BOROUGH OF WOOD GREEN. ANNUAL REPORT of the Medical Officer of Health and School Medical Officer for the Year 1942. MALCOLM MANSON, M.C., G.M., M.A., M.D., D.P.H. Medical Officer of Health and School Medical Officer. 1943 Crusha & Son, Ltd., Tottenham, Wood Green, Palmers Green and Enfield. WOOD 24 BOROUGH OF WOOD GREEN. PUBLIC HEALTH COMMITTEE. The Mayor, Alderman E. J. Anderton. L.D.S., J.P. (Chairman). The Deputy Mayor, Councillor A. R. Harrison, J.P. Alderman Mrs. J. J. Bolster, J.P. Councillor P. H. P. Forney. Alderman C. H. Nash, J.P. Councillor A. McIntosh. Alderman H. Tudor Rhys, J.P. Councillor Major S. North. Councillor F. Corbett, J.P. Councillor Mrs L. C. Vant. MATERNITY AND CHILD WELFARE COMMITTEE. Councillor Mrs. L. C. Vant (Chairman). The Mayor and Deputy Mayor. Alderman Mrs. J. J. Bolster, J. P. Councillor Mrs. J. Cole. Councillor F. H. P. Forney. Co-opted Members Mrs. Blue. Mrs. A. Knight. Mrs. E. C. Waghorne. 2 STAFF during 1942. *Medical Officer of Health.—Malcolm Manson, M.C., G. M., M.A., M.D., D.P.H. * Assistant Medical Officer of Health.—Margaret McDonald Miller, M.B., Ch.B., D.P.H. * District Sanitary Inspectors.—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 Insp. Joint Board, Cert. Meat and Food Inspection. *Health Visitors.—Miss F. L. Orwin, C.M.B. ; Miss F. Medd, C.M.B.; Miss G. Shaw, C.M.B. Chief Clerk.—G. W. Jones. Assistant Clerks.—(W. T. Gloster, G. Penberthy, K. Overy, in H.M. Forces). Temporary appointments: G. Maidlow, Mrs. G. Ogden, Miss E. Daeche. Clerk for Maternity and Child Welfare.—Mrs. Wass. Each of the Health Visitors holds a General Training Certificate, and Miss Orwin and Miss Shaw hold the Health Visitor's Certificate. * Officers in respect of whom salary contributions are made under the Public Health Act by Exchequer Grants. 3 Public Health Department. Convent School, Earlham Grove, Wood Green, N.22. 14th September, 1943. To the Mayor, Aldermen and Councillors, of the Borough of Wood Green. Ladies and Gentlemen, T beg to submit my Annual Report as Medical Officer of Health for the year 1942. The Report is very much reduced in length, in accordance with the instructions of the Ministry of Health, and gives only a bare outline of the work of the Health Department during the year. The vital statistics are on the whole satisfactory, the Birth Rate higher than it has been since 1923, and the Death Rate a little lower than in 1941. The Infantile Mortality Rate—37 per 1,000 live births—is higher than it was in 1941, the corresponding rate then of 31 being the lowest ever recorded in Wood Green. There has been no serious epidemic of infectious disease, and there is no evidence suggesting serious deterioration in the health of the community such as plight be expected in the third year of a world war. The normal health services have been maintained without diminution, and I wish to express my thanks to every member of my staff for their loyal co-operation throughout the year. Your obedient servant, MALCOLM MANSON, Medical Officer of Health. 4 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (acres) 1,607 Population—Estimate supplied by the Registrar-General 44,840 Number of inhabited houses (end of 1942, according to the Rate Books) 13,635 Rateable Value, 1942 £541,442 Sum represented by a penny rate £2,331 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births— Total M. F. Legitimate 675 364 311 Birth Rate 15.7 per 1,000 Illegitimate 29 14 15 Still Births 14 9 5 Rate per 1,000 births 19.5 Deaths 573 280 293 Death Rate 12.7 per 1,000 Deaths from Puerperal Causes:— Puerperal Sepsis Nil. Rate per 1,000 Births, 1.4. Other Puerperal Causes Rate per 1,000 Births, 4.2. Deaths of Infants under 1 year of age:— All Infants 26 Rate per 1,000 Live Births, 37. Legitimate 25 Rate per 1,000 legitimate Live Births, 36. Illegitimate 1 Rate per 1,000 illegitimate Live Births, 34. Deaths from:— Cancer (all ages) 94 Measles (all ages) 2 Whooping Cough (all ages) 1 Diarrhoea (under 2 years of age) 3 Number of Births notified 652 Number of Births Registered