AC439 (1) WOOD 6 reew Borough of Wood Green. Annual Report of the Medical Officer of Health and School Medical Officer for the Year 1935. MALCOLM MANSON, M.C., M.A., M.D., D.P.H. Medical Officer of Health and School Medical Officer. 1936. Cru8ha & Son, Ltd., Wood Oreen, Tottenham and Enfield. A. Accidents due to Traffic 8 Acts of Parliament 13 Ambulance Service 12 B. Bacteriological Examinations 14 Baths 21 Births 5 Bye-laws 14 C. Clinics— M. & C. W 15 School 15 Tuberculosis 16 Venereal 16 D. Day Nursery 20 Deaths 6 Diphtheria Immunisation 38 Disinfection, etc. 42 Drainage and Sewerage 21 F. Factory and Workshop Acts 27 Food and Drugs Acts. 34 Food Inspection 33 Foster Mothers 20 H. Hospitals 9 House-to-House Inspection 26 Housing Statistics 30 I. Infantile Mortality 7 Infectious Diseases— Cases removed to Hospital 36 Cases attending Schools 37 INDEX to the Report of the Medical Officer of Health. M. Maternity & Child Welfare— Ante-Natal Clinic 18 Centres 17 Dental Work 19 Free Food 19 Home Visiting 19 Maternity Hospital provision 18 Maternity and Nursing Homes 9 Maternal Mortality 7 Sunlight Treatment 19 Toddlers Clinic 18 Midwives 9 Mortuary 32 N. Nursing in the Home 8 P. Poor Law Relief 8 Population 5 R. Rent Restriction Acts 32 Rivers and Streams 21 S. Sanitary Inspection 21 Shops' Act 30 Slaughterhouses 34 Social Conditions, etc 4 Staff 2 Statistical Tables— Birth and Death Rates 45 Causes of Death 46 Infectious Diseases 49 Infantile Mortality 48 Meteorological Report 51 Tuberculosis 50 Vital Statistics 44 T. Tuberculosis 40 V. Vital Statistics, Extract from 4 W. Water Supply 21 Z. Zymotic Mortality 7 Borough of Wood Green. PUBLIC HEALTH COMMITTEE. Councillor E. J. Anderton, L.D.S. (Chairman). The Mayor (Alderman H. Tudor Rhys, J.P.). The Deputy Mayor (Alderman F. G. Holmes, J.P.). Councillor H. Barnes. Councillor Mrs. A. Duncan. Councillor Mrs. J. Cole. Councillor B. L. Lloyd. Councillor F. Corbett. Councillor A. Oliver. Councillor W. G. Doyle. Councillor W. J. Payne. Councillor H. E. Teale. 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 A. R. Harrison. Councillor Mrs. J. Cole. Councillor Mrs. L. C. Vant. Co-opted Members:— Mrs. L. Barnes. Mrs. M. Blue. Mrs. E. L. Corbett. 2 STAFF during 1935. * Medical Officer of Health.—Malcolm Manson, M.C., M.A., M.D., D.P.H. *Assistant Medical Officer of Health.—Miss Margaret McDonald Miller, M.B., Ch. B., D.P.H. *District Sanitary Inspectors.—S. C. Stanbury, Cert. R. San. Inst., Cert. Meat and Food Inspection; G. C. Billing, Cert. R. San. Inst., Cert. Meat and Food Inspection; W. McCauley, Cert. R. San. Inst., Cert. Meat and Food Inspection (appointed June 1935.). *Health Visitors.—Miss G. Moore, C.M.B. ; Miss F. Orwin, C.M.B. ; Miss F. Medd, C.M.B. *Nurse-in-Charge, Day Nursery.—Miss C. Hunt (resigned November 1935). Miss V. W. Moss (appointed January 1936). 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 Moss 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 Ashburton House, Wood Green, N.22. June 10th, 1936. To the Mayor, Aldermen and Councillors 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 1935. The year has been uneventful so far as the health of the community is concerned, and the district has been free from any serious outbreak of infectious disease. The vital statistics are on the whole satisfactory; the birth-rate is very slightly higher and the death-rate appreciably lower than the corresponding rates for the previous year. I desire 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 every member of the Health Department for work well done. 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 53,470 Number of inhabited houses (end of 1935, according to the Rate Books) 13,429 Rateable Value, 1935 £511,876 Sum represented by a penny rate £2,050 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births— Total. M. F. Legitimate 548 274 274 Birth Rate 10.7. Illegitimate 22 14 8 Stillbirths 22 11 11 Rate per 1,000 births, 37.1. Deaths 529 249 280 Death Rate, 9.9. 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 27 Rate per 1,000 live births, 47. Legitimate 26 Rate per 1,000 legitimate live births, 47. Illegitimate 1 Rate per 1,000 illegitimate live births, 45. Deaths from:— Measles (all ages) — Whooping Cough (all ages) — Diarrhoea (under 2 years of age) 10 5 POPULATION. The Registrar-General's estimate of population for 1935 was 53,470, and I have used this figure to calculate the birth and death rates for the year. It represents a decrease of 285 in the population from that of 1934 which was 53,755, and this is the fourth successive year in which the Registrar-General's estimate has shown a slight decrease of population. During that period several hundred new houses have been built in the district, and as the birth-rate during these years has been slightly higher than the death-rate, the estimate if correct must mean that the number of people leaving the district each year exceeds by several hundreds the number coming in. With the district now practically fully buiit up, the likelihood is that the slight fall in population which has been evident during the past few years will continue. BIRTHS. The number of live births registered during the year was 570, as compared with 564 for 1934 and 601 for 1933. Of the 570, 288 were male and 282 female. The birth-rate was 10.7 per 1,000 of population, a very slight increase on that for the previous year, which was 10.5. The birth-rate for the whole country was 14.7, and for the 121 great towns (which include Wood Green) it was also 14.7, so that in 1935 as in previous years the birth-rate in Wood Green was very much lower than both that of the whole country and that of the great towns. 22 stillbirths were registered, 11 male and 11 female. The births registered in the borough were distributed in the different Wards as follows:— Alexandra-Bowes 83 Town Hall 264 Noel Park 144 491 6 DEATHS. The number of deaths belonging to Wood Green, after making the necessary adjustments for inward and outward transfers, was 529, 249 male and 280 female. This represents a death-rate of 9.9 per 1,000 of population, which compares favourably with that for the previous year, which was 10.5. It compares favourably also with that for the country as a whole, which was 11.7, and that of the 121 great towns, which was 11.8. Of the total deaths, 288 or 54 per cent. occurred in persons over 65 years of age. The corresponding percentage for 1934 was 49 and for 1933 was 52. The distribution of deaths over the year was as follows:— First quarter, 147; second, 139; third, 101; and fourth, 142. The distribution of deaths according to Wards was:— Alexandra-Bowes 166 Town Hall 187 Noel Park 176 529 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 161 deaths, or 30 per cent. of all the deaths. Of these deaths from heart disease, two-thirds occurred in persons over 65 years of age. Cancer came second as a cause of death with 83 deaths, and was followed by cerebral haemorrhage with 35 deaths, "other circulatory diseases" with 29 deaths, and pneumonia with 26 deaths. Tuberculosis was the cause of death in 24 cases, a much 7 smaller number than usual. Only 2 deaths were attributed to influenza. 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 15. Of this number, one was due to scarlet fever, four to diphtheria and ten to diarrhoea. Of the ten deaths from diarrhoea or gastro-enteritis no fewer than eight occurred in one hospital, most of them in babies born in the hospital. The Zymotic Death Rate was 0.28 per 1,000 of population as compared with 0.13 for the previous year. INFANTILE MORTALITY. The number of deaths occurring in children under 12 months of age was 27, and the Infantile Mortality Rate 47 per 1,000 live births. This is not so favourable as that for the previous year, when there were only 21 infantile deaths and an Infantile Mortality Rate of 37. The increase was more than accounted for by the large number of deaths due to gastro-enteritis, to which I have referred already. 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 of 27 infantile deaths no fewer than 15 occurred in the first month of life. The chief causes of death were gastroenteritis, which accounted for ten deaths and broncho-pneumonia which accounted for six. MATERNAL MORTALITY. Only one death was registered as a maternal death, the death in this case being due to puerperal sepsis. The Maternal Mortality Rate was, therefore, 1.7 per 1,000 births. In another case, however, death occurred from sepsis after self-induced abortion, but as 8 the finding at the inquest was "felo de se," this death appears among those registered as due to suicide, and not among the puerperal deaths. 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 1935:— No. of Persons Amount gra: nted £ s. d. Ordinary Cases 1,134 14,639 12 7 Unemployed Cases 1,171 3,242 15 1 Total 2,305 17,882 7 8 The amount granted in 1934 was £15,106 19s. 6d. 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 1935. There were 108 accidents in the High Road and 114 elsewhere in Wood Green, as compared with 134 and 163 respectively during 1934, and the use of a motor ambulance was required on 200 occasions as compared with 239 in 1934. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Professional Nursing in the Home. (a) General. The Wood Green Nursing Association, which is affiliated to the Queen's Institute of Nursing, provides a home nursing service for sick persons in the Borough who are under the care of 9 medical practitioners. The services of two nurses maintained by the Association are much in request by members of the Association, but there is, in my opinion, room for considerable extension of this work in Wood Green. (b) Infectious Diseases. It is part of the duty of the Health Visitors to visit cases of ophthalmia neonatorum, measles, whooping cough or pneumonia occurring in young children in their areas. By arrangement with the 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. During the year eight midwives residing in the Borough notified their intention to practise. MATERNITY AND NURSING HOMES. There was one Maternity Nursing Home in the Borough during 1935 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, Muswell 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 fifty patients. 10 The cases admitted are for the most part those of scarlet fever and diphtheria, but in case of need accommodation 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. 3. Tuberculosis. Provision for the treatment of tuberculosis is made by the Middlesex County Council, and I am indebted to Dr. Tate, the County Medical Officer, for the following information showing the accommodation available at the different institutions during 1935. Institution. Accommodation. Type of case. Adults. Children. M. F. County Sanatorium, Harefield 129 129 56 Pulmonary—Sanatorium. 