L.I AC439(1) Borough of Moob Green, Annual Report of the Medical Officer of Health and School Medical Officer for the Year 1934. MALCOLM MANSON, M.C., MA., M.D., D.P.H. Medical Officer of Health and School Medical Officer. 19 3 5 - Crusha & Son, Ltd., Wood Green. Tottenham and Enfield, K Vt/O0b /J INDEX to the Report of the Medical Officer of Health. A. Accidents due to Traffic 8 Acts of Parliament 12 Ambulance Service 11 B. Bacteriological Examinations 40 Baths 20 Births 5 Bye-laws 13 C. Clinics— M. &C.W 14 School 14 Tuberculosis 15 Venereal 15 D. Day Nursery 18 Deaths 6 Disinfection 40 Drainage and Sewerage 19 F. Factory and Workshop Acts 25 Food and Drugs Acts 33 Food Inspection 31 Foster Mothers 18 H. Hospitals 9 House-to-House Inspection 24 Housing Statistics 28 I. Infantile Mortality 7 Infectious Diseases— Cases removed to Hospital 34 Cases attending Schools 35 M. Maternity & Child Welfare— Ante-Natal Clinic 17 Centres 14 Dental Work 17 Free Food 18 Home Visiting 18 Maternity Hospital provision 17 Maternity and Nursing Homes 9 Maternal Mortality 7 Sunlight Treatment 18 Midwives 9 Mortuary 30 N. Nursing in the Home 8 P. Poor Law Relief 7 Population 5 R. Rent Restriction Acts 30 Rivers and Streams 19 S. Sanitary Inspection 21 Slaughterhouses 32 Social Conditions, etc 4 Staff 2 Statistical Tables— Birth and Death Rates 43 Causes of Death 44 Infectious Diseases 47 Infantile Mortality 46 Meteorological Report 49 Tuberculosis 48 Vital Statistics 42 T. Tuberculosis 38 V. Vital Statistics, Extract from 4 W. Water Supply 19 Z. Zymotic Mortality 7 Borough of Woob (Breen. PUBLIC HEALTH COMMITTEE. Councillor E. J. Anderton, L.D.S. (Chairman). The Mayor (Alderman F. G. Holmes, J.P.). The Deputy Mayor (Alderman S. B. Colei, J.P.). Alderman H. Tudor Rhys, J.P. Councillor Mrs. A. Duncan. Councillor H. Barnes. Councillor. A. R. Harrison. Councillor. F. Corbett. Councillor B. L. Lloyd. Councillor. W. G. Doyle. Councillor A. Oliver. Councillor W. J. Payne. MATERNITY AND CHILD WELFARE COMMITTEE. Alderman Mrs. J. J. Bolster, J.P. (Chairman). Councillor E. J. Anderton, Councillor Mrs. A. Duncan. L.D.S. Councillor F. W. Locke. Councillor Mrs. J. Cole. Councillor Mrs. L. C. Vant. Co-opted Members:— Mrs. L. Barnes. Mrs. Blub. Dr. E. SummE'Rskill. 2 STAFF during 1934. *Medical Officer of Health.—Malcolm Manson, M.C., MA., M.D., D.P.H. *Assistant Medical Officer of Health.—Miss Gwenddolen Brooke, M.R.C.S., L.R.C.P., D.P.H. (resigned April, 1934). Miss Margaret McDonald Miller, M.B., Ch.B., D.P.H, (from April, 1934). *District Sanitary Inspectors.—S. C. Stahbuby, Cert. R. San. lust., 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. Obwin, C.M.B.; Miss F. Medd, C.M.B. *Nurse-in-C'harge, 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 Visitors' Certificate. *Officers in respect of whom salary contributions are made under the Public Health Acts by Exchequer Grants. 3 Town Hall, Wood Green, N.22. 27th May, 1935. 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 1934. Apart from the fact that scarlet fever, fortunately of a very mild type, was widely prevalent throughout the year, 1934 has been uneventful so far as the health of the community is concerned. So far as vital statistics are concerned there has been a further fall in the birth-rate for the sixth year in succession, and the births exceeded the deaths only by the very narrow margin of two. I have again to express my thanks to the Chairmen of the Public Health and Maternity and Child Welfare Committees, and to the Council generally for the consideration and help I have received, and to the whole staff of the Health Department for their willing co-operation throughout the year. Your obedient servant, MALCOLM MANSON, Medical Officer of Health. 4 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (acres) 1,607 Population—Estimate supplied by the Registrar-General 53,755 Number of inhabited houses (end of 1934, according to the Rate Books) 13,265 Rateable Value, 1934 £511,828 Sum represented by a penny rate £2,022 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births— Total. M. F. Legitimate 548 277 271 Birth Rate 10.5. Illegitimate 16 8 8 Stillbirths 12 6 6 Rate per 1,000 births, 20.8. Deaths 562 269 293 Death Rate, 10.5. Deaths from puerperal causes:— Puerperal sepsis 1 Rate per 1,000 births, 1.7 Other puerperal causes Rate per 1,000 births, Nil. Total 1 Rate per 1,000 births, 1.7, Deaths of infants under 1 year of age:— All infants 21 Rate per 1,000 live births, 37. Legitimate 19 Rate per 1,000 legitimate live births, 35. Illegitimate 2 Rate per 1,000 illegitimate live births, 125. Deaths from— Measles (all ages) 1 Whooping Cough (all ages) 2 Diarrhoea (under 2 years of age) 1 5 POPULATION. The Registrar-General's estimate of population for 1934 was 53,755, and 1 have used this figure to calculate the birth and death rates for the year. It represents a. decrease of 455 in the population from> that of 1933, which was 54,210. As the number of births and deaths occurring during the year was almost exactly the same, and as over eighty new houses have been built, this estimate, if correct, nnust mean that the number of people who have left the district during the year exceeds by several hundreds the number who have come in. I stated in my report last, year that the close approximation of the birth-rate to the death-rate and the fact that very little further building of new houses was to be looked for in the district would seem to indicate that, mo further increase in the population but rather a decrease was to be looked for, and the statistics for 1934 lend support to the correctness of this forecast. BIRTHS. The number of live births registered during the year was 564, as compared with 601 for 1933, and 681 for 1932. Of the 564, 285 were male and 279 female. The birth-rate was 10.5 per 1,000 of population, as compared with 11.1 for the previous year, and 12.5 for 1932. It is the lowest rate ever recorded in Wood Green. The birth-rate for the whole country was 14.8, and for the. 121 great towns (which include Wood Green) was 14.7, so that in 1934, as for many years past, the birth-rate in Wood Green was very appreciably lower than both that of the whole country and that of the great towns. 12 stillbirths were registered, 6 male and 6 female. The births registered in the borough were distributed in the different Wards as follows:— Alexandra-Bowes 98 Town Hall 279 Noel Park 119 496 6 DEATHS. The number of deaths belonging to Wood Green, after making the necessary adjustments for inward and outward transfers, was 5-62, 269 male and 293 female. This number is only two less than the number of births registered. It represents a death-rate of 10.5 per 1,000 of population, which is very slightly higher than that for the previous year, which was 10.4. It compares favourably with that O'f the country as a whole, and that of the 121 great towns, which in each case was 11.8. Of the total deaths, 276, or 49 per cent., occurred in persons over 65 years of age. The corresponding percentage for 1933 was 52. The distribution of deaths over the year was as follows:— First quarter, 185; second, 146; third, 91; and fourth, 140, the heaviest mortality being as usual in the first quarter of the year and the lowest in the third. The distribution of deaths according to Wards was:— Alexandra-Bowes 158 Town Hall 223 Noel Park 181 562 Table III in the Appendix gives the causes of all deaths occurring in Wood Green during the year, and Table IV shows their distribution 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 cause of death, being responsible for no fewer than 179 deaths, or almost one-third of all the deaths. Of these deaths from heart, disease, more than half occurred in persons over 65 years of age. Cancer came second as a cause of death with 97 deaths, and was followed by pneumonia with 40 deaths, tuberculosis with 35 deaths, and "other circulatory diseases" with 35 deaths. Only 5 deaths were attributed to influenza as compared with 21 in 1933. 7 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 7. Diphtheria was responsible for three deaths, whooping cough for two, and measles and diarrhoea for one each. The Zymotic Death Rate was 0.13 per 1,000 of population as compared with 0.01 for the previous year. INFANTILE MORTALITY. The number of deaths occurring in children under 12 months of age was 21, and the Infantile Mortality Rate 37 per 1,000 live births. This is a considerable improvement on the previous year when there were 32 infantile deaths and an Infantile Mortality Rate of 53. The rate for the whole country in 1934 was 59, and for the 121 great towns 63. The individual causes of the infantile deaths and the age at which death took place are shown in Table V. It will be seen that of the total infantile deaths one-half occurred during the first week, and two-thirds during the first month of life. MATERNAL MORTALITY. Only one mother died during the year as a result of childbirth. The death in this case was due to puerperal sepsis. The Maternal Mortality Rate was 1.7 per 1,000 births. The rate for 1933 was 1.6. 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 1934:— Persons. Amount granted. 1,988 £15,106 19s. 6d. The amount granted in 1933 was £15,360 lis. 4d. 8 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 1934. There were 134 accidents in the High Road and 163 elsewhere in Wood Green, as compared with 117 and 132 respectively during 1933, and the use of a motor ambulance was required on 239 occasions as compared with 144 in 1933. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Professional Nursing in the Home. (a) General. For many years past the Wood Green Charity Trustees have employed two district nurses whose services have been available for sick persons in the district who are under the care of medical practitioners. Much useful work has been done by these nurses, and large numbers of the poorer members of the community have benefited greatly from their services in time of sickness. It. has been felt all along, however, by the Trustees that sufficient advantage was not being taken by the community generally of the nursing services available, and in the early part of the past, year steps were taken to form a District Nursing Association on a provident contributory basis. As a result the Wood Green Nursing Association has been formed, affiliated to the Queen's Institute of Nursing, and a home nursing service is now provided by this Association. The Association has made very considerable headway since its inception in June, 1934, and already considerably more home nursing is being done than under the former system. Very generous assistance to the new Association has been given by the Wood Green Charity Trustees. (h\ In feet ions 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 9 the Nursing Association, 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, and during the year the payment of a subsidy to a midwife resident in the Borough was discontinued. During the year 9 midwives residing in the Borough notified their intention to practise. MATERNITY AND NURSING HOMES. There were two Maternity Nursing Homes in the Borough during 1934 registered by the Middlesex County Council. Supervision of the Nursing Homes and of the midwives practising in the Borough is in the hands of the County Council. HOSPITALS. 