in the Borough 318 5 POPULATION. The estimate of population supplied by the Registrar-General is higher by 970 than for the previous year, but is still very much lower than for the years just before the war. The low figure is most likely due to the fact that a large number of men and women have left the district on joining the forces, and at the same time there has been no influx of people into the Borough. There is no definite evidence of an appreciable permanent fall in the population. BIRTHS. The number of live births registered during the year was 704, which gives a Birth Rate of 15.7 per 1,000. This is a very great improvement on the number of births in 1941 which was 523, with a Birth Rate of 11.9. DEATHS. The number of deaths credited to Wood Green, after making the neeessary adjustments for inward and outward transfers was 573. This gives a Death Rate of 12.7, which is an improvement on that for the previous year which was 13.4, and a very great improvement on that for 1940, which was 15.9. The causes of death are shown in Table III in the Appendix, and it will be seen that the principal cause of death was heart disease which was responsible for 156 deaths. Other diseases of the circulatory system were credited with 29 deaths, and intracranial vascular lesions with 51 deaths, so that no fewer than 236 deaths out of a total of 573 were attributed to diseases of the heart and circulation. Respiratory diseases, excluding pulmonary tuberculosis, were credited with 70 deaths, while deaths due to tuberculosis numbered 34. Cancer was responsible for 94 deaths, a slight increase on 88, the number for 1941. Only 4 deaths occurred from the principal zymotic diseasesenteric fever, smallpox, measles, scarlet fever, diphtheria, whooping cough and diarrhoea (in children under 2 years)—namely, 1 death from whooping cough, and 3 from diarrhoea. The zymotic death rate was 0.07 per 1,000 of population. 6 INFANTILE MORTAILITY. The number of deaths of children under 12 months was 26, and the Infantile Mortality Rate 37 for 1,000 live births. This is not so good as the rate for the previous year which was 31, the lowest on record in Wood Green. Of the total of 26 infantile deaths, no fewer than 14 occurred in the first week of life, and 20 during the first month. MATERNAL MORTALITY. Four deaths occurred following miscarriage or childbirth. One was the result of criminal abortion for which a conviction for manslaughter was obtained. The others were the result of different complications of childbirth. The Maternal Mortality Rate was 5.6 per 1,000 births, which compares very unfavourably with the previous year when there were no maternal deaths. MATERNITY AND CHILD WELFARE. The number of live births registered as belonging to Wood Green was 704. Of these the number registered as actually occurring in the Borough was 318, and in 254 of these cases one or other of the Council Midwives was in attendance at the confinement. It will be observed that considerably more than half of the births belonging to Wood Green took place in hospitals outside the Borough or in reception areas to which mothers were sent under the Government evacuation scheme. CHILD WELFARE CENTRES. The total attendances during the year were 12,931 compared with 10,814 in the previous year. The attendances at the Centre in Alexandra Park were 3,049 compared with 2,023 in 1941. The number of children brought to the Centres was 1,691, of whom 779 were infants under 1 year of age and 912 of from 1 to 5 years of age. 7 The number of children seen by Dr. Miller at the Centres during the year was 1,619, of whom 752 were infants and 867 children of from 1 to 5 years. Of the 25 infantile deaths which occurred during the year in only 7 cases had the baby been brought to one of the Centres. An Ante-Natal Clinic was held at the White Hart Lane Centre on Tuesday afternoons and Friday mornings throughout the year. The number of expectant mothers who attended during the year was 538. Twenty-eight women were sent to Maternity Hospitals for confinement under