4 LIBRARY BOROUGH OF WOOD GREEN. ANNUAL REPORT of the Medical Officer of Health and School Medical Officer for the Year 1943. MALCOLM MANSON, M.C., G.M., M.A., M.D., D.P.H., Medical Officer of Health and School Medical Officer. 1944. Crusha & Son, Ltd. (T.U.)» Wood Green, Palmers Green, Enfield and Tottenham. woos 25 BOROUGH OF WOOD GREEN, PUBLIC HEALTH COMMITTEE. The Mayor, Alderman E. J. Ander.ton, L.D.S., J.P. [Chairman). The Deputy Mayor, Councillor A. R. Harrison, J. P. Alderman Mrs. J. J. Bolster, J. P. Councillor F. 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. M. Blue. Mrs. A. Knight. Mrs. E. C. Waghorne. 2 STAFF during 1943. * 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. 31st August, 1944. To the Mayor, Aldermen and Councillors of the Borough of Wood Green. Ladies and Gentlemen, I beg to submit my Annual Report as Medical Officer of Health for the year 1943. The Report is again a very short one, in accordance with the instructions of the Ministry of Health, and gives little more than an outline of the work of the Health Department during the year. The year has been uneventful so far as the health of the community is concerned. The vital statistics are satisfactory and do not suggest that the health of the community has been appreciably impaired by the privations of four years of war. There has not been any serious prevalence of infectious disease. The normal health services have been maintained without diminution. I have again to express my thanks to the Chairman and members of the Public Health and Maternity and Child Welfare Committees for the consideration and help I have received from them, and to all the staff of the Health Department 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 44,710 Number of inhabited houses (end of 1943, according to the Rate Books) 13,635 Rateable Value, 1943 £542,775 Sum represented by a penny rate £2,102 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births— Total. M. F. Legitimate 719 368 351 Birth Rate 16.8 per 1,000 Illegitimate 37 18 19 Still Births 15 10 5 Rate per 1,000 births 19.4 Deaths 553 264 289 Death Rate 12.3 per 1,000 Deaths from Puerperal Causes:— Puerperal Sepsis 1 Rate per 1,000 Births, 1.3. Other Puerperal Causes 1 Rate per 1,000 Births, 1.3. Deaths of Infants under 1 year of age:— All Infants 31 Rate per 1,000 Live Births, 41. Legitimate 31 Rate per 1,000 legitimate Live Births, 43. Illegitimate Nil. Rate per 1,000 illegitimate Live Births, — Deaths from:— Cancer (all ages) 97 Measles (all ages) Nil Whooping Cough (all ages) 1 Diarrhoea (under 2 years of age) 2 Number of Births notified 707 Number of Births Registered in the Borough 287 5 POPULATION. The estimate of population supplied by the Registrar-General is slightly lower than that for the previous year, and very much lower than that for the years just preceding the war. With the large number of men and women who have left the district to join the forces, and with the number who have evacuated for the period of the war, it is very difficult to arrive at a very accurate estimate of what the actual population is, but the estimate supplied is not likely to be very far from the truth. BIRTHS. The number of live births registered during the year was 756, which gives a Birth Rate of 16.8 per 1,000. This compares favourably with 704 and 15.7 the corresponding figures for the previous year, and the Birth Rate is the highest recorded in Wood Green since 1923. There were 15 still-births giving a Still-Birth Rate of 19.4. per 1,000 births. DEATHS. The number of deaths credited to Wood Green, after the necessary adjustments have been made for inward and outward transfers was 553. This gives a Death Rate of 12.3, which is very slightly lower than that for the previous year, which was 12.7. The individual causes of death are shown in Table III in the Appendix, and it will be seen that the principal cause of death was again heart disease, which was responsible for 129 deaths. Other diseases of the circulatory system were the cause of death in 25 cases, and intracranial vascular