4 (for male and f emale altern ately) 8 Pulmonary—Observation. County Sanatorium, Clare Hall, South Mimms 120 66 — Pulmonary—late sanatorium and hospital. Heather wood 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. 11 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 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 Wood Green and Southgate Hospital, £100 to the Prince of Wales's Hospital, and £100 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. 12 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. During the year the Ambulance was used on 1,349 occasions, 185 being cases of street accident (14 of which were for neighbouring authorities) and 43 cases of illness in the street. The total mileage for the year was 10,189. The sums received from various users amounted in all to £25 9s. 6d. The question of the provision of a second ambulance has been under consideration by the Public Health Committee during the year. (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. 13 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. Permissive Acts Adopted. Baths and Washhouses Acts, 1846 to 1925. Infectious Diseases (Prevention) Act, 1890. Public 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. 14 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 43. 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, 1890, with respect to Telegraph and other wires. (2) 1923, Rules with respect to Allotments. (3) 1927, Bye-laws with respect 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. (9) 1935, Bye-laws with respect to Nuisances. (10) 1935, Bye-laws with respect to Slaughter-houses. 15 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 Clinics Monday, 2 p.m. to 4 p.m. The Council. 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.. Congregational Church Hall, Alexandra Park Road— Tuesday, 2 p.m. to 3 p.m. ,, Child Welfare Clinic Thursday, 10 a.m. to 12 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) ,, 16 Name and Situation. Provided by Aural— The Child Welfare Centre, White Hart Lane (1 session per fortnight) The Education Committee. Dental— Stuart Villa, Stuart Crescent (5½ 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 Hospftal 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 1935 as belonging to Wood Green was 570 according to the information supplied by the Registrar-General. The number of births registered in the Borough during the year was 491, and the percentage notified under the Notification of Births Act was 95.9. The number of stillbirths registered was 22 and the number notified 21. Child Welfare Centres. Maternity and Child Welfare Clinics were held at the Centre in White Hart Lane on Monday afternoons, Wednesday mornings and afternoons and Friday mornings, and in the Hall attached 17 to the Congregational Church at the junction of Alexandra Park Road and Albert Road on Thursday mornings throughout the year. The attendances at the Centres during the year are shown in the following table:— January 1,090 February 1,059 March 1,157 April 1,134 May 1,290 June 1,166 July 1,563 August 1,055 September 1,401 October 1,780 November 1,396 December 1,217 Total 15,308 The attendances in 1934 were 14,559. The attendances at the Centre in the Alexandra Park area numbered 2,380, as compared with 1,995 in 1934. The number of individual children brought to the Centres during the year was 1,489, of whom 687 were infants under 1 year of age, and 802 of from 1 to 5 years of age. The number of children seen by Dr. Miller at the Centres during the year was 1,466. 681 of these were infants under 12 months of age, who made 2,955 attendances, while 785 were children of from 1 to 5 years of age and their attendances numbered 2,166. Of the 27 infantile deaths which occurred during the year, in only 6 cases had the baby been brought to one of the Welfare Centres. 18 Ante-Natal Clinic. An ante-natal clinic was held at the White Hart Lane Welfare Centre every Friday afternoon, and for one hour on Tuesday afternoons. The number of expectant mothers seen by the Medical Officer was 277 and the total attendances made numbered 954.' The remainder of the Tuesday afternoon Clinic was allotted to post-natal cases, the number seen being 35 and the attendances 49. Toddlers' Clinic. A special clinic for Toddlers has been held one afternoon per month throughout the year, where children between the ages of two and five years are subjected to medical inspection. By this means a considerable proportion of children have at least one medical inspection before attaining school age. The number of attendances during the year was 206. 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. 25 cases were sent to these maternity hospitals during the year. A large number of mothers in Wood Green are admitted to the North Middlesex Hospital for confinement, mostly through the Public Assistance Committee, and the total number of births occurring in hospital or nursing home is increasing steadily year by year. During the year conferences were held with neighbouring authorities on the subject of maternity hospital accommodation, as a result of which representations were made to the Middlesex County Council with a view to the provision of increased accommodation. 19 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 anaesthetic) 25 ,, (with gas) 469 Fillings 52 Scalings, etc. 199 Advice only 228 Dentures provided 22 Light Treatment. By arrangement with the Middlesex County Council, mothers and children are sent, as occasion arises, to the North Middlesex County Hospital for artificial sunlight treatment. Home Visiting. During the year the Health Visitors made a total of 7,271 home visits to mothers and children. 3,017 of these visits were to babies under one year of age, 3,864 to children of from 1 to 5 years of age, and 390 were ante-natal visits to expectant mothers. Free Food. Free food, consisting mostly of dried milk or malt and cod liver oil, was issued during the year to necessitous expectant and nursing mothers attending the Centres, at a cost of £120 7s. 1d. Cows' milk was issued similarly at a cost of £170 10s. 1d., Free dinners were also supplied to necessitous mothers at the Feeding Centre in White Hart Lane at a cost of £7 19s. 9d. 20 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 foster-mothers and foster-children on the register at the end of the year was 13 and 14 respectively. Day Nursery. The work of the Day Nursery has been carried on as in previous years at Stuart Villa, where, in spite of the poorness of the accommodation, much good work has been done. The question of erecting a new Day Nursery was raised again during the year, but no progress has so far been made with the proposal. The following table shows the attendances made at the Day Nursery throughout the year, and the corresponding figures for the previous year:— 1935. 1934. January 364 423 February 420 418 March 420 546 April 473 423 May 356 371 June 308 522 July 498 417 August 229 450 September 343 434 October 546 390 November 355 278 December 375 391 4,687 5,063 21 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 sewerage to a pumping station situated in Tottenham. Here the sewage is pumped into the London County Council's sewers, by arrangement with that Council. The pumping station and main sewer in Lordship Lane are under the control of a Joint Drainage Committee, consisting of representatives from Tottenham and Wood Green. The surface-water drains discharge into the Council's surfacewater sewers through which the surface-water flows into the Moselle and Muswell Brooks, and by these is carried finally into the River Lea. BATHS. In 1935 the new swimming pool at Durnsford Road was open for the first time for the full summer season, May to September, and in spite of considerable periods of very cold weather, the attendances were very satisfactory, and it was obvious that the demand for proper open-air bathing facilities in the district is very great. The attendances numbered in all 138,378—114,141 adults and 24,237 children. During the eight weeks the pool was open in 1934 the attendances were 51,827. 22 The attendances at the Western Road Baths and at the openair bath on the racecourse at Alexandra Park for 1935 and the three preceding years are shown below. Western Road Baths. Open-air Bath. Adults. School Children. Adults. School Children. 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 1935 115,507 43,054 11,951 7,036 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 659 Re-inspections 1,034 Complaints investigated 121 Inspections under the Housing (Consolidated) Regulations, 1925 586 Inspections under the Housing Acts. 166 Re-inspections 1,122 Inspections of Houses let in lodgings 26 Re-inspections 163 Total 3,877 Inspections under the Rent Restrictions Act 20 Grand Total 3,897 Enquiries in connection with Infectious Disease:— Smallpox 3 Scarlet Fever 429 Diphtheria 86 Tuberculosis 87 Enteric 2 Total 607 23 Inspections of Registered Premises:— Factories 17 Workshops 201 Workplaces:— Butcher's Shops 962 Dairies 177 Fried Fish Shops 142 1,281 Slaughter-houses 86 Outworkers 128 Total 1,713 Miscellaneous Inspections:— Urinals 320 Passageways 78 Cinemas and other places of entertainment 38 Ice cream premises 102 Stalls—day and night visits 570 Smoke observations 3 Total 1,111 Total inspections during the year 2,824 Action Taken:— Issued. Completed . Verbal intimations 39 39 Preliminary Notices:— Public Health Act, 1875, Section 94 166 158 Public Health Act, 1875, Section 36 175 173 Public Health Act (Amendment) Act, 1890, Section 22 1 1 Housing Act, 1925, Section 5 5 5 Housing Act, 1930, Section 17 192 133 Infectious Disease (Prevention) Act, 1890, Section 5 225 225 Wood Green Urban District Council Act, 1920, Section 77 11 11 Factory and Workshop Act, 1901, Section 99 1 1 Bye-laws regulating houses let in lodgings 13 20 Shops Act, 1934, Section 10 23 13 812 740 24 Statutory Notices:— Issued. Completed. Public Health Act, 1875, Section 94 11 8 Public Health Act, 1875, Section 36 3 2 Public Health Act, 1875, Section 41 1 1 Public Health Act (Amendment) Act, 1907, Section 25 9 2 Housing Act, 1930, Section 17 14 12 Infectious Disease (Prevention) Act, 1890, Section 5 7 7 The Wood Green Urban District Council Act, 1920, Section 77 1 1 The Wood Green Urban District Council Act, 1920, Section 48 2 - Bye-laws regulating houses let in lodgings — 1 41 34 Work Carried out:— Drainage Works:— Drains reconstructed 15 Drains repaired 3 Drains unblocked and cleansed 25 Soil and vent shafts repaired or provided 10 Fresh air inlets repaired or provided 14 Sink and bath wastes repaired 26 Inspection chambers repaired 10 Interceptors repaired 6 Drains tested 61 170 Water Closets:— New water-closets provided 4 New water-closet pans