LIBRARY Borough of Wood Green Annual Report OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER FOR THE YEAR 1939. MALCOLM MANSON, M.C., M.A., M.D., D.P.H. Medical Officer of Health and School Medical Officer. 1940. Crusha & Son, Ltd., Tottenham, Enfield, Wood Green and Palmers Green. Wood 23 Borough of Wood Green. PUBLIC HEALTH AND MATERNITY AND CHILD WELFARE COMMITTEE. Alderman E. J. Anderton, L.D.S. (Chairman). The Mayor (Councillor A. R. Harrison, J.P.). The Deputy Mayor (Alderman Mrs. J. J. Bolster, J.P.). Alderman A. J. Blue. Councillor Mrs. A. Duncan, J.P. Alderman F. G. Holmes, J.P. Councillor W. H. Evans. Alderman H. T. Rhys, J.P. Councillor W. J. Payne. Councillor Mrs. J. Cole. Councillor W. A. Vant. Councillor J. J. Wren. Co-opted Members :— Mrs. A. Barrett. Mrs. M. Blue. Mrs. E. M. Bottom. 2 STAFF during 1939. * 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 8th, 1939); G. C. Billing, Cert.R.San.Inst., Cert. Meat and Food Inspection; W. McCauley, Cert.R.San.Inst, and San. Insp. Joint Board, Cert. Meat and Food Inspection; F. James, Cert.R.San.Inst, and San. Insp. Joint Board, Cert. Meat and Food Inspection, commenced duty August 2nd, 1939. *Nurse-in-Charge, Day Nursery.—Miss Y. W. Moss. * Health Visitors.—Miss G. Moore, C.M.B., Miss F. L. Orwin, C.M.B., Miss F. Medd, C.M.B. Chief Clerk.—G. W. Jones. Assistant Clerks.—W. T. Gloster, G. Penberthy, S. Swinnerton (temporary, resigned June, 1939), K. Overy (appointed July, 1939). Clerk for Maternity and Child Welfare.—Mrs. Wass. Each of the Health Visitors holds a General Training Certificate, 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, Convent School, Earlham Grove, Wood Green, N.22, December 30th, 1940. To the Mayor, Aldermen and Councillors or 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 1939. In accordance with the instructions of the Minister of Health, the Report has been much curtailed and does not supply the usual detailed information of the work of the Health Department. The usual statistical tables have, however, been provided so that the annual records of the health conditions in the Borough may as far as possible be continuous and complete. Up to the outbreak of war the work of the Department had been carried on as usual, although a very heavy burden had already been placed on it, in the preparation and organisation of the medical part of the Council's Air Raid Precautions Scheme. The sudden death of Mr. Stanbury, the Senior Sanitary Inspector early in the year laid an added burden on the department, as it was several months before it was possible to fill the vacancy. Mr. Stanbury had been in the Council's service for 32 years, during which time he had always been an efficient and tactful officer and a very loyal colleague, and by his death the Council lost a very good servant, and the Health Department one of its most useful members. 4 With the outbreak of the war the majority of the staff of the department found themselves actively engaged on A.R.P. work, and for several weeks the normal routine work of the department was very seriously reduced. As soon as possible, however, the normal health services were resumed, and before the end of the year the services were running as normally as was possible under the changed conditions brought about by the war. I wish to thank the members of the Public Health and Maternity and Child Welfare Committee and the Council generally for their support during the year, and also the members of my staff for their loyal co-operation. The extra work thrown on them has, in many cases, involved the sacrifice of a very large amount of their leisure time, but the sacrifice has been willingly made and I am very grateful for it. 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: For calculation of Birth Rate 52,700 For calculation of Death Rate, etc. 50,700 Number of inhabited houses (end of 1939, according to the Rate Books) 13,792 Rateable Value, 1939 £539,247 Sum represented by a penny rate £2,155 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births— Total. M. F. Legitimate 599 309 290 Birth Rate 11.8 perl,000 Illegitimate 25 12 13 Stillbirths 26 11 15 Rate per 1,000 births, 40. Deaths 594 281 313 Death Rate 11.7 per 1,000 Deaths from Puerperal Causes:— Puerperal Sepsis 2 Rate per 1,000 Births, 3.1. Other Puerperal Causes 0 Rate per 1,000 Births, Nil. Total 2 Rate per 1,000 Births, 3.1. Deaths of Infants under 1 year of age:— All Infants 21 Rate per 1,000 Live Births, 34. Legitimate 19 Rate per 1, 000 legitimate Live Births, 32. Illegitimate 2 Rate per 1,000 illegitimate Live Births, 83. Deaths from:— Cancer (all ages) 104 Measles (all ages) — Whooping Cough (all ages) 1 Diarrhoea (under 2 years of age) 2 6 POPULATION. The Registrar-General has supplied two estimates of population for the year 1939. One, 52,700, which is to be used for calculating the Birth Rates, represents the normal population, while the other, 50,700, makes allowance for the changes in population which resulted from war conditions. This latter figure is used in calculating Death Rates and the incidence of infectious disease. BIRTHS. The number of live births registered during the year was 624, giving a Birth Rate of 11.8, which is appreciably less than 12.3. the rate for the two previous years. The births registered in the borough were distributed in the different Wards as follows:— Alexandra-Bowes 72 Town Hall 244 Noel Park 97 413 DEATHS. The number of deaths belonging to Wood Green, after making the necessary adjustments for inward and outward transfers, was 594. This represents a Death Rate of 11.7 per 1,000 of population, which compares very unfavourably with 10.1, the rate for the previous year. Of the total deaths, no fewer than 321, or 54 per cent., occurred in persons over 65 years of age. The chief causes of death were very much as in former years. Heart disease was responsible for 179 deaths, or 30 per cent. of all the deaths, while cancer caused 104 deaths, pneumonia 30 and tuberculosis 28. 