Tottenham Urban District Council. REPORT on the Health of Tottenham FOR THE YEAR 1913. harringay : GREEN WAY & Co., T. U. Printers, 435 Green Lanes. 3 Cottcnbam Urban District Council. MEMBERS FOR THE HIGH CROSS WARD. Date o fRetirement. 1. Edward Thomas Elder 1916 2. Edward Thorold Garland 1915 3. John Hurdus Dobson, J.P. 1915 4. Albert Ernest Harvey 1914 5. William John George Bresson 1914 MEMBERS FOR THE MIDDLE WARD. 6. Albert Edward Beales 1916 7. Oliver Frederick Broadway 1916 8. William Henry Clench 1915 9. Edward William Cox 1915 10. Vacancy . 1914 MEMBERS FOR THE LOWER WARD. 11. Edwin Frost 1916 12. Frederick William Jones 1916 13. Isaac Akker 1915 14. Thomas Inglis 1915 15. John Barker 1914 MEMBERS FOR THE WEST GREEN WARD. 16. Philip Buck 1916 17. Frederick Joseph Hollier 1916 18. Charles Wieland 1915 19. Thomas Elderfield 1914 20. Edward Fyson Marchant 1914 MEMBERS FOR THE HARRINGAY WARD. 21. Harry Spencer . . 1916 22. Lister Clegg 1915 23. Mark John Sims 1915 24. Walter William Lewin, J.P. 1914 25. Patrick Bernard Malone, J.P. 1914 MEMBERS FOR THE ST. ANN'S ROAD. 26. Arthur Hume 1916 27. William James Turrell 1916 28. Thomas Francis Taylor 1915 29. Charles Edward Brown 1914 30. Frank Brooking 1914 4 Cottenham Urban District Council. Public Health Committee : Chairman : (Ex-Officio), Councillor P. Buck. (Vice-Chairman) of the Council). Members : (Ex-Officio), Councillor E. Frost, J.P. (Chairman of the Council). Councillor J. Barker. Councillor L. Clegg. Councillor W. H. Clench. Councillor T. Elderfield. Councillor A. E, Harvev. Councillor T. F. Tavlor. Representatives on the Middlesex Districts Joint Small Por Hospital Board. Councillor P. Buck. Councillor W. W. Lewin, J.P. Councillor M. J. Sims. Council's Representative on the Metropolitan Water [ Board, under the Metropolis Water^Het, 1902. Councillor P. B. Malone, J.P. 5 HEADS OF DEPARTMENTS. Clerb: —E. Crowne, Esq., F.C.I.S. Engineer and Surveyor:—W. H. Prescott, Esq., M.Inst.C.E., M.Inst. Mech.E., Barrister-at-Law. Treasurer :—E. Young, Esq., A.S.A.A. Clerk, Education Committee:—W. Mallinson, Esq. Superintendent, Fire Brigade:—S. M. Eddington, Esq. Librarian:—W. J. Bennett, Esq., F.L.A. PUBLIC HEALTH STAFF. Medical Officer of Health : David C. Kirkhope, M.D.,Ch.M., D.P.H., Barrister-at-Law. Male Sanitary Inspectors: *Redston, W. (Chief Inspector) Harringay Ward. (117 Broadwater Road). *Portman, W. C High Cross Ward. (16 West Road). *West, W. P. St. Ann s Ward. (33 Drayton Road). *Miller, H. W. Middle Ward. (117 Sperling Road). *SniLLito, J. A. Lower Ward. (32 Willoughby Park Road). *Smith, J. B.(Cert. San. insp. Exam. Board) West Green Ward. (86 Chester Road;. Female Sanitary Inspectors: Parsons, Mrs. J. E. (Cert. San. Insp. Exam. Board). * Lamb, Miss M. * The Officials so marked hold the Certificate of the Royal Sanitary Institute. † ,, ,, ,, Meat Inspector's Certificate. ‡ This Inspector also' holds the Diploma of the Incorporated Institute of Hygiene. Inspector under the Shops Hcts: Stacy, H. J. 6 Clerical Staff: Cozens, A. G., Senior Clerk. Baker, S. Office Clerks. Goddard, V. Garvey, R., Correspondence and Reports Clerk. (Cert. Royal Sanitary Institute). Mortuary Httendant : F. Smith, 72 Beaconsfield Road. Disinfectors: A. Pitney (Houses). j. Mitchell (Clothing). H. Bysouth ADDRESSES OF OTHER PUBLIC OFFICERS, MORE OR LESS CONNECTED WITH PUBLIC HEALTH WORK. Registrars of Births and Deaths : East Tottenham : Mr. H. J. Roynon, 664 High Road. West Tottenham : Mr. E. S. Chapman, 22 Langham Road. Relieving Officers: East Tottenham : Mr. A. J. Wrampling, 689 High Road. West Tottenham : Mr. J. Graville, 186 West Green Road. Public Vaccinators: Dr. W. H. Plaister, 632 High Road. Dr. W. Millar, 139 West Green Road. Dr. W. J. S. Ewan, 99 Philip Lane. Vaccination Officer: Mr. H. J. Roynon, 664 High Road. Coroner's Offieer : Mr. G. T. Gilli.ingham, 9 Arnold Road, Philip Lane. 8 INTRODUCTION to the ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH Public Health Department, Council Buildings, Tottenham. January, 1914 To the Chairman and Members of the Tottenham Urban District Council. Gentlemen, I beg to submit to you the Annual Report on the Health, Sanitary Conditions, and Vital Statistics of the District for the year ended 31st December 1913. I was appointed your Medical Officer on the 5th November, 1912, and commenced my duties on the 1st January 1913, so that this Report records the work of the Public Health Department during my first year of office. The Public Health (Tuberculosis) Regulations, 1912, came into operation on the 1st February, 1913, making all types of Tuberculosis notifiable to the Medical Officer of Health for the district within which the place of residence of the person is situate at the date of notification. 9 For purposes of administration, in relation to the Shops Acts 1912 and 1913, the District was divided into the "Harringay" and "Tottenham Remainder" areas, and Half-holiday Closing Orders have been made for Wednesday in respect of the former rea, and for Thursday with respect to the latter. A complete and revised register of shops has been prepared on the card index system. Tottenham participated largely in the widely prevailing epidemic of Scarlet Fever and Diphtheria during the last four months of the year. I have to thank the Chairman and Members of the Public Health Committee and of the Council for their unfailing courtesy and support. I am, Gentlemen, Your obedient Servant, David C. Kirkhope. 10 Geographical Position, etc. Tottenham is situated in latitude 51° 39' 59" N., and in longitude 0° 4' 31" W. from Greenwich. It is bounded on the East by Walthamstow in Essex (from which it is separated by the River Lee), on the West by Hornsey and Wood Green, on the North by Edmonton, and on the South by Hackney and Stoke Newington. The form of the Parish is irregularly trapezoidal. Tottenham is, with one exception, the most populous Urban District in Middlesex, and without any exception contains the greatest number of persons per acre ; the number of houses and inhabitants continues to increase at the exceptional rate which characterizes so many London suburbs. For the purposes of local representative government the Parish is divided into six Wards, viz. Harringay, West Green, St. Ann's, High Cross, Middle and Lower. Every Ward returns five members, thus making the total 30, of which the local Council is composed. Geology of the District. The range of chalk hills from Hungerford to Cromer dips gently beneath the sand to the South-east, while the range from Hungerford to Dover dips gently towards the North ; the chalk of the two ranges is connected, passing beneath Middlesex, Essex, Suffolk, and Norfolk, and even beyond • 11 them beneath the sea bordering" the coast of the three latter counties ; we are therefore to conceive the whole of this tract to be situated in a vast hollow in the chalk, which is geologically termed the chalk basin of London. The layer of sand which passes above this chalk from Hungerford to Dover is the very sand from which rises the water which supplies the wells of Tottenham. The fact appears to be that the water which falls on the sand where it is superficial (from Hungerford to within some distance of Tottenham), together with that which passes into it from the chalk, percolates the stratum of sand underlying the clay ; hence where an opening is made through the clay, the water rises nearly or quite to the surface, on the principle of seeking its level—the level of the sand at the foot of the chalk hills and of the clay at Tottenham being nearly the same (see Geological Map). The sand lies in a hollow in the chalk and the clay in a hollow in the sand. Robinson's " History of Tottenham." 12 13 GEOLOGICAL MAP. Summary of the more Important Vital Statistics for 1913. Arca of District 3,033 Acrcs. Population (Registrar General's Estimate) 145,736. Density 48.05 persons per acre. Births 3,781 (Birth Rate 25.9). Deaths 1,621 (Death Rate 11.1). Infant Mortality 339 Deaths under 1 year, equal to 89.6 per 1000 Births. Zymotic Death Rate 1.02 per 1,000 of the (7 principal Zymotic Diseases). Population. Death Rate from Phthisis 089 „ „ Death Rate from Diarrhoea 0.56 „ „ 15 GENERAL DISTRICT STATISTICS. RATES AND RATEABLE VALUE. Datk. Half Year ending Amount of Rates in the Amount produced by a Id. Rate (General) Rateable Value G. D. R. W. R. £ £ September, 1903 2/4 7d. 1,613 454,145 March, 1904 2/3 6d. 1,678 478 644 September, 1904 2/3 *3d. 1,709 478,492 March, 1905 2/2 — 1,727 483,360 September. 1905 2/2 — 1,772 493,517 March, T906 2/- — 1,803 502,360 September, 1906 2/- — 1.850 509,081 March, 1907 1/11 - 1,856 512,826 September, 1907 2/2 — 1,850 518,430 March, 1908 2/2 - 1.875 546,141 September, 1908 2/3 — 1,890 533.349 March, 1909 2 /6 — 1,895 536,220 September, 1909 2/6 - 1,900 543,079 March, 1910 2/4 - 1,902 544,660 September, 1910 2/2 - 1,910 549.625 March, 1911 2/2 - 1,920 552,105 September, 1911 2/2 - 1,930 555.005 March, 1912 2/3 - 1,950 554,145 September, 1912 2/2 - 2.000 563.295 March, 1913 2/1 — 2,015 570,584 September, 1913 2/- — 2.050 572,745 March. 1914 2/- - 2,120 578,662 * To June 24U1, 1904, only. POPULATION. The Registrar General Estimate that the population of Tottenham calculated to the middle of 1913 numbered 145,736. * * * * The Treasurer's figures, ascertained to November for rating purposes, show that there were 20,116 houses let to 16 one tenant, and that the number of tenements, or portions of houses let to and occupied by separate tenants, amounted to 7,251. The rate per inhabited house varied from 5.49 in the Lower Ward to 718 in St. Ann's Ward. The rate per inhabited tenement varied from 2.74 in the Lower Ward to 3.59 in St. Ann's Ward. Calculating" from the Treasurer's figures, the population in November would have been 147,838, without making any deduction for contingencies. * * * * The number of births during the year was 3,781, and the number of deaths amounted to 1,621, showing a natural increase in the population of 2,160. Chart showing incidence of Births and Deaths in Tottenham during the different months of 1913. Chart showing chief causes of Death in Tottenham, the recognised infectious diseases being coloured in red and the other diseases in black. 17 Acreage of Tottenham, 3,033. Year Houses Inhabited houses Population 1901 17,976 16,441 102,531 1902 18,536 17,341 106,535 1903 19,837 18,908 109,749 1904 20,667 19,467 112,981 1905 21,254 19,924 116,232 1906 23,613 21,606 119,503 1907 24,536 22,350 122,793 1908 25,230 23,015 126,146 1909 26,186 23,962 129,464 1910 26,953 24,193 132,303 1911 27,665 25,773 138,326 1912 27,995 26,744 142,015 1913 28,167 27.367 145,736 Return of Houses, etc., at November, 1913, as supplied to us by the Treasurer's Department. Ward Acreage Total No. of Houses Inhabited Houses Empty Houses Other Assessments Rateable Value High Cross 460 4.839 4,661 178 201 £ 110,698 Middle, East 475 2,821 2,735 86 108 47,498 Middle, West 165 2,876 2,819 57 124 53,168 Lower 950 4,857 4,724 133 243 84,890 West Green 471 3,797 3,726 71 100 71,422 Harringay 266 4,154 4,084 70 236 96,862 St. Ann's 246 4,823 4,618 205 168 73,853 Throughout — — — — 12 40,271 the Parish / Total 3,033 28,167 27,367 800 1,192 £578,662 28,167 18 BIRTHS. 3,781 births occurred during the year. That number falls short of the number for last year by two, and the birth rate has fallen from 26.6 to 25.9. 1,951 of the children born were males, and 1,830 females. The illegitimate births numbered 87, representing a percentage of 2.3. The percentage for 1912 was 2.6, for 1911 1.1, and for 1910 16. 3,312 births were notified in compliance with the requirements of the Notification of Births Act. Doctors notified 559, Midwives, 1,554, and 1,199 notifications were received from other sources. The total number of births registered in England and Wales was 881,480, giving a birth rate of 23.9 per 1,000. The rate for 1912 was 23.8, and that was the lowest on record. The declining birth rate in a district whose population is rapidly increasing calls for comment. It is the opinion of your Medical Officer that this anomalous condition does not arise from natural causes. Physiological rules cannot be violated with impunity, and it may well be that many afflictions which are becoming increasingly prevalent are due to irregularities of the kind suggested. 19 Ward Births Percentage to Population Harringay 556 2.58 West Green 500 2.63 St. Ann's 711 2.59 High Cross 618 2.41 Middle 737 2.57 Lower 659 2.78 Total 3,781 2.59 Quarterly Return of Births for the different Wards (1913). Harringay West Green St. Ann's High Cross Middle Lower Total March 137 117 165 166 198 161 944 June 149 152 210 168 196 182 1057 September 138 126 181 154 192 163 954 December 132 105 155 130 151 153 826 Total 556 500 711 618 737 659 3,781 20 Table showing number of Births in 1913 and Birth Rates—in Wards_ Ward No. of Births Population Rate Harringay 556 21,485 25.8 West Green 500 18,940 26.3 St. Ann's 711 27,406 259 High Cross 618 25,609 24.1 Middle 737 28,608 25.7 Lower 659 23,688 27.8 Total 3,781 145,736 25.9 Table showing number of Births and Deaths in District during the year 1913, in quarters. Births Deaths. Quarter to 31st March Males 464 220 Females 480 253 ,, 30th June Males 555 172 Females 502 176 ,, 30th September Males 482 208 Females 472 169 ,, 31st December Males 450 213 Females 376 210 Total Males 1,951 813 Females 1,830 808 3,781 1,621 21 Male and Female Births and Deaths Registered in the Fifty-second Week of each of the Seven Years 1907-1913. 