C.I Ac439(1) WOOD GREEN M Borough of wooD Green. Annual Report of thb MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL OFFICER for the YEAR 1936. MALCOLM MANSON, M.C., M.A., M.D., D.P.H Medical Officer of Health and School Medical Officer. 1937. Crusha & Son,, Ltd., Tottenham, Enfield, Wood Green and Palmer* Green. Wood 20 INDEX to the Report of the Medical Officer of Health. A. Accidents due to Traffic 9 Ambulance Service 12 B. Bacteriological Examinations 40 Baths 19 Births 5 C. Clinics 13 D. Day Nursery 18 Deaths 6 Diphtheria 36 Disinfection, etc 40 Drainage and Sewerage 18 F. Factory and Workshop Acts 24 Food and Drugs Acts 33 Food Inspection 31 Foster Mothers 17 H. Hospitals 10 House-to-House Inspection 23 Housing Statistics 27 I. Infantile Mortality 7 Infectious Diseases— Cases removed to Hospital 34 Cases attending Schools 35 M. Maternity & Child Welfare— Ante-Natal Clinic 15 Centres 14 Dental Work 17 Free Food 17 Home Visiting 17 Maternity Hospital provision 15 Maternity and Nursing Homes 10 Maternal Mortality 7 Sunlight Treatment 17 Midwives 9 Mortuary 31 N. Nursing in the Home 9 O Overcrowding 29 P. Poor Law Relief 8 Population 5 R. Rent Restriction Acts 29 Rivers and Streams 18 S. Sanitary Inspection 20 Slaughterhouses 32 Social Conditions, etc 4 Staff 2 Statistical Tables— Birth and Death Rates 44 Causes of Death 45 Infectious Diseases 48 Infantile Mortality 47 Meteorological Report 50 Tuberculosis 49 Vital Statistics 43 T. Tuberculosis 11. 38 V. Vital Statistics, Extract from 4 W. Water Supply 18 Z. Zymotic Mortality 7 Borough of Woob Green. PUBLIC HEALTH COMMITTEE. Councillor E. J. Anderton, L.D.S. (Chairman). The Mayar (Alderman A. J. Blue, J.P.). The Deputy Mayor (Alderman H. Tudor Rhys, J.P.). Alderman Mrs. J. J. Bolster, Councillor Mrs. A. Duncan. J P Councillor B. L. Lloyd. Alderman F. G. Holmes, J.P. Councillor W. J. Payne. Councillor Mrs.. J. Cole. Councillor H. E. Teal,e. Councillor W. G. Doyle. Councillor W. A. Vant. MATERNITY AND CHILD WELFARE COMMITTEE. Councillor Mrs. A. Duncan (Chairman). Alderman Mrs. J. J. Bolster, Councillor Mrs. J. Cole. J.P. Councillor H. E. Teale. Councillor E. J. Anderton, Councillor Mrs. L. C. Vant. .L. D. S. Co-opted Members:— Mrs. L. Barnes. Mrs. M. Blue (Mayoress). Mrs. E. L. Corbett. 2 STAFF during 1936. *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. *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 V. W. Moss. Chief Clerk.—G. W. Jones. Assistant Clerks.—W. T. Gloster, A. Hutchings, Cert. S.I.B.. N. F. Trustcott (resigned July, 1936), G. Penberthy (appointed August, 1936). *Clerk for Maternity ancl 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 Or win hold the new Health Visitors' Certificate. *Officers in respect of whom salary contributions are made under the Public Health Acts by Exchequer Grants. 3 Public Health Department, Ashburton House, Wood Green, N.22. June 25th, 1937. To the Mayor, Aldermen and Councillors of the Borough op Wood Green. Ladies and Gentlemen, I beg to present to you my Annual Report as Medical Officer of Health for the year 1936. The chief feature of the year, from the Health point of view, was the very heavy incidence of diphtheria, and particularly the severe outbreak in one of the elementary schools whioh was responsible for no fewer than eight deaths among the children. The birth-rate for the year is the highest for five years. The death-rate and infantile mortality rates are, unfortunately also higher than in the previous year. I wish to express my thanks again to the Chairman of the Public Health and Maternity and Child Welfare Committees, and to the Council generally for the consideration and help which I have received, and to the whole staff of the Health Department for their willing co-operation at all times. 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 53,620 Number of inhabited houses (end of 1936, according to the Rate Books) 13,679 Rateable Value, 1936 £522,229 Sum represented by a penny rate £2,081 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births— Total. M. F. Legitimate . 677 358 319 Birth Rate 13.1. Illegitimate 23 12 11 Stillbirths 16 10 6 Rate per 1,000 births, 23.6. Deaths 588 280 308 Death Rate, 10.9. Deaths from Puerperal causes :— Puerperal sepsis — Rate per 1,000 births, 0.0. Other puerperal causes 1 Rate per 1,000 births, 1.4. — Rate per 1,000 births, 1.4- Total 1 Deaths of infants under 1 year of age:—- All infants 38 Rate per 1,000 live births, 54. Legitimate 38 Rate per 1,000 legitimate live births, 56. Illegitimate - Rate per 1,000 illegitimate live births, 0.0. Deaths from :— Cancer (all ages) 91 Measles (all ages) 2 Whooping Cough (all ages) 2 Diarrhoea (under 2 years of age) 7 5 POPULATION. The Registrar-General's estimate of population for 1936 was 53,620 and I have used this figure to calculate the birth and death rates for the year. It represents an increase of 150 in the population from that of 1935 which was 53,470. The increase is very slight, but it is the first increase in five years, the previous four years all showing slight decreases, so that the population to-day is 900 less than at the time of the last census in 1931. As Wood Green is now practically built up there is not likely to be any great increase in the number of inhabited houses, and therefore no very great increase in the population in the immediate future. BIRTHS. The number of live births registered during the year was 700 as compared with 570 in 1935, and 564 in 1934. The number of births is the highest since 1931, and represents a birth-rate of 13.1, as compared with 10.7 in 1935. The birth-rate for the whole country was 15.4 and for the 122 great towns (which includes Wood Green) it was 15.6. In spite of the improvement therefore which has taken place this year, the birth-rate for Wood Green is still appreciably lower than both that of the whole country and that of tihe great towns. 16 stillbirths were registered, 10 male and 6 female. The births registered in the Borough were distributed in the different Wards as follows:— Alexandra-Bowes 80 Town Hall 278 Noel Park 119 477 6 DEATHS. The number of deaths belonging to Wood Green, after making the necessary adjustments for inward and outward transfers was 588, 280 male and 308 female. This gives a death-rate of 10.9 per thousand of population, an appreciably higher rate than that for 1935 whioh was 9.9. The death rate for the whole country was 12.1 and that for the 122 great towns 12.3. Of the total deaths, 293. or almost exactly 50 per cent, occurred in persons over 65 years of age. The corresponding percentage for 1935 was 54. The distribution of deaths over tihe year was as follows:— First quarter, 184; second, 125; third, 126; and fourth, 153. The distribution of deaths according to Wards was :— Alexandra-Bowes 187 Town Hall 174 Noel Park 227 588 Table III in the Appendix give* the causes of all death* occurring in Wood Green during the year, and Table IV shows their distribution both according to cause of death, and to age at death. The former table is supplied by the Registrar-General, wihile the latter has been compiled in the Health Department. This fact accounts for the slight discrepancies which are to be detected in the numbers attached to individual causes of death. It will be seen from Table III that as in previous years the commonest cause of death was heart disease, which was responsible for no fewer than 142 deaths. Of these more than two-thirds occurred in persons over 65 years of age. Cancer came second as a cause of death with 91 deaths, and was followed by tuberculosis which was responsible for 51 deaths, more than twice as many as in the previous year. Of this number, no fewer than 31 or 60 per cent, occurred in 7 persons less than 35 years of age. "Other circulatory diseases" were responsible for 37 deaths, pneumonia for 36 deaths, and cerebral haemorrhage for 35 deaths. 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 23. Of this number, 12 were due to diphtheria, 2 each to measles and whooping cough, and 7 to diarrhoea. The seven deaths of young children due to diarrhoea or gastro-enteritis all occurred in hospitals outside the district. Of the twelve deaths due to diphtheria, I shall have something to say later in this report. The Zymotic Death Rate was 0.42 per 1,000 of population, as compared with 0.28 for the previous year. INFANTILE MORTALITY. The number of deaths occurring in children under 12 months of age was 38 and the Infantile Mortality Rate 54 per 1,000 live births. This compares unfavourably with the rate for the previous year which was 47 and even more so with that for 1934 which was 37. The principal cause of the increased infantile mortality both in 1935 and 1936 has been the unduly large number of deaths caused by gastro-enteritis. 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 38 infantile deaths, 9 occurred in the first week of life and 18 in the first four weeks. The cihief causes of death were bronchopneumonia which was responsible for 7 deaths, gastro-enteritis for 6 and haemorrhage for 6 deaths, these last deaths being practically all the result of difficult delivery. MATERNAL MORTALITY. Only one death was registered as a maternal death, the cause of death in this case being eclampsia following premature labour. As this is a case wthere deatn would almost certainly have been 8 vented, had the advice given been taken, it may be of interest to give a short account of it. The patient attended the Ante-Natal Clinic early in her pregnancy and was found to show definite signs of toxaemia for which she was at once sent to Hospital. In hospital a serious view was taken of her condition and the obstetric surgeon proposed to terminate the pregnancy forthwith in the interests of the mother. This offer the mother refused and she returned home, placing herself under the care of her own doctor, who treated her as well as it was possible to do by special diet and other measures. Premature labour occurred in the eighth month and was followed immediately by eclampsia. Patient was admitted at once to hospital, and everything possible done for :her, but unfortunately death occurred a few days later. The popular Press has devoted considerable attention of recent years to the subject of maternal mortality, and the necessity for improving ante-natal and maternity hospital services. Here we have a death occurring which was not prevented in spite of the fact that both ante-natal advice and hospital provision was readily available, but unfortunately not taken advantage of. 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 1936 :— No. of Persons Amount granted £ s. d. Ordinary Cases 1,011 18,349 18 8 Unemployed Cases 484 3,161 4 2 Total 1,495 21,511 2 10 The amount granted in 1935, was £17,882 7s. 8d. 9 ACCIDENTS DUE TO TRAFFIC. Information with regard to street accidents has been obtained from the reports which are now sent by the Commissioner of Police to the Borough Surveyor. During 1936 there were 105 accidents in the High Road and 124 elsewhere in Wood Green involving personal injury, and the use of a motor ambulance was required on 195 occasions as compared with 200 in 1935. 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 medical practitioners. The services of two nurses maintained by the Association are much in request by members of the Association and while the work of the Association has made very good progress during the past year, there is still, in my opinion, room for considerable extension of this work in Wood Green. (b) Infectious Diseases. It is part of the duty of 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. Noi midwives are employed by the Council. During the year eight midwives residing in the Borough notified their intention to practise. 10 During the year application was made to the Minister of Health for powers to act as the local supervising authority under the Midwives Act, 1936. This would have empowered the Wood Green Council to appoint whole-time midwives sufficient for the needs of the district. Unfortunately the Minister refused his, consent to the application, and the local supervising authority for Wood Green is the Middlesex County Council. The County Council has, however, asked whether the Wood Green Council will agree to act as the County Council's agents for the district of Wood Green, and the Wood Green Council has agreed to do so. The Wood Green Council will, therefore, in the near 'future, appoint a sufficient number of whole-time midwives to meet the needs of the district, and the cost of their salaries will be met by the County Council. MATERNITY AND NURSING HOMES. There was one Maternity Nursing Home in the Borough during 1936 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, Finchlev, 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. 