the normal hospital arrangements made by the Council, while 102 were sent to Maternity Homes or Hostels in reception areas under the Government Evacuation Scheme. The Council Midwives attended 254 births in the Borough during the year. HOME VISITING. The Health Visitors made a total of 4,724 visits during the year. Of these 333 were ante-natal visits to expectant mothers, 1,878 to babies under 1 year of age and 2,513 to children of from 1 to 5 years. They also continued to act as Infant Life Protection Visitors visiting all licensed foster-mothers and foster-children at regular intervals. There were 6 foster-mothers and 8 foster-children on the register at the end of the year. Free Food. Free food, consisting of dried milk and cod liver oil and malt "was issued during the year to necessitous expectant and nursing mothers attending the Centres at a cost of £56 10s. 5d. Cod liver oil and fruit juices were issued at the Child Welfare Centres by the staff of the Local Food Office. 8 War-time Day Nursery. In June a War-time Day Nursery with accommodation for forty children of mothers engaged on war work was opened in the disused St. Michael's Infant School in Bounds Green Road, which was adapted for the purpose. The accommodation provided has been found inadequate for the needs of the community, and a second War-time Day Nursery is in course of erection in White Hart Lane. SANITARY INSPECTION OF THE AREA. The following tables give a very brief summary of the routine work of the Sanitary Inspectors during the year. Inspections and Re-inspections of dwelling houses:— Total 1,846 Enquiries in connection with Infectious Diseases:— Total 185 Inspections of registered premises:— Total 1,763 Miscellaneous Inspections:— Total 1,008 Work Carried Out:— Drains reconstructed - Drains repaired 54 New water closets - Water closets repaired 83 Premises cleansed, etc. 7 Rooms disinfested 27 Accumulations of refuse removed 4 Keeping of animals discontinued — Dampness in premises remedied 155 House repairs 602 Miscellaneous 176 Total 1,008 House-to-House Inspection. Number of houses inspected:— Total 266 Rent Restrictions Acts. Certificates granted under above heading during 1942:— Total 7 9 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 Tuberculin Tested. Accredited. Pasteurised. 4 - 15 Supplementary Licences to sell milk from premises which are outside the area of the Licensing Authority. Tuberculin Tested. Accredited. Pasteurised. 2 — 2 (b) Other Foods. The undermentioned foodstuffs were certified as unfit for human consumption daring the year:— Unfit by reason of Decomposition: 1 Calf's Head. 56¾ lbs. Pork Luncheon Meat. 9¼ lbs. Fore Hock Bacon. 64 lbs. Pork Chips. 170 lbs. Sausage Meat. 8 lbs. Sausage. 25¼ lbs. Cheese. 26 lbs. Curd Cheese. 208 Meat Pies. 20½ stone Wet Fish. 416 Fish Cakes. 28 Pasties. 6 stone Smoked Fillet. 5 lbs. Sugar. 887 Crumpets. 320 Rolls. 198 Baps. 304 Cakes. 10 Unfit by reason of Decomposition—continued: 87 Loaves. 56 lbs. Spring Onions. 575 lbs. Peas. 36 lbs. Broad Beans. 6 cwts. Onions. 43 lbs. Apples. 33 1 lb. packets Porridge. 72 Eggs. 11 lbs. 14 oz. Butter. 9¾ lbs. Sultanas. Preserved Food: 526 lb. tins Pork Luncheon Meat. 90 tins Meat. 96 tins Fish. 320 tins Vegetables. 477 tins Fruit. 23 jars Paste. 5 tins Soup. 17 jars Pickles. 3 bottles Sauce. 176 tins Milk. Unfit by being Contaminated with, Broken Glass: 341 Crumpets. 98 Scotch Baps. 2 Scotch Crumpets. 1 Flapjack. 5 Large Loaves. 3 Hovis Loaves. 4 Currant Loaves. 11 Fancy Loaves. 41 Rolls. 2 jars Winchester Paste. 2 jars Pickles. Unfit by being Contaminated with Sewage through flooding. 30 lbs. Sugar. 25 lbs. Rice. 20 lbs. Tapioca. 3 lbs. Blancmange. 28 lbs. Haricot Beans. 