and the Wood Green Charity Trustees, and an offer of nursing assistance made. In many of the cases this ofler was accepted, but in the majority of cases, the patient was removed to hospital. Puerperal Fever and Puerperal Pyrexia. Four cases of puerperal fever were notified. One of these was removed to hospital where she unfortunately died. Two of the other cases occurred in hospital and the fourth at home. All three made good recoveries Twelve cases of puerperal pyrexia were notified, no fewer than eleven of these cases occurring in hospital. Ophthalmia Neonatorum. Four cases of this disease were notified, three of them from hospital. In all four cases recovery occurred without any damage to vision. Non-Notifiable Infectious Diseases. The following is a statement of the numbers of cases of nonnotifiable infectious diseases reported to me during the year by the head teachers of the elementary schools. Chickenpox 112 Measles 66 Mumps 220 Whooping Cough 118 Skin Infections 28 544 39 On receipt of these notifications, visits to the homes are made by the School Nurses to ensure that proper treatment is being provided and the necessary precautions taken in each case. TUBERCULOSIS. Table VII in the Appendix shows that the number of new cases of tuberculosis coming to the knowledge of the Health Department during the year was 71, 62 pulmonary and 9 non-pulmonary. Of these, 66 were notified by doctors practising in the district or from hospital, while five were cases transferred from other districts. The number of notifications received in the previous year was 59. 32 deaths were certified as due to tuberculosis, as compared with 41 for the previous year. Of these, 26 were due to pulmonary and 6 to non-pulmonary disease. The death rate from tuberculosis was 0.59 per 1,000 of population, as compared with 0.75 in 1932. Of the 32 deaths which occurred, 5 were in persons who had not previously been notified as cases of tuberculosis in this district. The arrangements for providing treatment for sufferers from tuberculosis are in the hands of the County Council, and Dr. J. R. Dobson, the Tuberculosis Officer has kindly supplied me with the following figures relating to cases from Wood Green which came under his care during the year:— Total number of new tubercular cases 56 Transfers from other districts (not included in above) 5 Total number of non-tubercular cases, including contacts 103 Cases undiagnosed on 31st December, 1933 1 Tubercular cases supervised at or from the Dispensary in 1933 185 Tubercular cases still on the register at the end of 1933 145 40 During the year 50 cases were sent to hospital or sanatorium. The sanatoria or hospitals to which they were admitted are shown below:— Pulmonary Cases. Nonpulmonary Cases. Brompton Hospital 4 — Clare Hall 12 — Eversfield Chest Hospital 2 — Eairlight Sanatorium 3 — Grosvenor Sanatorium 1 — Harefield Sanatorium 28 — Hendon Cottage Hospital — 2 King Edward VII Sanatorium 1 — Lord Mayor Treloar Hospital — 2 Melton Lodge — 1 National Hospital, Benenden 2 — North Middlesex Hospital 4 — Preston Hall 1 — Royal National Sanatorium, Bournemouth 2 - Royal Northern Hospital 1 — Royal Sea Bathing Hospital — 3 Victoria Home — 1 61 9 BACTERIOLOGICAL WORK. The bacteriological examination of specimens from the district is carried out at the Joint Isolation Hospital, and during 1933 the following examinations were made:— Positive. Negative. Total. Diphtheria 24 453 477 Pulmonary Tuberculosis 20 121 141 44 574 618 41 DISINFECTION. The number of articles dealt with at the Disinfecting Station during the year was as follows:— Articles disinfected after tuberculosis 160 „ „ „ other infectious diseases 2,264 „ „ „ cancer 110 2,534 Articles destroyed 150 The number of rooms disinfected by the Health Department was as follows:— After tuberculosis 54 „ other infectious diseases 367 „ cancer 15 436 42 APPENDIX. Table I Vital Statistics of Wood Green, 1921-33. Year. Population estimated to middle of each year. Nett Births belonging to the District. Nett Deaths belonging to the District. Under 1 year of age. At all ages. Total No. Rate per 1,000 population Illegitimate No. Total No. Rate per 1,000 live births. Illegitimate No. Rate per 1,000 illegitimate births. No. Rate per 1,000 population (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 1921 51,100 905 17.71 24 63 70 6 250 493 9.64 1922 51,290 873 17.02 26 41 47 4 154 524 10.21 1923 51,540 896 17.38 34 34 38 0 — 491 9.52 1924 51,840 762 14.7 15 32 42 3 200 513 9.89 1925 51,960 740 14.24 17 35 47 2 118 507 9.75 1926 51,940 802 15.44 26 32 40 1 38 457 8.79 1927 52,260 687 13.14 18 35 51 1 56 509 9.73 1928 52,750 732 13.8 22 30 41 0 - 478 9.06 1929 53,410 721 13.5 26 43 60 3 115 605 11.32 1930 53,410 719 13.4 30 26 36 3 100 534 10.0 1931 54,520 719 13.2 30 32 44 2 66 549 10.1 1932 54,500 681 12.5 20 28 41 4 200 556 10.2 1933 54,210 601 11.1 24 32 53 2 83 565 10.4 43 Table II. Birth-Rate, Death-Rate and Analysis of Mortality during 1933. Birth-rate per 1,000 population. Annual Death-Rate per 1,000 Population. Rate per 1,000 Births. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 years). Total Deaths under 1 year. England and Wales 14.4 12.3 0.01 0.00 0.05 0.02 0.05 0.06 0.57 0.54 7.1 64 118 County Boroughs and Great Towns (including London) 14.4 12.2 0.00 0.00 0.06 0.02 0.06 0.08 0.55 0.48 9.4 67 132 Smaller Towns (population, 25,00050,000 at Census 1931) 14.5 11.0 0.00 0.00 0.04 0.02 0.04 0.04 0.53 0.44 4.9 56 London 13.2 12.2 0.00 0.00 0.02 0.02 0.08 0.08 0.61 0.58 11.6 59 Wood Green 11.1 10.4 0.00 0.00 0.00 0.00 0.02 0.02 0.38 0.53 0.00 53 44 Table III. Causes of Death during the year 1933. Causes of Death. Male. Female. Typhoid and Paratyphoid Fevers - - Measles — — Scarlet Fever - - Whooping Cough — 1 Diphtheria 1 — Influenza 10 11 Encephalitis Lethargica — — Cerebro-spinal Fever — - Tuberculosis of Respiratory System 20 6 Other Tuberculous Diseases 1 5 Syphilis — — General Paralysis of the Insane, Tabes Dorsalis 1 1 Cancer, Malignant Disease 31 38 Diabetes 4 1 Cerebral Haemorrhage, etc. 10 15 Heart Disease 70 105 Aneurysm 2 1 Other Circulatory Diseases 14 11 Bronchitis 6 6 Pneumonia (all forms) 11 24 Other Respiratory Diseases 2 2 Peptic Ulcer 9 1 Diarrhoea, etc. (under two years) — — Appendicitis 2 — Cirrhosis of Liver 1 — Other Diseases of Liver, etc. - 2 Other Digestive Diseases 7 7 Acute and Chronic Nephritis 10 7 Puerperal Sepsis — 1 Other Puerperal Causes — — Congenital Debility, Premature Birth, Malformation, etc. 16 10 Senility 3 6 Suicide 6 1 Other Violence 16 6 Other Defined Diseases 23 21 Causes ill-defined or unknown — — Totals 276 289 45 Table IV. Causes of, and Ages at Death during the year 1932. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 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 upwards. Typhoid, etc. - - - - - - - - - - - - - Measles - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - Whooping Cough 1 — 1 - - - - - - - - - - Diphtheria 1 - - 1 - - - - - - - - - Influenza 20 - - - - - - - - 5 2 9 4 Encephalitis Lethargica - - - - - - - - - - - - - Cerebro-Spinal Fever - - - - - - - - - - - - - Tuberculosis of Respiratory System 26 - - - - - - - 1 10 7 8 - Other Tuberculous Diseases 6 — 1 1 1 — — — 1 2 — — — Syphilis - - - - - - - - - - - - - General Paralysis of Insane - - - - - - - - - - - - - Cancer, Malignant Disease 65 - - - - - - - - 2 7 24 32 Diabetes 3 - - - - - - - - 1 1 1 - Cerebral Haemorrhage, etc. 36 - - - - - - - - - 1 6 29 Heart Disease 169 - - - - - 1 - - 6 5 38 119 Aneurysm 2 - - - - - - - - - - 2 — Other Circulatory Diseases 20 - - - - - - - - - - 2 18 Bronchitis 15 - - - - - - - - - - 4 11 Pneumonia (all forms) 39 1 2 1 - - - - - - 5 5 25 Other Respiratory Diseases 10 - - - - - - - - 2 — 4 4 Peptic Ulcer 10 - - - - - - - - - 3 6 1 Diarrhoea, etc. (under 2) - - - - - - - - - - - - - Appendicitis 2 - - - - - - 1 - - - 1 — Cirrhosis of Liver 1 - - - - - - - - - - - 1 Other Diseases of Liver - - - - - - - - - - - - - Other Digestive Diseases 9 - - - - - - - - - - 3 6 Acute and Chronic Nephritis 20 - - - - - - - 2 1 1 6 10 Puerperal Sepsis - - - - - - - - - - - - - Other Puerperal Causes - - - - - - - - - - - - - Congenital Debility, etc. 26 26 - - - - - - - - - - - Senility 14 - - - - - - - - - - 1 13 Suicide 7 - - - - - - - - 1 1 3 2 Other Violence 22 — 1 — 1 1 1 — 2 7 2 3 4 Other Defined Diseases 41 5 — 2 - — 1 — 1 2 5 10 15 Causes ill-defined - - - - - - - - - - - - - Totals 565 32 5 5 2 1 3 1 7 39 40 136 294 46 Table V. Deaths of Infants under One Year of age, showing cause of death and age at death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Total under 1 year. Acute haemothorax 1 — — — 1 — — — — 1 Atelectasis 1 — — — 1 — — — — 1 Bronchitis - - - - - 1 - - - 1 Broncho Pneumonia - - - - - - - 1 — 1 Debility 1 1 — — 2 — — — — 2 Empyema - - - - - - - 1 — 1 Erysipelas - - - - - 1 - - - 1 Congenital Defect 1 — — — 1 — — — — 1 Gastro Enteritis - - - - - 2 - - - 2 Marasmus — — — — — 1 1 — — 2 Osteomyelitis - - - - - 1 - - - 1 Pneumococcal Meningitis - - - - - - - - 1 1 Premature Birth 9 4 3 — 16 — — — — 16 Status Lymphaticus - - - - - - 1 - - 1 13 5 3 — 21 6 2 2 1 32 Table VI. Infectious Diseases Notified during the year 1933. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Ward. At Ages—Years. Town Hall. Noel Park. Central. Bowes Park. Alexandra Park. Total Cases removed to Hospital or Sanatorium. Total Deaths. 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 Smallpox - - - - - - - - - - - - - Scarlet Fever 192 - 44 116 14 14 4 - 50 45 26 23 48 176 Diphtheria 24 - 6 12 3 3 — - 9 4 9 2 - 24 1 Enteric Fever — - — — — — — - — - - - Erysipelas 20 2 1 2 1 4 5 5 6 5 3 4 2 12 1 Pneumonia 39 2 5 2 13 16 1 11 8 3 8 9 12 35 Acute Poliomyelitis 1 1 - - - - - - 1 - - - - - Ophthalmia Neonatorum 4 4 - - - 2 1 - 1 3 - Pulmonary Tuberculosis 57 — 1 3 18 24 10 1 18 18 8 5 8 61 26 Tuberculosis 9 — 1 2 1 5 — — 2 4 2 1 — 9 6 Puerperal Fever 4 — - — — 4 — — 1 1 - 2 - 3 1 Puerperal Pyrexia 12 - - - 5 7 - — 4 1 3 1 3 11 - Totals 362 6 56 140 44 74 35 7 101 89 55 46 71 311 70 47 48 Table VII. TUBERCULOSIS New Cases and Mortality during 1933. Age Periods. New Cases. Deaths. Respiratory. Nonrespiratory . Respiratory. Nonrespiratory . M. F. M. F. M. F. M. F. 0 - - - - - - - - 1 — 1 1 — — — — 3 5 — — — 1 — — — — 10 2 1 1 — — — — — 15 4 3 — — — 1 1 — 20 5 6 - 1 1 — - 1 25 12 10 2 1 6 3 1 35 4 3 1 1 5 2 - — 45 1 1 — — 5 - — 55 6 2 — 3 - — 65 and upwards 1 - - - - - - - Totals 35 27 5 4 20 6 1 5 Above includes transfers (5) from other Districts. 5 non-notified T.B. deaths occurred. 49 METEOROLOGICAL REPORT FOR YEAR ENDING 31st DECEMBER, 1933. Month, 1933. Total Rainfall. Maximum Rainfall. No. of Wet Days. Maximum Temperature. Minimum Temperature. Inches. Inches. Date. Degrees Date. Degrees. Date. January 1.63 0.37 4th 17 53 2nd 20 22nd February 0.95 0.21 26th 11 56 5th 22 23rd March 221 0 59 16th 14 65 28th 36 27th April 0.72 0.24 25th 7 74 11th 30 18th and 22nd May 1.47 0.56 6th 13 79 22nd 38 14 th June 1.57 0.25 16th 14 85 4th and 5th 44 19th July 0.99 0.22 12th 13 91 27th 53 12th, 14th, 15th August 0.57 0.15 15th 5 92 6th 48 20th September 2.36 0.48 19th 10 81 3rd and 4th 41 14th and 15th October 1.59 0.50 29th 10 69 23rd 31 27th November 0.90 0.45 15th 10 57 7th 31 15th and 30th December 0.19 0.10 27th 3 46 22nd and 23rd 23 13th Total for year 15.15 — — 127 — — - - Note.— Maximum Rainfall 16th March, 0.59ins. ,, Rate of Rainfall 20th September, 1.00ins. per hour; duration 10 minutes. ,, Temperature 6th August, 92° Fahr. Minimum ,, 22nd January, 20° Fahr. (Temperature taken in shade.) This report has been kindly supplied by the Borough Engineer and Surveyor. EDUCATION COMMITTEE. Chairman: Alderman F. G. Holmes. Vice Chairman: Councillor Mrs. Duncan. Alderman Mrs. Bolster, J. P. Councillor F. Corbett. Alderman Rev. W. Winston Councillor W. G. Doyle. Haines. Councillor F. W. Locke. Councillor E. C. Bigg. Councillor S. North. Councillor J. Burr. Miss Lightfoot. Mrs. Cole. Mrs. E. M. Smith, M.A. Rev. Canon G. Curtis. Rev. Dr. Stevens. Mr. H. G. Garlick. B.Sc. Mr. W. A. Vant. Mrs. Harrison. CARE AND AFTER-CARE SUB-COMMITTEE. Chairman: Alderman Mrs. Bolster. J. P. Alderman Rev. W. Winston Mrs. Barrett. Haines. Mr. F. V. Denham. Mrs. Cole. Mrs. Denham. Mrs. Harrison. Miss Irvine. Miss Lightfoot. Mrs. Jackson. Mrs. E, M. Smith, M.A. Mrs. Shaw. Mr. W. A. Vant. Mrs. Braithwaite. Director of Education: C. H. Jarvis, M.A., LL.D. Wood Green Education Committee. SCHOOL MEDICAL SERVICE. ANNUAL REPORT, 1933. Town Hall, Wood Green, N.22. March 10th, 1934. To the Chairman and Members of the Wood Green Education Committee. Mr. Chairman, Ladies and Gentlemen, I beg to present to you my Annual Report as School Medical Officer for the year 1933. The form of the Report has been prescribed by the Board of Education and I have, as far as possible, followed the suggestions made as to its arrangement. 1.—STAFF. The School Medical Staff during 1933 consisted of the following:— School Medical Officer.—Malcolm Manson, M.A., M.D., D.P. H. Assistant School Medical Officer.—Gwenddolen J. Brooke, M.R.C.S., L.R.C.P., D.P.H. Ophthalmic Surgeon.—J. S. Boden, O.B.E., M.B., B.S., M.R.C.S., L.R.C.P. Aural Surgeon.—A. R. Friel, M.A., M.D., F.R.C.S.I. Dental Surgeon.—S. A. McLaren, L.D.S. School Nurses.—Miss B. M. Gray and Miss J. M. Hopkins. Medical Visitation Officer.—Mrs. E. Rudd. Teacher in Charge of Speech Defect Clinic.—Miss E. M. Dawson. Dental Attendant.—Miss J. Collyer. School Medical Clerk.—Miss F. Jarvis. 3 No changes occurred in the personnel of the Staff during the year. All the members are full-time officers with the exception of the Ophthalmic Surgeon, the Aural Surgeon and the Special Teacher for Speech Defects. The Ophthalmic Surgeon holds six Eye Clinics per month and the Aural Surgeon two Ear Clinics per month. The speech-training classes are held twice weekly. 2.—CO-ORDINATION WITH OTHER HEALTH SERVICES. The School Medical Officer is also Medical Officer of Health and Medical Officer to the Maternity and Child Welfare Committee, and there is the closest possible co-operation between the Child Welfare and School Medical work. When children attending the Child Welfare Centres or under the care of the Health Visitors in their homes, reach school age their records are passed on to ihe School Medical Department, so that there is continuity of observation, and where necessary, of treatment. By arrangement also with the Maternity and Child Welfare Committee which pays part of the salaries of the officers concerned, the use of the Dental Clinic at Stuart Villa is available for children under school age, and the same is the case also with the Eye and Ear Clinics. This very useful arrangement makes it possible for defects in young children to be dealt with at the earliest possible moment, instead of waiting until school age is reached before treatment is provided. 3.