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. 11 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 1936. Institution. Accommodation. Adults. Children. Type of case. M. F. County Sanatorium, Harefield 150 150 60 Pulmonary—Sanatorium. 4 4 10 Pulmonary—Observation. County Sanatorium, Clare Hall, South Mimms 120 66 — Pulmonary. Heatherwood Hospital, Ascot — — 25 Non-pulmonary. Victoria Home, Margate — — 6 Non-pulmonary. Use is also made of many other institutions suitable for different types of tubercular patients to which cases are sent as occasion arises. 4. Maternity. Arrangements have been made with three maternity hospitals, namely, the Mothers' Hospital, Clapton, the Royal Northern Hospital, Holloway, and the City of London Maternity Hospital, for 12 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 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. (а) Unmarried Mothers. (b) Illegitimate Infants and Homeless Children. No provision is made for either of these classes of case, but an endeavour is made to assist individual cases as they arise. AMBULANCE FACILITIES. (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. 13 (6) 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 1,568 occasions, 163 being cases of street accident (2 of which were for neighbouring authorities) and 47 cases of illness in the street. The total mileage for the year was 11,895. The sums received from various users amounted in all to £20 12s. 6d. I have recently reported to the Public Health Committee on the necessity for the provision of a second ambulance. The recommendation has been approved by the Committee but the ambulance has not yet been provided. (c) Maternity Cases. The Council's ambulance is also used when necessary to carry maternity cases to hospital. CLINICS AND TREATMENT CENTRES. The days and hours of all Clinics and Treatment Centres were given in detail in my Annual Report for 1935, and as there has been no change during the year it is not necessary to repeat the information here. MATERNITY AND CHILD WELFARE. The number of live births registered during 1936 as belonging to Wood Green was 700 according to the information supplied by the Registrar-General. The number of births registered in the Borough during the year was 477, and the percentage notified under the Notification of Births Act was 93.6. The number of stillbirths registered was 16 and the number notified 15. 14 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 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 1,222 February 1,097 March 1,318 April 1,362 May 1,381 June 1,293 July 1,784 August 1,066 September 1,861 October 1,888 November 1,127 December 1,468 Total 16,867 The attendances in 1935 were 15,308 and in 1934, |14,559. The attendances at the Centre in the Alexandra Park area numbered 2,699, as compared with 2,380 in 1935, and 1,995 in 1934. The number of individual children brought to the Centres during the year was 1,522, of whom 768 were infants under 1 year of age, and 754 of from 1 to 5 years of age. The number of children seen by Dr. Miller at the Centres during the year was 1,488. 764 of these were infants under 12 16 months of age who made 3,201 attendances, while 724 were children of 1 to 5 years of age and their attendances numbered 1,997. Of the 38 infantile deaths which occurred during the year, in only 12 cases had the baby been brought to one of the Clinics. Ante-Natal Clinic. An ante-natal Clinic was held at the White Hart Lane Centre every Friday afternoon, and for one hour on Tuesday afternoons. The number of expectant mothers seen by the Medical Officer was 244 and the total attendances made numbered 843. The remainder of the Tuesday afternoon Clinic was allotted to post-natal cases, the number seen being 43 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 166. 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 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 some through the Public Assistance Committee but most on their own initiative and by direct arrangement with the hospital. From the time of booking until tlhe actual confinement, these mothers are keptl under observation by the obstetrical surgeon at the hospital. To prevent the necessity for more frequent attendance at the hospital 16 during this period than is absolutely necessary, an arrangement has been made with the County Health Department, by which the routine supervision of these mothers is carried out at our Ant© Natal Clinic in Wood Green. The mother is still seen at the hospital at fixed intervals or at any time in case of any abnormality being detected at tihe Clinic, and the ultimate responsibility for the case remains with the hospital. Very definite advantages, however, result from this co-operation between the hospital a-nd the local Child Welfare Authority. The mother is relieved of the fatigue of regular long journeys to hospital for the purpose of routine examination. She has the benefit of all the facilities provided at the local Child Welfare Centre, such as instruction in personal hygiene, making of infant clothes, and provision of extra nourishment in case, of need. She is also in constant touch with the Health Visitors who visit her in her home and give her the help and advice which is so useful at such a time particularly to young mothers. Altogether this is a very useful form of cooperation between hospital and local authority. The number of births occurring in hospital or nursing home is increasing steadily year by year, and in Wood Green as in other districts it is becoming increasingly difficult for all mothers who desire confinement in hospital to find the necessary accommodation. During the year conferences have been held with the neighbouring authorities of Hornsey and Finchley and joint communications made to the Middlesex County Council with a view to inducing the County to make more ample and convenient provision for maternity hospital accommodation for these three districts. It is understood that the County proposes to increase the accommodation provided at the North Middlesex Hospital, but it is felt that, this proposal does not altogether meet the case. 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 Centre. 17 The following is a record of the work done during the year New patients treated 155 Attendances made 516 Extractions (with local anaesthetic) 15 (with gas) 232 Fillings 93 Scalings, etc. 264 Advice only 83 Dentures provided 29 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 sunligiht treatment. Home Visiting. During the year the Health Visitors made a total of 7,212 visits. 2,900 of these visits were to babies under one year of age, 3,885 to children of from 1 to 5 years of age, and 427 were antenatal visits to expectant mothers. Free Food. Free food, consisting mostly of dried milk or cod liver oil and malt, were issued during the year to necessitous expectant and nursing mothers attending the Centres, at a cost of £152 15s. Od. Cows' milk was issued similarly at a cost of £145 15s. 9d. Free dinners were also supplied to necessitous mothers at the Feeding Centre in White Hart-lane at a cost of £1 9s. 6d. Children and Young Persons Acts, 1908 to 1932. The Health Visitors have continued to act as Infant Life Protection Visitors during the year. The numbers of foster-mothers and foster-children on the register at the end of the year were 18 and 19 respectively. 18 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 continues to be done. I have again drawn the Maternity and Child Welfare Committee's attention to the necessity for providing a new building adequate for this very valuable activity, and at the moment plans are in preparation for a new Day Nursery. The following table shows the attendances made at the Day Nursery throughout the year, and the corresponding figures for the previous year:- 1936. 1935. January 294 364 February 377 420 March 391 420 April 356 473 May 637 356 June 356 308 July 668 498 August 442 229 September 592 343 October 699 546 November 508 355 December 484 375 Totals 5,804 4,687 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 19 connected to the main, sewers which carry the sewage to a pumping station situated in Tottenham. Here the sewage is pumped into the London County Council's sewers, by arrangements 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 M us well Brooks, and by these is carried finally into the River Lea. BATHS. Wood Green is well provided with public baths. The Swimming Pool in Durnsford Road was open for the third year during the summer months, but owing to the prevalence of cold and wet weather, the attendances were much fewer than during the previous summer. Every endeavour is made to maintain the efficiency and attractiveness of this open-air bath, and the cleanliness of the water is assured by the fact that the whole contents of the pool are filtrated, strained, aerated and chlorinated once in every six hours. The Western Road Baths were closed for reconstruction from September to the end of the year so that the attendances there were also much fewer than in previous years. With the reconstruction and modernisation of these baths, Wood Green is now well equipped with public baths for all seasons of the year, and from the numbers attending it is obvious that good use is made of them. The filtration at the Western Road Baths is carried out by a Peterson Standard Pressure Filter installed in 1928. The attendances at the Swimming Pool in Durnsford Road, the Western Road Baths and the open-air bath on the racecourse at Alexandra Park for the last three years are shown below:— Swimming Pool. Western Road Baths. Open-Air Bath. Adults. Children. Adults. Children. . Adults. Children. 1934 51,827 137.900 47,121 11,864 5,443 (open for 8 weeks) 1935 114,141 24,237 115,507 43,054 11,951 7,036 1936 78,456 20,647 77,550 26,019 10,504 3,244 20 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 the Public Health Acts 631 Re-inspections 916 Complaints investigated 175 Inspections under the Housing (Consolidated) Regulations, 1925 702 Inspections under the Housing Acts 256 Re-inspections 1,736 Inspections of houses-let-in-lodgings 5 Re-inspections 76 Total4,497 Inspections under the Rent Restrictions Act 7 Grand Total 4,504 Enquiries in connection with Infectious Diseases:— Smallpox — Scarlet Fever 2I3 Diphtheria 190 Tuberculosis 68 Enteric 7 Other Diseases 3 Total 481 Inspections of Registered Premises:— Factories 6 Workshops 185 Workplaces:— Butcher shops 977 Dairies 247 Fried fish shops 277 Other workplaces 46 1,547 Slaughterhouses 219 Out-workers 110 Total 2,067 21 Miscellaneous Inspections:— Urinals 352 Passageways 98 Cinemas and other places of entertainment 31 Ice cream premises 112 Stalls—day and night visits 648 Smoke observation 1 Total 1,242 Total inspections during the year 3,309 Action Taken:— Issued. Completed. Verbal intimations 35 35 Preliminary Notices:— Public Health Act, 1875, Section 94 205 192 Public Health Act, 1875, Section 36 101 84 Housing Act, 1925, Section 5 4 4 Housing Act, 1930, Section 17 324 278 Infectious Disease (Prevention) Act, 1890, Section 5 198 198 Wood Green Urban District Council Act, 1920, Section 77 19 6 Bye-laws regulating houses let in lodgings 11 11 Shops Act, 1934, Section 10 — 10 862 783 Statutory Notices:— Public Health Act, 1875, Section 94 6 8 Public Health Act, 1875, Section 36 3 1 Public Health Act, 1875, Section 41 1 — Housing Act, 1930, Section 17 28 26 Infectious Disease (Prevention) Act, 1890, Section 5 3 3 Wood Green Urban District Council Act, 1920, Section 48 3 3 Public Health Act, 1925, Section 46 3 2 47 43 Work Carried out :— Drainage Works:— Drains reconstructed 12 Drains repaired 5 Drains unblocked and cleansed 29 Soil and vent shafts repaired or provided 42 Fresh air inlets repaired or provided 12 Sink and bath wastes repaired or provided 55 Inspection chambers repaired or provided 11 Interceptors repaired or provided 5 Drains tested 