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 4. Of this number two were due to diarrhoea and one each to diphtheria and whooping cough. The zymotic death rate was 0.07 per 1,000 of population, as compared with 0.11 for the previous year. 7 INFANTILE MORTALITY. The number of deaths occurring in children under 12 months of age was 21 and the Infantile Mortality Rate 34 per 1,000 live births. This is an improvement on the rate for 1938, which was 38, and is the lowest ever recorded in Wood Green. The individual causes of the infantile deaths and the age at which death occurred are shown in Table V. Of the total of 21 deaths it will be seen that 10 occurred in the first week of life and a further 5 during the next three weeks. MATERNAL MORTALITY. Two deaths were ascribed to puerperal sepsis, giving a Maternal Mortality Rate of 3.1 per 1,000 births. In one case the sepsis followed an abortion, while in the other it followed induction of labour in a case of eclampsia. 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 1939 :— No. of persons. Amount granted. £ s. d. Ordinary cases 1,304 21,310 1 11 Unemployed 185 1,526 12 3 Totals 1,489 £22,836 14 2 The amount granted in 1938 was £22,762 4s. Od. 8 GENERAL PROVISION FOR HEALTH SERVICES FOR THE AREA. The arrangements set out in detail in the Annual Report for 1938 relating to the general provision of health services for the Borough remain unchanged, and may be regarded as satisfactory. MATERNITY AND CHILD WELFARE. The number of live births registered during the year 1939 as belonging to Wood Green was 624, according to the information supplied by the Registrar-General. The number of births registered during the year in the Borough was 413, and the percentage notified under the Public Health Act, 1936, was 96.4. The number of stillbirths was 26, 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 was 15,030, compared with 17,196 in 1938 and 17,383 in 1937. The falling off in the number of attendances occurred during the last four months of the year, after the outbreak of war. The attendances at the Centre in the Alexandra Park area numbered 2,314, as compared with 3,287 in 1938 and 3,022 in 1937. The number of individual children brought to the Centres during the year was 1,712, of whom 836 were infants under 1 year of age and 876 of from 1 to 5 years of age. 9 The number of children seen by Dr. Miller at the Centres during the year was 1,667. 818 of these were infants under 12 months of age, who made 2,750 attendances, while 849 were children of 1 to 5 years of age and their attendances numbered 1,590. Of the 21 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 346 and the total attendances made numbered 1,675. The remainder of the Tuesday afternoon Clinic was allotted to post-natal cases, the number seen being 15 and the attendances 17. Toddlers' Clinic. A special Clinic for Toddlers has been held one afternoon per month throughout the year, where children between the ages of 2 and 5 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 163. Maternity Hospital Provision. Arrangements are in force with three hospitals, namely, the Mothers' Hospital, Clapton, the Royal Northern Hospital, Holloway, and the City of London Maternity Hospital for the admission of cases from Wood Green Centres. 20 cases were sent to these maternity hospitals during the year. Midwives. During 1939, the Council midwives attended 146 live births and 6 still births in the Borough. In addition to the Council midwives there were four private midwives practising in the district. 10 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 cases 103 Attendances 274 Extractions 222 General anaesthetic cases 73 Local anaesthetic cases 6 Other treatment and advice 230 Dentures provided 25 Light Treatment. By arrangement with the Middlesex County Council mothers and children are sent, as occasion arises, to the North Middlesex County Hospital for artificial sunlight treatment. Home Visiting. During the year the Health Visitors made a total of 4,225 visits. 1,625 of these visits were to babies under one year of age, 2,289 to children of from 1 to 5 years of age, and 311 were ante-natal 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 Centre, at a cost of £659 5s. 11d. Infant Life Protection. The Health Visitors have continued to act as Infant Life Protection Visitors during the year. The number of foster-mothers 11 and foster-children on the register at the end of the year were 7 and 7 respectively. Day Nursery. Evacuated to Maplestead on September 4th, 1939, and transferred to St. Margarets, Ware, early in February, 1940. Attendances during 1939 were 6,297 (while in Wood Green 3,596, when evacuated 2,701), compared with 6,284 in 1938. On the outbreak of war the Day Nursery was evacuated to Maplestead, near Halstead, Essex, where it was carried on as a Residential Nursery. All the children attending the Day Nursery were evacuated along with the whole Nursing Staff, so that there was complete continuity of care and management. The children were comfortably housed and well cared for in their new premises, but as the premises were considered rather dangerous in the event of fire occurring, it was considered advisable to move them to other quarters at St. Margarets, Ware, and this was done early in 1940. The attendances of children at the Day Nursery from January 1st up to the removal on September 4th numbered 6,297. SANITARY INSPECTION OF THE AREA. The following table gives a very brief summary of the dayto-day work of the Sanitary Inspectors. The number of inspections made and to a less extent the actual number of improvements effected is considerably less than in a normal year. This was due in the first instance to the loss of an inspector in the first half of the year by the sudden death of Mr. Stanbury and in the second to the fact that the inspectors in common with most of the other members of the Health Department had to devote a very large part of their time and effort to civil defence duties. 12 Sanitary Inspection of the Area Inspections and Re-inspections of dwelling houses:— Total 1,516 Enquiries in connection with Infectious Diseases:— Total 142 Inspections of registered premises:— Total 1,677 Miscellaneous Inspections:— Total 2,096 Work Carried Out:— Drains reconstructed 31 Drains repaired 229 New water closets 3 Water closets repaired 111 Premises cleansed, etc. 10 Rooms disinfested .. 