—SCHOOL HYGIENE. The extensive reconstruction of the Noel Park Schools which has been in progress during the past two years was completed during the summer, and the result is such as to justify the expenditure of so much time and money. The schools have been completely modernised, and the well arranged and adequately lighted classrooms are a very great improvement on the conditions which previously obtained. Other notable improvements are the provision of school halls, a gymnasium, a medical inspection room, and up-to-date sanitary conveniences. The completion of the work at the Noel Park Schools has also allowed the new class rooms at Lordship Lane School, which had so far been occupied by children from Noel Park, to be made available now for Lordship Lane School. The result is very much improved accommodation there also. 4 In St. Paul's School alterations and extensions have been carried out during the year, whereby an extra class room, a medical inspection room, and a corridor have been provided, and improvements made in the cloak-room and sanitary conveniences. 4.—MEDICAL INSPECTION. The system of medical inspection has been as in previous years, an inspection of all the children in the different code age-groups having been made in each school during the year. At the routine inspections the total number of children examined was 2,348. Of these 714 were entrants, 711 belonged to the second, and 635 to the third age group, while 288 were of ages outside the three code age-groups. In addition to these routine inspections, 968 special cases were examined, and 1976 children re-examined. The "specials" are children who are referred to the School Medical Officers by the Nurses, Teachers or School Attendance Officers, or who are brought for examination by parents or guardians. Many of these special cases are seen at school at the time of the ordinary medical inspections but the majority are seen at the School Clinic on Tuesday or Saturday mornings. The children re-examined are those who have been found at previous routine or special examination to be suffering from defects which require either to receive treatment or to be kept under observation. The total number of the children on the registers of the elementary schools on December 31st, 1933, was 6,042. The number examined by the School Medical Officers during the year was 3,316. 5.—FINDINGS OF MEDICAL INSPECTION. Tables II, and III and IV at the end of this Report give details of the defects found as a result of medical inspection, and of the treatment obtained by the children found in need of it. Table II A shows the number of defects found, classified as either requiring treatment or to be kept under observation, while Table II B shows the actual number of children in each of the age groups examined at the routine inspections, found to be in need of treatment. This table shows that of 2,050 children examined in the code age-groups, 198 or 9.5 per cent. were found to show definite defects calling for 5 treatment, while of 288 children examined at other ages, 18 or 6.25 per cent. were found to require treatment. In the different age-groups, the percentages were: entrants 7.5, second age-group 10.25, and third age-group 11.2. These percentages compare favourably on the whole with those for the previous year. (a) Malnutrition. Thirty-three children were recorded as suffering from malnutrition. There were many others of course whose state of nutrition was for one reason or another not altogether satisfactory, but in these thirty-three the defect was apparently due to some failure or neglect to provide sufficient or proper nourishment, or to inability on the part of the child to profit by the nourishment provided. There is, I am glad to say, not much evidence of actual neglect on the part of parents, but in many cases the family circumstances are such that it is difficult to provide a sufficiency of good food for the children. In these cases the Care Committee is of very great assistance in providing meals at the feeding centre, or milk at school, or malt and oil or virol at the School Clinic. In previous reports I have stressed the importance of the provision of a sufficiency of milk for the proper nutrition of the growing child, and I have little doubt that the spread of the milk habit which appears to be taking place among the school children is causing a definite improvement in their nutrition. In the great majority of the schools, milk clubs have been in existence for the past few years, and a varying number of children in these schools are supplied daily with a bottle containing a third of a pint of milk at a cost of one penny per bottle. The average number of children taking advantage of this provision is rather less than a thousand, and I would like to see it very much increased, but in addition there are many children who have a regular and adequate supply of milk at home. (b) Uncleanliness. The standard of cleanliness among the children remains very high, and reflects great credit on the vast majority of the mothers. Over 50,000 individual inspections of school children were made during the year, and the number of exclusions on account of verminous conditions was only 195. In some cases the same children were excluded on more than one occasion, so that the actual number of offenders was even smaller than this figure would indicate. 6 (c) Minor Ailments and Diseases of the Skin. One hundred and thirty-six children were referred for treatment on account of minor ailments, these including various skin conditions, minor injuries and external diseases of the ears and eyes. Some of these children were treated privately or at hospital, but the great majority received treatment at the School Clinic. (d) Visual Defects and External Eye Disease. Eighty-four children were recommended for treatment on account of defective vision or squint, while one hundred and fiftyeight with minor defects of vision were referred for observation. Thirty-two children were found to require treatment for external diseases of the eye, while thirty-two were referred for observation. (e) Nose and Throat Defects. Seventeen children were recommended operative treatment on account of enlarged tonsils and adenoids, while 287 were referred for observation. These figures show that while a very large number of children were found to show definite enlargement of the tonsils, the number in whom the condition was such as to make operation advisable, was very small. It is possible, of course, that a proportion of those cases referred for observation may be found at a later date to require operation. Other conditions of the throat or nose requiring treatment, were found in forty-eight children, while twenty-one were referred for observation. (f) Ear Disease and Defective Hearing. Twelve children were found to be so deaf as to require treatment for the defect, while three others were kept under observation. Other forms of ear disease calling for treatment were found in forty-five children, and six others were kept under observation for minor defects. (g) Dental Defects. The result of the inspections carried out by the School Dental Surgeon is shown in Table IV, Group V. Practically all children from six to thirteen years are now included in the dental scheme of inspection and treatment; of a total of 3,635 children inspected during the year, no fewer than 2,779 or just over 75 per cent. were found to require dental treatment, and of these the number actually treated was 1,942. 