Borough of Wood Green. Annual Repart OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER FOR THK YEAR 1938. MALCOLM MANSON, M.C., M.A., M.D., D.P.H Medical Officer of Health and. School Medical Officer. 1939. Crusha & Son, Ltd., Tottenham, Enfleld, Wood Green and Palmera Green. INDEX. MEDICAL OFFICER OF HEALTH SECTION. page A. Accidents due to Traffic 9 Ambulance Service 14 B. Bacteriological Examinations 39 Baths 20 Births 6 C. Clinics14 D. Day Nursery 18 Deaths 7 Disinfection, etc. 39 Drainage and Sewerage 20 F. Factories 25 Food and Drugs Acts 32 Food Inspection 30 Foster Mothers 18 H. Hospitals 11 House-to-House Inspection 24 Housing Statistics 27 I. Infantile Mortality 8 Infectious Diseases— Cases Removed to Hospital 33 Cases Attending Schools 34 M. Maternity and Child Welfare— Ante-Natal Clinic 16 Centres 15 Dental Work 17 Free Food 18 Home Visiting 18 Maternity Hospital Provision 16 Maternity and Nursing Homes 11 Maternal Mortality 9 Sunlight Treatment 17 page Midwives 10 Mortuary 29 N. Nursing in the Home 10 P. Poor Law Relief 9 Population 6 R. Rent Restriction Acts 29 Rivers and Streams 19 S. Sanitary Inspection 21 Slaughterhouses 30 Social Conditions, etc. 5 Staff 2 Statistical Tables— Birth and Death Rates 42 Causes of Death 43 Infectious Diseases 46 Infantile Mortality 45 Meteorological Report 48 Tuberculosis 47 Vital Statistics 41 T. Tuberculosis 37 V. Vital Statistics, Extract from 5 W. Water Supply 19 Z. Zymotic Mortality 8 Borough of Wood Green. PUBLIC HEALTH COMMITTEE. Alderman E. J. Anderton, L.D.S. (Chairman). The Mayor (Alderman Mrs. J. J. Bolster, J.P.). The Deputy Mayor (Alderman A. J. Blue. J.P.). Alderman F. G. Holmes, J.P. Councillor Mrs. A. Duncan, J.P. Alderman H. Tudor Rhys, J.P. Councillor W. H. Evans. Councillor Mrs. J. Cole. Councillor B. L. Lloyd. Councillor W. G. Doyle. Councillor W. J. Payne. Councillor J. J. Wren. MATERNITY AND CHILD WELFARE COMMITTEE. Councillor Mrs. A. Duncan, J.P. (Chairman). Alderman E.J. Anderton, L.D.S. Councillor T.A.Warburton. Alderman Mrs. J. J. Bolster, J.P. Councillor J. J.Wren. Councillor Mrs. J. Cole. Co-opted Members:— Mrs. A. Barrett. Mrs. M. Blue. Mrs. E. L. Corbett. 2 STAFF during 1938. * Medical Officer of Health.—Malcolm Manson, M.C., M.A., M.D., D.P.H. * Assistant Medical Officer of Health.—Miss Margaret McDonald Miller, M.B., Ch.B., D.P.H. *District Sanitary Inspectors.—S. C. Stanbury, Cert.R.San.Inst., Cert. Meat and Food Inspection (deceased February, 1939); G. C. Billing, Cert.R.San.Inst., Cert. Meat and Food Inspection; W. McCauley, Cert.R.San.Inst., Cert. Meat and Food Inspection. *Nurse-in-Charge, Day Nursery.—Miss V. W. Moss. * Health Visitors.—Miss G. Moore. C.M.B., Miss F. L. Orwin, C.M.B., Miss F. Medd, C.M.B. Chief Cleric.—G. W. Jones. Assistant Clerks.—W. T. Gloster, A. Hutchings, Cert.S.I.B. (resigned June, 1938), G. Penberthy, S. Swinnerton (appointed temporarily July, 1938). *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 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. July 26th, 1939. 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 1938. The year has been one of very great activity as in addition to the ordinary routine health work, which increases steadily year by year, there have been laid on the Health Department, particularly during the second half of the year, very heavy responsibilities under the Government's Air Raid Precautions Scheme. These responsibilities comprising as they do, among other duties, the siting and adaptation of buildings—First-Aid Posts, Stretcher Party and Ambulance Depots, the training of many hundreds of volunteers in the various duties of first-aid personnel, and the development of an emergency ambulance organisation, have necessarily involved a very great deal of work which, until a few weeks ago, has been borne entirely by the ordinary staff of the department with the assistance of a small number of enthusiastic A.R.P. volunteers. Our work has not 4 been made any easier by the frequency with which Government Departments have found it necessary to change their plans and directions, but we have been fortunate in having the able assistance of the local division of the St. John Ambulance Brigade, and the local detachment of the British Red Cross, as well as hundreds of volunteers who have enrolled in the A.R.P. medical services. To all these I wish to express my thanks for the readiness with which they have devoted their time and labour to the object of acquiring the efficiency which will make them of service to their fellows in case of emergency. I desire also to thank the members of the Public Health and Maternity and Child Welfare Committees and the Council generally for the interest taken in matters affecting the public health, and finally, the members of my staff for the loyal and willing service they have given throughout a very busy year. This service has necessarily, in the case of many of them, involved the sacrifice of a large amount of leisure time, but it has been, as always, ready and willing service. Your obedient Servant, MALCOLM MANSON, Medical Officer of Health. 5 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (acres) 1,607 Population—Estimate supplied by the Registrar-General 53,190 Number of inhabited houses (end of 1938, according to the Rate Books) 13,776 Rateable Value, 1938 £532,908 Sum represented by a penny rate £2,105 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births— Total. M. F. Legitimate 635 342 293 Birth Rate 12.3 Illegitimate 17 9 8 Stillbirths 25 20 5 Rate per 1,000 births, 36.7. Deaths 540 248 292 Death Rate 10.1. Deaths from Puerperal causes:— Puerperal sepsis — Rate per 1,000 Births, Nil. Other Puerperal causes 2 Rate per 1,000 Births, 2.9. Total 2 Rate per 1,000 Births, 2.9. Deaths of Infants under 1 year of age:— All infants25 Rate per 1,000 Live Births, 38. Legitimate 24 Rate per 1,000 legitimate Live Births, 38. Illegitimate 1 Rate per 1,000 illegitimate Live Births, 59. Deaths from:— Cancer (all ages) 92 Measles (all ages) 3 Whooping Cough (all ages) — Diarrhoea (under 2 years of age) 1 6 POPULATION. The Registrar-General's estimate of population for 1938 was 53,190 and I have used this figure to calculate the birth and death rates for the year. It represents a decrease of 320 in the population from that of 1937 which was 53,510, and is the lowest figure given since 1928. The decrease must be due to movement of population out of Wood Green of which I have no personal knowledge, as there is an excess of births year by year over deaths. This decrease is, however, not very great and for all practical purposes the population may be regarded as almost stationary. BIRTHS. The number of live births registered during the year was 652, giving a birth-rate of 12.3, exactly the same as for the previous year. The birth-rate for the whole country was 15.1, and for the 126 great towns (which include Wood Green) it was 15.0. Wood Green's birth-rate was, therefore, as is usually the case, appreciably lower than both that of the whole country and that of the great towns. Twenty-five stillbirths were registered, 20 male and 5 female. The births registered in the Borough were distributed in the different Wards as follows:— Alexandra-Bowes 67 Town Hall 253 Noel Park 111 434 7 DEATHS. The number of deaths belonging to Wood Green, after making the necessary adjustments for inward and outward transfers, was 540, 248 male and 292 female. This represents a death-rate of 10.1 per thousand of population, which is an improvement on 11.1, the death-rate for the previous year. The death-rate for the whole country for 1938 was 11.6 and that for the 126 great towns 11.7. Of the total deaths no fewer than 298 or 55.2 per cent. occurred in persons over 65 years of age. The corresponding percentage in 1937 was 57.5 and in 1936, 50. The distribution of deaths over the year was as follows:—First quarter, 168; second, 131; third, 107; and fourth, 134. The distribution of deaths according to Wards was:— Alexandra-Bowes 172 Town Hall 183 Noel Park 185 540 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 for many years past, was heart disease which was responsible for no less than 176 deaths or almost one-third of all deaths. Of these 176 deaths more than two-thirds occurred in persons over 65 years of age. 8 The next most common cause of death was cancer, which was responsible for 92 deaths as compared with 79 for the previous year and 91 for 1936. Pneumonia was the cause of death in 30 cases, and tuberculosis of all forms was the cause of death in 28 cases. 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 6. Of this number three were due to measles, two to diphtheria and One to diarrhoea. The zymotic death-rate was 0.11 per 1,000 of population as compared with 0.26 for the previous year. INFANTILE MORTALITY. The number of deaths occurring in children under 12 months of age was 25, and the Infantile Mortality Rate 38 per 1,000 live births. This is a very considerable improvement on the rate for 1937 which was 48, and is the lowest since 1934 when the rate was 37. The individual causes of the infantile deaths and the age at which death took place are shown in Table Y. Of the total of 25 deaths no fewer than 10 took place in the first week of life and a further 7 before the end of the first month. The chief causes of death were prematurity, which was given as the cause of death in nine cases, and broncho-pneumonia, which was responsible for seven deaths. MORTALITY OF CHILDREN BETWEEN ONE AND FIVE YEARS. Five deaths occurred in children over one and under five years. Of these two were caused by diphtheria, two by bronchopneumonia, and one by measles. These deaths represent a death rate in this age group of 0.09 per 1,000 of the total population and 0.9 per cent. of the total deaths for the year at all ages. 9 MATERNAL MORTALITY. Two deaths were registered as maternal deaths. In one case death was due to heart disease complicating pregnancy, and in the other the cause of death was toxic vomiting of pregnancy. There were no deaths due to puerperal sepsis. The Maternal Mortality Rate was 2.9 per 1,000 births, as compared with 4.5 for the previous year. 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 1938 :— No. of persons. Amount granted. £ s. d. Ordinary cases 1,254 21,318 0 0 Unemployed 145 1,444 4 0 Totals 1,399 £22,762 4 0 The amount granted in 1937 was £21,362 17s. 2d. 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 1938, there were 107 accidents in the High Road and 124 elsewhere in Wood Green involving personal injury, and the use of a motor ambulance was required on 207 occasions as compared with 215 in 1937. 