11 INFECTIOUS DISEASE. Table IV in the Appendix gives details of the notifications of infectious disease received during 1942. The total 689 is considerably less than that for the previous year which was 802, but it is still high, very largely on account of the large number of notifications of measles and whooping cough. The infections were generally of a mild type, and in 361 cases of measles only two deaths occurred, while there was only one death in 95 cases of whooping cough. There were 87 cases of scarlet fever and 22 cases of diphtheria, but no death from either disease. Of the 22 cases of diphtheria 10 occurred in persons over 15 years of age. Thirty-four deaths occurred from tuberculosis and 27 from pneumonia. DIPHTHERIA IMMUNISATION. Diphtheria immunisation was carried out as in former years. "When this procedure was first commenced in 1929, the great majority of the children immunised were of school age, and it was difficult to persuade parents to bring younger children to be protected. During the past few years however more and more children aged 12 months and over have been immunised, and the majority brought for immunisation are now under school age, for the most part in the second year of life. This is a very great advance as it is in the early years of life that diphtheria is most dangerous, and protection therefore most valuable. During 1942, 1,212 children in all received full courses of injections, 730 of whom were under 5 years of age and 482 between 5 and 15 years. Twelve cases of diphtheria occurred in children under 15 years of age, during the year, but in none of these cases had the child ever been immunised. The material now used for immunisation in all cases is Alum Precipitated Toxoid provided free by the Ministry of Health. It is estimated that over 50 per cent. of all children under 5 years of age in Wood Green have been immunised, and over 80 per cent. of those between 5 and 15 years. 12 SCABIES. An account of the measures taken to deal with the greatly increased prevalence of scabies is given on page 5 of my Annual Report as School Medical Officer for 1942, to which reference may be made. BACTERIOLOGICAL WORK. The bacteriological examination of specimens from the Borough is carried out at the Joint Isolation Hospital, and during the year the following examinations were made:— Positive. Negative. Total. Diphtheria 11 238 249 Pulmonary Tuberculosis 6 69 75 Others 3 6 9 20 313 333 DISINFECTION AND DISINFESTATION. The number of articles dealt with at the Disinfecting Station was as follows :— Articles disinfected 2,485* Articles destroyed 63 160 rooms were disinfected on account of infectious disease, and 86 rooms disinfested on account of the presence of vermin. *This figure includes 1,448 articles disinfected for Scabies. 13 APPENDIX. Table I. Vital Statistics of Wood Green, 1931-42. 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) 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 1940 46,230 605 13.1 42 23 39 3 71 737 15.9 1941 43,870 523 11.9 25 16 31 0 — 589 13.4 1942 44,840 704 15.7 29 25 37 1 34 573 12.7 14 Table II. Birth-Rate, Death-Rate and Analysis of Mortality during 1942. 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 year. England and Wales 15.8 11.6 0.00 - 0.01 0.00 0.02 0.05 0.03 5.2 49 126 County Boroughs and Great Towns (including London) 17.3 13.3 0.00 - 0.02 0.00 0.03 0.06 0.09 7.5 59 148 Smaller Towns (populalation, 25,000-50,000 at Census 1931) 18.4 12.1 0.00 - 0.01 0.00 0.02 0.04 0.10 4.8 46 London 14.0 13.9 0.00 — 0.01 0.00 0.04 0.02 0.07 8.6 60 Wood Green 15.7 12.7 0.00 — 0.04 0.00 0.02 0.00 0.02 4.2 37 15 Table III. Causes of Death during the year 1942. Causes of Death. Male. Female. Typhoid and Paratyphoid Fevers - - Cerebro-Spinal Fever 1 — Scarlet Fever — — Whooping Cough 1 — Diphtheria — — Tuberculosis of Respiratory System 17 13 Other forms of Tuberculosis 1 3 Syphilitic Diseases 2 — Influenza 1 Measles 1 1 Acute Polio-mvelitis and Polio-encephalitis — — . Acute Inf. Encephalitis 1 — Cancer of B. Cav. and Oesophagus—Male 1 — Uterus 1 Cancer of Stomach and Duodenum 10 6 Cancer of Breast — 13 Cancer of all other sites 43 20 Diabetes 1 2 Intra-Cran. Vase. Lesions 18 33 Heart Disease 65 91 Other Diseases of Circulatory System 11 18 Bronchitis 20 22 Pneumonia 18 9 Other Respiratory Diseases 1 — Ulcer of Stomach or Duodenum 9 3 Diarrohea under 2 years of age 2 1 Appendicitis — 1 Other Digestive Diseases 6 10 Nephritis 8 5 Puerperal and Post-Abort. Sepsis — 1 Other Maternal Causes — 3 Premature Birth 7 3 Congenital Malformations, Birth Injuries, Infantile Diseases 7 3 Suicide 4 5 Road Traffic Accidents 1 2 Other violent causes 4 5 All other causes 20 18 Totals 280 293 91 Table IV. Infectious Diseases Notified during the year 1942. 