65 Accumulations of refuse removed 14 Keeping of animals discontinued 3 Dampness in premises remedied 520 Houses repaired 2,042 Miscellaneous 188 Total 3,216 House-to-House Inspection. Number of houses inspected, 1939:— Total 48 Rent Restrictions Acts. Certificates granted under above heading during 1939:— Total 4 13 INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. 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 — 12 Supplementary Licences to sell milk from premises which are outside the area of the Licensing Authority. Tuberculin Tested. Accredited. Pasteurised. 1 — 1 (b) Meat. Slaughterhouse Inspections 158 Cattle. Pigs. Sheep. Animals killed 177 296 1,300 Destroyed for Tuberculosis 1 cwt. 10 lbs. nil nil Destroyed for other than Tuberculosis 35 lbs. 20 lbs. 28 lbs. (c) Other Foods. The undermentioned foodstuffs were condemned as unfit for human consumption during the year:— Corned beef 444 lbs. Jellied veal 252 lbs. Sardines 121 lbs. Pressed Pork 12 lbs. 14 FACTORIES AND HOMEWORK. 1.—Inspection. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories with mechanical power 97 19 — Factories without mechanical power 98 8 — Other Premises under the Act (including works of building and engineering construction, but not including outworkers' premises) — — — Total 195 27 — 2.—Defects Found. Particulars. Number of Defects. 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) 1 1 — — Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) — — — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7) insufficient — — — — unsuitable or defective 24 23 — — 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) 2 2 — — Total 27 25 — — 15 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 34 1 50 13 — 19 The making-up, ornamenting, finishing and repairing of table linen, or other household linen, and any process incidental thereto — — — — — — The making of curtains and furniture hangings and any process incidental thereto 1 — 1 — — — The making or filling of cosaques, Christmas crackers, Christmas stockings or similar articles or parts thereof.. 1 — 2 2 — 2 Total 36 1 53 15 — 21 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 7 Public Health Acts:— Matters notified by H.M. Inspector of Factories — Defects remedied following H.M.I.'s notifications — 16 NEW HOUSES BUILT DURING 1939. I am indebted to the Borough Surveyor for the following information relating to new houses erected in Wood Green during 1939:— Number of houses erected during 1939 4 Number of flats erected during 1939 31 Number of houses built by the Council — Number built by other bodies and persons 35 PUBLIC MORTUARY. Bodies deposited during the year 50 Inquests held 14 Post-mortem examinations 45 Causes of death:— Accidental 5 Natural causes 40 Suicide 5 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Table VI in the Appendix gives details of the notifications of infectious disease received during the year. The total number of cases notified was 190, a very low figure compared with the previous year, when the number was 279. The decrease is accounted for by the low incidence of diphtheria and, to a lesser degree, of scarlet fever, while there was also a reduced number of notifications of tuberculosis, 51 as compared with 69. The number of cases removed to hospital or sanatorium was 168, as compared with 232 in 1938, and the number of deaths from notifiable infectious disease was 60 the same number as in 1938. 17 The distribution of scarlet fever and diphtheria over the year was as follows:— Scarlet Fever. Diphtheria. First quarter 22 4 Second quarter 19 6 Third quarter 21 2 Fourth quarter 4 12 66 24 The incidence of these two diseases, so far as school attendance is concerned, was as follows:— Scarlet Fever. Diphtheria. Attending elementary schools in Wood Green 35 6 Attending Glendale County School 2 — Attending Trinity County School 4 1 Attending Private schools — — Attending schools outside the Borough 2 — Under school age 14 4 Over school age 9 13 66 24 Scarlet Fever. 66 cases were notified as compared with 92 in 1938. The disease was generally of a mild type and no deaths occurred. 18 Diphtheria. 24 cases of diphtheria were notified as compared with 63 in 1938. One death occurred in a child of school age. Immunisation against diphtheria was carried out as in previous years, but as a result of school closure at the commencement of the war and the evacuation of a large proportion of the children, the number of cases immunised was very much less than in previous years. During the year 345 children received a full course of protective injections and a further seven were undergoing a course at the end of the year. 257 children were Schick-tested during the year, 253 of these being children who had been immunised in 1938. The 345 children immunised in 1939 were awaiting the Schick-test at the end of the year. The material used for immunisation was toxoid-antitoxin mixture, which was given in three injections at intervals of a fortnight. Cerebro-Spinal Fever. Three cases of this disease were notified, in one of which a baby of two months death occurred. Anterior Poliomyelitis. Two cases of this disease were notified, both in children under school age. They were both removed to a general hospital in London. Puerperal Pyrexia. Two notifications of puerperal pyrexia were received. In both cases recovery took place. Erysipelas. Sixteen cases of erysipelas were notified, recovery taking place in every case. Pneumonia. 