1. Fever. Wood Green is one of four authorities (Hornsey, Finchley, Wood Green and Friern Barnet) which together own and control the Joint Isolation Hospital, Coppetts Road, M us well Hill. 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 need acommodation is also available for most other infectious diseases, except smallpox, puerperal fever and ophthalmia neonatorum, for which other provision has been made. 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. 10 3. T uberculosis. 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 1934. Accommodation. Institution. Adults. Children . Type of case. M. P. County Sanatorium. 129 129 56 Pulmonary—Sanatorium. Harefield 4 (for male and f emale altern ately) 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. 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, for the admission, at an inclusive charge to the mother, of maternity cases recommended by the Medical Officer at. the Maternity and Child Welfare Centres. 5. Children. There is no special children's hospital in this neighbourhood but children are taken into the North Middlesex County Hospital 11 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 or, as it is now called, the Wood Green and Southgate Hospital, is situated in Wood Green and has accommodation for 52 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 County 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, £1.00 to the Prince of Wales's Hospital, and £50 to the Royal Northern Hospital. Other Institutions. (a) 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. (a) 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. 12 During; the year the Ambulance was used on 1,589 occasions, 208 being cases of street accident (14 of which were for neighbouring authorities), and 41 cases of illness in the street. The total mileage for the year was 11,836. The sums received from various users amounted in all to £24 14s. 0d. It will be seen from these figures that very full use is made of the ambulance service, and the question of providing a second ambulance is at present under consideration by the Health Committee. (c) Maternity Cases. The Council's ambulance is also used when necessary to carry Maternity cases to Hospital. 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. Electric Lighting Orders Confirmation (No. 1) Act, 1902 (incorporating Wood Green. Electricity Lighting Order, 1902). Wood Green Urban District Council Acts, 1903 and 1920. Alexandra Park and Palace (Public Purposes) Acts, 1900, 1903, 1905 and 1913. Tottenham and Edmonton Gas Act, 1913. North Metropolitan Electric Power Supply (Consolidation) Act, 1928. North Metropolitan Electric Power Supply Act, 1932. 13 Permissive Acts Adopted. Baths and Washhouses Acts, 1846 to 1925. Infectious Diseases (Prevention) Act, 1890. Publio Libraries Acts, 1892 to 1919. Small Dwellings Acquisition Acts, 1899 to 1923. Local Government and Other Officers, Superannuation Act, 1922. The following parts and sections of:— (a) Public Health Acts (Amendment) Act, 1907:— Part II.—Streets and Buildings—Section 17, 18, 20, 21, 22, 24, 25, 28, 29, 31 and 32. Part III.—Sanitary Provisions—Sections 34, 35, 36. 37, 38, 45, 48, 49, 50 and 51. Part IV.—Infectious Diseases—Sections 60, 61, 62. 63, 64, 65, 66 and 68. Part X.—Miscellaneous—Sections 92, 93, 94 and 95. (b) Public Health Act, 1925 Part II.—Streets and Buildings—Sections 17, 18, 19, 23, 24, 25, 26. 27, 30, 31 and 35. Part III.—Sanitary Provisions—Section 4-3. Part IV.—Verminous Premises, etc.—Sections 45, 46, 47, 48, 49 and 50. Part V.—Watercourses, Streams, etc.—Sections 53 and 55. Bye-laws, Regulations, etc. (1) 1901, Bye-laws under the Public Health Act (Amendment) Act, 18901, with respect to Telegraph and other wires. (2) 1923, Rules with respect to Allotments. (3) 1927, Bye-laws with resipect to New Streets and Buildings. (4) 1930, Bye-law with respect to Smoke Abatement. (5) 1931, Bye-laws with respect to Houses let in lodgings. (6) 1934, Good Rule and Government Bye-laws. (7) 1934, Standing Orders for the regulation of Proceedings and Business of the Council. (8) 1934, Bye-laws with respect to the Employment of Children. 14 CLINICS AND TREATMENT CENTRES. MATERNITY AND CHILD WELFARE CENTRES. The days and hours of the Maternity and Child Welfare Centres are as follows:— Name and Situation. Day and Hour Open. Provided by The Welfare Centre, White Hart Lane, N.22— Child Welfare Monday, 2 p.m. to 4 p.m. The Council. 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. ,, Congregational Church Hall, Alexandra Park Road— .Child Welfare Thursday, 10 a.m. to 12 ,, Clinic noon A Toddlers' Clinic is held at the White Hart Lane Welfare Centre one afternoon per month. SCHOOL CLINICS. Name and Situation. Provided by Minor Ailments— Stuart Villa, Stuart Crescent, N.22 (daily) The Education Committee. Ophthalmic— The Child Welfare Centre, White Hart Lane ,, (1 session weekly and 1 extra session per fortnight) 15 Name and Situation. Provided by Aural— The Child Welfare Centre, White Hart Lane The Education (1 session per fortnight) Committee. Dental— Stuart Villa, Stuart Crescent (5| days weekly) ,, Speech Defects— Stuart Villa, Stuart Crescent (2 sessions per ,, week) Artificial Sunlight Treatment.—Provided at the North Middlesex County Hospital, under an agreement with the Middlesex County Council, at a charge of Is. per child visit, and at the Royal Northern Hospital at the same charge. 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 borough. MATERNITY AND CHILD WELFARE. The number of live births registered during 1934 as belonging to Wood Green was 564 according to the information supplied by the Registrar-General. The number of births registered in the borough during the year was 496 and the percentage notified under the Notification of Births Act was 96.4. The number of stillbirths registered was 12 and the number notified was 9. 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 throughout the year, and at the Pavilion in the Albert Road Recreation Ground on Thursday mornings until the 16 end of April, when the Clinic was transferred to the new Hall attached to the Congregational Church at the junction of Alexandra Park Road and Albert Road. The attendances at the Centres during the year are shown in the following table:— January 1,154 February 1,229 March 1,140 April 1,260 May 1,111 June 1,195 July 1,598 August 887 September 1,268 October 1,561 November 1,027 December 1,129 Total 14,559 The attendances in 1933 were 15,018. The attendances at the Centre in the Alexandra Park area numbered 1,995 as compared with 2,178 in 1933. The number of individual children brought to the Centres during the year was 1,437, of whom 728 were infants under 12 months of age, and 709 of from 1 to 5 years of age. The number of children seen by the Assistant Medical Officer in attendance at the Centres during the year was 1,367. 700 of these were infants under 12 months of age, who made 2,369 attendances, while 667 were children of from 1 to 5 years of age and their attendances numbered 2,008. Of the 21 infantile deaths which occurred during the year, in only 3 cases had the baby attended one of the Welfare Centres. 17 Ante-Natal Clinic. An ante-Natal Clinics 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 the Medical Officer was 257 and the total attendances made numbered 980. The remainder of the Tuesday afternoon Clinic was allotted to Post-Natal cases, the number seen being 80 and the attendances 96. Toddlers' Clinic. A special Clinic for Toddlers has been held one afternoon per month since the beginning of November where children between the ages of two and five years are subjected to medical inspection. The attendances so far have been satisfactory, and it is hoped that by this means a considerable proportion of children will have at least one medical inspection before attaining school age. Maternity Hospital Provision. Arrangements are 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. 20 oases 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. The following is a record of the work done during the year:— Extractions (with local anaesithetic) 35 ,, (with gas) 509 Fillings 84 Scalings, etc. 191 Advice only 220 Dentures provided 43 18 Light Treatment. By arrangement with th© 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 7,470 home visits to mothers and children. 2,747 of these visits were to babies under one year of age, 4,335 to children of from 1 to 5 years, and 388 were ante-natal visits to expectant mothers. Free Food. Free food, consisting mostly of dried milk, Virol or malt and ood liver oil, was issued during the year to necessitous, expectant and nursing mothers attending the Ctentres, at a cost of £117 2s. Od. Cow's milk was issued similarly at a cost of £132 Is. lid. Free dinners were also supplied to necessitous mothers at the Feeding Centre in White Hart Lane at a cost of £16 16s. Od. Children and Young Persons Acts, 1908 to 1932. The Health Visitors have continued to act as Infant Life Protection Visitors during the year. The number of fostermothers and foster-children on the register at the end1 of the year was 16 and 17 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 good work continues to be done. The question of providing a new Day Nursery is again under consideration, and I sincerely hope that satisfactory premises will be erected at an early date. 19 The following table shows the attendances made at the Day Nursery throughout the year, and the corresponding figures for the previous year:— 1934. 1933. January 423 367 February 418 382 March 546 483 April 423 348 May 371 404 June 522 459 July 417 440 August 450 442 September 434 393 October 390 428 November 278 418 December 391 478 5,063 5,042 SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The whole Borough 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 Borough, 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 Borough are connected up to the Council's sewers. There is a dual system of drainage, the soil drains being connected to the main sewers which carry the sewage to a. pumping 20 station situated in Tottenham. Here the sewage is pumped into the London County Council's sewers, by arrangement with that Counoil. 