1907 1908 1909 1910 1911 1912 1913 Births London Total Births 1548 1438 2182 1956 1864 1434 1345 Males 824 703 1137 1025 994 740 729 Females 724 735 1045 931 870 694 616 Tottenham Total Births 25 67 74 57 58 35 44 Males 10 26 38 23 29 10 26 Females 15 41 36 34 29 25 18 Deaths London . Total Deaths 1326 1038 1502 1358 1325 1249 1215 Males 689 515 773 656 701 637 623 Females 637 523 729 702 624 612 592 Tottenham Total Deaths 18 38 35 27 34 29 18 Males 12 19 13 12 17 16 6 Females 6 19 22 15 17 13 12 Excess of Births over Deaths for the last 10 Years. Years Population Excess 1904 112,981 2,176 1905 116,232 2,033 1906 119,503 2,001 1907 122,793 2,153 1908 126,146 2,197 1909 129,464 2,306 1910 132,803 2,184 1911 138,326 2,044 1912 142,015 2,188 1913 145,736 2,160 22 Births and Birth Rates, Deaths and Death Rates for the Towns named for the 53 weeks ended 3rd January, 1914. (Extracted from the Registrar General's Annual Summary). Town Estimated population to middle of 1913 Births Deaths Annual Kate per 1,000 living Births Deaths Tottenham 145,736 3,796 1,634 26.0 11.2 West Ham 294,223 9,282 4,335 31.5 14.7 Brighton 133,096 2,477 1,833 18.6 13.7 Portsmouth 241,256 5,989 2,998 24.8 12.4 Southampton 122,412 2,951 1,581 24.1 12.9 Norwich 123,288 2,760 1,740 22.3 14.1 Plymouth 133,083 2,695 1,790 20.2 13.4 Birmingham 859,644 23,876 12,857 27.7 14.9 Nottingham 264,735 6,110 3,805 23.0 14.3 Birkenhead 135,557 3,989 1,988 29.4 14.6 Liverpool 756,553 23,095 13,799 30.5 18.2 Bolton 183,879 4,036 2,931 21.9 15.9 Manchester 730,976 19,276 11,561 26.3 15.8 Salford 233,849 6,336 3,752 27.0 16.0 Oldham 149,936 3,535 2,564 23.5 17.0 Blackburn 133,971 2,968 2,124 22.1 15.8 Preston 118,070 2,862 2,037 24.2 17.2 Bradford 290,540 5,804 4,411 19.9 15.1 Sheffield 471,662 13,511 7,544 28.6 15.9 Hull 287,032 8,175 4,309 28.4 15.0 Sunderland 152,377 4,797 2,749 31.4 18.0 Newcastle-on-Tyne 271,295 7,479 4,149 27.5 15.2 Dublin 403,000 11,392 8,326 28.2 20.6 Belfast 396,000 11,280 7,647 28.4 19.3 96 Great Towns 17,852,766 455,059 260,155 25.4 14.5 23 DEATHS. The death rate for 1913 was 11.1 per 1,000, the lowest death rate since 1903. The total number of deaths amounted to 1,621. 1,428 deaths were registered in the District. From that number 262 is deducted, being the number of "non-residents" dying in Tottenham, and 455 is added, the number of "residents" who have died outside the district. Of the total number, 813 were males and 808 females. The following table gives the sex and age distribution :— Male. Female. Deaths under 1 year 196 143 , from 1—5 years 72 78 ,, ,, 5 15 ,, 33 32 ,, ,, 15 25 ,, 38 37 „ 25—65 291 274 ,, 65 and upwards 183 244 813 808 The corrected death rate, that is the recorded death rate multiplied by the "factor for correction of sex and age distribution," was 11.35. Measles, Whooping Cough, and Diphtheria accounted for the deaths of 66 young people. Tuberculosis in its 24 various forms caused fatal results in 164 instances. Deaths from malignant disease numbered 130, 71 of these occurring between the ages of 55 and 75. The deaths of 153 persons were registered as resulting from heart disease. Diseases of the respiratory organs, excluding Consumption, caused £21 deaths. Diseases of the gastro intestinal tract, exclusive of malignant disease, caused 110 deaths. L.G.B. Table III sets out fully the numbers of deaths in each age group, with their causes: Quarterly Return of Deaths for the different Wards (1913). Harrin gay West Green St. Ann's High Cross Middle Lower Total March 61 54 109 80 89 79 473 June 57 36 77 45 62 71 348 September 41 40 96 59 73 68 377 December 44 40 93 30 86 81 423 203 170 375 264 310 299 1621 Table showing Infantile Deaths for every Quarter of 1913 in Wards. Harringay West Green St. Ann's High Cross Middle Lower Total March 11 10 29 13 22 14 99 June 9 7 22 9 14 11 72 September 4 3 25 10 17 19 78 December 8 5 14 16 25 22 90 32 25 90 48 78 66 339 25 Table showing number of Deaths from Special Diseases during every Quarter of 1913. Ward Small Pox Scarlet Fever Diphtheria & Memb. Croup Enteric Phthisis Measles Whooping Cough Diarrhœa Total. Harringay March ... ... 1 ... 6 ... ... 1 8 June ... ... ... ... 6 ... 1 ... 7 September ... ... 1 ... 1 ... 1 2 5 December ... ... 1 ... 6 ... ... 2 10 Ward Total ... ... 3 ... 19 ... 2 5 29 West Green March ... ... ... ... 6 1 1 ... 8 June ... ... ... ... 5 1 1 ... 7 September ... ... ... ... 4 ... 1 ... 5 December ... ... ... ... 3 ... ... 2 5 Ward Total ... ... ... ... 18 2 3 2 25 St. Ann's March ... 1 ... ... 11 3 1 3 19 June ... ... ... ... 7 4 ... 4 15 September ... ... 1 ... 8 2 2 15 28 December ... ... 3 ... 7 2 ... 4 16 Ward Total ... 1 4 ... 33 11 3 26 78 High Cross March ... ... 2 ... 9 3 ... 1 15 June ... ... ... ... 1 ... ... 1 2 September ... ... 1 ... 5 ... ... 3 9 December ... ... 3 ... 7 1 ... 4 15 Ward Total ... ... 6 ... 22 4 ... 9 41 Middle March ... ... 2 ... 4 5 1 4 16 June ... ... 1 ... 3 ... ... 2 6 September ... ... 4 ... 6 2 ... 6 18 December ... ... ... ... 7 ... ... 6 13 Ward Total ... ... 7 ... 20 7 1 18 53 Lower March ... ... 1 ... 4 7 ... 3 15 June ... ... ... ... 7 1 ... 2 10 September ... ... 2 ... 4 ... ... 11 17 December ... ... 1 ... 4 ... 1 7 13 Ward Total ... ... 4 ... 19 8 1 23 55 Whole District Total ... 1 24 ... 131 32 10 83 291 26 Table showing number of Deaths in 1913 and Death Rates— in Wards. Ward No. of Deaths Population General Death Rates Infant Mortality per 1000 of the Population Infant Mortality per 1000 Births Harringay 203 21.485 94 1.4 57.5 West Green 170 18,940 89 1.3 50.6 St. Ann's 375 27,406 136 3.2 126.5 High Cross 264 25,609 10.3 1.8 77.6 Middle 310 28,608 10.8 2.7 105.8 Lower 299 23,688 12.6 2.7 1001 Total 1.621 145,736 111 2.3 89.6 Comparison of Tottenham's General and Zymotic Death Rates during the last 20 years General Death Rate Zymotic Death Rate 1894 130 1.9 1895 14.6 1.7 1896 13.2 2.5 1897 13.6 2.1 1898 14.6 2.3 1899 15.1 2.0 1900 14.7 2.4 1901 14.6 3.7 1902 13.4 2.1 1903 13.0 1.9 1904 13.8 1.9 (nearly) 1905 13.7 1.3 1906 12.4 2.1 1907 13.5 1.8 1908 12.5 1.7 1909 11.4 1.2 1910 11.4 1.3 1911 13.1 1.9 1912 12.2 0.7 1913 11.1 1.0 27 Table showing the Annual Deaths and Death Rates from Special Diseases during the Quinquennium, 1909-1913. Disease 1909 1910 1911 1912 1913 No. of Deaths Rate per 1000 No. of Deaths Rate per 1000 No. of Deaths Rate per 1000 No. of Deaths Rate per 1000 No. of Deaths Rate per 1000 Small Pox ... ... ... ... ... ... ... ... ... ... Scarlet Fever 10 .07 4 .03 1 .007 2 .014 1 .006 Diphtheria 22 .17 13 .09 14 .101 16 .112 24 .164 Typhoid Fever 1 .00 11 .09 3 .021 6 .04 ... ... Measles 16 .12 30 .22 65 .469 22 .154 32 .219 Diarrhœa 18 .13 14 .10 164 1.185 24 .169 83 .569 Phthisis 69 .53 74 .55 139 1.004 142 .999 131 .898 Whooping Cough 23 .17 31 .23 21 .151 33 .267 10 .068 Puerperal Fever 4 .03 3 .02 3 .021 4 .028 3 .020 Cancer 100 .77 93 .70 100 .722 109 .767 130 .892 Table showing Population, and General and Zymotic Death Rates for 1913, as compared with the Six Previous Census Years. Year Population of Tottenham Death Rate from all causes Death Rate per 1000 from 7 principal Zymotic Diseases 1861 13,875 19.3 3.4 1871 22.857 20.6 4.7 1881 46,441 16.9 2.8 1891 70,294 159 1.7 1901 103,243 14.6 3.7 1911 138,326 131 1.9 1913 145,736 111 1.02 28 Weekly Return of Deaths registered in Tottenham, 1913 Week ended Males Females Week ended Males Females Jan. 4 14 22 July 5 9 14 „ 11 16 21 ,, 12 7 11 ,, 18 11 11 „ 19 17 6 25 19 18 „ 26 10 8 Feb. 1 13 20 Aug. 2 17 7 ,, 8 19 18 „ 9 14 8 „ 15 16 17 ,, 16 16 17 ,, 22 18 17 „ 23 13 13 Mar. 1 19 18 „ 30 10 8 „ 8 14 14 Sept. 6 18 9 „ 15 12 16 „ 13 10 11 „ 22 17 22 „ 20 16 11 „ 29 15 21 „ 27 20 12 April 5 18 15 Oct. 4 5 12 „ 12 12 17 ,, 11 12 14 „ 19 19 24 „ 18 12 17 „ 26 11 9 „ 25 14 13 May 3 11 12 Nov. 1 17 21 „ 10 10 15 „ 8 16 18 „ 17 11 13 „ 15 14 13 „ 24 4 13 ,, 22 16 9 „ 31 12 4 „ 29 14 17 June 7 8 11 Dec. 6 16 14 „ 14 13 5 „ 13 18 19 ,, 21 9 14 „ 20 16 12 „ 28 12 8 „ 27 6 13 29 General, Zymotic and Special Disease Death Rates for each year of the Decennium 1904—1913. Year Births Deaths Zymotic Diseases Small Pox Measles Scarlet Fever Diphtheria Whooping Cough Enteric Fever Diarrhœa Cancer Infant Mortality 1904 31.8 13.9 2.14 .01 .36 .07 .20 .16 .06 1.28 .42 124 1905 30.9 12.8 1.31 ... .09 .04 .16 .54 .05 .43 .76 115 1906 31.1 13.8 2.18 ... .41 .15 .10 .18 .05 1.29 .65 131.7 1907 31.1 13.5 1.8 ... .32 .08 .09 .43 .03 .30 .72 100.0 1908 29.9 12.5 1.7 ... .31 .10 .15 .07 .04 .39 .74 95.55 1909 29.9 11.4 1.2 ... .12 .07 .17 .17 .00 .13 .77 88.63 1910 27.8 11.4 1.3 ... .22 .03 .09 .23 .09 .10 .70 86.5 1911 27.9 13.1 1.9 ... .46 .00 .10 .15 .02 1.18 .72 123.0 1912 266 11.2 0.7 ... .15 .01 .11 .26 .04 .16 .76 79.5 1913 25.9 11.1 1.02 ... .21 .006 .16 .06 ... 0.56 .89 89.6 In the above and previous similar tables the various rales have been corrected in accordance with the Registrar General's estimated population for the different years. INFANT MORTALITY. The birth rate continues to decline. The population increased by nearly 4,000 during the past year, and the number of births was reduced by 2. The birth rate for 1912 was 26.6, and for 1913, 25.9, The number of deaths of children under one year of age was 339, giving an infant mortality rate of 89.6 per 1,000. births, an increase of 10 per 1,000 over last year's rate. A comparison of this with last year's returns shows that gastro-intestinal disorders accounted for more than three 30 times the number of deaths this year. The exact numbers are 23 for 1912 and 72 for 1913. But lung diseases also caused a larger number of infant deaths, namely 62 for last year, 90 for this. There is some satisfaction, however, in being able to record a very considerable fall in the deaths from Prematurity and the debilitating ailments of infancy. Whereas the deaths from these causes in 1912 numbered 112, in 1913 they numbered only 86. I am confident that the saving of life in respect of those children born prematurely or whose environmental conditions seriously prejudiced the chances of survival, is largely due to the vigilance given and assistance afforded by the female staff, who visit the parents of the new-born. With the attention that they give personally and with the aid of such charitable agencies as they can invoke, there seems to be no reason why any child born in Tottenham should die from neglect. The weekly weighing of babies meets with increasing favour, but, unfortunately, the parents that we are most anxious should bring their infants to be weighed are those who show the greatest reluctance to attend. The mothers' dinners are well attended, and the scope of the Mothers' Welcome is being extended. The Doctors who attend give their valuable services willingly, the mothers receive a wholesome meal at little cost, and sewing classes are held where mothers are advised how they can 31 utilise their small incomes to the best advantage. The School has now received the official recognition of the Board of Education, and a grant in respect of it may be expected. It is with gratitude that we have to acknowledge the substantial help received from the Women's Imperial Health Association, but for whose assistance it would be impossible for the work to be carried on to its present extent. if at all. The annual amount we have received from that Association is £50, which goes far to pay the outlay in connection with the maintenance of the buildings wherein the mothers' classes are held and dinners dispensed. The following is a short resume of the work of the female staff in so far as it relates to infants :— Visits paid in connection with the Notification of Births Act 2,149 Re-visits 491 Babies Weighed 3,164 Particulars of Infant Feeding :— Babies entirely breast fed 1,387 Babies partly breast fed and partly hand fed :— Breast and Cows Milk 43 Breast and Nestle „ 29 Breast and Other Foods 19 — 91 Babies entirely hand fed :— Cows Milk or Glaxo 91 Nestles Milk 72 Other Foods 15 — 178 32 BREAST FEEDING. Advice to Mothers.- Keep yourself in good health. The health: of your baby depends upon your own during pregnancy. Take good and wholesome food at regular meals only. Do not take spirits, beer, stout, or much tea, but rather milk or cocoa. See that your bowels act every day. When possible take exercise in he open air every day, and keep your window open night and day. 1. Feed your Baby regularly, by the Clock, and not by Guesswork or whenever it Cries. Babies get indigestion, feel uncomfortable, and cry if they are not fed at regular times. 2. Never give your Baby a Dummy Teat. It is simply a bad habit, and dirty and dangerous. 3. As babies sometimes cry because they are thirsty, sips of warm water may be given. Breast Feeding. Mother's Milk is the Best, Cheapest, and Safest Food for Infants. 1. Get your baby into good and regular habits of feeding. Babiesform bad habits just as easily as grown-up people. 2. Keep the Child at the breast about ¼ hour at each feed. 3. Do not feed more often than every two hours during the day, and once between 11 at night and 6 in the morning. Never let the baby feed too fast. Wake the baby if asleep at feeding times. The time between feeds should be gradually increased until by the beginning of the third month the breast is given every three hours, and at the age of six months, five times in the day and not at all between 11 at night and 6 in the morning. The best times are 6 a.m., 10 a.m., 2 p.m., 6 p.m., and at 10 p.m. In this way the mother gets a rest at night, and so does the baby's stomach. 