25 cases of pneumonia were notified, but 32 deaths were certified as due to pneumonia, an indication that notification of this disease is not satisfactory. All notified cases are visited by the District Nurses and an offer of home-nursing assistance made. 19 Non-Notifiable Infectious Diseases. The number of cases of non-notifiable infect ious diseases reported to me during the year from the elementary schools was as follows. All these cases were visited in their homes by the school nurses, to make sure that proper treatment is being obtained and the necessary precautions taken. Chicken-pox 24 Measles 2 Mumps 43 Whooping Cough 98 Skin Infections 4 171 The total of 171 is very small compared with 702 the corresponding number for the previous year. The very low number is due very largely to the almost entire absence of measles during the year. Tuberculosis. Table YII 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 58, 51 respiratory and 7 non-respiratory. Of this number 51 were notified by doctors in the district or from hospital, while 7 were transfers from other districts. The number of notifications received in 1938 was 78. The number of deaths certified as due to tuberculosis was 28, of which 26 were caused by respiratory and 2 by non-respiratory disease. In the previous year the corresponding numbers were 21 and 7. The death rate from tuberculosis was 0.55 per 1,000 of population, as compared with 0.52 in 1938. Daring the year 62 cases of tuberculosis were sent to hospital or sanatorium. The institutions to which they were admitted are shown overleaf. 20 Pulmonary cases. NonPulmonary cases. Archway Hospital 1 _ Brompton Hospital 4 _ Clare Hall Sanatorium 7 _ Eversfield Chest Hospital 7 _ Fairlight Sanatorium, Hastings . 2 _ Grosvenor Sanatorium 2 _ Harefield Sanatorium 14 _ Kelling Sanatorium, Norfolk 1 _ North Middlesex Hospital 17 _ Papworth Village Settlement 4 _ Royal Free Hospital 1 _ Royal National Sanatorium Bournemouth 1 _ White House, Milford-on-Sea 1 _ 62 _ 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. Insulin. Two necessitous patients residing in the Borough have been provided with insulin free of charge. The total cost to the Council was £5 17s. Od. 31 BACTERIOLOGICAL WORK. The bacteriological examination of specimens from the Borough is carried out at the Joint Isolation Hospital and during 1939 the following examinations were made :— Positive. Negative. Total. Diphtheria 37 268 305 Enteric Fever 0 2 2 Pulmonary Tuberculosis 7 68 75 Others 1 4 5 45 342 387 DISINFECTION AND DISINFESTATION. The number of articles dealt with at the Disinfecting Station during the year was as follows :— Articles disinfected after tuberculosis .. . . 94 Articles disinfected after other infectious diseases, etc. 2,486 Articles disinfected after cancer. 71 2,651 Articles disinfested of vermin 144 Articles dealt with for tenants moving into Council Houses . 412 556 Total number of articles destroyed . 361 The number of rooms disinfected was as follows :— Rooms disinfected after tuberculosis 17 Rooms disinfected after other infectious diseases.. 125 Rooms disinfected after cancer 9 — 151 Rooms treated for vermin 102 253 The method of disinfestation used was the same in as previous years, and described fully in my Annual Report for 1938. 22 APPENDIX. Table I. Vital Statistics of Wood Green, 1921-39. Year. (1) Population estimated to middle of each year. (2) Nett Births belonging to the District. Nett Deaths belonging to the District. Under 1 year of age. At all ages. Total No. (3) Rate per 1,000 population. (4) Illegitimate No. (5) Total No. (6) Rate per 1,000 live births. (7) Illegitimate No. (8) Rate per 1,000 illegitimate births. (9) No. (10) Rate per 1,000 population . (11) 1921 51,100 905 17.71 24 63 70 6 250 493 9.64 1922 51,290 873 17.02 26 41 47 4 154 524 10.21 1923 51,540 896 17.38 34 34 38 0 _ 491 9.52 1924 51,840 762 14.7 15 32 42 3 200 513 9.89 1925 51,960 740 14.24 17 35 47 2 118 507 9.75 1926 51,940 802 15.44 26 32 40 1 38 457 8.79 1927 52,260 687 13.14 18 35 51 1 56 509 9.73 1928 52,750 732 13.8 22 30 41 0 _ 478 9.06 1929 53,410 721 13.5 26 43 60 3 115 605 11.32 1930 . 53,410 719 13.4 30 26 36 3 100 534 10.0 1931 54,520 719 13.2 30 32 44 2 66 549 10.1 1932 54,500 681 12.5 20 28 41 4 200 556 10.2 1933 54,210 601 11.1 24 32 53 2 83 565 10.4 1934 53,755 564 10.5 16 21 37 2 125 562 10.5 1935 53,470 570 10.7 22 27 47 1 45 529 9.9 1936 53,620 700 13.1 23 38 54 0 _ 588 10.9 1937 53,510 659 12.3 21 32 48 2 95 593 11.1 1938 53,190 652 12.3 17 25 38 1 59 540 10.1 1939 52,700 and 50,700 624 11.8 25 21 34 2 83 594 11.7 23 Table II. Birth-Rate, Death-Rate and Analysis of Mortality during 1939. 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 1 Enteritis (under 2 years). Total Deaths under 1 year. England and Wales 15.0 12.1 0.00 _ 0.01 0.01 0.03 0.05 0.21 4-.6 50 126 County Boroughs and Great Towns (including London) 14.8 12.0 0.00 _ 0.01 0.00 0.03 0.05 0.19 6.3 53 148 Smaller Towns (popula.lation, 25,000-50,000 at Census 1931) 15.6 11.2 0.00 _ 0.01 0.00 0.02 0.04 0.20 3 .0 40 London 12.3 11.9 0.00 _ 0.00 0.00 0.04 0-02 0.18 8.2 48 Wood Green 11.8 11.7 _ _ _ _ 0.02. 0.02 0.17 3.2 34 24 Table III. Causes of Death during the year 1939. Causes of eath. Male. Female. Typhoid and Paratyphoid Fevers — — Measles — — Scarlet Fever — — Whooping Cough — 1 Diphtheria 1 — Influenza 2 7 Encephalitis Lethargica — — Cerebro-Spinal Fever — 1 Tuberculosis of the Respiratory System 15 1l Other Tuberculous Diseases i 1 Syphilis 1 — General Paralysis of the Insane, Tabes Dorsalis .. 5 1 Cancer, Malignant Disease 50 54 Diabetes 3 5 Cerebral Haemorrhage, etc. 13 17 Heart Disease 82 97 Aneurysm 2 3 Other Circulatory Diseases 12 18 Bronchitis 11 5 Pneumonia (all forms) 20 12 Other Respiratory Diseases 3 3 Peptic Ulcer 2 0 Diarrhoea, etc. (under 2 years) 1 1 Appendicitis 1 2 Cirrhosis of Liver 0 5 Other Diseases of Liver 0 1 Other Digestive Diseases 1 6 Acute and Chronic Nephritis 11 8 Puerperal Sepsis — 2 Other Puerperal Causes — — Congenital Debility, Premature Birth, Malformation, etc. 11 4 Senility .. 1 14 Suicide 2 3 Other Violence 7 10 Other Defined Diseases 21 19 Causes ill-defined or unknown — — Diarrhoea (2 years and over) 2 2 Totals 281 313 25 Table IV. Causes of, and Ages at Death during the year 1939. 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 Scarlet Fever Whooping Cough i — 1 Diphtheria i i Influenza 4 3 — i Encephalitis Lethargica Cerebro-Spinal Fever 1 1 — — — — — — — — — — Tuberculosis of the Respiratory System 26 — — —_ 7 5 4 4 4 2 _ Other Tuberculous Diseases .. 2 — — 2 — — — — — — — — Syphilis 2 — — — — — — — — 1 — — General Paralysis of Insane .. 4 — — — — — — — 1 2 1 — Cancer, Malignant Disease .. 