BOROUGH OF WOOD GREEN. ANNUAL REPORT of the Medical Officer of Health and School Medical Officer for the Year 1944. •a MALCOLM MANSON, M.C., G.M., M.A., M.D., D.P.H., Medical Officer of Health and School Medical Officer. 1945. Cruaha & Son, Ltd., Tottenham, Wood Green, Palmers Green and Enfield. Wood 26 BOROUGH OF WOOD GREEN. PUBLIC HEALTH COMMITTEE. The Mayor, Alderman E. J. Anderton, L.D.S., J.P. (Chairman). The Deputy Mayor, Alderman A. R. Harrison. 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 1944. * 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 San. Insp. Joint Board, Cert. Meat and Food Inspection. *Health Visitors.—Miss F. L. Orwin, S.C.M. ; Miss F. Medd, S.C.M. ; Miss G. Shaw, S.C.M. ; Miss I. P. Lucas, S.C.M. (commenced Oct., 1944). Chief Clerk.—G. W. Jones. Assistant Clerks.-—(W. T. Gloster, G. Penberthy, K. Overy, in H.M. Forces). Temporary appointments: G. Maidlow, resigned Sept., 1944, G. H. Osborn, commenced Oct., 1944, Mrs. G. Ogden, Miss V. Fellows. Clerk for Maternity and Child Welfare.—Mrs. Wass. Each of the Health Visitors holds a General Training Certificate and Miss Orwin, Miss Shaw and Miss Lucas, hold the Health Visitors Certificate. *Officers in respect of whom salary contributions are made under the Public Health Act by Exchequer Grants. 3 Public Health Department, White Hart Lanh (Old) School, Wood Green, N.2S. 17th September, 1945. To the Mayor, Aldermen and Councillors of the Borough of Wood Green. Ladies and Gentlemen, I beg to present to you my Annual Repor t as Medical Officer of Health for the year 1944. The Report is a short one, in obedience to the instructions of the Ministry of Health, and gives very little more than an outline of the work of the Health Department during the year. The year has been uneventful so far as the general health of the community is concerned. The vital statistics are good, the Birth Rate higher than in any year since 1920, and the Infantile Mortality Rate equal to the lowest ever recorded in Wood Green. There has been no serious prevalence of infectious disease, and the normal health services have been maintained without any diminution. I wish again to express my thanks to the Chairmen and members of the Public Health and Maternity and Child Welfare Committees for their consideration and help, and to all the members of the Health Department staff for their loyal co-operation throughout the year. I am 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 44,060 Number of inhabited houses (end of 1944, according to the Rate Books) 13,641 Rateable Value, 1944 £545,051 Sum represented by a penny rate £2.115 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births— Total. M. F. Legitimate 778 409 369 Birth Rate 18.7 per 1,000 Illegitimate 46 31 15 Still Births 19 14 5 Rate per 1,000 births 22.5 Deaths 564 301 263 Death Rate 12.8 per 1,000 Deaths from Puerperal Causes:— Puerperal Sepsis 1 Rate per 1,000 Births, 1.2. Other Puerperal Causes 1 Rate per 1,000 Births, 1.2. Deaths of Infants under 1 year of age:— All Infants 26 Rate per 1,000 Live Births, 31. Legitimate 21 Rate per 1,000 legitimate Live Births, 27. Illegitimate 5 Rate per 1,000 illegitimate Live Births, 108. Deaths from:— Cancer (all ages) 95 Measles (all ages) Nil Whooping Cough (all ages) 1 Diarrhoea (under 2 years of age) 3 Number of Births notified 742 Number of Births Registered in the Borough 307 5 POPULATION. The estimate of population supplied by the Registrar-General is again lower than that for the previous year, and very appreciably lower than that for pre-war years. So many men and women have left the district to join the Forces and so many others have been evacuated for the period of the war that it is difficult to arrive at a very accurate estimate of the actual population. The estimate suppied may, however, be regarded as reasonably accurate. BIRTHS. The number of live births registered during the year was 824, which gives a Birth Rate of 18.7 per 1,000 of population. This is appreciably higher than the rate for the previous year, which was 16.8, and is the highest recorded in Wood Green since 1920'. There were 19 still-births, giving a Still-Birth Rate of 22.5 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 