10 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 nurses provided by the Association are much in request by the members, and I am glad to state that steady progress is being made in extending the work of the Association, so much so that the nursing staff is being increased. A contribution of £150 was made by the Borough Council to the funds of the Wood Green District Nursing Association for the year 1938-39. (b) Infectious Disease. It is part of the duty of the Health Visitors to visit cases of Ophthalmia Neonatorum, Measles, Whooping Cough or Pneumonia occurring in young children in their areas. By arrangement with the Nursing Association, notified cases of Pneumonia are visited by the District Nurses and nursing assistance is supplied whenever asked for. Midwives. During the year seven midwives residing in the Borough notified their intention to practise in Wood Green. In addition to these there were at the beginning of the year four municipal midwives appointed by the Council acting as agents for the Middlesex County Council which is the Supervising Authority under the Midwives Act, 1936. A very large proportion of the births belonging to Wood Green occur each year in hospitals or nursing homes, and it was soon apparent that at the present time there is not enough work in the district for four municipal midwives as well as seven 11 private ones. The number of municipal midwives was accordingly reduced to three at the end of August. The remaining three midwives have not been fully employed during the year, but their services are becoming more and more in request, and as the number of midwives engaged in private practice decreases in the ordinary course of events, there is more likelihood of their being fully employed in the future. The cost of the Municipal midwifery service is met by the Middlesex County Council, and the fees charged in individual cases are graduated according to the financial circumstances of the patient. MATERNITY AND NURSING HOMES. One Maternity Nursing Home and one Nursing Home were registered by the Middlesex County Council in the Borough of Wood Green during 1938. 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. 12 2. Smallpox. The Middlesex County Council is responsible for the provision of isolation accommodation for cases of smallpox occurring in this Borough. The accommodation is provided by arrangement between the Middlesex and London County Councils at one of the London County Council Smallpox Hospitals. 3. Tuberculosis. Provision for the treatment of tuberculosis is made by the Middlesex County Council, and I am indebted to Dr. Tate, the County Medical Officer, for the following information showing the accommodation available at the different institutions during 1938. Institution. Accommodation. Type of case. Adults. Children . M. F. County Sanatorium, 150 150 60 Pulmonary—Sanatorium. Harefield 4 4 10 Pulmonary—Observation. County Sanatorium, Clare Hall, South Mimms 132 66 — Pulmonary — late Sanatorium . The White House, Milford-on-Sea — 24 — Pulmonary. Victoria Home, Margate — — 6 Non-Pulmonary. In addition to the above, 24 beds are reserved in the Royal Chest Hospital, City Road, for male or female patients as required. 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- 13 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 £500 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. 14 AMBULANCE FACILITIES. (a) Infectious Cases. By arrangement between the Joint Isolation Hospital Committee and the London County Council, cases of infectious disease are removed to hospital in ambulances belonging to the London County Council. (b) Non-Infectious and Accident Cases. The Council provides a Motor Ambulance for the conveyance of non-infectious, sick and accident cases, which is housed at the Fire Station and is available at all hours. During the year tlhe ambulance was used on 2,167 occasions, 273 being cases of accident or cases of illness in the street. In addition 201 cases were carried for us by ambulances belonging to other authorities. The total mileage for the year was 14,317. The sums received from various users amounted in all to £36 8s. 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. I am glad to state that steps are now being 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. 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. 15 MATERNITY AND CHILD WELFARE. The number of live births registered during 1938 as belonging to Wood Green was 652 according to the information supplied by the Registrar-General. The number of births registered in the Borough during the year was 434 and the percentage notified under the Public Health Act, 1936, was 98.7. The number of stillbirths registered was 25 and the number notified 25. 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 1,223 March 1,794 April 1,229 May 1,455 June 1,383 July 1,712 August 1,514 September 1,424 October 1,315 November 1,463 December 1,450 Total 17,196 The attendances in 1937 were 17,383 and in 1936, 16,867. 16 The attendances at the Centre in the Alexandra Park area numbered 3,287 as compared with 3,022 in 1937 and 2,699 in 1936. The number of individual children brought to the Centres during the year was 1,616 of whom 833 were infants under 1 year of age and 783 of from 1 to 5 years of age. The number of children seen by Dr. Miller at the Centres during the year was 1,481. 751 of these were infants under 12 months of age who made 2,746 attendances, while 730 were children of 1 to 5 years of age and their attendances numbered 1,990. Of the 25 infantile deaths which occurred during the year, in only 3 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 352, and the total attendances made numbered 1,467. The remainder of the Tuesday afternoon Clinic was allotted to post-natal cases, the number seen being 33 and the attendances 40. 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 varying number of children have at least one medical inspection before attaining school age. The number of attendances during the year was 181. Maternity Hospital Provision. Arrangements are in force with three hospitals, namely, the Mothers' Hospital, Clapton, the Royal Northern Hospital, Hollo- 17 way, and the City of London Maternity Hospital for the admission of cases from Wood Green Centres. 23 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 two years 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 co-operation 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 176 Attendances made 639 Extractions (with local anaesthetic) 16 Extractions (with gas) 160 Fillings 58 Scalings, etc. 320 Advice only 190 Dentures provided 40 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. 18 Home Visiting. During the year the Health Visitors made a total of 6,052 visits. 2,340 of these visits were to babies under one year of age, 3,250 to children of from 1 to 5 years of age, and 462 were antenatal visits to expectant mothers. Free Food. Free food, consisting of cows' milk, dried milks and cod liver oil and malt, was issued during the year to necessitous expectant and nursing mothers attending the Centres at a cost of £552 14s. 6d. Free dinners were also supplied to necessitous mothers at the Feeding Centre in White Hart Lane at a cost of £2 17s. 6d. Infant Life Protection. The Health Visitors have continued to act as Infant Life Protection Visitors during the year. The number of foster-mothers and foster-children on the register at the end of the year were 19 and 19 respectively. Day Nursery. In January, 1938, plans prepared by the Borough Surveyor for a new Day Nursery and School Clinic to be erected on a site in White Hart Lane were approved by the Council and sent to the Ministry of Health and Board of Education for approval. It was hoped that the new premises would be ready for occupation by the end of 1938, but unfortunately, for one reason or another, no progress has been made and the work has not even yet been put out for tender. I am assured by the Borough Surveyor that this will be done in the very near future, so that there is a possibility of work on this very much required building being commenced before the end of 1939. It is very much to be regretted that there 19 should be so much delay in getting on with this project, as the conditions under which the Day Nursery and School Clinic staffs carry out their work at present are far from ideal and make the work unnecessarily difficult. The following table shows the attendances made at the present Day Nursery throughout the year, and the corresponding figures for the previous year. 1938. 1937. January 427 327 February 516 267 March 702 358 April 435 425 May 526 410 June 466 526 July 578 494 August 431 307 September 539 434 October 538 475 November 531 453 December 595 565 Totals 6,284 5,041 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. 20 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 station situated in Tottenham. Here the sewage is pumped into the London County Council's sewers by arrangement with that Council. The pumping station and main sewer in Lordship Lane are under the control of a Joint Drainage Committee consisting of representatives from Tottenham and Wood Green. The surplus water drains discharge into the Council's surfacewater sewers through which the surface-water flows into the Moselle and Muswell Brooks, and by these is carried finally into the River Lee. During the past year the Council has agreed to participate in the East Middlesex Sewerage Scheme which is being promoted by the Middlesex County Council, and when it comes into operation will deal with the sewage disposal of a large area comprising Wood Green and neighbouring districts in East Middlesex as well as certain adjacent districts in the counties of Hertford and Essex. BATHS. The open-air Swimming Pool in Durnsford Road was open throughout the summer months but the attendances showed a marked falling off compared with previous years, the result of the persistence of cold, wet weather during a great part of the summer. The attendances at the Swimming Pool at the Western Road Baths and at the open-air bath on the racecourse at Alexandra Pari for the last three years are shown below :— Swimming Pool. Western Road Baths. Open-Air Bath. Adults Children Adults Children Adults Children 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 1938 44,231 14,272 94,986 40,620 9,477 2,135 21 SANITARY INSPECTION OF THE AREA. The information given in this section is a brief record of the activity of the Sanitary Inspectors during the year. Inspections:— Inspection of dwelling-houses :— Initial inspections under the Public Health Acts 548 Re-inspections 977 Complaints investigated 172 Inspection under the Housing (Consolidated) Regulations, 1925 and 1932 507 Inspections under the Housing Acts 235 Re-inspections 1,068 Inspections of houses-let-in-lodgings 6 Re-inspections 39 3,552 Inspections under the Rent Restrictions