297 468 22 Water-closets:— New water-closets provided 2 New W.C. pans and traps provided 88 Water-closets repaired 69 Foul water-closets cleansed 16 Flushing apparatus repaired or provided 74 249 Cleansing:— Premises lime washed 4 Premises otherwise cleansed 9 Rooms cleansed after disinfection 201 Rooms disinfested 243 Accumulations of refuse removed 17 Keeping of animals discontinued 3 477 Dampness:— Roofs repaired, etc. 215 Eaves gutters repaired or provided 88 Rainwater pipes repaired or provided 74 Damp proof courses provided 22 Walls rendered or dampness otherwise remedied 183 582 House repairs:— Floors repaired—wood 98 Floors repaired—concrete 55 Coppers repaired or provided 89 Ceilings redecorated 898 Walls redecorated 843 General repairs 969 Fireplaces repaired 139 Stoves repaired or provided 104 Premises repainted externally 36 3,231 Miscellaneous:— Food stores repaired or provided 218 Yard pavings repaired, etc. 88 Dustbins provided 127 Water supply taken from mains 4 Baths, sinks and lavatory basins fixed 93 Gullies fixed 14 544 Total works carried out during the year 5,551 23 HOUSE-TO-HOUSE INSPECTION. NUMBER OF HOUSES INSPECTED, 1936. Road. No. of Houses. No. of Rooms. Families. Persons per room. Adults. Children. Acacia Road 43 247 205 29 0.95 Boreham Road 46 255 174 20 0.76 Chapmans Terrace 4 20 17 1 0.90 Cobham Road 59 349 264 33 0.85 Crossway 14 70 62 21 1.19 Croxford Gardens 20 100 91 26 1.17 Earlham Road 19 124 75 5 0.65 Eleanor Road 51 243 159 24 0.75 Fletton Road 22 110 72 5 0.70 Gospatrick Road 41 205 176 36 1.03 Herbert Road 24 130 77 9 0.66 James Gardens 20 100 88 26 1.14 Meads Road 32 188 151 16 0.89 Nightingale Road 8 46 31 6 0.80 Perth Road 21 105 99 29 1.22 Queen's Road 83 479 299 42 0.71 Richmond Road 40 200 126 11 0.68 Rivulet Road 67 335 325 68 1.17 White Hart Lane 7 35 32 6 1.09 Winkfield Road 81 512 397 40 0.85 Totals 702 3853 2920 453 0.88 FACTORIES, WORKSHOPS, WORKPLACES, LAUNDRIES, AND HOMEWORK. 1.—Inspection. Including Inspections made by the Sanitary Inspectors. Premises Inspections. Notices Prosecutions. Factories— (Including Factory Laundries) 6 2 — Workshops— (Including Workshop Laundries) 185 3 — Workplaces— (Other than Outworkers' Premises) 1547 10 — Total 1738 15 — 2.—Defects Found. Particulars. Found Remedied Referred to H.M. Inspectr Prosecutions. Nuisances under the Public Health Acts— Want of Cleanliness 14 14 — — Want of Ventilation — — — — Overcrowding — — — Want of Drainage of floors — — — — Other Nuisances 4 4 — — Sanitary Accommodation— Insufficient 2 2 Unsuitable or Defective 2 2 — — Not separate for Sexes — — — — Offences under the Factory and Workshop Acts— Illegal Occupation of Underground Bakehouse — — — — Other offences (excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) — — — — Total 22 22 — — 24 25 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 12 27 30 36 The making- up, ornamenting, finishing and repairing of table linen, or other household linen, and any process incidental thereto 1 — 1 2 — 2 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 — — — Total 14 — 29 33 — 39 26 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 19 Dining Rooms 16 Laundries 1 Bakehouses 15 Boot Repairers 6 Mechanical Repairs 6 Upholstery 6 Other Workshops 20 Total 89 5.—Other Matters. Factory and Workshop Acts:— Matters notified to H.M. Inspector of Factories — Underground Bakehouses (S.101):— Certificates granted during the vear — In use at the end of the year — Public Health Acts:— Matters notified bv H.M. Inspector of Factories 1 Defects remedied following H.M.I. 's notifications 1 27 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)1,594 (b) Number of inspections made for the purpose 4,322 (2) (a) Number of dwelling-houses (included under sub-head 1 above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 702 (b) Number of inspections made for the purpose1,578 (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 682 2.—Remedy of defects during the year without service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 565 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 28 (2) Number of dwelling-houses which were dered fit after service of formal notices— (a) By owners 25 (b) By Local Authority in default of owners 1 28 (B) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 13 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 11 (b) By Local Authority in default of owners — (C) Proceedings under Sections 19 and 21 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (2) Number of houses demolished in pursuance of Demolition Orders Nil. (D) Proceedings under Section 20 of the Housing Act, 1930 (as substituted by Section 84 of the Housing Act, 1935)— (1) Number of separate tenements or underground rooms or parts of buildings in respect of which Closing Orders were made 3 (2) Number of separate tenements or underground rooms or parts of buildings in respect of which Closing Orders were determined, the tenement or room or part of building having been rendered fit 1 4.—Housing Act, 1935.—Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year 110 (2) Number of families dwelling therein 110 (3) Number of persons dwelling therein 641 (b) Number of new cases of overcrowding reported during the year 150 29 (c) (1) Number of cases of overcrowding relieved during the year 40 (2) Number of persons concerned in such cases 251 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding — (e) Any other particulars with respect to crowding conditions upon which the Medical Officer of Health may consider it desirable to report — Rent Restriction Acts. Five certificates were granted under the above heading during the year 1936. Overcrowding. In accordance with Section I of the Housing Act, 1935, an inspection of the whole district was made in the early months of the year to ascertain the extent of overcrowding in Wood Green. In the preliminary inspection 13,615 dwellings were visited, 293 of which were found to be empty, thus leaving 13,322 dwellings of which particulars were entered on Form A. The information obtained at the preliminary inspection showed that 111 of these houses were overcrowded according to the standard of the Act and 741 possibly overcrowded. A more detailed inspection and measurement of these overcrowded and possibly overcrowded dwellings—852 in all—showed that the number of dwellings actually overcrowded according to the standard laid down in the Act was 150. No overcrowding was found in any of the Wood Green Council houses in White Hart-lane or Durnsford Road, but 6 cases of overcrowding were found in the London County Council's White Hart Lane Housing Estate. By the end of the year the number of overcrowded dwellings had been reduced from 150 to 110. This was achieved almost 30 entirely by the action of the overcrowded families themselves in finding other accommodation with the assistance in many instances of sympathetic landlords. This was particularly the case with one large housing estate, the Artisans and General Dwellings Company Estate where every case of overcrowding was relieved as soon as possible after notification by the offer of a larger house. One case of overcrowding was relieved by the provision of a Council house. This was one of the tenants in the Neville Place Slum Clearance Scheme. In the autumn months the vast majority of the houses in the district were visited again and measured in detail, so that the necessary information might be in the possession of the Health Department to enable it to supply any owner before or on the " appointed day" on which the overcrowding provisions of the Housing Act, 1935, came into effect, with the permitted number of persons in respect of any dwelling in which he was interested. The appointed day for Wood Green was January 1st, 1937. To deal with the overcrowding found to exist in Wood Green, I have advised the Council that a minimum of 30 new houses is required to house the most serious cases. So far, unfortunately, no progress has been made in proceeding with this provision, on account of the difficulty of finding a suitable site. NEW HOUSES BUILT DURING 1936. I am indebted to the Borough Surveyor for the following information relating to new houses erected in Wood Green during 1936 :— Number of houses elected during 1936 221 Number of flats erected during 1936 95 Number of houses built by the Council 18 Number built by other bodies and persons 298 The 18 houses shown above as built by the Council during the year were those built in Perth Road to house the tenants of the houses demolished in the Slum Clearance at Neville Place. 31 PUBLIC MORTUARY. Bodies deposited during the year 41 Inquests held 9 Post-mortem examinations 31 Causes of death Accidental 7 Natural causes 30 Suicide 1 For lodgement only 3 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. (Tuberculin Tested). Accredited. Pasteurised. 5 1 13 Supplementary Licences to sell milk from premises which are outside the area of the Licensing Authority. (Tuberculin Tested). Accredited. Pasteurised. 2 2 All the firms concerned produced and bottled this graded milk at premises outside this borough. (3) It has not been necessary to refuse or revoke registration of any retailer. 32 (b) Meat. There is only one licensed slaughterhouse in the Borough and the occupier has given notice of the times of slaughtering so that all animals killed on the premises may be examined by the Sanitary Inspector before being disposed of. There are no public slaughterhouses in the Borough. The following details show the number of carcases inspected after slaughter with the number of condemnations for tuberculosis and other diseases :— Cattle (bullocks and heifers) 274 Sheep 74 Lambs 823 Pigs 855 Condemned for tuberculosis. Weight. Whole carcase and organs 1 784 lbs. Parts of carcases and organs 26 893 lbs. Condemned for disease other than tuberculosis. Whole carcase and organs .. 1140 lbs. Livers and lungs 28 168 lbs. Total weight of meat condemned, 1,985 lbs. =17 cwt. 2 qrs. 25 lbs. (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. 33 The undermentioned foodstuffs were condemned as unfit for human consumption during the year :— Corned Beef 144 lbs. Pressed Pork 252 lbs. Veal 24 lbs. Turkeys (63) 756 lbs. Fish 40 lbs. Total 1,216 lbs. = 10 cwt. 3 qrs. 12 lbs. SALE OF FOOD AND DRUGS ACTS. The Middlesex County Council is the Authority for taking samples under the above Acts, and Mr. R. Robinson, Chief Officer of the Public Control Department, has kindly supplied the following figures concerning samples taken in Wood Green during 1936:— Articles. No. of samples taken. Adulterated. Milk 77 — Milk, sterilized 19 1 Hake 2 — Lard 2 — Lemon Sole 4 — Minced Beef 3 — Paste 3 — Rum 1 — Vinegar 2 — 113 1 No prosecutions were instituted during the year. 34 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Table VI in the Appendix shows the details of the notifications of infectious disease received during the year. The total number of cases notified was 323, which is rather less than the total for the previous year, 368. The fall in numbers was due to the very low incidence of scarlet fever which was responsible for only 98 notifications as compared with 201 in 1935, and 292 in 1934. On the other hand the incidence of diphtheria was very much increased, 99 notifications as compared with 39 in the previous year. The total number of cases removed to hospital or sanatorium was 297, and the number of deaths due to infectious disease was 100, a very marked increase on the number for the previous year which was 57. The increase was due to the very high mortality from diphtheria, pneumonia and tuberculosis, all of which was much higher than in 1935. 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 36 19 29 Diphtheria 13 30 54 Enteric Fever 2 1 1 Erysipelas 2 4 2 Measles 1 7 5 Totals 54 61 91 In addition, 1 case of scarlet fever, 2 of diphtheria and 1 of enteric fever were removed to other isolation hospitals. 35 The distribution of scarlet fever and diphtheria over the year is shown below :— Scarlet Fever. Diphtheria. First quarter 26 24 Second quarter 31 35 Third quarter 22 15 Fourth quarter 19 25 Totals 98 99 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 39 62 Glendale County School — — Trinity County School 2 — Private Schools — — Schools outside Wood Green 7 1 Under school age 23 24 Over school age 27 12 Totals 98 99 Scarlet Fever. This disease was much less prevalent in 1936 than in either of the two preceding years, only 98 notifications being received as compared with 201 in 1935, and 292 in 1934. The disease was very evenly distributed over the year and was uniformly of a very mild type, with no deaths. 