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. 20 to 25 years. 25 to 35 years. 35 to 45 years. 45 to 55 years. 55 to 65 years. 65 & upwards. Scarlet Fever 87 - 19 41 18 4 1 2 2 - - - 19 30 38 72 - Diphtheria 22 — 4 5 3 3 1 3 2 — 1 — 6 4 12 22 — Cerebro-Spinal Fever 3 1 - - - - - - - - 1 1 1 — 2 3 1 Enteric Fever - - - - - - - - - - - - - - - - - Erysipelas 16 - - - - - 1 2 — 2 5 6 3 7 6 3 — Pneumonia 20 — 2 2 1 1 — 3 — 4 4 3 6 7 7 5 27 Acute Poliomyelitis 1 — 1 — 1 1 — Puerperal Pyrexia 6 — — — — 3 3 — — 3 2 1 4 1 Pulmonary Tuberculosis 69 1 2 1 7 9 18 13 8 6 4 32 16 21 63 30 Non-Pulmonary Tuberculosis 4 - - - 1 2 - - - 1 - - 3 1 - 1 4 Food Poisoning 2 - - - - - - - - 1 1 — 1 1 — — — Measles 361 15 132 212 1 1 - - - - - - 104 156 101 7 2 Whooping Cough 95 7 46 38 2 — — — 1 1 — — 41 31 23 5 1 Ophthalmia Neonatorum 1 1 - - - - - - - - - - 1 - - - - Dysentery 2 1 — 1 - - - - - - - - - 1 1 2 — Totals 689 26 203 301 28 18 15 31 18 17 18 14 221 256 212 188 66 17 Table V. TUBERCULOSIS. New Cases and Mortality during 1942. Age Periods. New Cases. Deaths. Respiratory Nonrespiratory. Respiratory Nonrespiratory . M. f. m. f. m. f. m. f. 0 — 1 - - - - - - 1 - - - - - - - - 5 2 1 — 1 — — — 1 15 5 11 2 — 3 4 — 1 25 7 11 — - 2 6 - 1 35 7 6 — — 3 3 - — 45 6 4 — 1 4 — 1 — 55 4 2 — — 4 — — — 65 and upwards 2 2 — — 1 — — — Totals 33 38 2 2 17 13 1 3 Above includes transfers (2) from other Districts. 12 non-notified t.B. deaths occurred. EDUCATION COMMITTEE. Chairman: Councillor T. A. Warburton. Vice-Chairman: Alderman Mrs. J. J. Bolster, J. P. Alderman F. G. Holmes, J. P. Mrs. E. M. Bottom. Councillor Mrs. J. Cole. Mr. H. J. Booker. Councillor F. Corbett, J. P. Mrs. H. S. Harrison. Councillor F. Hodge. Rev. F. E. Jones. Councillor A. McIntosh. Miss C. M. Lightfoot. Councillor A. Oliver. Mrs. M. V. Mackie. Councillor F. F. Tomlin. Rev. Father G. Mason. Councillor Mrs. L. C. Vant. Mrs. F. L. Waymark. CARE AND AFTER-CARE COMMITTEE. Chairman: Alderman Mrs. J. J. Bolster, J. P. Councillor Mrs. J. Cole. Miss C. M. Lightfoot. Councillor Mrs. L. C. Vant. Mrs. M. V. Mackie. Mrs. E. L. Corbett. Mrs. A. McIntosh. Mrs. H. S. Harrison. Mrs. E. C. Waghorne. Mrs. L. Jenkins. Mrs. F. L. Waymark. (The Chairman and Vice-Chairman of the Education Committee.) Director of Education: C. H. Jarvis, M.A., LL. D. Wood (Green £ducation Committee. SCHOOL MEDICAL SERVICE. ANNUAL REPORT, 1942. Public Health Department, Convent School, Earlham Grove, Wood Green, N. 22. June 17th, 1943. 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 1942. The Board of Education has requested that the Annual Report should again be as brief as possible so that only the barest outline of the school medical service is given. STAFF. There have been no changes in the School Medical Staff during the year. MEDICAL INSPECTION. Table 1 in the Appendix gives the numbers of children inspected in the different age-groups at the routine medical inspections, while Table II gives a classification of the state of nutrition of the children inspected in these age-groups. The number inspected in 1942 was very much higher than in the previous year, the vast majority of the evacuated children having now returned to Wood Green, and was very little less than that of a normal year before the war. NUTRITION. The state of nutrition of the children inspected in the different routine age-groups is set out in Table II, and does not show any appreciable change from pre-war years. Thus of the total number 3 of children inspected, 28.73 per cent. were classified as of excellent nutrition, and 59.06 per cent. as normal. The corresponding percentages for the previous year were 20.38 and 63.64, for 1940 28.38 and 