Act 21 Grand Total 3,573 Enquiries in connection with Infectious Diseases:— Smallpox — Scarlet Fever 185 Diphtheria 128 Tuberculosis 159 Enteric Fever 2 Other Diseases 6 Total 480 Inspections of Registered Premises:— Factories with mechanical power 114 Factories without mechanical power 38 Workplaces:— Butchers' shops 936 Dairies 202 Fried fish shops 210 Other workplaces 22 1,370 Slaughterhouses 124 Outworkers 104 Total 1,750 22 Miscellaneous Inspections:— Urinals 304 Passageways 68 Cinemas, etc. 25 Ice cream premises 102 Stalls—day and night visits 587 Smoke observations 7 — 1,093 Grand Total 2,843 Action Taken :— Issued. Completed. Verbal intimations 27 27 Preliminary Notices:— Public Health Act, 1936, Section £3 65 62 Public Health Act, 1936, Section 75 67 64 Housing Act, 1936, Section 4 7 7 Housing Act, 1936, Section 9 215 227 Public Health Act, 1936, Section 167 156 156 Wood Green Urban District Council Act, 1920, Section 77 4 4 Byelaws regulating houses let in lodgings 7 7 548 554 Statutory Notices:— Public Health Act, 1936, Section 39 9 9 Public Health Act, 1939, Section 45 2 2 Public Health Act, 1936, Section .75 1 I Public Health Act, 1936, Section 83 — — Public Health Act, 1936, Section 93 2 6 Housing Act, 1936, Section 9 22 32 Wood Green Urban District Council Act, 1920, Section 77 1 1 Byelaws regulating houses let in lodgings 1 1 38 52 Work Carried Out:— Drainage works:— Drains reconstructed 24 Drains repaired 4 Drains unblocked and cleansed 29 Soil and vent shafts repaired or provided 26 Fresh air inlets repaired or provided 12 Sink and bath wastes repaired or provided 42 Inspection chambers repaired or provided 14 Interceptors repaired or provided 6 Drains tested 42 199 23 Water closets:— New water closets provided 3 New W.C. pans and traps provided 135 Water closets repaired 39 Foul water closets cleansed 29 Flushing apparatus repaired or provided 67 273 Cleansing:— Premises limewashed 2 Premises otherwise cleansed 14 Rooms cleansed after disinfection 235 Rooms disinfested 148 Accumulations of refuse 14 Keeping of animals discontinued 3 416 Dampness:— Roofs repaired, etc. 197 Eaves gutters repaired or provided 69 Rainwater pipes repaired or provided 57 Damp proof courses provided 32 Walls rendered or dampness otherwise remedied 159 514 House repairs:— Floors repaired—wood 84 Floors repaired—concrete 47 Coppers repaired or provided 72 Ceilings redecorated 964 Walls redecorated 897 General repairs 1,006 Fireplaces repaired 129 Stoves repaired or provided 89 Premises repainted externally 17 3,305 Miscellaneous:— Foodstores repaired or provided 37 Yard pavings repaired, etc. 106 Dustbins provided 85 Water supply taken from mains 12 Baths, sinks and lavatory basins fixed 127 Gullies fixed 10 377 Total works carried out during the year 5,084 24 HOUSE-TO-HOUSE INSPECTION. NUMBER OF HOUSES INSPECTED, 1938. Road. No. of Houses. No. of Rooms. Families. Persons per room. Adults. Children. Chapmans Terrace 4 20 18 — 0.90 Commerce Road 12 36 26 14 1.11 Crossway 14 70 60 19 1.13 Croxford Gardens 20 100 96 27 1.23 Elm Cottages, Station Road 6 18 20 1 1.17 Grainger Road 20 120 76 6 0.68 Granville Road 14 61 40 17 0.93 Gospatrick Road 41 205 176 29 l.00 James Gardens 20 100 88 27 1.15 Perth Road 39 177 163 34 1.11 Rivulet Road 67 355 314 72 1.09 Sandford Avenue 63 320 226 22 0.78 Selborne Road 45 162 132 29 0.99 Tintern Road 29 159 100 14 0.72 White Hart Lane 7 35 31 5 1.03 Willingdon Road 58 353 254 45 0.85 Wolseley Road 48 150 132 30 1.08 Totals 507 2441 1952 391 0.96 25 FACTORIES AND HOMEWORK. 1 .—Inspection. Including Inspections made by Sanitary Inspectors. aPremises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories with mechanical power 114 27 — Factories without mechanical power 38 4 — Other Premises under the Act (including works of building and engineering construction, but not including outworkers' premises) — — — Total 152 31 — 2.—Defects Found. Particulars. Number of Defeots. Number of defects in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Want of cleanliness (S.l) Overcrowding (S.2) — — — — Unreasonable temperature (S .3) 4 4 — — Inadequate ventilation (S.4) — — — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7) insufficient — — — — unsuitable or defective 27 19 not separate for sexes Other offences — — — (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937) Total .. 31 23 — — 26 3.—Homework. Nature of Work. Outworkers' Lists under Section 110 of Factories Act, 1937. 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 16 — 41 18 7 49 The making-up, ornamenting, finishing and repairing of table linen, or other household linen, and any process incidental thereto 1 — o 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 18 — 44 22 8 55 4.—Other Matters. Factories Act, 1937:-— Matters notified to H.M. Inspector of Factories — Underground Bakehouses (S.54):— Certificates granted during the year — In use at the end of the year Public Health Acts :— Matters notified by H.M. Inspector of Factories 3 Defects remedied following H.M.I.'s notifications 3 27 HOUSING STATISTICS. 1.-—Inspection of dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,317 (b) Number of inspections made for the purpose 3,401 (2) (a) Number of dwelling-houses (included under sub-head 1 above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 507 (6) Number of inspections made for the purpose 1,339 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation . 576 2.—Remedy of defects during the, year without service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 502 3 —Action under Statutory Powers during the year:— (A) Proceedings under Sections 9, 10 and 16 of Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Notices were served requiring repairs 22 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 32 (b) By Local Authority in default of owners Nil. 28 (B) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 16 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 18 (b) By Local Authority in default of owners Nil. (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:— (a) (1) Number of dwellings overcrowded at the end of the year 27 (2) Number of families dwelling therein 27 (3) Number of persons dwelling therein 210 (b) Number of new cases of overcrowding reported during the year Nil. 29 (c) (1) Number of cases of overcrowding relieved during the year 18 (2) Number of persons concerned in such cases 90 (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 Nil. Rent Restriction Acts. Three certificates were granted under the above heading during the year 1938. NEW HOUSES BUILT DURING 1938. I am indebted to the Borough Surveyor for the following information relating to new houses erected in Wood Green during 1938 :— Number of houses erected during 1938 9 Number of flats erected during 1938 10 Number of houses built by the Council Number built by other bodies and persons 19 PUBLIC MORTUARY. Bodies deposited during the year 37 Tnquests held 15 Post-mortem examinations 30 Causes of death :— Accidental 5 Natural causes 20 Infanticide 1 Suicide 9 For lodgement only 2 3U INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The greater part of the milk supply is in the hands of large firms and combines, who supply 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. 4 — 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 been necessary to refuse registration of one retailer as the premises were unsatisfactory. (6) 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. 31 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 109 610 324 Number inspected 109 610 324 All diseases except tuberculosis. Whole carcases condemned — Carcases of which some part or organ was condemned 12 23 — Percentage of the number inspected affected with disease other than tuberculosis 11% 4% Tuberculosis only. — Whole carcases condemned — Carcases of which some part or organ was condemned 7 6 Percentage of the number inspected affected with tuberculosis 6% — 2% Total weight of meat condemned—5 cwts. 16 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:— Corned beef 433 lbs. Jellied veal 510 lbs. Sardines 31 lbs. 974 lbs. Crabs (56) 1 barrel 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 1938:— ]Articles. No. of Samples taken. Adulterated. Milk 74 1 Milk, sterilised 31 2 Aspirin 2 1 Butter 6 — Camphorated Oil 1 — Confectionery 3 — Eucalyptus Oil 1 — Gin 1 — Hake 6 2 Lamb's liver 1 — Lemon sole 1 1 Sardines 1 — Sheep's liver 2 — Whisky 6 1 White Precipitate Ointment 3 2 Zinc ointment 1 — 140 10 Number of Prosecutions—1. Number of Convictions—Nil. Costs imposed—£1 1s. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Table VI in the Appendix sets out the details of the notifications of infectious disease received during the year. The total 32 33 number of cases notified was 279 an increase of 30 over the figure for the previous year. There was a small increase in the number of cases of scarlet fever and diphtheria, 92 and 63 as compared with 72 and 46 for the previous year. The number of cases removed to hospital or sanatorium was 232 as compared with 215 in 1937, and the total deaths from notifiable infectious disease was <50 as compared with 68 in 1937. The following table shows the number of cases of disease admitted to the .Joint Isolation Hospital from the various Wards in the Borough :— AlexandraBowes. Town Hall. Noel Park. Scarlet Fever 19 18 36 Diphtheria 17 21 22 Chicken-pox 1 — 1 Cerebro-Spinal Fever 1 — — Enteric Fever — 1 — Erysipelas 1 3 2 Measles 5 — 5 Totals 44 43 66 In addition 1 case of scarlet fever and 1 case of diphtheria were removed to other isolation hospitals. The distribution of scarlet fever and diphtheria over the year is shown below :— Scarlet Fever. Diphtheria. First quarter 22 11 Second quarter 25 16 Third quarter 22 14 Fourth quarter 23 22 92 63 34 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 56 31 Glendale County School 2 Trinity County School — Private Schools 1 1 Schools outside Borough 2 3 Under school age 19 15 Over school age 12 13 92 63 Scarlet Fever. 92 cases of scarlet fever were notified during the year as compared with 72 in 1937. The disease was evenly distributed throughout the year but the ward most affected was Noel Park in which almost half of the total number of cases occurred. 74 cases in all were admitted to hospital. The disease was for the most part of very mild type, and no deaths occurred. Diphtheria. 63 cases of diphtheria were notified as compared with 46 in 1937. All except one were admitted to hospital. The disease was of a moderately severe type, and two deaths occurred, both in children of 4 years. Immunisation against diphtheria has been carried out as in previous years, mostly in the infant departments of the elementary schools, but also among children under school age. The numbers immunised in 1938 are for several reasons rather less than in previous years. 