33 Weaning. Keep the baby on the breast entirely for nine months, if possible. Never wean during July, August, or September if you can help it. Wean slowly, giving first one feed of cow's milk a day, and then gradually increasing the number. Crusts of Bread with butter or dripping and a lightly boiled egg may now be added. From One Year Upwards. Do not give butcher's meat before the age of 18 months. Children must have no tea or stimulants, and such articles as pork, shell fish, "fried fish," lobsters, baked pastry, new bread and hot cakes, are liable to cause convulsions, and must be carefully avoided. They should have three or four meals a day, and no food or sweets should be taken between meals. Beer and Spirits are poison to a child, and must never be given. If you think the baby is not thriving on the breast, do not give up breast feeding before the age of 9 months without asking a doctor. Rules for Daily Use. Let the baby sleep in its own cot, and lie in it during the day. A banana crate, box, basket, or drawer serves equally well. If the child cries see if the napkin wants changing or if the baby is cold and not properly covered up. Never rock the baby. Wake the baby up at the proper time for feeding. Clothing. Give the baby a warm woollen vest with long sleeves, a soft knitted or flannel binder, a long flannel nightdress, and an outer dress. Do not use a tight or stiff binder. Never use flannelette. " Shorten " at 2-3 months old. Keep to the vest and one flannel petticoat and dress, but now put on warm stockings instead of socks. Bath the baby once a day, and wash it once a day as well, using very little soap. Dry thoroughly, especially in ears and all folds of skin. Undress and dress the baby quickly so that it does not catch cold. Babies must always be kept warm. The windows of the bedroom and living room, except at bath time, should always be kept open at the top, as wide as the weather will allow. 34 The baby should be kept out of doors in the daytime as much as possible, and may sleep out of doors in mild weather in a sheltered place. Do not give Soothing Syrups, Teething Powders, or Purges without the Doctor's Orders. Babies should be weighed regularly. If a baby cries often—does not increase in weight—does not sleep—is frequently sick—is constipated has diarrhoea—snuffles—has cold feet—has a discharge from the eyes —or has a rash on the body or under the napkin, it is not well, and. should be seen by the doctor. BOTTLE FEEDING. Note.—These directions are not intended to apply to those babies who are ordered a special diet by a doctor. Advice to Mothers. (See "Breast Feeding") Bottle Feeding. Give only milk until the baby is about nine months old. Do not give condensed milk or any other infant food, unless ordered by the doctor. Never give Separated or Skimmed Milk to a Baby. Milk. Get good fresh milk twice a day. Boil it at once, pour it into a clean jug, cover with a clean cloth, and stand the jug in cold water. In hot weather the water should be changed often so as to be as cool and fresh from the tap as possible. Bottle. Bottles with long tubes should never be used. Wash the bottle and teat thoroughly in hot water after each feed, and keep them in clean cold water until the next feed. When washing the teat turn it inside out and hold it under the tap. Feeding. Measure the milk carefully. Give the same amount at each feed, not more one time than another. If the child does not finish the food, what is left should not be given again to the baby. Give the milk warm. 35 From ¼ to ½ teaspoonful of fresh cream should be added to each feed, and the same amount of white sugar. About ½ teaspoonful of olive or cod liver oil should be given twice a day if no cream is put into the bottle. From Birth to Three Weeks Old. Never feed more often than every two hours in the day time, and once between 11 at night and 6 in the morning. At first the baby does not want more than one tablespoonful of milk and two tablespoonsful of water. By the time it is three weeks old it may be having 1 to 1½ tablespoonsful of milk and 2 of water. From Three Weeks to Three Months Old. Gradually increase the quantity at each feed up to 3 to 4 tablespoonsful of milk and 3 of water, and the times between feeds to every 3 hours by day and once between 11 at night and 6 in the morning. From Three Months to Six Months Old. By the time the baby is six months old it should take 6 to 7 tablespoonsful of milk and 2 of water at each feed. Do not feed more often than every four hours, and not at all at night. From Six to Nine Months Old. Gradually decrease the water until the baby is taking 8 to 10 tablespoonsful of milk and no water at each feed. A little orange juice or stewed apple may now be given. From Nine to Twelve Months Old. Continue to give milk, but crusts of bread with butter or dripping, and a lightly boiled egg may be added. From One Year Upwards. (See "Breast Feeding.") " Rules for Daily Use," etc. (See " Breast Feeding.") 36 INFECTIOUS DISEASES and Statistics relating thereto. SMALL POX. No case of Small Pox was notified during 1913. The immunity from Small Pox for many years has, apparently, set at rest the minds of the inhabitants of the district respecting the probability of an invasion. They have the vigilance of the Public Health Service alone to thank for their safety. Personal precautionary measures are being increasingly neglected, and no efforts of the Sanitary Authorities will be able to stay the ravages of the disease once an entrance is obtained for it. The protection afforded by vaccination is observed as much in the breach as in the acceptance, as the following figures show, and I am constrained to emphasize the danger to which the community is being exposed by the unpardonable neglect of parents to protect their children from Small Pox. The Vaccination Officer's return gives the number of vaccination certificates received for the year as 1,430. During the same period 1,419 declarations of "conscientious'' objection were returned. Nearly 50 per cent. of the children accounted for have therefore been denied the protection that vaccination affords. 37 Not infrequently infected ships reach our ports, and passengers and crew who show no symptoms of the disease are placed under no restraint. Sporadic cases are constantly occurring in different quarters of the Kingdom. The importation of the disease within this district would, in the existing state of affairs, set alight an epidemic that would be unsurpassed in its virulence and mortality. SCARLET FEVER. 591 notifications of Scarlet Fever were sent to us in 1913, but there were only 585 actual cases of the disease. One case only terminated fatally, giving a fatality rate (i.e. the percentage fatality amongst those affected) of .17 per cent. as compared with .62 in 1912; .4 in 1911; 1.5 in 1910; 1.7 in 1909; and 1.8 in 1908. The death rate from Scarlet Fever was .006, as compared with .04 in 1912, .007 in 1911, .02 in 1910, and .06 in 1909. The following table shows the incidence and mortality from the disease in the various wards. SCARLET FEVER. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Totals Harringay Cases 5 13 5 3 7 5 3 2 20 8 12 10 93 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... West Green Cases 8 5 6 2 2 2 2 7 3 10 22 7 76 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... St. Ann's Cases 2 3 5 5 3 5 7 3 5 7 8 4 57 Deaths 1 ... ... ... ... ... ... ... ... ... ... ... ... High Cross Cases 11 2 6 4 3 1 4 9 13 22 20 15 110 Deaths ... .. ... ... ... ... ... ... ... ... ... ... ... Middle Cases 2 7 2 5 5 ... ... 4 14 36 25 23 123 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... Lower Cases 1 3 3 5 5 5 15 20 22 27 20 126 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... 38 The attack rate per 1,000 of the population in the administrative County of Middlesex for Scarlet Fever in 1913 was 3.28, and for Diphtheria 1.43. Tottenham compared unfavourably with the County, its rates being 4.21 and 1.92 respectively. In point of population, Tottenham may be compared with Willesden, and the attack rates for Scarlet Fever and Diphtheria in the latter district (with a slightly larger number of inhabitants) were 3.24 and 1.49 respectively. In the neighbouring parish of Edmonton, where the population is rather less than half, the rates for these two infectious diseases were 6.82 and 1.86 respectively. The following list shows the attack rates for Scarlet Fever and Diphtheria in those towns whose populations most closely approximate to that of Tottenham. Town. Population. Scarlet Fever. Attack Rate. Diphtheria. Attack Rate. Sunderland 151,832 5.14 1.20 Oldham 148,839 6.30 0.62 East Ham 138,450 3.86 1.87 Blackburn 133,560 201 0.60 Birkenhead 133,427 4.08 1.07 Brighton 132,265 5.30 1.20 An epidemic of Scarlet Fever of a mild type began in the first week of September and continued into the first quarter of 1914. During the last three weeks in October and the first week in November respectively, the numbers of notifications received were 34, 35, 24 and 27. There appears to have been a general decline since then, although 39 the notifications in the last week of November numbered 33, and in the first week of December 26. This epidemic was of a wide-spread character, and the increase and decline in the weekly number of notifications was synchronous with the increase and decline in London as a whole. This general prevalence caused an unusual demand to be made upon the accommodation afforded by the Metropolitan Asylums Board's Hospitals for these cases. The Tottenham Urban District Council, in consideration of the payment of a certain sum to the Metropolitan Asylums Board, have secured the retention of 100 beds for patients coming from their area suffering from particular infectious diseases. This limited number of beds proved quite inadequate to meet the needs of the district in this epidemic, and many cases had to be nursed at home who ought properly to have been removed to Hospital. It is gratifying to record, however, that of the cases retained at home, none died. I may here be permitted to point out that the arrangement with the M.A.B. above referred to was entered into in the year 1894, when the population of Tottenham numbered about 74,000. The population has more than doubled since then, and the question whether the time has now arrived for more ample provision to be made for the isolation of the infectious sick is one worthy of your serious consideration. The epidemic commenced very soon after the opening of the schools. But the most careful investigation of the cases failed to show that the schools played any conspicuous part in the dissemination of the infection. About a dozen children with evidences of desquamation were excluded on 40 suspicion that they were convalescing from Scarlet Fever, but duplications in the class rooms from which they were removed were conspicuously absent. An unusually large number of multiple notifications, that is, two or more cases occurring in the same house, were received during the year, and especially during the latter part. In no less than 7.9 instances did we receive multiple notifications, dual 49 times, triple 22 times, quadruple 6 times, and quintuple twice. The largeness of the number was probably accounted for by the necessity of nursing so many cases at home, owing to the insufficient hospital accommodation. Eleven members of the staffs of the different hospitals in the district were affected. Scarlet Fever followed shortly upon the receipt of an injury in 5 cases, the injuries being burns, extraction of teeth (2), removal of tonsils, and dog bite. In 5 instances the patient arrived in Tottenham from a distance whilst incubating the disease. Eleven cases were traced to contact with members of other households suffering from the disease. Fifteen cases arose after the return home of Scarlet Fever patients from hospital. The time between the arrival of the patient from hospital and the onset of disease in the subsequent case or cases varied from three days to six weeks. When the period intervening between the arrival home of the discharged patient and the onset of disease in the subsequent case or cases extended to 5 or 6 weeks it was found that the former suffered from such conditions as discharging ears or nose, enlargement of glands, or desquamation. 41 Weekly Return of Cases of Scarlet Fever, Diphtheria and Enteric Fever Week ended Scarlet Fever Diphtheria Enteric Fever Jan. 4 6 2 1 „ 11 8 4 ... „ 18 9 11 l „ 25 6 6 ... Feb. 1 5 2 ... „ 8 8 8 ... „ 15 11 4 ... „ 22 8 3 ... March 1 8 6 ... „ 8 5 2 1 „ 15 4 1 ... „ 22 3 3 1 „ 29 8 7 ... April 5 3 2 ... „ 12 4 2 ... „ 19 4 2 ... „ 26 10 4 ... May 3 2 2 ... „ 10 4 1 ... „ 17 5 1 1 „ 24 8 3 1 „31 7 7 ... June 7 5 5 ... „ 14 2 2 ... „ 21 6 5 ... „ 28 2 3 1 July 5 4 3 ... „ 12 7 5 ... „ 19 4 4 1 „ 26 6 3 ... Aug. 2 11 4 ... „ 9 11 3 ... „ 16 5 3 ... „ 23 4 4 ... „ 30 9 3 ... Sept. 6 12 7 ... „ 13 27 3 ... „ 20 16 5 1 „ 27 20 8 1 Oct. 4 18 16 ... „ 11 30 6 ... „ 18 33 7 ... „ 25 24 10 ... Nov. 1 27 8 ... „ 8 19 4 ... „ 15 19 11 ... „ 22 20 10 ... „ 29 29 4 1 Dec. 6 27 12 ... „ 13 20 4 ... „ 20 15 7 ... „ 27 17 6 1 42 Special precautions to be observed when cases of Scarlet Fever, Diphtheria, Typhoid or other infectious diseases are nursed at home. 1.—Children from the house in which any infectious case of the above-mentioned kind is nursed, should not attend either a day or Sunday School, and any of the inhabitants suffering from "Sickness," sore throat, lumps in the neck, or peeling of the skin, should be immediately reported to the doctor. 2.—Notice of any library or school books in use on the premises should be given to the Public Health Department at the Municipal Buildings, so that arrangements may be made for their disinfection, and no new books should be borrowed until the rooms, bedding, clothing, etc., have been disinfected. 3.