7 (h) Orthopaedics and Postural Defects. Nine children were found to be suffering from crippling defects. All of these except two have received orthopaedic treatment at hospital during the year; of these two, one is incapable of further improvement, and the other a child whose parents persistently refuse to subject the child to operative treatment. (i) Heart Disease and Rheumatism. Evidence of some abnormality of the heart was found present in fifty-seven children. In the majority of cases there was no evidence of organic disease and the condition was thought to be functional. Among the twenty-four cases of organic disease, there were several congenital cases, but in most the heart condition was the result of rheumatism. Rheumatism, with or without affection of the heart, was seen in thirty children during the year, ten boys and twenty girls. In most cases the rheumatic pains were very slight and only occasional, but in six cases definite attacks of acute rheumatism occurred during (he year for which hospital treatment had to be obtained. All these cases of rheumatism and heart disease are kept under regular supervision at the School Clinic. (j) Tuberculosis. Eight children were found to show signs suggestive of pulmonary tuberculosis. These were referred to the County Tuberculosis Officer for detailed examination, and in no case was the diagnosis of tuberculosis confirmed. Three children were found to suffer from glandular tuberculosis. In one of these cases sanatorium treatment was obtained, while in the other two the disease was quiescent. 6.—FOLLOWING UP. All defects discovered at medical inspection are brought to the notice of the parents or guardians, with a request that the necessary treatment be obtained without delay. Later the homes are visited by the Visitation Officer, to see whether treatment is being obtained and if not to impress on the parent the importance of obtaining it. As a rule parents are willing and anxious to obtain whatever treatment is found to be necessary, but from time to time considerable pressure has to be brought to bear on individual parents before 8 treatment is provided. The number of visits paid during the year by the Visitation Officer in the work of following up defects found at medical inspection has been 1,724. 7.—ARRANGEMENTS FOR TREATMENT. The normal procedure is to recommend all parents of children, found to require medical treatment, to obtain the necessary treatment privately from the family doctor or at hospital. Where the household circumstances are such as to make it impossible to obtain treatment privately, treatment is provided for certain types of defect under arrangements made by the Education Committee. Thus treatment is provided at the School Clinic for minor ailments, dental defects, and defects of vision, of hearing and of speech. Tonsils and adenoids are dealt with and ultra-violet light treatment provided at the North Middlesex Hospital, and ultra-violet light treatment, and X-ray treatment for ringworm at the Royal Northern Hospital. (а) Minor Ailments. Seven hundred and seventy-five children were treated at the Clinic for minor ailments, these comprising mainly, septic conditions of the skin, minor injuries, inflammatory conditions of the ears and eyes, and other similar conditions which tend to receive little attention at home, but may if neglected give rise to ill-health in the child. (b) Tonsils and Adenoids. Only eight children were operated on under the Committee's scheme during the year, for enlarged tonsils and adenoids, while a further nine were dealt with privately at home or in hospital. This is much the lowest number of cases dealt with by operation for many years, although the number has been falling steadily for the past seven years. It is probable that formerly there was a tendency to treat many cases by operation which might have responded successfully to less drastic measures, while the practice today is to recommend operation only in those cases where it is obvious that the condition of the throat is definitely injuring the child's health. (c) Visual Defects. The number of children dealt with by Dr. Boden at the Eye Clinic was 660, 191 of these being new cases. 278 had spectacles 9 prescribed for them, and of this number 262 had obtained the spectacles by the end of the year. In addition 20 children are known to have been dealt with for visual defects, by private practitioners or in hospital, and 13 provided with spectacles. All the children dealt with by Dr. Boden are seen by him at regular intervals at the Clinic and in this way careful supervision is exercised over all children for whom spectacles have been prescribed under the Committee's scheme. Lists of the children who ought to be wearing spectacles are kept at each school, and any alterations made in these lists are notified to the head teachers. The Eye Clinic is held at the Maternity and Child Welfare Centre in White Hart Lane. (d) Ear Disease and Defective Hearing. Like the Eye Clinic, the Ear Clinic is held at the Maternity and Child Welfare Centre in White Hart Lane. The number of children seen by Dr. Friel during the year was 151, of whom 18 were children under school age, and the total attendances made were 454. 45 of the children treated were suffering from suppurative ear disease, and the result of their treatment, by zinc ionization and by other methods is shown in the following table. Nature of Disease Total. Cured. Lost Sight of. Still under Treatment . Requiring Hospital Treat, ment. Acute Suppurative Otitis Media 16 16 .. .. .. Chronic Suppurative Otitis Media due to:— (a) Tympanic Sepsis 11 6 .. 3 2 (6) T.S. and Granulations 4 3 .. 1 .. (c) T.S. and Polypus 1 1 .. .. .. Attic Disease 3 .. .. 3 .. Mastoid Disease 4 1 .. .. 3 External Otitis 3 1 .. 2 .. Not diagnosed 3 1 .. .. 2 Total 45 29 0 9 7 In addition to these cases of suppurative ear disease, a large number of children have been treated by Dr. Friel for catarrhal inflammation and defective hearing. A very successful method of treatment adopted in these cases is diastolisation, which gives excellent results in reducing the inflammatory condition of the nasal 10 passages, thus enabling the child to breathe more freely, and so reducing the catarrh which so frequently is the cause of defective hearing. (e) Dental Defects. The work done by the School Dental Surgeon is shown in Table IV, Group V, of the Statistics. The figures given there are an indication of the amount and the nature of the work done. Every attempt is being made by the Dental Surgeon to concentrate on the routine inspection and treatment, and to discourage the casual case which is, far too often, the case in which treatment has been refused when advised at the time of the routine inspection, because the mother did not believe in fillings, and only asked for at a later stage when the tooth is no longer saveable, and nothing but extraction is possible. It will be seen that the ratio of fillings to extractions in permanent teeth is very satisfactory 2,678 fillings to 396extractions. In the case of the temporary teeth, on the other hand, much less time is given to fillings, and the extractions are very greatly in excess of fillings, 2,056 to 397. Almost the whole elementary school population is now covered by routine inspection and treatment, which means that the Dental Surgeon's time is very fully occupied in trying to overtake all the work there is to do. The work, I am glad to say, is being well and carefully done, and during the past few years there has been a very considerable improvement in the condition of the children's teeth generally. (f) Defects of Speech. Miss Dawson, the teacher in charge of the Speech Defect Clinic has held two classes each week during the year, one for children of twelve years and over, and the other for children under twelve. Each class is limited to eight pupils, so that each child can receive individual attention. The principal defect dealt with is stammering, but other defects have also been treated during the year, such as the defective pronunciation of cleft palate cases, and difficulties in pronouncing individual letters. Improvement in most of these cases is slow, but with the co-operation of the parents and of the children themselves, a very great deal can be done, and excellent results are obtained in a 'arge proportion of the cases dealt with. (g) Artificial Sunlight Treatment. Only one child received artificial sunlight treatment under arrangements made by the Committee, during the year. This was 11 a very delicate boy, who in addition suffered from organic heart disease. He appeared to derive considerable benefit from the ultra-violet light treatment. 