462 children received full courses of protective 35 injections, the course consisting of three injections of ToxoidAntitoxin Mixture given at intervals of a fortnight, and a further 21 were undergoing a course at the end of the year. 358 children were Schick-tested during the year, and 261 were awaiting the Schick Test at the end of the year. The total number of children who have been immunised in Wood Green to the end of 1938 was 5,430 and of this number 17 are known to have since contracted diphtheria. In all these cases the attack has been very mild and all have made a good recovery. Cerebro-Spinal Fever. One case of this disease was notified. The patient was a healthy young adult who possibly contracted the disease abroad as he had just returned from a Continental holiday a few days before becoming ill. Ee was very gravely ill on admission to hospital but made an amazingly rapid and complete recovery, under treatment by one of the new sulphonamide preparations, which are proving of very great value in the treatment of many infectious conditions. Enteric Fever. One case of enteric fever was notified, a woman of 46 years. The patient was admitted to hospital and made a good recovery. Anterior Poliomyelitis. One case of this disease was notified, a man of 59 years. He was admitted to a general hospital outside the district. Puerperal Pyrexia. Eight cases of puerperal pyrexia were notified, four of whom were admitted to hospital. Recovery took place in every case. 36 Ophthalmia Neonatorum. Three cases of this disease were notified, two of whom were admitted to hospital. Recovery without impairment of yision occurred in each case. Pneumonia. There were 23 notifications of pneumonia. Notification of this disease has never been satisfactory, as may be seen from the fact that although there were only 23 cases notified there were 30 deaths certified as due to pneumonia. All notified cases are visited by the District Nurses, under an arrangement made with the District Nursing Association and an offer of home-nursing made. Erysipelas. Eighteen cases of erysipelas were notified, six of whom were admitted to hospital. Recovery took place in every case, erysipelas being one of the infections which respond very favourably to the use of the new sulphonamide preparations to which I have already referred. Non-Notifiable Infectious Diseases. The number of cases of non-notifiable infectious diseases reported to me during the year from the elementary schools was as follows :— Chicken-pox 145 Measles 440 Mumps 77 Whooping Cough 45 Skin Infections 5 702 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. 37 Prevention of Blindness. No action has been taken under Section 176 of the Public Health Act, 1936, for the prevention of blindness or for the treatment of persons suffering from any disease or injury to the eyes. 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 78, 67 respiratory and 11 nonrespiratory. Of this number 69 were notified by doctors practising in the district or from hospital, while 9 were transfers from other districts. The number of notifications received in 1937 was 67. The number of deaths certified as due to tuberculosis was 28, of which 21 were caused by respiratory and 7 by non-respiratory disease. In the previous year the corresponding figures were 24 and 2. The death rate for tuberculosis was 0.52 per 1,000 of population, as compared with 0.48 in 1937, and 0.95 in 1936. Of the 21 deaths certified as duo to respiratory tuberculosis 16 occurred in the age period between 20 and 45 years. Seven of these were in males and nine in females. Of the total of 28 deaths due to all forms of tuberculosis, six 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 46 Transfers from other districts (not included in above) 14 Total number of tubercular cases supervised at or from the Dispensary in 1938 217 New cases and contacts examined and found to be non-tubercular in 1938 88 Total number of tubercular cases still on the Register at the end of 1938 172 38 During the year 74 cases were sent to hospital or sanatorium. The institutions to which they were admitted are shown below:— Pulmonary cases. NonPulmonary cases. Brompton Hospital 1 — Clare Hall Sanatorium 7 — Eversfield Chest Hospital 4 — Fairlight Sanatorium, Hastings.. 2 — Harefield Sanatorium 28 — Kelling Sanatorium. Norfolk 1 — National Hospital, Benenden 1 — North Middlesex Hospital 18 — Royal Chest Hospital 1 — Royal National Hospital, Ventnor 2 — Royal National Sanatorium, Bournemouth 1 Royal Sea Bathing Hospital, Margate — 5 Royal Northern Hospital 1 — St. Peter's Hospital 1 — University College Hospital 1 — 69 5 Public Health (Prevention of Tuberculosis) Regulations, 1925. It has not been necessary to take any action under these regulations, which relate to persons suffering from pulmonary tuberculosis employed in the milk trade. Nor has any action been taken under Section 172 of the Public Health Act, 1936, which deals with the compulsory removal to hospital of persons suffering from tuberculosis. 39 Insulin. As for several years past, a supply of insulin has been provided free of charge for the use of necessitous patients residing in Wood Green. Two patients received in all 25,800 units at a cost of £6 8s. 11d. BACTERIOLOGICAL WORK. The bacteriological examination of specimens from the Borough is carried out at the Joint Isolation Hospital and during 1938 the following examinations were made :— Positive. Negative. Total. Diphtheria 88 342 430 Enteric Fever 1 1 2 Pulmonary Tuberculosis 9 96 105 Others — 3 3 98 442 540 DISINFECTION AND DISINFESTATION. The number of articles dealt with at the Disinfecting Station during the year was as follows:— Articles disinfected after tuberculosis 116 Articles disinfected after other infectious diseases, etc. 2,124 Articles disinfected after cancer 80 2,320 Articles disinfested of vermin 333 Articles dealt with for tenants moving into Council houses 405 738 3,058 40 Total number of articles destroyed 214 The number of rooms disinfected was as follows:— Rooms disinfected after tuberculosis 29 Rooms disinfected after other infectious diseases 205 Rooms disinfected after cancer 1 235 Rooms treated for vermin 148 38a The figures given above in connection with disinfection and disinfestation will show that this work involves the expenditure of a good deal of time and labour. The number of houses disinfested during the year was 67, 3 of these being Council houses and the others belonging to private owners. The results of the disinfestation of verminous houses have been generally satisfactory and it is very rare now for a house to require disinfestation a second time. The woodwork of the infested rooms, that is, the skirting boards, architraves and picture rails are removed by a carpenter and sprayed or painted with Cromessol B solution. The rooms are fumigated on three successive occasions at weekly intervals with sulphur dioxide. The preventive measures taken with the furniture of new tenants for Council houses have also been very successful. The furniture is removed from the old house in a special van in which it is fumigated by hydrocyanic acid gas. All cushions, bedding, 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 four years and have proved very satisfactory. 41 APPENDIX. Table I. Vital Statistics of Wood Green, 1921 -38. Year. Population estimated to middle of each year. Nett Births belonging to the District. Nett Deaths belonging to the District. Under 1 year of age. At all ages. Total No. Rate per 1,000 population . Illegitimate No. Total No. Rate per 1,000 live births. Illegitimate No. Rate per 1,000 illegitimate births. No. Rate per 1,000 population. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 1921 51,100 905 17.71 24 63 70 6 250 493 9.64 1922 51,290 873 17.02 26 41 47 4 154 524 10.21 1923 51,540 896 17.38 34 34 38 0 491 9.52 1924 51,840 762 14.7 15 32 42 3 200 513 9.89 1925 51,960 740 14.24 17 35 47 2 118 507 9.75 1920 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 1930 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 1938 53,190 652 12.3 17 25 38 1 59 540 10.1 42 Table II. Birth-Rate, Death-Rate and Analysis of Mortality during 1938. 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. Diarrhoea and Enteritis (under 2 years). Total Deaths under 1 year. England and Wales 15.1 11.6 0.00 0.00 0.04 0.01 0.03 0.07 0.11 5.5 53 126 County Boroughs and Great Towns (including London) 15.0 11.7 0.00 — 0.05 0.01 0.03 0.07 0.10 7.8 57 148 Smaller Towns (populalation, 25,000-50,000 at Census 1931) 15.4 11.0 0.00 0.00 0.03 0.01 0.02 0.06 0.11 3.6 51 London 13.4 11.4 0.00 — 0.06 0.01 0.03 0.05 0.06 13.1 57 Wood Green 12.3 10.1 — — 0.05 0.00 0.00 0.04 0.04 1.6 38 43 Table III. Causes of Death during the year 1938. Causes of Death. Male. Female. Typhoid and Paratyphoid Fevers Measles 1 2 Scarlet Fever — — Whooping Cough — — Diphtheria — 2 Influenza 2 — Encephalitis Lethargica — — Cerebro-Spinal Fever — — Tuberculosis of the Respiratory System 12 9 Other Tuberculous Diseases 3 4 Syphilis 2 — Oeneral Paralysis of the Insane, Tabes Dorsalis — 1 Cancer, Malignant Disease 41 51 Diabetes 2 8 Cerebral Haemorrhage, etc. 9 18 Heart Disease 74 102 Aneurysm — 2 Other Circulatory Diseases 12 20 Bronchitis 10 5 Pneumonia (all forms) 14 16 Other Respiratory Diseases 2 2 Peptic Ulcer 3 1 Diarrhoea, etc. (under 2 years) — I Appendicitis 2 4 Cirrhosis of Liver 1 — Other Diseases of Liver — 1 Other Digestive Diseases 3 1 Acute and Chronic Nephritis 5 7 Puerperal Sepsis — — Other Puerperal Causes — 2 Congenital Debility, Premature Birth, Malformation, etc. 6 8 Senility 2 3 Suicide 7 2 Other Violence 8 6 Other Defined Diseases 27 14 Causes ill-defined or unknown — — Totals 248 292 44 Table IV. Causes of, and Ages at Death during the year 1938. 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 5 years. 5 and under 15 years. 