98 — — — — — 1 10 13 26 29 19 Diabetes 5 — — — — — — — — — 2 3 Cerebral Haemorrhage, etc. .. 37 — — — — — 1 2 2 2 3 27 Heart Disease 186 — — — — 2 1 10 7 44 47 75 Aneurysm 5 — — — — — — — — — 2 3 Other Circulatory Diseases .. 26 — — — — — — 1 — 9 7 9 Bronchitis 14 — — — 1 — — 2 1 3 7 Pneumonia (all forms) 35 2 — 1 — 2 2 3 4 8 6 7 Other Respiratory Diseases .. 8 — — — — — — 1 — 3 1 3 — — — — — — — — — 1 Diarrhoea (under 2 years) 2 2 — — — — — — — — — — Appendicitis 3 — — — — — 1 — 1 1 — — 3 1 — Other Diseases of Liver — — — — — — — — — — Other Digestive Diseases 7 — — — — — 1 1 — 3 1 1 Acute and Chronic Nephritis.. 19 — — — — 1 1 — 4 2 8 3 Puerperal Sepsis 2 — — — — — — 1 1 — — — Other Puerperal Causes — — — — — — — — — — — — Congenital Debility, etc. 15 14 — 1 — — — — — — — — 16 — — — — — — — — — — 16 Suicide 5 — — — — — 1 — 3 — 1 — Other Violence 15 1 — — 1 1 3 1 — 2 1 7 Other Defined Causes 48 1 — —— 3 — 1 4 9 6 15 9 Causes ill-defined — — — — — — — — — — — — Totals 594 21 1 4 6 13 18 38 52 120 131 190 26 Table V. Deaths of Infants under One Year of age, showing cause of death and age at death. Under 1 week. 1—2 weeks. j 2—3 weeks. 3—4 weeks. 1 Total under 4 weeks. I—3 months. 3—6 months. 6—9 months. 9—12 months 1 Total under 1 year. Asphyxia Neonatorum .. 1 — — — 1 — — — — 1 Asthenia — I — — 1 — — — — 1 Broncho-Pneumonia 1 — — — 1 — 1 — — 2 Cerebral Haemorrhage 1 — — — 1 — — — — 1 Convulsions 1 — — — — — — — 1 Diarrhoea — — — — — — — 1 2 Haemolytic Jaundice 1 — — — 1 — — — — 1 Icterus Neonatorum — — 2 — 2 1 — — — 3 Intestinal Obstruction — — — — — — 1 — — 1 Intracranial Haemorrhage 1 — — — 1 — — — — 1 Marasmus — — — 1 1 — — — — 1 Meningococcal Meningitis — — — — — — 1 — — 1 Premature Birth 3 — — — 3 — — — — Pulmonary Atelectasis — — 1 — 1 — — — — 1 Toxaemia 1 — — — 1 — — _ _ 1 Totals 10 1 3 1 15 1 4 — 1 21 27 Table VI Infectious Diseases Notified during the year 1939. Notifiable Disease. Cases Notified in Whole Borough. Total Cases Notified in each Ward. Total Cases removed to Hospital or Sanatorium. Total Deaths. All Ages. At Ages—Years. AlexandraBo wes. Town Hall. Noel Park Under 1 year. 1 to 5 years. j 5 to 10 years. J 10 to 15 years. 15 to 20 years. 20 to 25 years. 25 to 35 years. 35 to 45 years. 45 to 55 years. 55 to 65 years. 65 and upwards Scarlet Fever 66 14 31 11 1 6 1 2 _ _ _ 18 17 31 58 _ Diphtheria 24 1 3 4 — 4 2 9 1 6 9 9 23 1 Cerebro-Spinal Fever .. 3 1 — 1 1 1 2 3 1 Enteric Fever — — — — — Erysipelas 16 — — — — — 2 2 4 3 4 1 2 9 5 7 1 Ophthalmia Neonatorum — — — — — — Pneumonia 25 — 3 — 2 — 1 3 8 1 6 1 6 9 10 14 32 Acute Poliomyelitis 2 — 2 — — — — — — 2 2 Puerperal Pyrexia 2 — — — — — 1 1 — — — — 1 1 2 — Pulmonary Tuberculosis 45 — 1 — 1 8 5 16 5 5 3 1 12 21 12 62 26 Non-Pulmonary — — — — — — — — — — — — — — — — — culosis 6 — — 1 1 — 4 1 5 2 Dysentery 1 — — 1 — — — — — — — — — — 1 — — Totals 190 2 23 38 15 13 21 31 21 9 14 3 46 70 74 168 63 28 Table VII. TUBERCULOSIS. New Cases and Mortality during 1939. " Age Periods. New Cases. Deaths. Respiratory. Nonrespiratory . Respiratory. Nonrespiratory. M. F. M. F. M. F. M. F. 0 — — — — — — — — 1 1 — — — — — 1 1 5 1 — 3 — — — — — 15 6 9 2 2 3 4 — — 25 13 6 — — 2 3 — — 35 2 4 — — 1 3 — — 45 4 1 — — 3 1 — — 55 3 — — — — — — — 65 and upwards.. 1 — — — 2 — — — Totals 31 20 5 2 15 11 1 1 Above includes transfers (7) from other Districts. 4 non-notified T.B. deaths occurred. 1st 1C METEOROLOGICAL REPORT FOR YEAR ENDING 31st DECEMBER, 1939. Month. 1939. Total Rainfall. Maximum Rainfall. No. of Wet Days. Maximum Temperature. Minimum Temperature. Inches. Inches. Date. Degrees. Date. Degrees. Date. January 4.09 0.92 25th 16 54 16th, 18th 25 5th February 0.68 0.23 28th 7 59 19th 29 2nd March 0.72 0.21 11th 10 62 3rd 30 27th April 1.69 0.76 30th 11 74 12th 32 1st May 1.69 0.58 15th 9 76 24th 37 2nd June 1.32 0.38 10th 8 85 7th 43 13 th July.. 1.83 0.43 21st 13 80 5th 49 1st August 2.76 0.67 2nd 11 81 19 th 50 11th, 13th September .. 0.94 0.51 1st 6 68 I6th, 17th 48 28th October 2.95 0.60 4th 12 64 5th 41 27th November .. 1.17 0.36 14th 7 58 6th, 7th, 8th, 36 19th, 21st 30th December .. 1.25 0.50 8th 15 55 2nd 21 29th Total for year 21.09 — 125 Note.—Maximum Rainfall .. .. .. 0.92ins., 25th January. ,, Rate of Rainfall.. .. 2.20ins. per hour; duration 7 mins., 21st July. ,, Temperature .. .. 85° Fahr., 7th June. Minimum Temperature .. .. 21° Fahr., 29th December. Note.—The Rain Gauge was out of order for 7 days in March, 5 days in October and 16 days iri November. The Thermometers were out of order for 10 days in September. EDUCATION COMMITTEE. Chairman : Alderman F. G. Holmes, J.P. Vice-Chairman : Councillor Mrs. Duncan, J.P. Alderman Mrs. J. J. Bolster, J.P. Councillor Mrs. J. Cole. Councillor W. G. Doyle. Councillor D. C. Leech. Councillor W. A. Vant. Councillor T. A. Warburton. Councillor J. H. Yeats Councillor H. Barnes. . Mr. H. J. Gari.ick, B.Sc. Mrs. H. S. Harrison. Rev. F. Jones. Miss C. M. Lightfoot. Mrs. M. V. Mackie. Rev. G. Mason. Mrs. F. Waymark. Mr. P. A. Tracey. 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. Way'mark. Mrs. Barrett. Mrs. E. L. Corbett. Miss J. Irvine. Mrs. E. M. Jackson. Mrs. E. C. Waghorne. Mrs. Knight. (The Chairman and Vice-Chairman of the Education Committee.) Director of Education : C. H. Jarvis, M.A., LL.D. Moob $reen JEbucaticm Committee. SCHOOL MEDICAL SERVICE. ANNUAL REPORT, 1939. Ashburton House:, 298, High Road, Wood Green, N.22. July, \Wi 1940. To the Chairman and Members of the Wood Greien Education Committee, Mr. Chairman, Ladieis and Gentlemen, I beg to present to you my Annual Report as School Medical Officer for the year 1939. The year has been an abnormal one and in common with every other side of the Education Committee's work, the School Medical Service was very gravely disturbed at the beginning of September, when a large proportion of the school children was evacuated to various reception areas in Essex, and the schoolsi were completely closed for several weeks. For the first week or two it was not possible to carry out any school medical work, but at the earliest possible moment a commencement was: made with dental and minor ailment clinics followed very shortly afterwards by the resumption of eye and ear clinics, and by the end of the year, all our medical services were in action with the exception of the Speech Clinic. These services catered for the children remaining in Wood Green, and at the same time an effort- was made to assist in the arrangements made for the children in the reception areas. One of our School Nurses was sent to Great Dunmow, in Essex, in the middle of September to help to look after the Wood Green children in the schools there, a,nd at the same time one of our Health Visitors was sent to HaJstead where she combined with her duties as Health Visitor those of School Nurse in respect of the Wood Green children in the schools there. Both these officers remained in the reception areas until the end of the year, by which time the number of evacuated children had been much reduced. 