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. The bathing facilities in Wood Green were very much improved during 1934 by the opening in August of the new open-air bathing pool in Durnsford Road. The pool is of the most modern type, measuring 165 feet by 92 feet, with a depth increasing from 3ft. 6in. to 15 feet, and a total cubic capacity of 600,000 gallons. It is supplied with cubicle, dressing room and locker accommodation sufficient for approximately 1,000 users, adequate sun-bathing space, a cafe and car park. The water is passed through a filtration plant supplied by Messrs. Bell Brothers, of Denton, which filters, strains, aerates and chlorinates the whole contents of the pool once in every six hours. The attendances during the eight weeks the new pool was open amounted 51,827. The attendances at the Western Road Baths and the open-air bath on the racecourse at Alexandra Park for 1934 and the three preceding years are shown below. Western Road Baths. School Open-air Bath. School Adults. Children. Adults. Children. 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 1934 137,900 47,121 11,864 5,443 21 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 389 Re inspections 693 Complaints investigated 104 Inspections under the Housing (Consolidated) Regulations, 1925 485 Inspections under the Housing Acts 140 Re-inspections 1274 Inspections of Houses let in lodgings 43 Re-inspections 292 Total 3,420 Inspections under the Rent Restriction Acts 16 Grand Total 3,436 Enquiries in oonnection with Infectious Disease:— Smallpox 2 Scarlet Fever 565 Diphtheria 51 Tuberculosis 77 Meningitis 1 Enteric 2 Total 693 Inspections of Registered Premises:— Factories 6 Workshops 138 Workplaces:— Butcher's Shops 757 Dairies 207 Fried Fish Shops 73 1,037 Slaughter-houses 51 Outworkers 64 Total 1,296 22 Miscellaneous Inspections: — Urinals 136 Passageways 78 Cinemas and other places of entertainment 33 Ice cream premises 59 Stalls—day and night visits 558 Smoke observations 13 Total 877 Total inspections during the year 2,173 Action Taken:— Issued. Completed. Verbal intimations 29 29 Preliminary Notices:— Public Health Act, 1875, Section 94 144 143 Public Health Act, 1875, Section 36 27 37 Public Health Act (Amendment) Act, 1890, Section 22 1 1 Public Health Act, 1925, Section 72 1 1 Housing Act, 1925, Section 5 1 1 Housing Act, 1930, Section 17 179 151 Infectious Disease (Prevention) Act, 1890, Section 5 288 288 Wood Green Urban District Council Act, 1920, Section 77 5 5 Factory and Workshop Act, 1901, Section 99 3 3 Bye-laws regulating houses let in lodgings 27 41 676 671 Statutory Notices:— Public Health Act, 1875, Section 94 18 16 Public Health Act, 1875, Section 36 4 5 Public Health Act, 1875, Section 41 1 1 Public Health Act, 1925, Section 46 1 1 Public Health Act (Amendment) Act, 1907, Section 25 1 2 Public Health Act (Amendment) Act, 1907, Section 37 1 Housing Act, 1930, Section 17 14 12 Infectious Disease (Prevention) Act, 1890, Section 5 22 22 The Wood Green Urban District Council Act, 1920, Section 77 1 1 Bye-laws regulating houses let in lodgings 3 3 65 64 23 Work Carried out : — Drainage Works: — Drains reconstructed 9 Drains repaired 2 Drains unblocked and cleansed 18 Soil and vent shafts repaired or provided 8 Fresh air inlets repaired or provided 8 Sink and bath wastes repaired 32 Inspection chambers repaired 5 Interceptors repaired 2 Drains tested 109 193 Water Closets:— New water-closets provided 2 New water-closet pans provided 64 Water-closets repaired 15 Foul water-closets cleansed 16 Flushing apparatus repaired or provided 39 136 Cleansing:— Premises limewashed 5 Premises otherwise cleansed 4 Rooms cleansedl after disinfection 310 Premises disinfested 25 Accumulations of refuse removed 14 Keeping of animals discontinued 6 364 Dampness:— Roofs repaired, etc. 103 Eaves gutters repaired or provided 38 Rainwater pipes repaired or provided 23 Damp proof courses provided 7 Walls rendered 16 Dampness otherwise remedied 24 211 House repairs:— Floors repaired—wood 39 Floors repaired—conorete 11 Coppers repaired or provided 33 Ceilings redecorated 663 Walls redecorated 667 General repairs 582 1,995 HOUSE-TO HOUSE INSPECTION. NUMBER OF HOUSES INSPECTED, 1934. Road. No. of Houses. No. of Rooms. Families. Persons per room. Adults. Children. Chapmans Terrace 4 20 16 2 0.90 Clarendon Road 14 63 65 10 1.19 Commerce Road 70 369 318 49 0.99 Crossway 14 70 57 26 1.18 Croxford Gardens 20 100 91 29 1.20 Durnsford Road 39 245 152 36 0.76 Edwards Terrace 7 28 26 1 0.96 Gospatrick Road 41 205 175 42 1.05 Granville Road 103 540 434 71 0.93 James Gardens 20 100 84 28 1.12 Palace Mansions 4 17 15 11 1.52 Perth Road 21 105 87 33 1.14 Rhys Avenue 8 50 31 7 0.76 Rivulet Road 67 335 316 80 1.18 Western Road 46 269 248 43 1.08 White Hart Lane 7 35 33 6 1.11 Totals 485 2551 2148 474 1.02 24 Miscellaneous:— Food stores repaired or provided 48 Yard pavings repaired 30 Dustbins provided 96 Water supply taken from mains 5 Baths, sinks and lavatory basins fixed 82 Gullies fixed 4 Overcrowding remedied 2 267 Total works carried out during the year 3,147 25 FACTORIES, WORKSHOPS, WORKPLACES, LAUNDRIES. AND HOMEWORK. 1.—Inspection. Including Inspections made by the Sanitary Inspectors. Premises. Inspections. Notices. Prosecutions. Factories— (Including Factory Laundries) 6 2 - Workshops— (Including Workshop Laundries) 138 6 - Workplaces— (Other than Outworkers' Premises) 1037 2 - Total 1181 10 - 2—Defects Found. Particulars. Found. Remedied Referred to H.M. Inspectr Prosecutions. Nuisances under the Public Health Acts— Want of Cleanliness 5 5 — — Want of Ventilation — — — — Overcrowding — — — — Want of Drainage of floors — — — — Other Nuisances 2 2 — — Sanitary Accommodation— Insufficient — — — — Unsuitable or Defective 3 3 — — Not separate for Sexes — — — — Offences under the Factory and Workshop Acts— Illegal Occupation of Underground Bakehouse Other offences (excluding offenoes relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). . - - - - Total 10 10 — — 26 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 22 - 43 13 - 24 The making-up, ornamenting, finishing and repairing of table linen, or other household linen, and any process incidental thereto 1 1 3 4 The making of curtains and furniture hangings and any process dental thereto - - - 1 - 1 The making or filling of cosaques, Christmas crackers, Christmas stockings or similar articles or parts thereof 1 - 1 - - - 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 - - - - - - The making or repairing of umbrellas, sunshades, parasols, or parts thereof - - - - - - Total 25 — 46 17 — 29 27 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 20 Dining Rooms 15 Laundries 2 Bakehouses 16 Boot Repairers 11 Mechanical Repairs 6 Upholstery 2 Other Workshops 24 Total 96 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 - Public Health Acts: — Matters notified by H.M. Inspector of Factories 3 Defects remedied following H .M .1.'s notifications 3 28 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) 1,057 (b) Number of inspections made for the purpose 3,316 (2) (a) Number of dwelling-houses (included under sub-head 1 above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 485 (b) Number of inspections made for the purpose 1,191 (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 420 2.—Eemedy 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 373 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 14 29 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners 12 (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 25 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 26 (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 ground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 30 Rent Restriction Acts. Eight certificates were granted under the above heading during the year 1934. NEW HOUSES BUILT DURING 1934. I am indebted to the Borough Surveyor for the following information relating to new houses erected in Wood Green during 1934:— Number of houses erected during 1934 76 Number of flats erected during 1934 10 Number of houses built by the Council Nil Number built by other bodies and persons 86 PUBLIC MORTUARY. Bodies deposited during the year 44 Inquests held 14 Post-mortem examinations 36 For lodgment only 2 Causes of death:— Natural causes 30 Accidental 4 Misadventure 1 Suicide 7 31 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 — 5 1 17 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 1 — 2 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. 32 (b) Meat. There is only one licensed slaughterhouse in the Borough, 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 Borough. (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. Bovine carcase 640 Bovine livers and lungs 72 Pigs'plucks 4 Sheep hearts 28 Fish 98 Chocolates ½ The total weight condemned during the year was 7 cwts. 2 qrs. 2½ lbs. 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 33 of the Public Control Department has kindly supplied the following figures concerning samples taken in Wood Green during 1934:— No. of samples Articles. taken. Adulterated. Milk 114 - Milk, sterilised 21 - Butter 2 - Cream 1 - Cream pastry 7 5 Hake 5 1 Lemon sole 2 - Meat 1 Meat pie 1 - Minced beef 3 - Sausages 3 - Whisky 6 - 166 6 Number of prosecutions 2 Number of convictions 2 Fines and costs imposed £4 4s. Od. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. The prevalence of notifiable infectious disease throughout the district was considerably greater in 1934 than in the previous year, the total number of notifications received being 448 as compared with 362 in 1933. The increase could be accounted for entirely by the increased prevalence of scarlet fever, which was responsible for well over one half of all the notifications received. The total number of cases removed to hospital or sanatorium was 402, a very large increase on the number for the previous year, which was 311. 34 The following table shows the number of cases of infectious disease admitted to the Joint Isolation Hospital from the various Wards in the town. AlexandraBowes. Town Hall. Noel Park. Joint Isolation Hospital. Scarlet Fever 62 89 112 Diphtheria 10 5 15 Erysipelas 2 4 3 Measles 4 8 1 Chicken Pox - 1 - Whooping Cough 1 1 2 Pneumonia - 1 - Enteric Fever - 2 - Totals 79 111 133 The distribution of scarlet fever and diphtheria over the year is shown below. Scarlet Fever. Diphtheria. First quarter 51 4 Second quarter 52 7 Third quarter 76 4 Fourth quarter 113 16 Totals 292 31 35 The incidence of scarlet fever and diphtheria, so far as school attendance is concerned, was as follows Scarlet Fever. Diphtheria. Attending elementary schools in Wood Green 174 18 Glendale County School 2 - Trinity County School 4 - Schools outside Wood Green 19 - Under school age 49 10 Over school age 44 3 Totals 292 31 Scarlet Fever. The incidence of scarlet fever was very considerably greater during 1934 than during the previous year, the number of cases notified being 292 as compared with 192 in 1933, and 110 in 1932. The disease was prevalent throughout the whole year, but most widely during the third and fourth quarters. 