564. This gives a Death Rate of 12.8, which is slightly higher than that for the previous year, 12.3. The individual causes of death are shown in Table III. in the Appendix.. It will be seen that, as in former years, the principal cause of death was heart disease, which was responsible for 141 deaths. Other diseases of the circulatory system caused death in 22 cases, and intra-cranial vascular lesions in 62 cases, so that out of a total of 564 deaths, no fewer than 225 were attributed to diseases of the heart and circulation. Diseases of the respiratory system, excluding pulmonary tuberculosis, were responsible for 71 deaths, and deaths due to tuberculosis numbered 24. The number of deaths certified as due to cancer was 95. Only 4 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 3 from diarrhoea. The zymotic death rate was 0.09 per 1,000 of population. 6 INFANTILE MORTALITY. The number of deaths of children under 12 months was 26, which gives an Infantile Mortality Rate of 31 per 1,000 live births. This rate compares very favourably with that for the previous year, which was 41, and is the same as that for 1941, the lowest ever recorded in Wood Green. Of the total of 26 infantile deaths, no fewer than 10 occurred within 24 hours of birth, and 18 occurred during the first month of life. Of the 10 occurring during the first 24 hours, 7 were certified as premature, and it is obvious that it is in the direction of reducing the number of deaths of premature children that our chief hope of reducing the Infantile Death Rate still further lies. Early in the year the Ministry of Health issued Circular 20/44, giving advice to Welfare Authorities on steps to be taken to provide special care for premature infants, and acting on this advice special equipment has been obtained, comprising special draughtproof cot, electric blanket-pad. hot water bottles, special feeding bottles, etc., and is available for issue where the premature baby and mother are nursed at home. MATERNAL MORTALITY. Two deaths occurred following1 childbirth, one due to puerperal sepsis and the other to toxaemia. The Maternal Mortality Rate was 2.4 per 1,000 births, practically the same as that for 1943, which was 2.6. MATERNITY AND CHILD WELFARE. The number of live births registered as belonging to Wood Green was 824. Of these the number actually occurring in the Borough was 294, and in 253 of these cases the mother was attended in her confinement by one or other of the Council's midwives. Almost 65 per cent. of the births belonging to Wood Green took place outside the district, many of them in hospitals or nursing homes in reception areas to which mothers were sent under the Government exacuation scheme. The number of births notified was 742, 90 per cent. of all the births registered. 7 CHILD WELFARE CENTRES. The total attendances at White Hart Lane Centre were 10,622, compared with 15,702 in the previous year and 121,931 in 1942, while at Alexandra Park Centre they were 3,012, compared with 3,759 in 1943 and 3,049 in 1942. The reduction in the number of attendances in each case occurred during the months when flying bombs and rockets were prevalent. At these times mothers were advised not to bring their children to the Centres any oftener than was absolutely necessary. The number of children brought to the Centres was 2,147, of whom 1,226 were infants under one year and 921 of from one to five years. The number of children seen by Dr. Miller at the centres during the year was 2,066, and of these 1,196 were infants and 870 children from one to five years. Of the 26 infantile deaths which occurred during the year, in only three cases had the baby been brought to one of the Centres. Ante-natal clinics were held at the White Hart Lane Centre on Tuesday afternoons and Friday mornings throughout the year. The number of expectant mothers who attended, was 445. Fifty-two women were sent to Maternity Hospitals for confinement under the normal hospital arrangements made by the Council, while 76 were sent to Maternity Homes or Hostels under the Government Evacuation Scheme. HOME VISITING. The Health Visitors made a, total of 5,322 visits during the year. Of these 287 were ante-natal visits to expectant mothers, 2,438 to babies under one year, and 2,597 to children of from one to five years. They also continued to act as Infant Life Protection Visitors, visiting all licensed foster-mothers and foster-children at regular intervals. There were 4 foster-mothers and 4 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 £25 16s. 1d. Cod-liver oil and fruit-juice were issued at the Child Welfare Centres with the co-operation of the staff of the local Food Office. 