lesions in 52 cases, so that 206 deaths out of a total of 553 were attributed to diseases of the heart and circulation. Respiratory diseases, excluding pulmonary tuberculosis, were responsible for 79 deaths, while deaths due to tuberculosis numbered 25, as compared with 34 for the previous year. Cancer was responsible for 97 deaths. Only 3 deaths occurred from the principal zymotic diseases— enteric fever, smallpox, measles, scarlet fever, diphtheria, whooping cough and diarrhoea (in children under 2 years)—1 death from whooping cough and 2 from diarrhoea. The zymotic death rate was 0.06 per 1,000 of population. 6 INFANTILE MORTALITY. The number of deaths of children under 12 months was 31, and the Infantile Mortality Rate 41 per 1,000 live births. This is not so good as the rate for the previous year which was 37. Of the total of 31 infantile deaths, no fewer than 14 occurred in the first week of life, and 21 during the first month. MATERNAL MORTALITY. Two deaths occurred following miscarriage or childbirth, one due to puerperal sepsis and the other to toxaemia. The Maternal Mortality Rate was 2.6 per 1,000 births, an improvement on 5.6, the rate for 1942. MATERNITY AND CHILD WELFARE. The number of live births registered as belonging to Wood Green was 756. Of these the number which actually occurred in the Borough was 287, and in 238 of these cases the mother was attended by one or other of the Council Midwives at her confinement. It will be seen that almost 60 per cent. of the births belonging to Wood Green took place outside the district, for the most part in hospitals, or in maternity institutions in reception areas to which mothers were sent under the Government evacuation scheme. In spite of this fact the number of births notified was 707, 94 per cent. of all the births registered. CHILD WELFARE CENTRES. The increase in the birth-rate during the past two years has been reflected in the increased attendances at the infant welfare centres where the strain both on the staff and the accommodation has at times been severe. The total attendances at White Hart Lane Centre were 13,702 compared with 12,931 in the previous year and 10,814 in 1941, and the attendances at the Centre in Alexandra Park were 3,759 compared with 3,049 in 1942, and 2,023 in 1941. 7 The number of children brought to the Centres was 1,931, of whom 1,204 were infants under 1 year of age and 727 of from 1 to 5 years of age. The number of children seen by Dr. Miller at the Centres during the year was 1,862, of whom 1,187 were infants and 675 children of from 1 to 5 years of age. Of the 31 infantile deaths which occurred during the year in only 8 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 478. The Council Midwives attended 238 births in the Borough during the year. Forty-five women were sent to Maternity Hospitals for confinement under the normal hospital arrangements made by the Council while 63 were sent to Maternity Homes or Hostels in reception areas under the Government Evacuation Scheme. HOME VISITING. The Health Visitors made a total of 4,961 visits during the year. Of these 389 were ante-natal visits to expectant mothers, 2,148 to babies under 1 year of age, and 2,424 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 9 foster-mothers and 9 foster-children on the register at the end of the year. # Free Food Free food, consisting of dried milk and cod liver oil emulsion was issued during the year to necessitous expectant and nursing mothers attending the Centres at a cost of £36 9s. 8d. Cod liver oil and fruit juice were issued at the Child Welfare Centres by the staff of the Local Food Office. 