85 cases were admitted to Isolation Hospitals. 36 Diphtheria. Diphtheria was much more prevalent in 1936 than in any year since 1930, the number of notifications received being 99 as compared with 39 in 1935 and 31 in 1934. In every case the patient was removed to an Isolation Hospital. The disease was unfortunately of a very severe type and was responsible for twelve deaths. Of these twelve deaths three occurred in children of from 2 to 5 years, eight in children of from 5 to 15 years, and one in an adult. 62 cases were notified in children attending schools in Wood Green, one in a child attending an outside school; 24 were children under school age, and 12 were over school age. Of the 63 school children, 44 attended the Alexandra Schools, the outbreak of diphtheria there being responsible for 56 cases altogether, the extra twelve being represented by three teachers and nine children under school age. I have given a detailed account of this outbreak on pages 13 to 16 of my Annual Report as School Medical Officer, which is printed along with this report, so that it is not necessary for me to go over the same ground again here. It is sufficient to say that the outbreak was the worst we have had in Wood Green for many years,, and the disease of a virulent type, eight deaths occurring in the 56 cases affected. The first case was reported in January and the last in December. The 43 cases not connected with this school outbreak were spread very evenly over the year. Many were of the mild type to which we have mostly been accustomed during recent years, but others were of the virulent or ''gravis" type, and four deaths in all occurred. In three cases death occurred within 48 hours of admission to hospital and in the fourth an adult death occurred on the seventh day. Immunisation against Diphtheria has been carried on as in previous years, mostly among children in the infant and junior departments of the elementary schools, but also among children under school age. During the year, 1,005 children received full courses of protective injections, and a further 55 were undergoing a course at the end of the year. 429 children were Schick tested during the year and 845 were awaiting Schick Test at 37 the end of the year. The total number of children immunised in Wood Green to the end of 1936, was 4,240, and of this number 12 are known to have since contracted diphtheria. In all of these cases the attack was mild and in no case has the disease terminated fatally. Enteric Fever. Four cases of typhoid and one of para-typhoid fever were notified. Four cases were admitted to the Joint Isolation Hospital and the fifth which had been admitted to a general hospital outside the district was removed to a neighbouring isolation hospital. In every case recovery occurred. Two of the typhoid cases contracted the infection whilst on holiday at a south-coast town where there was a severe outbreak of this disease. Anterior Poliomyelitis. Two cases occurred. One was nursed at home and the other removed to a general hospital. In both cases a good recovery resulted. Pneumonia. Twenty-two notifications of pneumonia were received. All cases notified were visited by the District Nurse, under an arrangement made between the Council and the District Nursing Association, and an offer of nursing assistance made. Puerperal Fever and Puerperal Pyrexia. Five cases of puerperal fever were notified, four of them from a nursing home. In one case unfortunately death occurred, the patient belonging to another district. There were fourteen notifications of puerperal pyrexia, one from a nursing home, and the others from hospitals. In every case recovery took place. 38 Ophthalmia Neonatorum. Six notifications of this disease were received. In five cases the child was treated at home, and in the sixth the baby was sent to a special hospital. In every case complete recovery took place. 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 188 Measles 393 Mumps 39 Whooping Cough 141 Skin Infections 27 788 788 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. Tuberculosis. Table VII in the Appendix shows that the total number of new cases coming to the knowledge of the Health Department during the year was 71, 62 respiratory and 9 non-respiratory. Of these 59 were notified by doctors practising in the district, or from hospital, while 12 cases were transferred from other districts. The number of notifications received in the previous year was 61. The number of deaths certified as due to tuberculosis was 51, of which 46 were due to respiratory and 5 to non-respiratory disease. This is a very considerable increase on the figure for 1935 which was 24. The death-rate was 0.95 per 1,000 of population as compared with 0.45 in 1935 and 0.65 in 1934. The death-rate from tuberculosis for the whole country for 1936 was 0.58. 39 Of the forty-six deaths certified as due to respiratory tuberculosis, no fewer than twenty-five occurred in early adult life from 15 to 35 years. Of these twelve were in males and thirteen in females. Of the total of fifty-one deaths occurring from all forms of tuberculosis, seven were in persons who had not previously been notified in this district, as suffering from tuberculosis. 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 43 Transfers from other districts (not included in above)12 Total number of non-tubercular cases (including contacts) 96 Cases undiagnosed on 31st December, 1936 2 Total number of tubercular cases supervised at or from Dispensary in 1936 214 Total number of tubercular cases still on Register at the end of 1936 147 During the year 74 cases were sent to hospital or sanatorium. The sanatoria or hospitals to which they were admitted are shown below:— Pulmonary Cases. Nonpulmonary Cases. British Legion Village, Bournemouth l 1 — Clare Hall Sanatorium 14 — Colindale Hospital, Hendon 1 — Eversfield Chest Hospital, St. Leonardson-Sea 2 — Harefield Sanatorium 25 — Hendon Cottage Hospital — 1 40 National Hospital, Benenden 1 — National Temperance Hospital — 1 North Middlesex County Hospital 19 — Northern Hospital, Winchmore Hill 2 — Old Manor House, Broadstairs 1 — Royal National Hospital, Ventnor 1 — Royal National Sanatorium, Bournemouth 1 — Royal Sea Bathing Hospital, Margate — 2 St. Bartholomew's Hospital 1 — St. Luke's Hospital, Chelsea 1 — 70 4 BACTERIOLOGICAL WORK. The bacteriological examination of specimens from the borough is carried out at the Joint Isolation Hospital, and during 1936 the following examinations were made:— Positive. Negative. Total. Diphtheria 117 1,494 1,611 Pulmonary Tuberculosis 21 113 134 Enteric 1 3 4 Others — —1 — 139 1,610 1,749 DISINFECTION, Etc. The number of articles dealt with at the Disinfecting Station during the year was as follows:— Articles disinfected after tuberculosis 239 ,, ,, ,, other infectious diseases 3,014 cancer 87 3,340 ,, disinfested of vermin 553 41 Articles dealt with for tenants moving into Council houses 258 ,, dealt with for families moved from a Slum Clearance Area 340 1,151 4,491 Total number of articles destroyed.. 346 The number of rooms disinfected was as follows:— Rooms disinfected after tuberculosis 47 ,, ,, ,, other infectious diseases 301 ,, ,, ,, cancer 11 359 ,, treated for vermin 243 243 602 It will be seen from the particulars given above that during the year a very considerable amount of time and labour has been devoted to the work of disinfestation of verminous property and household effects. There has, unfortunately been a very definite increase during the past few years in this as in other districts of bug-infestation of houses, and a great deal of work has in consequence been thrown on the Health Department. For several years we had a great deal of trouble with bug-infestation of Council houses, and in my report for 1934 I described in detail the method which we had found to be generally successful in dealing with the problem. The same method is now in general use in dealing with houses belonging to private owners. In these, the owner is required to remove the woodwork of the infested rooms, i.e., the skirting boards, architraves, picture-rails etc., while the actual spraying and fumigation is done by the Health Department, and the bedding disinfested at the Council's disinfecting 42 station. The total number of houses disinfested during 1936 was 114. Of these 9 were Council houses and the others belonged to private owners. As a means also of preventing infestation of Council houses by the admission of new tenants, we have continued throughout the year the system of making it obligatory on all new tenants to have their furniture subjected to fumigation by hydrocyanic acid gas before admission to the new house. The furniture is removed from the old house in a special van in which it is fumigated by a firm of professional fumigators employed by the Council, and installed in the new house later in the day. Meanwhile, all bedding, cushions, etc., have been stoved at thhe Council's steam disinfector. As a further precaution still all new Council tenants are advised by letter to be very careful to see that any second-hand furniture and particularly any beds purchased by them is free from vermin before it is taken into a Council house, and if there is any suggestion of verminous infestation the suspected article may be removed to the Council's disinfector to be cleaned. These arrangements for dealing with the furniture and bedding of new Council tenants have been in force now since July, 1935, and have been very satisfactory in every way. 43 APPENDIX. Table I Vital Statistics of Wood Green, 1921-36. Year. Population estimated to middle of each year. Net Births belonging to the District. Nett Deaths belonging to the District. Under 1 year of age. At all ages. Total No. Rate per 1,000 population Illegitimate No. Total No. Rate per 1,000 live births. Illegitimate No. Rate per 1,000 illegitimate births. No. Rate per 1,000 population (1) (2) (3) (4) (5) (6) (7) (8) 9) (10) (11) 1921 51,100 905 17.71 24 63 70 6 250 493 9.64 1922 51,290 873 17.02 26 41 47 4 154 524 10.21 1923 51,540 896 17.38 34 34 38 0 — 491 9.52 1924 51,840 762 14.7 15 32 42 3 200 513 9.89 1925 51,960 740 14.24 17 35 47 2 118 507 9.75 1926 51,940 802 15.44 26 32 40 1 38 457 8.79 1927 52,260 687 13.14 18 35 51 1 56 509 9.73 1928 52,750 732 13.8 22 30 41 0 — 478 9.06 1929 53,410 721 13.5 26 43 60 3 115 605 11.32 1930 53,410 719 13.4 30 26 36 3 100 534 10.0 1931 54,520 719 13.2 30 32 44 2 66 649 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 1936 53,620 700 13.1 23 38 54 0 — 588 10.9 44 Table II. Birth - Rate, Death - Rate and Analysis of Mortality during 1936. Birth-rate per 1,000 population. Annual Death - Rate per 1,000 Population. Rate per 1,000 Births. All Causes. Typhoid and Paratyphoid Fevers. i Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. 1 Diarrhoea and j Enteritis (under 2 years). Total Deaths under year. England and Wales 15.4 121 0.01 — 0.07 0.01 0.05 0.07 0.14 0.52 5.9 59 122 County Boroughs and Great Towns (including London) 15.6 12.3 0.01 — 0.09 0.01 0.06 0.08 014 0.45 8.2 63 143 Smaller Towns (population, 25,00050,000 at Census 1931) 15.6 11.5 0.00 — 0. 04 0.01 0.04 0.05 0.15 0.39 3.4 55 London 14.1 12.6 0.01 — 0.14 0.01 0.06 0.05 0.14 0.52 14.4 66 Wood Green 1.31 10.9 — — 0.04 — 0.04 0.22 0.09 0.50 10.0 54 45 Table III. Causes of Death during the year 1936. Causes of Death. Male. Female. Typhoid and Paratyphoid Fevers Measles 1 1 Scarlet Fever — — Whooping Cough 2 — Diphtheria 2 10 Influenza 4 1 Encephalitis Lethargica — 1 Cerebro - spinal Fever — — Tuberculosis of Respiratory System 30 16 Other Tuberculous Diseases 4 1 Syphilis 1 — General Paralysis of the Insane, Tabes Dorsalis .. 3 1 Cancer, Malignant Disease 41 50 Diabetes 3 8 Cerebral Haemorrhage, etc. 14 21 Heart Disease 61 81 Aneurysm — — Other Circulatory Diseases 15 22 Bronchitis 4 7 Pneumonia (all forms) 19 17 Other Respiratory Diseases 2 — Peptic Ulcer 5 2 Diarrnoea, etc. (under two years) 1 6 Appendicitis .. 