—The patient should be isolated in a well-ventilated room, situated as far from the noises of the house and street as possible, and no one except the person acting as nurse should be allowed to enter the room. All superfluous furniture, more especially of the soft variety, should be immediately removed from the room chosen. It is well also to have the floor mopped out, preferably with water containing some disinfectant, a fire should be kept burning day and night, and due precautions taken regarding the ingress of fresh and the egress of foul air. The nurse or nurses should wear dresses that can be easily washed, and are not too loose or soft in texture; they should, moreover, wash their hands after 43 every attendance on the sick person, and wash at least hands and faces, and change their outer clothes, when going off duty. No visitors, and especially no children, should be allowed in the infected house, and no domestic pets (and more especially no cats) should be allowed in the sick room. 4.—Special cups, saucers, glasses, spoons, forks, etc., should be kept for the patient, and all spare food left from the sick room immediately destroyed. 5.—Soiled linen, including underclothing, handkerchiefs, bedclothes, towels, diapers, etc., etc., should be immersed in a large pail of water, in which 8 or 10 ozs. of common washing soda has been previously dissolved, left to soak for a day, and then boiled in a copper. Materials which do not bear boiling should be placed in a liquid disinfectant for a couple of hours and then washed. Discharges from the mouth, nose, or ear should be received on rags or paper, which must be burnt forthwith. No dust should be allowed to accumulate in the room, and the floor ought to be moistened, preferably with a weak disinfectant solution, before dusting, and the dust collected burnt immediately. 6.—During convalescence, a daily warm bath is advisable, unless forbidden by the doctor for some special reason; the face, hair, and hands, in particular, should be thoroughly cleansed. 7.—In cases of Typhoid Fever nursed at home, particular care must be taken to receive both the stools and urine, as they are passed, into a suitable solution of Perchloride of Mercury, Carbolic Acid or other disinfectant, next to cover 44 the vessel containing them with a cloth soaked in disinfectant and allow it to stand for about half an hour before emptyingit (carefully) into the nearest W.C. No excreta or refuse of any kind from the sick room should find its way into the ashbin or be thrown upon the surface of any waste or other ground that may adjoin the premises. The Public Health Department undertakes the disinfection of the sick room, bedding, clothes, etc. free of all cost immediately the Medical Officer of Health is notified that the patient is considered free from infection by his Doctor moreover disinfectants are supplied gratis, to houses in which actual or suspected cases of infectious disease exist, on application at any of the three undermentioned places before 10.30 on any morning except Sunday. 1.—The Council's Depot, Clyde Road. 2. -Coombes Croft House, 712 High Road. 3.—St. Ann's Fire Station, Minster Road. DIPHTHERIA. What was stated last year in respect of this disease might be repeated this year, except that the numbers of cases of Scarlet Fever and Diphtheria have materially increased. 19G cases of Diphtheria were notified during 1912, and 258 cases have been notified during 1913. It is a recognised fact that epidemics of Scarlet Fever and Diphtheria run concurrently, and that has been the experience in this district. 45 The fatality from Diphtheria considerably exceeded that from Scarlet Fever, and basing our figures upon the cases which occurred during the year 1913, the fatality rate was 9.30 per cent. The deaths from Diphtheria numbered 24, which, with a population of 145,730, gives a death rate of 16. DIPHTHERIA AND MEMBRANOUS CROUP (1913). Number of Attacks, of Deaths, and Case Fatality at different ages. Ages Attacks Deaths Per cent. fatality Under one year 3 1 33.3 I to 2 years 7 3 42.8 2 „ 3 21 3 14.3 3 „ 4 „ 21 2 9.5 4 „ 5 „ 27 5 18.5 5 „ 6 „ 21 5 23.8 6 ,, 7 „ 22 3 13.6 7 „ 8 „ 19 1 5.2 8 ,, 9 „ 11 1 9.0 9 „ 10 „ 14 ... ... 10 „ 15 „ 40 ... ... 15 „ 20 „ 17 ... ... 20 „ 25 „ 14 ... ... 25 „ 35 „ 16 ... ... 35 „ 45 „ 3 ... ... 45 ,, 55 „ 2 ... ... 55 „ 65 „ ... ... ... Over 65 „ ... ... ... 258 24 9.3 46 During the year the weekly returns for Diphtheria reached two figures on six occasions only, viz.—in the weeks ended January 18th, October 4th and 25th, November 15th and 22nd, and December 6th. In the week ended October 4th, 17 cases were notified, that week appearing to indicate the acme of the invasion. What has been said respecting school influence in the case of Scarlet Fever cannot be repeated in respect of Diphtheria. A striking indication of the probability that children occupying the same class-room infect one another with the Klebs Lœffler Bacillus was afforded in one of our schools. Four children were notified as suffering from Diphtheria, who on enquiry were found to have attended the same class. With the aid of the Assistant School Medical Officer, bacteriological examination of the throat swabs of all the children in the class was made. On the day of the examination, a further case was notified from the same class-room. Three children then attending the class were found to be harbouring the germs in their throats, though manifesting no other symptoms of the disease. These were isolated, and no other cases were notified from that class. On following up those cases excluded there were found in each instance to have been suspicious indications of the disease having affected other members of the family. No fatality attended any of the cases kept at home on account of the inability of the Metropolitan Asylums Board to provide accommodation for them. Of course, it ought to be stated, that the worst cases were sent to the hospital, and as vacancies occurred there, the most urgent cases were first removed. 47 In 19 instances two members of the same family were affected, in two instances three, and twice four members suffered. From one house five persons were notified as suffering from Diphtheria, but these belonged to two families. Twelve members of the Hospital staffs contracted Diphtheria. In certain instances association with previous sufferers could be traced. A mother who visited her children at the hospital contracted the disease. A boy of 6 years of age had been resident in hospital for five months suffering from Scarlet Fever. A week after his discharge his brother and sister, aged 3 and 4½ years respectively, fell sick with Diphtheria and were removed to Hospital. The boy who had recovered from Scarlet Fever was taken by his mother to visit those in hospital, and was detained by the Hospital Superintendent because he was found to be suffering from Diphtheria. A Scarlet Fever patient returned from Hospital on 29th January. On 10th February a girl of 14 residing in the same house, but belonging to a different family, was removed to Hospital suffering from Diphtheria. I have reason to believe that great care is exercised before discharging convalescents from Hospital to ascertain that they are free from infection. Additional precautions are, however, necessary, and the occurrences referred to above point to the wisdom (1) of keeping children who have 48 returned from Hospital separate from susceptible persons for a period of weeks, and (2) of refraining from visiting patients in the Infectious Diseases Hospital except in the extremest emergencies, and then only when the greatest precautions have been taken to avoid contact with the patient. A boy of 13 was found by the M.O.H. to be suffering from a Tonsillar Diphtheria at the time of the routine medical inspection. Two patients came into the district while suffering from the disease. It was reported to the Sanitary Inspector that a child of 7 drank some water (which was not intended for drinking) from the school playground four days before the case was notified, and another child developed the disease four days after having brought home a stray cat. A girl admitted to a Tottenham Institution on 8th April, was removed thence on 2nd May to the Metropolitan Asylums Board Hospital suffering from Diphtheria. She recovered and went home to Chiswick. On 4th November she was readmitted to the Institution, and on 17th November was removed to Chiswick suffering from Scarlet Fever. The expense of nursing this patient during her first illness and the cost of her removal when she contracted Scarlet Fever in the second, consequently fell upon the Tottenham Council, although her home was in Chiswick, and she came into Tottenham for special treatment only. A visitor from the Midlands paid severely for her foolhardiness. Her child was brought to Tottenham 49 while suffering from Diphtheria in its incubation stage, or contracted the disease while on a visit to some friends here. Upon being acquainted with the nature of the child's ailment, the mother hastened back to her home, against the advice of the medical attendant. When the Inspector called and found that patient and mother were gone, enquiries were set on foot to learn the train by which they had travelled and their destination. The Medical Officer of Health of the district and the Railway Company were communicated with. The Railway Company's employees were able to identify the carriage in which mother and child travelled. That and the waiting room were disinfected. The cab that took them from the Station to their home was discovered and also disinfected. The mother contracted the complaint, was admitted to the Isolation Hospital, and narrowly escaped with her life. After her recovery she was prosecuted by the Sanitary Authority and heavily fined for contravening the provisions of the law relating to infectious diseases. Let me repeat, for the information of medical men in the district, what was stated in last year's report, that antitoxic serum is supplied, upon their requisition, at the Council Buildings, or, when these are closed, at the adjoining Fire Station. Also I would remind them that the bacteriological examination of throat swabs for the Diphtheria bacillus is undertaken by the Medical Officer of Health, and reports furnished to them with the least possible delay. It is 50 pleasing to your Medical Officer to record that expressions of appreciation of the value of the bacteriological reports to the Tottenham Practitioners have repeatedly been given, and he trusts that the usefulness of the laboratory will be extended. DIPHTHERIA. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Harringay Cases 7 7 2 2 3 1 2 1 8 5 1 1 40 Deaths ... ... 1 ... ... ... ... 1 ... 1 ... ... 3 West Green Cases 3 1 3 3 ... 1 1 ... 3 4 3 2 24 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... St. Ann's Cases 3 ... 2 1 3 2 1 1 3 11 11 6 44 Deaths ... ... ... ... ... ... ... ... 1 ... 2 1 4 High Cross Cases 7 4 7 3 1 3 6 7 4 10 6 11 69 Deaths ... 1 1 ... ... ... 1 ... ... 1 2 1 7 Middle Cases 2 4 5 ... 5 7 3 4 7 8 6 6 57 Deaths ... ... 2 ... ... 1 1 1 2 ... ... ... 7 Lower Cases 1 1 ... 1 2 1 2 2 ... 1 10 3 24 Deaths ... 1 ... ... ... ... 1 1 ... ... ... 1 4 ENTERIC FEVER. Eleven cases of Enteric Fever were notified during the year. Of the cases notified, one person had eaten winkles six weeks previous to onset of illness, and developed a rash at the time. The occupation of a second person affected was that of mussel vendor. Four patients followed occupations that took them outside the district Careful enquiry in every case failed to show that there was a common origin for any two, and long intervals intervened between the different notifications. 51 A child was notified as suffering from Continued Fever, and this case proved subsequently to be one of Enteric Fever. No deaths were recorded as resulting from Enteric Fever during the year. We have been unable to discover so satisfactory a record for any year for which figures are available. ENTERIC FEVER Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Harringay Cases ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... West Green Cases ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... St. Ann's Cases ... ... 1 ... 1 ... ... ... 1 ... ... ... 3 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... High Cross Cases 1 ... ... ... 1 ... ... ... 1 ... ... 1 4 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... Middle Cases ... ... ... ... ... ... ... ... ... ... 1 ... 1 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... Lower Cases ... ... 1 ... ... 1 1 ... ... ... ... ... 3 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... Table showing Percentage of Removals of all the Notifiable Diseases. Ward Cases Removals Percentage Harringay 145 85 694 West Green 112 59 52.6 St. Ann's 121 84 69.4 High Cross 198 138 69.6 Middle 207 111 53.6 Lower 169 103 60.9 52 Table showing Percentage of Removals of Cases of Scarlet Fever, Diphtheria, and Enteric Fever. Ward Cases Removals Percentage Harringay 133 85 63.9 West Green 100 58 580 St. Ann's 104 84 80.7 High Cross 193 138 71.5 Middle 181 111 61.3 Lower 153 102 66.6 Notifications and Cases of Infectious Disease. 1911 1912 1913 Notified Actual Cases Notified Actual Cases Notified Actual Cases Small Pox ... ... ... ... ... ... Diphtheria 127 111 198 196 258 252 Membranous Croup Erysipelas 108 103 77 77 76 76 Scarlet Fever 270 250 327 322 591 585 Enteric Fever 21 20 16 14 11 10 Puerperal Fever 12 12 4 4 7 7 Polio-myelitis ... ... 12 12 14 14 Pulmonary Tuberculosis ... ... 408 408 427 427 Cerebro Spinal Fever ... ... ... ... ... ... Total 538 496 1,042 1,033 1,384 1,371 53 Quarterly Return of Cases of Infectious Disease notified in the various Wards. Ward Small Pox Scarlet Fever Diphtheria Typhoid Fever Erysipelas Puerperal Fever Total Harringay March ... 23 16 ... 2 ... 41 June ... 15 6 ... 2 ... 23 September ... 25 11 ... ... 1 37 December ... 30 7 ... 4 ... 41 Ward Total ... 93 40 ... 8 1 142 West Green March ... 19 7 ... 1 ... 27 June ... 6 4 ... 1 ... 11 September ... 12 4 ... 3 ... 19 December ... 