8 War-time Day Nursery. The St. Michael's War-time Nursery in Bounds Green Road which was opened in June, 1942, with accommodation for 40 children was open throughout the year with an average daily attendance of 31. In November the new Nursery in White Hart Lane was opened with accommodation for 50 children. The average attendance during November and December was 24. The low attendances in this case were largely due to the prevalence of whooping cough in the district during the late months of the year. SANITARY INSPECTION OF THE AREA. The following table gives a very brief summary of the routine work of the Sanitary Inspectors during the year:— Inspections and Re-inspections of dwelling houses:— Total 2,543 Enquiries in connection with Infectious Diseases:— Total 247 Inspections of registered premises:— Total 1,488 Miscellaneous Inspections:— Total 967 Work Carried Out:— Drains reconstructed 6 Drains repaired 93 New water closets - Water closets repaired 96 Premises cleansed, etc. 1 Rooms disinfested 29 Accumulations of refuse removed 6 Keeping of animals discontinued - Dampness in premises remedied 275 House repairs 953 Miscellaneous 147 Total 1,606 H0trsE-t0-H0irsE Inspection. Number of houses inspected (Council houses):— Total 266 Kent Restrictions Acts. Certificates granted under above heading during 1943:— Total 2 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. 5 — 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 during the year:— Unfit for reason of Decomposition. 123 Meat Pies. 36 Pork Pies. 20 lbs. Sausage Meat. 5½ lbs. Meat Paste. 3¼ lbs. Luncheon Sausage Meat. 32 lbs. Pork and Beef Galantine. 12 lbs. Beef Chips (Sausages). 25 lbs. Bacon. 156 lbs. Rabbits. 2 stone Skinned Fillet. 9 stone Finnan Haddock. 1½ stone Ling. 5 stone Kippered Mackerel. 8 stone Megrims. 2½ stone Monk. 3½ stone Skate Wings. 1 stone Soles. 5 stone Whiting. 3 packets Dried Eggs. 10 Unfit by reason of Decomposition—continued: 640 small tins Egg Substitute. 1390 large tins Egg Substitute. 6 lbs. Self Raising Flour. 20½ lbs. Apple Cake. 20 lbs. Fruit Cake. 255 packets Rolled Oats. 56 lbs. Macaroni. 26 lbs. Blanc-Mange Powder. 500 Maggis Cubes. 73 packets "Convoy" Mixture. 122 cartons ' 'Viteem.” Preserved Food: 15 6-lb. tins Pork Luncheon Meat. 75 tins Meat. 218 tins Fish. 125 tins Vegetables. 351 tins Fruit. 39 jars and tins Meat and Fish Paste. 6 tins Soup. 21 jars Pickles. 1 bottle Sauce. 121 tins Milk. 8 jars and tins Jam. Unfit by being Contaminated with Broken and Powdered Glass: 16 Bun Loaves. 16 2s. 6d. Cakes. 90 1s. 6d. Cakes. 57 1s. Cakes. 25 bags Self Raising Flour. 8 bags Plain Flour. 18 lbs. Fruit Cake. 5 lbs. 7 ozs. Madeira Cake. 6 1 -lb. iars Jam. Unfit by being Contaminated with Moth Larvae and Pupae: 96 lbs. Split Peas. 21 lbs. Mixed Meal and Beans. 290 lbs. Semolina. 10 lbs. Tit-Bits. 12 packets "Glemar" Pudding. 11 INFECTIOUS DISEASE. Table IV in the Appendix gives details of the cases of infectious disease notified during 1943. The total 776 is rather higher than that for the previous years which was 689. The number is high very largely on account of the large number of notifications of measles and whooping cough. The infections generally were of a, mild type, no death occurred in 356 cases of measles, and only one death in 106 cases of whooping cough. There were 155 cases of scarlet fever notified and 26 of diphtheria, but no death from either disease, 1943 being the fourth year in succession in which no death from diphtheria has occurred in Wood Green. Thirty-four deaths occurred from pneumonia and 25 from tuberculosis. DIPHTHERIA IMMUNISATION. Immunisation against diphtheria was carried out as in former years, the number immunised during the year being 1,043. Of these 674 were under 5 years of age, and 369 from 5 to 15 years. The material used for immunisation in all cases was Alum Precipitated Toxoid provided free by the Ministry of Health. At the end of the year it was estimated that 60 per cent. of all children under 5 years of age, and 82 per cent. of children from 5 to 15 years had been immunised. SCABIES. Scabies continued to be prevalent in the Borough throughout the year although not to the same extent as in 1942. 