2 1 Cirrhosis of Liver 1 1 Other Diseases of Liver, etc. 1 4 Other Digestive Diseases 9 8 Acute and Chronic Nephritis 7 7 Puerperal Sepsis — — Other Puerperal Causes — 1 Congenital Debility, Premature Birth, Malformation , etc. 14 6 Senility 2 3 Suicide 1 1 Other Violence 14 11 Other Defined Diseases 17 20 Causes ill-defined or unknown — — Totals 280 308 46 Table IV. Causes of, and Ages at Death during the year 1936. 2. 3. 4. 5. 6. 7. 8. 9. 10.11.12. 13. All Apes. Under 1year. 1 and under 2 year 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 5 5 years 55 and under 65 years. 5 and under 75 years. 75 years and upwards. Typhoid, etc. — — — — — — — — — — — — Measles 2 — 1 — 1 — — — — — — — Scarlet Fever — — — — — — — — — — — — Whooping Cough 2 2 — — — — — — — — — — Diphtheria 12 — — 3 8 — — 1 — — — — Influenza 5 — — — — — 1 — — 3 1 — Encephalitis Lethargica 1 — — — — — 1 — — — — — Cerebro - Spinal Fever — — — — — — — — — — — — Tuberculosis of Respiratory System 46 — 1 — 1 11 14 2 9 8 — — Other Tuberculous Diseases 5 1 1 1 1 — — — — — 1 — Syphilis — — — — — — — — — — — — General Paralysis of Insane 3 — — — — — — 1 — — — 2 Cancer, Malignant Disease 83 — — — — — 4 4 16 20 27 12 Diabetes 7 — — — — — — — — — 6 1 Cerebral Haemorrhage, etc. 40 — — — — — — 1 3 9 12 15 Heart Disease 137 — — — — 5 2 5 9 17 37 62 Aneurysm — — — — — — — — — — — — Other Circulatory Diseases 33 — — — — — — 1 — 4 11 17 Bronchitis 11 — — — — — — — 1 4 3 3 Pneumonia (all forms) 48 7 — 2 — — 2 1 5 8 9 14 Other Respiratory Diseases 5 — — — — — — 1 — 2 — 2 Peptic Ulcer 5 — — — — — 1 1 1 — 1 1 Diarrhoea, etc. (under 2) 7 6 1 — — — — — — — — — Appendicitis 3 — — — — — 1 — — — —2 — Cirrhosis of Liver 2 — — — — — — — 2 — — — Other Diseases of Liver 2 — — — — — — — ——— 2 Other Digestive Diseases 11 1 — — — — 1 — 2 1 1 5 Acute and Chronic Nephritis 15 — — — — — 2 3 2 1 3 4 Puerperal Sepsis — — — — — — — — — — — — Other Puerperal Causes 1 — — — — — 1 — — — — — Congenital Debility,— etc. 20 20 — — — — — — — — — — Senility 9 — — — — — — — — — 1 8 Suicide 2 — — — — — — — — 1 1 — Other Violence 24 — 1 — 1 2 1 1 — 4 2 12 Other Defined Diseases 47 1 — 1 2 3 — 4 8 11 7 10 Causes ill-defined — — — — — — — — — — — — Totals 588 38 5 7 14 21 31 26 58 95 125 168 47 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. 1 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 — — 1 — 1 1 5 — — 7 Congenital Deformities, &c — 1 1 — 2 — — — — 2 Convulsions — — — — — 1 — — — 1 Digestive Diseases — 1 — — 1 — — — — 1 Gastro Enteritis — — — — — 1 2 3 — 6 Haemorrhage 3 — 1 1 5 — — — — 5 Heart Failure 1 — — — 1 — — — — 1 Icterus Neonatorum 1 — — — 1 — — — — 1 Inanition — — — — — 1 — — — 1 Marasmus — — — 1 1 1 1 1 — 4 Premature Birth 2 — — — 2 — — — — 2 Prolonged Labour 1 — — — 1 — — — — 1 Spina Bifida — 2 — — 2 — — — — 2 Tubercular Meningitis — — — — — — — 1 — 1 Whooping Cough — — — — — — — — 2 2 Totals 9 4 3 2 18 5 8 5 2 38 48 Table VI. Infectious Diseases Notified during the year 1936. Notifiable Disease. Cases Notified in Whole Borough. Total Oases Notified in each Ward. Total Cases removed to Hospital or Sanatorium. Total Deaths. At Ages —Years. Alexandra-Bowes. Town Hall. Noel Park. All ages. 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 98 — 23 35 10 8 6 7 5 1 3 — 41 23 34 85 — Diphtheria 99 2 23 34 31 1 — 5 2 — 1 — 15 30 54 99 12 Encephalitis Lethargica — — — — — — — — — — — — — — — 1 1 Enteric Fever 5 — 1 — 2 — — — — 1 1 — 3 1 1 5 — Erysipelas 13 — 1 — 1 — — 1 2 2 4 2 2 6 5 8 — Ophthalmia Neonatorum 6 6 — — — — — — — — — — 1 4 1 1 — Pneumonia 22 — 2 2 — 3 2 5 2 4 2 2 9 5 8 5 36 Acute Poliomyelitis 2 1 — 1 — — — — — — — — 1 — 1 1 — Puerperal Fever 5 — — — — — — 4 1 — — — 1 4 — 5 — Puerperal Pyrexia 14 — — — — 1 2 10 1 — — — 4 7 3 13 — Pulmonary Tuberculosis 51 — 1 1 — 7 9 15 7 7 4 — 21 18 12 70 46 Non-Pulmonary Tuberculosis 8 — 1 — 2 2 2 — — — 1 — 3 3 2 4 5 Totals 323 9 52 73 46 20 21 47 20 15 16 4 101 101 121 297 100 49 Table VII. TUBERCULOSIS. New Cases and Mortality during 1936. Age Periods. New Cases. Deaths. Respiratory. Nonrespiratory. Respiratory. Nonrespiratory. M. F. M. F. M. F. M. F. 0 — — — — — — 1 — 1 1 — 1 — — — 1 — 5 1 1 — — — — — — 10 — 1 1 1 — 1 1 1 15 2 5 1 1 1 5 — — 20 4 8 — 2 2 3 — — 25 6 13 — — 9 5 — — 35 8 — — 1 2 — — — 45 7 — — — 8 1 — — 55 4 — — 1 7 1 — — 65 and upwards.. — 1 — — 1 — 1 — Totals 33 29 3 6 30 16 4 1 Above includes transfers (12) from other Districts. 7 non-notified T.B. deaths occurred. 50 METEOROLOGICAL REPORT FOR YEAR ENDING 31st DECEMBER, 1936. Month. Total Rainfall. Maximum Rainfall. No. of Wet Days. Maximum Temperature. Minimum Temperature. 1936. Inches. Inches. Date. Degrees. Date. Degrees. Date. January 4.11 0.84 9th 18 58 9th 18 18 th February 1.32 0.36 17th 15 55 18th 16 11th March 0.55 0.10 25th 26th & 28th 11 63 22nd 25 3rd April 1.05 0.33 20th 10 65 28th and 30th 23 10th and 13th May 0.28 0.12 17th and 22nd 4 77 18th 37 21st and 28th June 3.28 0.46 25th 19 87 20th 41 3rd July 2.78 0.73 28th 20 79 5th 45 30th August 0.37 0.09 10th and 19th 10 82 16th 48 28th September 2.36 0.59 20th 17 75 11th 40 28th October 1.38 0.38 24th 12 67 15th 32 3rd and 21st November 2.6 0.7 11th 18 57 17th 30 22nd,24th&28th December 1.75 0.42 14th 20 55 2nd, 3rd, 17th and 18th 27 7th Total for year 21.83 — — 174 — — — — Note.—Maximum Rainfall 0.84ins. 9th January. ,, Rate of Rainfall 1.8ins. per hour; duration 15 minutes, 28th July. ,, Temperature 87° Fahr. 20th June. Minimum ,, 16° Fahr. 11th February. (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. Mrs. E. M. Bottom. Councillor Mrs. J. Cole. Mr. H. J. Garlick, B.Sc. Councillor W. G. Doyle. Rev. H. Harris. Councillor F. H. P. Forney. Mrs. H. S. Harrison. Councillor D. C. Leech. Miss C. M. LightFoot. Councillor F. F. Tomlin. Mrs. M. V. Mackie. Councillor Mrs. L. C. Vant. Rev. G. Mason. Councillor W. A. Vant. Mr. H. Smith. CARE AND AFTER CARE SUB-COMMITTEE. Chairman: Alderman Mrs. J. J. Bolster, J. P. Councillor Mrs. J. Cole. Mrs. E. Agombar. Councillor Mrs. L. C. Vant. Mrs. A. Barrett. Mrs. E. M. Bottom. Mrs. W. Braithwaite. Mrs. Harrison. Mrs. E. L. Corbett. Miss C. M. Lightfoot. Miss J. Irvine. Mrs. M. V. Mackie. Mrs. E. M. Jackson. (The Chairman and Vice-Chairman of the Education Committee.) Director of Education: C. H. Jarvis, M.A., LL.D. Mood Green Education Committee. SCHOOL MEDICAL SERVICE. ANNUAL REPORT 1936. Ashburton House, 298, High Road, Wood Green, N.22. April 10th, 1937. 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 1936. As in former years, the form of the report has been determined by the Board of Education and I have followed generally the suggestions made as to its arrangement. I.—STAFF. The School Medical Staff during 1936 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.—G. S. Williams, L.D.S. ; D. W. MacBean, L.D.S. School Nurses.—Miss B. M. Gray; Miss J. M. Hopkins (resigned May, 1936); Miss N. Gardner (commenced September, 1936). 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 change in the personnel of the Staff during the year was the resignation of Miss Hopkins, one of the School Nurses, on the occasion of her marriage, and the appointment of Miss Gardner as her successor. All the members of the Staff are full-time officers, with the exception of the Ophthalmic Surgeon, the Aural Surgeon, Mr. MacBean, who does the dental surgery for the two secondary schools, and Miss Dawson, who conducts the Speech Defects Clinic, all of whom are engaged on a sessional basis. II.—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 services. 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 discovered, instead of waiting until school age is reached before treatment is provided. III.—SCHOOL HYGIENE. No structural alterations of any importance were made in any of the schools during the past year. Plans were in preparation, however, for the erection of a new school to take the place of White Hart Lane School, and for extensive alterations at Lordship Lane and Bounds Green Schools. IV.—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. At these routine inspections the number of children examined was 2,520. Of these, 692 were entrants, 765 belonged to the second and 513 to the third age-group, while 550 were of ages outside these three groups. 4 In addition to these routine inspections, 1,053 special cases were examined and 2,469 children re-examined. The "specials" are children who have been referred to the School Medical Officers by the School Nurses or teachers, or who are brought for examination by parents or guardians. A small proportion of these special cases are seen at school at the time of the ordinary medical inspections, but the great 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 examination 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, 1936, was 5,543. The number examined by the School Medical Officers during the year was 3,573. V.—FINDINGS OF MEDICAL INSPECTION. The details of the medical inspections, the defects found and the number for which treatment was provided will be found in the statistical tables at the end of this Report. Table Ic shows the number of children found at the routine medical inspections to require treatment. These numbers are again very small, and must be regarded as very satisfactory. Their smallness is very largely due to the close co-operation which exists between the schools and the school medical service, and to the use made of the facilities provided at the School Clinic for advice and treatment. Defects in children are, as a rule, brought to our notice by the head teachers at a very early stage, and the necessary treatment may be arranged for or provided weeks or months before the routine medical inspections are due to take place in particular schools. 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 or to be kept under observation. It will be observed that at the routine inspections the number of defects found to require treatment is low compared with those which require to be kept under observation, whereas at the special inspections the defects found to require treatment are very much in excess of those referred for observation. 5 (a) Nutrition. Table IIb gives a classification of the nutrition of the children inspected during the year in the routine age-groups. Of the total number of children examined in these groups it will be seen that 26 per cent, were classified as excellent from the point of view of nutrition, 61.4 as normal, 12.1 as slightly subnormal, and only .5 as bad. If columns A and B in the table are taken together, and columns B and C, it is seen that the nutrition of 87.4 per cent, of the children examined was either excellent or normal, while that of 12.6 per cent, was either slightly subnormal or bad. These figures are, on the whole, fairly satisfactory, but there is, of course, room for considerable improvement yet. If the different age groups are examined separately, it will be seen that the figures for the first two groups, the entrants and the eight-year-old children are not quite so good as those for the third age group or twelve-year-old children, or the "other routine inspections," which in Wood Green are mostly children of thirteen or fourteen years. Thus, of the children leaving school at the end of their elementary school life, at least 30 per cent. are found to be of excellent nutrition and only 10 per cent. slightly subnormal or bad. I remarked in my report for 1935 that a steady, if slow, improvement is taking place in the nutrition of the children in this district. We still find the occasional badly nourished child, the malnutrition sometimes the result of poverty, but more often perhaps due to other causes. Where poverty is the cause, a great deal can be done and is being done by the provision of free milk at school, free dinners at the centre, and free cod-liver oil; and where previous illness is a cause of malnutrition, help can be given by sending the child to a convalescent home. Where the poor nutrition is the result not of lack of food, but of bad feeding habits, poor discipline in the home, and too short hours of sleep, the remedy is not so easy. Repeated insistence in interviews with parents on the importance of proper feeding, and particularly of the paramount importance in the diet of the protective foods—milk, butter, cheese, eggs, fruits and vegetables—is no doubt having some effect in promoting right ideas among the parents on the subject of feeding, and a good deal is being done by the provision