provided 38 Water-closets repaired 25 Foul water-closets cleansed 26 Flushing apparatus repaired or provided 39 132 25 Cleansing:— Premises limewashed 3 Premises otherwise cleansed 2 Rooms cleansed after disinfection 232 Rooms disinfested 124 Accumulations of refuse removed 8 Keeping of animals discontinued 7 376 Dampness:— Roofs repaired, etc. 143 Eaves gutters repaired or provided 56 Rainwater pipes repaired or provided 29 Damp proof courses provided 6 Walls rendered 25 Dampness otherwise remedied 44 303 House repairs:— Floors repaired—wood 38 Floors repaired—concrete 18 Coppers repaired or provided 38 Ceilings redecorated 619 Walls redecorated 597 General repairs 557 Fireplaces repaired 64 Stoves repaired 52 Premises repainted 20 2,003 Miscellaneous:— Food stores repaired or provided 20 Yard pavings repaired 37 Dustbins provided 225 Water supply taken from mains 6 Baths, sinks and lavatory basins fixed 47 Gullies fixed 12 Overcrowding remedied 1 348 Total works carried out during the year 3,332 26 HOUSE-TO HOUSE INSPECTION. NUMBER OF HOUSES INSPECTED, 1935. Road. No. of Houses. No. of Rooms. Families. Persons per room. Adults. Children. Alexandra Road 49 302 189 27 0.72 Blenheim Road 27 165 136 18 0.93 Blenheim Grove 9 36 29 6 0.97 Buller Road 9 42 39 7 1.09 Chapmans Terrace 4 20 17 1 0.90 Cross way 14 70 60 25 1.21 Croxford Gardens 20 100 91 27 1.18 Gospatrick Road 41 205 177 38 1.05 Homecroft Road 47 255 175 24 0.78 James Gardens 20 100 85 28 1.13 Lordship Cottages 5 20 18 4 1.10 May Terrace 10 40 23 2 0.63 Neville Place 19 76 66 10 1.00 Norman Avenue 81 371 298 43 0.92 Perth Road 21 105 88 31 1.13 Ringslade Road 53 213 156 24 0.85 Rivulet Road 67 335 323 74 1.18 Warberry Road 44 177 158 23 1.02 Warlborough Road 32 130 97 8 0.81 Watsons Road 7 28 24 9 1.18 White Hart Lane 7 35 33 6 1.12 Totals 586 2825 2282 435 0.96 27 FACTORIES, WORKSHOPS, WORKPLACES, LAUNDRIES, AND HOMEWORK. 1.—Inspection. Including Inspections made by the Sanitary Inspectors. Premises. Inspections. Notices. Prosecutions Factories— (Including Factory Laundries) 17 3 - Workshops— (Including Workshop Laundries) .. 201 2 - Workplaces— (Other than Outworkers' Premises) 1281 3 — Total 1499 8 — 2—Defects Found. Particulars. Found. Remedied Referred to H.M. Inspectr Prosecutions. Nuisances under the Public Health Acts— Want of Cleanliness 4 4 — — Want of Ventilation — — — — Overcrowding 1 1 — — Want of Drainage of floors — — — — Other Nuisances 3 3 — — Sanitary Accommodation— Insufficient 1 1 — — Unsuitable or Defective 2 2 — — 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 11 11 - - 28 3.—Homework. Nature of Work. Outworkers' Lists under Section 107 of Factory and Workshop Act, 1901. Received twice in the year. Received once in the year. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. The making, cleaning, washing, altering, ornamenting, finishing and repairing of wearing apparel 20 - 47 25 - 30 The making-up, ornamenting, finishing and repairing of table linen, or other household linen, and any process incidental thereto 1 - 1 3 - 3 The making of curtains and furniture hangings and any process incidental 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 - — — 1 — 1 The making or repairing of umbrellas, sunshades, parasols or parts thereof — - - - - - Total 23 — 50 30 — 35 29 4.—Registered Workshops. Workshops on the Register (S. 131) at the end of the year. (Important classes of Workshops, such as Workshop Bakehouses may be enumerated here). Class. Number. Wearing Apparel 25 Dining Rooms 14 Laundries 1 Bakehouses 16 Boot Repairers 12 Mechanical Repairs 9 Upholstery 5 Other Workshops 32 Total 11 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.I.'s notifications 3 30 SHOPS ACT, 1934. The above Act came into force on the 30th day of December, 1934, and all shops to which the Act applies have been inspected to see if they comply with the requirements of Section 10 of the Act with regard to heating, ventilation, lighting, sanitary conveniences, washing facilities and facilities for the taking of meals. Number of inspections made 902 Number of informal notices served 23 Number of informal notices complied with 13 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) 1,437 (b) Number of inspections made for the purpose 3,756 (2) (a) Number of dwelling-houses (included under sub-head 1 above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 586 (b) Number of inspections made for the purpose 1,072 (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 576 2.—Remedy of defects during the year without service of formal Notices. 31 Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 484 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 (2) Number of dwelling-houses which were dered fit after service of formal notices— (а) 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 16 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 12 (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 32 (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 Rent Restriction Acts. Six certificates were granted under the above heading during the year 1935. NEW HOUSES BUILT DURING 1935. I am indebted to the Borough Surveyor for the following information relating to new houses erected in Wood Green during 1935:— Number of houses erected during 1935 44 Number of flats erected during 1935 53 Number of houses built by the Council Nil Number built by other bodies and persons 97 PUBLIC MORTUARY. Bodies deposited during the year 39 Inquests held 13 Post-mortem examinations 36 Causes of death:— Natural causes 30 Accidental 4 Suicide 5 33 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 15 Supplementary Licences to sell milk from premises which are outside the area of the Licensing Authority. Certified. Grade A (Tuberculin Tested). Grade A (Pasteurised). Pasteurised. 2 2 — 1 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. 34 (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 carcases 600 Bovine liver and lungs 38 Pigs' pluck 6 Pigs' heads and necks 67 Pressed pork 264 Other meat 18½ Fish 168 Chocolates 8 Fruit (139 tins) 184 The total weight condemned during the year was 12 cwts. 9½ lbs. 35 SALE OF FOOD AND DRUGS ACTS. The Middlesex County Council is the Authority for taking samples under the above Acts, and Mr. R. Robinson, Chief Officer of the Public Control Department, has kindly supplied the following figures concerning samples taken in Wood Green during 1935:— Articles. No. of samples taken. Adulterated. Milk 90 — Milk, sterilized 8 — Arrowroot 3 — Butter 8 — Gin 2 — Honey 1 — Lemon Sole 12 2 Minced Beef 4 1 Mustard 2 — Pepper 1 — Sausages 10 2 Sugar 1 — Vinegar 6 — Whisky 1 — 149 5 No prosecutions were instituted during the year. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Table VI in the Appendix shows the details of the notification of infectious disease received during the year. The total number 368 was considerably less than that for the previous year, which was 448. The fall in numbers was entirely due to the diminished prevalence of Scarlet Fever which was responsible for only 201 notifications as compared with 292 for the previous year. The total number of cases removed to hospital or sanatorium was 300, and the number of deaths due to infectious disease was 57. Of these 26 were due to pneumonia and 24 to tuberculosis. Diphtheria 36 was the cause of death in 4 cases and scarlet fever and encephalitis lethargica each caused one death. The distribution of scarlet fever and diphtheria over the year is shown below. Scarlet Fever. Diphtheria. First quarter 89 10 Second quarter 42 8 Third quarter 24 7 Fourth quarter 46 14 Totals 201 39 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. Scarlet Fever 54 51 62 Diphtheria 11 14 13 Erysipelas 4 2 5 Encephalitis Lethargica 1 — — Whooping Cough — 1 2 Measles 2 — — Mumps 1 1 - Enteric Fever 2 — 1 Totals 75 69 83 In addition, one case of diphtheria was admitted to one of the L.C.C. Hospitals. 37 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 103 20 Glendale County School 4 — Trinity County School 6 1 Private Schools 3 — Schools outside Wood Green 9 — Under school age 40 10 Over school age 36 8 Totals 201 39 Scarlet Fever. This disease was considerably less prevalent in 1935 than in the previous year, the number of cases notified being 201 as compared with 292 in 1934. The disease was most widely prevalent in the early months of the year, 89 cases being notified during the first quarter. 170 cases were admitted to the Isolation Hospital. The disease generally was of a very mild type, but one death occurred —the first from scarlet fever for four years. In this case, the patient, a young child, died of broncho-pneumonia complicating scarlet fever. Diphtheria. Thirty-nine notifications of diphtheria were received as compared with thirty-one in the previous year. All these cases were removed to the Isolation Hospital. The disease tended to be of an increasingly severe type and three of the cases admitted to hospital died. Another death occurred in a school child belonging to Wood Green, who turned ill while on a visit to friends in the country, and died after admission to an isolation hospital. 38 Immunisation against diphtheria has been carried on as in previous years, for the most part among the children attending the infant and junior departments of the elementary schools, and to a lesser extent among children under school age. 841 children received full courses of protective inoculations during the year, and a further 101 were undergoing a course of injections at the end of the year. The total number of children immunised in Wood Green, since immunisation was commenced, amounted at the end of 1935 to almost 3,300, and of this number only two were known to have contracted diphtheria, up to the end of the year. One of these, which occurred in 1934, was an extremely mild case. The other, which occurred towards the end of 1935, was a moderately severe case, but made a very good recovery. Smallpox. No case of smallpox was notified during the year. Enteric Fever. Four cases of enteric fever were notified. Three were admitted to the Isolation Hospital, and the fourth, which was a very mild case, was nursed at home. In all cases recovery took place. Lethargic Encephalitis. One case of this disease occurred. The disease was of very severe type, and the patient, a child of school age, unfortunately died. Anterior Poliomyelitis. One case was notified. The disease was of mild type, and the patient, a secondary school child, made a very good recovery. Pneumonia. Twenty-eight notifications of pneumonia were received. All cases notified were visited by the District Nurses, and an offer of 39 nursing assistance made. In some cases this offer was accepted, but in most the patient was removed to hospital. Puerperal Fever and Puerperal Pyrexia. Four cases of puerperal fever were notified. Three were removed to one of the L.C.C. Hospitals, under the arrangement made between this Council and the London County Council. A fourth case occurred in a hospital in which the confinement had taken place. In all four cases recovery took place, but death occurred in a fifth case which had not been notified. There were ten notifications of puerperal pyrexia. Recovery took place in each case. Ophthalmia Neonatorum. Seven notifications of this disease were received. Five of them occurred in patients in hospitals. In six cases complete recovery took place. In the seventh the child was removed to another district before recovery was complete. 