267 cases were removed to hospital. The disease generally was of the mild type which has prevailed for several years past, and for the third year in succession no deaths occurred from scarlet fever. Diphtheria. Thirty-one notifications of diphtheria were received as compared with 24 in the previous year. All cases notified were removed to the isolation hospital, where recovery took place in every case except two. Another death from diphtheria took place in the case of a child who had not been notified, the diagnosis in this case being made by the Coroner after a post-mortem examination. Immunisation against diphtheria has been carried on as in previous years, for the most part among children attending the infant departments of the elementary schools, and to a lesser extent among children under school age. The total number who had 36 received a full course of protective injections by the end of 1934 was almost 2,500, and of these, almost 2,000 had been subsequently Schick-tested and found immune. Of this number only one is known to have developed diphtheria subsequently, and in this case the attack was of a very mild character. Smallpox. No case of smallpox was notified during the year. Enteric Fever. One notification of this disease was received. The infection was thought to have been contracted at a seaside town. The patient was admitted to hospital and made a good recovery. Cerebro-Spinal Fever. Two notifications of this disease were received, both from hospitals outside the district, to which the patients had been admitted. Death occurred in one case. Anterior Poliomyelitis. One case was notified in a child of 5½ years. He was nursed at home and made a good recovery. Lethargic Encephalitis. One case occurred in a child of 5 years. She also was nursed at home and made a good recovery. Pneumonia. Twenty-eight notifications of pneumonia were received. All cases notified were visited by the District Nurses and an offer of nursing assistance made. In some cases this was accepted, but in the majority of cases the patient was removed to hospital. 37 Puerperal Fever and Puerperal Pyrexia. Two cases of puerperal fever were notified. Both were removed to one of the L.C.C. Hospitals under the arrangement made between this Council and the London County Council, and in each case recovery took place. In a third case which occurred in a nursing home outside the district, death unfortunately resulted. Three notifications of puerperal pyrexia were received. Recovery took place in each case. Ophthalmia Neonatorum. Two notifications of this disease were received, both from hospitals outside the district. In each case recovery occurred without any damage to vision. Non-Notifiable Infectious Diseases. The numbers of cases of non-notifiable infectious diseases reported to me during the year from the elementary schools were as follows:- Chickenpox 172 Measles 530 Mumps 15 Whooping Cough 70 Conjunctivitis 58 Skin infections 27 872 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. 38 TUBERCULOSIS. Table Vll in the Appendix shows that the number of new cases of tuberculosis coming to the knowledge of the Health Department during the year was 78, 66 pulmonary and 12 non-pulmonary. Of these, 68 were notified by doctors practising in the district, or from hospital, while ten were cases transferred from other districts. The number of notifications received in the previous year was 66. Thirty-five deaths were certified as due to tuberculosis, as compared with 32 for the previous year. Of these, 32 were due to pulmonary and 3 to non-pulmonary disease. The death rate from tuberculosis was 0.65 per 1,000 of population as compared with 0.59 in 1933. Of the 35 deaths which occurred, 5 were in persons who had not previously been notified as oases 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 43 Transfers from other districts (not included in above) 11 Total number of non-tubercular cases, including oontacrts 52 Cases undiagnosed on 31st December, 1934 - Tubercular cases supervised at or from Dispensary in 1934 200 Tubercular cases still on the register at the end of 1934 152 39 During the year 73 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 13 - Creaton Sanatorium, Northampton 1 - Eversfield Chest Hospital 1 - Grosvenor Sanatorium, Ashford 1 - Harefield Sanatorium 26 - Hendon Cottage Hospital — 1 King Edward VII Sanatorium, Midhurst 2 - Lord Mayor Treloar Hospital, Alton - 2 National Hospital, Benenden 1 - North Middlesex Hospital 13 - Preston Hall, Aylesford 1 - Royal National Sanatorium, mouth 1 - Royal National Hospital, Ventnor 2 - Royal Sea Bathing Hospital, Margate - 1 St. Anthony's, Cheam - 1 Victoria Home, Margate - 1 Victoria Park Hospital, E. 1 - 67 6 40 BACTERIOLOGICAL WORK. The bacteriological examination of specimens from the borough is carried out at the Joint Isolation Hospital, and during 1934 the following examinations were made:— Positive. Negative. Total. Diphtheria 20 561 581 Pulmonary Tuberculosis 17 127 144 Enteric - 1 1 Others - 3 3 37 692 729 DISINFECTION. The number of articles dealt with at the Disinfecting Station during the year was as follows:— Articles disinfected after tuberculosis 216 ,, ,, ,, other infectious diseases 2,913 ,, ,, ,, cancer 115 ,, ,, on account of vermin 67 3,311 Articles destroyed 74 The number of rooms disinfected by the Health Department was as follows:— After tuberculosis 49 ,, other infectious diseases 428 ,, cancer 5 For vermin 121 603 41 Disinfestation. During the last three months of the year a considerable amount of attention had to be paid to the work of ridding a number of the Council Houses on the White Hart Lane estate from infestation by bugs. The procedure adopted, which has been found to be very successful, has briefly been as follows: The woodwork of the infested rooms, i.e., the skirting boards, architraves and picture rails, are removed by the carpenter and immediately sprayed or painted with Cromessol B. solution. The bedding is removed to the disinfecting station where it is disinfected by steam and returned the same day. The rooms, meanwhile, are sealed up and fumigated by a very strong concentration of sulphur dioxide. Thereafter all defects in the plaster are made good and the skirting and architraves replaced. It has been found best not to replace the picture rails. The fumigation is repeated twice at intervals of seven and fourteen days. The results obtained by this procedure have on the whole been very satisfactory. 42 APPENDIX. Table I Vital Statistics of Wood Green, 1921-34. Year. Population estimated to middle of each year. Nett Births belonging to the District. Nett Deaths belonging to the District. Total No. Under 1 year of age. At all ages. Total No. Bate per 1,000 population Illegitimate No. Bate per 1,000 live births. Illegitimate No. Bate per 1,000 illegitimate births. No. Bate 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 1934 53,755 564 10.5 16 21 37 2 125 562 10.5 43 Table II. Birth-Rate, Death-Rate and Analysis of Mortality during 1934. Birth-rate per 1,000 population. Annual Death-Rate per 1,000 Population. Rate per 1,000 Births. All Causes. Typhoid and Paratyphoid Fevers. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 years). Total Deaths under year. England and Wales 14.8 11.8 0.00 0.00 0.09 0.02 0.05 0.10 0.14 0.54 5.5 59 121 County Boroughs and Great Towns (including London) 14.7 11.8 000 0.00 0.12 0.02 0.06 0.11 012 0.47 7.4 63 132 Smaller Towns (population, 25,000. 50,000 at Census 1931) 15.0 11.3 0.00 0.00 0.07 0.02 004 0.09 014 0.42 3.6 53 London 13.2 11.9 0.00 0.00 0.20 0.02 0.07 0.11 0.12 0.56 12.6 67 Wood Green 10.5 10.5 0.00 0.00 002 0.00 0.04 006 0.09 0.52 1.7 37 44 Table III, Causes of Death during the year 1934. Causes of Death. Male. Female. Typhoid and Paratyphoid Fevers - - Measles i - Scarlet Fever .. - - Whooping Cough - 2 Diphtheria i 2 Influenza 4 1 Encephalitis Lethargica - - Cerebro-spinal Fever 1 - Tuberculosis of Respiratory System 18 14 Other Tuberculous Diseases 1 2 Syphilis 1 - General Paralysis of the Insane, Tabes Dorsalis 3 - Cancer, Malignant Disease 40 57 Diabetes 4 3 Cerebral Haemorrhage, etc. 7 14 Heart Disease 77 82 Aneurysm 1 3 Other Circulatory Diseases 18 17 Bronchitis 7 12 Pneumonia (all forms) 26 14 Other Respiratory Diseases 4 4 Peptic Ulcer 3 1 Diarrhoea, etc. (under two years) 1 - Appendicitis 3 1 Cirrhosis of Liver - - Other Diseases of Liver, etc. - 4 Other Digestive Diseases 4 6 Acute and Chronic Nephritis 6 2 Puerperal Sepsis - 1 Other Puerperal Causes - - Congenital Debility, Premature Birth, t ion, et 4 5 Senility 4 2 Suicide 5 4 Other Violence 7 12 Other Defined Diseases 18 23 Causes ill-defined or unknown - 1 Totals 269 293 45 Table IV. Causes of, and Ages at Death during the year 1934. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. All Ages.. Unde l 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 1 1 - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - Whooping Cough 2 2 - - - - - - - - - - - Diphtheria 3 - - - - - 3 - - - - - - Influenza 5 1 - - - - - - - 1 — 1 2 Encephalitis Lethargica - - - - - - - - - - - - - Cerebro-Spinal Fever 1 - - - - - - - - 1 - - - -Tuberculosis of Respiratory System 32 - - - 1 - - - 4 13 5 8 1 Other Tuberculous Diseases 2 - - - - - 2, - - - - - - Syphilis 1 - - - - - - - - - - - 1 General Paralysis of Insane 2 - - - - - - - - - - - 2 Cancer, Malignant Disease 93 - - - - - - - - 2 6 42 43 Diabetes 5 - - - - - - 1 - - - - 4 Cerebral Haemorrhage, etc. 30 - - - - - - - - 1 - 9 20 Heart Disease 147 - - - - - 2 2 1 5 8 33 96 Aneurysm 5 - - - - - - - - - 1 3 1 Other Circulatory Diseases 27 - - - - - - - - 2 2 11 12 Bronchitis 22 - - - - - - - - 1 - 2 18 Pneumonia (all forms) 52 2 - 2 - 2 - - 2 2 3 10 29 Other Respiratory Diseases 6 - - - - - - - - 1 - 2 3 Peptic Ulcer 2 - - - - - - - - - - 1 1 Diarrhoea, etc. (under 2) 1 1 - - - - - - - - - - - Appendicitis 3 - - - - - 1 - 1 - - 1 - Cirrhosis of Liver - - - - - - - - - - - - - Other Diseases of Liver 2 - - - - - - - - - - 2, Other Digestive Diseases 7 - - - - - - - - - - 3 4 Acute and Chronic Nephritis 8 - - - - - - 1 - - 4 3 Puerperal Sepsis 1 - - - - - - - - 1 - - - Other Puerperal Causes - - - - - - - - - - - - Congenital Debility, etc 13 13 - - - - - - - - - - - Senility - - - - - - - - - - - - 5 Suicide 9 - - - - - - - - 2 2 4 1 Other Violence 18 - - - - - - 1 1 3 2 4 7 Other Defined Diseases 55 1 - - - - 3 2 1 6 6 14 20 Causes ill-defined 2 - - - - - - - - 1 - - 1 Totals 562 21 2 2 1 2 12 6 11 42 35 152 276 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 year. Asphyxia Pallida 1 - - - 1 - - - - 1 Atelectasis 1 - - - 1 - - - - 1 Broncho Pneumonia - - - - - - - 1 1 2 Gastro Enteritis - - - - - - - - 1 1 General Peritonitis - - - - - - - 1 - 1 Icterus Gravis Neonatorum 1 - - - 1 - - - - 1 Influenza - - - - - - 1 - - 1 Intra Cranial Haemorrhage 1 - - - - - - - 1 Measles - - - - - - - - 1 1 Premature Birth 6 1 1 1 9 - - - - 9 Whooping Cough - - - - - - 1 1 - 2 10 1 1 1 13 - 2 3 3 21 47 Table VI. Infectious Diseases Notified during the year 1934. Notifiable Disease. Cases Notified in Whole District. Total Oases Notified in each Ward. Total Cases removed to Hospital or Sanatorium. Total Deaths. All ages. At Ages—Years. Alexandra-Bowes. Town Hall. Noel Park. 