8.—INFECTIOUS DISEASES. The incidence of infectious disease among the school population was very much less during 1933 than during the previous year, the total number of cases notified to me from the schools being 651, as compared with 1,217 during 1932. The following list gives the numbers of the different infectious diseases notified from the elementary schools:— Scarlet Fever 98 Diphtheria 9 Chickenpox 112 Measles 66 Mumps 220 Whooping Cough 118 Skin Infections 28 Total 651 The notifications received from the schools were spread fairly evenly over the first three-quarters of the year, very few being received during the last quarter, except a small batch of measles cases notified in one of the infant schools in December. The months during which the incidence was heaviest were March and April, when mumps was prevalent in three of the schools, and June and July when chickenpox and whooping cough were prevalent in several of the infant departments. So far as scarlet fever and diphtheria were concerned these diseases, and particularly the latter, were responsible for comparatively little infection among the school children, and in the case of scarlet fever only a few more cases occurred during the year in the school population than in the rest of the community, while the number of cases of diphtheria occuriing in school children was less than half of the total number notified. This is shown in the following table which gives the cases of scarlet fever and diphtheria notified in the individual schools, and in persons over and under school age. 12 Schools affected by Infectious Disease during 1933:— School. Scarlet Fever. Diphtheria Alexandra Boys 5 - ,, Girls 1 1 ,, Infants 3 3 Bounds Green Boys 2 - Girls 4 - ,, ,, Infants 10 - Lordship Lane Boys 3 2 ,, ,, Girls 7 - ,, ,, Infants 4 1 Noel Park Boys 5 — ,, ,, Girls 4 — ,, ,, Infants 12 — Rhodes Avenue 14 — St. Michaels Mixed .. 3 — ,, Infants .. 6 1 St. Pauls 3 - White Hart Lane Boys 5 1 ,, Girls 4 - ,, ,, ,, Infants 3 - Glendale County School 1 2 Trinity County School 2 - Private Schools 4 - Schools outside district 6 1 Under School age 49 6 Over School age 32 6 Totals 192 24 In previous reports I have referred to the immunisation of children against diphtheria which has been in progress in Wood Green since the end of 1929. The work goes steadily on as part of the routine activity of the Health Department and is carried out in the infant and junior departments of the schools and at the School Clinic. The infant and junior departments are visited in rotation and the offer of immunisation made to all children not already 13 immunised. The response varies very much in different schools, being very good in some, and not so good in others, but on the whole steady progress is being made, and in some schools a very large proportion of the children have been protected. In several of the schools the proportion of children protected exceeds fifty per cent., and experience shows that where such a high percentage of the children attending any school is immune, there is very little chance of diphtheria spreading in the school. As a matter of fact only five cases of diphtheria have occurred in all the infant and junior departments during the year, that is in the departments in which immunisation is carried out regularly, and these have all been sporadic cases, not connected in any way with one another. The total number of children who had received a full course of injections at the end of 1933 was 1,951. Of this number 1,517 had been Schick-tested and found immune, five months after the course of injections had been completed. 248 were awaiting the final Schick-test, and 186 had failed to attend for test. These figures are on the whole very satisfactory, and show that the work is progressing steadily, if a little slowly. So far as the efficiency of the immunisation is concerned it is still the case that no child who has received a full course of injections, and after a negative Schick-test been granted a certificate of successful immunisation, has subsequently developed diphtheria. During the year three children who had each received three protective injections were sent to hospital with the diagnosis of diphtheria. Of these, E.H., 5½ years had a course of injections in 1931. The Schick-test was still positive, and further injections were recommended. These were refused. In March, 1933 he had a bad attack of laryngeal diphtheria and was in hospital for eight weeks. J. T., 5J years had a course of injections in 1932, but did not attend when sent for, for Schick-testing. In June, 1933 she was removed from a general hospital outside this district to a neighbouring isolation hospital as a case of nasal diphtheria. On arrival there, there was no evidence of diphtheria found, and the diagnosis was not confirmed. K.P., 2 years 8 months, had a course of injections in 1931, but the Schick-test was still positive. After a second course the test became negative. In August, 1933, she was sent to hospital with the diagnosis of nasal diphtheria, but on arrival in hospital was found to be suffering from Scarlet Fever, and no evidence of diphtheria was discovered. 14 9.—OPEN-AIR EDUCATION. There are no open-air schools in Wood Green nor are there any open-air classrooms in any of the public elementary schools. Practically the only form of open-air education enjoyed by the children is the open-air class conducted in the school playground during the summer months. I am glad to say that considerable use is made of this method of teaching. In a few of the schools however other forms of open-air education have been enjoyed during the year by a limited number of the scholars. In Bounds Green Boys' and Bounds Green Girls' Schools, school journeys were arranged as in former years. 39 boys from Bounds Green Boys' School, accompanied by two teachers took part in a school journey with Folkestone as the centre for a fortnight in July, while 21 girls from Bounds Green Girls' School, accompanied by two teachers, had a school journey at Babbacombe in Devon for a fortnight in June. These journeys are, in my opinion, excellent not only from the educational but also from the health point of view. In White Hart Lane Girls' School, the staff organised and conducted a school camp, which was held at Ancton near Bognor Regis for the whole period of the Whitsuntide holiday. 