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 138 Measles 82 Mumps 361 Whooping Cough 150 Skin Infections 10 741 On receipt of these notifications, visits to the homes are made by the School Nurses to make sure that proper treatment is being provided and the necessary precautions taken in each case. 40 Tuberculosis. Table VII in the Appendix shows that the number of new cases of tuberculosis coming to the knowledge of the Health Department during the year was 61, 52 respiratory and 9 nonrespiratory. Of these 52 were notified by doctors practising in the district or from hospital, while 9 cases were transferred from other districts. The number of notifications received in the previous year was 78. Twenty-four deaths were certified as due to tuberculosis, as compared with thirty-five for the previous year and thirty-two for 1933. Of these, twenty-three were due to respiratory and one to non-respiratory disease. The death-rate from tuberculosis was 0.45 per 1,000 of population, as compared with 0.65 in 1934. Of the twenty-four deaths which occurred, four were in persons who had not previously been notified as cases of tuberculosis in this district. The arrangements for providing treatment for sufferers from tuberculosis are in the hands of the County Council and Dr. J. R. Dobson, the Tuberculosis Medical 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 45 Transfers from other districts (not included in above) 9 Total number of non-tubercular cases (including contacts) 73 Cases undiagnosed on 31st December, 1935 1 Total number of tubercular cases supervised at or from Dispensary in 1935 206 Total number of tubercular cases still on the Register at the end of 1935 162 41 During the year 48 cases were sent to hospital or sanatorium. The sanatoria or hospitals to which they were admitted are shown below:— Pulmonary Cases. Nonpulmonary Cases. Bishopsbourne Home, Broadstairs 1 — British Legion Village, Bournemouth 1 — Clare Hall Sanatorium 13 — Eversfield Chest Hospital, St. Leonardson-Sea 2 - Harefield Sanatorium 21 — Merivale Sanatorium, Chelmsford 1 — North Middlesex Hospital 6 — Preston Hall, Aylesford 1 — Royal National Hospital for Consumption, Ventnor 1 - Royal Sea Bathing Hospital, Margate - 1 47 1 BACTERIOLOGICAL WORK. The bacteriological examination of specimens from the borough is carried out at the Joint Isolation Hospital, and during 1935 the following examinations were made:— Positive. Negative. Total. Diphtheria 38 545 583 Pulmonary Tuberculosis 14 142 156 Enteric — 2 2 Others 3 3 6 55 692 747 42 DISINFECTION. The number of articles dealt with at the Disinfecting Station during the year was as follows:— Articles disinfected after tuberculosis 147 ,, ,, ,, other infectious diseases 2,485 ,, ,, ,, cancer 188 ,, ,, on account of vermin 485 3,305 Articles destroyed 249 The number of rooms disinfected by the Health Department was as follows:— After tuberculosis 34 ,, other infectious diseases 294 ,, cancer 6 For vermin 124 458 Disinfestation. During the past few years increasing attention has had to be devoted to houses infested with bugs, and in my report for 1934 I described the method which we had found successful in dealing with the problem in some of the Council houses on the 43 White Hart Lane Estate. The same method has been followed during 1935, both in houses belonging to the Council and in houses belonging to private owners. In these latter the owners have been required to remove the woodwork of the infested rooms, i.e., the skirting boards, architraves, picture rails, etc., while the actual fumigation has been done by the Health Department and the bedding disinfected at the Council's disinfecting station. During the year a further step in preventing infestation of Council houses was taken, when the Council made it obligatory on all new tenants of Council houses to have their furniture subjected to fumigation by hydrocyanic acid before admission to the new house. The furniture is removed from the old house, fumigated and installed in the new house, under arrangements made by the Council, and at the same time the bedding is stoved at the Council's steam disinfector. These arrangements have been in force since July 1st, 1935, and have proved satisfactory in every way. 44 APPENDIX. Table I. Vital Statistics of Wood Green, 1921-35. Year. (1) Population estimated to middle of each year. (2) Nett Births belonging to the District. Nett Deaths belonging to the District. Under 1 year of age. At all ages. Total No. (3) Rate per 1,000 population (4) Illegitimate No. (5) Total No. (6) Rate per 1,000 lire births. (7) Illegitimate No. (8) Rate per 1,000 illegitimate births. (9) No. (10) Rate per 1,000 population (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 1935 53,470 570 10.7 22 27 47 1 45 529 9.9 45 Table 11. Birth-Rate, Death-Rate and Analysis of Mortality during 1935. 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 1 2 years). Total Deaths under 1 year. England and Wales 14.7 11-7 0.00 0.00 0.03 0.01 0.04 0.08 0.18 0.52 5.7 57 121 County Boroughs and Great Towns (including London) 14.8 11.8 0.00 0.00 0.04 0.01 0.04 0.09 0.16 0.45 7.9 62 140 Smaller Towns (population, 25,00050,000 at Census 1931) 14.8 11.2 0.00 0.00 0.03 0.01 0.03 0.07 0.17 0.41 3.8 55 London 13.3 11.4 0.00 0.00 0.00 0.01 0.04 0. 06 0.11 0.51 11.2 58 Wood Green 10.7 9.9 0.00 0.00 0.00 0.02 0.00 0. 07 0.04 0.37 17.5 47 46 Table III. Causes of Death during the year 1935. Causes of Death. Male. Female. Typhoid and Paratyphoid Fevers - - Measles - - Scarlet Fever - 1 Whooping Cough - — Diphtheria 3 1 Influenza 2 — Encephalitis Lethargica 1 — Cerebro-spinal Fever — — Tuberculosis of Respiratory System 12 11 Other Tuberculous Diseases 1 - Syphilis 1 — General Paralysis of the Insane, Tabes Dorsalis 2 - Cancer, Malignant Disease 40 43 Diabetes 4 2 Cerebral Haemorrhage, etc. 13 22 Heart Disease 72 89 Aneurysm — 1 Other Circulatory Diseases 14 15 Bronchitis 7 8 Pneumonia (all forms) 9 17 Other Respiratory Diseases 4 — Peptic Ulcer 5 1 Diarrhoea, etc. (under two years) 5 5 Appendicitis 2 4 Cirrhosis of Liver 1 2 Other Diseases of Liver, etc. 1 2 Other Digestive Diseases 7 11 Acute and Chronic Nephritis 6 6 Puerperal Sepsis — 1 Other Puerperal Causes — — Congenital Debility, Premature Birth, Malformation, etc. 2 6 Senility — 5 Suicide 3 3 Other Violence 8 6 Other Defined Diseases 23 18 Causes ill-defined or unknown 1 — Totals 249 280 47 Table IV. Causes of, and Ages at Death during the year 1935. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. All Ages. Under 1 year. 1 and under 2 years. 2 and under 6 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years 65 and under 65 years. 5 and under 75 years. 75 years and upwards. Typhoid, etc. - - - - - - - - - - - - Measles - - - - - - - - - - - - Scarlet Fever 1 - - 1 - - - - - - - - Whooping Cough - - - - - - - - - - - - Diphtheria 4 — — 1 2 1 - - - - - - Influenza 2 - - - - - - - 2 - - - Encephalitis Lethargica 1 - - - 1 - - - - - - - Cerebro-Spinal Fever - - - - - - - - - - - - Tuberculosis of Respiratory System 23 - - - - 6 5 1 2 7 2 - Other Tuberculous Diseases 1 - - - - - 1 - - - - - Syphilis - - - - - - - - - - - - General Paralysis of Insane 1 - - - - - 1 - - - - - Cancer, Malignant Disease 79 - - - - - - 6 14 19 22 18 Diabetes 5 - - - - - - - 1 4 - - Cerebral Haemorrhage, etc. 42 - - - - - - 2 2 6 15 17 Heart Disease 155 — — — — 3 2 5 8 25 45 67 Aneurysm - - - - - - - - - - - - Other Circulatory Diseases 26 — — — — 1 — 1 1 6 9 8 Bronchitis 17 — — 1 — — 1 — 1 2 2 10 Pneumonia (all forms) 30 6 1 1 — — 1 2 4 2 4 9 Other Respiratory Diseases 7 - - - - - - 1 1 2 3 - Peptic Ulcer 5 — — — — 1 1 — — 1 2 - Diarrhoea, etc. (under 2) 10 10 — — — — — - - — - - Appendicitis 6 — — — 2 — 1 2 1 — — - Cirrhosis of Liver 3 - - - - - - - 1 1 1 - Other Diseases of Liver - - - - - - - - - - - - Other Digestive Diseases 9 1 - - - - - 1 3 1 1 2 Acute and Chronic Nephritis 13 - - - 1 - - 1 1 6 4 - Puerperal Sepsis 1 - - - - - - 1 - - - - Other Puerperal Causes - - - - - - - - - - - - Congenital Debility, etc. 9 9 - - - - - - - - - - Senility 10 - - - - - - - - - 3 7 Suicide 6 — — — — 1 — 1 2 — 2 - Other Violence 14 — — — 1 — 1 — - 4 4 4 Other Defined Diseases 48 1 — — 1 — 2 3 8 7 13 13 Causes ill-defined 1 - - - - - - - - - 1 - Totals 529 27 1 4 8 13 16 27 52 93 133 155 48 Table V. Deaths of Infants under One Year of age, showing cause of death and age at death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Total under 1 year. Atelectasis 1 - - - 1 - - - - 1 Broncho Pneumonia - - - - - 3 1 1 1 6 Gastritis — — — — — — 1 — — 1 Gastro Enteritis — 1 6 — 7 1 — — 2 10 General Peritonitis 1 — — — 1 — — — — 1 Icterus Gravis Neonatorum — — 1 — 1 — — — — 1 Intussusception — 1 — — 1 — — — — 1 Malnutrition - - - - - 1 - - - 1 Pneumonia — — 1 — 1 — — — — 1 Premature Birth 1 — - — 1 1 — — — 2 Splenic Anaemia — 1 — — 1 — — — — 1 White Asphyxia 1 — — — 1 — — — — 1 4 3 8 — 15 6 2 1 3 27 49 Table VI. Infectious Diseases Notified during the year 1935. Notifiable Disease. Cases Notified in Whole District. Total Cases 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 10 years. 10 to 15 years. 15 to 20 years. 20 to 25 years. 25 to 35 years. 35 to 45 years. 45 to 55 years. 55 to 65 years. 65 and upwards* Scarlet Fever 201 1 40 85 40 8 9 11 5 2 - - 67 62 72 170 1 Diphtheria 39 - 11 14 5 3 3 - 3 - - - 11 15 13 39 4 Dysentery 1 - - - - - 1 - - - - - - - 1 1 - Encephalitis Lethargica 1 - - 1 - - - - - - - - 1 - - 1 1 Enteric Fever 4 - - - 1 — 1 - 1 - 1 - 3 - 1 3 - Erysipelas 20 - - 2 - 1 2 2 2 1 5 5 4 7 9 13 - Ophthalmia Neonatorum 7 7 - - - - - - - - - - - 6 1 5 - Pneumonia 28 — 5 2 1 2 1 6 4 3 3 1 9 11 8 7 26 Acute Poliomyelitis 1 — — - 1 - - - - - - - - 1 - 1 - Puerperal Fever 4 - - - - 1 - 3 - - - - 1 2 1 4 1 Puerperal Pyrexia 10 — - - - - 5 4 1 - - - 2 3 5 8 - Pulmonary Tuberculosis 47 — — - - 8 7 15 7 3 7 - 15 18 14 47 23 Non-Pulmonary Tuberculosis 5 — 1 1 — 2 - 1 - - - - 2 2 1 1 1 Totals 368 8 57 105 48 25 29 42 23 9 16 6 115 127 126 300 57 50 Table VII. TUBERCULOSIS. New Cases and Mortality during 1935. Age Periods. New Cases. Deaths. Respiratory. Nonrespiratory . Respiratory. Nonrespiratory . M. F. M. F. M. F. M. F. 0 - - - - - - - — 1 — — 1 — — — — — 5 — — — 2 — — — — 10 - - - - - - - - 15 6 2 - 2 — — - — 20 5 5 — 2 2 4 - — 25 9 6 — 1 3 2 1 — 35 6 2 — — 1 — — — 45 1 2 — — 1 1 — — 55 5 3 — 1 4 3 — — 65 and upwards — — — — 1 1 — — Totals 32 20 1 8 12 11 1 — Above includes transfers (9) from other Districts. 