Borough of Wood Green. Annual Report ' OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER FOR THE YEAR 1937. MALCOLM MANSON, M.C., M.A., M.D., D.P.H. Medial Officer of Health And School Medical Officer 1938 Crusha & Son, Ltd. Tottenham, Enfield, Wood Green and Palmers Green. WOOD 21 Borough of Wood Green. PUBLIC HEALTH COMMITTEE. Alderman E. J. Anderton, L.D.S. (Chairman). The Mayor (Alderman A. J. Blue, J.P.). The Deputy Mayor (Alderman H. Tudor Rhys, J.P.). Alderman Mrs. J. J. Bolster, J. P. Councillor Mrs. A. Duncan. Alderman F. G. Holmes, J. P. Councillor B. L. Lloyd. Councillor Mrs. J. Cole. Councillor W. J. Payne. Councillor W. G. Doyle. Councillor H. E. Teale. Councillor W. A. Vant. MATERNITY AND CHILD WELFARE COMMITTEE. Councillor Mrs. A. Duncan (Chairman). Alderman Mrs. J. J. Bolster, J. P. Councillor Mrs. J. Cole. Alderman E. J. Anderton, L.D.S. Councillor H. E. Teale. Councillor Mrs. L. C. Vant. Co-opted Members:— Mrs. L. Barnes. Mrs. M. Blue. Mrs. E. L. Corbett. 2 STAFF during 1937. *Medical Officer of Health.—Malcolm Manson, M.C., M.A., M.D., D.P.H. *Assitant 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. *Nwse-in-Charge, Bay Nursery.—Miss V. W. Moss. *Health Visitors.—Miss G. Moore, C.M.B., Miss F. Orwin, C.M.B., Miss F. Medd, C'.M.B. Chief Clerk.—G. W. Jones. Assistant Clerks.—W. T. Gloster, A. Hutchings, Cert. S.I.B., G. Penberthy. *Clerk for Maternity and Child Welfare.—Mrs. Wass. Each of the Health Visitors holds a General Training Certificate, as does also Miss Moss at the Day Nursery; and Miss Moore and Miss Orwin hold the new Health Visitors' Certificate. *Officers in respect of whom salary contributions are made under the Public Health Acts by Exchequer Grants. 3 Public Health Department, Ashburton House, Wood Green, N.22. June 3rd, 1938. To the Mayor, Aldermen and Councillors of the Borough of Wood Green. Ladies and Gentlemen, I beg to present to you my Annual Report as Medical Officer of Health for the year 1937. The twelve months under review have been uneventful from the health point of view, the incidence of infectious disease low, and the vital statistics on the whole, satisfactory, although the rise in the birth-rate recorded a year ago has not been fully maintained. I desire to express my thanks to the Chairmen of the Public Health and Maternity and Child Welfare Committees, and to the Council generally for the consideration and help which I have received, and to every member of the Health Department for loyal and 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 53,510 Number of inhabited houses (end of 1937, according to the Rate Books) 13,758 Rateable Value, 1937 £525,365 Sum represented by a penny rate £2,088 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births— Total. M. F. Legitimate 638 332 306 Birth Rate 12.3. Illegitimate 21 9 12 Stillbirths 20 10 10 Rate per 1,000 births, 30.3. Deaths 593 285 308 Death Rate, 11.1. Deaths from Puerperal causes:— Puerperal sepsis 2 Rate per 1,000 Births, 3.0. Other Puerperal causes 1 Rate per 1,000 Births, 1.5. Total 3 Rate per 1,000 Births, 4.5. Deaths of infants under 1 year of age:— All infants 32 Rate per 1,000 Live Births' 48. Legitimate 30 Rate per 1,000 legitimate Live Births, 47. Illegitimate 2 Rate per 1,000 illegitimate Live Births, 95. Deaths from:— Cancer (all ages) 79 Measles (all ages) 1 Whooping Cough (all ages) 5 Diarrhoea (under 2 years of age) 4 5 POPULATION. The Registrar-General's estimate of population for 1937 was 53,510, and I have used this figure to calculate the birth and death rates for the year. It represents a slight decrease of 110 in the population from that of 1936 which was 53,620. The variation in population from year to year is now very slight, and for all practical purposes the population may now be regarded as almost stationary. BIRTHS. The number of live births registered during the year was 659, as compared with 700 in 1936 and 570 in 1935. The birth-rate was 12.3 as compared with 13.1 for 1936, the highest rate recorded in Wood Green since 1931. The birth-rate for the whole country was 14.9 and for the 125 great towns (which include Wood Green) it was also 14.9. The birth-rate for Wood Green was therefore, as is practically always the case, appreciably lower than both that of the whole country and that of the great towns. 20 stillbirths were registered, 10 male and 10 female. The births registered in the Borough were distributed in the different Wards as follows:— Alexandra-Bowes 79 Town Hall 259 Noel Park 111 449 6 DEATHS. The number of deaths belonging to Wood Green, after making the necessary adjustments for inward and outward transfers was 593, 285 male and 308 female. This gives a death-rate of 11.1 per thousand of population, which is very slightly higher than that of the previous year, 10.9. The death-rate for the whole country for 1937 was 12.4 and that for the 125 great towns 12.5. Of the total deaths 341 or 57.5 of all the deaths occurred in persons over 65 years of age. The corresponding percentage in 1936 was 50. The distribution of deaths over the year was as follows:— First quarter 181; second 148; third 126; and fourth 138. The distribution of deaths according to Wards was:— Alexandra-Bowes 182 Town Hall 203 Noel Park 208 593 Table III in the Appendix gives the causes of all deaths occurring in Wood Green during the year, and Table IV shows their distribution both according to cause of death and to age at death. The former table is supplied by the Registrar-General, while the latter is compiled in the Health Department, and this fact accounts for the discrepancies which are to be detected in the numbers attached to the individual causes of death. It will be seen from Table III that the commonest cause of death, as in previous years, was heart disease which was responsible for no less than 183 deaths, or not very far short of one third of all the deaths. This does not necessarily mean that heart disease is as common and as fatal a condition in Wood Green as these figures would seem to suggest. Not less than two-thirds of these deaths certified as 7 due to heart disease occurred in people over 65 years where death was probably the result of general exhaustion resulting from old age, and heart disease appears in the death certificate because death occurs only when the heart fails to function any longer. Senility as a cause of death is very rarely seen on death certificates in these days, and there is little doubt that many deaths which were in former days ascribed to senility are now certified as due to heart disease. The next most common cause of death was cancer which was responsible for 79 deaths, as compared with 91 deaths for the previous year. Pneumonia was responsible for 33 deaths and bronchitis for 24. Tuberculosis of all forms was the cause of death in 26 cases as compared with 51 in 1936. 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 14. Of this number five were due to whooping cough, three to. diphtheria, and one each to scarlet fever and measles. There were four deaths of children under 2 years of age, caused by diarrhoea or gastroenteritis. All of these occurred in hospitals outside the district, to which the children had been admitted. The zymotic death-rate was 0.26 per 1,000 of population, as compared with 0.42; for the previous year. INFANTILE MORTALITY. The number of deaths occurring in children under 12 months of age was 32, and the Infantile Mortality Rate 48 per 1,000 live births. This is an improvement on the rate for 1936, which was 54, and is almost as good as that for 1935, which was 47. The individual causes of the infantile deaths and the age at which death took place are shown in Table V. Of the total of 32 deaths, no fewer than 11 took place during the first week of life, and 8 a further 2 before the end of the first month. The chief causes of death were congenital debility, which was responsible for seven deaths, and broncho-pneumonia, and gastro-enteritis, each of which caused five deaths. MORTALITY OF CHILDREN BETWEEN ONE AND FIVE YEARS. Ten deaths occurred in children over one and under five years. Of these five were caused by whooping cough, two by diphtheria, and one by scarlet fever. Two were due to broncho-pnuemonia, and one resulted from a burning accident. These deaths represent a death-rate in this age group of 0.19 per 1,000 of the total population, and 1.7 per cent of the total deaths for the year at all ages. MATERNAL MORTALITY. Three deaths were registered as maternal deaths, death in two cases occurring from septicaemia following a miscarriage. In the third case death occurred from pneumonia and heart disease following a difficult labour. During the previous year only one maternal death occurred, and it is disappointing to have to record three during 1937. The maternal mortality rate was 4.5 per 1,000 births. 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 1937. No. of persons. Amount granted. £ s. d. Ordinary Cases 1,661 19,295 0 11 Unemployed 399 2,067 16 3 Totals 2,050 £21,362 17 2 The amount granted in 1936 was £21,511 2s. l0d. 9 ACCIDENTS DUE TO TRAFFIC. Information with regard to street accidents has been obtained from the reports which are sent by the Commissioner of Police to the Borough Surveyor. During 1937, there were 132 accidents in the High Road and 133 elsewhere in Wood Green involving personal injury, and the use of a motor ambulance was required on 215 occasions as compared with 195 in 1936. GENERAL PROVISION FOR 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 the two nurses provided by the Association are much in request by the members, and I am glad to know that slow if steady progress is being made in extending the work of the Association. (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. During the year nine midwives residing in the Borough notified their intention to practise in Wood Green. Until practically the end of the year there were no municipal midwives practising 10 in Wood Green, but. in October the Council acting as agents for the County Council of Middlesex, which is the Supervising Authority, under the Midwives Act, 1936, appointed four municipal midwives, one of whom commenced work in Wood Green in December. It is at least very doubtful whether there will be sufficient work in Wood Green to keep four municipal midwives adequately employed, when such a large proportion of confinements take place year by year in hospitals and nursing homes, but the provision of a municipal midwifery service i.s certainly a step in the right direction. The cost of the service is met by the County Council. MATERNITY AND NURSING HOMES. There were two Maternity Nursing Homes in the Borough during 1937 registered by the Middlesex County Council. Supervision of the Nursing Homes and of the midwives practising in the Borough is in the hands of the County Council. HOSPITALS. 