of a regular supply of milk in schools 6 at half-price by the Milk Marketing Board. The proportion of elementary school children in Wood Green availing themselves of this provision is well over fifty per cent., and in addition a considerable number of children are provided with a free supply throughout the year on medical grounds. Apart from the direct and immediate beneficial result of this daily supply of milk, it would seem reasonable to expect that the children are learning the habit of milk drinking, a habit which ought to be of great value to them in later life. (b) Cleanliness. The standard of cleanliness among the children remains high, and reflects credit on the vast majority of parents. The occasional verminous child is, however, still found, but not so frequently as in former years. The number of individual inspections of children for cleanliness made by the School Nurses during the year was over 42,000, and the number of children excluded on account of verminous conditions was 157. (c) Minor Ailments and Diseases of the Skin. One hundred and seven children were referred for treatment on account of minor ailments, these including various skin conditions, minor injuries and external diseases of the ears and eyes. Some of these children were treated privately or at hospital, but the great majority received treatment at the School Clinic. (d) Visual Defects and External Eye Diseases. Fifty-eight children were recommended for treatment on account of defective vision or squint, while 246 children suffering from minor defects of vision were kept under observation. Nineteen children were found to require treatment for external diseases of the eye, and twenty were kept under observation. (e) Nose and Throat Defects. Twenty-eight children were recommended to have operative treatment for enlarged tonsils and adenoids, and 231 were referred for observation. A further thirty-nine children had other conditions of the throat or nose calling for treatment, and two others were referred for observation. 7 (f) Ear Disease and Defective Hearing. Twelve children were found to be so deaf as to require treatment for this defect, and other forms of ear disease requiring treatment were found in twenty-five children. (g) Dental Defects. The results of the inspections carried out by the School Dental Officer are shown in Table V. 4,000 children in all were inspected during the year, and of these 3,226 were found to be in need of dental treatment. Of this number 2,128 actually received treatment at the Dental Clinic. (h) Orthopaedic and Postural Defects. Twelve children were classified as cripples. Of these, one-half were old cases of non-pulmonary tuberculosis which were either quiescent or cured. All twelve were under hospital treatment or observation. (i) Heart Disease and Rheumatism. Evidence of abnormality of the heart was found in forty-six children. In only fourteen of these cases was the child thought to be suffering from organic disease of the heart, and in the majority of these cases the disease was rheumatic in origin. Including these cardiac cases, forty-two children in all were seen during the year suffering from rheumatism. Most of these cases were not very severe, but in a few cases very definite attacks of acute rheumatism had occurred, for which active treatment at home or in hospital had been obtained. All cases of rheumatism and heart disease are kept under regular observation at the School Clinic. (j) Tuberculosis. Seven cases of pulmonary tuberculosis were seen in school children during the year. One of these was admitted to sanatorium early in the year. All the others had already received sanatorium treatment and were in a quiescent state, so that it was possible for them to attend school. Six cases of non-pulmonary tuberculosis were kept under observation at the clinic. Two cases were in institutions, and one death in hospital occurred from tuberculous meningitis. 8 VI. —FOLLOWING-UP. All defects discovered at medical inspections are reported to the parents or guardians, with a recommendation that the necessary treatment be obtained as soon as possible. Later, the Visitation Officer visits the homes to see whether treatment has been obtained. In most cases I am glad to say there is little or no delay in obtaining the necessary treatment, 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 by the Visitation Officer in the work of following-up the defects found at medical inspection has been 2,012. VII.— ARRANGEMENTS FOR TREATMENT. Arrangements for treatment remain as in former years. Wherever possible parents are recommended to obtain treatment for their children privately from the family doctor or at hospital, but where the family circumstances make it difficult or impossible for this to be done, provision has been made by the Education Committee for the treatment of certain types of defect. At the School Clinic treatment is provided 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, ultra-violet light treatment is provided at the North Middlesex Hospital and the Royal Northern Hospital, and X-ray treatment for ringworm at the Royal Northern Hospital. (a) Minor Ailments. Eleven hundred and sixty-three 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. Only one child was operated on during the year, under the Committee's scheme, for enlarged tonsils and adenoids, while eighteen received operative treatment privately at home or in hospital. Children dealt with under the Committee's scheme are 9 admitted to the Prince of Wales's or the Royal Northern Hospitals for a minimum of two nights, being admitted the day previous to and discharged not sooner than the day after operation. The children are brought 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 743, 237 of these being new cases. 317 children had spectacles prescribed for them, and of this number 298 had obtained the spectacles by the end of the year. In addition, a further ten children obtained spectacles privately or from hospital. (d) Ear Disease and Defective Hearing. The number of children seen by Dr. Friel at the Ear Clinic during the year was 197, of whom 143 were cases seen for the first time. 56 of these children were treated for otorrhoea, and of these 41 were cured, 5 still under treatment at the end of the year, 4 referred to hospital for operative treatment, while 6 left the district before treatment was completed. In addition to these, a large number of children were treated for defects of hearing due to catarrh of the middle ear, chronic nasal catarrh and nasal obstruction, with very satisfactory results. The total attendances at the Ear Clinic during the year numbered 509. (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 school population, so that dental treatment is available for every child during his elementary school life. Our endeavour has been, as in former years, to concentrate as far as possible on conservative treatment, and to discourage the casual case which wishes to attend only when the teeth are actually causing pain or discomfort. It will be seen that so far as permanent teeth are concerned, the ratio of fillings to extractions is very satisfactory, 3,030 fillings to 481 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. 10 (f) Defects of Speech. The Speech Defect Clinic deals with children suffering from stammering and other defects of speech. Two classes are held, one for children of twelve years and over and one for children under twelve, and each class is held twice weekly. The classes are limited to eight children each, so that individual attention may be given. This work is, in my opinion, very well worth doing, and although the improvement in most cases is necessarily very slow, on the whole excellent results are obtained, and in a considerable proportion of cases complete cure is achieved. VIII.—INFECTIOUS DISEASES. The incidence of infectious disease in the elementary schools was very much the same in 1936 as in the previous year so far as numbers were concerned. 889 cases were notified in 1936 as compared with 864 in 1935. The following table gives the numbers of cases of the different infectious diseases notified from the elementary schools in 1936 and 1935. 1936. 1935. Scarlet Fever 39 103 Diphtheria 62 20 Chicken-pox 188 138 Measles 393 82 Mumps 39 361 Whooping Cough 141 150 Skin Infections 27 10 Total 889 864 It will be seen that measles was much more prevalent in 1936 than in 1935, 393 cases as compared with 82. The disease was most prevalent in the early months of the year, 311 cases being notified in the first quarter and 82 in the second. Chicken-pox was widely prevalent in the first quarter, and whooping cough in the last. The incidence of scarlet fever was very low as compared with 1935, but that of diphtheria much higher than in 1935. 11 The incidence of scarlet fever and diphtheria during 1936 is shown in the following table:— School. Scarlet Fever. Diphtheria. Alexandra Boys — 7 ,, Girls 3 32 ,, Infants 8 5 Bounds Green Boys 2 — ,, ,, Girls 3 — ,, ,, Infants 3 2 Lordship Lane Boys — 2 ,, ,, Girls — 1 ,, ,, Infants 1 2 Noel Park Boys — 1 ,, ,, Girls 4 — ,, ,, Infants 2 3 Rhodes Avenue 8 — St. Michael's Mixed 2 3 ,, ,, Infants — — St. Paul's 2 1 White Hart Lane Boys — 1 ,, ,, ,, Girls — — ,, ,, ,, Infants 1 2 Glendale County School — — Trinity County School 2 — Private Schools — — Schools outside Borough 7 1 Under School Age 23 24 Over School Age 27 12 Totals 98 99 Scarlet Fever. Diphtheria. 1st Quarter 26 24 2nd ,, 31 35 3rd 22 15 4th ,, 19 25 Totals 98 99 12 It will be seen in this table that of the 62 cases of diphtheria notified in elementary school children, no fewer than 44 occurred in the Alexandra Schools. These 44 cases represent an outbreak of very great severity spread over a considerable period, and I wish to give a short account of the outbreak. The first case was notified and admitted to hospital on January 24th. This was a girl of 9 years from the Girls' Department, suffering from a very severe attack of diphtheria, and death occurred on February 6th, the fourteenth day of illness. On February 1st the second case was notified, a child of 4½ years attending the Infants' Department. This child was also very gravely ill and died on February 6th, on the seventh day of illness. These two children were cousins and were possibly in contact with one another outside school hours. On February 12th three more cases were notified from the Girls' Department, all from different classes, and during the next fortnight a further ten cases were notified, nine from the Girls' Department, including a teacher, and one from the Boys' Department. On February 18th the Girls' Department was closed, to be reopened on March 2nd. From February 23rd to March 16th no cases occurred, but one case was notified on March 17th, and during the next ten days four further cases occurred, three in the Girls' Department and one in the Boys', this last case terminating fatally. During April and May a further sixteen cases occurred. Of these, seven, including one teacher, were from the Girls' Department, two from the Infants' and one from the Boys' Department. The remaining six cases were children under school age, contacts of cases attending school, and all of them from two families occupying the same house. During June and July no cases were reported, but on August 1st a girl of eleven years was admitted to hospital with a very severe attack which proved fatal within a few hours. Three more cases occurred during August, with one death; two in September; two in October; six in November, including one teacher in the Girls' Department; and three during the first two days of December. Since then no further cases have occurred. The cases occurring during the different months of the year are shown in the following table:— 13 Over or under School Girls. Boys. Infants. Age. Total January 1 — — — 1 February 11 1 1 2 15 March 4 1 — — 5 April 2 1 2 1 6 May 4 — — 6 10 June — — — — — July — — — — — August 2 — — 2 4 September 1 1 — — 2 October 2 — — — 2 November 3 2 2 1 8 December 2 1 — — 3 Totals 32 7 5 12 56 It will be seen from these figures that the total number of cases connected with the outbreak was 56, 44 of these being children attending the Alexandra Schools, three teachers in the Girls' Department and nine other children under or over school age. The outbreak was at its worst in the month of February when 15 cases occurred, but there were ten cases in May and eight in November. The only months in which no fresh cases occurred were June and July. The outbreak was characterised throughout its course by the great severity of the majority of the cases, the clinical picture suggesting at once the "gravis" type which has been so common during recent years in many centres in the north of England. In most cases the throat lesions were very extensive, involving the tonsils, soft palate and anterior fauces with considerable oedema of the throat, and in many cases very marked swelling of the cervical glands. The response to antitoxin treatment was usually slow, and in most cases the throat condition cleared up only after very large doses of serum, as much as 200,000 units of diphtheria antitoxin being required in several cases. 