42 girls from the school enjoyed the experience of living in tents from the 2nd to the 12th of June, under the command of Miss Harvey, the head teacher, who had as assistants three of her teachers, and a nurse. The camp was a great success from every point of view, and its success reflects great credit on all concerned. In addition to this school camp for one school, there was as in former years the School Camp arranged by the Juvenile Organisations Committee available for children from all the schools. The camp was held at Dymchurch from August 19th to September 2nd, and 191 elementary school children, 105 boys and 86 girls had an excellent holiday there under ideal weather conditions. The children were, as in former years, carefully selected by the Juvenile Organisations Committee with the help of the head teachers, the preference being given to those most in need of a holiday, and least likely for financial or other reasons to obtain one in any other way. Many of the children were specially recommended by myself on medical grounds. The children were medically examined, weighed and measured before going to camp, and again weighed and measured on their return 15 home. In the majority of cases the benefit derived from the holiday was very evident and the gain in weight appreciable. Quite apart from every other consideration, this annual camp organised and provided by the Juvenile Organisations Committee for such a large number of the less fortunately situated children in Wood Green, is, in my opinion, an excellent institution from the health point of view, and the Wood Green children are greatly indebted to this Committee for the very practical interest taken in their welfare. 10.—PHYSICAL TRAINING. Physical training in the schools is carried out under the direction of the teachers, and there is no direct association with the School Medical Service. From time to time however children are sent for medical examination, where there seems to be a doubt as to whether they are able to take part in the ordinary physical exercises or in swimming. The Education Committee has recently decided to appoint two organisers of physical training to supervise the physical training in the schools. School Baths. The attendances of school children at the Western Road Public Baths during the year numbered 42,783 as compared with 40,984 in 1932, while those at the Open-Air Bath were 9,365 as compared with 5,693 in 1932. The increase in attendances, particularly at the Open-Air Bath is no doubt very largely due to the excellent summer of 1933, but it is obvious that swimming is a very popular form of exercise among the school children, and one which should be encouraged. The number of certificates of proficiency in swimming awarded to school children during the year was 2,253, as compared with 1,601 in 1932. Of this number, 307, 219 boys and 88 girls were awarded certificates for swimming half-a-mile. These figures are very satisfactory and reflect great credit on the Wood Green Schools' Sports Association which does so much to encourage swimming among the school children. 11.—PROVISION OF MEALS. A hot mid-day meal is provided throughout the year at the Feeding Centre in White Hart Lane for a number of children who are found to be in need of such a provision. These children are for the 16 most part selected on economic grounds, and they are usually recommended by the teachers or by members of the Care Committee, but a number are recommended by myself on medical grounds. The administration of the Feeding Centre is in the hands of the Director of Education, and the ladies of the Care Committee are responsible for the menus. The dinners provided are wholesome and nutritious, and the benefit resulting from the regular provision of a good mid-day meal is very evident in many of the children. The number of children receiving dinners at the Centre during the year was 222, of whom 198 were fed free, 22 for part payment and 2 for full payment. The total number of meals provided was 25,506, of which 20,719 were given free, 4,579 for part payment and 208 for full payment. The average cost per meal was 4.1 pence of which 1.8 pence represented the actual cost of food and 2.3 pence the cost of administration. The food is served and the children waited on at table by a number of ladies, mostly members of the Care Committee, and to these ladies the Education Committee is much indebted for this very useful service. In addition to the meals served at the Feeding Centre, 3,752 meals were provided at the Myopic Centre for the children attending there. Of these, 1,401 meals were given free, 477 for part payment, and 1,874 for full payment. These meals are cooked at the Feeding Centre. Apart from this provision of meals, a number of children are supplied with milk at school, free of cost in necessitous cases, while a number of others are supplied with malt and cod-liver oil, or virol at the School Clinic either free or at cost price, on the recommendation of the School Medical Officers. 12.—CO-OPERATION. (a) Of Parents. The parents of the school children continue to take a good deal of interest in the school medical inspections, and 69 per cent. of all the children inspected were accompanied by a parent or guardian at the inspection. In the infant schools the percentage of parents attending was as high as 90, while in the other age groups the percentage attendances of parents were, in the second group (or intermediates) 76, and in the third group (or leavers) 48 respectively. 17 The attendances at the routine dental inspections were not so good, only 43 per cent. of the parents attending. The attendance of parents, particularly at the medical inspections is of great assistance to the medical officers as it enables them to get first-hand information as to the child's previous health, and also makes it easy to direct the attention of parents to defects found present, and to the treatment indicated. The parents are generally grateful for the advice given, and ready to act on it, and there is no doubt that the success of the school medical service depends largely on their willing co-operation. (b) Of Teachers. From the teachers in the schools we also receive active cooperation. Without their interest and help our work would lose much of its effect, and would not proceed so smoothly and quietly as it does. The head teachers show themselves keenly interested in the school medical work, and I am glad to be able again to express my thanks to them for their assistance. I am indebted also to the School Attendance Officers for their co-operation at all times. (c) Or Voluntary Bodies. Of the voluntary bodies whose activities are of value to the School Medical Service, the chief is the Juvenile Organisations Committee. This Committee's most striking activity is the organisation and running of the Children's Holiday Camp at Dymchurch to which I have referred above. Other valuable activities comprise the running of gymnasia, clubs for indoor and outdoor sports, and dancing classes for school children, all of them of very definite benefit to the children and young people taking advantage of them. Mention should also be made of the Boot and Clothing Fund raised and administered by the Care Committee which supplies boots and clothing to necessitous children in the schools. I have also to record my indebtedness to the Tottenham Deanery Council for Moral Welfare for the assistance received from its representative in connection with difficult cases whose moral welfare has required special supervision, and to the National Society for Prevention of Cruelty to Children for the assistance of its inspector in dealing with an occasional difficult parent. 18 13.