1. Fever. Wood Green is one of four authorities (Hornsey, Finchley, Wood Green and Friern Barnet) which together' own and control the Joint Isolation Hospital, Coppetts Road, Muswell Hill. The Hospital is a good one, with an excellent modern observation block, built on the cubicle system, and has accommodation for one hundred and fifty patients. 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. 1.1 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, fo,r the following information showing the accommodation available at the different institutions during 1937. Institution. Accommodation. Type of case. Adults. Children . M. F. County Sanatorium, 150 150 60 Pulmonary—Sanatorium. Harefield 4 4 10 Pulmonary—Observation. County Sanatorium, 132 66 — Pulmonary—late Glare Hall, South Mimms torium. Heather wood Hospital, — 25 Non-pulmonary. Ascot 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 Hos- 12 pital, Holloway, and the City of London Maternity Hospital, for the admission, at an inclusive charge to the mother, of maternity cases recommended by the Medical Officer at the Maternity and Child Welfare Centres. 5. Children. There is no special children's hospital in this neighbourhood but children are taken into the North Middlesex County Hospital and the Royal Northern Hospital. Many children from Wood Green receive treatment also at the Great Ormond Street Hospital for Sick Children. 6. Other. Wood Green and Southgate Hospital is situated in Wood Green and has accommodation for 52 patients. A considerable proportion of the cases dealt with belong to Wood Green. Other general hospitals to which patients are sent from Wood Green are the Prince of Wales's Hospital, Tottenham, the North Middlesex County Hospital, Edmonton, and the Royal Northern Hospital, Holloway. All of these are accessible by tram or bus. During the year the Council contributed £400 to the Wood Green and Southgate Hospital, £100 to the Prince of Wales's Hospital, and £100 to the Royal Northern Hospital. Other Institutions. (a) Unmarried Mothers. (b) Illegitimate Infants and Homeless Children. No provision is made for either of these classes; of case, but an endeavour is made to assist individual cases as they arise. 13 AMBULANCE FACILITIES. (a) Infectious Cases. By arrangement between the Joint Isolation Hospital Committee and the London County Council, eases of infectious disease are removed to hospital in ambulances belonging to the London County Council. (b) Non-Infectious and Accident Cases. The Council provides a Motor Ambulance for the conveyance of non-infectious, sick and accident cases, which is housed at the Fire Station and is available at all hours. During the year the ambulance was used on 1,848 occasions, 180 being cases of street accidents (8 of which were for neighbouring authorities) and 57 cases of illness in the street. In addition 95 cases were carried for us by ambulances belonging to other authorities. The total mileage for the year' was 11,929. The sums received from various users amounted in all to £25 5s. 0d. I have reported on more than one occasion to the Public Health Committee that one ambulance is no longer adequate for all the work required, and that a second ambulance is necessary. No steps have so far been taken to meet this requirement. (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. 14 Details of these Clinics and centres are shown in leaflets which have been provided at all the Post Offices in the Borough and are available there on request. MATERNITY AND CHILD WELFARE. The number of live births registered during 1937 as belonging to Wood Green was 659 according to the information supplied by the Registrar-General. The number of births registered in the Borough during the year was 449, and the percentage notified under the Notification of Births Act, was 93.6. The number of stillbirths registered was 20, and the number notified 18. 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 1,234 February 1,326 March 1,549 April 1,345 May 1,274 June 1,846 July 1,461 August 1,183 September 1,853 October 1,414 November 1,350 December 1,548 Total 17,383 15 The attendances in 1936, were 16,867 and in 1935, 15,308. The attendances at the Centre in the Alexandra Park area numbered 3,022, as compared with 2,699 in 1936 and 2,380 in 1935. The number of individual children brought to the Centres during the year was 1,543, of whom 795 were infants under 1 year of age, and 748 of from 1 to 5 years of age. The number of children seen by Dr. Miller at the Centres during the year was 1,492. 782 of these were infants under 12 months of age who made 2,872 attendances, while 710 were children of 1 to 5 years of age and their attendances numbered 2,034. Of the 32 infantile deaths which occurred during the year in only 8 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 268, and the total attendances made numbered 1,062. The remainder of the Tuesday afternoon Clinic was allotted to post-natal cases, the number seen being 43 and the attendances 63. 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 subject 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 246. 16 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. 21 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, and from the time of their booking until the actual confinement, these mothers are kept under observation by the obstetrical surgeon at the hospital. An arrangement was made a year ago with the County Health Department by which the routine ante-natal supervision of these mothers is carried out at our Ante-Natal Clinic. This arrangement has worked well, and is of benefit to all concerned, ensuring close cooperation between the hospital and the local ante-natal clinic, and saving the mothers the fatigue of regular long journeys to hospital. 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. The following is a record of the work done during the year:— New patients treated 178 Attendances made 557 Extractions (with local anaesthetic) 4 Extractions (with gas) 131 Fillings 59 Scalings, etc 427 Advice only 168 Dentures provided 30 17 Light Treatment. By arrangement with the Middlesex County Council, mothers and children are sent, as occasion arises, to the North Middlesex County Hospital for artificial sunlight treatment. Home Visiting. During the year the Health Visitors made a total of 6,459 visits. 2, 384 of these visits were to babies under one year of age, 3,580 to children of from 1 to 5 years of age, and 495 were antenatal visits to expectant mothers. Free Food. Free food, consisting mostly of dried milk or cod liver oil and malt, was issued during the year to necessitous expectant and nursing mothers attending the Centres at a cost of £226 8s. 5d. Cow's milk was similarly issued at a cost of £226 7s 9d. Free dinners were also supplied to necessitous mothers at the Feeding Centre in White Hart Lane at a cost of £5 48. 6d. Infant Life Protection. The Health Visitors have continued to act as Infant Life Protection Visitors during the year. The numbers of fostermothers and foster-children on the register at the end of the year were 15 and 17 respectively. Day Nursery. During the year plans were prepared by the Borough Surveyor for a new Day Nursery and School Clinic, to be erected on a site in White Hart Lane. These plans were approved by the Council and are now awaiting approval by the Ministry of Health and Board of Education. It is hoped that the new building will be completed before the end of 1938. 18 The following table shows the attendances made at the present Day Nursery throughout the year, and the corresponding figures for the previous year:— 1937. 1936. January 327 294 February 267 377 March 358 391 April 425 356 May 410 637 June 526 356 July 494 668 August 307 442 September 434 592 October 475 699 November 453 508 December 565 484 Totals 5,041 5,804 SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The whole Borough is in the area supplied by the Metropolitan Water Board and every house has a constant supply. Rivers and Streams. There are two watercourses in the Borough, the Muswell Stream and the Moselle Brook. Both of these are culverted, so that there are no open streams in the area. Drainage and Sewerage. All premises in the Borough are connected up to the Council's sewers. There is a dual system of drainage, the soil drains being connected to the main sewers which carry the sewage to a pumping 19 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 Muswell Brooks, and by these is carried finally into the RivetLee. BATHS. The open-air Swimming Pool in Durnsford Road, and the Public Baths in Western Road, continue to be well patronised, although the record of attendances during the first year shows a considerable falling off in numbers. So far as the Swimming Pool is concerned this was no doubt due to the prevalence of cold wet weather throughout part of the summer months, while at Western Road, the closure of the bath for reconstruction was the cause of the reduced attendances. Both baths are provided with efficient systems of filtration and chlorination which ensures the safety and attractiveness of the water. 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 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 1937 71,317 22,569 64,252 22,110 10,667 3,466 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 696 Re-inspections 1,010 Complaints investigated Inspections under the Housing (Consolidated) Regulations, 193 1925 555 Inspections under the Housing Acts 390 Re-inspections 1,634 Inspections of houses-let-in-lodgings 6 Re-inspections 113 Total 4,597 Inspections under the Rent Restrictions Act 25 Grand Total 4,622 Enquiries in connection with Infectious Diseases:— Smallpox - Scarlet Fever 14 6 Diphtheria 93 Tuberculosis 87 Enteric 5 Other Diseases 11 Total 342 Inspections of Registered Premises:— Factories.. 