284 cases in all received treatment at the First Aid Post in White Hart Lane School. Of these 130 were children of school age, 59 children under school age, and 95 adults. The preparation used was Benzyl Benzoate Emulsion, and the results have been very satisfactory. So far as the general cleanliness of the community is concerned, there is little evidence of any deterioration in this respect during the war years in spite of housing difficulties and the discomforts and crowding of shelter life. A few requests have been received during the year for advice or assistance in dealing with infestation by 12 head-lice from firms employing numbers of young women. So far as the children of the Borough are concerned, I am glad to state that the standard of cleanliness remains very high, and the number of children requiring attention by the Council's nursing staff has been very small. 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 11 297 308 Pulmonary Tuberculosis 5 83 88 Others 2 9 11 18 389 107 DISINFECTION AND DISINFESTATION The number of articles dealt with at the Disinfecting Station was as follows:— Articles disinfected 1,175* Articles destroyed 53 215 rooms were disinfected on account of infectious disease, and 88 rooms disinfested on account of the presence of vermin. *This figure includes 225 articles disinfected for Scabies. 13 APPENDIX. Table I. Vital Statistics of Wood Green, 1931-43. 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 1943 44,710 756 16.8 37 31 41 0 - 553 12.3 14 Table II. Birth-Rate, Death-Rate and Analysis of Mortality during 1943. 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 16.5 121 0 00 — 0.02 0.00 003 0.03 0.37 5.3 49 126 County Boroughs and Great Towns (including London) 18.6 14.2 0.00 - 0.02 0 00 003 0.04 0.36 7.9 58 148 Smaller Towns (populalation, 25,000-50,000 at Census 1931) 19.4 12.7 0.00 - 0.02 o.0o 0 03 0.04 0.37 4.4 46 London 15.8 15.0 0.00 — 0.02 0.00 0.03 0.02 0.27 10.4 58 Wood Green 16.8 12.3 0.00 — 0.00 0.00 0.02 0.00 0.22 2.6 41 15 Table III. Causes of Death during the year 1943. Causes of Death. Male. Female. Typhoid and Paratyphoid Fevers Cerebro-Spinal Fever — 1 Scarlet Fever — — Whooping Cough — 1 Diphtheria — — Tuberculosis of Respiratory System 12 10 Other forms of Tuberculosis 1 2 Syphilitic Diseases 1 3 Influenza 4 6 Measles — — Acute Polio-myelitis and Polio-encephalitis — — Acute Inf. Encephalitis — — Cancer of B. Cav. and Oesophagus—Male 5 — Uterus — 7 Cancer of Stomach and Duodenum 5 5 Cancer of Breast — 10 Cancer of all other sites 37 28 Diabetes 1 3 Intra-Cran. Vase. Lesions 21 31 Heart Disease 54 75 Other Diseases of Circulatory System 18 7 Bronchitis 20 19 Pneumonia 16 18 Other Respiratory Diseases 5 1 Ulcer of Stomach or Duodenum 8 1 Diarrohea under 2 years of age 2 Appendicitis 2 — Other Digestive Diseases 7 5 Nephritis 4 4 Puerperal and Post-Abort. Sepsis — 1 Other Maternal Causes — 1 Premature Birth 4 4 Congenital Malformations, Birth Injuries, Infantile Diseases 5 7 Suicide 2 Road Traffic Accidents 1 1 Other violent causes 8 9 All other causes 23 27 Totals 264 289 Table IV. infectious Diseases Notified during the year 1943. 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 155 - 37 91 17 5 1 3 - 1 - - 44 51 60 128 - Diphtheria 26 — 6 3 6 3 1 4 2 1 - - 5 7 14 25 — Cerebro-Spinal Fever 6 1 3 — — — — 1 — 1 - - 1 — 5 6 1 Enteric Fever — ' — — — — — — — — — — — — — Erysipelas 27 - - - - - - 2 3 7 8 7 11 7 9 8 — Pneumonia 47 2 5 3 3 — — 2 4 12 7 9 16 17 14 13 34 Acute Poliomyelitis — .—. — — _. — — — — - — Puerperal Pyrexia 2 — — — — — 1 1 — — 2 2 2 Pulmonary Tuberculosis 43 — 3 1 — 4 10 14 6 3 1 1 12 15 16 46 22 Non-Pulmonary Tuberculosis.. 3 - - - - 2 - - 1 - - - 1 1 1 - 3 Food Poisoning — — — — — — — — —. — — — Measles 356 16 179 141 12 1 2 2 2 — 1 — 124 119 113 14 — Whooping Cough 106 7 51 45 2 — — — —- 1 — — 31 49 26 7 1 Ophthalmia Neonatorum 2 2 - - - - - - - - — — 1 1 — 1 — Dysentery 3 1 1 -— — — — — — — — 1 1 1 1 3 — Totals 776 29 285 284 40 15 14 29 19 26 17 18 247 270 259 253 63 16 Table V. TUBERCULOSIS. New Cases and Mortality during 1943. Age Periods. New Cases. Deaths. Respiratory. Nonrespiratory . Respiratory Nonrespiratory . M. F. M. F. M. F. M. F. 0 - - - - - - - - 1 3 - - - - - - - 5 2 — 1 - - - - - 15 9 6 2 — 3 3 1 1 25 7 9 — — 1 3 — — 35 4 4 — 1 1 1 — — 45 2 1 — — 1 1 — — 55 1 — — - 2 1 — 1 65 and upwards — 1 — - 4 1 — — Totals 28 21 3 1 12 10 1 ' 2 Above includes transfers (7) from other Districts, 4 non-notified T.B. deaths occurred. 