8 War-time Day Nurseries. Both war-time nurseries were in full use throughout the year, the average daily attendance at St. Michael's being 30.9, and that at the White Hart Lane Nursery 32.3. These nurseries have filled a very useful role in allowing so many mothers to engage in work of national importance, with the knowledge that their children were being well looked after while they were at work. The health of the nursery children has on the whole been very satisfactory, and there has been very little infectious disease in either nursery. 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 1,984 Enquiries in connection with Infectious Diseases:— Total 116 Inspections of registered premises:— Total 1,449 Miscellaneous Inspections:— Total 954 Work Carried Out:— Drains reconstructed nil Drains repaired 74 New water closets 1 Water closets repaired 55 Premises cleansed, etc. 6 Rooms disinfested 13 Accumulations of refuse removed nil Keeping of animals discontinued 2 Dampness in premises remedied 169 House repairs 449 Miscellaneous 194 Total 963 House-to-House Inspection. Number of houses inspected (Council houses):— Total 207 Rent Restrictions Acts. Certificates granted under above heading during 1944: — 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:— 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 by reason of Decompositon. 241 Tins of fish. 69 Tins of Meat. 13 Jars of Pickles. 29 Tins of Vegetables. 142 Tins of Milk. 1 Jar of Honey. 217 Eggs. 31 lbs. of Jam. 6½ lbs. of Cheese 11 Tins of Soup. 9 Tins of Beans. 3 lb. of Dried Fruit. 1,313 lb. of Fish. 540 Fish Cakes. 94 lb. of Sausages. 13 lb. of Pressed Beef. 9½ lb. of Pressed Pork. 12 Packets Pudding Mixture. 2 Jars of Fish Paste. 3 Tins of Mustard. 2 Tins of Coffee. 4 Tins of Meat and Vegetables. 10 Unfit by reason of Decomposition—continued: 40 Rabbits. 1 Bottle of Tomato Sauce. 1 Jar Soya Cream. 7 Tins of Fruit. 2 lb. of Ox Tongue. 1 Packet of Cocoa. 30 lb. of Cake. 26 Meat Pies. 40 lb. of Sausage Meat. Food rendered unfit by enemy action. 33 lb. Sausages. 402 Cakes. 19 Tins of Meat. 263 Pastries. 64½ lb. of Bacon. 25 Pies. 12 Sausage Rolls. 6 lb. Preserved Meat. 6 Fish Cakes. 169 Bottles of Cordial. 269 lbs. of Jam. 134½ lbs. Flour. 11 Packets of Dried Egg. 126 lb. of Sugar. 6 lb. of tea. 18 Bottles of Coffee. 154 Preserves. 3 Tins of Milk. 11 Tins of Fish. 16 Blocks of Salt. 246 lb. of Sweets. 408 Bars of Chocolate. 102 Packets of Cake Mixture. 4 lb. of Lard. 148 Packets of Cereals. 12 Packets of Lemonade. 1 Tin of Dried Milk. 83 Soup Squares. 16½ lb. of Lentils. 11 Food rendered unfit by enemy action—continued: 91 lb. of Split Peas. 31½ lb. of Pork. 15 lb. Sausage Meat. 88 Loaves of Bread. 190 Rolls. 4½ lb. of Rice. lb. Beans. lb. Barley. 25 Packets of Stuffing. 3,341 lb. of Vegetables. 34½ lb. of Biscuits. 840 lb. of Kippers. 2½ lb. of Fats. 1 lb. of Butter. 1¼ lb. of Spices. 1 Packet of Dried Herbs 8 Bottles of Vinegar. 6 lb. of Syrup. 4 Tins of Vegetables. 1 Packet of Blanc Mange. 44 lb. of Bread Crumbs. 70 lbs. of Dried Fuit. Unfit by being contaminated with broken and powdered glass. 17 lbs. of Sweets. Unfit by being contaminated with Moth larvae and pupae. 297 Soup Squares. 1 cwt. 3½ lbs. of Soya Flour. 448 Packets of Breakfast Food. 30 lb. of Dried Fruit. Unfit by being contaminated by Rats, Mice and Cats. 73 lb. of Chocolate. 24 1-lb. Packets of Sweetened Milk. 46 lbs. of Rice. 21 lb. of Haricot Beans. 19 lb of Butter Beans. 14 lb. of Cocoa. 