9 Workshops 205 Workplaces:— Butcher shops 1,028 Dairies 221 Fried fish shops 290 Other workplaces 19 1,558 Slaughterhouses 251 Out-workers 121 Total 2,144 21 Miscellaneous Inspections:— Urinals 385 Passageways 7 Cinemas, etc. 32 Ice cream premises 125 Stalls—day and night visits 679 Smoke observation 15 Total 13,13 Grand Total 3,457 Action Taken :— Verbal intimations Issued. Completed. 41 41 Preliminary Notices:— Public Health Act, 1875, Section 94, and Public Health Act, 1936, Section 93 129 129 Public Health Act, 1875, Section 36, and Public Health Act, 1936, Section 75 244 239 Housing Act, 1936, Section 4.. 5 5 Housing Act, 1936, Section 9.. 333 258 Infectious Disease (Prevention) Act, 1890, Section 5, and the Public Health Act, 1936, Section 167 . 122 122 Wood Green Urban District Council Act, 19-0, Section 77 61 67 Bye-laws regulating houses let in lodgings 11 10 903 830 Statutory Notices:—- Public Health Act, 1875, Section 94, and Public Health Act, 1936, Section 93 10 5 Public Health Act, 1875, Section 36 8 6 Public Health Act, 1936, Section 83 1 - Public Health Act, 1936, Section 39 1 1 Public Health (Amendment) Act, 1907, Section 25 7 7 Housing Act, 1936, Section 9 44 28 Wood Green Urban District Council Act, 1920, Section 77 .. 1 1 Public Health Act, 1925, Section 46 1 2 Byelaws regulating houses-let-in-lodgings 1 1 74 51 22 Work Carried out:— Drainage Works:— Drains reconstructed 20 Drains repaired 5 Drains unblocked and cleansed 35 Soil and vent shafts repaired or provided 30 Fresh air inlets repaired or provided 19 Sink and bath wastes repaired or provided 58 Inspection chambers repaired or provided 17 Interceptors repaired or provided 10 Drains tested 54 248 Water-closets:— New water-closets provided 2 New W.C. pans and traps provided 159 Water-closets repaired 47 Foul water-closets cleansed 35 Flushing apparatus repaired or provided 76 319 Cleansing:— Premises limewashed 5 Premises otherwise cleansed 19 Rooms cleansed after disinfection 124 Rooms disinfested 217 Accumulations of refuse 22 Keeping of animals discontinued 2 389 Dampness:— Roofs repaired, etc. 219 Eaves gutters repaired or provided 78 Rainwater pipes repaired or provided 66 Damp proof courses provided 40 Walls rendered or dampness otherwise remedied 172 575 23 House repairs:— Floors repaired—wood 92 Floors repaired—concrete 56 Coppers repaired or provided 85 Ceilings redecorated 1,005 Walls redecorated 989 General repairs 976 Fireplaces repaired 143 Stoves repaired or provided 106 Premises repainted externally 22 3,454 Miscellaneous:- Foodstores repaired or provided 42 Yard pavings repaired, etc. 152 Dustbins provided 419 Water supply taken from mains 15 Baths, sinks and lavatory basins fixed 146 Gullies fixed 8 Total works carried out during the year 782 5,767 24 HOUSE -TO -HOUSE INSPECTION. NUMBER OF HOUSES INSPECTED, 1937. Road. No. of Houses. No. of Rooms. Families. Persons per room. Adults. Children. Acacia Road 44 255 205 43 0.97 Chapmans Terrace 4 20 18 - 0.90 Crossway 14 70 61 22 1.18 Croxford Gardens 20 100 95 32 1.27 Dagmar Road 38 200 155 25 0.90 Edith Road 12 60 40 4 0.73 Gospatrick Road 41 205 177 33 1.02 James Gardens 20 100 88 29 1.17 Lakefield Road 24 145 98 11 0.75 Meads Road 13 80 55 1 0.70 Palace Road 52 299 196 26 0.74 Palace Gates Road 5 35 24 9 0.94 Parkhurst Road 44 264 178 22 0.76 Perth Road 39 177 164 34 1.12 Rivulet Road 67 355 312 83 1.18 Sidney Road 52 305 207 31 0.78 Willingdon Road 59 354 269 28 0.84 White Hart Lane 7 35 37 7 1.26 Totals 555 3039 2379 440 0.93 25 FACTORIES, WORKSHOPS, WORKPLACES, LAUNDRIES, AND HOMEWORK. 1.—Inspection. Including Inspections made by the Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories— (Including Factory Laundries) 9 2 — Workshops— (Including Workshop Laundries) 205 5 — Workplaces— (Other than Outworkers' Premises) 1558 5 — Total 1772 12 — 2. Defects Found. Particulars. Number of Defects. Number of offences in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts— Want of Cleanliness 8 8 — — Want of Ventilation — — — — Overcrowding — — — — Want of Drainage of floors — — — — Other Nuisances 5 5 — — Sanitary Accommodation— Insufficient — — — — Unsuitable or Defective 1 1 — — Not separate for Sexes — — — — Offences under the Factory and Workshop Acts— Illegal Occupation of Underground Bakehouse(s. 101) — — — — 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 14 14 — — 26 3.—Homework. Nature of Work. Outworkers' Lists under Section 107 of Factory and Workshop Act, 1901. Received twice in the year. Received once in the year. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. The making, cleaning, washing, altering, ornamenting, finishing and repairing of wearing apparel 19 — 45 25 8 45 The making-up, ornamenting, finishing and repairing of table linen, or other household linen, and an? process incidental thereto 1 — 2 2 — 4 The making of curtains and furniture hangings and any process incidental thereto — — — 2 1 2 The making or filling of cosaques, Christmas crackers, Christmas stockings or similar articles or parts thereof 1 — 1 — — — Total 21 — 48 29 9 51 27 4.—Registered Workshops. Workshops on the Register (S.131) at the end of the year. (Important classes of Workshops, such as Workshop Bakehouses may be enumerated here). Class. Number. Wearing Apparel 16 Dining Rooms 15 Laundries 1 Bakehouses 13 Boot Repairers 6 Mechanical Repairs 7 Upholstery 5 Other Workshops 20 Total 83 5.—Other Matters. Factory and Workshop Acts:— Matters notified to H.M. Inspector of Factories — Underground Bakehouses (S.101):— Certificates granted during the year — In use at the end of the year — Public Health Acts:— Matters notied by H.M. Inspector of Factories 1 Defects remedied following H.M.I.'s notifications 1 28 HOUSING STATISTICS. 1.—Inspection of dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,647 (b) Number of inspections made for the purpose 4,404 (2) (a) Number of dwelling-houses (included under sub-head 1 above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 555 (b) Number of inspections made for the purpose 1,410 (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 790 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 639 3.—Action under Statutory Powers during the year:— (A) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 44 (2) Number of dwelling-houses which were dered fit after service of formal notices— (a) By owners 27 (b) By Local Authority in default of owners 1 29 (B) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 28 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 20 (b) By Local Authority in default of owners 1 (C) Proceedings under Sections 11 and 13 of the Housing Act, 1936— (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. (D) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil. (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil. 4.—Housing Act, 1936—Part iv—Overcrowding:— (а) (1) Number of dwellings overcrowded at the end of the year 45 (2) Number of families dwelling therein 45 (3) Number of persons dwelling therein 300 (b) Number of new cases of overcrowding reported during the year 1 30 (c) (1) Number of cases of overcrowding relieved during the year 65 (2) Number of persons concerned in such cases 348 (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 Nil (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report — Rent Restriction Acts. Six certificates were granted under the above heading during the year 1937. NEW HOUSES BUILT DURING 1937. I am indebted to the Borough Surveyor for the following information relating to new houses erected in Wood Green during 1937.— Number of houses erected during 1937 27 Number of flats erected during 1937 52 Number of houses built by the Council Nil. Number built by other bodies and persons 79 PUBLIC MORTUARY. Bodies deposited during the year 37 Inquests held 6 Post-mortem examinations 32 Causes of death:— Accidental 4 Natural causes 27 Suicide 2 For lodgement only 4 31 INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The greater part of the milk supply in this borough is in the hands of large firms and combines, who supply the milk in bottles filled at their depots outside the borough. (1) No cattle are kept in the borough. (2) The following licences for the sale of milk under special designations have been granted during the year:— Licences in respect of shop or other premises (not being the establishment at which the milk is produced or bottled) at or from which the milk is sold. (Tuberculin Tested). Accredited. Pasteurised. 6 - 14 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. (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. 32 The following details show the number of carcases inspected after slaughter with the number of condemnations for tuberculosis and other diseases:— Cattle. Sheep and Lambs. Pigs. Number killed 329 1,401 947 Number inspected 329 1,401 947 All diseases except tuberculosis. Whole carcases condemned — — — Carcases of which some part or organ was condemned 86 75 41 Percentage of the number inspected affected with disease other than tuberculosis 26% 5% 4% Tuberculosis only. Whole carcases condemned 1 — — Carcases of which some part or organ was condemned 11 — 21 Percentage of the number inspected affected with tuberculosis 3½% — 2% Total weight of meat condemned—1 ton 6 cwts. 27 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. The undermentioned foodstuffs were condemned as unfit for human consumption during the year:— Pressed pork 348 lbs. Veal 54 lbs. Calf sweetbreads 10 lbs. Fish 42 lbs. Total 454 lbs. 4 cwt. 6 lbs. 33 SALE OF FOOD AND DRUGS ACTS. The Middlesex County Council is the Authority for taking samples under the above Acts, and the Chief Officer of the Public Control Department, has kindly supplied the following figures concerning samples taken in Wood Green during 1937.— Articles. No. of samples taken. Adulterated. Milk 110 1 Milk, sterilised 5 — Butter 5 — Cream 2 — Cream Pastries 2 — Gin 2 — Sheep's liver 5 2 Vinegar 6 4 Whisky 9 — 146 7 Number of Prosecutions—4. Number of Convictions—3. Fines and costs imposed—£5 12s. 