60.1, and for 1939 30.1 and 59.8. While it must be remembered that the assessment of the state of nutrition of a child depends almost altogether on the personal judgment of the examining doctor, the fact that there has been no change in the medical staff during these years should indicate that the same standards of assessment have been used over the period. There is therefore no evidence that the nutrition of the children has depreciated during the years of war. At the lower end of the scale it will be seen in Table II that only four children have been classified as of bad nutrition, and that 204, or 11.96 per cent., have been classified as slightly subnormal. The corresponding percentages for the three previous years were 15.97, 11.1 and 9.8 respectively. SCHOOL CANTEENS AND THE PROVISION OF MEALS. There is little doubt that the provision of milk and meals at school has been a valuable factor in maintaining the nutrition of the children. Canteens were open throughout the whole year at White Hart Lane, Noel Park, Alexandra and Rhodes Avenue Schools, and at these Canteens a total of/184,343 mid-day meals were supplied. The average number of children taking advantage of these school meals was 925, distributed as follows, among the four Canteens : White Hart Lane, 150; Noel Park, 300; Alexandra, 300; and Rhodes Avenue, 175. The percentage of the elementary school population taking advantage of the school meals provided was just under 30. Excellent advantage was also taken of the opportunity of receiving milk at school, 83.7 of the total number of children availing themselves of this provision. In addition to this, 59,617 bottles of milk were provided free of cost to 195 children whose parents were not in a position to pay for it. From these figures it will be seen that during the third year of the war, a very great deal was being done by the Education Authority to mitigate the hardship which rationing entails on the school children, and, as I have already said, I am satisfied that this provision of meals and milk is of the greatest possible value in maintaining a satisfactory state of nutrition. It is to be hoped that both the School Canteen and the provision of milk at school will remain as a permanent feature of elementary school routine, and it is of the greatest importance that every effoit should be made to 4 increase the use made of the School Canteens during the present emergency. INFECTIOUS DISEASE. The following Table gives the number of cases of infectious disease notified from the elementary schools in 1942 and also those for the two previous years:— 1942 1941 1940 Scarlet Fever 66 32 41 Diphtheria 7 15 7 Chicken-pox 158 13 8 Measles 132 177 46 German Measles 1 2 126 Mumps 152 1 — Whooping Cough 22 68 5 Ringworm 4 1 — Skin Infections 29 10 — 571 319 233 The greatly increased number of notifications during 1942 was due almost entirely to the widespread prevalence of Chicken¬pox and Mumps, which together accounted for over three hundred notifications. SCABIES. The 29 cases of skin infections shewn in the table given above included a small number of cases of Scabies. These were notified from the schools, but a very much larger number were found at medical inspections or at the School Clinic, and it became evident early in the year that in Wood Green, as in most other districts, there was a very marked increase in the incidence of Scabies. With the consent of the Civil Defence Committee a Scabies Cleansing Station was established at the First Aid Post in White Hart Lane School, where treatment of all mothers and children found to be suffering from Scabies has been carried out by the Nursing Staff of the First Aid Post. From March to the end of the year, 282 cases in all were treated at the Aid Post, 166 of whom were school children. The preparation used for treatment has been Benzyl Benzoate Emulsion, which has given very good results. and the routine treatment now carried out is to give the patient a hot bath with 5 Soap and water, followed after drying by an application of the Benzyl