15 and under 25 years 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and over. Typhoid, etc. — — — — — — — — — — — — Measles 3 — — 1 2 — — — — — — — Scarlet Fever — — — — — — — — — — — — Whooping Cough — — — — — — — — — — — — Diphtheria 2 — — 2 — — — — — — — — Influenza — — — — — — — — — 1 1 Encephalitis Lethargica — — — — — — — — — — — — Cerebro-Spinal Fever — — — — — — — — — — — — Tuberculosis of the Respiratory System 21 — — — — 5 8 3 i 2 2 — Other Tuberculous Diseases 7 — — 3 1 2 — — — 1 — Syphilis — — — — — — — — — 1 — — General Paralysis of Insane 1 — — — — — — 1 — — — — Cancer, Malignant Disease 90 — — — — — 2 6 11 28 26 17 Diabetes 10 — — — — 1 — 2 4 3 Cerebral Haemorrhage, etc. 26 — — — — — — — 4 9 7 6 Heart Disease 172 — — — 1 1 7 4 7 24 44 84 Aneurysm 1 — — — — — — — — — 1 — Other Circulatory Diseases 30 1 5 11 13 Bronchitis 16 1 — — — — — — 1 5 1 8 Pneumonia (all forms) 35 5 2 2, 8, 2 7 8 7 Other Respiratory Diseases 4 — — — — — — — 2 — 1 1 Peptic Ulcer 4 — — — — 1 — — 1 1 1 — Diarrhoea (under 2 years) 1 1 — — — — — — — — — — Appendicitis 5— — — — — — — — — — 4 1 Cirrhosis of Liver 2 — — — — 1 — 1 — — — Other Diseases of Liver — — — — — — — — — — — — Other Digestive Diseases 2 — — — — — 1 — — — — 1 Acute and Chronic Nephritis 12 — — — — — 2 — 2 1 3 4 Puerperal Sepsis — — — — — — — — — — — — Other Puerperal Causes 2 — — — — — 1 1 — — — — Congenital Debility, etc. 14 14 — — — — — — — — — — Senility 7 — — — — — — — — — 1 6 Suicide 9 — — — — — — — — 3 — Other Violence 14 1 — — 2 2 1 1 1 2 3 1 Other Defined Diseases 47 3 — — 2 o 2 4 2 7 10 15 Causes ill-defined — — — — — — — — — — — — Totals 540 25 2 3 12 13 27 24 38 98 130 168 45 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 we-ks. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Total under 1 year. Atrophy — — — — — — 1 — — 1 Bronchitis — — 1 — 1 — — — — 1 Broncho-Pneumonia 1 2 — — 3 1 1 — — 5 Gastro-Enteritis — — — — — 1 — — — 1 Hydronephrosis — — — — — 1 — — — 1 Hydrocephalus — — — — — 1 — — — 1 Icterus Neonatorum 1 — — — 1 — — — — 1 Infanticide — — — — — 1 — — — 1 Marasmus — — — — — 1 — — — 1 Mastoiditis — — — — — — 1 — — 1 Peritonitis — — 1 — 1 — — — — 1 Premature Birth 8 1 — — 9 — — — — 9 Spinal Meningo Myelocele 1 — — — 1 — — — — 1 Totals .. 11 3 2 — 16 6 3 — — 25 46 Table VI Infectious Diseases Notified during the year 1938. Notifiable Disease. Cases Notified in Whole Borough. Total Cases Notified in each Ward. Total Cases removed to Hospital or Sanatorium. Total Deaths. At Ages—Years. AlexandraBowes. Town Hall. Noel Park. All Ages. Under 1 year. 1 to 5 years. 5 to 10 years. 10 to 15 years. 15 to 20 years. j20 to 25 years. 25 to 35 years. 35 to 45 years. 45 to 55 years. 55 to 65 years, 65 and upwards Scarlet Fever 92 1 18 49 11 3 2 5 1 0 _ 21 27 44 74 — Diphtheria 63 — 16 21 13 4 3 3 2 1 — 18 21 24 61 2 Cerebro-Spinal Fever 1 — — — — — 1 1 — 1 Enteric Fever 1 — — — — — — — — — — — — 1 1 Erysipelas 18 1 3 3 3 8 3 9 6 6 Ophthalmia Neonatorum 3 3 — — — _ 1 1 1 2 Pneumonia 23 — 2 6 1 1 2 3 2 1 2 3 9 7 7 8 30 Acute Poliomyelitis 1 — — — — — — — — — 1 — — — 1 1 — Puerperal Pyrexia 8 — — — — 1 2 2 3 5 2 1 4 Pulmonary Tuberculosis 59 — 1 1 — 4 11 16 11 8 6 1 13 20 26 69 21 Non-Pulmonary culosis 10 — — 3 2 1 2 1 — 1 — — 3 2 5 5 7 Totals 279 4 37 80 27 14 24 30 22 17 12 12 74 90 115 232 60 47 Table VII. TUBERCULOSIS. New Cases and Mortality during 1938. Age Periods. New Cases. Deaths. Respiratory. Nonrespiratory. Respiratory. Nonrespiratory. M. F. m. F. M. F. M. F. 0 — — — — — — — — 1 1 — — — — — — — 5 — 1 1 2 — — — — 10 — — 3 — — — 2 1 15 4 — 1 — — — — — 20 6 7 1 1 4 1 1 — 25 11 10 1 — 2 6 — 2 35 7 5 — — 1 2 — — 45 6 2 — 1 1 — — — 55 6 — — — 2 — — — 65 and upwards 1 — — — 2 — — 1 Totals 42 25 7 4 12 9 3 4 Above includes transfers (9) from other Districts. 6 non-notified T.B. deaths occurred. 48 METEOROLOGICAL REPORT FOR YEAR ENDING 31st DECEMBER, 1938. Month. Total Rainfall. Maximum Rainfall. No. of Wet Days. Maximum Temperature. Minimum Temperature. 1938. Inches. Inches. Date. Degrees. Date. Degrees. Date. January 2.49 0.37 16th 21 54 12th, 13th, 16th, 24th 31 2nd February 0.15 0.04 17th 6 55 25th, 26th 28 24th March 0.31 0.13 25th 3 67 20th 32 7th, 12th, 13th April 0.02 0.02 2nd 1 66 1st 32 17th May 0.82 0.57 28th 11 77 14th 37 8th June 0.26 0.14 3rd 6 78 19th, 21st 41 2nd July 0.90 0.32 28th 11 83 30th 46 1st August 1.08 0.26 7th 8 83 3rd, 4th 41 31st September 1.65 0.67 27th 10 78 13th, 24th 40 15th October 2.59 0.68 3rd 14 64 9th 31 23rd November 3.49 1.20 25th 14 69 5th 29 26th December 3.07 0.82 16th 15 56 5th 20 20th Total for year 16.83 — — 120 — — — — Note.—Maximum Rainfall 1.2ins., 25th November. ,, Rate of Rainfal 1.92ins. per hour; duration 10 mins., 27th July. ,, Temperature 83° Fahr., 30th July and 3rd and 4th August. Minimum Temperature 20° Fahr., 20th December. 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. Councillor Mrs. J. Cole. Councillor W. G. Doyle. Councillor D. C. Leech, B.A. Councillor F. F. Tomlin. Councillor W. A. Vant. Councillor T. A. Warburton. Councillor J. H. Yeats. Mr. H. J. Garlick, B.Sc. Mrs. H. S. Harrison. Mr. B. Jerwood. Rev. F. Jones. Miss C. M. Lightfoot. Mrs. M. V. Mackie. Rev. G. Mason. Mrs. F. Waymark. CARE AND AFTER CARE SUB-COMMITTEE. Chairman: Alderman Mrs. J. J. Bolster, J.P. Councillor Mrs. J. Cole. Councillor T. A. Warburton. Mrs. H. S. Harrison. Miss C. M. Lightfoot. Mrs. M. V. Mackie. Mrs. F. Waymark. Mrs. E. Agombar. Mrs. A. Barrett. Mrs. E. L. Corbett. Miss J. Irvine. Mrs. E. M. Jackson. Mrs. E. C. Waghorne. (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, 1938. Ashbbrton House, 298, High Road, Wood Green, N.22. 13th May, 1939. To the Chairman and Members of the Wood Green Education Committee, Mr. Chairman, Ladies and Gentlemen, I beg to present to you my Annual Report as School Medical Officer for the year 1938. The health of the children generally has remained good during the year and the incidence of infectious disease has again been low. I.—STAFF. The School Medical Staff during 1938 was as follows:— School Medical Officer.—Malcolm Manson, M.C., 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.— F. P. M. Clarke, B.Sc., B.A., L.R.C.P.E., L.R.C.S.E., L.R.F.P.S.G. Dental Surgeons.—G. S. Williams, L.D.S.; D. W. MacBean, L.D.S. School Nurses.—Miss B. M. Gray, S.R.N., C.M.B.; Miss N. Gardner, S.R.N., C.M.B. 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 (resigned 31.7.38). 3 II.—CO-ORDINATION. Co-ordination between the School Medical Service and other health services provided by the Council is secured by the fact that the medical and dental officers engaged in the school medical work also serve the Maternity and Child Welfare Committee in looking after children under school age. III.—SCHOOL HYGIENE. Mr. Matthews, the Borough Surveyor, informs me that with the exception of a lavatory added to Lordship Lane Infants' Department, no work of any note has been completed in any of the Council's Schools during 1938. A commencement was made during the year with the erection of the new White Hart Lane School which will shortly be completed. Cloakroom additions have also been commenced at the Domestic Centre in White Hart Lane, and alterations to convert an old building at White Hart Lane into a new Dining Centre. Extensive alterations were also commenced at Bounds Green School at the end of the year. IV.—MEDICAL INSPECTION. The age groups of the children inspected have been as in former years, those specified by the Board of Education, viz.: (a) Entrants; (b) children of eight years; and (c) children of twelve years or over. There have also been special inspections of children referred by head teachers or school nurses or brought for examination by parents or guardians. In addition, all physically or mentally defective children have been examined at regular intervals, as well as all children who are supplied with meals at the feeding centre or with milk or malt and oil, and, finally, all children found at the routine inspections throughout the year to show defects have been re-examined at the end of the year. The following table gives a summary of the medical inspections carried out during the year. 4 A. Routine Medical Inspections:— Entrants 573 Second Age Group 587 Third Age Group 481 Total 1,641 Other Routine Inspections 482 Grand Total 2,123 B. Other Inspections:— Special Inspections 941 Re-inspections 2,327 The total number of children on the registers of the elementary schools on December 31st,.1938, was 5,224. The number examined by the School Medical Officers during the year was 3,064. V.—FINDINGS OF MEDICAL INSPECTION. Full details of the medical inspections, the defects found and the number for which treatment was provided are shown in the statistical tables at the end of this Report. Table 1c shows the number of children found at the routine inspections to require treatment. This number is again very small, due in very large fact to the close co-operation between the schools and the school medical services, which ensures that defects in children are brought to our notice in a large number of cases at a very early stage, so that treatment may be arranged and provided weeks or months before the children concerned are due for routine medical inspection. In this way the number of defects requiring treatment, which are 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 inspected in these groups the nutrition in 25.11 per cent. 5 was said to be excellent, in 62.88 normal, in 11.59 slightly subnormal, and in 0.42 bad. If columns A and 15 are taken together and columns C and 1), it will be seen that in 87.99 per cent. of the children the nutrition was either excellent or normal, while in 12.01 per cent. it was either sub-normal or bad. The corresponding figures for the previous year were 87.35 and 12.64. These figures are on the whole satisfactory, and show that there is no evidence of very serious malnutrition among the elementary school population, but there is still obvious room for improvement. If the figures for the different age-groups are examined separately it will be seen that as in previous years, those for the first two groups, the entrants and the eight-year-old children are not so good as those for the third age-group, the twelve-year-old children or the "other routine inspections," many of whom are children of thirteen or fourteen years. The nutrition of the children leaving school is very definitely better than that of children in their early years at school. Every opportunity is taken by the School Medical Officers of advising parents or guardians as to the care and nutrition of their children, the advice given relating not only to the actual food supplied, but to feeding habits, insufficient sleep, discipline in the home, and all other factors involved in the question of nutrition. Where poverty in the home is a cause of malnutrition, help is given by the provision of free milk in school, free dinners at the centre, or provision of cod-liver oil. In many cases help is given by sending the child to a convalescent home. A factor of very great importance to the nutrition of the school children is the advantage taken of the daily supply of milk at halfprice by the Milk Marketing Board. I am glad to say that an increasing number of children avail themselves of this provision, and at the end of the year the number being supplied regularly with milk at school was more than two-thirds of the number on the registers of all the elementary schools. In addition, about 250 children are supplied with free milk throughout the year on medical grounds. It is obvious