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 292 1 46 214 23 16 2 - 74 95 123 267 - Diphtheria 31 1 7 20 1 2 - - 10 5 16 31 3 Enteric Fever 1 - - - - 1 - - - 1 - 1 - Cerebro-spinal Fever 2 - 1 - 1 - - - - 1 1 2 1 Encephalitis Lethargica 1 - - 1 - - - - 1 - - - - Erysipelas 17 1 1 - 1 5 6 3 3 6 8 11 - Pneumonia 28 - - 2 3 10 8 5 9 8 11 8 40 Acute Poliomyelitis 1 - - 1 - - - - 1 - - - - Ophthalmia Neonatorum 2 2 - - - - - - 2 - - 2 - Pulmonary Tuberculosis 56 - - 3 13 30 10 - 14 15 27 67 32 Non-Pulmonary Tuberculosis 12 - - 6 3 2 1 - 4 4 4 6 3 Puerperal Fever 2 - - - 1 1 - - 1 1 - 2 1 Puerperal Pyrexia 3 - - - - 3 - - 1 1 1 2 - Totals 448 5 55 237 46 70 27 8 120 137 191 399 80 48 Table VII. TUBERCULOSIS. New Cases and Mortality during 1934. Age Periods. New Cases. Deaths. Respiratory. Nonrespiratory. Respiratory. Nonrespiratory. M. F. m. F. M. F. m. f. 0 - - - - - - - - 1 - - - - - 1 - - 5 1 — 2 1 — — 1 1 10 1 1 — 3 — — — — 15 2 5 1 2 2 2 — — 20 3 5 — — 3 2 — — 25 17 11 1 1 3 5 — — 35 3 5 — — 3 2 — — 45 6 2 — — 3 1 — — 55 2 2 — 1 3 1 — — 65 and upwards — — — — 1 — — — Totals 35 31 4 8 18 14 1 1 Above includes transfers (10) from other Districts. 5 non-notified T.B. deaths occurred. 49 METEOROLOGICAL REPORT FOR YEAR ENDING 31st DECEMBER, 1934. Month. Total Rainfall. Maximum Rainfall. No. of Wet Days. Maximum Temperature. Minimum Temperature. 1934. Inches. Inches. Date. Degrees. Date. Degrees. Date. January 1.75 0.52 13th 18 59 17th 21 22nd and 23rd F ebruary 0.12 0.05 3rd and 28th 4 55 16th 21 2nd March 1.54 0.26 11th and 20th 16 60 24th 28 25th April 1.18 0.66 27th 8 76 15th 25 7th May 0.51 0.22 16th 6 80 12th 35 16 th June 1.19 0.45 28th 9 87 17th and 18th 45 7th, 11th, 12th July 0.54 0.33 24th 6 87 8th and 17th 50 3rd, 4th, 24th August 1.61 0.77 28th 12 84 18th 40 26th September 2.10 0.81 15th 9 83 14th 42 21st October 1.13 0.16 2nd and 3rd 17 74 1st 28 31st November 1.74 0.66 9th 8 54 18th 29 12th December 5.36 0.50 14th 24 58 3rd 34 21st Total for year 18.77 — — 137 — — — — Note.—Maximum Rainfall 15th September, 0.81ins. ,, Rate of Rainfall 15th September, 2¼ ins. per hour; duration 20 minutes. ,, Temperature 17th and 18th June and 8th and 17th July, 87. Fahr. Minimum ,, 22nd and 23rd January and 2nd February, 21. Fahr. (Temperature taken in shade.) This report has been kindly supplied by the Borough Engineer and Surveyor. EDUCATION COMMITTEE. Chairman: Alderman F. G. Holmes, J.P. Vice-Chairman: Councillor Mrs. A. Duncan. Alderman Mrs. J.J. Bolster, J.P. Alderman Rev. W. Winston Haines. Councillor Mrs. J. Cole. Councillor F. Corbett. Councillor W. G. Doyle. Councillor F. W. Locke. Councillor S. North. Councillor Mrs. L. C. Vant. Rev. Canon G. Curtis. Mr. H. J. Garlick, B.Sc. Rev. H. Harris, M.A. Mrs. H. S. Harrison. Mrs. M. V. Mackie. Miss C. M. Lightfoot. Mrs. E. M. Smith, M.A. Mr. W. A. Vant. CARE AND AFTER CARE SUB-COMMITTEE. Chairman: Alderman Mrs. J. J. Bolster, J.P. Alderman Rev. W. Winston Haines. Councillor Mrs. J. Cole. Councillor Mrs. L. C. Vant. Mrs. E. Agombar. Mrs. A. Barrett. Mrs. W. Braithwaite. Mrs. H. S. Harrison. Miss J. Irvine. Mrs. E. M. Jackson. Miss C. M. Lightfoot. Mrs. E. M. Smith, M.A Director of Education: C. H. Jarvis, M.A., LL.D. Mood Green Education Committee SCHOOL MEDICAL SERVICE. ANNUAL REPORT, 1934. Town Hall, Wood Green, N.22. April 5th, 1935. 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 1934. As in former years, the form of the Report has been prescribed by the Board of Education and I have followed generally the suggestions made as to its arrangement. 1.—STAFF. The School Medical Staff during 1934 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. (resigned April, 1934); Margaret McDonald Miller, M.B., Ch.B., D.P.H. (commenced May, 1934). 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 (retired November, 1934); Miss E. Mitcham (commenced December, 1934). Teacher in Charge of Speech Defect Clinic.—Miss E. M. Dawson. Dental Attendant.—Miss J. Collyer. School Medical Clerk.—Miss F. Jarvis (resigned July, 1934); Miss K. Chatfield (commenced July, 1934). 3 Three changes occurred in the personnel of the Staff during the year. Dr. Brooke, who had been Assistant Medical Officer since January, 1932, resigned in April on the occasion of her marriage, and was succeeded in May by Dr. Miller. Mrs. Rudd, who had done very useful work for many years as Medical Visitation Officer, retired on superannuation in November, and her place has been taken by Miss Mitcham. Miss Jarvis, the School Medical Clerk, retired in July on the occasion of her marriage, and has been succeeded by Miss Chatfield. All the members of the Staff 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. II.—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 naturally the closest possible co-operation between the Child Welfare and the School Medical work. When children reach school age their records are passed on from the Child Welfare Centres to the 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 Dental Clinic at Stuart Villa is available for children under school age, and the same is the case with the Eye and the Ear Clinics. This makes it possible for defects in young children to be dealt with as soon as they are discovered, instead of waiting until school age is reached before treatment is provided. III.—SCHOOL HYGIENE. Compared with previous years very little work of any considerable extent has been carried out on school buildings during the year. The chief work done has been the installation of electric light in the Lordship Lane Schools, the redecoration of these schools, and the provision of a new block floor in the Lordship Lane Infant School Hall. 4 IV.—MEDICAL INSPECTION. The medical inspections have been carried out on the same plan 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 2,459. Of these, 626 were entrants, 749 belonged to the second, and 552 to the third age-group, while 532 were of ages outside these three groups. In addition to these routine inspections 1.034 special cases were examined, and 2,838 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, 1934, was 5,824. The number examined by the School Medical Officers during the year was 3,593. V.—FINDINGS OF MEDICAL INSPECTION. Tables II, 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 shows that of 1,927 children examined in the code age-groups, only 141 showed definite defects calling for treatment; while of 532 children examined at other ages, 43 were found to require treatment. These figures must be regarded as very satisfactory. 5 (a) Malnutrition. The number of children recorded as suffering from malnutrition was only nineteen. There were, of course, others in a poorly nourished condition, whose poor condition was due to a definite disease, but in the case of these nineteen no such disease was present to account for the malnutrition, the defect being due either to failure or neglect on the part of the parents to provide proper nourishment, or to inability on the part of the child to profit by the nourishment provided. There is, I am glad to say, very little evidence of neglect on the part of parents, but there are very many cases where the family circumstances are such that when the high rent which is, unfortunately, so common in Wood Green has been paid, the amount left over from the weekly wage is obviously inadequate to provide all that is necessary in the wav of food and clothing for the family. In this type of case the Care Committee plays a very useful part, in providing meals at the feeding centre, or milk at school, or malt and oil at the School Clinic, and there is little doubt that these services by the Care Committee contribute in no small measure to the satisfactory state of nutrition of the elementary school children in Wood Green. In previous reports I have referred to the importance of the provision of a sufficient supply of milk to the growing child, and I have expressed the opinion that the steady growth of the milk habit among the children which has resulted from the institution of milk clubs in the schools is bound to cause a definite improvement in the nutrition of the children. During the past year the scheme set on foot by the Milk Marketing Board to provide milk for school children at one-half the former price has resulted in a very greatly increased number of the children in Wood Green having their daily bottle of milk, and over 60 per cent, of the elementary school children now avail themselves of this provision. (b) Uncleanliness. The standard of cleanliness among the children remains very high, and reflects great credit on the vast majority of the mothers. The school nurses visit the schools regularly to carry out routine inspections of the children for cleanliness. Over 40,000 individual inspections of children were made during the year, and the number 6 of exclusions on account of verminous conditions was only 195. These exclusions in many cases referred to the same children on more than one occasion, so that the actual number of offenders was much less than 195. (c) Minor Ailments and Diseases op the Skin. One hundred and twenty-nine 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. Seventy-seven children were recommended for treatment on account of defective vision or squint, while one hundred and seventy-four with minor defects of vision were referred for observation. Thirty-three children were found to require treatment for external diseases of the eye, while twenty-three were referred for observation. (e) Nose and Throat Defects. Nineteen children were recommended operative treatment on account of enlarged tonsils and adenoids, while two hundred and seven were referred for observation. Other conditions of the throat or nose requiring treatment were found in fifty-nine children, while twenty others were referred for observation. (f) Ear Disease and Defective Hearing. Eleven children were found to be so deaf as to require treatment for the defect, while four others were kept under observation. Other forms of ear disease requiring treatment were found in thirtynine children, and five others were kept under observation. (g) Dental Defects. The' result of the inspections carried out by the School Dental Surgeon is seen