3 The Board of Education has recognised that, owing to the abnormal conditions which have arisen out of the war with the necessary disturbance of the regular work of the School Medical Service, it is impossible for School Medical Officers to present reports for 1939 on as comprehensive a scale as in normal years, while at the same time the urgent need for economy makes it desirable to- keep the cost of producing reports as low as possible. I have therefore thought it right to confine myself as far as possible to supplying only such information as is necessary to maintain the continuity of the Report for 1939 with those of previous years. The statistics are presented with the minimum of comment, and no attempt has been made to describe in detail the work of the speoial services, dental, ophthalmic, aural, etc. In every case these were unchanged from former years, for the first eight months of the year, and I have already briefly stated how far they were able to function after September 3rd. I.—STAFF. The School Medical Staff in 1939 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. Gardiner, 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 M. Freeman. School Medical Clerks.—Miss J. Collyer; Miss L. Ebeling (commenced 20.2.39, resigned 10.6.39); Miss 0. Puttick (commenced 21.8.39). 4 II.—SCHOOL HYGIENE. Very needed improvements were completed in several of the schools during the year, but the part-use of the schools chiefly concerned for civil defence purposes, has so far prevented full benefit being obtained from the improvements by the school children. An excellent new school, well planned and beautifully equipped, was opened in White Hart Lane to take the place of the old White Hart Lane School at the beginning of September, and the gymnasium has been in use as an excellent First Aid Post ever since. At Lordship Lane School and at Bounds Green School extensive alterations and additions were completed only in time for these schools also to be made use of in part as Ambulance and Stretcher Party Depots. In all three cases the accommodation put at the disposal of the civil defence services is admirably suited for the purpose, and has been of the greatest possible assistance in organising the medical services essential for A.R.P. purposes1. III.—MEDICAL INSPECTION. There was no change during the year in the age-groups of children inspected. The following table gives a summary of the medical inspections carried out between January 1st and August 31st. A. Routine Medical Inspections :— Entrants 539 Second Age Group 628 Third Age Group 129 Total 1,596 Other Routine Inspections .. 429 Grand Total 2,025 B. Other Inspections:— Special Inspections 596 Re-inspections 1,030 5 IV.—-FINDINGS OF MEDICAL INSPECTION AND ARRANGEMENTS FOR TREATMENT. 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 t'his report. Table IV gives details of the treatment provided. The arrangements made for providing treatment have remained unchanged from previous years, and it is not necessary to describe them again. At the end of the ordinary statistical tables are three tables, A, B and C, which give details of the work carried out by Dr. Clarke at the Ear Clinic. V.—INFECTIOUS DISEASES. The incidence of infectious disease in the elementary school population was very low during 1939, the number of cases notified from the elementary schools being- only 2112' as compared with 800 in 1938, and 519 in 1937. 1938, and 519 in 1937. The following table gives the numbers of cases of different infections notified from the schools in 1939, 1938 and 1937. 1939. 1938. 1937. Scarlet Fever 35 56 41 Diphtheria 6 32 24 Chicken-pox 24 145 25 Measles 2 440 99 Mumps 43 77 172 Whooping Cough 98 45 146 Skin Infections 4 5 12 Total 212 800 519 The incidence of scarlet fever and diphtheria during 1939 is shown in the following table. It will be seen that only 35 cases of scarlet fever and only six cases of diphtheria occurred among children attending the elementary schools. These figures compare very favourably with those for the previous year, which were respectively 56 and 32. 6 School. Scarlet Fever. Diphtheria Alexandra Boys 1 2 ,, Girls 1 — ,, Infants 4 — Bounds Green Boys 1 3 ,, ,, Girls 2 — ,, ,, Infants 1 — Lordship Lane Boys .. 1 — ,, ,, Girls .. 1 — ,, ,, Infants 2 — Noel Park Boys 1 — ,, ,, Girls 2 — ,, ,, Infants 13 — Rhodes Avenue 2 — St. Michael's Mixed .. — — ,, Infants 1 — St. Paul's 2 — White Hart Lane Boys — 1 ,, Girls — — ,, ,, ,, Infants — — Glendale County 2 — Trinity County 4 1 Private Schools — .— Schools outside Borough 2 — Under School Age 14 4 Over School Age 9 13 66 24 1st quarter 22 4 2nd 19 6 3rd 21 2 4th ,, 4 12 66 24 Immunisation against diphtheria has been continued during the year, but owing to the school closure and the evacuation of a large proportion of the children, the number of cases dealt with has been very much less than in a normal year. During 1939, 345 7 children received a full course of protective injections, and a further seven were undergoing a course at the end of the year. 257 children were Schick-tested during the year, 263 of these being children who had been immunised in 1938. The 345 children who were protected during 1939 were awaiting the Schick Test at the end of the year. VI.