17 EDUCATION COMMITTEE. Chairman: Councillor T. A. Warburton. Vice-Chairman: Alderman Mrs. J. T. Bolster, T.P. Alderman F. G. Holmes, J.P. Councillor Mrs. J. Cole. Councillor F. Corbett, J.P. Councillor W. H. Evans. Councillor F. Hodge. Councillor A. Oliver. Councillor Mrs. L. C. Vant. Mr. H. J. Booker. Mrs. E. M. Bottom. Rev. W. E. Fielding. Mrs. S. L. Fowler. Mrs. H. S. Harrison. Miss C. M. Lightfoot. Mrs. M. V. Mackie. Rev. Father G. Mason. CARE AND AFTER-CARE SUB-COMMITTEE. Chairman: Alderman Mrs. J. J. Bolster, J.P. Councillor Mrs. J. Cole. Councillor Mrs. L. C. Vant. Mrs. A. M. Bennett. Mrs. E. M. Bottom. Mrs. E. L. Corbett. Mrs. H. S. Harrison. Miss C. M. Lightfoot. Mrs. M. V. Mackie. Mrs. A. Mclntosh. Mrs. E. C. Waghorne. Director of Education: C. H. Jarvis, M.A., LL.D. Wood Brecn Education Committee. SCHOOL MEDICAL SERVICE. ANNUAL REPORT, 1943. Public Health Department, Convent School, Earlham Grove, Wood Green, N.22. July 31st, 1944. To the Chairman and Members of the Wood Green Education Committee. Mr. Chairman, Ladies and Gentleman, I beg to present to you my Annual Report as School Medical Officer for the year 1943. The Report is again a very brief one— in accordance with the request of the Board of Education, and only the barest outline of the school medical service is given. MEDICAL INSPECTION. Table I in the Appendix gives the numbers of children inspected in the different age-groups at the routine medical inspections and also the numbers of special inspections and re-inspections. The numbers inspected were smaller than in the previous year, but in 1942 the number was very high, particularly in the entrant group. NUTRITION. Table II shows the state of nutrition of the children inspected in the different routine age-groups, and 1 am glad to say, that there is little change from previous years, and no evidence that the nutrition of the children has deteriorated during the years of war. The percentage of the children examined, who were classified as of excellent nutrition was 25.35 and of those classified as of normal nutrition 63.20. The percentage of children slightly subnormal nutrition was 11.12 and those classified as definitely of bad nutrition were only .3 per cent, of all the children examined. These percentages vary very little from those of previous years. 2 SCHOOL CANTEENS AND THE PROVISION OF MEALS AND MILK. There is little doubt that the maintenance of the nutrition of the average school child at a satisfactory level, is due in very large fact to the organised provision of meals and milk at school. Throughout the whole year Canteens were in operation at White Hart Lane, Noel Park, Alexandra, Lordship Lane and Rhodes Avenue Schools, and from August onwards there was also a Canteen at Bounds Green School. The average number of children taking advantage of the school meals was 1,475, and the total number of meals provided during the year was 267,979. The percentage of the elementary school children having school meals was just over 30, while the percentage taking advantage of school milk was as high as 83. The latter figure is very satisfactory, but the former not so satisfactory, and I should like to see a much higher proportion of the children taking advantage of the school dinners. In addition to the very large number of children receiving milk in school for payment, 171 children whose parents were not in a position to pay for milk were provided with 52,334 bottles of milk free of cost. It is obvious that the provision of school meals and of milk in school to such large numbers of children involves a great deal of organisation and hard work, much of which has to be borne by the teaching staff of the schools. The service rendered in this respect is in my opinion of the highest importance for the well-being of the children, and the teachers are in the best position to sec the beneficial results of this war-time service in which they take so active a