in Table IV, Group V. The dental scheme of inspection and treatment now covers practically all the school children, and it will be seen that, in all, 5,294 children were 7 inspected during the year. Of these the number found to require dental treatment was 3,625 and the number actually treated was 2,547. These figures are a considerable improvement on those for the previous year. (h) Orthopaedics and Postural Depects. Fifteen children were found to be suffering from crippling or postural defects requiring treatment. All of these have received orthopaedic hospital treatment or been under hospital observation during the year, with the exception of two, both of which are incapable of further improvement. (i) Heart Disease and Rheumatism. Evidence of cardiac abnormality was found in fifty-seven children. In the majority of these cases there was no evidence of organic disease, and among the twenty-five cases of organic disease several were congenital cases. In the others the commonest cause of disease was rheumatism, and in all, including these rheumatic heart cases, forty-two children were seen suffering from rheumatism during the year. In most of these cases the rheumatic pains were only occasional and not very severe, but in several cases there were definite attacks of acute rheumatism for which active treatment at home or in hospital had to be obtained. All these cases of rheumatism and heart disease are kept under regular supervision at the School Clinic. (j) Tuberculosis. Only two cases of active pulmonary tuberculosis were seen in school children during the year, both of which were admitted to Sanatorium. Five children who had been in Sanatorium but were now recovered or quiescent were kept under observation, and in every case they were able to attend school. Twelve cases of nonpulmonary tuberculosis, all of them quiescent or cured, were also kept under observation. VI.—FOLLOWING UP. All defects discovered at medical inspection are reported to the parents or guardians, with a request that the necessary treatment be obtained as soon as possible. Later, visits are paid to the 8 homes by the Visitation Officer, to see whether treatment is being obtained and, if not, to impress on the parent the importance of obtaining it. In most cases the necessary treatment is obtained without undue delay either privately or at hospital or at the School Clinic, but in a minority of cases considerable pressure has to be brought to bear on individual parents before 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 2,365. VII.—ARRANGEMENTS FOR TREATMENT. The normal procedure is to recommend the parents of children found to require medical treatment to obtain the treatment privately from the family doctor or at hospital, but where the circumstances are such as to make it difficult or impossible to obtain treatment privately, provision has been made by the Education Committee for the treatment of certain types of defect . Treatment is provided at the School Clinic for minor ailments, dental defects, and defects of vision, hearing and speech. Tonsils and adenoids have been 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. (a) Minor Ailments. Seven hundred and fifty-eight 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 fittle attention at home, but may, if neglected, have a detrimental effect on the health of the child. (b) Tonsils and Adenoids. Only two children were operated on during the year under the Committee's scheme for enlarged tonsils and adenoids, while a further eight were dealt with privately at home or in hospital. This number is very small and is only a fraction of the number which used to be dealt with by operation a few years ago. The procedure adopted is not to recommend operation except in those cases where it is obvious that the throat condition is definitely injuring the child's health. 9 (c) Visual Defects. The number of children dealt with by Dr. Boden at the Eye Clinic was 782, 316 of these being new cases. 313 children had spectacles prescribed for them, and of this number 293 had obtained the spectacles by the end of the year. In addition, a further 18 children were provided with spectacles privately or at hospital. 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 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 185, of whom 25 were children under school age. and the total attendances made were 541. 59 of the children treated were suffering from suppurative ear disease, and the results of the treatment given are shown in the following table. Nature of Disease Total. Cured. Lost Sight of. Still under Treatment. Requiring Hospital Treat, ment. Acute Suppurative Otitis Media 23 21 .. .. 2 Chronic Suppurative Otitis Media due to:— (a) Tympanic Sepsis 8 8 .. .. .. (b) T.S. and Granulations 4 3 .. .. .. (c) T.S. and Polypus 1 1 .. .. .. Attic Disease 7 .. .. 7 .. Mastoid Disease 9 2 .. 1 6 External Otitis 5 5 .. .. .. Not diagnosed 2 2 .. .. .. Totals 59 42 0 9 8 In addition to these cases of suppurative disease of the ear, Dr. Friel has treated a large number of children for catarrhal 10 inflammation and defective hearing. Excellent results have been obtained by diastolisation, a method of treatment which reduces the inflammatory condition of the nasal passages, enabling the child to breathe more easily, and so reducing the catarrh which is so often a 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. It will be seen that the scheme of dental inspection now covers practically the whole elementary school population, so that dental treatment is available for every school child during his whole elementary school life. Every effort is made to concentrate as much as possible on conservative treatment and to discourage the casual case which only wishes to attend for extractions at a stage when the affected teeth are no longer saveable. It will be seen that, so far as permanent teeth are concerned, the ratio of fillings to extractions is very satisfactory, 3,095 fillings to 481 extractions. In the case of temporary teeth, on the other hand, very much less time is devoted to fillings, the number of which is negligible compared with that of extractions. Various changes have been made in our procedure during the past year with a view to emphasising the importance of the preventive and conservative side of the dental work, and these changes have resulted in considerable improvement taking place. (f) Defects of Speech. The Speech Defect Clinic has continued to deal with children suffering from defects of speech, two classes being held each week, one for children of twelve years and over and the other for children under twelve. The improvement in most cases is necessarily slow, as each child requires individual attention, but the results are, on the whole, very gratifying, and in a large proportion of the cases dealt with complete cure is obtained. VIII.—INFECTIOUS DISEASES. The incidence of infectious disease in the school population was considerably greater in 1934 than during the previous year, the total number of cases notified to me from the schools being 1,064, as compared with 651 in 1933. 11 The following table gives the numbers of the different infectiousdiseases notified from the elementary schools:— Scarlet Fever 174 Diphtheria 18 Chickenpox 172 Measles 530 Mumps 15 Ringworm 9 Whooping Cough 70 Skin Infections 18 Conjunctivitis 58 Total 1,064 It will be seen that measles was responsible for more than half of the total number of notifications received. This disease was very prevalent during the early months of the year, 295 notifications being received from the schools in the first quarter and 211 in the second, while in the third and fourth the numbers were 21 and 3 respectively. Of the other non-notifiable diseases chickenpox was responsible for 172 cases and whooping cough for 70. A small outbreak of conjunctivitis in one of the schools was responsible for 58 cases of "pink eye" which yielded very readily to active treatment at the school clinic. Scarlet fever was prevalent in the district throughout the whole year but particularly in the last quarter, and was responsible in all for 174 cases among elementary school children. The incidence of diphtheria was very low, only eighteen cases being reported in school children. The incidence of Scarlet Fever and Diphtheria during 1934 is shown in the following table:— School. Scarlet Fever Diphtheria. Alexandra Boys 15 2 ,, Girls 13 1 ,, Infants 9 — Bounds Green Boys 6 1 ,, ,, Girls 4 — ,, ,, Infants 9 1 12 School. Scarlet Fever Diphtheria. Lordship Lane Boys 6 1 ,, ,, Girls 6 1 ,, ,, Infants 13 — Noel Park Boys 5 4 ,, Girls 10 1 ,, ,, Infants 12 3 Rhodes Avenue 7 2 St. Michael's Mixed 11 — ,, Infants 13 — St. Paul's 5 1 White Hart Lane Boys 10 — Girls 11 — ,, ,, ,, Infants 9 — Glendale County School 2 — Trinity County School 4 — Private Schools — — Schools outside Borough 19 — Under School age 49 10 Over School age 44 3 Totals 292 31 Immunisation against diphtheria has continued to be offered to the parents of all children in the infant departments of the schools, and to children under eight years of age in the junior departments. This work has been in progress now for several years, and has become part of the ordinary routine activity of the Health Department. It is carried out for the most part in the schools, the infant and junior departments being visited in rotation and the offer of immunisation made to all children not already immunised. The response varies very much from school to school, the number of acceptances being very high in some schools and very low in others. On the whole, however, progress is being made, and it is hoped that as the parents realise the value of the procedure, more advantage will be taken of the opportunity offered. As it is, there are several of the departments in which the number of children protected is well over fifty per cent., and experience shows that where such a high proportion of the children attending a school is immune, there is very little danger of diphtheria spreading. 13 The total number of children who had received a full course of injections at the end of 1934 was 2,389. Of this number, 1,918 had been Schick-tested and found immune, the Schick test being done, as a rule, five months after the course of injections has been completed. 