39 9 ... 3 ... 51 Ward Total ... 76 24 ... 8 ... 108 St. Ann's March ... 10 5 1 5 ... 21 June ... 13 6 1 2 ... 22 September ... 15 5 1 4 ... 25 December ... 19 28 ... 5 ... 52 Ward Total ... 57 44 3 16 ... 120 High Cross March ... 19 18 1 1 ... 39 June ... 8 7 1 3 ... 19 September ... 26 17 1 5 ... 49 December ... 57 27 1 5 1 91 Ward Total ... 110 69 4 14 1 198 Middle March ... 11 11 ... 5 ... 27 June ... 10 12 ... 3 1 26 September ... 18 14 ... 6 2 40 December ... 84 20 1 6 1 112 Ward Total ... 123 57 1 20 4 205 Lower March ... 7 2 1 2 ... 12 June ... 10 4 1 1 ... 16 September ... 40 4 1 2 1 48 December ... 69 14 ... 5 ... 88 Ward Total ... 126 24 3 10 1 164 54 MEASLES. The teachers of the Council Schools send weeklyreturns of children absent because of infectious diseases. These returns showed that 741 children suffered from Measles during the year. There was no actual epidemic prevalence during the year, but the epidemic that caused certain of the Infants' Departments to be closed during the extended Christmas holiday of 1912 had not entirely declined when the schools re-opened at the beginning of 1913. Although the number of notified cases fell short of the number notified in 1912, by 33, the mortality was higher by 10. The actual numbers were :— Cases notified in 1912 774 1913 741 Deaths during 1912 22 1913 32 The death rate from Measles per 1,000 of the population for 1913 was 0.219. The heaviest mortality was in the second year of life, when 14 died. The notifications give us timely notice of the occurrence of particular cases of Measles, and a school nurse visits the homes of the patients at once to recommend that medical assistance should be sought. 55 WHOOPING COUGH. 361 cases of Whooping Cough were notified voluntarily from the schools. We have no regular means of ascertaining the occurrence of Whooping Cough in children under school age, yet all the deaths from that disease, 10 in number, occurred in children under 5 years of age, 4 being in the first year of life. The death rate per 1,000 of the population was 0'068, as compared with 0'267 for 1912. 56 Deaths from Measles and Whooping Cough (in weeks). Week ended Measles Whooping Cough Week ended Measles Whooping Cough Jan. 4 1 ... July 5 1 ... „ 11 1 1 „ 12 ... 1 „ 18 ... ... „ 19 1 1 „ 25 1 ... „ 26 ... ... Feb. 1 1 ... Aug. 2 ... ... „ 8 1 ... „ 9 1 ... „ 15 ... ... „ 16 ... ... „ 22 1 ... „ 23 ... ... Mar. 1 2 ... „ 30 1 ... „ 8 1 ... Sept. 6 1 ... „ 15 1 1 „ 13 ... ... „ 22 1 ... „ 20 ... 2 „ 29 4 1 „ 27 ... ... April 5 1 ... Oct. 4 ... ... „ 12 1 ... „ 11 ... ... „ 19 1 ... „ 18 1 ... „ 26 1 ... „ 25 1 ... May 3 ... ... Nov. 1 ... ... „ 10 ... ... „ 8 ... ... „ 17 ... ... „ 15 ... ... „ 24 ... ... „ 22 1 ... „ 31 ... ... „ 29 1 1 June 7 ... 1 Dec. 6 ... ... „ 14 ... ... 13 ... ... „ 21 ... 1 „ 20 ... ... „ 28 ... ... „ 27 ... ... 57 DIARRHŒA. Diarrhœa and Enteritis caused 64 deaths in children under 1 year, 18 in children in their second year, and 1 in a child over 2 years of age, or 83 in all. The following table shows the distribution of the fatal cases in Wards, with the rate per 1,000 of the population. WARD. NO. OF DEATHS. DEATH RATE. W est Green 2 .10 Harringay 5 .23 High Cross 9 .35 Middle 18 .62 St. Ann's 26 .94 Lower 23 .97 The factors which seem to influence the incidence of Summer Diarrhoea most markedly are density of population and the atmospheric and ground temperatures The areas having the densest populations suffered most, and the week ended September 27th showed the heaviest mortality. The average atmospheric temperature (maximum) was 66-8 for the month of September, and the four foot thermometer registered an average temperature of 60.5. The number of deaths for 1913 (83) greatly exceeded that for 1912 (24), whereas in 1911 the deaths numbered 164, or, approximately, double the mortality for the year under review. The beneficent work of the Lady Sanitary Inspectors continues, and the leaflets upon child feeding, sent to parents, instruct them how children that cannot b breast-fed ought to be nourished, and particularly call attention to the urgency for medical treatment when diarrhœa is prevalent. Mortality from Diarrhœa and Enteritis antonq Children under 2 years of age per 1,000 Births in the following Towns in each week of the Third, or Summer Quarter of 1913. Town 13 weeks ended 27th Sept.'13 July 5th July 12th July. 19th July. 26th Aug. 2nd Aug. 9th Aug. 16th Aug. 23rd Aug. 30th Sept. 6th Sept. 13th Sept. 20th Sept. 27th London 54.0 9.8 18.7 15.9 257 22.5 34.2 44.5 57.1 81.9 92.7 107.7 102.1 89.4 West Ham 97.5 6.1 42.4 48.5 48.5 66.7 66.7 127.3 115.2 133.4 151.5 187.9 139.4 133.3 East Ham 27.3 ... ... ... 14.7 29.4 14.7 14.7 29.4 29.4 58.8 102.9 14.7 44.1 Portsmouth 41.6 8.8 8.8 8.8 ... 17.7 35.4 17.7 79.6 44.2 141.6 531 70.8 53.1 Southampton. 35.2 ... 36.4 ... ... 18.2 ... ... 36.4 ... ... 90.9 127.3 145.5 Norwich 45.4 20.4 20.4 20.4 ... ... 40.8 ... 40.8 122.4 61.2 61.2 142.9 61.2 Plymouth 74.8 ... 20.4 ... ... 40.8 81.6 244.9 102.0 102.0 122.4 102.0 40.8 122.4 Birmingham 84.9 15.8 9.0 22.6 33.9 27.1 43.0 79.2 90.5 147.1 135.7 176.5 176.5 147.1 Nottingham 75.7 ... 18.0 ... 27.0 9.0 9.0 81.1 81.1 81.1 198.2 180.2 144.1 153.2 Birkenhead 149.6 13.0 39.0 39.0 194.8 129.9 324.7 376.6 129.9 272.7 129.9 116.9 64.9 103.9 Liverpool 88.4 34.1 45.5 40.9 31.8 59.1 54.5 111.4 100.0 138.6 111.4 150.0 150.0 122.7 Bolton 89.2 25.6 ... 12.8 25.6 38.5 51.3 76.9 128.2 141.0 153.8 230.8 141.0 141.0 Manchester 70.8 8.0 15.9 29.2 18.6 47.7 63.7 108.8 103.4 108.8 90.2 119.4 111.4 95.5 Salford 61.2 8.1 32.3 32.3 8.1 16.1 32.3 80.6 72.6 32.3 121.0 145.2 121.0 96.8 Oldham 44.0 ... ... 15.4 46.2 30.8 ... 46.2 15.4 76.9 30.8 92.3 92.3 123.1 Blackburn 85.6 ... ... ... 35.1 17.5 70.2 17.5 87.7 122.8 228.1 210.5 228.1 87.7 Preston 66.7 ... 18.2 ... 18.2 36.4 36.4 18.2 36.4 109.1 54.5 218.2 181.8 145.5 Bradford 80.6 8.8 8.8 8.8 43.9 35.1 52.6 61.4 70.2 131.6 157.9 128.8 166.7 184.2 Sheffield 72.2 26.7 153 19.1 42.0 72.5 72.5 87.8 84.0 91.6 122 1 122.1 91.6 91.6 Hull 95.6 25.3 6.3 12.7 44.3 25.3 19.0 88.6 101.3 101.3 170.9 240.5 202.5 202.5 Sunderland 87.8 10.5 10.5 21.1 10.5 31.6 73.7 52.6 42.1 52.6 1684 263.2 147.4 252.6 Tottenham 40.5 ... ... ... 41.7 41.7 13.9 41.7 27.8 55.6 111.1 41.7 27.8 1250 59 ERYSIPELAS. 76 cases of Erysipelas were notified; 8 from Harringay, 8 from West Green, 16 from St. Ann's, 14 from High Cross, 20 from Middle Ward, and 10 from the Lower Ward. Two deaths resulted from this disease, both occurring in persons over 65 years of age. The death rate was therefore half that of last year. Some difficulty has been experienced in dealing with this disease when it occurs in homes where the patients cannot be nursed properly. It is hoped that some arrangement will be made soon to meet this difficulty. PUERPERAL FEVER. Seven cases of Puerperal Fever were notified during 1913 : four of these were in the Middle Ward and one each in Harringay, High Cross, and Lower Wards. Three deaths occurred from this disease, giving a death rate of 0 02 per 1,000. POLIOMYELITIS. 14 cases of Poliomyelitis were notified during the year. Particulars of all these were furnished to the Local Government Board at the request of that body. It will be interesting to learn whether any valuable result will arise out of this notification of this disease. Of all these cases only one could be said to be in the acute (and possibly the infective) stage, All the other cases 60 showed evidences of an antecedent ailment, in the paralysis, that remained; but none of them could be said to be in an infective condition at the time of notification. Some of the cases were taken to hospital for quite other ailments, and, presumably, because they were paralysed, were notified as suffering from Poliomyelitis. The question arises, is the payment of the notification fees by the Sanitary Authority for such cases justified, since it does not appear in the least probable that the Public Health will be in any way conserved by an acquaintance with these old cases. There were no duplications in the homes of those notified. No deaths from this disease were recorded. TUBERCULOSIS. The Public Health (Tuberculosis) Regulations, 1912, revoking the Public Health (Tuberculosis-) Regulations, 1911, and making all cases of Tuberculosis notifiable, irrespective of the seat of disease, are now in operation. Article XII. of the Regulations reads "Upon the receipt of a notification under these Regulations the Mtdical Officer of Health, or the officer of the Local Authority under the instructions of the Medical Officer of Health, shall make such enquiries and take such steps as are necessary or desirable for investigating the source of infection, for preventing the spread of infection, and for removing conditions favourable to infection." The circular letter accompanying the Regulations, from the Local Government Board, states "When a case is notified, enquiry 61 should be made to ascertain the state of health of all other members of the household." From the introduction of the Regulations on February 1st, 1913, till the end of the year, 591 cases were notified, some of them more than once; under the old Regulations 50 cases were notified during the first month of the year, giving a total for the twelve months of 641. Of these cases, 427 were of lung affection and 214 were of other forms of Tuberculosis. It is true that the Public Health Authorities cannot deal with a prevailing disease unless it is known to them where the particular sufferers from that disease reside and frequent, but it is equally true that only a fraction of these notified cases are infective. It is extremely doubtful whether many of the conditions notified are tubercular in character, for instance, enlarged cervical glands, otorrhœa, and catarrhal conditions of the lungs in children. Many are cases of closed tuberculosis e.g. glands, joints, lesions of the small bones, and consolidations of the lungs. Lesions of the lungs are of a higher degree of infectivity than skin, gland, bone and joint affections, indeed it is doubtful whether many of the latter have any infective character. Nevertheless all notifications receive the same attention, and much labour is spent in clerical work and in following up that is productive of little good. It in the first instance only cases demonstrated by bacteriological process had been made notifiable, and the energies of the Sanitary Authority concentrated upon these, there can be no doubt that the good results would have been more marked. Material advantage has been gained and much duplication of work has been averted by the co-operation of 62 the Public Health Department and the Tuberculosis Officer appointed to this district under the National Health Insurance Act. While the Sanitary Authority continues to exercise supervision over the sanitary conditions of the dwellings of the insured consumptives, the Tuberculosis Officer takes medical charge of the patients and contacts. The same enquiries are made respecting the notified sufferer by the Medical Officer of Health or Sanitary Inspector as are made by the Tuberculosis Officer or Tuberculosis Nurse, and whoever first receives the information passes it to the other official when he finds that the case properly belongs to the latter. Certain uninsured consumptives also receive the attention of the Tuberculosis Officer at the Central Dispensary, 50 Silver Street, Edmonton, and when the Dispensary is opened in Tynemouth Road, Tottenham, many more uninsured patients are likely to derive benefit from the treatment to be administered there. The site of the Tottenham Dispensary, located as it is in the immediate vicinity of the Prince of Wales's Hospital, seems to be well chosen, as the hospital has every equipment that will aid in the diagnosis of obscure cases and in the treatment of surgical and all other forms of Tuberculosis. The three beds that the Tottenham Urban District Council have at their disposal in the Clare Hall Sanatorium are constantly filled with the uninsured who are not in receipt of Poor Relief; but, unfortunately, owing to the long residence necessary to effect lasting benefit upon even the earliest cases, only a small number can be aided in the course of a year. One of the patients treated in one of these beds 63 died there during the year after a residence of nine months. Were a home established where sufferers in an advanced stage would be removed from houses that afford no accommodation for the necessary isolation, it would be a great boon both to the sufferers, since they would receive there such medical care as their various conditions require, decent food, and comfortable lodging, and the inhabitants of the houses from which they were derived would be released from the danger of having the disease communicated to them. Verbal and printed instructions are given to patients, urging upon them the great necessity of observing hygienic measures, but it cannot be said that they are observed as they ought to be. Scrupulous cleanliness, the open window, healthy exercises, and simple, wholesome food are desiderata that are unattainable by the average poor consumptive, or do not appeal to him. If the ambulant sufferer were persuaded to avoid crowded and particularly dark and crowded places of public resort it would be conducive to his own health and the health of others. Deaths from Pulmonary Tuberculosis numbered 131, the death rate being 0"89. The following table shows the ages at which death occurred in our cases. 