—BLIND, DEAF, DEFECTIVE and EPILEPTIC CHILDREN. A register is kept of all defective children in the district, and every effort is made to keep this register as full and accurate as possible. It is based very largely on the results of the routine and special medical inspections, but for such of the children as do not attend school, we are indebted to the assistance of the School Attendance Officers, School Nurses, Health Visitors and others. All defective children are kept under regular supervision and seen by the School Medical Officer at regular intervals. When the defect is such that a special school is indicated, steps are taken to secure this provision where at all possible. (a) Blind. There is one child from Wood Green at the School for the Blind at Swiss Cottage. Five others whose eyesight is so bad as to make it difficult for them to profit by the ordinary form of instruction given in an elementary school, are in attendance at the Myopic Centre in Lordship Lane. The commonest defect found in these children is a high degree of myopia, which while quite sufficient to prevent them from profiting by the ordinary methods of instruction in an elementary school, does not prevent them from receiving instruction in a special school. The children are under the regular supervision of the School Ophthalmic Surgeon, and the school is visited at regular intervals by the School Medical Officer. The children as a rule do well, and some of them improve sufficiently to be able to return to ordinary schools. The school provides accommodation for children from Finchley, Hornsey, Tottenham, Enfield and Middlesex County as well as from Wood Green. The number on the roll at the end of the year was 37 . Of these five belonged to Wood Green, fifteen to Tottenham, seven to Hornsey, six to Enfield, two to Middlesex and one to Finchley. A mid-day meal is available at the school for those children who are unable to go home at mid-day. (b) Deaf. There are six children on the register who are so deaf as not to be able to profit by instruction in an ordinary elementary school. These attend the Tottenham Special School for the Deaf, under arrangements made between the Wood Green and Tottenham Authorities. 19 (c) Mentally Defective. Fifteen mentally defective children from Wood Green were in attendance at the Joint Special School for Mental Defectives at Finchley during the year. The degree of mental defect present in these children varies greatly, but the majority can be classed as high grade defectives. The school is visited and the children inspected by the School Medical Officer at regular intervals and some of these children, particularly the high grade defectives, make quite considerable progress. Five children classed as mental defectives were attending ordinary elementary schools, and two private schools. These children would all do very much better at the Special School, but it is difficult to convince the parents of this, and many parents have a strong prejudice against their defective child being sent to a school for defectives. Four mentally defective children were not attending any school, but for these and for older mental defectives from Wood Green and neighbouring districts an Occupation Centre is provided in Shropshire Hall, Gladstone Avenue, by the Central Association for Mental Welfare. The Occupation Centre is in my opinion a very useful institution which provides interesting and useful occupation for a large number of unfortunates for whom no other provision is made. The defectives are kept under regular medical supervision, and treatment of their dental defects and minor ailments is arranged for at the School Clinic. (d) Epileptics. Two children suffering from severe epilepsy are on the special register. One of these was able to attend school for part of the year, and has recently been sent to an Epileptic Colony. The other has been quite unable to attend school. 15.—NURSERY SCHOOLS. There is no Nursery School in Wood Green, but classes are held in two of the Infant Departments, for children under school age. These classes meet a very definite need, and provide a healthy environment during the day for a number of children whose home circumstances are not too good. 20 16.—SECONDARY SCHOOLS. By arrangement between the Middlesex and Wood Green Education Authorities, the routine and special medical inspections of the pupils at the two Secondary Schools in Wood Green, have been carried out as in former years by Dr. Brooke and myself. Defects found at medical inspection are reported to the parents who make their own arrangements for treatment. The arrangement arrived at with the Middlesex Education Committee in 1931 whereby treatment for visual and dental defects in secondary school pupils was to be provided at the School Clinic, was still in abeyance during 1933, but I am glad to say there is every prospect of it being brought into force during 1934. 17.—PARENTS' PAYMENTS. A small charge is made to parents for treatment given to children at the dental clinic and the ear clinic, but no charge is made for attendance at the minor ailments clinic, although a box is always available for voluntary contributions. Wherever possible the full cost of operation for tonsils and adenoids, of artificial sunlight treatment, and of spectacles provided at the eye clinic is recovered from parents. Whenever the circumstances of the parents are such as to make it difficult or impossible for them to meet the full cost of treatment given to their children, these circumstances are considered by the Care and After Care Committee, and the cost charged to the parents reduced or remitted as the case may be. 18.—HEALTH EDUCATION. In July 1932 the question of the teaching of hygiene in the schools was discussed at a meeting of the Joint Advisory Committee representing the Education Committee and the teaching staff, and a recommendation was made to the Education Committee, which was subsequently adopted, to the effect that the teaching of hygiene should be included in the curriculum and time-tables of all classes in Junior and Senior Schools, and that the work should be based on the Board of Education's Handbook of Suggestions on Health Education. 21 Use has been made again during the year of the small handbooks on health published by the Health and Cleanliness Council and written specially for boys and girls leaving school. Copies of these are given to every boy and girl on leaving school. For the past few years advantage has also been taken of the services of the lecturer provided by the Dental Board of the United Kingdom. Visits are made to all the schools by the lecturer who gives a lecture demonstration on dental hygiene, the early evidence of dental decay and its prevention, and the importance of early and adequate treatment. Considerable interest is aroused in the children by these lectures, which cannot fail to be helpful. 19.—MISCELLANEOUS. Under the bye-laws regulating the employment of children and young persons, I have examined twenty children during the year. Two were rejected on medical grounds and the others granted employment certificates. I have also as in former years examined a number of new teachers on their appointment, and individual teachers from time to time on the instructions of the Committee. In concluding my Report, I desire again to express my thanks to the Education Committee for its continued support and encouragement of the school medical services, to the Director of Education and his staff for assistance which is always readily given, and to all the members of my own staff for their loyal and willing cooperation. I am, Ladies and Gentlemen, Your obedient servant, MALCOLM MANSON, School Medical Officer. 22 APPENDIX. MEDICAL STATISTICAL TABLES, 1933. TABLE I.—RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTION. Age. Entrants. 3 4 5 6 Other Ages. Total. Boys - 20 215 91 36 362 Girls - 19 208 91 34 352 Totals - 39 423 182 70 714 Age. Second Age Group (8 to 9 Years). 8 Other Ages. Total. Boys 280 89 369 Girls 246 96 342 Totals 526 185 711 Age. Third Age Group. 12 13 14 Other Ages. Total. Boys 284 51 2 - 337 Girls 237 57 3 1 298 Totals 521 108 5 1 635 23 A.—ROUTINE MEDICAL INSPECTION—Continued. Number of other Routine Inspections. Boys 127 Girls 161 Total 288 Grand Total. Entrants Second Age Group. Third Age Group. Other Routine Inspections. Total. Boys 362 369 337 127 1195 Girls 352 342 298 161 1153 Totals 714 711 635 288 2348 B.