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to fuither the recommendations of the Circular the card index
system which the Health Visitors have for the children on their
district has been divided into three groups. Group A consists
of healthy children in satisfactory homes who need only to be
visited on the request of the mother ; Group B consists of healthy
children in reasonably satisfactory homes who will need to be
visited regularly every six months at least ; Group C are children
in unsatisfactory homes who need constant visiting and supervision.
Arrangements have also been made whereby Health Visitors
are informed of homes where school children have been excluded
from school on account of verminous conditions. On the whole
our investigations would show that the district of Enfield is reasonably
satisfactory, for which credit must be given not only to our
Health Visitors and School Nurses but also to the whole of the
Enfield teaching staff, and, of course, the parents. This does
not mean, however, that there is no room for improvement. In
Enfield individual attention to particular homes is now required
rather than mass propaganda to the district as a whole.
The real value of a maternity and child welfare service in a
district is easily assessed by reference to the condition of children
when they enter school at the age of five years. During the course
of the year I have attempted to see what the position is in Enfield.
Of the 453 children examined shortly after admission to school
77 per cent. had already been immunised against diphtheria. In
a further 6.6 per cent. there was some uncertainty because the
parents were not present at the routine inspection. This is a
figure which is reasonably satisfactory and may account for the
fact that only five cases of diphtheria were notified in the whole
district during 1943, not one of whom had been immunised against
this disease.
As regards the nutrition of our entrants 90 per cent. were
either of normal nutrition or of excellent nutrition; 8.7 per cent.
were found to be slightly below par and this percentage included
children who had recently had an illness temporarily reducing their
vitality. Six children, i.e., 1.3 per cent. showed malnutrition.
The children below par and those suffering from malnutrition
were followed up at our clinics.
As regards the throat condition of the entrants 71.3 per cent.
had normal throats, 10.1 per cent. had already had their tonsils
removed making a total of 81.4 per cent. Of the remainder, 6.6
per cent., i.e., 30 children needed to have an operation for removal
of tonsils and adenoids, leaving 12 per cent. who were placed on a
list for further observation.