64 PHTHISIS (DEATHS). Male Female 4 months 2 years 5 ” 5 8 years 31 14 16 15 3 at 17 2 at 18 18 3 at 19 19 20 2 at 21 2 at 22 2 at 22 3 at 23 24 3 at 24 2 at 28 25 29 3 at 26 2 at 31 27 2 at 32 5 at 28 4 at 33 3 at 29 34 30 2 at 35 32 36 4 at 33 37 35 2 at 38 36 2 at 39 2 at 38 40 39 41 40 3 at 43 3 at 41 2 at 44 2 at 42 45 44 47 2 at 45 48 46 3 at 50 2 at 47 52 3 at 48 54 49 56 2 at 52 57 3 at 57 2 at 58 2 at 58 2 at 59 60 61 61 68 62 71 65 73 68 72 Total 72 Total 59 65 The following table shows the number of cases notified from each Ward of the district. PULMONARY TUBERCULOSIS. Jan. Feb. Mar. April May June Jn'y Aug. Sept. Oct. Nov. Dec. Total Harringay Cases 4 7 3 ... 3 2 5 2 2 6 4 6 44 Deaths 2 3 1 2 1 3 ... ... 1 ... 3 3 19 West Green Cases 9 10 7 3 5 6 2 2 2 8 2 5 61 Deaths 2 2 2 2 2 1 1 1 2 1 1 1 18 St. Ann's Cases 9 15 18 5 7 8 3 4 11 8 4 9 101 Deaths 2 5 4 2 3 2 2 1 5 5 2 33 High Cross Cases 10 9 7 5 6 5 6 7 5 6 2 3 71 Deaths 5 3 1 1 3 1 1 4 1 2 22 Middle Cases 11 7 11 6 2 5 7 4 9 15 5 5 87 Deaths ... 1 3 ... 1 2 2 3 1 1 3 3 20 Lower Cases 7 12 9 2 7 4 5 ... 6 2 5 4 63 Deaths 2 2 3 2 2 2 1 1 1 3 19 TUBERCULOUS DISEASES OTHER THAN PULMONARY TUBERCULOSIS. The deaths notified under this heading numbered 33, as compared with GO last year: the death rate was, therefore, 22 per 1,000. Last year it was .42 per 1,000. Tuberculous Meningitis caused 20 deaths, and the following table gives the distribution of the other 13 cases according to the various organs affected. General Tuberculosis 3; Kidney and Bladder 2; Throat 2; Tubercular Peritonitis 2; Mesenteric Glands 1; Abdominal 1; Dorsal Vertebrae 1; Tubercular Pneumonia 1. DISEASES OF THE RESPIRATORY SYSTEM. Pneumonia caused 154 deaths, Bronchitis 147, and other diseases of Respiratory Organs 20. These numbers closely 66 correspond with those of last year. The extremes of life suffered most severely, 86 deaths occurring in persons over 65 years, and 123 in children under two years. The death rate from Pneumonia was 1.0 and from Bronchitis 1.0. CANCER. 130 deaths resulted from malignant disease: 66 cases were of males, and 64 of females. The organs affected were as noted:— CARC1NOMATA. males. females. Urogenital System 5 17 Breast - 13 Digestive Organs (including Pancreas and Liver) 10 4 Gastro-intestinal 26 20 Respiratory (including Larynx) 5 1 Mouth, Tongue, Pharynx 'and CEsophagus 13 1 Mediastinum 1 Jaw 3 1 Abdomen - 1 Spine — 1 Undefined 1 2 SARCOMATA. Bone 2 1 Eye — 1 Lymphosarcoma — 1 All the deaths except 4 occurred in patients over 35 years of age, and the greater number of these over 55. 67 The following table shows the distribution of the deaths in the different wards of the district and months of the year. CANCER. Jan. Feb. Mar. April May June J«iy Aug. Sept. Oct. Nov. Dec. Total Harringay 1 1 1 1 2 I 3 2 1 1 2 16 West Green 1 3 1 1 1 3 2 2 2 2 1 3 22 St. Ann's 1 2 2 ... 1 2 2 2 2 ... 1 15 High Cross ... 1 1 3 ... 1 1 2 4 2 1 4 20 Middle 3 2 1 3 2 3 2 1 3 4 2 4 30 Lower 2 1 3 1 1 3 2 3 2 2 4 3 27 Total 8 10 9 9 7 12 8 13 15 13 9 17 130 VIOLENCE. There were 53 Deaths from violence, 6 of these being suicidal. 52 deaths resulted from a similar cause last year. 33 of this year's deaths occurred among males, and 20 among females. 8 fatalities were due to drowning, 7 to being knocked down (3 by Motor 'bus, 2 by train, 1 by tram car, and 1 by bicycle), 7 to falls, 6 to suffocation in bed, 4 to burns, 2 to hanging, 2 to blows on head, 2 to cut throat, 2 to coal gas poisoning, 2 to scalds, 2 to bullet wounds (one being a murder), and the remainder to various other causes. L.G.B. Table 1. Table showing the Population, Birth Rate, and Death Rate from all causes, in Tottenham during the last six years. Year Population estimated to Middle of each Year Births Total Deaths Registered in the District Deaths of Nonresidents registered in the District Deaths of Residents not registered in the District. Nett Deaths belonging to the District Uncorrected Number Nett Under 1 Year of Age At all Ages Number Rate Number Rate Number Rate per 1.000 Netc Births Number Rate 1 2 3 4 5 6 7 8 9 10 7 i 12 13 1908 126,146 ... 3778 29.9 1545 12.2 235 271 361 95.5 1581 12.5 1909 129,464 ... 3792 29.9 1387 10.7 201 299 336 88.6 1485 11.4 1910 132,803 3699 3696 27.8 1372 10.3 190 333 320 86.5 1515 11.4 1911 138,326 3781 3861 27.9 1747 12.6 312 382 475 123.0 1817 131 1912 142,015 3687 3783 26.6 1415 10.0 272 452 301 79.5 1595 11.2 1913 145,736 3718 3781 25.9 1428 9.8 262 455 339 89.6 1621 11.1 69 Notes to (L.G. B.) Table 1. The nett rate is the true one, as it represents the deaths of all Tottenham people, whether they took place within or without the Parish, and is the rate adopted by the Registrar-General, non-residents being always allocated to the district to which they belong. By the term "Non-Resident," is meant persons brought into the district on account of illness, and dying there; and by the term "Resident" is meant persons who have been taken out of the District on account of illness, and have died elsewhere. 1.—Institutions within the District receiving sick and infirm persons from outside the District:— Prince of Wales's General Hospital, The Green. Metropolitan Asylums Board (North Eastern) Hospital, St Ann's Road. Jewish Home and Hospital for Insurables, High Road. 2.—Institutions outside the District receiving sick and infirm persons from the District:— South Mimms Small-pox Hospital. Edmonton Union Workhouse and Infirmary. Metropolitan Asylums Board Hospitals (other than North Eastern). 3.—Other Institutions, the deaths in which have been distributed among the several localities in the District:— Great Northern Hospital. Middlesex Hospital. St Bartholomew's Hospital. Children's Hospital, Great Ormond Street, W. Mildmay Hospital. German Hospital. 70 "West London Hospital. London Temperance Hospital. Royal Waterloo Hospital. Brompton Hospital. Cancer Hospital, Chelsea. Freidenham Hospital, Hampstead. Consumption Hospital, Kensington. Guy's Hospital. Maternity Hospital, Hackney. Passmore Edwards Hospital, Wood Green. City of London Lying in Hospital. Royal Hospital for Incurables, Wandsworth. Queen's Hospital, Bethnal Green. London Hospital. University College Hospital. Colney Hatch Asylum. Napsbury Asylum. Essex and Colchester Asylum. Broadmoor Asylum. Metropolitan Hospital. Royal Free Hospital. East London Hospital. Hampstead General Hospital. Chest Hospital, Victoria Park. Seaman's Hospital, Greenwich. Homoeopathic Hospital, Great Ormond Street. Royal Hospital (Chest), City Road. St. Joseph's Hospice, Hackney. Central London Throat and Ear Hospital. Hospital of S.S. John and Elizabeth. Whitechapel Infirmary. Hackney Infirmary. L.G.B. Table 11.— table of eases of Injectious Disease coming to the knowledge of the Medical Office) of Health dining the year 1913, in the Tottenham I rban District, classified according to diseases, ages, and localities. Notifiable Disease Number of Cases Notified. Total Cases Notified in Each Locality. Total Casks Removed to Hospital At all Ages At Ages—Years. I 2 3 4 5 6 Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards HarrinSay West Green St. Ann's High Cross Middle Lower Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera (C) Plague (P) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup 258 3 77 132 26 18 2 ... 40 24 44 69 57 24 190 Erysipelas 76 4 6 7 7 26 19 7 8 8 16 14 20 10 ... Scarlet Fever 585 3 120 382 49 28 3 ... 93 76 57 110 123 126 378 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 11 ... ... 2 2 6 ... 1 ... ... 3 4 1 3 10 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 Puerperal Fever 7 ... ... ... 5 2 ... ... 1 ... ... 1 4 1 1 Cerebro-spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 14 2 7 5 ... ... ... ... 3 3 1 ... 2 5 ... Pulmonary Tuberculosis 427 1 6 69 89 177 76 9 44 61 101 71 87 63 ... Other forms of Tuberculosis 214 7 47 103 26 23 6 2 13 31 36 37 59 38 ... Totals 1,593 20 263 701 204 280 106 19 202 204 258 306 353 270 580 L.G.B. TABLE III. TABLE OL DEA THS during the Year 1913 in the Tottenham Urban Sanitary Districtclassified according to Diseases, Ages, and Localities. Causes of Death Deaths at the subjoined ages of " Residents " whether occurring in or beyond the District Deaths at all ages of "Residents" belonging to Localities, whether occurring in or beyond the District Total Deaths whether of "Residents" or "non-Residents" in Institutions in the District All Ages Under 1 year 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 35 35 and under 45 45 and under 55 55 and under 65 65 and | under 75 75 and under 85 85 and upwards Harringay West Green St. Ann's High Cross Middle Lower 1 2 3 4 5 6 7 8 9 10 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 32 5 14 9 ... ... ... ... ... ... ... ... ... ... 2 11 4 7 8 42 Scarlet Fever 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Whooping Cough 10 4 2 4 ... ... ... ... ... ... ... ... ... 2 3 3 1 1 30 Diphtheria and Croup 24 2 3 9 ... ... ... ... ... ... ... ... ... 3 ... 4 6 7 4 43 Influenza 12 ... ... ... ... ... 2 2 1 2 1 4 ... 3 1 2 1 2 8 ... Erysipelas 2 ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 ... ... Phthisis (Pulmonary Tuberculosis) 131 2 1 ... 3 27 30 28 18 15 5 2 ... 19 18 33 22 20 19 1 Tuberculous Meningitis 20 4 4 3 7 2 ... ... ... ... ... ... ... 5 2 4 2 1 6 10 Other Tuberculous Diseases 13 1 ... 3 2 1 1 1 1 1 2 ... ... 2 ... 5 2 19 35 7 Cancer, malignant disease 130 ... ... ... ... 2 2 19 21 35 36 ... ... 16 22 15 20 30 27 21 Rheumatic Fever 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 11 6 2 1 2 ... ... ... ... ... ... ... ... 2 1 1 1 4 2 2 Orgnnic Heart Disease 153 ... ... 2 7 7 13 15 15 29 45 18 2 18 21 35 25 19 35 13 Bronchitis 147 35 5 2 2 ... 3 4 5 24 40 23 4 21 12 39 16 26 33 6 Pneumonia (all forms) 154 55 25 14 3 3 9 11 14 8 9 2 1 15 13 40 25 1 32 1 29 24 Other diseases of Respiratory organs '20 2 1 ... ... ... ... 3 2 5 3 4 ... 6 2 5 5 ... Diarrhoea and Enteritis 83 64 18 1 ... ... ... ... ... ... ... ... ... 5 2 26 9 18 23 20 Appendicitis and Typhlitis 11 ... ... 1 5 2 ... ... ... 1 ... ... ... 2 3 ... 2 3 1 14 Cirrhosis of Liver 11 ... ... ... ... ... 1 ... 7 3 ... 4 ... 2 2 3 ... ... Alcoholism 5 ... ... ... ... ... 1 1 1 2 ... ... ] 1 1 ... 2 1 Nephritis and Bright's Disease . 49 ... 1 ... ... 1 5 2 10 14 12 ... ... 6 8 10 12 7 6 10 Puerperal Fever 3 ... ... ... ... 2 1 ... ... ... ... ... ... 1 ... ... 2 ... 1 Other accidents and diseases of Pregnancy and Parturition 7 ... ... ... ... ... 5 2 ... ... ... ... ... 1 1 2 2 1 2 Congenital Debility and Malformation, including Premature Birth 92 92 ... ... ... ... ... ... ... ... ... ... ... 8 7 24 18 23 12 6 Violent Deaths, excluding Suicide 47 9 1 5 3 6 4 8 4 ... 2 4 ... 6 5 10 12 7 7 19 Suicides 6 ... ... ... ... ... ... 3 2 ... ... 1 ... 2 1 1 1 Other Defined Diseases 445 58 10 8 16 21 23 24 51 52 75 73 34 55 46 101 80 90 73 78 Diseases ill-defined or unknown 1 1 1 Totals 1621 339 87 63 65 75 100 123 152 190 233 153 41 203 170 375 264 310 299 375 73 Notes to (L.G.B.) Table III. (a) In this tablj all deaths of "Residents" occurring in public institutions, whether within or without the district, are included with the other deaths in the columns for the several age groups (columns 3-10). They are also included c.mong the deaths in their respective " Localities " according to the previous addresses of he deceased as given by the Registrars. Draths of "Non-Residents" occurring in public institutions in the district are in like manner excluded from columns 3-10 and 11-16 of this table. (b) All deaths occurring in public institutions situated within the district, whether of "Residents" or of "NonResidents " are, in addition to being dealt with as in note (a) entered in the last column of this table. (c) Under the heading of "Diarrhoea," are included deaths certified as from diarrhoea, alone or in combination with some other cause of ill-defined nature ; and also deaths certified as from Epidemic Enteritis ; Zymotic Enteritis ; Epidemic Diarrhoea, Summer Diarrhoea ; Dysentry and Dysenteric Diarrhoea; Gastro-Enteritis and Muco-E teritis ; Choleraij Diarrhoea, Cholera Nostras (in the absence of Asiatic Cholera). Deaths from diarrhcea secondary to some other welldefined disease are included under the latter. Under the headings of "Cancer" and "Puerperal Fever" are included all registered deaths from causes comprised within these general terms. 74 L.G.B. Table IV. Table of Infant Mortality during the year 1913. CAUSE OK DEATH Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Total Deaths under 1 year All causes, Certified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 4 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 1 2 1 1 5 Diphtheria and Croup ... ... ... ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 2 2 4 Abdominal Tuberculosis (b) ... ... ... ... ... 1 ... ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... 2 ... ... 2 Meningitis (not Tuberculous) 1 ... ... ... 1 1 2 3 ... 7 Convulsions 4 ... 1 ... 8 4 1 4 2 19 Laryngitis ... ... ... ... ... ... ... ... 1 1 Bronchitis ... 1 1 ... 2 6 12 11 4 35 Pneumonia (all forms) ... 2 ... 3 5 8 13 15 14 55 Diarrhoea ... 1 ... ... 1 12 20 6 4 43 Enteritis ... 1 1 2 4 2 8 1 4 19 Gastritis ... ... 4 1 5 2 3 1 2 13 Syphilis ... ... ... ... ... ... ... ... 1 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... 1 ... ... 1 3 2 ... ... 6 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Congenital Malformations(c) 1 ... 2 ... 3 1 1 ... 1 6 Premature birth 45 4 7 1 57 3 1 ... ... 61 Atrophy, Debility Marasmus 6 2 2 10 8 4 3 1 26 Other Causes 8 ... 2 3 13 3 3 2 4 25 Cerebral Spinal Meningitis ... ... ... ... ... ... ... ... 1 1 68 15 20 10 113 55 75 49 47 339 Nett Births in the year Nett Deaths in the Year legitimate 3,694. illegitimate 87. legitimate infants 324. illegitimate infants 15. 