4 non-notified T.B. deaths occurred. or I—* METEOROLOGICAL REPORT FOR YEAR ENDING 31st DECEMBER, 1935. Month. 1935. Total Rainfall. Maximum Rainfall. No. of Wet Days. Maximum Temperature. Minimum Temperature. Inches. Inches. Date. Degrees. Date. Degrees. Date. January 0.74 0.26 10th 10 55 1st 24 28th February 2.19 0.43 24th 13 56 15th 28 8th March 0.49 0.23 23rd 6 68 21st 25 10th April 2.88 0.55 7th 20 66 24th and 30th 32 4th and 5th May 1.03 0.32 30th 8 73 6th and 29th 32 17 th June 2.8 0.53 9th 20 87 25th 43 8th July 0.85 0.57 1st 6 85 10th and 12th 44 30th August 1.93 0.48 22nd 7 88 22nd 43 1st September 3.10 0.58 24th 15 75 13th 38 25th October 3.26 0.76 3rd 11 64 16th 30 20th and 25th November 3.71 0.56 7th 18 62 3rd 23 24th, December 2.73 0.53 31st 17 52 26th, 27th, 28th 30th and 31st 15 22nd Total for year 25.71 - - 151 - - - - Note.—Maximum Rainfall 0.76ins. 3rd October. ,, Rate of Rainfall 1st July, 2ins. per hour; duration 30 minutes. ,, Temperature 88° Fahr. 22nd August. Minimum ,, 15° Fahr. 22nd December. (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 (deceased 24.1.36). Councillor J. Burr. Councillor Mrs. J. Cole. Councillor F. Corbett. Councillor W. G. Doyle. Councillor F. Ferrier Tomlin. Councillor Mrs. L. C. Vant. Mr. J. Batstone. Mrs. E. M. Bottom. Rev. Canon G. Curtis. Mr. H. J. Garlick, B.Sc. Rev. H. Harris. Mrs. H. S. Harrison. Miss C. M. Lightfoot. Mrs. M. V. Mackie. CARE AND AFTER CARE SUB-COMMITTEE. Chairman: Alderman Mrs. J. J. Bolster, J. P. (The Chairman and Vice-Chairman of the Education Committee). Alderman Rev. W. Winston Haines (deceased 24.1.36). Councillor Mrs. J. Cole. Councillor Mrs. L. C. Vant. Mrs. E. Agombar. Mrs. A. Barrett. Mrs. E. M. Bottom. Mrs. W. Braithwaite. Mrs. H. S. Harrison. Miss J. Irvine. Mrs. E. M. Jackson. Miss C. M. Lightfoot. Mrs. M. V. Mackie. Director of Education: C. H. Jarvis, M.A., L.L.D. Wood Green Education Committee. SCHOOL MEDICAL SERVICE. ANNUAL REPORT, 1935. Ashburton House, Wood Green, N.22. March 31st, 1936. 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 1935. 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 1935 consisted of the following:— School Medical Officer.—Malcolm Manson, M.A., M.D., D.P. H. Assistant School Medical Officer.—Margaret McDonald Miller, M.B., Ch.B., D.P.H. Ophthalmic Surgeon.—J. S. Boden, O.B.E., M.B., B.S., M.R.C.S., L.R.C.P. Aural Surgeon.—A. R. Friel, M.A., M.D., F.R.C.S.I. Dental Surgeons.—S. A. McLaren, L.D.S. (resigned May, 1935); G. S. Williams, L.D.S. (commenced June, 1935); D. W. MacBean, L.D.S. School Nurses.—Miss B. M. Gray and Miss J. M. Hopkins. Medical Visitation Officer.—Miss E. Mitcham. Teacher in Charge of Speech Defect Clinic.—Miss E. M. Dawson. Dental Attendant.—Miss J. Collyer. School Medical Clerk.—Miss K. Chatfield. 3 The only changes in the personnel of the Staff during the year were the resignation of Mr. McLaren, the School Dental Officer, in May, on the occasion of his appointment to a similar post under the Middlesex County Council, the appointment of Mr. Williams as his successor, and the appointment of Mr. D. W. MacBean, a former full-time Dental Officer under this authority, to carry out the dental inspection and treatment of Secondary School children on a part-time basis. All the members of the Staff are full-time officers with the exception of the Ophthalmic Surgeon, the Aural Surgeon, the Special Teacher for Speech Defects, and Mr. MacBean. 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, and two evening sessions per week are devoted to dental treatment of Secondary School children. 2.—CO-ORDINATION WITH OTHER MEDICAL 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 School Medical work. The specialist medical and dental services provided by the Education Committee are available also, by arrangement with the Maternity and Child Welfare Committee, for children under school age, and this arrangement makes it possible for defects in young children to be dealt with as soon as they are apparent, instead of waiting until school age is reached before treatment is provided. 3.—SCHOOL HYGIENE. Compared with most years there has been little work of any considerable extent carried out on school buildings during the year. The chief work done has been at the Alexandra Schools where electric light has been installed, the roof retiled, and galleries removed from the classrooms in the Infants' Department. Minor improvements have been carried out at various other schools. 4.—MEDICAL INSPECTION. 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. 4 At these routine inspections the number of children examined was 2,280. Of these 612 were entrants, 505 belonged to the second and 546 to the third age-group, while 617 were of ages outside these three groups. The entrants are children starting school for the first time, the second group eight years' old children, and the third children of twelve years or over, who have not previously been examined in this group. In addition to these routine inspections, 1,078 special cases were examined, and 2,368 children re-examined. The "specials" are children who are referred to the School Medical Officers by the School 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 at special consultations on Tuesday or Saturday mornings. The children re-examined are those who have been found at previous routine or special examinations to be suffering from defects which require either to receive treatment or to be kept under observation. The total number of children on the registers of the elementary schools on December 31st, 1935, was 5,652. The number examined by the School Medical Officers during the year was 3,358. 5.—FINDINGS OF MEDICAL INSPECTION. The details of the medical inspections, the defects found and the treatment provided will be found in the statistical tables at the end of this Keport. Table Ic shows the number of children found at the routine medical inspections to require treatment. These numbers are small and must be regarded as very satisfactory. Their smallness is due in large part to the close co-operation which exists between the schools and the school medical service, and to the abundant use made of the School Clinic. Defects in children are very frequently brought to our notice by the School Staffs and the necessary treatment arranged for or provided weeks or perhaps months before the routine medical inspections are due to take place in particular schools, and in this way the number of defects actually requiring treatment found at the routine inspections tends to be very small. Table iia gives details of the defects found both at the routine and the special examinations, classified as either requiring treatment 5 or to be kept under observation. It will be seen from the figures given that at the routine inspections the number of defects found to require treatment is very low compared with those which require to be kept under observation. On the other hand at the special inspections the defects found requiring treatment are very much in excess of those referred for observation. (a) Nutrition. Table IIb gives a classification of the nutrition of the children inspected during the year in the routine age group. This is a new table provided this year for the first time and is of value in giving a general idea of the state of nutrition of the children at different periods of school life. While the actual differentiation between excellent and normal or normal and slightly subnormal depends very largely on the personal opinion of the examiner, it must be regarded as satisfactory that of the total children examined no less than 89.2 per cent. were classified as either excellent or normal, and only 10.8 per cent. as slightly subnormal or bad. The very low percentage of bad, 0.7 per cent., is also satisfactory, although even this low figure is capable of reduction in a district like Wood Green. If the different age groups are taken separately it will be seen that the figures in the second age group, that is the children of eight years, are not so good as among entrants or third age group children, that is children of twelve years or over, and that the figures for "other routine inspections" which in Wood Green are mostly children of thirteen or fourteen years, are the best of all, 94 per cent. of these children being classified as excellent or normal, and only 0.2 per cent. as bad. As this is the first year these figures have been supplied it is of course impossible to make any detailed comparison with previous years, but my own impression is that a steady, if slow, improvement is taking place in the nutrition of the children in this district. One still sees the occasional badly nourished child, the malnutrition being due not always to sickness or even poverty, but more often to carelessness or ignorance. This type of case is, fortunately, very much less common than formerly, but still presents a problem to the School Medical Officers. The other type of case where the malnutrition is due to poverty, can be and is dealt with in Wood 6 Green by the provision of free meals, free milk and cod-liver oil, and when due to effects of illness it can be dealt with by sending the child to a convalescent home. It is more difficult, however, to deal with the poorly nourished child whose condition is due to careless feeding habits, poor discipline in the home, and inadequate hours of rest. I have remarked in previous reports on the very great importance which all interested in nutrition attribute to the supply of milk to the growing child, and I am glad to be able to report that very considerable advantage continues to be taken of the provision of a regular supply of milk to school children at half-price by the Milk Marketing Board. Well over 50 per cent. of the elementary children in Wood Green avail themselves of this very excellent provision, and in addition a considerable number have a free supply throughout the year on medical grounds. This regular supply of milk is bound to have a very beneficial effect on the nutrition of the children generally, and for my own part I would like to see every child in our schools, no matter what his home circumstances, provided with milk at school every day throughout his school life. The daily supply of milk at school should not, however, take the place of but should be in addition to the regular supply of milk at home. (b) Cleanliness. The standard of cleanliness among the children remains very high, and reflects great credit on the vast majority of the parents. The schools are visited regularly by the school nurses for the purpose of carrying out routine inspections of the children for cleanliness. The number of individual inspections of children made during the year was over 38,000, and the number of exclusions made on account of verminous conditions was only 175. As in many cases the same children were excluded on more than one occasion it will be realised that the actual number of offenders was considerably less than this number. (c) Minor Ailments and Diseases of the Skin. One hundred and twenty 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. 