— OPEN-AIR EDUCATION. Bounds Green Girls' School carried out a school journey to Ryde, in the Isle of Wight, for a fortnight in May in which 24 children and two teachers took part. The Juvenile Organisations' Camp was held as usual in August at New Romney and 158 children went to camp, 85 boys and 73 girls. As in former years the children wyho went to camp derived very great benefit from their holiday. Six boys and six girls were sent for periods of six weeks to the Russell Cotes School of Recovery, at Parkstone, Dorset, and three boys and two girls to Collington Manor, Bexhill. Four boys and 13 girls were sent to the Palmers Green Holiday Home at Shoeburyness. VII.—PHYSICAL TRAINING. The arrangements were unchanged from the previous year, and were in the hands of the teachers, supervised by special organisers. School Baths. The attendances made by children at the Western Road Baths were 26,712i, while those at the Swimming Pool in Durnsford Road numbered 12,194. The number of school children gaining certificates of proficiency in swimming from the Wood Green School Sports Association during the year was 851. This number included 101 certificates for swimming 880' yards. VIII.—PROVISION OF MEALS. Meals were provided as in former years at the Dining Centre in White Hart Lane School. The number of children w'ho received meals at the Centre din ing the year was 134, and of this number 8 106 were fed free, 20 for part payment, and eight for full payment. The total number of meals provided was 14,869, and of these 12,706 were provided free, 1,876 for part payment and 287 for full payment. The average cost per meal was 6.9 pence, of which 3.2 pence represented the actual cost of food and 3.7 pence the cost of administration. In addition to these meals provided on medical grounds, 2,407 meals were provided for the 29 children attending the Partially Sighted Classes. Of these, 1,124 were provided free, 97 for part payment, and 1,186 for full payment. Apart from this provision of meals, 328 children were provided with milk at school free of cost daily, the number of bottles of milk issued between January 1st and July 31st being 34,568. Many others were supplied with malt and cod liver oil at the School Clinic, either free or at cost price on the recommendation of the School Medical Officers. IX.—BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. The arrangements for dealing with all defective children were as in former years, children with very defective vision being sent to the Partially Sighted School, deaf children to the Tottenham School for the Deaf, and mental defectives to the Joint Special School at Finchley. X.—SECONDARY SCHOOLS. The medical inspection of the pupils attending the Secondary Schools is usually carried out for the most part in the autumn term. The closure of Trinity School and the evacuation of large numbers of pupils from both Trinity and Glendale Schools, made it impossible to do any inspections in the autumn term this year, so that a much smaller number of children was examined than usual— only 196 as compared with 706 in the previous year. Dental treatment, and to a less extent ophthalmic treatment, of secondary school children was also seriously interfered with during the autumn term. 9 XI.—SCHOOL CLINIC. Once again I regret to have to report that the new School Clinic has not yet materialised. The need for improved accommodation increases every year, and it is to be hoped that when the present emergency has passed, a commencement will be made with the new Clinic. In concluding this very brief report, I would like to thank the Education Committee for the support it has constantly given to the work of the School Medical Staff. I would like also to thank the Director of Education and his staff for assistance always readily given, and finally all the members of my own staff for loyal and willing service throughout the year. Your obedient servant, MALCOLM MANSON, School Medical Officer. II) APPENDIX. MEDICAL STATISTICAL TABLES, 1939. TABLE I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 539 Second Age Group 628 Third Age Group 429 Total 1,596 Number of other Routine Inspections 429 Grand Total 2,025 B.—Other Inspections. Number of Special Inspections and Re-inspections 1,626 TABLE II.—Classification of the Nutrition of Children Inspected During the Year in the Routine Age Groups. Age Groups Number of Children Inspected A B C D (Excellent) (Normal) (Slightly subnormal) (Bad) No. % No. % No. % No. %  Entrants 539 137 25.6 344 63.8 57 10.5 1 0.2 Second Age Group 628 159 25.0 384 61.1 83 10.3 2 0.3 Third Age Group 429 149 34.7 247 57.5 32 7.4 1 0.2 Other Routine Inspections 429 165 38.5 236 55.0 28 6.5 — — Total 2025 610 30.1 1211 59.8 200 9.8 4 0.2 TABLE III. RETURN OF EXCEPTIONAL CHILDREN IN THE AREA. Blind Children. Name. Age. Address. At a Public Elementary School. At another Institution. At no School or Institution. S. P. 15 yrs. N.22 — Yes — 11 Deaf Children. Name. Age. Address. At a Public Elementary School. At another Institution. At no School or Institution. S. P. 15 vrs. N.22 — Yes — (Both these entries refer to the same boy. He has for several years past been attending the School for the Deaf, Philip Lane, Tottenham. In July of 1939 his eyesight was found to be so difficult that he was recommended for admission to a school for the blind, but before a vacancy could be found for him he was evacuated with the School for the Deaf.) TABLE IV.—TREATMENT TABLES. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table VI.) Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm—Scalp— (i) X-Ray Treatment — — — (ii) Other Treatment — — — Ringworm—Body — — — Scabies 17 — 17 Impetigo 44 — 44 Other skin disease 13 — 13 Minor Eye Defects (external and other, but excluding cases falling in Group II) 49 1 50 Minor Ear Defects 60 — 60 . Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 352 15 367 Total 535 16 551 12 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) 501 10 514 Other defect or disease of the eyes (excluding those recorded in Group I) 56 4 60 Total 560 14 574 Under the Authority's Scheme. Otherwise. Total. No. of children for whom spectacles were (a) Prescribed 223 11 234 (b) Obtained 213 11 224 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioneror Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 17 32 — — 2 — — — 13 — — — 15 — (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids. (iv) Other defects of the nose and throat. 