211 were awaiting the Schick test at the end of the year, and 260 had failed to attend for testing when sent for. So far as the efficiency of the immunisation is concerned, only one case has occurred in which a child who had received a full course of injections, and after a negative Schick test been granted a certificate of successful immunisation, has subsequently developed even a mild attack of diphtheria. This particular child was immunised in January and February, 1930, and was Schick negative when tested in October, 1930. In April, 1934, he developed a sore throat which was thought to be suspicious of diphtheria. He was admitted to the Isolation Hospital and treated as a very mild case of diphtheria, being discharged well after four weeks. In the case of two other children, both of whom had been immunised in 1931, swabs taken from the throat during an attack of tonsillitis were reported positive in 1934. In neither case was there any clinical evidence of diphtheria. In one case the condition cleared up immediately, but in the other the swabs were positive for several weeks, although the child appeared to be perfectly well. IX.—OPEN-AIR EDUCATION. There are no open-air schools in Wood Green, nor are there any open-air class rooms in any of the 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. Considerable use seems to be 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. 35 boys from Bounds Green Boys School accompanied by two teachers took part in a school journey at Rhyl for a fortnight in June, while 21 girls from Bounds Green Girls School accompanied by two teachers had a school journey at Babbacombe, in Devon, also for a fortnight in June. These school journeys, as I have had occasion 14 to remark in previous reports, are excellent not only from the educational but also from the health point of view. In addition to these two school journeys, there was, as there has been for many years, a School Camp arranged by the Juvenile Organisations Committee for selected children from all the schools. The camp was held again at Dymchurch from August 17th to 31st, and 197 elementary school children had an excellent holiday. Twelve of these were boys from the School Sports Association, but the others, 98 boys and 87 girls, were children Selected from the different schools by the Juvenile Organisations Committee with the help of the head teachers, and in some cases on the recommendation of the School Medical Officers. The preference was naturally given to those children who seemed to be most in need of a holiday and least likely to be able to obtain one in any other way. The children were medically examined, weighed and measured before going to camp, and again weighed and measured on their return home. The benefit derived from the holiday was in practically every case very marked, and the gain in weight appreciable, and there is little doubt that both the children themselves and their parents are very grateful to the Juvenile Organisations Committee for the excellent holiday provided. This provision year by year is not carried out without very considerable expenditure of time and energy both in raising the money and in organising the camp, and Wood Green is fortunate in having a voluntary Committee of this kind which makes such a practical contribution year after year to the health and well-being of such a large number of its less fortunately situated children. X.—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. During the year the Education Committee in association with three neighbouring Education Committees appointed 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 47,121, as compared with 42,783 15 in the previous year, while those at the Open-Air Bath on the Alexandra Park Race Course were 5,443, as compared with 9,365 in 1933. There has been a steady increase in the attention given to swimming in the schools for many years past, and it is obvious that swimming is a very popular form of exercise among the children. The number of certificates of proficiency in swimming awarded to school children during the year was 2,097. Of this number 265, 170 boys and 95 girls, were awarded certificates for swimming 880 yards. These figures are highly satisfactory and reflect great credit on the Wood Green Sports Association, which does so much to encourage swimming among the school children. XI.—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. The children are, for the most part, selected on economic grounds, and are usually recommended by the teachers or by members of the Care Committee, although 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 food is served and the children waited on at table by a rota of ladies, most of whom are members of the Care Committee. The dinners provided have always been wholesome and nutritious, and some improvement has been made recently by introducing more variety into the menus and by improving the kitchen equipment. The number of children receiving dinners at the Centre during the year was 200, of whom 161 were fed free, 36 for part payment and 3 for full payment. The total number of meals provided was 22,649, of which 15,516 were given free, 7,086 for part payment and 47 for full payment. The average cost per meal was 4.4 pence, of which 2 pence represented the actual cost of food and 2.4 pence the cost of administration. In addition to the meals served at the Feeding Centre, 3,017 meals were provided at the School for the Partially Sighted in Lordship Lane for the children attending there. Of these, 1,129 meals were given free, 320 for part payment and 1,568 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, and a number of others 16 supplied with malt and cod-liver oil at the School Clinic either free or at cost price, on the recommendation of the School Medical Officers. XII.—CO-OPERATION. {a) Or Parents. The parents of the children are for the most part interested in the school medical inspections, and the great majority of the children are accompanied by a parent or guardian on these occasions. This is particularly the case in the infant departments, where over 90 per cent, of the parents attended, and to a lesser degree in the case of the second inspections, where 75 per cent, of the parents attended, while in the case of the leavers the attendance of parents was not so good, less than 40 per cent, attending. The attendance -of parents at the medical inspections is of considerable assistance to the Medical Officers as it enables them to get first-hand information as to the child's previous health, and makes it easy to direct attention to defects found present and to the treatment indicated. The parents as a rule are grateful for any advice given and ready to act on it, and there is no doubt that the success of the school medical service depends very largely on their willing co-operation. '(b) Of Teachers. To the teachers in the schools we are indebted for willing -co-operation at all times. 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 interested in our work, and I am glad to be able, as in former years, to express my thanks to them for their assistance. I have also to thank the School Attendance Officers for their very useful co-operation throughout the year. (c) Of Voluntary Bodies. Of the voluntary bodies whose activities are of value to the School Medical Service the chief is the Juvenile Organisations Committee. The 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 activities comprise the 17 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 express my thanks to the Tottenham Deanery Council for Moral Welfare for assistance received from its representative in connection with difficult cases whose moral welfare has required special supervision, and to the National Society for the Prevention of Cruelty to Children for the assistance of the local inspector in dealing with an occasional difficult parent. XIII.—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 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 for assistance to School Attendance Officers, School Nurses, Health Visitors and others. All defective cnildren are kept under 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 was one child from Wood Green at a certified school for the blind, while five others whose eyesight was so bad as to make it difficult for them to profit by instruction in an ordinary elementary school were in attendance at the Myopic Centre in Lordship Lane, or, as it should be more accurately described, the School for the Partially Sighted, not all the children who attend there suffering from myopia. The children there are under the regular supervision of the School Ophthalmic Surgeon, and the school is visited at regular intervals by the School Medical Officer. During the year certain modifications in the educational methods adopted for the instruction of these children have been made as a result of the recommendations contained in a special report of a Committee of 18 Inquiry into Problems relating to Partially Sighted Children, published in June, 1934, by the Board of Education. The general effect of these modifications is to allow not only the non-myopic but also the myopic children to do a certain amount of reading in school from books printed in specially legible type. This tends both to increase the interest of the school work and to reduce the amount of retardation which results from the visual disability from which these children suffer. The Wood Green School for the Partially Sighted provides accommodation not only for our own children, but for those from Hornsey, Tottenham, Enfield and Middlesex County. The number on the roll at the end of the year was thirty-one. Of these, five belonged to Wood Green, fourteen to Tottenham, six to Hornsey, four to Enfield and two to Middlesex. A mid-day meal is available at the school for those who are unable to go home at mid-day. (b) Deaf. There are five children on the register who are so deaf as not to be able to profit from 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. (c) Mentally Defective. Thirteen mentally defective children from Wood Green were in attendance at the Joint Special School for Mental Defectives at Finchley at the end of the year. The majority of these could be classed as high-grade defectives. The school is visited and the children medically inspected by the School Medical Officer at regular intervals, and many of these children are found to make quite considerable progress. Three children classed as mentally defective were in attendance at ordinary elementary schools, and one at a private school, the parents in each case objecting to their defective child being sent to a school for defectives. Five mentally defective children were not attending any school. 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. This Centre fulfils a very useful function in providing interesting 19 and useful occupation for a large number of unfortunates for whom no other provision is made. The defectives attending are medically inspected at regular intervals, and treatment for their dental defects and minor ailments is arranged for at the School Clinic. (d) Epileptics. Three children suffering from epilepsy are on the special register. One of them is so severely afflicted as not to be able to attend school. The two others had responded to treatment so well as to be able to attend school. XV.