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 249, a considerable reduction from 323, the number for the previous year. The reduction was due almost entirely to the fall in numbers of cases of scarlet fever and diphtheria. The number of cases of scarlet fever1 notified was only 72 as compared with 98, 201, and 2(92 respectively, in the three previous years. The number of cases of diphtheria notified, 46, was 34 less than half the number lor the previous year, 99. The number of cases removed to hospital or sanatorium was 215 as compared with 297 in 1936, and the total deaths from notifiable infectious diseases was 68 as compared with 100 in 1936. The following table shows the number of cases of disease admitted to the Joint Isolation Hospital from the various Wards in the town:— AlexandraBowes. Town Hall. Noel Park. Scarlet Fever 17 20 27 Diphtheria 7 18 19 Bronchitis 2 — — Enteric — 2 — Erysipelas 2 — 1 Measles 2 2 1 Pneumonia 1 — — Whooping Cough 1 2 4 Totals 32 44 52 In addition, 1 case of diphtheria, 1 of dysentery and 1 of acute poliomyelitis were removed to other isolation hospitals. The distribution of scarlet fever and diphtheria over the year is shown below:— Scarlet Fever. Diphtheria. First quarter 11 15 Second quarter 16 3 Third quarter 18 8 Fourth quarter 27 20 Totals 72 46 35 The incidence of scarlet fever and diphtheria, so far as school attendance is concerned, was as follows:— Scarlet Fever. Diphtheria. Attending elementary schools in Wood Green 41 24 Glendale County School — 1 Trinity County School — — Private Schools — — Schools outside Borough 2 — Under school age 16 6 Over school age 13 15 72 46 Scarlet Fever. Only 72 cases of scarlet fever were notified during the year, as compared with 98 in 1936. The disease was fairly evenly distributed over the year and throughout the district, the largest number of cases being notified in the last quarter. It was for the most part of a mild type, but one death occurred in a child under school age. Of the 72 cases notified, 64 were admitted to hospital. Diphtheria. Diphtheria was not nearly so prevalent in 1937 as in the previous year, the number of notifications received being only 46, as compared with 99 in 1936. Of the cases notified, all except one, were admitted to hospital. The disease was for the most part of a moderately severe type, and two deaths occurred. Another death was certified as due to diphtheria, the patient in this case dying in a General Hospital of diabetes which was said to be complicated by diphtheria. 36 Immunisation against diphtheria has been carried on just as in previous years, for the most part in the infant and junior departments of the elementary schools, but also among children under school age. During the year 738 children received full courses of protective injections—each course consisting of three injections of Toxoid-Antitoxin Mixture given at intervals of a fortnight—and a further 12 were undergoing a course at the end of the year. 1,226 children were Schick-tested during the year, and 206 were awaiting the Schick Test at the end of the year. The total number of children immunised in Wood Green to the end of 1937 wras 4,978, and of this number 14 are known to have since contracted diphtheria. In all these cases the attack was mild and all have made a good recovery. Enteric Fever. Two cases were notified as enteric fever, and both turned out to be para-typhoid. One case was notified from a general hospital outside the district. The other was notified at home and was admitted to the Isolation Hospital. In neither case was it possible to discover the source of infection, and in both oases recovery occurred. Dysentery. Three cases of dysentery were notified, one a child of three months, who had been admitted to a hospital in London, and two adults who were nursed at home. No. deaths occurred. Cerebro-Spinal Fever. Two notifications of this disease were received from a general hospital outside the district, one an adult of 33 years and the other a child of 9 months. Both cases proved fatal. Death also occurred in another case, a child of 4 years also in the same hospital, which was not notified. 37 Anterior Poliomyelitis. Two cases of Anterior Poliomyelitis were notified both in school children. In neither case was the attack a severe one, and complete recovery took place. Pneumonia. Thirty-eight 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. Puerperal Fever and Puerperal Pyrexia. One case of puerperal fever was notified from a hospital outside the district. The patient made a good recovery. Eleven cases of puerperal pyrexia were notified, nine of them from hospitals outside the district, of the remaining two, one was sent to a London County Council hospital under an arrangement made with the County Council, and the other was nursed at home. Ophthalmia Neonatorum. Three cases of this disease were notified. One case was admitted to a special hospital, one attended an ophthalmic hospital as an out-patient, and the third was nursed at home. Complete recovery took place in all three cases. Non-Notifiable Infectious Diseases. The number of cases of non-notifiable infectious diseases reported to me during the year' from the elementary schools were as follows. Chicken-pox 25 Measles 99 Mumps 172 Whooping Cough 146 Skin Infections 12 Total 454 38 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 of tuberculosis coming to the knowledge of the Health Department during the year was 67, 59 respiratory and 8 non-respiratory, Of this number, 57 were notified by doctors practising in the district, or from hospital, while 10 were transferred from other districts. The number of notifications received in 1936 was 71. The number of deaths certified as due to tuberculosis was 26, of which 24 were due to respiratory and 2 to non-respiratory disease. These figures are a very great improvement on those for 1936, when there were 51 tuberculosis deaths, 46 respiratory and 5 non-respiratory. The death-rate was 0.48 per 1,000 of population, as compared with 0.95 in 1936, and 0.45 in 1935. Of the 24 deaths certified as due to respiratory tuberculosis, 16 occurred in the age period from 20 to 45 years. Of these eleven were in males and five in females. Of the total of 26 deaths due to all forms of tuberculosis five 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 41 Transfers from other districts (not included in above) 10 Total number of tubercular cases supervised at or from the Dispensary in 1937 206 New cases and contacts examined and found to be non-tubercular in 1937 81 Total number of tubercular cases still on the Register at the end of 1937 158 39 During the year 68 cases were sent to hospital or sanatorium. The sanatoria or hospitals to which they were admitted are shown Below :— Pulmonary Cases. NonPulmonary Cases. Brompton Hospital 4 — Clare Hall Sanatorium 11 — Eversfield Chest Hospital, St. Leon ards-on-Sea 1 — Fairlight Sanatorium, Hastings 1 — Harefield Sanatorium 25 — Hendon Cottage Hospital — 1 King Edward VII Sanatorium, Midhurst 2 — National Hospital, Benenden 2 — North Middlesex Hospital 15 — Preston Hall, Aylesford 2 — Royal Sea Bathing Hospital, Magate — 1 St. Luke's Hospital, Chelsea 1 — University College Hospital 1 — Victoria Home for Invalid Children Margate — 1 Totals 65 3 BACTERIOLOGICAL WORK. The bacteriological examination of specimens from the borough is carried out at the Joint Isolation Hospital and during 1937 the following examinations were made:— 40  Positive. Negative. Total. Diphtheria 26 346 372 Enteric — 2 2 Dysentery — 2 2 Pulmonary Tuberculosis 4 91 95 Others — 2 2 30 443 473 DISINFECTION, Etc. The number of articles dealt with at the Disinfecting Station during the year was as follows:— Articles disinfected after tuberculosis 289 „ „ „ other infectious diseases 1,596 „ „ „ cancer 43 1,928 „ disinfested of vermin 736 „ dealt with for tenants moving into Council houses 698 1,434 3,362 Total number of articles destroyed 304 The number of rooms disinfected was as follows:— Rooms disinfected after tuberculosis 44 „ „ „ other infectious diseases 226 „ „ „ cancer 3 273 „ treated for vermin 217 217 490 41 It will be seen from the figures given above that the disinfestation of verminous property and household effects is responsible for the expenditure of a good deal of time and labour. During the year 99 houses were disinfested, 20 of these being Council houses and the others belonging to private owners. The results of the disinfestation have been generally satisfactory. This is also true of the preventive measures taken in the case of the furniture of all new tenants accepted for Council houses. The furniture is removed from the old house in a special van in which it is fumigated by hydrocyanic acid gas. All bedding, cushions, etc., are at the same time disinfected by steam, and the furniture and bedding installed in the new house later in the same day. These measures have now been in force for almost three years, and appear to be quite satisfactory. 42 APPENDIX. Table I Vital Statistics of Wood Green, 1921-37. Year. Population estimated to middle of each year. Nett Births belonging to the District. Nett Deaths belonging to the District. Total No. Rate per 1,000 population Illegitimate No. Under 1 year of age. At all ages. Total No. Rate per 1,000 live births. Illegitimate No. Rate per 1,000 illegitimate births. No. Rate per 1,000 population (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 1921 51,100 905 17.71 24 63 70 6 250 493 9.64 1922 51,290 873 17.02 26 41 47 4 154 524 10.21 1923 51,540 896 17.38 34 34 38 0 — 491 9.52 1924 51,840 762 14.7 15 32 42 3 200 513 9.89 1925 51,960 740 14.24 17 35 47 2 118 507 9.75 1926 51,940 802 15.44 26 32 40 1 38 457 8.79 1927 52,260 687 13.14 18 35 51 1 56 509 9.73 1928 52,750 732 13.8 22 30 41 0 — 478 9.06 1929 53,410 721 13.5 26 43 60 3 115 605 11 .32 1930 53,410 719 13.4 30 26 36 3 100 534 10.0 1931 54,520 719 13.2 30 32 44 2 66 549 10.1 1932 54,500 681 12.5 20 28 41 4 200 556 10.2 1933 54,210 601 11.1 24 32 53 2 83 565 10.4 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 1937 53,510 659 12.3 21 32 48 2 95 593 11.1 43 Table II. Birth-Rate, Death-Rate and Analysis of Mortality during 1937. Birth-rate per 1,000 population. Annual Death-Rate per 1,000 Population. Rate per 1,000 Births. All Causes. Typhoid and Paratyphoid Fevers. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 years). Total Deaths under 1 year. England and Wales 14.9 12.4 0.00 0.00 0.02 0.01 0.04 0.07 0.45 0.54 5.8 58 125 County Boroughs and Great Towns (including London) 14.9 12.5 0.01 - 0.03 0.01 0.04 0.08 0.39 0.45 7.9 62 148 Smaller Towns (population, 25,00050,000 at Census 1931) 15.3 11.9 0.00 0.00 0.02 0.01 0.03 0.05 0.42 0.42 3.2 55 London 13.3 12.3 0.00 — 0.01 0.01 0.06 005 0.38 0.51 12.0 60 Wood Green 12.3 11.1 — — 0.02 0.02 0.09 0.05 0.26 0.49 6.1 48 44 Table III. Causes of Death during the year 1937. Causes of Death. Male. Female. Typhoid and Paratyphoid Fevers — — Measles 1 — Scarlet Fever 1 — Whooping Cough 3 2 Diphtheria 1 2 Influenza 8 6 Encephalitis Lethargica — — Cerebro-spinal Fever 3 — Tuberculosis of Respiratory System 16 8 Other Tuberculous Diseases — 2 Syphilis 2 — General Paralysis of the Insane, Tabes Dorsalis 1 — Cancer, Malignant Disease 44 35 Diabetes 2 5 Cerebral Haemorrhage, etc. 14 15 Heart Disease 73 110 Aneurysm 1 2 Other Circulatory Diseases 10 21 Bronchitis 16 8 Pneumonia (all forms) 12 21 Other Respiratory Diseases 1 4 Peptic Ulcer 6 1 Diarrhoea, etc. (under two years) 3 1 Appendicitis 4 2 Cirrhosis of Liver 2 1 Other Diseases of Liver, etc. — — Other Digestive Diseases 9 7 Acute and Chronic Nephritis 6 13 Puerperal Sepsis — 2 Other Puerperal Causes — 1 Congenital Debility, Premature Birth, Malformation, etc. 9 6 Senility 2 3 Suicide 3 2 Other Violence 14 7 Other Defined Diseases 18 21 Causes ill-defined or unknown — — Totals 285 308 45 Table IV. Causes of, and Ages at Death during the year 1937. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. All Ages. Under 1 year. 1 and under 2 years. 2 and under 6 years. and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 15 and under 56years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. Typhoid, etc. — — — — — — — — — — — — Measles 1 1 — — — — — — — — — — Scarlet Fever 1 — — 1 — — — — — — — — Whooping Cough 5 — 2 2 1 — — — — — — — Diphtheria 3 — — 2 — 1 — — — — — — Influenza 14 — — — — — — — — 3 5 6 Encephalitis Lethargica — — — — — — — — — — — — Cerebro-Spinal Fever 3 2 — — — — 1 — — — — — Tuberculosis of Respiratory System 24 — — — — 2 7 7 1 5 2 — Other Tuberculous Diseases 2 — — — 1 — — — — 1 — — Syphilis 1 — — — — — — — 1 — — — General Paralysis of Insane 1 — — — — — — — — — — 1 Cancer, Malignant Disease 72 — — — — — 1 3 8 16 28 16 Diabetes 6 — — — — — — 1 — 2 3 — Cerebral Haemorrhage, etc. 36 — — — — — — — 2 6 13 15 Heart Disease 174 1 — — — 1 2 6 12 22 51 79 Aneurysm 2 — — — — — — — — — 1 — Other Circulatory Diseases 20 — — — — — — — 1 — 6 8 Bronchitis 32 — — — — — — — 3 8 4 17 Pneumonia (all forms) 40 5 1 — — 2 — 4 6 7 7 8 Other Respiratory Diseases 6 — — — — — — — 2 — 2 2 Peptic Ulcer 7 — — — — — — — 1 3 2 1 Diarrhoea, etc. (under 2) 6 5 1 — — — — — — — — — Appendicitis 6 — — — 1 1 1 — — 2 1 — Cirrhosis of Liver 3 — — — — — — — 2 — 1 — Other Diseases of Liver — — — — — — — — — — — — Other Digestive Diseases 13 — — — — — — — — 3 3 7 Acute a d Chronic Nephritis 18 — — — — — 1 — — 7 5 5 Puerperal Sepsis 2 — — — — — 1 1 — — — — Other Puerperal Causes 1 — — — — — — 1 — — — — Congenital Debility, etc. 15 15 — — — — — — — — — — Senility 10 — — — — — — — — — 1 9 Suicide 5 — — — — 1 1 — 1 2 — — Other Violence 21 — — 1 1 2 4 2 — 3 1 7 Other Defined Diseases 43 3 — — 2 — 1 4 4 5 10 14 Causes ill-defined — — — — — — — — — — — — Totals 593 32 4 6 6 10 20 29 45 100 146 195 46 Table V. Deaths of Infants under One Year of age, showing cause of death and age at death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Total under 1 year. Asphyxia — — — — — — 1 — — 1 Atelectasis 1 — — — 1 — — — — 1 Broncho-Pneumonia 1 — — — 1 — 1 2 1 5 Congenital Debility 2 2 — — 4 2 1 — — 7 Gastro Enteritis — — — — — 3 1 — 1 5 Heart Disease 1 — — — 1 — — — — 1 Marasmus — — — — — 1 1 — — 2 Measles — — — — — — — 1 — 1 Melaena Neonatorum 1 — — — 1 — — — — 1 Meningococcal Meningitis — — — — — — 1 — 1 2 Peritonitis 1 — — — 1 1 — — — 2 Premature Birth 4 — — — 4 — — — — 4 Totals 11 2 — — 13 7 6 3 3 32 47 Table VI Infectious Diseases Notified during the year 1937. Notifiable Disease. Cases Notified in Whole Borough. Total Oases Notified in each Ward. Total Cases removed to Hospital or Sanatorium. Total Deaths. All ages At Ages — Years. Alexandra-Bowes. Town Hall. Noel Park. Under 1 year. 1 to 5 years. 5 to 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 72 — 15 28 17 4 3 3 2 — — — 19 23 30 64 1 Diphtheria 46 1 5 16 11 2 4 3 4 — — — 7 20 19 45 3 Cerebro Spinal Fever 2 1 — — — — — 1 — — — — 1 1 — 2 3 Dysentery 3 1 — — — — — — — 1 — 1 — 2 1 1 — Enteric Fever 2 — — — 1 — 1 — — — — — — — — 2 — Erysipelas 12 — — — — — — 1 1 2 3 5 3 5 4 5 — Ophthalmia Neonatorum 3 3 — — — — — — — — — — 1 1 1 1 — Pneumonia 38 3 1 4 — 2 1 4 9 3 3 8 10 12 16 14 33 Acute Poliomyelitis 2 — — — 2 — — — — — — — — 2 — 2 — Puerperal Fever 1 — — — — — — 1 — — — — — — 1 1 2 Puerperal Pyrexia 11 — — — — 2 1 6 2 — — — 8 2 1 10 — Pulmonary Tuberculosis 49 — — 1 3 3 11 11 7 6 5 2 16 11 22 65 24 Non-Pulmonary Tuberculosis 8 — 1 1 2 — 1 — 1 — 1 1 3 — 5 3 2 Totals 249 9 22 50 36 13 21 31 26 12 12 17 68 81 100 215 68 48 Table VII. TUBERCULOSIS. New Cases and Mortality during 1937. Age Periods. New Cases. Deaths. Respiratory. Nonrespiratory. Respiratory. Nonrespiratory. M. F. M. F. M. F. M. F. 0 — — — — — — — — 1 — — — 1 — — — — 5 1 — — 1 — — — — 10 2 1 1 1 — — — 1 15 1 2 — — — — — — 20 8 6 — 1 2 — — — 25 6 8 — — 4 3 — — 35 5 4 1 — 5 2 — — 45 6 — — — — 1 — — 55 7 — — 1 3 2 — 1 65 and upwards — 2 1 — 2 — — — Totals 36 23 3 5 16 8 — 2 Above includes transfers (10) from other Districts. 5 non-notified T.B. deaths occurred. 49 METEOROLOGICAL REPORT FOR YEAR ENDING 31st DECEMBER, 1937. Month. 1937. Total Rainfall. Maximum Rainfall. No. of Wet Days. Maximum Temperature. Minimum Temperature. Inches. Inches. Date. Degrees. Date. Degrees. Date. January 3.15 0.47 1st 20 54 3rd 27 29th February 3.55 0.65 7th 22 57 15th 30 26th and 27th March 1.83 0.42 10th 16 56 18th, 20th, 21st 25 9th April 2.21 0.42 2nd 14 63 27th 35 26th May 2.50 0.57 20th 16 83 25th 40 5th, 9th & 17th June 1.74 0.68 12th 9 74 21st and 22nd 46 2nd,18th & 20th July 0.64 0.21 15th 9 Thermometer out of order 49 7th and 29th August 1.84 0.84 13th 6 88 6th 50 14th, 15th&22nd September 1.19 0.26 9th and 16th 14 80 7th 40 20th October 1.98 0.73 22nd 9 68 1st and 2nd 37 17th November 1.15 0.55 1st 7 58 1st 23 20th December 2.91 0.54 1st 15 53 1st, 22nd, 23rd, 24th 24 19th Total for year 24.69 — — 157 — — — — Note.—Maximum Rainfall 0.84ins. 13th August. ,, Rate of Rainfall 3ins. per hour; duration 10 minutes, 4th August. ,, Temperature 88° Fahr. 6th August. Minimum ,, 23° Fahr. 20th November. (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. Mrs. H. S. Harrison. Councillor F. H. P. Forney. Rev. F. Jones. 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 J. H. Yeats. Mrs. D. Rycraft. 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. E. C. Waghorne. Mrs. H. S. 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. Wood Green Education Committee. SCHOOL MEDICAL SERVICE. ANNUAL REPORT, 1937. Ashburton House, 298, High Road, Wood Green, N.22. 19th March, 1938. To the Chairman and Members of the Wood Green Education Committee. Mr. Chairman, Ladies and Gentlemen, I beg to present my Annual Report as School Medical Officer for the year 1937. The general health of the school children has been good throughout the year and the incidence of infectious disease low. I —STAFF. The School Medical Stall" during 1937 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, (resigned December, 1937). Dental Surgeons.—G. S. Williams, L.D.S. ; D. W. MacBean, L.D.S. School Nurses.- Miss B. M. Gray; Miss N. Gardner. 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 No change in the personnel of the staff occurred during the year, but at the end of the year the Committee lost the services of Dr. A. R. Friel, who has been Aural Surgeon in charge of the Ear Clinic since 1930. Dr. Friel has been extremely successful in his treatment of ear and nose conditions in our school children, and very largely as a result of the work done by him at the Ear Clinic there has been a very remarkable diminution in the number of cases of discharging ears found in our schools, as well as in other conditions affecting the nose and ears. In Dr. Friel's place the Committee has obtained the temporary services of Dr. F. P. M. Clarke, who has had considerable experience of the same type of work under other Education Authorities. II.-CO-ORDINATION WITH OTHER MEDICAL SERVICES. Complete co-ordination exists between the School Medical services and those provided for children under school age by the Maternity and Child Welfare Committee. The specialist medical and dental services provided by the Education Committee are available also for children under school age, and are increasingly used. III.—SCHOOL HYGIENE. No remarks are called for on this occasion under this heading, except to note that a commencement has now been made with the erection of the new school to take the place of White Hart Lane School, and that it is hoped to make early progress with extensive alterations at Lordship Lane and Bounds Green Schools. IV.—MEDICAL INSPECTION. Medical inspection has been carried out on the same lines as in previous years and has comprised (1) the routine inspection in the schools of children in the three age-groups recommended by the Board of Education, namely, (as) entrants, (b) children of eightyears, (c) children of twelve years or over; (2) the special inspection of children referred by head teachers, school nurses, school enquiry officers, or brought for examination by the parents or guardians; (3) the inspection at regular intervals of physically or mentally defective children ; and (4) the regular inspection of children supplied 4 with milk or malt and oil at the cost of the Education Committee. In addition, there is the re-examination towards the end of the year of all children who have been found at previous routine or special examinations to be suffering from defects which require either to receive treatment or to be kept under observation. The total number of children on the registers of the elementary schools on December 31st, 1937, was 5,413. The number examined by the School Medical Officers during the year was 3,562. V.—FINDINGS OF MEDICAL INSPECTIONS. 