7 lb. of Macaroni 37 lb of Sweets 12 RATS AND MICE (DESTRUCTION) ACT, 1919. The M.C.C.'s powers and duties under the above Act were delegated to the Wood Green Borough Council with effect from the 1st April, 1944. Pending the formal delegation, the Council agreed to act on behalf of the County Council as the statutory local authority as from the 1st February, 1944. Each of the three Sanitary Inspectors was appointed to administer the Act in his area, and Mr. J. Harris was appointed as Rodent Operative for the District. 220 Premises have been inspected, and it was found necessary to carry out treatment in 154 of these. 1,836 visits were made. LONDON SEWER RAT CAMPAIGN. As part of the campaign against rats and mice organised by the Infestation Branch of the Ministry of Food, a concerted attack was made by the 44 local authorities concerned on the rats in the area covered by the London County Council's main drainage system. The campaign was carried out in three stages. The first stage included the identification of all soil sewer manholes and side inlets, lifting and greasing the covers and clearing the benohings. The second and third stages were the pre-baiting and poison treatment periods. The Public Health Department and the Borough Engineer's Department co-operated in the carrying through of the campaign in Wood Green. Four squads of men were employed, each consisting of two men supplied by the Borough Engineer and one by Civil Defence. The preliminary stage was completed by the 11th December, 1943, and on the 13th December the first baiting treatment was commenced. 13 The campaign in Wood Green was completed on the 12th February, 1944. 664 manholes were baited. A total of 2,648 unpoisoned baits and 489 poisoned baits were laid, an estimated kill of 5,4212 rats being obtained. 1,648 unpoisoned baits and 162 poisoned baits were laid during the second treatment, with an estimated kill of 825 rats. The net result of this campaign, therefore, was that well over 6,000 rats were destroyed in the sewers in Wood Green. INFECTIOUS DISEASE. Table IV. in the Appendix gives details of all cases of infectious disease notified during 1944. The total of 527 cases is very much lower than the corresponding number for the previous year, which was 776. The incidence of infectious disease was very low, apart from measles and whooping cough, but in these diseases the infection was generally of a mild type, so that no death occurred in the 232 cases of measles and only one in the 134 cases of whooping -cough which were notified. There were 51 cases of scarlet fever with no deaths, and only 9 oases of diphtheria. For the fifth year in succession no death has occurred from diphtheria in Wood. Green. There were 24 deaths from tuberculosis and 3® from pneumonia. DIPHTHERIA IMMUNISATION. Immunisation against diphtheria was carried out as in former years, but the number immunised fell very much below that for the previous year, the fall being very largely due to interruption of the work during the period of fly-bomb and rocket activity. The number immunised was 516, 358 of these being under 5 years of age and 158 from 5 to 15 years. The material used in all cases was Alum Precipitated Toxoid, provided free by the Ministry of Health. At the end of the year it was estimated that 55 per cent. of children under 5 years and 88 per cent. of children from 5 to 15 years had been immunised. 14 SCABIES. Scabies continued to be prevalent in the Borough throughout the year, the incidence remaining practically unchanged from the previous year. Treatment was provided at the First Aid Post in White Hart Lane School for 277 cases. Of these 112 were adults, 116 children of school age, and 49 children under school age. 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 no evidence of any general deterioration in this respect. During the summer months large numbers of children of all ages were examined in connection with evacuation, and the number found to show any sign of lice infestation was very small indeed. Any children so found were promptly dealt with, and the Health Visitors and School Nurses keep a very close watch as a routine on the clean liness of all children coming under their care. The standard of cleanliness in Wood Green children is, I am glad to say, very high indeed. 