—NURSERY SCHOOLS. There is no Nursery School in Wood Green, but for the past few years classes for children under school age have been held in two of the Infant Departments. These classes continue to meet a very definite need, and provide a healthy environment during the day for a number of children whose home circumstances are not altogether satisfactory. XVI.—SECONDARY SCHOOLS. By arrangement between the Middlesex County and Wood Green Education Authorities, the routine and special medical inspections of the pupils attending the two Secondary Schools in Wood Green have been carried out as in former years by the Assistant School Medical Officer and myself. Defects found at medical inspection are reported to the parents, who make their own arrangements for treatment. It will be remembered that an arrangement was arrived at with the Middlesex Education Committee some years ago by which treatment for visual and dental defects in secondary school pupils was to be provided at the School Clinic. This had not come into force by the end of 1934, but I am glad to say that a commencement has now been made in April, 1935. XVII.—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 20 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. When the circumstances of the parents are such as to make it difficult or impossible for them to meet the full cost of treatment supplied to their children, these circumstances are put before the Care and After-Care Committee, and the sum charged to the parents reduced or remitted, as the case may be. XVIII.—HEALTH EDUCATION. In 1932 a recommendation made by the Joint Advisory Committee of the Education Committee and the teaching staff was adopted by the Education Committee 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. From enquiry made from time to time in different schools, I understand that this recommendation is being followed, and I have recently been very glad to see in one of the schools a syllabus drawn up by the head teacher for the use of the staff which covered the ground very well and supplied definite evidence that instruction in this very important subject is being regularly and satisfactorily given in the schools. XIX .—MISCELLANEOUS. Under the bye-laws regulating the employment of children and young persons, I have examined fifteen children during the year. One was 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 at the request of the Committee. Before concluding this Report, I wish to mention one matter of which most members of the Education Committee need no reminding, and that is the unsatisfactory state of the School Clinic. The building, as the Committee is well aware, is old and in poor state of repair. In addition, the accommodation is in many 21 respects inadequate, and at times there is very considerable overcrowding, as, for instance, when minor ailment, dental and speech defect clinics are being held at the same time, as is sometimes inevitable. By arrangement with the Maternity and Child Welfare Committee, the Eye and Ear Clinics are held at the Child Welfare Centre in White Hart Lane, and while this arrangement works very well, it would, of course, be much better if we had a really satisfactory School Clinic, in which all our medical treatment could be carried out. I am well aware of the difficulties which have stood in the way hitherto of a new Clinic being provided, and also that the subject is under consideration by the Committee at the moment, but I think it right to remind the Committee of the difficulties under which our work is at present being done, and of the importance of providing more satisfactory accommodation at the earliest possible moment. In conclusion, I wish to express my appreciation of the support and encouragement which the Education Committee has at all times given to its school medical services. I wish also to thank the Director of Education and his staff for assistance which is always readily available, and my own staff for the loyal and willing service on which 1 can invariably count. I am, Ladies and Gentlemen, Your obedient servant, MALCOLM MANSON, School Medical Officer. 22 APPENDIX MEDICAL STATISTICAL TABLES, 1934. TABLE I.— RETURN OF MEDICAL INSPECTIONS. A.— ROUTINE MEDICAL INSPECTION. Age. Entrants. 3 4 5 6 Other Ages. Total. Boys - 11 189 69 34 303 Girls - 16 183 89 35 323 Totals - 27 372 158 69 626 Second Age Group (8 to 9 Years). Age. 8 Other Ages. Total. Boys 305 76 381 Girls 292 76 368 Totals 597 152 749 Third Age Group. Age. 12 13 14 Other Ages. Total. Boys 215 54 8 - 277 Girls 200 70 5 - 275 Totals 415 124 13 - 552 23 A.— ROUTINE MEDICAL INSPECTION—Continued. Number of other Routine Inspections. (Varied Ages) Boys 273 Girls 259 Total 532 Grand Total. Entrants Second Age Group. Third Age Group. Other Routine Inspections. Total. Boys 303 381 277 273 1234 Girls 323 368 275 259 1225 Totals 626 749 552 532 2459 B.— OTHER INSPECTIONS. No. of Special Inspections. No. of Re-Inspections. Boys 483 1193 Girls 551 1645 Totals 1034 2838 24 TABLE II. A.— RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DEC., 1934. 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) Malnutrition 9 6 4 ... Skin Ringworm— Scalp ... ... 7 2 Body ... ... 4 ... Scabies ... ... 12 1 Impetigo 1 1 7 1 Other Diseases (non-Tuberculous) 1 7 25 6 Eye Blepharitis 4 5 5 ... Conjunctivitis 4 1 10 1 Keratitis ... 1 ... ... Corneal Opacities ... ... ... ... Defective Vision 65 155 2 1 (excluding Squint) Squint 9 18 1 ... Other Conditions 7 17 3 2 Ear Defective Hearing 8 4 3 ... Otitis Media 2 1 1 ... Other Ear Diseases 10 3 17 1 Nose and Throat. Chronic Tonsillitis only 5 184 12 22 Adenoids only 2 ... ... ... Chronic Tonsillitis and Adenoids ... 1 ... ... Other Conditions 21 7 38 13 Enlarged culous Cervical Glands (Non-Tuber- ... 50 1 23 Defective Speech 4 14 1 1 25 TABLE II— continued. Routine Inspections. Special Inspections. No. of Defects. No. of Defects Defect or Disease. 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 10 12 ... ... Functional 4 7 ... 1 Anæmia 6 96 ... 1 Lungs Bronchitis 5 7 2 1 Other Non- Tuberculous Diseases ... 5 1 2 Tuberculosis Pulmonary— Definite ... 2 ... 2 Suspected ... 1 1 ... Non-Pulmonary— Glands ... 1 ... ... Bones and Joints ... ... ... 2 Skin ... ... ... ... Other Forms ... ... ... ... Nervous System. Epilepsy ... ... 5 1 Chorea ... 2 1 ... Other Conditions ... 9 1 8 Deformities. Rickets 1 1 1 ... Spinal Curvature ... 8 ... 1 Other Forms 2 7 4 6 Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 3 17 40 33 26 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 626 33 52 Second Age Group 749 46 6.1 Third Age Group 552 62 11.2 Total (Prescribed Groups) 1927 141 7.3 Other Routine Inspections 532 43 8.0 27 TABLE III. 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—5. 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. 5 - - - 5 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 - 4 - - 6 28 MENTALLY DEFECTIVE CHILDREN. Feeble- Minded Children. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 13 3 1 5 22 EPILEPTIC CHILDREN. Children Suffering From Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. - 2 - 1 3 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. - - 2 - 2 II.— Children Suffering from Non-Pulmonary Tuberculosis. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. - 7 1 2 10 B.— Delicate Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 1 26 - - 27 29 C.— Crippled Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. - 10 - - 10 D.— Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 1 - - - 1 CHILDREN SUFFERING FROM MULTIPLE DEFECTS. Boys. 1 Mental Defect and Epilepsy. Not attending School. 1 ,, ,, ,, ,, Notified to County. 1 ,, ,, ,, ,, ,, ,, Girls. 1 Mental Defect and Epilepsy. Notified to County. 1 ,, ,, ,, Hemiplegia. Special School for Mental Defectives. 30 TABLE IV. Return of Defects Treated during the Year Ended 31st December, 1934. TREATMENT TABLE. Group I.— Minor Ailments (excluding Uncleanliness, for which 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 3 - 3 Ringworm—Body 6 - 6 Scabies 7 - 7 Impetigo 46 - 46 Other skin diseases 49 - 49 Minor Eye Defects (external and other, but excluding cases falling in Group II.) 150 - 150 Minor Ear Defects 129 - 129 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 368 - 368 Totals 758 - 758 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. No. of children for whom spectacles were Under the Authority's Scheme. Otherwise. Total. Prescribed (1) Obtained (2) (i) Under the Authority's Scheme. (ii) Otherwise. (ii) Under the Authority's Scheme. (ii) Otherwise. (1) (2) (3) (4) Errors of Refraction (including squint). 673 21 694 313 8 293 18 (Operations for squint should be recorded separately in the body of the School Medical Officer's Report.) Other Defect or Disease of the Eyes (excluding those recorded in Group I) 109 2 111 Total 782 23 805 Group III.— Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) - - 2 - - - 8 - - - 10 - 51 61 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and Adenoids, (iv) Other defects of the nose and throat. 32 Group IV.— Orthopaedic and Postural Defects. 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 - - - - - 4 4 Group V.— Dental Defects. (1) Number of Children who were— (2) Half-days devoted to:— (a) Inspected by the Dentist— Aged: Inspection 37 Total 424 Treatment 3871 Routine Age Groups 5 220 Total 4901 (3) Attendances made by children for treatment 4234 6 430 7 518 8 621 (4) Fillings:- 9 580 Permanent teeth 3095 Total 3191 10 623 11 628 Temporary teeth 96 12 511 (5) Extractions:— 3 457 14 269 15 44 Permanent teeth 481 Total 4093 Temporary teeth 3612 Specials 393 (6) Administrations of general anaesthetics for extractions 1073 Grand Total 5294 (b) Found to require treatment 3625 (7) Other operations:— Permanent teeth 470 Total 544 Temporary teeth 74 (o) Actually treated 2547 33 Group VI.— Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses 12. (ii) Total number of examinations of children in the Schools by School Nurses 41823. (iii) Number of individual children found unclean .. 195. (iv) Number of children cleansed under arrangements made by the Local Education Authority Nil. (v) Number of cases in which legal proceedings were taken :— (а) Under the Education Act, 1921 Nil. (b) Under School Attendance Byelaws Nil. STATEMENT of the Number of Children Notified During the Year ended 31st December, 1934, by the Local Education Authority to the Local Mental Deficiency Authority . Total Number of Children Notified, 7. 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 - - (ii) Children unable to be instructed in a Special School without detriment to the interests of other children: (a) Moral defectives - - (6) Others 1 1 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 2 3 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 3 4 34