—OTHER INSPECTIONS. No. of Special Inspections. No. of Re-Inspections. Boys 518 1010 Girls 450 966 Totals 968 1976 24 TABLE II. A.—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DEC., 1933. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, bnt not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition 21 3 8 1 Ringworm— Skin Scalp ... ... ... ... Body ... ... ... 2 Scabies 1 ... 3 7 Impetigo ... 2 12 6 Other Diseases (non-Tuberculous) 4 5 15 11 Blepharitis 2 4 2 1 Conjunctivitis 1 1 6 1 Keratitis ... 1 ... ... Eye Corneal Opacities ... ... ... ... Defective Vision 78 139 3 3 (excluding Squint) Squint 2 16 1 ... Other Conditions 10 19 7 2 Ear Defective Hearing 5 1 7 2 Otitis Media 3 1 ... ... Other Ear Diseases 21 2 21 3 Nose and Throat. Chronic Tonsillitis only 9 247 8 37 Adenoids only ... 2 ... 1 Chronic Tonsillitis and Adenoids ... ... ... ... Other Conditions 23 13 25 8 Enlarged Cervical Glands (Non-Tuberculous) ... 29 1 19 Defective Speech 3 9 3 1 25 26 TABLE II—continued. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment (1) (2) (3) (4) (5) Heart and Circulation. Heart Disease— Organic 11 6 7 ... Functional 18 9 6 ... Anæmia 3 161 ... 3 Lungs Bronchitis 4 19 ... 5 other Non-TuberculousDiseases ... 8 ... ... Tuberculosis Pulmonary— Definite ... ... ... ... Suspected 4 1 3 ... N on-Pul monary— Glands 1 1 ... 1 Spine ... ... ... ... Hip ... ... ... ... Other Bones and Joints ... ... ... ... Skin ... ... ... ... Other Forms ... ... ... ... Nervous System. Epilepsy ... 1 ... 2 Chorea ... ... ... ... Other Conditions ... 5 ... 3 Deformities. Rickets 1 4 ... ... Spinal Curvature 1 3 ... ... Other Forms 1 3 2 7 Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 7 19 13 39 B —NUMBER OF INDIVIDUAL CHILDREN FOUND AT ROUTINE MEDICAL INSPECTION TO REQUIRE TREATMENT (excluding Uncleanliness and Dental Diseases). Group. Number of Children. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. (1) (2) (3) (4) Prescribed Groups— Entrants 714 54 7.5 Second Age Group 711 73 10.25 Third Age Group 635 71 11.2 Total (Prescribed Groups) 2060 198 9.5 Other Routine Inspections •288 18 6.25 27 TABLE ID. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. CHILDREN SUFFERING FROM MULTIPLE DEFECTS. Children suffering from any combination of the following types of defect: Blindness (not partial Blindness), Deafness (not partial Deafness), Mental Defect, Epilepsy, Active Tuberculosis, Crippling (as defined in the penultimate category of the Table), Heart Disease—4. BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 1 — — — 1 PARTIALLY BLIND CHILDREN. At Certified Schools for the Blind. At Certified Schools for the Partially Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 5 — — — 5 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 4 — — — 4 PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 2 — 5 — — 7 28 MENTALLY DEFECTIVE CHILDREN. Feeble-Minded Children. At Certified Schools for Mentally Defective Children. At Public Elelnentary Schools. At Other Institutions. At no School or Institution. Total. 15 5 2 4 26 EPILEPTIC CHILDREN. Children Suffering From Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 1 — 1 2 PHYSICALLY DEFECTIVE CHILDREN. A.—Tuberculous Children. I.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — — 3 — 3 II.—Children Suffering from Non-Pulmonary Tuberculosis. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 12 2 1 15 B.—Delicate Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 14 — — 14 29 C.—Crippled Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 8 — 1 9 D.—Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 1 — — 1 2 CHILDREN SUFFERING FROM MULTIPLE DEFECTS. Boys. 1 Mental Defect and Epilepsy. Not attending School. 1 ,, ,, ,, ,, Notified to County. Girls. 1 Mental Defect and Blindness. At Cranford House, Maidenhead. 1 ,, ,, ,, Hemiplegia. At Elementary School. 30 TABLE IV. Return of Defects Treated during the Year Ended 31st December, 1933. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for whioh see Group VI). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm—Scalp - - - Ringworm—Body Scabies 3 — 3 Impetigo. 31 — 31 Other skin diseases 12 — 12 Minor Eye Defects (external and other, but excluding cases falling in Group II.) 56 — 56 Minor Ear Defects.. 175 — 175 Miscellaneous e.g., minor injuries, bruises, sores, chilblains, etc.) 498 - 498 Totals 775 — 775 31 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. No. of Defects dealt with. Total. Under the Authority's Scheme. Submitted to refraction by private practitioner or at hospital, apart from the Authority 's Scheme Otherwise. (1) (2) (3) (4) (5) Errors of Refraction (including Squint). (Operations for Squint should be recorded separately in the body of the Report).. 619 20 639 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 41 - - 41 Totals 660 20 — 680 Number of Children for whom spectacles were prescribed— (a) Under the Authority's Scheme 278 (b) Otherwise 7 Number of children who obtained or received spectacles— (a) Under the Authority's Scheme 262 (b) Otherwise 13 (i) Tonsils only, (ii) Adenoids only. (iii) Tonsils and Adenoids, (iv) Other defects of the nose and throat. 32 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Total number treated. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioneror Hospital, apart from the Authority's Scheme. Total. Received other forms of Treatment. (1) (2) (3) (4) (5) (i) - (ii) - (iii) 8 (iv) - (i) - (II) - (iii) 9 (iv) - (i) - (ii) - (iii) 17 (iv) - 48 65 Group IV.—Orthopaedic and Postural Dbfects. Under the Authority's Scheme (1) Otherwise. (2) Total number Treated. Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. (i) (ii) (iii) (i) (ii) (iii) Number of children treated. - — — — — 7 7 33 Group V.—Dental Defects. (1) Number of Children who were— (a) Inspected by the Dentist— Aged: 4 15 (2) Half-days devoted to:— Inspection 40 Treatment 382 Total 422 (3) Attendances made by children for treatment 3753 (4) Fillings:— Permanent teeth 2678 total 3075 Temporary teeth 397 (5) Extractions:— Permanent teeth 396 Temporary teeth 2056 Total 2452 (6) Administrations of general anaesthetics for extractions 783 (7) Other operations:— Permanent teeth 144 Total 290 Temporary teeth 146 Routine Ago Groups 5 79 Total 2904 6 209 7 316 8 380 9 370 10 373 11 392 12 361 13 320 14 65 15 18 l6 6 Specials 731 Grand Total 3635 (b) Found to require ment treat- 2779 (c) Actually treated 1942 Group VI.—Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the Schoo Nurses 15. (ii) Total number of examinations of children in the Schools by School Nurses 51224. (iii) Number of individual children found unclean 195. (iv) Number of children cleansed under arrangements made by the Loc Education Authority Nil. (v) Number of cases in which legal proceedings were taken:— (а) Under the Education Act, 1921 Nil. (б) Under School Attendance Byelawe Nil. STATEMENT or the Number or Children Notified During the Year ended 31st December, 1933, by the Local Education Authority to the Local Mental Deficiency Authority. Total Number of Children Notified, 2. ANALYSIS OF THE ABOVE TOTAL. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots — — (b) Imbeciles — — (c) Others 1 — (ii) Children unable to be instructed in a Special School without detriment to the interests of other children: (a) Moral defectives — - (6) Others 1 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 — — 3. Feeble-minded children notified under Article 3, i.e., "special circumstances" cases — — 4. Children who, in addition to being mentally defective, were blind or deaf — — Grand Total 2 — 34