that the milk-drinking habit is becoming strongly established among the school children and I am very grateful to the head teachers and staffs of the schools generally for the 6 support they have given to the scheme for providing milk in school, and for the willingness with which they have carried out all the extra work which it involves. It is safe to say that without their support and encouragement the scheme could make very little headway. (b) Cleanliness. The standard of cleanliness among the school children remains very high, as will be seen from the fact that although 32,340 individual examinations of children for cleanliness: were made by the school nurses during the year, the number of children excluded from school on account of uncleanliness was only 80. (c) Minor Ailments and Diseases of the Skin. Seventy 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. Eighty-four children were recommended for treatment on account of defective vision or squint, while 229 children suffering from minor defects of vision were kept under observation. Seven children were found to require treatment for external diseases of the eye, and twenty-six were kept under observation. {e) Nose and Throat Defects. Twenty-nine children were recommended for operative treatment for enlarged tonsils and adenoids and 155 were referred for observation. Thirty-one children were found to be suffering from other conditions of the throat and nose for which treatment was required, and four others were referred for observation. (f) Ear Disease and Defective Hearing. Four children were recommended for treatment on account of deafness, and two were referred for observation. Twenty-nine 7 children were found with other forms of ear disease requiring treatment and five others were referred for observation. (g) Dental Defects. The results of the inspections carried out by the School Dental Surgeon are set out in Table V. 3,787 children in all were inspected during the year, and of this number 2,803 were found to be in need of dental treatment. The actual number treated at the Dental Clinic was 2,176. (h) Orthopædic and Postural Defects. Fifteen children were classified as cripples, ten of whom were cases of non-pulmonary tuberculosis, for the most part quiescent or cured. All fifteen were under treatment or observation at home or at hospital during the year. (i) Heart Disease and Rheumatism, Evidence of heart disease was found in thirty-five children. In eleven of these cases the child was suffering from organic disease of the heart and in the majority of these cases the disease was rheumatic in origin. In addition to these heart cases a further twelve children were seen during the year suffering from definite rheumatism. All children suffering from rheumatism or from heart disease are kept under regular observation at the School Clinic, and when institutional treatment is indicated, assistance is given in finding the necessary accommodation. (j) Tuberculosis. Five cases of pulmonary tuberculosis were seen in school children during the year. Two of these received sanatorium treatment. Ten cases of non-pulmonary tuberculosis were found in school children. Of these, two were active and had institutional treatment, two were at certified special schools, 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 and a request made that the necessary 8 treatment be obtained as soon as possible. Later, the Visitation Officer visits the homes, and continues to visit at intervals until the treatment recommended has been provided. The number of visits paid during the year in following up defects found has been 1,970. VI1.—ARRANGEMENTS FOR TREATMENT. These arrangements have remained as in former years. Whereever possible parents are expected to obtain treatment for their children privately from the family doctor or at hospital. Where family circumstances make this impossible, 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 can be dealt with at the Prince of Wales, the Royal Northern or the North Middlesex Hospital: ultraviolet light treatment may be obtained at the North Middlesex or the Royal Northern Hospital, and X-ray treatment for ringworm at the Royal Northern Hospital. (a) Minor Ailments. Nine hundred and ninety-six 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 eyes, ears or nose, and other like conditions which tend to receive insufficient attention at home, but may, if neglected, be injurious to the child's health. (b) Tonsils and Adenoids. Five children were operated on during the year, under the Committee's scheme, for enlarged tonsils and adenoids, while twenty-six were dealt with privately by their own doctors or in hospital. The children dealt with under the Committee's scheme are admitted to the Prince of Wales, Royal Northern or North Middlesex Hospital for a minimum of two nights, being admitted the day previous to, and discharged not sooner than the day after the operation. They 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 738, 240 of whom were new cases. 335 children had 9 spectacles prescribed for them at the Clinic, and all of these except four had obtained the spectacles by the end of the year. A further eleven children were fitted with spectacles privately or at hospital. (d) Ear Disease and Defective Hearing. The work of the Ear Clinic at White Hart Lane has been carried out during the year by Dr. Clarke who has followed generally the same methods of treatment which met with such success in the hands of his predecessor, Dr. Friel. Zinc ionisation was used with good effect in practically all the cases of chronic discharging ears treated. Diastolisation was used in a large number of children with nasal affections, many of them complicating ear conditions, while in several cases of infected nasal sinuses the Praetz method of displacement was successfully employed. The tables following page 32, which have been prepared by Dr. Clarke, give a very detailed record of all the children treated by him during the year with full information as to complications, treatment and results of treatment. The total number of school children attending the Ear Clinic during 1938 was 161. (e) Dental Defects. The work done by the School Dental Surgeon is shown in detail in Table V. The scheme of dental inspection covers practically the whole elementary school population, but it is not possible with one dental officer and one dental surgery to inspect every child every year and provide the necessary treatment for all who accept the offer of treatment. Under these circumstances the policy followed is to concentrate, as far as possible, on conservative treatment and to discourage the casual cases which wish to attend only when in pain or discomfort. The ratio of fillings to extractions in permanent teeth remains high, 2,794 fillings to 707 extractions. In temporary teeth very few fillings have been done, and many extractions. (f) Defects of Speech. The Speech Defect Clinic has been held twice weekly throughout the year. There are two classes, one for children of twelve years and over, and the other for children under twelve. Each 10 class is limited to eight children so that the total number of children dealt with is small, and each child receives individual attention. The chief defect treated is stammering but treatment is also given for other defects such as cleft-palate speech and defective articulation. Progress in most cases tends to be slow, but the results obtained are generally very good and fully justify the expenditure of time and money on this type of defect. VIII.—INFECTIOUS DISEASES. The number of cases of infectious diseases notified from the elementary schools in 1938 was 800. This is a considerable increase on the figure for 1937 which was 519, while in 1936 the number was 889. The following table gives the numbers of cases of the different infections notified from the elementary schools in 1938, 1937 and 1936. 1938 1937 1936 Scarlet Fever 56 41 39 Diphtheria 32 24 62 Chicken-pox 145 25 188 Measles 440 99 393 Mumps 77 172 39 Whooping Cough 45 146 141 Skin Infections 5 12 27 Total 800 519 889 The most prevalent infection in 1938 was measles, -140 cases as against 99 in 1937. Chicken-pox was also very prevalent, 145 cases as against 25 in the previous year. On the other hand both mumps and whooping cough were much less prevalent, 77 and 45 cases respectively as compared with 172 and 146 for 1937. The incidence of both scarlet fever and diphtheria was again low, only 56 cases of the former and 32 of the latter occurring among the elementary school children. 11 The incidence of scarlet fever and diphtheria during 1938 is shown in the following table:— School. Scarlet Fever. Diphtheria. Alexandra Boys 2 — ,, Girls 2 — ,, Infants 4 2 Bounds Green Boys — 5 ,, ,, Girls 3 2 ,, ,, Infants 9 2 Lordship Lane Boys 1 — ,, ,, Girls — 3 ,, ,, Infants 5 5 Noel Park Boys 2 2 ,, ,, Girls 2 1 ,, ,, Infants 12 — Rhodes Avenue 2 — St. Michael's Mixed 1 1 ,, Infants 5 1 St. Paul's — — White Hart Lane Boys — 2 „ „ „ Girls 1 — ,, ,, ,, Infants 5 5 Glendale County 2 — Trinity County — — Private Schools 1 1 Schools outside Borough 2 3 Under School Age 19 15 Over School Age 12 13 Totals 92 63 1st Quarter 22 11 2nd „ 25 16 3rd „ 22 14 4th „ 23 22 92 63 12 It will be seen that both the scarlet fever and the diphtheria cases were distributed fairly evenly throughout the year, and through all the schools, the highest number of cases of scarlet fever occurring in any one school department being twelve in Noel Park Infants', while no department had more than five cases of diphtheria. Four departments were free from scarlet fever and seven from diphtheria, while one school, St. Paul's, was entirely free throughout the year from both infections. Immunisation against diphtheria 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 number immunised during 1938 was not so good as in previous years, 462 receiving a full course of protective injections, while a further 24 were undergoing a course at the end of the year. 358 were Schicktested during the year, 157 of these being children who had been immunised in 1937. 