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 4 196 200 Pulmonary Tuberculosis 3 72 75 Vincent's Organisms 3 4 7 Puerperal Infection — 1 1 Gonococci — 1 1 10 274 284 DISINFECTION AND DISINFESTATION. The number of articles dealt with at the Disinfecting Station were as follows:— Articles disinfected 1,056 Articles destroyed 26 106 rooms were disinfected on account of infectious disease, and 94 rooms disinfested on account of the presence of vermin. 15 Appendix. Table I. Vital Statistics of Wood Green, 1931-44. Year. (I) 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 1 i ve 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 1944 44 ,060 824 18.7 46 26 31 5 108 564 12.8 16 Table II. Birth-Rate, Death-Rate and Analysis of Mortality during 1944. Birth-rate per 1,000 population. Annual Death-Rate per 1,000 Population. Rate per 1,000 Births. All Causes. Typhoid and Paratyphoid Fevers. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under 2 years). Total Deaths under 1 year. England and Wales 17.6 11.6 0.00 0.00 0.01 0.00 0.03 0.02 0.12 4.8 46 126 County Boroughs and Great Towns (including London) 20.3 13.7 0.00 0.00 0.01 0.00 0.03 0.01 0.10 7.3 52 148 Smaller Towns (population 25,000-50,000 at Census 1931) 20.9 12.4 0.00 0.00 0.01 0.00 0.02 0.03 0.11 4.4 44 London 15.0 15.7 0.00 0.00 0.00 0.00 0.04 0.01 0.08 10.1 61 Wood Green 18.7 12.8 0.00 0.00 0.00 0.00 0.02 0.00 0.02 3.6 31 17 Table III. Causes of Death during the year 1944. Causes of Death. Male. Female. Typhoid and Paratyphoid Fevers Cerebro-Spinal Fever — — Scarlet Fever — - Whooping Cough — 1 Diphtheria — — Tuberculosis of Respiratory System 13 7 Other forms of Tuberculosis 1 3 Syphilitic Diseases 2 1 Influenza 1 - Measles - - Acute Polio-myelitis and Polio-encephalitis — - Acute Inf. Encephalitis — — Cancer of Buc. Cav. and Oesophagus—Male 7 — Uterus—Female - 3 Cancer of Stomach and Duodenum 10 4 Cander of Breast - 11 Cancer of all other sites 35 25 Diabetes - 3 Intra-Cranial Vascular Lesions 25 37 Heart Disease 70 71 Other Diseases of Circulatory System 13 9 Bronchitis 16 6 Pneumonia 24 14 Other Respiratory Diseases 4 7 Ulcer of Stomach or Duodenum 7 - Diarrhoea under 2 years of age 3 - Appendicitis 2 1 Other Digestive Diseases 6 6 Nephritis 5 5 Puerperal and Post-Abort. Sepsis — 1 Other Maternal Causes 1 Premature Birth 6 2 Congenital Malformations, Birth Injuries, Infantile Diseases 4 5 Suicide 4 2 Road Traffic Accidents - - Other Violent causes 21 17 All other causes 22 21 Totals 301 263 18 Table IV. Infectious Diseases Notified during the year 1944- 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 51 - 8 26 14 2 - 1 - - - - 18 16 17 36 - Diphtheria 9 - 1 — 2 3 1 - 1 1 — — 4 1 4 9 - Cerebro-Spinal Fever 3 - - - - 1 - - 2 - - - - - 3 3 - Enteric Fever — - - - - - - - - - - - - - - - - Erysipelas 15 - - - - - - - 3 4 7 1 4 10 1 3 - Pneumonia 26 1 1 4 1 — 1 2 2 <) 3 5 4 15 7 7 38 Acute Poliomyelitis 1 - — — 1 — — - — — — — 1 — — 1 — Puerperal Pyrexia 2 '- — — - — 1 1 — — — — — 1 1 2 1 Pulmonary Tuberculosis 44 - 1 — 1 9 5 11 10 2 3 2 12 16 16 46 20 Non-Pulmonary Tuberculosis 5 - 1 3 1 - - - - - - - 1 1 3 - 4 Malaria (Non-civilian) 1 - — — — — 1 — — — — — — — 1 — — Measles 232 7 115 102 5 2 — 1 — — — — 89 74 69 14 — Whooping Cough 134 16 02 23 2 — — 1 — — — — 27 49 58 5 1 Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - Dysentery 4 — — 1 1 — — 1 1 — — — 3 — 1 3 — Totals 527 24 219 159 28 17 9 18 19 13 13 8 163 183 181 129 64 19 Table V. TUBERCULOSIS. New Cases and Mortality during 1944. Age Periods. New Cases. Deaths. Respiratory, Non. respiratory. Respiratory. Nonrespiratory. m. F. m. F. m. f. m. F. 0 - - - - - - - - 1 — 1 1 — - - - 2 5 1 1 3 1 — — 1 — 15 8 6 — — 4 2 — 1 25 4 8 — — 2 2 — — 35 4 6 - - - - - - 45 1 1 — — 1 — — — 55 3 — — — 4 2 — — 65 and upwards 1 1 — — 2 1 — — Totals 22 24 4 1 13 7 1 3 Above includes transfers (2) from other Districts. 3 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. Mr. H. J. Booker. Councillor Mrs. J. Cole. Dr. C. W. Buckby. Councillor F. Corbett, J. P. Mrs. E. L. Corbett. Councillor W. H. Evans. Rev. W. E. Fielding. Councillor F. Hodge. Mrs. S. L. Fowler. Councillor A. Oliver. Mrs. M. V. Mackie. Councillor J. H. Tripp. Rev. Father G. Mason. Councillor Mrs. L. C. Vant. Miss W. Staff. CARE AND AFTER-CARE COMMITTEE. Chairman: Alderman Mrs. J. J. Bolster, J. P. Councillor Mrs. J. Cole. Mrs. E. L. Corbett. Councillor Mrs. L. C. Vant. Mrs. M. V. Mackie. Mrs. E. Bennett. Mrs. A. McIntosh. Dr. C. W. Buckby. Miss W. Staff. Mrs. E. C. Waghorne. Director of Education: C. H. Jarvis, M.A., LL.D. SCHOOL MEDICAL SERVICE STAFF. December, 1944. School Medical Officer.