14 Death occurred in eight cases, five from the Girls' Department, two from the Infants' and one from the Boys'. The day of illness on which death occurred was as early as the third in two cases, and as late as the forty-sixth and forty-seventh in two other cases. I have said above that the very great severity of the majority of the cases suggested that the disease was of the "gravis" type, but bacteriological investigation did not altogether confirm this. Swabs taken from the throat or nose were positive in practically every case, and in about a third of the cases, including all the most severe cases, swabs were sent to Dr. W. M. Scott, of the Ministry of Health, for determination of the type of organism. In the early cases Dr. Scott found that the organism did not conform altogether either to the "mitis" or to the "gravis" type as usually described. In formation of colonies it had the characteristics of the "mitis" type, while in the fermentation tests it conformed to the "gravis" type. Previous examples of this new mixed type had been found on two occasions in the north of England, but not in the London area. Cultures from some of the later cases in the outbreak were reported by Dr. Scott to be definitely "gravis'' in type, a finding which was altogether in keeping with the clinical features of the disease. Of the 56 cases connected with this outbreak 8 occurred in children who had previously been given full courses of protective injections against diphtheria. Two of the eight had been immunised five years previously, four two years, and one sixteen months previously. All these had been Schick tested subsequently to immunisation and were found to be Schick negative. In the eighth case the course of injections had been completed only seven months before the onset of the disease, but as the child had not been brought for the subsequent Schick test there was no information available as to whether she was Schick negative or not. It has to be admitted that these figures are rather disconcerting. It is not surprising perhaps that after five years an immunity which had been conferred by artificial means should have passed off in two cases, when we remember that even a severe attack of diphtheria does not always confer lasting immunity, so that second attacks of the disease are commonly met with. The fact, however, that children immunised as recently as two years or even sixteen months 15 previously contracted the disease most probably means that the protection which had been given by the injections of toxoidantitoxin, while quite adequate against an ordinary outbreak of diphtheria, was not quite strong enough to protect against the very virulent type of diphtheria to which these children were exposed in this outbreak. This view is, perhaps, strengthened by the fact that of over four thousand children who have been immunised in Wood Green during the past few years, apart from these eight cases, only four others have been known to contract diphtheria subsequently. In no case occurring in an immunised child has the disease terminated fatally, and during the recent outbreak it was obvious that the immunised children had on the whole very much less severe attacks than the non-immunised. Although immunisation has been offered year by year to all children in the infant departments of the Wood Green schools for the past seven years, at the time of this outbreak little more than twenty-five per cent. of all the children in the three departments of the Alexandra Schools had been immunised. Towards the end of the year, when cases were continuing to occur, immunisation was offered to every child in the school not previously immunised, and more than half of the children on the roll availed themselves of the offer. As it happens, there have been no further cases in the school since this special campaign of immunisation was carried out. All teachers in the Infants' and Girls' Departments found to be Schick negative were also immunised. So far as immunisation generally is concerned, the total number of children who received full courses of protective injections during the year was 1,005, and a further 55 were undergoing a course at the end of the year. 429 children were Schick-tested during the year. Of these, 269 were children who had been immunised during 1935. 845 children who had received full courses of injections were awaiting the Schick test at the end of the year. IX.—OPEN-AIR EDUCATION. There are no open-air schools in Wood Green, and no open-air classrooms in any of the elementary schools. The only form of open-air education enjoyed by the children is the open-air class 16 conducted in the playground during the summer months, and considerable use continues to be made of this method of teaching. In two of the schools, however, another form of open-air education has been enjoyed by a limited number of children. 31 boys and 2 teachers from Bounds Green Boys' School took part in a school journey to Lyme Regis for a fortnight in June and July, while 25 girls and 2 teachers from Bounds Green Girls' School had a school journey to Ryde for a fortnight in June. These school journeys enjoy great popularity in these two schools, and seem to me to be an ideal method of pursuing education under excellent health conditions. There was also, as in former years, a School Camp in August at Dymchurch, arranged by the Juvenile Organisations Committee for a selected number of children from all the elementary schools. The number of elementary school children sent this year from Wood Green was 184. These children were selected by the Juvenile Organisations Committee with the help of the head teachers, and in some cases on the recommendation of the School Medical Officers. The preference was, naturally, given to children who seemed 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. This provision of a holiday year by year to such a large number of the less fortunately circumstanced children in our schools is, as I have said on many previous occasions, a very valuable contribution to the health and well-being of these children, and Wood Green is fortunate in having such an excellent organisation as the Juvenile Organisations Committee, capable of carrying out such a valuable service. 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, sometimes 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 five girls to Collington Manor, Bexhill. 17 A further ten boys and ten girls were sent for periods of a fortnight each to the Shoeburyness Holiday Home, which is run by the Palmers Green Samaritan Society. X.—PHYSICAL TRAINING. Physical training in the schools is carried out by the teachers and is directed and supervised by two special organisers. There is no direct association with the School Medical Service. School Baths. The attendances of school children at the Western Road Baths during the year numbered 26,019, at the Open-Air Bath on the Alexandra Park Race Course 3,244, and at the Swimming Pool in Durnsford Road 20,647. These figures are all lower than those for the previous year. This was due, in the case of the open-air baths, to the very poor summer weather we enjoyed, and in the case of the Western Road Baths to the fact that these baths were closed for a large part of the year on account of reconstruction. The number of certificates of proficiency in swimming awarded to school children during the year was 895. Of this number, 117—77 boys and 40 girls—were awarded certificates for swimming 880 yards. These numbers are much smaller than in previous years owing to the closure of the Western Road Baths. XI.—PROVISION OF MEALS. A hot mid-day meal is provided throughout the year at the Feeding Centre in White Hart Lane for a number of children who are found to be in need of such a provision. The children are, for the most part, selected on economic grounds and are usually recommended by the teachers in the schools, although a number are recommended by myself on definitely 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 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 subject to periodic revision to prevent monotony in the meals. 18 The number of children who received meals at the Centre during the year was 166, and of this number 122 were fed free of cost, 42 for part payment, and 2 for full payment. The total number of meals provided was 15,782, of which 11,251 were given free, 4,513 for part payment, and 18 for full payment. The average cost per meal was 5.9 pence, of which 2.5 pence represented the actual cost of food, and 3.4 pence the cost of administration. In addition to the meals served at the Feeding Centre, 2,865 meals were provided at the School for the Partially Sighted, in Lordship Lane, for the children attending there. Of these, 1,551 were given free, 202 for part payment, and 1,112 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 are supplied with malt and cod-liver oil at the School Clinic either free or at cost price, on the recommendation of the School Medical Officers. XII.—CO-OPERATION. (a) Of Parents. The parents of the children are usually interested in the school medical examination, and the majority of the children are accompanied on these occasions by a parent or guardian. At the entrants' examinations more than 90 per cent, of the children were attended by a parent or guardian. At the intermediate inspections the percentage of parents attending was over 70, and in the case of the leavers it was over 30. The parents, as a rule, are glad to get advice about their children and ready to act on it, and the success of the school medical work depends very largely on their co-operation. (b) Of Teachers. The co-operation of the teachers has been as ready and willing as in previous years. Without their willing co-operation the work of the school medical service would lose much of its effect, and would not proceed so smoothly and quietly as it does. Our work 19 makes many demands on the time and work of the head teachers particularly, and I am glad to be able to express my thanks to them for the assistance they give us. The School Attendance Officers have also been helpful in bringing to our notice children requiring attention, and I am indebted to them for their help. (c) Of Voluntary Bodies. Of the voluntary bodies for whose help the school medical service is grateful, the chief is the Juvenile Organisations Committee, to which I have referred above in connection with the Children's Holiday Camp at Dymchurch. Other activities of this organisation 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 provided many of the poorer children with boots and clothing during the year. Assistance has 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 been neglectful to obtain necessary treatment for their children, and I am very grateful to the officers of both these organisations for their assistance, which is readily available at all times. I am also very grateful to the Palmers Green Samaritan Society for enabling us to send children to their Holiday Home at Shoeburyness on very advantageous terms. (d) Juvenile Employment Bureau. The school medical records of all children reaching schoolleaving age are handed on to the Juvenile Employment Bureau as soon as the children leave school. These records are carefully examined before being handed over and a note made on them for the guidance of the Bureau in all cases where unsuitability for any particular type of work is indicated. 20 XIII.—BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. A register is kept of all defective children in the district, and every effort is made to keep this register as accurate as possible. It is based very largely on the results of the routine and special medical inspections, but for information about 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. (a) Blind. There are no blind children of school age in Wood Green, and only one child whose eyesight is so defective as to make it difficult for her to profit by instruction in an ordinary elementary school. This child is in attendance at the Partially Sighted School in Lordship Lane. The children there are under the regular supervision of the School Ophthalmic Surgeons, and the school is visited regularly by the School Medical Officer. The Wood Green School for the Partially Sighted provides accommodation not only for Wood Green children, but for children from other educational authorities. The total number of partially sighted children attending at the end of the year was twenty-four. Of these, one only belonged to Wood Green, fourteen to Tottenham, four to Enfield, three to Hornsey, and one each to Finchley and Edmonton. A mid-day meal is provided at the school for children who are unable to go home. (b) Deaf. There are four 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. 21 (c) Mentally Defective. Twelve mentally defective children from Wood Green were attending the Joint Special School for Mental Defectives at Finchley. Many of these children are high-grade defectives who may be expected to do very well. The school is visited and the children examined by the School Medical Officer at regular intervals. Two children classed as mentally defective were attending ordinary elementary schools, and three others were not attending any school. For this type of child and for older mental defectives from Wood Green and neighbouring districts, the Occupation Centre at Shropshire Hall in Gladstone Avenue performs a useful service in providing occupation during the day. The mental defectives attending the Occupation Centre are medically inspected twice a year, 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 ordinary school. XV.—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. In the absence of a proper Nursery School, these classes meet a definite need in providing a healthy environment during the day for young children whose home circumstances are not altogether satisfactory. XVI.—SECONDARY SCHOOLS. By arrangement between the Middlesex County and Wood Green Education Authorities, the routine and special medical inspections of the pupils attending the two Secondary Schools in Wood Green are carried out by Dr. Miller and myself. Defects found at medical inspection are reported to the parents, who make their own arrangements for treatment. In the case of dental defects 22 and defects of vision, treatment is now provided at the School Clinic under an arrangement made with the County Education Committee. This work has now been done for almost two years, with very satisfactory results. The dental work is done by Mr. MacBean, part-time Dental Officer, and the eye work by Dr. Boden, our School Ophthalmic Surgeon. XVII.—PARENTS' PAYMENTS. A small charge is made to parents for treatment given to children at the dental clinic and 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 operations 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 the treatment provided, the case is reported to the Care and AfterCare Committee and the sum charged to the parents reduced or remitted. XVIII.—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. XIX.—SCHOOL CLINIC. Before concluding this Report, I wish to remind the Committee again of the unsatisfactory state of the School Clinic. The Committee is well aware that the present clinic is a very poor structure, which during recent years has become increasingly inadequate for the steadily increasing amount of work which has to be carried out in it. At times the overcrowding, when several clinics have to be conducted at the same time, is so great as to hamper the work. For several years the Eye and Ear Clinics have had to be held at 23 the Child Welfare Centre, and since the dental treatment of the secondary school pupils has been undertaken, this work has had to be done in the evenings for lack of accommodation during the day. I am well aware that the Education Committee is not itself responsible for the failure to provide a new School Clinic, but it is my duty again to remind the Committee that a new clinic is long overdue and is urgently required. In conclusion, I wish to express my appreciation of the support and encouragement which the Education Committee has at all times given to the school medical services. I wish also to thank the Director of Education and his staff for assistance which is always readily given, and every member of my own staff for the loyal and willing service on which I can invariably count. I am, Ladies and Gentlemen, Your obedient servant, MALCOLM MANSON, School Medical Officer. 24 APPENDIX. MEDICAL STATISTICAL TABLES, 1936. TABLE I.—RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Age. Entrants . Total. 3 4 5 6 Other Ages. Boys — 24 183 103 35 345 Girls — 12 204 93 38 347 Totals .. — 36 387 196 73 692 Second Age Group (Intermediates). Age. 8 Other Ages. Total. Boys 263 118 381 Girls 295 89 384 Totals .. 558 207 765 Third Age Group (Leavers). Age. 12 13 14 Other Ages. Total. Boys 190 49 8 — 247 Girls 203 63 — — 266 Totals .. 393 112 8 — 513 25 Number of Other Routine Inspections. Varied Ages. Total. Boys 307 307 Girls 243 243 550 550 Grand Total. Entrants Second Age Group. Third Age Group. Other Routine Inspections. Total. Boys 345 381 247 307 1280 Girls 347 384 266 243 1240 Totals 692 765 513 550 2520 B.—OTHER INSPECTIONS. No. of Special Inspections. No. of Re-Inspections. Boys 471 1056 Girls 582 1413 Totals 1053 2469 C.—CHILDREN FOUND TO REQUIRE TREATMENT. Number of Individual Children found at Routine Medical Inspections to Require Treatment (excluding Defects of Nutrition, Uncleanliness and Dental Diseases). Group. For all conditions recorded in Table IIa. Total. Entrants 57 57 Second Age Group 62 62 Third Age Group 35 35 Total (Prescribed Groups) 154 154 Other Routine Inspections 30 30 Grand Total 184 184 26 TABLE II. A.—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DEC., 1936. 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— (1) Scalp ... ... 2 ... (2) Body ... ... 3 ... (3) Scabies 1 ... 25 ... (4) Impetigo 4 1 10 1 (5) Other Diseases (non-Tuberculous) 9 13 9 3 TOTAL (Heads 1 to 5) 14 14 49 4 Eye (6) Blepharitis 7 2 2 1 (7) Conjunctivitis 6 1 1 ... (8) Keratitis ... 1 ... ... (9) Corneal Opacities ... ... ... ... (10) Other Conditions (excluding Defective Vision and Squint) 15 3 ... TOTAL (Heads 6 to 10) 1.3 19 6 1 (11) Defective Vision (excluding Squint) 48 228 3 ... (12) Squint 7 18 ... ... Ear (13) Defective Hearing 10 ... 2 ... (14) Otitis Media 5 ... 1 ... (15) Other Ear Diseases 14 ... 11 1 Nose and Throat. (16) Chronic Tonsillitis only 15 213 12 17 (17) Adenoids only 1 1 ... (18) Chronic Tonsillitis and Adenoids ... ... ... ... (19) Other Conditions 26 1 13 1 (20) Enlarged Cervical Glands (NonTuberculous) 1 40 ... 3 Total carried forward 154 534 97 27 27 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 154 534 97 27 (21) Defective Speech 5 9 11 6 Heart and Circulation. Heart Disease— (22) Organic 3 10 ... 1 (23) Functional 31 1 ... (24) Anaemia 2 42 ... ... Lungs (25) Bronchitis 1 5 ... ... (26) Other Non-Tuberculous Diseases 5 ... ... Tuberculosis Pulmonary— (27) Definite ... 1 ... ... (28) Suspected ... 1 2 2 Non-Pulmonary— (29) Glands ... ... ... ... (30) Bones and Joints ... ... ... 1 (31) Skin ... ... ... ... (32) Other Forms ... 1 ... ... TOTAL (Heads 29 to 32) ... 1 ... 1 Nervous System. (33) Epilepsy ... 2 ... ... (34) Chorea ... 1 1 2 (35) Other Conditions ... 1 1 Deformities. (36) Rickets ... 1 ... ... (37) Spinal Curvature ... 4 ... ... (38) Other Forms 1 10 5 2 (39) Other Defects & Diseases (excluding Defects of Nutrition, Uncleanliness and Dental Diseases) 14 32 42 16 TOTAL 180 690 159 58 28 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. % No. % No. % No. % Entrants 692 160 23.1 435 62.9 94 13.6 3 0.4 Second Age Group 765 155 20.3 502 65.6 105 13.7 3 0.4 Third Age Group 513 153 29.8 300 58.5 56 10.9 4 0.8 Other Routine Inspections 550 188 34.2 309 56.2 50 9.1 3 0.5 Total 2520 656 26.0 1546 61.4 305 12.1 13 0.5 29 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. — 1 — — — 1 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. 1 — — — — 1 MENTALLY DEFECTIVE CHILDREN. Feeble-Minded Children. (a) (b) (c) (d) Total. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At Other Institutions. At no School or Institution. 12 2 — 3 17 30 EPILEPTIC CHILDREN. Children Suffering From Severe Epilepsy. (a) (b) (c) Ad) Total. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. — 3 — 1 4 PHYSICALLY DEFECTIVE CHILDREN. A.—Tuberculous Children. I.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) (a) (b) (c) (d) Total. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. — 7 1 — 8 II.—Children Suffering from Non-Pulmonary Tuberculosis. (a) (b) (c) (d) Total. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. — 4 2 — 6 B.—Delicate Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 25 — — 25 31 C.—Crippled Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 1 1 1 3 D.—Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — — — 1 1 CHILDREN SUFFERING FROM MULTIPLE DEFECTS. Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Mental Defect and Epilepsy.. — — 1 1 2 Hental Defect and Hemiplegia 1 — — — 1 32 TABLE IV.—TREATMENT TABLES. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table VI.) Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm—Scalp— (i) X-Ray Treatment .. — — — (ii) Other Treatment 2 — 2 Ringworm—Body 8 — 8 Scabies 32 1 33 Impetigo 75 — 75 Other skin disease 15 8 23 Minor Eye Defects (external and other, but excluding cases falling in Group II) 142 1 143 Minor Ear Defects 104 2 106 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 785 14 799 Total 1,163 26 1,189 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Number of Defects dealt with. Under the Authority's Scheme. Otherwise. Total. Errors of Refraction (including squint) 683 14 697 Other defect or disease of the eyes (excluding those recorded in Group I) 60 3 63 Total 743 17 760 Under the Authority's Scheme. Otherwise. Total. No. of children for whom spectacles were (a) Prescribed 317 10 327 (b) Obtained 298 10 308 33 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioneror 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) — — 1 — — — 18 — — — 19 — 88 107 (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 — — — — 4 5 34 TABLE V.—DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist— (a) Routine Age Groups— AGE 4 5 6 7 8 9 10 11 12 13 14 15 16 TOTAL Number 31 201 232 286 324 348 411 410 307 350 254 68 26 3,248 (b) Specials 752 (c) Total (Routine and Specials) 4,000 (2) Number found to require treatment 3,226 (3) Number actually treated 2,128 (4) Attendances made by children for treatment 4,180 (5) Half-days devoted to:— Inspection 26 (7) Extractions:— Permanent Teeth 481 Treatment 384 Temporary Teeth 1,562 Total 410 Total 2,043 (8) Administrations of general anaesthetics for extractions 716 (6) Fillings:— Permanent Teeth 3,030 (9) Other Operations:— Permanent Teeth 535 Temporary Teeth 115 Temporary Teeth 325 Total 3,145 Total 860 TABLE VI.—UNCLEANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 12 (ii) Total number of examinations of children in the Schools by School Nurses 42,977 (iii) Number of individual children found unclean 157 (iv) Number of individual 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 — 35 STATEMENT of the Number of Children Notified During the Year ended 31st December, 1936, by the Local Education Authority to the Local Mental Deficiency Authority. Total Number of Children Notified, 3. ANALYSIS OF THE ABOVE TOTAL. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots — — (b) Imbeciles — — (c) Others — 2 (ii) Children unable to be instructed in a Special School without detriment to the interests of other children: (a) Moral defectives — — (6) Others — — 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 1 — 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 1 2 36