261 children who had received 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. During the summer months, however, a certain amount of use is made of the playgrounds for open-air classes. Rounds Green Girls' School carried out a school journey to Ryde, in the Isle of Wight, for a fortnight in May, in which 27 children and 2 teachers took part. There was also the usual school camp in August at New Romney, arranged by the Juvenile Organisations Committee for a selected number of boys and girls from the elementary schools. The number of children sent was 163, 82 boys and 81 girls. These children, as in previous years, were for the most part selected by the Juvenile Organisations Committee with the help of the head teachers, the selection being made on economic grounds, but a certain number were recommended by the School Medical Officers on medical grounds. The children were medically examined, weighed and 13 measured before going to camp, and weighed and measured again on their return. The benefit resulting from a fortnight's holiday under excellent conditions was, as in former years, very striking in the great majority of the children. This annual holiday provided free of charge to a large number of children who for the most part have no other chance of getting such a holiday, is undoubtedly a very valuable contribution to the health and well-being of these children. As in former years a number of children were sent for limited periods, usually of six weeks, to residential open-air schools. These are usually poorly nourished or debilitated children, sometimes recovering from serious illness. Seven boys and seven girls were sent to the Russell Cotes School of Recovery, at Parkstone, Dorset, four boys and four girls to Collington Manor, Bexhill. In addition to these, twenty-four boys and twenty 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 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. Very good use was made of the facilities provided by the Wood Green Council at the various swimming pools. At the Western Road Baths the attendances made by school children during the year numbered 40,620, at the Open-Air Bath on the Alexandra Park Race Course 2,135, and at the Swimming Pool in Durnsford Road 14,272. The number of school children gaining certificates of proficiency in swimming from the Wood Green Schools' Sports Association during the year was 1,672. This number included 164 certificates for swimming 880 yards. 14 XI.—PROVISION OF MEALS. The Feeding Centre in White Hart Lane was open throughout the year, providing a hot mid-day meal to a large number of the less fortunate of the school children. These children are, for the most part, selected on economic grounds and are usually recommended by the teachers in the schools, but they are all approved in the first instance by the School Medical Officer and seen by him at regular intervals. The Feeding Centre is administered by the Director of Education, but responsibility for the food being wholesome and nutritious rests with the School Medical Officer. The dinners supplied are, in my opinion, good both as regards quantity and quality, and the use of a menu covering a period of three weeks ensures variety in the meals provided. 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 169, and of this number 136 were fed free, 30 for part payment and 3 for full payment. The total number of meals provided was 19,954, and of these 16,455 were provided free, 3,481 for part payment and 18 for full payment. The average cost per meal was 5.18 pence, of which 2.53 pence represented the actual cost of food, and 2.65 pence the cost of administration. In addition to the meals served at the Feeding Centre, 4,189 meals were provided at the School for the Partially Sighted, in Lordship Lane, for the children attending there. Of these, 2,328 were given free, 201 for part payment and 1,660 for full payment. These meals are cooked at the Feeding Centre. Apart from this provision of meals, an average of 240 children were provided with milk at school free of cost daily throughout the year, 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 Officers. XII.—CO-OPERATION. (a) Of Parents. The parents are usually interested in the school medical examinations, and fifty-eight per cent. of the children examined at 15 the routine inspections were accompanied by parents or guardians. At the entrants' examination 90 per cent. of the parents attended, at the intermediates 75 per cent., and at the leavers 33 per cent. The great majority of the parents are interested to receive any advice given about their children's health, and ready to act on it, and the success of the school medical work depends largely on the active co-operation of the parents. (b) Of Teachers. We have always been able in Wood Green to count on the ready and willing co-operation of the teachers in the schools in the school medical work. The frequent inspections carried out by medical officers, dental officer and school nurses made many demands on the time and work of the teachers and especially of the head teachers; and I am always glad to have this opportunity of thanking them all for their assistance. Have also to thank the School Welfare Officer for his assistance in bringing to our attention 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 already referred 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. To the Tottenham Deanery Council for Moral Welfare we have been indebted as in former years 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 troublesome cases where parents have been neglectful to obtain necessary treatment for their children. The services of both these officers are readily available at all times, and I am very grateful to them for their assistance. 16 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 medical records of all children reaching school-leaving 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 for her to benefit by instruction in an ordinary elementary school. This child has been 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 in attendance at the end of the year was twenty-eight. Of these, sixteen belonged to Tottenham, four each to Finchley and Edmonton, two to Middlesex, and one each to Hornsey and Wood Green. A mid-day meal is provided at the school for children unable to go home. 17 (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. Thirteen mentally defective children from Wood Green attend the Joint Special School for Mental Defectives at Finchley. Some of these are high-grade defectives who may be expected to do well, and I am glad to say that many of the children who have attended this school in the past have derived so much benefit from 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 mentally defective child was at a residential institution, four were attending ordinary elementary schools, and three were not at 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 here are medically inspected twice a year and treatment for dental defects and minor ailments is provided at the School Clinic. (d) Epileptics. Four children suffering from epilepsy were in attendance at ordinary schools. Three of these were very mild cases, the fourth was of steadily increasing severity, and at the end of the year she was 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. While these do not take the place of a Nursery School, they do meet a definite need in providing a healthy environment during the day for young children whose home circumstances are not too satisfactory. 18 XV.—SECONDARY SCHOOLS. By arrangement between the Middlesex County and Wood Green Education Committees, the routine and special 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. During the year, seven hundred and six secondary pupils were medically inspected, two hundred and ten received dental treatment, and ninety-eight had spectacles prescribed. XVI.—PARENTS' PAYMENTS. No change has been made in the arrangements previously in operation whereby parents make payments for certain forms of treatment provided. Where the circumstances of the parents make it difficult or impossible for them to meet these charges, the case is reported to the Care Committee and the sum charged reduced or waived. XVII.—SCHOOL CLINIC. In my Annual Report a year ago I was rash enough to express my pleasure at the prospect of a new School Clinic being provided in the very near future, and I expected that it would be in occupation before the end of 1938. Unfortunately my hopes have not been fulfilled and no appreciable progress appears to have been made with the project although the plans were approved by the Board of Education almost a year ago. It is very much to be hoped that a commencement will soon be made in providing this much-needed improvement. In conclusion I would like again to express my appreciation of the support and encouragement which the Education Committee has at all times given to the work of the School Medical StaS. I 19 wish also to thank the Director of Education and his staff for assistance which is always readily given, and finally all the members 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, 1938. TABLE I.—RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Age. Entrants. 3 4 5 6 Other Ages. Total. Boys — 19 189 72 30 310 Girls — 28 134 76 25 263 Totals — 47 323 148 55 573 Age. Second Age Group (Intermediates). 8 Other Ages. Total. Boys 219 50 269 Girls 248 70 318 Totals 467 120 587 Third Age Group (Leavers). Age. 12 13 14 Other Ages. Total. Boys 194 52 3 1 250 Girls 203 28 — — 231 Totals 397 80 3 1 481 21  Number of Other Routine Inspections. Varied Ages. Total. Boys 239 239 Girls 243 243 482 482 Grand Total. Entrants Second Age Group. Third Age Group. Other Routine Inspections. Total. Boys 310 269 250 239 1068 Girls 263 318 231 243 1055 Totals 573 587 481 482 2123 B.—OTHER INSPECTIONS. No. of Special Inspections. No. of Re-Inspections. Boys 481 1103 Girls 457 1224 Totals 941 2327 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 11a. Total. Entrants 1 36 37 Second Age Group 29 26 55 Third Age Group 30 14 44 Total (Prescribed Groups) 60 76 136 Other Routine Inspections 17 13 30 Grand Total 77 89 166 22 TABLE II. A.—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DEC., 1938. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Skin Ringworm— (1) Scalp ... ... 1 1 (2) Body ... ... 2 ... (3) Scabies 2 ... 17 ... (4) Impetigo 2 ... 3 ... (5) Other Diseases (non-Tuberculous) 4 2 3 ... TOTAL (Heads 1 to 5) 8 2 26 1 Eye (6) Blepharitis 2 4 1 ... (7) Conjunctivitis ... ... 2 ... (8) Keratitis ... ... ... ... (9) Corneal Opacities ... ... ... ... (10) Other Conditions (excluding Defective Vision and Squint) ... 21 2 1 TOTAL (Heads 6 to 10) 2 25 5 1 (11) Defective Vision (excluding Squint) 77 217 3 ... (12) Squint 4 12 ... ... Ear (13) Defective Hearing 1 2 3 ... (14) Otitis Media 4 1 3 ... (15) Other Ear Diseases 9 1 13 3 Nose and Throat. (16) Chronic Tonsillitis only 14 128 13 22 (17) Adenoids only ... 1 2 ... (18) Chronic Tonsillitis and Adenoids ... 4 ... ... (19) Other Conditions 16 3 15 1 (20) Enlarged Cervical Glands (NonTuberculous) 1 14 1 5 Total carried forward 136 410 84 33 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. Kequiring Treatment. Requiring to be kept under observation, but not requiring Treatment (1) (2) (3) (4) (5) Total brought forward 136 410 84 33 (21) Defective Speech 3 6 6 1 Heart and Circulation. ' H eart Disease— (22) Organic 2 6 1 2 | (23) Functional ... 