75 Mortuary Tabic for the Year 1913. Bodies Admitted. No. of Post Mortems N umber of Inquests Deaths from Violence Deaths from Drowning .Month Males Females Total Males Females Total January 7 9 16 7 8 15 16 2 0 February 8 11 19 8 8 16 19 1 1 March 6 10 16 5 10 15 16 1 1 April 8 10 18 2 7 9 18 1 0 May 2 4 6 2 3 5 6 0 1 June 13 4 17 11 4 15 17 1 0 July 10 6 16 7 6 13 16 1 0 August 13 7 20 12 6 18 20 0 2 September 15 4 19 8 3 11 17 0 1 October 10 6 16 7 4 11 13 0 0 November 13 4 17 13 4 17 17 0 1 December 10 9 19 10 6 16 19 0 2 Total 115 84 199 92 69 161 194 7 9 The following List gives the Causes to which Deaths were attributed by the Coroner's Juries. Syncope 44 Concussion of Brain 2 Phthisis 4 ACCIDENTS :— Pneumonia 29 Motor Car 3 Bronchitis 16 Burns 5 Convulsions 10 Tram Car 1 Congestion of Lungs 12 Run over in the Street 3 Inanition 7 Scalding 3 Suffocation 7 Bella Donna poisoniug 1 Peritonitis 2 SUICIDE :— Tuberculosis 5 Shooting 1 Gastritis 2 Hanging 3 Pleurisy . . 1 Cut Throat 1 Malnutriton 2 Drowning 9 Meningitis 7 On Railway 2 Apoplexy 2 Gas Poisoning 3 Inattention at birth 3 Poisoning 4 Appendicitis 1 MURDER:— Fractured Skull 6 Shooting 1 Fractured Ankle 1 Stabbing 1 76 COMPARISON OF THE HEALTH OF THE DIFFERENT WARDS. West Green Ward:—The General Death Rate was 8"9 per 1,000 of the population, the actual number of deaths being 170. This is the lowest General Death Rate in any of the Wards. West Green also had the lowest Infant Mortality Rate, viz:—50.6 per 1,000 births In order of frequency, deaths resulted from the following causes: Respiratory Diseases 27; Malignant Disease 22 ; Heart Disease 21; Phthisis and other Tuberculous Diseases 20: Kidney Diseases 8; Congenital Debility and Malformations 7 ; Infectious Diseases 6 ; Gastro-Intestinal Affections 5 ; Violent Deaths 5 ; Meningitis 1 ; Diseases of Parturition 1 ; Other defined diseases (not otherwise classified) 47. West Green had only 24 cases of Diphtheria out of a total for the district of 190. Harringay Ward:—The Death Rate from all causes was 94 per 1,000 of the population, and the Infant Mortality Rate 57'5 per 1,000 births. Deaths resulted from the following causes :—Respiratory Diseases 42 ; Phthisis and other Tuberculous Diseases 20; Heart Disease 18 ; Malignant Disease 1G ; Gastro-Intestinal Affections 11; Infectious Diseases 8 ; Congenital Debility and Malformations 8 ;. Violent Deaths 8 ; Kidney Diseases 6 ; Meningitis 2; Diseases of Parturition 2 ; Other defined diseases (not otherwise classified) 56. 77 Harringay suffered less than any other Ward from Tuberculosis, 57 cases only, out of a total of 641, being notified from that district. High Cross Ward:—The General Death Rate was 10.3 per 1,000 of the population, and the Infant Mortality Rate 77.6 per 1,000 births. In order of frequency, deaths resulted from the following causes:—Respiratory Diseases 42; Phthisis and other Tuberculous Diseases 26; Heart Disease 25; Malignant Disease 20; Congenital Debility and Malformations 18; Gastro-Intestinal Affections 13; Violent Deaths 13; Infectious Diseases 12; Kidney Diseases 12; Meningitis 1 ; Other defined diseases (not otherwise classified) 81; Diseases ill-defined or unknown 1. High Cross suffered most severely from Diphtheria, <59 cases out of a total of 190 occurring in that Ward. Middle Ward:—The Death Rate from all causes amounted to 10.8 per 1,000 of the population, and the Infant Mortality Rate 105.8 per 1,000 births. Deaths resulted from the following causes:—Respiratory Diseases 59; Phthisis and other Tuberculous Diseases 40; Malignant Disease 30; Gastro-Intestinal Affections 24; Congenital Debility and Malformations 23; Heart Disease 19; Infectious Diseases 18; Violent Deaths 8; Kidney Diseases 7; Meningitis 4; Diseases of Parturition 4; Other defined diseases (not otherwise classified) 90. 146 cases of Tuberculosis, out of a total of 641, were notified from the Middle Ward. 78 Lower Ward:- The General Death Rate was 12.6 per 1,000 of the population, and the Infant Mortality Rate 100.1 per 1,000 births. In order of frequency, deaths resulted from the following causes:- Respiratory Diseases 67; Phthisis and other Tuberculous Diseases 60; Heart Disease 35; Malignant Disease 27; Gastro-Intestinal Affections 24; Infectious Diseases 16; Congenital Debility and Malformations 12; Violent Deaths 8; Kidney Diseases 6; Meningitis 2; Diseases of Parturition 1; Other diseases (not otherwise classified) 75. The Lower Ward had the highest number of cases of Scarlet Fever viz:—126, out of a total of 585, but, with West Green, suffered less from Diphtheria than any other part of the district, 24 cases only occurring in the Ward out of 258. St. Ann's Ward :—The Death Rate from all causes was 13.6 per 1,000 of the population, and the Infant Mortality Rate 126.5 per 1,000 births. Deaths resulted from the following causes:—Respiratory Diseases 84; Phthisis and other Tuberculous Diseases 42; Heart Disease 35; Gastrointestinal Affections 28; Congenital Debility and Malformations 24; Infectious Diseases 21; Malignant Disease 15; Violent Deaths 11; Kidney Diseases 10; Diseases of Parturition 2; Rheumatic Fever 1; Meningitis 1; Other defined diseases (not otherwise classified) 101. St. Ann's suffered less than any other Ward from Scarlet Fever, 57 cases out of a total of 585 being notified from that Ward. 79 SCHOOLS AND SCHOOL HYGIENE. The following information is given at the request of the Local Government Hoard. A more detailed account of the work connected with, and the conditions prevailing in the Tottenham Schools is reported separately. Accommodation:- The accommodation (January 1914) in the provided Schools of the Tottenham Education Committee was for 125,321 children, and in the non-provided Schools for 2,422 children, giving a total accommodation for 27,743; there were on rolls 24,892 children; the average attendance, however, only amounted to 22,317. General Observations:—The following are a few hints to Caretakers and others who have the custody of the school premises. The Caretakers should keep the sanitary conveniences in a condition of scrupulous cleanliness, not merely by flushing the pans but by mopping them with a plentiful supply of disinfecting solution. The seats should be scrubbed above and below. Where trough closets are in use they should be scraped inside and outside at regular and frequent intervals, and swilled with Spirits of Salts when the slightest evidence of furring appears. Teachers and Caretakers should give great attention to the ventilation of school rooms and cloak rooms. The cloak room windows should be kept open practically constantly. The class room windows and ventilators should be opened to their fullest extent on every available opportunity, not only during the intervals while the children 80 are at play and before and after school hours, but whilst they are in school if the weather allows. The floors of the class rooms should be scrubbed not less frequently than once a month, and swept daily. Sanitary Conveniences:—In several of the schcols lavatory and w.c. accommodation is not provided for the teachers within the school buildings. In some of the schools this convenience could be afforded without great difficulty -or expense. Co-ordination between Public Health and Education Departments :— The following cases were notified to me under the provisions of the Infectious Disease (Notification) Acts 1889—1899 :— Scarlet Fever 382 Diphtheria and Membranous Croup 132 Poliomyelitis 5 Erysipelas 7 The following cases were notified by Teachers and Attendance Officers during the year :— Measles 741 Verminous conditions 19 Mumps 429 Swollen Glands 14 Whooping Cough 361 Tuberculosis 6 Ringworm (both varieties) 285 "Croup" 5 Chicken Pox 239 Diarrhœa 4 Various Skin Diseases 219 Debility 3 "Sore Throats" 116 Ear Diseases 3 "Colds" and Bronchitis 58 Abscess 2 Influenza 49 Yellow Jaundice 1 Eye Diseases 22 St. Vitus Dance 1 "Sickness" 22 Children excluded owing to Disease in house 281 81 The diseases in the latter group are not notifiable under the Infectious Disease (Notification) Acts, but the notifications lead to investigations, by School Nurses, Sanitary Inspectors, or, in special cases, by the Medical Officers, which often disclose conditions inimical to the Public Health. Arrangements:-The School Medical Officer examines all the elder boys, and the Assistant School Medical Officer all the girls and infants. There are three School Nurses, viz:—Mrs. Wallace, Miss Allen, and Miss Johns, who are occupied in attending at the medical examination of the school children and at the School Clinics, and in the "following up" of infectious, verminous, and dirty cases. T. W. Letchworth, Esq., F.R.C.S., continues to give his services as Oculist at the Eye Clinic, Bruce Castle, and errors of refraction are corrected by him, the cost of spectacles being in necessitous cases partly defrayed from the public funds. School Clinics are in operation, and such simple ailments as Ringworm, Impetigo, Eczema, etc, as are not receiving adequate treatment elsewhere are treated under the supervision of the School Medical Officers. This results in more Speedy restoration to health, with a correspondingbenefit to the school attendance and Government grant. Verminous children are cleansed at the Council's Disinfecting Station, Markfield Road. 82 FACTORY AND WORKSHOP ACT, 1901. In compliance with section 132, I beg to submit a resume of the work effected during the year—under the provisions of the above Act—in the form prescribed by the Home Office :— 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises Number of Inspections Written Notices Prosecutions Factories (including Factory Laundries) 189 37 ... Workshops (including Workshop Laundries) Workplaces (other than outworkers' premises included in Part 3 of this Report). 832 Total 1,011 37 ... 2.—Defects Found. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts*— Want of Cleanliness 7 7 ... ... Want of ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors 1 1 ... ... Other nuisances 22 22 ... ... Sanitary accommodation insufficient 7 7 ... ... unsuitable or defective ... ... ... .. not separate for sexes 1 1 ... ... Offences under the Factory & Workshop Act Illegal occupation of underground bakehouses (s. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (s.s. 97 to 100) 2 2 ... ... Other offences (excluding offences relating to outwork which are included in part 3 of this Report) ... ... ... ... Total 40 40 ... ... * Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 3.—Home Work. Nature of Work OUTWORKERS' LISTS, SECTION 107 OUTWORK IN UNWHOLESOME PREMISES, SECTION 108 OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110 Lists received from Employers Twice in the year Once in the year Lists Outworkers Lists Outworkers Instances Notices served Prosecutions Instances Orders made (S. 110) Prosecutions (Sections 109,110) Contractors Workmen Contractors Workmen Wearing Apparel- (1) making, &c. 2 ... 87 5 ... 27 ... ... ... ... ... ... (2) cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... Household Linen ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... ... ... ... ... ... ... Curtains & Furniture Hangings ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery ... ... ... ... ... ... ... ... ... ... ... ... Electro Plate ... ... ... ... ... ... ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... ... ... ... ... Brass and Brass Articles ... ... ... ... ... ... ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... ... ... ... ... Cables and Chains ... ... ... ... ... ... ... ... ... ... ... ... Anchors and Grapnels ... ... ... ... ... ... ... ... ... ... ... ... Cart Gear ... ... ... ... ... ... ... ... ... ... ... ... Locks, Latches and Keys ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... ... ... ... ... ... ... ... ... Artificial Flowers ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than Wire Nets ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... ... ... Racquet and Tennis Balls ... ... ... ... ... ... ... ... ... ... ... ... Paper, etc., Boxes Paper Bags ... ... ... ... ... ... ... ... ... ... ... ... Brush Making ... ... ... 1 ... 18 ... ... ... ... ... ... Pea Picking ... ... ... ... ... ... ... ... ... ... ... ... Feather Sorting ... ... ... ... ... ... ... ... ... ... ... ... Carding, &c., of Buttons, &c. ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... Chocolates and Sweetmeats ... ... ... ... ... ... ... ... ... ... ... ... Total 2 ... 87 6 ... 45 ... ... ... ... ... ... The figures required in columns 2 and 4 are the total number of lists received from Employers who sent them both in February and August as required by the Act, and of the entries of names of outworkers in those lists; there will, therefore, usually be double of the number of such employers and (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworkers' names will often be repeated. 84 4. Registered Workshops. Workshops on the Register (s. 131) at the end of the year Number Workshops 305 Laundries 34 Bakehouses 71 Total number of Workshops on Register 410 5.-—Other Matters. Class Number Matters notified to H.M. Inspector of Factories :- Failure to affix Abstract of the Factory and workshop Act (Sec. 133) 5 Action taken in matters referred by H.M.Inspector as remediable Notified by H.M. Inspector 9 under the Public Health Acts, but not under the factory and Workshop Act (s. 5) Reports (of action taken) sent to H.M. Inspector 6 Other ... Underground Bakehouses (s. 101): - Certificates granted during the year ... In use at the end of the year 5 Note.- The Factory and Workshop Act. 1901 (s. 132), requires the Medical Officer of Health in his Annual Report to the District Council to report specifically on the administration of that Act in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of Stale (Home Office). 