—Malcolm Manson, M.C., G.M., 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. (on Active Service); Miss G. M. Seal, L.D.S. ; J. B. Lyson, L.D.S. (parttime). School Nurses.—Miss B. M. Gray, S.R.N., C.M.B. ; Miss N. Gardiner, S.R.N., C.M.B. Speech Therapist.—Miss E. M. Dawson. Medical Visitation Officer.—Miss E. Mitcham. School Medical Clerks.—Miss G. Farrow; Miss Puttick (on Active Service). Dental Attendant.—Miss M. Freeman. Wood Green Education Committee. SCHOOL MEDICAL SERVICE. ANNUAL REPORT, 1944. Public Health Department, Convent School, Earlham Grove, Wood Green, N.22. July 21th, 1945. 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 1944. As this is the last of these reports which will be presented to the Wood Green Education Committee as a Part III Education Authority, I have thought it advisable to make the report a little more full than it has been during the years of the war, so as to put on record some account of the medical services which a Part III Authority for a district like Wood Green has been able to provide for the school children under its care. MEDICAL INSPECTION. Table I in the Appendix gives the number of children inspected in the different routine age-groups, and also the number of special inspections and re-inspections. The numbers inspected were rather larger than in the previous year. NUTRITION. Table II shows the state of nutrition of the children inspected in the different routine age-groups, and again there is practically no change from previous years and no evidence that there has been 3 any deterioration in the nutrition of the elementary school children in Wood Green during the years of war. The percentage of children classified as of excellent nutrition was 31,73, and of those classified as of normal nutrition 57.8. These two groups together represented 89.5 of the school children, the corresponding figure for the previous year being 88.5. 10 per cent. of the children were slightly subnormal and only .4 per cent. of bad nutrition. SCHOOL CANTEENS AND THE PROVISION OF MEALS AND MILK. I have stated in previous reports, and I wish to express the opinion again that the maintenance of the nutrition of the average school child at this satisfactory level is due in very large part to the provision of meals and milk at school. The average number of children having a mid-day meal at school varied throughout the year from 35 to 40 per cent. of the children in attendance at school, and the total number of meals provided during the year was 272,865. The percentage taking advantage of the provision of milk at school varied from 71 to 81 at different times during the year. In addition to the large number of children receiving milk for payment, 78 children who were recommended milk on medical grounds and whose parents were unable to pay for it, were provided with 20,686 bottles of milk free of cost. The provision of meals and milk at school necessarily involves a very great deal of organisation and work, much of it by the teaching staff of the schools. It is very gratifying therefore that advantage of it is taken by so many of the children, on whose health and well-being it cannot fail to have a beneficial effect. INFECTIOUS DISEASE. The following table gives the number of cases of infectious disease notified from the elementary schools in 1944, and also those for the two previous years. It will be seen that only three cases of diphtheria were notified, that the number of cases of scarlet fever was much lower than in the previous year, and that chicken-pox, measles, german measles and whooping cough were responsible for the great bulk of the notifications:— 4 1944 1943 1942 Scarlet Fever 41 106 66 Diphtheria 3 9 7 Chicken-pox . 