7 (d) Visual Defects and External Eye Diseases. Fifty-four children were recommended for treatment on account of defective vision or squint, while 209 suffering from minor defects of vision were referred for further observation. Seven children were found to require treatment for external diseases of the eye, and 23 were kept under observation. (e) Nose and Throat Defects. Thirty children were recommended to have operative treatment on account of enlarged tonsils and adenoids, while 203 were referred for observation. Other conditions of the throat or nose requiring treatment were found in 51 children, and 8 others were referred for observation. (f) Ear Disease and Defective Hearing. Six children were found to be so deaf as to require treatment for the defect, while two others were kept under observation. Other forms of ear disease requiring treatment were found in twenty-six children, and three others were kept under observation. (g) Dental Defects. The result of the inspections carried out by the School Dental Officer is given in Table V. 4,147 children were inspected during the year. Of these the number found to require dental treatment was 2,850, and of these 2,051 actually received treatment at the Dental Clinic. (h) Orthopaedics and Postural Defects. Eighteen children were classified as cripples. Of these eleven were old cases of non-pulmonary tuberculosis which were either quiescent or cured. The others were all under hospital treatment during the year. (i) Heart Disease and Rheumatism. Definite evidence of cardiac disease was found in twenty-four children. In only ten of these cases was the child thought to be suffering from organic disease of the heart, and in these cases the commonest cause was rheumatism. Including these rheumatic 8 cases, thirty children in all were seen during the year suffering from rheumatism. In the majority of these cases the evidence of rheumatism was only occasional and not very severe, but in a few cases definite attacks of acute rheumatism occurred for which active treatment in hospital or at home had to be obtained. All these cases of rheumatism and heart disease are kept under regular supervision at the School Clinic. (j) Tuberculosis. Six cases of pulmonary tuberculosis were seen in school children during the year. All of these had already received Sanatorium treatment and were in a quiescent state and in every case they were kept under observation at the Clinic and allowed to attend school. Eleven cases of non-pulmonary tuberculosis, all of them quiescent or cured, were also kept under observation. 6.—FOLLOWING-UP. All defects discovered at medical inspections are reported to the parents or guardians, with a request that the necessary treatment be obtained as soon as possible. Later, the Visitation Officer visits the homes, to see whether treatment has been obtained, and, if not, to impress on the parent the importance of obtaining it. In most cases there is no delay in following the advice given, but in a minority of cases pressure has to be brought to bear on the parents before treatment is provided. The number of visits paid during the year by the Visitation Officer in the work of following-up the defects found at medical inspections has been 1,831. 7. —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 are dealt with at the Prince of Wales's Hospital and the Royal Northern Hospital, 9 ultra-violet light treatment is provided at the North Middlesex and the Royal Northern Hospitals and X-ray treatment for ringworm at the Royal Northern Hospital. (a) Minor Ailments. Eight hundred and seventy-five children were treated at the Clinic for minor ailments, these comprising mainly septic conditions of the skin, minor injuries, inflammatory conditions of the ears and eyes, and other similar conditions which are apt to receive insufficient attention at home, but may, if neglected, have a detrimental effect on the health of the child. (b) Tonsils and Adenoids. Seven children were operated on during the year, under the Committee's scheme, for enlarged tonsils and adenoids, while a further seventeen were dealt with privately at home or in hospital. Under arrangements entered into by the Committee with the Prince of Wales and the Royal Northern Hospitals, children sent to these hospitals for operation are kept in hospital for a minimum of two nights, being admitted the day previous to, and discharged not sooner than the day following the day of operation. The children are taken home in the Council's ambulance, and visited for the next few days by the School Nurse. (c) Visual Defects. The number of children dealt with by Dr. Boden at the Eye Clinic was 751, 241 of these being new cases. 268 children had spectacles prescribed for them, and of this number 244 had obtained the spectacles by the end of the year. In addition, a further 16 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 at the Clinic. Lists of children who ought to be wearing spectacles are provided for each school, and any alterations made in these lists are notified to the head teachers. (d) Ear Disease and Defective Hearing. The number of children seen by Dr. Friel at the Ear Clinic during the year was 149, of whom 86 were cases seen for the first 10 time in 1935, and 15 of these were children under school age. Suppurating ears now form a minority of the cases dealt with at the Clinic and the results of the treatment given in these cases are shown in the following table:— Nature of Disease Total. Cured. Lost Sight of. Still under Treatment. Receiving Hospital Treatment. Acute Suppurative Otitis Media 8 8 .. .. .. Chronic Suppurative Otitis Media due to:— (a) Tympanic Sepsis 10 10 .. .. .. (b) T.S. and Granulations 9 6 .. 2 1 (c) T.S. and Polypus 3 2 1 .. .. Attic Disease 4 2 l 1 .. Mastoid Disease 2 .. .. 1 1 External Otitis 5 5 .. .. .. Not diagnosed 1 .. 1 .. .. Totals 42 33 3 4 2 In addition to these cases Dr. Friel has treated a large number of children for defects of hearing due to catarrh of the middle ear, nasal catarrh and nasal obstruction mostly due to deflected nasal septum. The nasal obstruction is satisfactorily dealt with in some of these cases by zinc electrolysis of the inferior turbinal, and in other cases excellent results are got by diastolisation, a method of treatment which reduces the inflammatory condition of the nasal passages, enabling the child to breathe more freely 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 during the year is shown in detail in Table V. It will be seen that the scheme of dental inspection covers practically the whole elementary school population, so that dental treatment is available for every child during his elementary school life. Every effort has been made, as in previous years, to concentrate as far 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, 2,717 11 fillings to 464 extractions. In the case of the temporary teeth, on the other hand, it is found best to devote much less time to fillings, the number of which is negligible compared with that of extractions. (f) Defects of Speech. The Speech Defect Clinic deals with children suffering from stammering and other defects of speech. Two classes are held each week, one for children of twelve years and over and the other for children under twelve. The classes are limited to eight children each, so that individual attention may be given. Improvement is necessarily slow, but very good results are obtained, and in a considerable proportion of the cases dealt with complete cure is obtained. 8.—INFECTIOUS DISEASES. The incidence of infectious disease in the elementary schools was not so severe in 1935 as in the previous year, the total number of cases notified to me being 864 as compared with 1,064 in 1934. The following table gives the numbers of the different infectious diseases notified from the elementary schools:— Scarlet Fever 103 Diphtheria 20 Chickenpox 138 Measles 82 Mumps 361 Whooping Cough 150 Skin Infections 10 Total 864 It will be seen that mumps was responsible for more than 40 per cent. of all the infectious cases. This disease was particularly prevalent in the second quarter of the year, 267 cases in all being reported in that quarter. Scarlet fever was prevalent in the district throughout the whole year, but more cases occurred in the first quarter than in any of the others. The incidence of diphtheria was low, only twenty cases occurring in children of school age. 12 The incidence of Scarlet Fever and Diphtheria during 1935 is shown in the following table:— School. Scarlet Fever. Diphtheria. Alexandra Boys 5 2 „ Girls 4 — „ Infants 11 — Bounds Green Boys 3 — „ „ Girls 2 1 „ „ Infants 18 — Lordship Lane Boys 4 — „ „ Girls 4 1 „ „ Infants 4 1 Noel Park Boys 6 1 „ „ Girls 2 1 „ „ Infants 6 3 Rhodes Avenue 5 3 St. Michael's Mixed 2 1 „ „ Infants 8 — St. Pauls 2 1 White Hart Lane Boys 1 2 „ „ Girls 8 1 „ „ Infants 8 2 Glendale County School 4 — Trinity County School 6 1 Private Schools 3 — Schools outside Borough 9 — Under School age 40 10 Over School age 36 8 Totals 201 39 Scarlet Fever. Diphtheria. 1st Quarter 89 10 2nd „ 42 8 3rd „ 24 7 4th „ 46 14 Totals 201 39 13 Immunisation against diphtheria has been offered as in previous years to all children in the infant departments of the schools, and to children under eight years of age in the junior departments, as well as to children under school age. This work has been in progress now for six years and has become part of the ordinary routine activity of the Health Department. It is carried out mostly in the schools, but immunisation sessions are also held at the School Clinic. The response to the offer of immunisation varies from school to school, but I am glad to say that progress is being made, and the number of children immunised in 1935 was higher than in any previous year. In all 841 children received full courses of three protective inoculations, and a further 101 were undergoing a course of injections at the end of the year. 637 children were Schick-tested during the year on the completion of a full course of injections. Of these 192 were children who had been immunised during 1934. 