Benzoate Emulsion with a further application next day. Every attempt is made to treat all the infested members of the family at the same time, and also to deal with the infected bed clothing by steam disinfection. Male adults found to be infected are sent to the Cleansing Station at Hornsey. The results obtained have on the whole been very satisfactory, and the Education Committee is much indebted to the personnel of the First Aid Post for the very useful service they have rendered to the school children in this matter. DIPHTHERIA IMMUNISATION. Immunisation was continued as in former years, but instead of paying special visits to the different schools for this purpose a regular immunisation session was held at the School Clinic once a week to which all cases for immunisation were invited. The number of children immunised during the year was 1,212, 730 of whom were under 5 years of age, and 482 of from 5 to 15 years. In concluding this report I wish again to express my thanks to the Education Committee for the support it has given to the School Medical Service, the Director of Education and his staff for their co¬operation at all times, and to all the members of my own staff for their loyal and willing service. Your obedient servant, MALCOLM MANSON, School Medical Officer. 6 APPENDIX. MEDICAL STATISTICAL TABLES, 1942. TABLE I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—Routine Medical Inspections. (1) Number of Inspections in the prescribed Groups— Entrants 749 Second Age Group 555 Third Age Group 401 Total 1,705 (2) Number of other Routine Inspections 350 Grand Total 2,055 B.—Other Inspections. Number of Special Inspections and Re-inspections 1,706 TABLE II. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Number of Children Inspected A (Excellent) B (Normal) C Slightly subnormal) D (Bad) No. % No. % No. % No. % 1,705 490 28.73 1,007 59.06 204 11.96 4 .23 TABLE III. GROUP I.—TREATMENT OF MINOR AILMENTS (excluding Uncleanliness, for which see Table V). Total Number of Defects treated or under treatment during the year under the Authority's Scheme 798 7 GROUP II.—TREATMENT OF DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments—Group I). Under the Authority's Scheme. Errors of Refraction (including squint) 549 Other defect or disease of the eyes (excluding those recorded in Group I) 61 Total 610 Number of Children for whom spectacles were— (a) Prescribed 241 (6) Obtained 220 Received Operative Treatment Nil Received other forms of Treatment 261 Total number treated 261 TABLE IV. DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist— (a) Routine age groups 3,033 (b) Specials 327 (c) Total (Routine and Specials) 3,360 (2) Number found to require treatment 1,973 (3) Number actually treated 1,820 (4) Attendances made by children for treatment 2,752 (5) Half-days devoted to— (7) Extractions— Inspection 31 Permanent Teeth 318 Treatment 333 Temporary Teeth 1,862 Total 364 Total 2,170 (8) Administrations of general anaesthetics for extractions 664 (6) Fillings— (9) Other Operations— Permanent Teeth 1,804 Permanent Teeth 542 Temporary Teeth 80 Temporary Teeth 790 Total 1,884 Total 1,332 8 TABLE V. VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses or other authorised persons 6 (ii) Total number of examinations of children in the Schools by School Nurses or other authorised persons 14,227 (iii) Number of individual children found unclean 61 (iv) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 — (v) Number of cases in which legal proceedings were taken— (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws 14 TABLE VI. BLIND AND DEAF CHILDREN. Number of totally or almost totally blind and deaf children who are not at the present time receiving education suitable for their special needs. The return should relate to all such children including evacuees resident in the Authority's area. At a Public Elementary School At an institution other than a Special School At no School or Institution Total not receiving suitable education Blind Children — - — Deaf Children — — — — 9