124 79 158 Measles 64 132 132 German Measles 89 12 1 Mumps 5 50 152 Whooping Cough 77 44 22 Ringworm 7 3 4 Skin Infections 19 17 29 429 452 571 DIPHTHERIA IMMUNISATION. The number of children immunised during the year was 516, of whom 358 were under five years of age, and 158 of from five to fifteen years. These figures are appreciably lower than those for former years, very largely due to the evacuation of large numbers of children on account of flying bombs and rockets. SCABIES. Scabies continued to occur in most of the schools throughout the year, the incidence being practically the same as in 1943. Treatment was available at the First Aid Post in White Hart Lane School and during the year 277 cases were treated, 112 of these being adults, and the remainder children, of whom 116 were of school age and 49 under school age. The results of treatment have been good. and the service rendered by the personnel of the First Aid Post has been of great assistance. ARRANGEMENTS FOR TREATMENT. The arrangements made for the treatment of defects found at medical inspection or in children brought to the School Clinic have remained without any great change throughout the years of the war. Wherever possible parents have been expected to obtain treatment for their children privately from the family doctor, or at hospital, but where family circumstances made this impossible, provision has 5 been made by the Education Committee for the treatment of certain types of defect. At the School Clinic treatment is provided for minor ailments, dental defects, and defects of vision, hearing and speech. Tonsils and adenoids requiring operative treatment can be dealt with at the Prince of Wales's, the Royal Northern, or the North Middlesex Hospitals. Ultra-violet light treatment may be obtained at the North Middlesex or the Royal Northern Hospitals, and X-ray treatment for ringworm at the Royal Northern Hospital. (a) Minor Ailments. Five hundred and forty-nine children were treated at the Clinic for minor ailments. These comprise for the most part septic conditions of the skin, minor injuries, inflammatory conditions of the eyes, ears or nose and other like conditions which tend to receive insufficient attention at home, but may. if neglected, be injurious to the child's health. (b) Tonsils and Adenoids. Seven children were operated on during the year, under the Committee's scheme, for enlarged tonsils and adenoids. The children are admitted to hospital for a minimum of two nights, being admitted the day previous to, and discharged not sooner than the day after the operation. They are brought home in the Council's ambulance and visited at home by the School Nurse. (c) Visual Defects. The number of children dealt with by Dr. Boden at the Eye Clinic was 584. 215 of these had spectacles prescribed for them at the Clinic, and 190 of these had obtained their spectacles before the end of the year. (d) Ear Disease and Defective Hearing. The work of the Ear Clinic has been carried out as in former years by Dr. Clarke, who devotes a great deal of time and care to the treatment of conditions of the nose and throat as well as those of the ear. Zinc ionisation is used with excellent results in cases of discharging ears. Diastolisation has been used in large numbers of children suffering from nasal affections, many of them complicating 6 ear conditions, while in cases of infected nasal sinuses the Proetz method of displacement has been employed with success. He has also had good results from the suction treatment of enlarged tonsils, a method of treatment which often renders removal of the tonsils unnecessary. The following table gives a return of cases seen at the Aural Clinics during 1944. Acute non-suppurative otitis media 11 Acute suppurative otitis media (5 with double otorrhoea) 30 Chronic suppurative otitis media . 