396 children who had received full courses of injections were awaiting Schick Test at the end of the year. So far as the efficiency of the immunisation is concerned, only one case of definite diphtheria was reported during the year, in a child who had been immunised. This child received two immunising injections in October, 1934, and one in December, 1934. In April, 1935, she was Schick-tested and was negative. In November, 1935, she had quite a definite attack of diphtheria and was admitted to hospital, where she made a good recovery. Three other children who had been immunised were found to have positive swabs, after being in contact with cases of diphtheria, but in all of these cases the swabs were negative after a few days, and none of them showed any other evidence of suffering from diphtheria. 9.—OPEN-AIR EDUCATION. There are no open-air schools in Wood Green, nor are there any open-air classes 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, and 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 by a limited number of the children. 14 In Bounds Green Boys' and Bounds Green Girls' Schools, school journeys have been arranged each year for many years. In 1935, 32 boys accompanied by 2 teachers from the former school took part in a school journey at Teignmouth for a fortnight at the end of June, while 22 scholars accompanied by 2 teachers from the Girls' School had a school journey at Babbacombe in Devon for a fortnight at the end of May. These school journeys are an ideal method of pursuing education under excellent health conditions. In addition to these two school journeys there was, as in former years, a School Camp arranged by the Juvenile Organisations Committee for selected children from all the schools. The camp was held at Dymchurch from August 17th to 31st, and 198 elementary school children had an excellent holiday. Four of these were children from the School Sports Association, and the others, 93 boys and 101 girls, were children selected from the elementary 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 given to those children who appeared to be most in need of a holiday, and least likely 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 most cases very evident, 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. The contribution which this Committee makes year by year in this way to the health and well-being of such a large number of the less fortunately situated children in the schools, is, in my opinion, a very valuable one, and the Education Committee is much indebted both to the Committee and its Secretary for the energy displayed in raising the necessary funds and perfecting the organisation, and also to the teachers and other helpers who act as supervisors at the Camp itself. As in former years also, a number of children were sent for limited periods, usually of six weeks, to residential open-air schools. These are mostly poorly nourished or debilitated children, often recovering from serious illness. Eight boys and eight girls were sent to the Russell Cotes School of Recovery at Parkstone, Dorset, and five boys and four girls to Collington Manor, Bexhill. 15 10.—PHYSICAL TRAINING. Physical training in the schools is carried out under the direction of the teachers, and there is no direct association with the School Medical Service. It is directed and supervised by two special organisers. School Baths. The attendances of school children at the Western Road Baths during the year numbered 43,054 as compared with 47,121 in the previous year, while those at the Open Air Bath on the Alexandra Park Race Course were 7,036 as compared with 5,443 in 1934. The attendances of school children at the Swimming Pool in Durnsford Road numbered 24,237. From these figures it will be seen that swimming is a very popular form of exercise among the children in Wood Green. The number of certificates of proficiency in swimming awarded to school children during the year was 1,763. Of this number, 234—129 boys and 105 girls—were awarded certificates for swimming 880 yards. These figures are very satisfactory and are a testimony to the zeal of the Wood Green Sports Association, which does so much to encourage swimming among the school children. 11.—PROVISION OF MEALS. A hot mid-day meal is provided throughout the year at the Feeding Centre in White Hart Lane for a number of children who are found to be in need of such a provision. The children are, for the most part, selected on economic grounds, and are usually recommended by the teachers in the schools, 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 number of ladies, most of whom are members of the Care Committee. The dinners provided are wholesome and nutritious, and the menu is revised from time to time to prevent monotony in the meals. The number of children receiving dinners at the Centre during the year was 142, of whom 101 were fed free of charge, 38 for part 16 payment, and 3 for full payment. The total number of meals provided was 15,704, of which 10,031 were given free, 5,618 for part payment, and 55 for full payment. The average cost per meal was 5.7 pence, of which 2.4 pence represented the actual cost of food and 3.3 pence the cost of administration. In addition to the meals served at the Feeding Centre, 2,331 meals were provided at the School for the Partially Sighted in Lordship Lane, for the children attending there. Of these 1,184 were given free, 302 for part payment and 845 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 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. 12.—CO-OPERATION. (a) Of Pakents. The parents of the children are generally interested in the school medical inspections, and the majority of the children are accompanied on these occasions by a parent or guardian. In the infant departments the percentage of parents attending was over 90, at the second inspection it was 75, while in the case of leavers it was 36. The parents as a rule are grateful for advice given and ready to act on it, and there is no doubt that the success of the school medical work depends very largely on their co-operation. (b) Of Teachers. From the teachers we get 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 arid quietly as it does. The head teachers show themselves interested in our work and I am glad to be able to express my thanks to them for their assistance. The School Attendance Officers have also been of assistance in bringing to our notice children requiring attention, and I am indebted to them for their help. 17 (c) Of Voluntary Bodies. The chief voluntary body whose activities are of value to the school medical work 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 include the running of gymnasia, clubs for indoor and outdoor sports, and dancing classes, all of them of great benefit to the children and young people taking advantage of them. The Boot and Clothing Fund raised and administered by the Care Committee has supplied many of the poorer children with boots and clothing during the year. Assistance has also been obtained from the representative of the Tottenham Deanery Council for Moral Welfare in connection with children whose moral welfare has required special supervision, and from the Inspector of the National Society for the Prevention of Cruelty to Children in dealing with parents who have not been too ready to obtain necessary treatment for their children, and I am very grateful to both of these organisations for their help. (d) Juvenile Employment Bureau. In a Memorandum issued in September, 1935, the Board of Education drew attention to the importance of active co-operation between the School Medical Service and the work of the Juvenile Employment and Advisory Committees. In Wood Green our school medical records have always been available when required by the Juvenile Employment Bureau, to supply any information likely to be helpful in deciding whether a boy or girl leaving school was unsuited for any particular type of employment. In December, 1935, however, all children leaving school were specially seen by the School Medical Officers and a special note made for the use of the Juvenile Employment Bureau in any case where the unsuitability of work of any particular type was indicated. It is proposed to make this inspection of all children about to leave school part of our ordinary medical service. 18 13.—BLIND, DEAF, DEFECTIVE and EPILEPTIC CHILDREN A register is kept of all defective children in the district, and every effort is made to keep this register as accurate as possible. It is based very largely on the results of the routine and special medical inspections, but for such children as do not attend school, we are indebted for assistance to School Attendance Officers, School Nurses, Health Visitors and others. All defective children are kept under supervision and seen by the School Medical Officer at regular intervals. Where the defect is such that a Special School is indicated, steps are taken to secure this provision. (а) Blind. There are no blind children of school age in Wood Green, but five children whose eyesight was so defective as to make it difficult for them to profit by instruction in an ordinary elementary school were in attendance at the School for Partially Sighted Children in Lordship Lane. These children are under the regular supervision! of the School Ophthalmic Surgeon, and the school is visited at regular intervals by the School Medical Officer. The Wood Green School for the Partially Sighted provides accommodation not only for our own children but for children from other educational authorities. The total number of partially sighted children at the end of the year was twenty-seven. Of these five belonged to Wood Green, ten to Tottenham, four to Hornsey, four to Enfield, two to Finchley, one to Edmonton and one to Middlesex. A mid-day meal is provided at the school for those children who are unable to go home. (b) Deaf. There are six children on the register who are so deaf as not to be able to profit from instruction at an ordinary elementary school. These attend the Tottenham Special School for the Deaf. (c) Mentally Defective. Eleven mentally defective children from Wood Green were attending the Joint Special School for Mental Defectives at Finchley. 19 A considerable proportion of these are high-grade defectives. The school is visited at regular intervals and the children inspected by the School Medical Officer. Three children classed as mentally defective were in attendance at ordinary elementary schools, the parents in these cases objecting to their defective child being sent to a school for defectives. Two mentally defective children were not attending any school. For these and for older mental defectives from Wood Green and neighbouring districts the Occupation Centre at Shropshire Hall in Gladstone Avenue performs a very useful service in providing occupation during the day. The mental defectives attending this Centre are medically inspected at regular intervals and treatment for dental defects and minor ailments is provided at the School Clinic. (d) Epileptics. Three children suffering from epilepsy are on the special register. None of these are so seriously affected as to necessitate exclusion from an elementary school. 