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 inspections to require treatment. This number is again small, a very satisfactory state of affairs, which, as I have remarked in previous reports, is very largely due to the close co-operation which exists between the schools and the school medical services, and to the use which is made of the facilities provided at the 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 many weeks or months before the particular children concerned are due for routine medical inspection. In this way the number of defects actually requiring treatment found at the routine inspections tends to be very small. (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 23.96 per cent. were classified as excellent as regards nutrition, 63.39 as normal, 12.5 as slightly subnormal, and only 0.19 as bad. If columns A and B in the table are taken together and columns B and C, it will be seen that in 87.35 per cent. of the children the nutrition was either excellent or normal, while in 12.64 per cent. it was either slightly subnormal or bad. These figures are practically identical with those for the previous year, and while they are, on the whole, fairly satisfactory, there is room yet for considerable improvement. 5 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 so good as those for the third agegroup, or twelve-year-old children, or the "other routine inspections," which are mostly children of thirteen or fourteen years. The nutrition of the children leaving school is definitely better than that of children in their early years at school. I have remarked in previous Annual Reports that a steady, if slow improvement is taking place in the nutrition of the children in Wood Green. The great majority of the children are well nourished and the number of really badly nourished children is diminishing as the years pass. This latter type of child is being helped so far as possible, when poverty is the cause of the malnutrition, by the provision of free milk at school, free dinners at the Centre, and free cod-liver oil. Where previous illness is the immediate cause of the malnutrition, help is often given by sending the child to a convalescent home. Where the poorly nourished state of the child is due not to lack of food, but to wrong feeding habits, poor discipline in the home, or insufficient rest, attempts are made to remedy these conditions by direct contact with the parents, either by seeing them at school or at the Clinic, or by the School Nurses visiting them in their homes. One factor in the improvement which is taking place in the nutrition of the school children is undoubtedly the advantage which is taken in all the schools of the daily supply of milk at half-price by the Milk Marketing Board. The proportion of elementary school children in Wood Green availing themselves of this provision remains steady at just under sixty per cent., and in addition an average of about 250 children are supplied with free milk throughout the year on medical grounds. (b) Cleanliness. The standard of cleanliness among the children remains very high, and reflects credit on the great majority of the parents. Almost 34,000 individual inspections of children for cleanliness were made by the nurses during the year, and the number of children excluded on account of verminous conditions was only 91. 6 (c) Minor Ailments and Diseases of the Skin. Ninety-five 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. These children were, for the most part, treated at the School Clinic. (d) Visual Defects and External Eye Diseases. Fifty-six children were recommended for treatment on account of defective vision or squint, while 256 children suffering from minor defects of vision were kept under observation. Sixteen children were found to require treatment for external diseases of the eye, and twenty-five were kept under observation. (e) Nose and Throat Defects. Thirty-seven children were recommended for operative treatment for enlarged tonsils and adenoids, and 231 were referred for observation. Forty-eight children were found to be suffering from other conditions of the throat and nose requiring treatment, and three others were referred for observation. (f) Ear Disease and Defective Hearing. Only two children were found to be so deaf as to require treatment for this defect, but thirty children were found with other forms of ear disease requiring treatment. (g) Dental Defects. The results of the inspections carried out by the School Dental Surgeon are set forth in Table V. 2,805 children in all were inspected during the year, and of this number 2,169 were found to be in need of dental treatment. The actual number treated at the Dental Clinic was 1,853. (h) Orthopaedic and Postural Defects. Thirteen children were classified as cripples. Seven of these were cases of non-pulmonary tuberculosis, for the most part quiescent 7 or cured. Of the others, two were cases of paralysis following anterior poliomyelitis. All twelve were under treatment at hospital or at home during the year. (i) Heart Disease and Rheumatism. Evidence of abnormality of the heart was found in forty-three children. In fifteen cases the child was thought to be suffering from organic disease of the heart, and in most of these cases the disease was rheumatic in origin. In addition to these cardiac cases of rheumatic origin a further eleven children were seen during the year suffering from definite rheumatism. All cases of rheumatism and heart disease are kept under regular observation at the School Clinic, and where institutional treatment is required, assistance is given in finding the necessary accommodation. (j) Tuberculosis. Six cases of pulmonary tuberculosis were seen in school children during the year. Four of these received sanatorium treatment, one was treated in hospital, and one in a residential institution. Of seven cases of non-pulmonary tuberculosis found in school children, two were active cases which were sent to special hospitals, one was sent for treatment to an orthopaedic hospital, and the others, which were old quiescent cases, were kept under observation at the Clinic. 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. The number of visits paid by the Visitation Officer in this work of following-up the defects found at medical inspections has been 2,099. VII.—ARRANGEMENTS FOR TREATMENT. No change has been made in these arrangements. Wherever possible, parents are recommended to obtain treatment for their 8 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 have been dealt with at the Prince of Wales's Hospital and the Royal Northern Hospital, ultra-violet light provided at the North Middlesex Hospital and Royal Northern Hospital, and X-ray treatment for ringworm at the Royal Northern Hospital. (a) Minor Ailments. Twelve hundred and forty-four children were treated at the Clinic for minor ailments. These comprise for the most part septic conditions of the skin, minor injuries, inflammatory conditions of the ears and eyes, and other like conditions which are apt to receive insufficient attention at home, but may, if neglected, be injurious to the child's health. (b) Tonsils and Adenoids. Two children were operated on during the year, under the Committee's scheme, for enlarged tonsils and adenoids, while twenty-three were dealt with privately by their own doctors or in hospital. Children dealt with under the Committee's scheme are admitted to the Prince of Wales's or to 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 747, 258 of these being new cases. 325 children had spectacles prescribed for them at the Clinic, and of this number 284 had obtained the spectacles by the end of the year. In addition, thirteen children were fitted with spectacles privately or at hospital. 9 (d) Ear Disease and Defective Hearing. The number of children seen by Dr. Friel at the Ear Clinic during the year was 184, of whom 132 were cases seen for the first time. Thirty-three of these children were treated for otorrhoea, and of this number twenty were cured, six still under treatment at the end of the year, two referred to hospital for operative treatment, and five ceased to attend 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 were 497. (e) Dental Defects. The work done by the School Dental Surgeon is set out in detail in Table Y. The scheme of dental inspection embraces practically the whole elementary school population, and dental treatment is available for every child during his elementary school life. The main endeavour is 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. The ratio of fillings to extractions in permanent teeth remains very high, 2,798 fillings to 532 extractions, while in temporary teeth very few fillings have been done and many extractions. (/) 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. Progress in most cases is slow, but on the whole the results are very good, and in many cases complete cure of the defect is obtained. 10 VIII.—INFECTIOUS DISEASES. The incidence of infectious disease in the elementary schools was considerably less in 1937 than in the previous year, so far as numbers of cases were concerned. 519 cases were notified in 1937 as compared with 889 in 1936. The following table gives the numbers of cases of the different infectious diseases notified from the elementary schools in 1937 and 1936. 1937. 1936. Scarlet Fever 41 39 Diphtheria 24 62 Chicken-pox 25 188 Measles 99 393 Mumps 172 39 Whooping Cough 146 141 Skin Infections 12 27 Total 519 889 It will be seen that the most prevalent infection in 1937 was mumps, 172 cases as against only 39 in the previous year. This disease was most prevalent in the first and last quarters of the year. Of the 146 cases of whooping cough, 110 occurred in the first quarter of the year. The incidence of scarlet fever was again low, just as in 1936, and of diphtheria very low, 24 cases only as compared with 62 in 1936. 