13 Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme (1) Otherwise. (2) Total number Treated. Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. (i) (ii) (iii) (i) (ii) (iii) Number of children treated 1 — — — 3 — 4 TABLE V.—DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist— (a) Routine Age Groups— AGE 4 5 6 7 8 9 10 11 12 13 14 15 16 TOTAL Number 7 93 242 269 243 258 245 232 189 149 121 34 17 2,099 (b) Specials 476 (c) Total (Routine and Specials) 2,575 (2) Number found to require treatment 2,139 (3) Number actually treated 1,440 (4) Attendances made by children for treatment 4,023 (5) Half-days devoted to:— (7) Extractions:— Inspection 16½ Permanent Teeth 383 Treatment 356½ Temporary Teeth 1,179 Total 373 Total 1,562 (8) Administrations of general anaesthetics for extractions 508 (b) Fillings:— (9) Other Operations:— Permanent Teeth 2,036 Permanent Teeth 352 Temporary Teeth 13 Temporary Teeth 210 Total 2,049 Total 562 14 TABLE VI.—UNCLEANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 4 (ii) Total number of examinations of children in the Schools by School Nurses 17,199 (iii) Number of individual children found unclean 41 (iv) Number of individual children cleansed under arrangements made by the Local Education Authority — (v) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws — STATEMENT of the Number of Children Notified During the Year ended 31st December, 1939, by the Local Education Authority to the Local Mental Deficiency Authority. Total Number of Children Notified, 2. 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 1 — (ii) Children unable to be instructed in a Special School without detriment to the interests of other children : (a) Moral defectives — — (b) 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 2 — 15 TABLE A. ACUTE OTITIS MEDIA, (I) CHILDREN OVER 5. Diagnosis. Total (Ears) Tonsils and Adenoids. Treatment. Result. Zinc lonisation. Antiseptic Treatment. 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. Deolined Treatment. A B C D E F G H I J K L Acute Non-Suppurative Otitis Media 3 — Operation before Clinic — — — — — — — — — — 3 No Operation — 3 — — 2 — 1 — — — Acute Non-Suppurative Otitis Media with Nasal Conditions: Enlarged Tonsils and Adenoids 4 2 Operation before Clinic — 2 — — 2 — — — — — 2 No Operation — 2 1 1 1 — — 1 — — Acute Suppurative Otitis Media 6 4 Operation before Clinic 2 2 — — 3 — — 1 — — 2 No Operation — . 2 — — 1 — — 1 — — Acute Suppurative Otitis Media with Nasal Conditions: Enlarged Tonsils and Adenoids 7 — Operation before Clinio — — — — — — — — — — 7 No Operation 2 6 7 1 2 — — 5 — — Totals 20 20 4 17 8 2 11 — i 8 — — (ii) CHILDREN UNDER 5. a b c d e f 0 h i j e l Acute Non-Suppurative Otitis Media 1 — Operation before Clinic — — — — — — — — — — 1 No Operation — — — — 1 — — — — — Aoute Suppurative Otitis Media 13 — Operation before Clinic — — — — — — — — — — 13 No Operation — 13 — — 12 — — 1 — — Acute Suppurative Otitis Media with Nasal Conditions: Enlarged Tonsils and Adenoids 3 — Operation before Clinic — — — — — — — — — — 3 No Operation — 3 — — 3 — — — — — Totals 17 17 — 16 — — 16 — — 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: 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 lonisation. 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 3 — — — — — — Operation before Clinic — — — — — — — — — — 1 1 — — 1 — No Operation 3 2 1 — 1 — — 1 1 — B Mastoid Disease 2 — — — — — — Operation before Clinic — — — — — — — — — — — — 2 — — — No Operation — 2 — 2 — — — 1 1* — C Enlarged Tonsils and Adenoids 6 — — — — — — Operation before Clinic — — — — — — — — — — — — — 6 — — No Operation 3 3 3 2 4 — — — 2 — D Nasal Catarrh: Rhinitis or Sinusitis — — — — — — — Operation before Clinic — — — — — — — — — — — — — — — — No Operation — — — — — — — — — — G External Otitis: Eczema .. 2 — — — — — — Operation before Clinic — — — — — — — — — — — — — — — 2 No Operation 2 — — — 2 — — — — Totals 13 — — — — - — 8 7 4 4 7 — — 2 4 — Chronio Suppurative Otitis Media (Tympanic Sepsis only) 8 Children over 5 years 5 Operation before Clinic 5 — — — 3 — 1 1 — — 3 No Operation 2 1 — — 3 — — — — — Chronio Suppurative Otitis Media (Tympanic Sepsis only) 1 Children under 5 years — Operation before Clinic — — — — — — — — — — 1 No Operation — 1 — — 1 — — — Chronio Suppurative Otitis Media with Nasal Conditions: Tonsils and Adenoids — Children under 5 years — Operation before Clinic — — — — — — — — — — — No Operation — — — — — — — — — — Grand Totals 22 15 9 4 4 14 — 1 3 4 — * Acute Mastoid Operation done. TABLE C. NOSE AND THROAT CONDITIONS. (I) CHILDREN OVER 5. Diagnosis. (Primary) Total. Tonsils and Adenoids. Secondary Conditions. Treatment. Result. Deafness. Nasal Catarrh. Enlarged Tonsils and Adenoids. Diastolisation. Proetz Displacement. Antiseptic Treatment. 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 9 Operation before Clinic 5 — 5 — 3 3 i — — 1 1 — 2 1 — No Operation 4 — 4 — 3 3 3 — — 1 — 1 1 1 — Nasal Obstruction , Rhinitis 23 Operation before Clinic 7 1 6 — 6 2 — — — — 2 3 — 1 — No Operation 16 2 10 4 12 6 — 3 — 6 3 3 1 — — Nasal Catarrh 24 Operation before Clinic 5 4 1 5 2 — — — 3 — 2 — — 1 No Operation 19 1 12 6 16 2 — 4 — 6 2 4 5 1 1 Enlarged Tonsils and Adenoids 10 Operation before Clinic — — — — — — — — — — — — — — — No Operation 10 2 4 4 4 — — 9 1 — 3 2 3 2 Totals 66 66 6 45 15 49 18 4 16 1 17 11 15 12 4 4 (ii) CHILDREN UNDER 5. A B C D E F G H I J K L M N O P Q Nasal Catarrh 6 Operation before Clinic 1 — 1 — 1 — — — I — — — — — No Operation 4 — 3 1 2 3 — 1 — 2 1 — 1 — — Enlarged Tonsils and Adenoids I Operation before Clinic — — — — — — — — — — — — — — — No Operation 1 — — 1 — — — 1 — — 1 — — — — Totals 6 6 — 4 2 3 3 — 2 — 3 2 — 1 — — TABLE D. MISCELLANEOUS CASES. 1 Wax in ears removed 9 2 Eczema of nose 1 3 Furuncle 1 4 Epistaxis 1 CASES TREATED AND DISCHARGED, 1938, KEPT UNDER OBSERVATION IN 1939. 1 Acute otitis 6 2 Chronic otorrhoea 4 3 Nasal conditions 11