15.—NURSERY SCHOOLS. There is no Nursery School in Wood Green, but classes for children under school age are held in two of the Infant Departments. These classes meet a definite need in providing a healthy environment during the day for young children whose home circumstances are not altogether satisfactory. 16.—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 are carried out by the Assistant School Medical Officer and myself. Defects found at medical inspections are reported to the parents who make their own arrangements for treatment. In the case of dental defects and defects of vision treatment is now provided at the School Clinic under an arrangement made with the County Education Committee. A commencement was made with this work in April, 1935, the dental inspection and treatment being carried 20 out by a part-time Dental Surgeon, Mr. MacBean, a former full-time officer in Wood Green, and the eye work by Dr. Boden, our School Ophthalmic Surgeon. 17.—PARENTS' PAYMENTS. A small charge is made to parents for treatment given to children at the dental clinic and the ear clinic, but no charge is made for attendance at the minor ailments clinic, although a box is always available for voluntary contributions. Wherever possible, the full cost of operation for tonsils and adenoids, of artificial sunlight treatment, and of spectacles provided at the eye clinic is recovered from parents. When the circumstances of the parents are such as to make it difficult or impossible for them to meet the full cost of treatment provided, the case is reported to the Care and After-Care Committee and the sum charged to the parents reduced or remitted. 18.—HEALTH EDUCATION. Teaching of hygiene based on the Board of Education's Handbook of Suggestions on Health Education is included in the curriculum and time-tables of all the Senior and Junior Schools, and in many of the schools considerable attention seems to be given to this important subject. For some years past advantage has been taken of the services of a lecturer provided by the Dental Board of the United Kingdom. The lecturer visits all the schools, and gives a lecture demonstration on dental hygiene, the early evidence of dental decay and its prevention and the importance of early and adequate treatment. The children appear to be much interested in the lectures which cannot fail to be helpful. Use has also been made during the year of the small handbooks on health published by the Health and Cleanliness Council, and written specially for boys and girls leaving school. Copies of these are given to every boy and girl leaving school. 21 In concluding my Report, I wish to express my thanks to the Education Committee for the support and encouragement which it invariably gives to the school medical services, to the Director of Education and his staff for assistance always readily available, and to every member of my own staff for loyal and willing cooperation in our work. I am, Ladies and Gentlemen, Your obedient servant, MALCOLM MANSON, School Medical Officer. 22 APPENDIX. MEDICAL STATISTICAL TABLES, 1935. TABLE I.— RETURN OF MEDICAL INSPECTIONS. A.— ROUTINE MEDICAL INSPECTION. Entrants. Age. 3 4 5 6 Other Ages. Total. Boys — 22 181 67 46 316 Girls — 19 180 64 33 296 Totals .. — 41 361 131 79 612 Second Age Group (Intermediates). Age. 8 Other Ages. . Boys 203 40 243 Girls 229 33 262 Totals 432 73 505 Third Age Group (Leavers). Age. 12 13 14 Other Ages. Total. Boys 236 49 5 1 291 Girls 215 32 8 — 255 Totals 451 81 13 1 546 23 Number of Other Routine Inspections. Varied Ages. Total. Boys 295 295 Girls 322 322 617 617 Grand Total. Entrants Second Age Group. Third Age Group. Other Routine Inspections. Total. Boys 316 243 291 295 1145 Girls 296 262 255 322 1135 Totals .. 612 505 546 617 2280 B.— OTHER INSPECTIONS. No. of Special Inspections. No. of Re-Inspections. Boys 512 1012 Girls 566 1356 Totals 1078 2368 24 TABLE II. A.— RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DEC., 1935. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Skin Ringworm— Scalp ... ... 1 1 Body ... 4 2 Scabies I ... 34 Impetigo 2 ... 5 2 Other Diseases (non-tuberculous) 12 6 28 6 TOTAL 15 6 72 11 Eye Blepharitis 1 1 ... ... Conjunctivitis 2 ... 4 ... Keratitis ... 1 ... ... Corneal Opacities ... 1 ... ... Other Conditions (excluding Defective Vision & Squint) 20 ... ... TOTAL 3 23 4 ... Defective Vision (excluding Squint) 46 195 2 ... Squint 5 14 1 ... Ear Defective Hearing 4 2 ... 2 Otitis Media 4 1 ... 1 Other Ear Diseases 4 1 18 ... Nose and Throat. Chronic Tonsillitis only 12 185 16 18 Adenoids only... 1 ... ... ... Chronic Tonsillitis and Adenoids 1 ... ... ... Other Conditions 23 6 28 2 Enlarged Cervical Glands (Non-Tuberculous) 2 33 2 7 Total carried forward 120 466 143 41 25 TABLE II—continued. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Total brought forward 120 466 143 41 Defective Speech 1 7 3 2 Heart and Circulation. Heart Disease— Organic 2 7 ... 1 Functional 2 12 ... Anaemia 7 35 1 2 Lungs Bronchitis 1 11 ... 1 other Non-Tuberculous Diseases 1 8 ... 2 Tuberculosis Pulmonary— Definite ... ... ... ... Suspected ... ... ... 1 Non-Pulmonary— Glands ... ... ... ... Bones and Joints ... 4 ... 2 Skin ... ... ... ... Other Forms ... 1 ... 2 TOTAL ... 5 ... 4 Nervous System. Epilepsy 1 3 2 2 Chorea ... 1 ... 2 Other Conditions ... 1 2 2 Deformities. Rickets 1 1 ... ... Spinal Curvature ... 5 ... ... Other Forms ... 14 6 3 Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 6 26 48 23 TOTAL 142 602 205 86 26 B.— Classification of the Nutrition of Children Inspected During the Year in the Routine Age Groups. Age Groups Number of Children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. 0/ /o No. % No. 0/ /o No. 0/ /o Entrants 612 198 32.4 366 59.8 46 7.5 2 0.3 Second Age Group 505 131 25.9 279 55.3 88 17.4 7 1.4 Third Age Group 546 184 33.7 302 55.3 55 10.1 5 0.9 Other Routine Inspections 617 276 44.7 298 48.3 42 6.8 1 0.2 Total 2280 789 34.6 1245 54.6 231 10.1 15 0.7 27 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. CHILDREN SUFFERING FROM MULTIPLE DEFECTS. BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — — — — — PARTIALLY SIGHTED 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. 3 — — 3 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. 3 — — — — 3 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. 11 3 — 2 16 28 EPILEPTIC CHILDREN. Children Suffering From Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 3 — — 3 PHYSICALLY DEFECTIVE CHILDREN. A.— Tuberculous Children. I.— Children Suffering from Pulmonary Tuberculosis. (Including pleura and Intro-thoracic glands.) At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 6 — — 6 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 3 1 11 B.—Delicate Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 25 — — 25 29 C.— Crippled Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 2 1 1 4 D.— Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 1 1 — ~~ 2 CHILDREN SUFFERING FROM MULTIPLE DEFECTS. Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Mental Defect and Epilepsy — — 2 1 3 Mental Defect and Hemiplegia 1 — — — 1 30 TABLE IV. Return of Defects Treated during the Year Ended 31st December, 1935. TREATMENT TABLE. Group I.— Minor Ailments (excluding Uncleanliness, for which see Table VI). Disease or Defect. (1) Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin— Ringworm—Scalp— (i) X — Ray Treatment - - - (ii) Other Treatment — — — Ringworm—Body 4 — 4 Scabies 24 1 25 Impetigo 48 1 49 Other skin diseases 28 1 29 Minor Eye Defects (external and other, but excluding cases falling in Group II.) 112 1 113 Minor Ear Defects 100 1 101 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) Totals 559 10 569 875 15 890 Group II.— Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. (1) No. of Defects dealt with. No. of children for whom spectacles were Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Prescribed (1) Obtained (2) Under the Authority's Scheme. Otherwise. Under the Authority's Scheme. Otherwise. Errors of Refraction (including squint). (Operations for squint should be recorded separately in the body of the School Medical Officer's 674 25 699 268 16 244 16 Other Defect or Disease of the Eyes (excluding those recorded in Group i) Total 77 10 87 751 35 786 31 Group III.—Treatment or 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) 49 73 - - 7 - - - 17 - - - 24 - (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids. (iv) Other defects of the nose and throat. 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 1 — — 2 — 5 8 32 TABLE V.— DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist— (a) Routine Age Groups— AGE 5 6 7 8 9 10 11 12 13 14 15 TOTAL Number 220 479 498 413 408 437 364 356 273 227 61 3,690 (b) Specials 457 (c) Total (Routine and Specials) 4,147 (2) Number found to require treatment 2,850 (3) Number actually treated 2,051 (4) Attendances made by children for treatment 4,044 (5) Half-days devoted to:— (7) Extractions:— Inspection 28 Permanent Teeth 464 Treatment 403 Temporary Teeth 2,390 Total 431 Total 2,854 (8) Administrations of general anaesthetics for extractions 705 Fillinors:— (9) Other Operations:— Permanent Teeth .. 2 2,717 Permanent Teeth 556 Temporary Teeth 57 Temporary Teeth 161 Total .. .. 2 2,774 Total 717 TABLE VI.— UNCLEANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 10 (ii) Total number of examinations of children in the Schools by School Nurses 38,482 (iii) Number of individual children found unclean 175 (iv) Number of children cleansed under arrangements made by the Local Education Authority — (v) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 (b) Under School Attendance Byelaws — 33 Statement of the Number of Children Notified During the Year ended 31st December, 1935, by the Local Education Authority to the Local Mental Deficiency Authority. Total Number of Children Notified, 4. ANALYSIS OF THE ABOVE TOTAL. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special (a) Idiots - (6) Imbeciles 1 — (c) Others — — (ii) Children unable to be instructed in a Special School without detriment to the interests of (a) Moral defectives .. - - (b) Others 1 - 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 — 2 3. Feeble-minded children notified under Article 3, i.e., "special circumstances" cases — - 4. Children who, in addition to being mentally defective, were blind or deaf — - Grand Total 2 2 34 .