11 The incidence of scarlet fever and diphtheria during 1937 is shown in the following table:— School. Scarlet Fever. Diphtheria. Alexandra Boys 2 — Girls 1 — ,, Infants 4 — Bounds Green Boys 1 — ,, ,, Girls 1 — ,, ,, Infants 4 1 Lordship Lane Boys 1 3 ,, ,, Girls 1 2 ,, ,, Infants 3 — Noel Park Boys 1 — ,. ,, Girls 2 1 ,, „ Infants 5 — Rhodes Avenue 5 — St. Michael's Mixed — 2 ,, Infants 1 1 St. Paul's 2 2 White Hart Lane Boys 1 3 ,, ,, „ Girls 2 3 „ „ „ Infants 4 6 Glendale County — 1 Trinity County — — Private Schools — — Schools outside Borough 2 — Under School Age 16 6 Over School Age 13 15 Totals 72 46 1st Quarter 11 15 2nd ,, 16 3 3rd „ 18 8 4th ,, 27 20 72 46 12 It will be seen from this table that the scarlet fever cases were distributed fairly evenly throughout all the elementary schools. So far as diphtheria is concerned, it is noteworthy that while most of the schools were affected, not a single case occurred in the Alexandra Schools, which were so seriously involved in the outbreak of 1936. One factor in this freedom from infection is probably the very high proportion of children in these schools who were successfully immunised towards the end of 1936. Immunisation has been carried on as in previous years, an offer of free immunisation being made to all children in all the infant departments not previously immunised, and to all other children whose parents desire it. The total number of children who received full courses of protective injections during the year was 738, and a further twelve were undergoing a course at the end of the year. 1,226 were Schick-tested during the year, 694 of these being children who had been immunised in 1936. 206 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. A certain amount of use is made of the playgrounds during the summer months for open-air classes. In two of the senior schools, however, a form of open-air education is enjoyed by a limited number of children year by year. This is the school journey which seems to be a well-established feature of Bounds Green Boys' and Girls' Schools. In the month of June, 28 boys and two teachers from the Boys' School had a school journey for a fortnight at Weston-super-Mare, while 34 girls and two teachers from the Girls' School went on a school journey to Ryde, in the Isle of Wight, also for a fortnight. There was also a School Camp in August at New Romney, arranged by the Juvenile Organisations Committee for a selected number of children from the elementary schools. The number of children sent was 163—80 boys and 83 girls. These children were, 13 for the most part, selected by the Juvenile Organisations Committee with the help of the head teachers, and a certain number were recommended by the School Medical Officers on medical grounds. The children were medically examined, weighed and measured before going to camp, and again weighed and measured on their return. As has been the experience, in former years, the benefit derived by the children from a fortnight's holiday under excellent conditions was in most cases very evident. This annual holiday provided free of charge to such a large number of the less fortunately circumstanced children in our schools cannot be regarded as other than a very valuable contribution to the health and well-being of these children. 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, for the most part, 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 four boys and three girls to Collington Manor, Bexhill. In addition to these, eighteen boys and twentyeight girls were sent for shorter periods, usually 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. No direct control over physical training is exercised by the School Medical Officer, but he is from time to time asked to examine children with a view to deciding whether they are fit to take part in the routine games and exercises practised in the schools. School Baths. Good use was made by the school children of the swimming facilities provided by the Wood Green Council. At the Western Road Baths the attendances made by school children during the year numbered 22,110, at the Open-Air Bath on the Alexandra Race Course 3,466, and at the Swimming Pool in Durnsford Road 14 22,569. The number of certificates of proficiency in swimming awarded to school children during the year was 737. These included 65 certificates for swimming 880 yards. These numbers are considerably smaller than those for previous years, owing to the fact that the Western Road Baths were closed for reconstruction during the first six months of the year. XI.—PROVISION OF MEALS. The Feeding Centre in White Hart Lane has been open throughout the year, providing a hot mid-day meal to a large number of the less fortunate of our school children. These 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 purely medical grounds. The Feeding Centre is administered by the Director of Education, but responsibility for the food supplied being wholesome and nutritious is borne by the School Medical Officer. The dinners supplied are, 1 consider, good both as regards quantity and quality, and endeavour is made to prevent monotony in the menus. The food is served and the children waited on by a number of ladies, most of whom are members of the Care Committee. The number of children who received meals at the Centre during the year was 166, and of this number 126 were fed free of cost, 38 for part payment, and 2 for full payment. The total number of meals provided was 16,698, of which 13,070 were given free, 3,593 for part payment and 35 for full payment. The average cost per meal was 5.5 pence, of which 2.5 pence represented the actual cost of food and 3.0 pence the cost of administration. In addition to the meals served at the Feeding Centre, 4,711 meals were provided at the School for the Partially Sighted, in Lordship Lane, for the children attending there. Of these, 2,546 were given free, 200 for part payment and 1,965 for full payment. These meals are cooked at the Feeding Centre. Apart from this provision of meals, a number of children were provided with milk at school free of cost, and a number of others with malt and cod-liver oil at the School Clinic either free or at cost price, on the recommendation of the School Medical Officer. 15 XII.—CO-OPERATION. (a) Of Parents. The parents are usually interested in the school medical examinations, and almost sixty per cent. of the children are accompanied by parents or guardians at the routine inspections. At the entrants' examinations almost 90 per cent. of the parents attend; at the intermediates less than 70 per cent., and at the leavers less than 40 per cent. The great majority of the parents are ready to give effect to the recommendations made by the School Medical Officers, and the success of our work depends very largely on their co-operation. In one direction more co-operation still is desirable, there being, unfortunately, many parents even yet who fail to take; advantage of the facilities offered for the treatment of their children at the Dental Clinic. (b) Of Teachers. We are fortunate in Wood Green in being able to depend on the ready and willing co-operation of the teachers in all the schools in the school medical work. Without their help the medical work would lose much of its value, and would not proceed so smoothly and quietly as it does. We make many demands on the time and work of the head teachers particularly, and I am glad to be able again to thank them for their assistance. I wish also to thank the School Welfare Officer for his assistance in bringing to our notice children unable to attend school, or requiring special consideration. (c) Of Voluntary Bodies. Of the voluntary bodies for whose help year by year the school medical service is grateful, the principal is the Juvenile Organisations Committee, to which I have made reference above in connection with the annual children's Holiday Camp. The Boot and Clothing Fund raised and administered by the Care Committee has, as in former years, provided many of the poorer children with boots and clothing. 16 To the Tottenham Deanery Council for Moral Welfare we have been indebted for assistance from their representative in dealing with children whose moral welfare has required special consideration, and to the National Society for the Prevention of Cruelty to Children for the assistance of the local representative, Inspector Martin, in dealing with several very troublesome cases where parents have been neglectful to obtain necessary treatment for their children. 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, who have allowed us to send children to their Holiday Home at Shoeburyness on very generous 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. 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 there are always a number of defective children who are unable to attend school, and for information about these children we are indebted to School Welfare 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, the necessary 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 17 for her to profit by instruction in an ordinary elementary school. This child is in attendance at the Partially Sighted School in Lordship Lane. This school provides accommodation not only for Wood Green children, but for children from other education authorities. The total number of children attending at the end of the year was twenty-eight. Of these, one only belonged to Wood Green, thirteen to Tottenham, five to Edmonton, four to Enfield, two each to Hornsey and Middlesex, and one to Finchley. A mid-day meal is provided at the school for children 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 children attend the Tottenham School for the Deaf. (c) Mentally Defective. Twelve mentally defective children from Wood Green are attending the Joint Special School for Mental Defectives at Finchley. Several of these are high-grade defectives who may be expected to do very well, and I am glad to say that many of the children who have attended this school in the past have benefited so much by the instruction given there that they have been able to earn their own living afterwards. The school is visited and the children examined by the School Medical Officer at regular intervals. One child who is really mentally defective was attending an ordinary school, and four others were not attending any school. For this type of child, as well as for older mental defectives from Wood Green and surrounding districts, the Occupation Centre at Shropshire Hall, in Gladstone Avenue, performs a useful service in providing occupation during the day. The mental defectives attending this 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, but not in such a severe form as to interfere with their education, were in attendance at 18 ordinary schools. One very severe case of epilepsy was unfit to attend any school, and has recently been sent to a Colony for Epileptics. XIV.