23 1 1(24) Anaemia 3 6 1 Lungs 25) Bronchitis 2 8 ... 2 26) Other Non-Tuberculous Diseases ... 6 1 ... Tuberculosis 'Pulmonary— (27) Definite ... 1 3 (28) Suspected . ... ... ... 1 N on -Pulmonary— (29) Glands ... 1 1 (30) Bones and Joints ... 2 1 (31) Skin... ... ... ... ... (32) Other Forms ... ... ... ... TOTAL (Heads 29 to 32) ... 3 1 1 N ervous System. (33) Epilepsy ... ... ... 1 (34) Chorea 1 i 1 1 (35) Other Conditions ... ... ... ... Deformities. (36) Rickets ... 1 ... ... (37) Spinal Curvatuie ... 3 ... 1 (38) Other Forms 8 8 3 2 (39) Other Defects & Diseases (excluding Defects of Nutrition, Uncleanliness and Dental Diseases) 14 24 56 17 TOTAL 169 506 154 66 24 B.—Classification of the Nutrition of Children Inspected During the Year in the Routine Age Groups. Age Groups Number of Children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. 0/ /o No. °/ /o No. 0/ /o No. % Entrants 573 118 20.59 377 65.79 76 13.26 2 0.35 Second Age Group 587 108 18.4 386 65.76 88 15.0 5 0.85 Third Age Group 481 157 32.64 282 58.63 41 8.52 1 0.21 Other Routine Inspections 482 150 31.12 290 60.17 41 8.51 1 0.21 Total 2123 533 25.11 1335 62.88 246 11.59 9 0.42 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 for the Partially Sighted. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 1 — 1 — 2 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 4 — — — 4 PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — — — — — — MENTALLY DEFECTIVE CHILDREN. Feeble-Minded Children. (a) At Certified Schools for Mentally Defective Children. (b) At Public Elementary Schools. (c) At Other Institutions. (d) At no School or Institution. Total. 13 3 1 3 20 26 EPILEPTIC CHILDREN. Children Suffering From Severe Epilepsy. (a) At Certified Special Schools. (b) At Public Elementary Schools. (c) At Other Institutions. (d) At no School or Institution. Total. — 4 — — 4 PHYSICALLY DEFECTIVE CHILDREN. A.—Tuberculous Children. 1.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoraoic glands.) (a) At Certified Special Schools. (b) At Public Elementary Schools. («) At Other Institutions. (d) At no School or Institution. Total. — 1 2 2 5 II.—Children Suffering from Non-Pulmonary Tuberculosis. (a) At Certified Special Schools. (b) At Publio Elementary Schools. (c) At . Other Institutions. (d) At no School or Institution. Total. 2 6 2 — 10 B.—Delicate Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 3 31 — — 34 27 C.—Crippled Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 1 1 — 1 3 D.—Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. —- 7 — 1 8 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 ace Table VI.) Disease or Defect. (1) Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin— Ringworm—Scalp— (i) X-Ray Treatment .. — — — (ii) Other Treatment 1 — 1 Ringworm—Bod\r 4 — 4 Scabies 15 — 15 Impetigo 44 1 45 Other skin disease 13 — 13 Minor Eye Defects (external and other, but excluding cases falling in Group II) 63 63 Minor Ear Defects 136 3 139 Miscellaneous {e.g., minor injuries, bruises, sores, chilblains, etc.) 720 30 750 Total 996 34 1,030 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) 669 15 684 Other defect or disease of the eyes (excluding those recorded in Group I) 69 7 76 Total 738 22 760 Under the Authority's Scheme. Otherwise. Total. No. of children for whom spectacles were (a) Prescribed 335 11 346 (6) Obtained 331 11 342 29 Group III.—Treatment op Depeots op Nose and Throat. Number op Depeots. 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 PractitionerorHospital, apart from the Authority's Scheme. (2) Total. (3) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 65 96 5 — — 26 — 31 (i) Tonsils only, (ii) Adenoids onlv. (iii) Tonsils and Adenoids. (iv) Other defects of the nose and throat. Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme (1) Otherwise (2) Residential treatment with education. Residential treatment without education, Non-residential treat- ment at an orthopaedic clinic. Residential treatment with education. Residential t eatment without education. Non-residential treat- ment at an orthopaedic clinic. Total number Treated. (i) (ii) (iii) (i) (ii) (iii) Number of children treated.. 2 — — — — — 2 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 TOTAL Number 11 150 343 391 371 (89 390 1 344 345!293 215 10 3,252 (6) Specials .. 535 (e) Total (Routine and Specials) 3,787 (2) Number found to require treatment 2,803 (3) Number actually treated 2,176 (4) Attendances made by children for treatment 4.461 (5) Half-days devoted to :— Inspection 23 (7) Extractions:— Permanent Teeth 707 Treatment 390 Temporary Teeth 1,944 Total 413 Total .. 2,651 (8) Administrations of gene anaesthetics for extractio ral ns 915 (6) Fillings:— Permanent Teeth 2,794 (9) Other Operations:— Permanent Teeth 499 Temporary Teeth 12 Temporary Teeth 395 Total 2,806 Total .. 894 TABLE VI.—UNCLEANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 9 (ii) Total number of examinations of children in the Schools by School Nurses 32,340 (iii) Number of individual children found unclean 80 (iv) Number of individual children cleansed under arrangements made by the Local Education Authority — (v) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 (6) Under School Attendance Byelaws .. — 31 STATEMENT of the Number of Children Notified During the Year ended 31st December, 1938, by the Local Education Authority to the Local Mental Deficiency Authority. Total Number of Children Notified, 10. ANALYSIS OF THE ABOVE TOTAL. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots — (b) Imbeciles — (c) Others 5 4 (ii) Children unable to be instructed in a Special School without detriment to the interests of other children : (a) Moral defectives .. — (6) Others 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 — 1 3. Feeble-minded children notified under Article 3, i.e., * 'special circumstances" cases — — 4. Children who, in addition to being mentally defective, were blind or deaf — — Grand Total 5 5 32 TABLE A. ACUTE OTITIS MEDIA, (i) CHILDREN OVER 5. Diagnosis. Total (Ears) Tonsils and Adenoids. Treatment. Result. Zinc Ionisation. Antiseptio Treatment. I Tonsils and Adenoids Conservative: Nasal: Diastolisation. Tonsils and Adenoids Operation. Cured. Improved. Still under Treatment or Observation. Left or Treatment Lapsed. Referred to Hospital for Operation. Declined Treatment. A B C D E F G H I J K L Acute Non-Suppurative Otitis Media 7 — Operation before Clinic – – – – – – – – – – 7 No Operation — 7 — — 6 — 1 — — — Acute Non-Suppurative Otitis Media with Nasal Conditions: Enlarged Tonsils and Adenoids 4 — Operation before Clinic – – – – – – – – – – 4 No Operation — 4 4 — 4 Acute Suppurative Otitis Media 4 — Operation before Clinic – – – – – – – – – – 4 No Operation — 4 — – 4 — – – – – Acute Suppurative Otitis Media with Nasal Conditions: Enlarged Tonsils and Adenoids 16 6 Operation before Clinic — 6 — 5 — 1 — — 10 No Operation — 10 6 7 — 1 1 1 — Totals 31 31 — 31 10 — 26 — 3 1 1 — (ii) CHILDREN UNDER 5. A B C D E F G H I J K L Acute Non-Suppurative Otitis Media 2 — Operation before Clinic – – – – – – – – – – 2 No Operation — 1 — 1 1 1 — — Acute Suppurative Otitis Media 7 • — Operation before Clinic – – – – – – – – – – 7 No Operation — 7 — 7 — — — — Acute Suppurative Otitis Media with Nasal Conditions: Enlarged Tonsils and Adenoids 3 1 Operation before Clinic — 1 — — 1 — — — 2 No Operation — 2 — — 1 — 1 — — Totals 12 12 — 11 — 1 10 — 1 1 — — table b . chronic suppurative otitis media. Diagnosis. Totals. (Ears) Diagnosis. Tonsils and Adenoids. Treatment. Result. (Children over 5.) Chronic Tympanic Sepsis Complicated by:— Granulations: Simple Polypi. Mastoid Disease. Enlarged Tonsils and Adenoids. Nasal Catarrh: j Rhinitis: Sinusitis. External Otitis: Eczema. Primary (Ear) Collateral (Nose and Throat) Cured. Improved. Still under Treatment or Observation. Left or Lapsed Treatment. Referred to Hospital for Operation. Declined Treatment. Old Operation. No Operation. Zinc Ionisation. Antiseptic Treatment or Cautery. Tonsils and Adenoids Conservative: Nasal: Diastolisation. Tonsils and Adenoids Operation. A B C D E F G H I J K L M N O A Granulations: Simple Polypi 5 2 — — — — Operation before Clinic 2 i — – 1 1 – – 1 — — 1 1 — No Operation 3 3 2 2 1 – 3 – – B Mastoid Disease 6 — 4 — — - — Operation before Clinic 2 1 – 2 1 1 – – — 2 — — — — No Operation 2 1 – 1 1 – – C Enlarged Tonsils and Adenoids 6 – – – – – Operation before Clinic – – – – – – – – – – — — — 4 2 — No Operation 2 4 3 – 3 3 – – D Nasal Catarrh: Rhinitis or Sinusitis 7 — 1 — — 2 — Operation before Clinic 1 1 3 – 2 1 1 – – — 1 — — 3 — No Operation 1 2 4 – 3 – – E External Otitis: Eczema 1 – 1 Operation before Clinic — 1 — – 1 –– – – – – – –— No Operation – – – – – – – – – Totals 25 3 8 — 5 8 1 14 15 13 — 16 2 3 4 –— — Chronic Suppurative Otitis Media solely (Tympanic Sepsis only) 14* Children over 5 years 8 Operation before Clinic 8 1 2 — — 7 — 1 — — — 6 No Operation 2 4 — 1 4 2 Chronic Suppurative Otitis Media solely (Tympanic Sepsis only) 2 Children under 5 years — Operation before Clinic – – – – – – – – – – 2 No Operation — 2 — 1 1 _ Chronio Suppurative Otitis Media with Nasal Conditions: Tonsils and Adenoids 3 Children under 5 years — Operation before Clinic — — — — 3 No Operation — 3 — 1 1 1 Grand Totals 44 28 26 13 1 29 2 5 8 — — * 2 Children had Bi-lateral Otorrhoea. TABLE C. NOSE AND THROAT CONDITIONS, (i) CHILDREN OVER 5. Diagnosis. (Primary) Total. Tonsils and Adenoids. Secondary Conditions. Treatment. Result. Deafness. J Nasal Catarrh. Enlarged Tonsils and Adenoids. Diastolisation. Antiseptic Treatment. Proetz Displacement. Tonsils and Adenoids. Cured. Improved. Still under Treatment or Observation. Left or Treatment lapsed. Referred to Hospital for Operation. Declined Treatment. Conservative Treatment. Operative Treatment. A B C D E F G H I J K L M N O P Q Sinusitis: Rhinitis 7 Operation before Clinic 2 — — — 2 — — — — 2 — — — — — No Operation 5 — — — 5 4 4 4 1 4 — — 1 — — Nasal Obstruction , Rhinitis 16 Operation before Clinic 2 — — — 2 2 — — — — 2 — — — — No Operation 14 — — — 14 14 — — 2 — 14 — — — — Nasal Catarrh 31 Operation before Clinic 11 — — — 11 — — — — 11 — — — — — No Operation 20 9 — — 20 9 — — — 16 — — 2 — 2 Enlarged Tonsils and Adenoids 13 Operation before Clinic — — — — — — — — — — — — — — — No Operation 13 3 — — 1 2 — — 10 2 — 9 — — 2 Totals 67 67 12 — — 55 31 4 4 13 35 16 9 3 — 4 (ii) CHILDREN UNDER 5. A B C D E F G H I J K L M N O P Q Nasal Catarrh 7 Operation before Clinic — — — — — — — — — — — — — — — No Operation 7 — — — 5 — — — — — — — — — 2 Enlarged Tonsils and Adenoids 4 Operation before Clinic — — — — — — — — — — — — — — — No Operation 4 — — — 4 — — — — — — — — — — Totals 11 11 — — 9 — — — 9 2