part. INFECTIOUS DISEASE. The following Table gives the number of cases of infectious disease notified from the elementary schools in 1943 and also those for the two previous years :— 1943 1942 1941 Scarlet Fever 106 66 32 Diphtheria 9 7 15 Chicken-pox 79 158 13 Measles 132 132 177 German Measles 12 1 2 Mumps 50 152 1 Whooping Cough 44 22 68 Ringworm 3 4 1 Skin Infections 17 29 10 452 571 319 3 It will be seen that there was an increased number of notifications of Scarlet Fever in 1943. The disease was fortunately of a mild type. Diphtheria continues to be responsible for a very small number of notifications. DIPHTHERIA IMMUNISATION. Immunisation was carried on as in previous years, a regular session for this purpose being held at the School Clinic once a week throughout the year. The number of children immunised was 1,043, of whom 674 were under 5 years of age, and 369 of from 5 to 15 years. SCABIES. This disease continued to occur throughout the year in most of the schools, although not quite so commonly as in the previous year. Treatment was again available at the First Aid Post in White Hart Lane School, and during the year 130 children of school age received treatment. The children treated who were under school age numbered 59, and the adults 95, so that the total number receiving treatment was 284. The results obtained have been on the whole very satisfactory, and the service given by the personnel of the First Aid Post has been of very real assistance to the Committee's regular staff and of great value to the children. In concluding this very brief report, I wish to express my thanks to the Education Committee for the support it has given at all times to the School Medical Service, to the Director of Education and his staff for their co-operation during the year, and to every member of my own staff for their loyal and willing service. Your obedient servant, MALCOLM MANSON, School Medical Officer. 4 TABLE I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—Routine Medical Inspections. (1) Number of Inspections in the prescribed Groups— Entrants 477 Second Age Group 444 Third Age Group 400 Total 1,321 (2) Number of other Routine Inspections 262 Grand Total 1,583 B.—Other Inspections. Number of Special Inspections and Re-inspections 1,344 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 Slightlysubnormal) D (Bad) No. °/ /o No. % No. % No. % 1,321 335 25.35 835 63.20 147 11.12 4 .30 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 880 5 MEDICAL STATISTICAL TABLES, 1942. 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) 503 Other defect or disease of the eyes (excluding those recorded in Group I) 86 Total 589 Number of Children for whom spectacles were— (a) Prescribed 212 (6) Obtained 192 Received Operative Treatment 1 Received other forms of Treatment 258 Total number treated 259 TABLE IV. DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist— (a) Routine age groups .. 4,040 (b) Specials 401 (c) Total (Routine and Specials) 4,441 (2) Number found to require treatment 2,223 (3) Number actually treated 1,916 (4) Attendances made by children for treatment 3,199 (5) Half-days devoted to— Inspection 39 Treatment 378 Total 417 (6) Fillings— Permanent Teeth 1,940 Temporary Teeth 159 Total 2,099 (7) Extractions— Permanent Teeth 215 Temporary Teeth 2,164 Total 2,379 (8) Administrations of general anaesthetics for extractions 694 (9) Other Operations— Permanent Teeth 649 Temporary Teeth 1,202 Total 1,851 6 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. (1) At a Public Elementary School (2) At an institution other than a Special School (3) At no School or Institution Blind Children — — — Deaf Children — — — TABLE V. VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses or other authorised persons 7 (ii) Total number of examinations of children in the Schools by School Nurses or other authorised persons 22,778 (iii) Number of individual children found unclean 67 (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:— (а) Under the Education Act, 1921 (b) Under School Attendance Byelaws -