10 Rhinitis; nasal catarrh ; nasal obstructions 64 Sinusitis 16 Diseased or hypertrophied tonsils 36 Miscellaneous; epistaxis, wax, eczema 9 Total 176 Ears ionised for otorrhoea 10 Diastolisation 51 Displacement 16 Tonsil Suction 22 (e) Dental Defects. The work done by Miss Seal, the Dental Surgeon, is shown in Table IV. The scheme of dental inspection covers practically the whole elementary and secondary school population, but it is not possible, with one dental officer and one dental surgery, to inspect every child each year, and provide the necessary treatment for all who accept the offer of treatment. For many years it has been necessary to hold evening sessions for dental treatment of the secondary school children on account of the lack of a second dental surgery, and one of the most clamant needs of the School Medical Service is a new School Clinic with ample accommodation for dental and other services. (f) Defects of Speech. The Speech Defect Clinic has been held twice weekly throughout the year. There are two classes, one for children of twelve years 7 and over and the other for children under twelve. Each class is limited to eight children so that the total number of children dealt with is small, and each child receives individual attention. Progress is not usually very rapid, but the results obtained from speechtherapy are generally very good, and fully justify the expenditure of time and money on this type of defect. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. A register is kept of all defective children in the district and every effort is made to keep this register as accurate as possible. It is based very largely on the results of the routine and special medical inspections, but there are always a number of defective children who are unable to attend school, and for information about these children we are indebted to School Welfare Officers, School Nurses, Health Visitors and others. All defective children are kept under supervision and visited by the School Medical Officer at regular intervals. Where the defect is such that a special school is indicated, the necessary steps are taken to secure this provision. In concluding this Report, I would like to express my appreciation of the support and encouragement which the Education Committee has at all times given to the work of the School Medical Staff. I wish also to thank the Director of Education and his staff for assistance always readily given. Dr. Jarvis has been an officer with whom his colleagues in the School Medical Service have always worked most harmoniously and from whom they have always received every possible help, and their good wishes go with him in his well-earned retirement. Finally I wish to thank all the members of my own staff for their loyal and willing service throughout the year. I am, Your obedient servant, MALCOLM MANSON, School Medical Officer. APPENDIX. MEDICAL STATISTICAL TABLES, 1944. TABLE I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—Routine Medical Inspections. (1) Number of Inspections in the prescribed Groups— Entrants 570 Second Age Group 525 Third Age Group 406 Total 1,501 (2) Number of other Routine Inspections .. 354 Grand Total 1,855 B.—Other Inspections. Number of Special Inspections and Re-inspections 1,387 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. % 1,501 476 31.73 867 57.8 152 1.013 6 .4 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 549 9 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) 504 Other defect or disease of the eyes (excluding those recorded in Group I) 80 Total 584 Number of Children for whom spectacles were— (a) Prescribed 215 (b) Obtained 190 Received Operative Treatment 7 Received other forms of Treatment 190 Total number treated 197 ■ TABLE IV. DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist— (a) Routine age groups 3,650 (6) Specials 336 (c) Total (Routine and Specials) 3,986 (2) Number found to require treatment 2,024 (3) Number actually treated 1,482 (4) Attendances made by children for treatment 2,542 (5) Half-days devoted to— (7) Extractions— Inspection 40 Permanent Teeth 100 Treatment 344 Temporary Teeth 1,635 Total 334 Total 1,735 (8) Administrations of general anaesthetics for extractions 642 (6) Fillings— (9) Other Operations— Permanent Teeth 1,484 Permanent Teeth 583 Temporary Teeth 174 Temporary Teeth 828 Total 1,658 Total 1,411 10 TABLE V. VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses or other authorised persons 3 (ii) Total number of examinations of children in the Schools by School Nurses or other authorised persons 8,609 (iii) Number of individual children found unclean 114 (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 - (6) Under School Attendance Byelaws — 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 — — — 11