—NURSERY SCHOOLS. There is no nursery school in Wood Green, but classes for children under school age are held in two of the Infant Departments. These, of course, do not take the place of a proper Nursery School, but they do meet a definite need in providing a healthy environment during the day for young children whose home circumstances are not altogether satisfactory. XV.—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 inspections are reported to the parents, who make their own arrangements for treatment. In the case of dental defects and defects of vision, treatment is provided at the School Clinic under an arrangement made with the County Education Committee. The dental work is done by Mr. MacBean, part-time Dental Officer, and the eye work by Dr. Boden, the School Ophthalmic Surgeon. Six hundred and twenty-nine secondary pupils were medically inspected during the year. XVI.—PARENTS' PAYMENTS. A small charge is made to parents for treatment given to children at the dental clinic and the ear clinic, but no charge is made for attendance at the minor ailments clinic, although a box is always available for voluntary contributions. Wherever possible, the full cost of 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 make it difficult or impossible for them to meet the full cost, the case is reported to the Care Committee and the sum charged to the parents reduced or remitted. 19 XVII.—SCHOOL CLINIC. In concluding this report, I cannot refrain from expressing my pleasure at the prospect of a new School Clinic being provided in the very near future. The Committee is well aware of the inadequacy of our present premises and the difficulties under which our work is done. The plans which have recently been approved by the Committee, and are now awaiting approval by the Board of Education, make proper provision for all the activities of the school medical service, and the improved accommodation should be an incentive to the staff to increased effort to carry out their work with benefit to the children and satisfaction to the community generally. In conclusion, I would like, as in former years, to express my appreciation of the support and encouragement which the Education Committee has at all times given to the efforts of the School Medical Staff. I wish also to thank the Director of Education and his staff for assistance which is always readily given, and, finally, every member of my own staff for loyal and willing service throughout the year. I am, Your obedient servant, MALCOLM MANSON, School Medical Officer. 20 APPENDIX. MEDICAL STATISTICAL TABLES, 1937. TABLE I.—RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Entrants . Age. 3 4 5 6 Other Ages. Total. Boys — 32 222 136 31 421 Girls — 19 213 132 43 407 Totals — 51 435 268 74 828 Second Age Group (Intermediates). Age. 8 Other Ages. Total. Boys 278 76 354 Girls 254 85 339 Totals 532 161 693 Third Age Group (Leavers). Age. 12 13 14 Other Ages. Total. Boys 222 42 6 270 Girls 220 71 5 — 296 Totals 442 113 11 — 566 21 Number of Other Routine Inspections. Varied Ages. Total. Boys 222 222 Girls 278 278 500 500 Grand Total. Entrants Second Age Group. Third Age Group. Other Routine Inspections. Total. Boys 421 354 270 222 1267 Girls 407 339 296 278 1320 Totals 828 693 566 500 2587 B.—OTHER INSPECTIONS. No. of Special Inspections. No. of Re-Inspections. Boys 453 1108 Girls 522 1416 Totals 975 2524 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 defective vision (excluding squint For all other conditions recorded in Table IIa. Total. Entrants 1 70 71 Second Age Group 22 38 60 Third Age Group 17 27 44 Total (Prescribed Groups) 40 135 175 Other Routine Inspections 10 23 33 Grand Total 50 158 208 22 TABLE II. A.—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DEC., 1937. 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. Requining to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Skin Rineworm— (1) Scalp ... ... 2 ... (2) Body ... ... 3 1 (3) Scabies 4 ... 9 ... (4) Impetigo 1 ... 3 ... (5) Other Diseases (non-Tuberculous) 14 12 13 1 TOTAL (Heads 1 to 5) 19 12 30 2 Eye (6) Blepharitis 8 2 1 ... (7) Conjunctivitis 3 ... ... ... (8) Keratitis ... 1 ... ... (9) Corneal Opacities ... 1 ... ... (10) Other Conditions (excluding Defective Vision and Squint) 2 20 2 1 TOTAL (Heads 6 to 10) 13 24 3 1 Ear (11) Defective Vision (excluding Squint) 50 233 1 ... (12) Squint 3 23 2 ... (13) Defective Hearing 2 1 ... ... (14) Otitis Media 6 1 ... ... (15) Other Ear Diseases 15 2 9 ... Nose and Throat. (16) Chronic Tonsillitis only 24 219 12 12 (17) Adenoids only ... ... 1 ... (18) Chronic Tonsillitis and Adenoids ... ... ... 1 (19) Other Conditions 27 3 21 ... (20) Enlarged Cervical Glands (Non- Tuberculous) 1 24 ... 2 Total carried forward 160 542 79 18 23 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 160 542 79 18 (21) Defective Speech 5 2 4 ... Heart and Circulation. Heart Disease— ('22) Organic 3 6 1 5 (23) Functional 25 3 ('24) Ansæmia 3 16 ... 1 Lungs (25) Bronchitis 4 5 ... 1 (26) Other Non-Tuberculous Diseases . 2 6 1 2 Tuberculosis Pulmonary— (27) Definite ... ... ... ... (28) Suspected 2 ... 1 ... Non-Pulmonary— (29) Glands ... ... ... ... (30) Bones and Joints ... 2 ... 1 (31) Skin ... ... ... ... (32) Other Forms ... ... 1 ... TOTAL (Heads 29 to 32) ... 2 1 1 Nervous System. (33) Epilepsy 2 5 2 1 / (34) Chorea 2 2 3 ... (35) Other Conditions ... 2 1 ... Deformities. (36) Rickets ... 1 ... ... (37) Spinal Curvature 3 3 1 ... (38) Other Forms 3 7 4 ... (39) Other Defects & Diseases (excluding Defects of Nutrition, Uncleanliness and Dental Diseases) 23 40 64 31 TOTAL 212 664 162 63 24 B.—Classification or the Nutrition of Children Inspected During the Year in the Roi^ine Aqe Groups. Age Groups Number of Children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Entrants 828 176 21.25 549 66.30 101 12.19 2 0.24 Second Age Group 693 151 21.79 425 01.32 116 16.74 1 0.14 Third Age Group 566 149 26.32 358 63.25 59 10.42 - — Other Routine Inspections 500 144 28.8 308 61.6 46 9.2 2 0.4 Total 25i87 620 23.96 1640 63.39 322 12.45 5 0.19 25 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 fo the Partiall. Sighted. 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) At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At Other Institutions. At no School or Total. Institution. 12 1 - 4 17 26 EPILEPTIC CHILDREN. Children Suffering From Sevebe Epilepsy. (a) At Certified Special Schools. (b) At Public Elementary Schools. (c) At Other Institutions. (d) At no School or Institution. Total. _ 3 - 1 4 PHYSICALLY DEFECTIVE CHILDREN. A.—Tubebculous Children. 1.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) (a) At Certified Special Schools. (b) At Public Elementary Schools. (c) At Other Institutions. (d) At no School or Institution. Total. - 1 4 1 6 II.—Children Suffering from Non-Pulmonary Tuberculosis. (a) At Certified Special Schools. (b) At Public Elementary Schools. (c) At Other Institutions. (d) At no School or Institution. Total. - 4 2 1 7 B.—Delicate Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. - 23 - - 23 27 C.—Crippled Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. - 1 3 2 6 D.—Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. - - 2 2 4 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 Hemiplegia 1 - - - 1 28 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 4 1 5 Scabies 21 - 21 Impetigo 62 4 66 Other skin disease 24 - 24 Minor Eye Defects (external and other, but excluding cases falling in Group II) 87 3 90 Minor Ear Defects 115 - 115 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 929 30 959 Total 1,244 38 1,282 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) Other defect or disease of the eyes (excluding those recorded in Group I) 693 54 15 3 708 57 Total 747 18 765 Under the Authority's Scheme. Otherwise. Total. No. of children for whom spectacles (a) Prescribed 325 13 338 (b) Obtained 284 13 297 29 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. (4) Total number treated. (5) Under the Authority's scheme in Clinic or Hospital. (1) By Private Practitioneror Hospital, apart from the Authority's Scheme. (2) Total. (3) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) - - 2 - - - 23 - - - 25 - 83 108 (i) Tonsils only. (ii) Adenoids only, defects of the nose and throat. (iii) Tonsils and Adenoids, se and throat. (iv) Other Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme (1) Otherwise. (2) Residential treatment with education. Residential treatment without education. Non-resid ntial treatment at an orthopaedic clinic. Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. Total number Treated. (i) (ii) (iii) (i) (ii) (iii) Number of children treated 2 - - - 2 3 7 30 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 — 94 260 236 333 286 265 291 230 187 129 66 3 2,380 (6) Specials 425 (c) Total (Routine and Specials) 2,805 (2) Number found to require treatment 2,169 (3) Number actually treated 1,853 (4) Attendances made by children for treatment 4,315 (5) Half-days devoted to:— (7) Extractions:— Inspection 18 Permanent Teeth 532 Treatment 415 Temporary Teeth 2,245 Total 433 Total 2,777 (8) Administrations of genera anaesthetics for extractions 1 842 Fillings:— (9) Other Operations:— Permanent Teeth 2,798 Permanent Teeth 587 Temporary Teeth 22 Temporary Teeth 571 Total 2,820 Total 1,158 TABLE VI.—UNCLE ANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 8 (ii) Total number of examinations of children in the Schools by School Nurses 33,894 (iii) Number of individual children found unclean 91 (iv) Number of individual children cleansed under arrangements made by the Local Education Authority (v) Number of cases in which legal proceedings were taken:— (а) Under the Education Act, 1921 (b) Under School Attendance Byelaws 31 STATEMENT of the Number of Children Notified During the Year ended 31st December, 1937, 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 — — (6) Imbeciles — — (c) Others 1 1 (ii) Children unable to be instructed in a Special School without detriment to the interests of other children: (a) Moral defectives — — (6) Others 1 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 — 3. Feeble-minded children notified under Article 3, i.e., "special circumstances" cases — — 4. Children who, in addition to being mentally defective, were blind or deaf — — Grand Total 1 2 32 1 1