85 WORKSHOPS, WORK-PLACES, AND HOMES OF OUTWORKERS. The Workshops, Work places, and Out-workers' Homes are kept under constant supervision by the Male and Female Sanitary Inspectors, and precautions are taken to ensure that the work done in these places is conducted under the best possible conditions CHIEF LOCAL INDUSTRIES. The main industries in Tottenham are building, cabinet making, pencil making, dress, blouse and mantle making piano making, the manufacture of sweets, stationery, india rubber, emery cloth, brushes, cyclostyle materials, lamps, and boots and shoes, brewing and mineral water manufacturing, bedstead making and motor manufacturing. LAUNDRIES. There are 47 Laundries in Tottenham. They have all been periodically inspected, and notices were served, when necessary, with regard to any defects found therein. \ BAKEHOUSES. There are G8 Bakehouses in the district, all of which have been subjected to frequent inspection. One bakehouse has been considerably enlarged and improved, new ovens being introduced and the walls being partly covered with glazed white tiles. £6 FOOD INSPECTIONS. 980 inspections have been made by the Ward Inspectors and the Medical Officer of Health ; the following list gives the distribution of the visits amongst the different classes of food purveyors :— Butchers' Shops 423 Fishmongers' Shops 260 Fruiterers' and Greengrocers' Shops 297 The inspections are carried out at frequent but irregular intervals and so that the shopkeepers may not be in a position to make preparations for the Inspectors' visits, and in such a manner as to excite as little attention as possible from customers or passers by. Appended is a list of the foodstuffs condemned during the year :— Meat Carcase of a Sheep ,, 4-lbs. Mutton Fish 1 trunk Catfish ,, I2-lb. Smoked Codling ,, 1 box Kippers ,, 2 Crabs ,, 12 lbs Hake ,, 1 box Skate „ 3 Skate ,, 50 lbs. Codling ,, 1 box "Coalie" ,, 1 trunk mixed Fish Fruit ½ bushel Apples ,, 1 case Pears. 87 SLAUGHTER-HOUSES. There are 14 private slaughter-houses in your district. All of them have been frequently inspected, and improvements have in some instances been effected during the year, under the advice and supervision of the Public Health Department. DAIRIES, COWSHEDS, AND MILKSHOPS. 18 applications (ll from purveyors, and 7 from dairymen) were received during the year for registration under the Dairies, Cowsheds, and Milkshops Order, 1885. There are at present upon the Register 9 Cowkeepers, 34 Dairymen, and 147 Purveyors of Milk. COWSHEDS, COWS, ETC. The cowsheds in your district are maintained, on the whole, in a satisfactory condition. FOOD AND DRUGS ACT. The Middlesex County Council is the authority responsible for the administration of the Food and Drugs Act in Tottenham. The County Food Inspectors took in the Tottenham area 721 samples during 1913, in connection with which 32 prosecutions were instituted, and 32 convictions obtained. 88 ICE CREAM. There are 83 Ice Cream premises in the district, most of which are small sweet shops; all have been regularly inspected. FISH SHOPS. There are 70 Fish Shops in Tottenham, which are, for the most part, maintained in a satisfactory condition. BUTCHERS' SHOPS. There are 95 Butchers' Shops in Tottenham ; some of those premises belong to small tradesmen who deal only in foreign meat. PAWNSHOPS. There are 13 Pawnbrokers' premises in Tottenham, all of which are kept in a clean and sanitary condition. Certain of these have to be inspected annually, and a satisfactory report must be given before certificates are granted. PUBLIC HOUSES. There are 59 Public Houses and 77 "Off-Licence" premises in Tottenham. GIPSY ENCAMPMENTS. We have had no trouble with gipsy encampments during the year; 13 were removed in 1910, and 33 in 1909. 89 COMMON LODGING-HOUSES. The Common Lodging-Houses at 2 and 4 Whitehall Street, 1 and 2 Union Row, and 80 High Cross Road, have been periodically inspected during the year so as to ensure that the requirements of the model bye-laws are complied with. Extra w.c. accommodation has been provided at the Lodging-House, 86 High Cross Road. SMOKE NUISANCE. 18 complaints of smoke nuisance were received by this Department during the year; none of the cases were so bad as to warrant a prosecution; altogether 54 ocservations were made. CHEMICAL AND BACTERIOLOGICAL LABORATORY. 135 specimens of Sputum and 1 specimen of Urine were examined for the Tubercle Bacillus, and 309 throat swabs for the Klebs Lœffler Bacillus, and 5 specimens of blood, taken from doubtful cases of Enteric Fever, were subjected to Widal's test. Hairs have been microscopically examined in a large number of cases of Ringworm. WATER SUPPLY. Tottenham derives its water supply from three sources, viz. :—East London (Sunbury), Kempton Park, and New River Works. 90 The following analyses have been supplied by Dr. A. C. Houston, Director of Water Analysis for the Metropolitan Water Board. They represent the averages of the Chemical and Bacteriological tests as applied for the twelve months April 1912 to March 1913 inclusive. CHEMICAL ANALYSES. Parts per 100,000. Fast London (Sunbury) Kempton Park New River Ammoniacal Nitrogeu .0002 .0008 .0040 Albuminoid ,, .0056 .0081 .0032 Oxidised ,, .44 .20 .29 Chlorine 1.92 1.45 1.89 Oxygen absorbed from .0777 .1058 .0466 Permanganate in 3 hours at 8C° F. Hardness Total 24.79 20.63 22.33 Permanent 8.17 5.27 4.53 BACTERIOLOGICAL ANALYSES. Average number of microbes per c.c. East London (Sunbury) Kempton park New River Grown upon Agar 3.1 3.4 3.3 ,, ,, Gelatine 16.1 15.9 12.6 The water supplied to Tottenham is hard, but otherwise is very good for domestic and culinary purposes. Every care is taken to render it epidemiologically sterile, that is, to remove all bacteria associated with water-borne epidemic diseases. 91 GENERAL SANITARY WORK. The work of the six male Sanitary Inspectors and the work of the two female Sanitary Inspectors so far as it relates to general sanitary matters is epitomised and subjoined. HARRINGAY WARD (Mr. W. Redston). House to house inspections 192 Smoke observations 22 Re-inspections 1602 Overcrowding 1 Drains, examined, tested, etc. 251 Accumulations of refuse 30 ,, unstopped 35 Visits in connection with cases ,, re-constructed & repaired 67 of infectious disease (including Tuberculosis) 319 Disconnecting traps inserted 8 R.W. pipes, wastes, etc., disconnected 3 Rooms inspected after disinfection 161 Dust bins provided 26 Other nuisances, etc. 25 Roofs repaired 31 Factories, No. of inspections 24 Gutters repaired and renewed 45 Workshops & workplaces „ 49 Cisterns cleaned, repaired, etc. 29 Laundries „ 56 W.C. new apparatus provided 21 Dairies, etc. 147 ,, repaired, cleaned, etc. 27 Cowsheds ,, 10 ,, Water Fittings repaired 40 Bakehouses ,, 30 New sinks provided 4 P.H. urinals ,, 242 Sink wastes repaired 31 Stables and Mews ,, 295 Wash-house floors repaired 15 Complaints investigated 40 Yards paved and drained 42 Appointments 145 Premises cleaned, etc. 54 School inspections 22 Ventilation below floor provided 26 Pawnbrokers 3 WEST GREEN WARD (Mr. J. B. Smith). House to house inspections 161 Rooms inspected after tion 101 Re-inspections 1150 Drains, examined, tested, etc. 541 Sub-let houses inspected 6 „ defective 86 Other nuisances, etc 35 ,, reconstructed & repaired 86 Laundries, number of inspections 5 Soil pipes and drains ventilated 40 Factories „ 10 R.W. pipes, wastes, etc., connected and repaired 50 Workshops X: workplaces ,, 29 Dairies, etc. ,, 44 Dust bins provided 16 Bakehouses 35 Roofs repaired 60 P.H. Urinals 32 Gutters ,, Stables and Mews „ 124 Cisterns cleaned, repaired, etc. 28 Slaughter-houses „ 97 W.C. new apparatus provided 9 Brooks and watercourses inspected 20 ,, repaired, cleaned, etc. 20 Yards paved and drained 49 Schools inspected 9 92 WEST GREEN WARD (Mr. J. B. Smith)—continued. Forecourts rendered 10 Ice cream makers' premises inspected 10 Premises, cleansed, etc., ordinary 48 Ventilation below floor provided 8 Complaints investigated 101 Overcrowding 2 Appointments 75 Accumulations of offensive matter removed 14 Supervisional visits 330 Visits in connection with cases of infectious disease, including Tuberculosis 383 ST. ANN'S WARD (Mr. W. P. West). House to house inspections 207 Smoke observations 4 Re-inspections 1390 Overcrowding 6 Drains, examined, tested, etc. 344 Accumulation of refuse 6 ,, unstopped 41 Visits in connection with cases of infectious disease, including Tuberculosis 375 ,, reconstructed 62 Soil pipes and drains ventilated 4 Disconnecting traps inserted 25 Rooms inspected after disinfection 93 R.W. pipes, sink wastes, etc., disconnected 7 Other nuisances 130 Factories, number of inspections 121 Dust bins provided 47 Workshops and workplaces 191 Roofs repaired 47 Laundries 35 Gutters repaired 16 Dairies, etc. 84 Cisterns cleaned, repaired, etc. 47 Bakehouses 45 W.C. new apparatus provided 16 P.H. Urinals 112 ,, repaired, cleaned, etc. 56 Stables and Mews 188 ,, water fittings repaired 47 Slaughter-houses 23 Yards paved and drained 85 Complaints investigated 76 Premises cleansed, etc. 161 Appointments 241 Ventilation below floors provided 4 HIGH CROSS WARD (Mr. W. C. Portman). House to house inspections 176 Visits in connection with cases of infectious disease, including Tuberculosis 450 Re-inspections 773 Drains examined, tested, etc. 231 ,, unstopped 7 Rooms inspected after disinfection 212 ,, re-constructed 29 Soil pipes and drains ventilated 23 Laundries, number of inspections 6 R.W. pipes, wastes, etc., connected and repaired, 4 Common Ladging houses ,, 28 Factories ,, 12 Dust bins provided 52 Workshops & workplaces ,, Roofs repaired 41 Dairies, etc. ,, 32 Gutters „ Cowsheds ,, Cisterns cleaned, repaired, etc. 16 Bakehouses ,, 8 W.C. new apparatus provided 5 P.H. Urinals ,, 86 ,, repaired, cleaned, etc. 4 Stables and Mews ,, 6 „ water fittings repaired 18 Slaughter-houses ,, 45 93 HIGH CROSS WARD (Mr. W. C. Portman)—continued. Yards paved and drained 68 Knackers-yards inspected 74 Forecourts rendered 28 Brooks and Watercourses spected 9 Premises cleansed, etc. 124 Ventilation below floor provided 1 Schools 4 Smoke observations 3 Complaints investigated 139 Overcrowding 13 Appointments 50 Accumulations of offensive matter removed 23 MIDDLE WARD (Mr. H. W. Miller). House to house inspections 210 Schools 7 Re-inspections 1730 Visits in connection with cases of infectious disease, including Drains examined, tested, etc. 229 ,, unstopped 35 Tuberculosis 311 ,, re-constructed 69 Rooms inspected after disinfection 204 Soil pipes, and drains ventilated and repaired 148 Other nuisances, etc. 30 R.W. pipes, wastes, etc., connected 116 Laundries, number of inspections Factories, workshops and 6 Dnst bins provided 87 workplaces 13 Roofs repaired 32 Dairies, etc. 45 Gutters „ Cowsheds ,, 4 Cisterns cleaned, repaired, etc. 38 Bakehouses „ 27 W.C. new apparatus provided 89 P.H. urinals ,, 46 ,, repaired, cleaned, etc. Stables and Mews ,, 26 Water fittings repaired 25 Slaughter-houses ,, 2 Yards paved and drained 57 Complaints investigated 59 Premises cleansed, etc. 105 Appointments 105 Smoke observations 20 Theatres, etc. 32 Overcrowding 14 Brooks inspected 16 Accumulations of refuse, etc. 15 Houses repaired under Housing, Town Planning, &c., Act 12 Houses without water supply 5 Ventilation below floor 3 LOWER WARD (Mr. J. A. Shill.ito). House to house inspections 200 Smoke observations 5 Re-inspections and appointments 1294 Overcrowding 12 Drains examined, tested, etc. 363 Accumulations of refuse 11 ,, unstopped 129 Visits in connection with cases of infectious disease, including ,, re-constructed 51 Soil pipes and drains ventilated 69 Tuberculosis 639 94 LOWER WARD (Mr. J. A. Shillito)—continued. Disconnecting traps inserted 39 Factories, number of inspections 90 R.W. pipes, wastes, etc., dis connected 39 Workshops & workplaces „ Common lodging houses ,, 41 Dust bins repaired or provided 42 Dairies, etc. ,, 57 Roofs repaired 29 Cowsheds „ 24 Gutters ,, 78 Bakehouses „ 38 Cisterns cleaned, repaired, etc. 50 Slaughter-houses ., 29 W.C. new apparatus provided 74 Butchers' shops „ 112 ,, repaired, cleaned, etc. 95 Complaints investigated 241 ,, ventilated 18 Animals kept so as to be a nuisance 7 ,, water fittings repaired 57 Yards paved and drained 45 Houses let in lodgings 25 Premises cleaned, etc. (ordinary) 89 Ice cream vendors 10 Ditto (after infectious disease) 163 Schools 7 Floors repaired 36 Miscellaneous 76 Ventilation below floor provided 15 SANITARY WORK CARRIED OUT BY Mrs. PARSONS AND Miss LAMB. 290 visits were made with respect to persons suffering from Phthisis. 13 „ „ „ „ „ „ other infectious diseases. 78 complaints were investigated. 94 workshops were inspected. 295 outworkers were visited. 97 visits were paid for various other reasons. (For information respecting babies see " Infant Mortality)." REFUSE DESTRUCTOR. The house refuse of the district is disposed of at the Refuse Destructor by burning. Tins and other disposable material realised over £200 for the year. The following table gives weekly particulars of the amounts and various kinds of refuse destroyed during 1913. Total of Refuse Destroyed for the Year ended December 31st, 1913. Week ended Trade Refuse Shop Refuse House Refuse Total Refuse Total Loads 1913 Tons Cwts Qrs Lbs. Tons Cwts. Qrs. Lbs. Tons Cwts. Qrs. Lbs. Tons Cwts. Qrs. Lbs. January 1 2 10 ... ... 24 13 3 7 509 1 1 14 536 5 0 21 246 „ 8 3 10 ... ... 32 4 1 7 674 17 3 0 710 12 0 7 321 „ 15 2 10 ... ... 29 12 1 0 565 15 1 21 597 17 2 21 279 „ 22 5 ... ... ... 29 13 2 7 561 14 1 14 596 7 3 21 276 „ 29 7 ... ... ... 29 9 1 0 556 16 2 0 593 5 3 0 276 February 5 8 ... ... ... 30 2 0 21 559 10 1 7 597 12 2 0 281 „ 12 3 10 ... ... 30 2 3 14 554 18 1 21 588 11 1 7 279 „ 19 2 10 ... ... 29 13 0 0 537 13 3 0 569 16 3 0 272 „ 26 6 ... ... ... 29 17 1 14 548 1 3 21 583 19 1 7 278 March 5 2 ... ... ... 29 16 1 21 569 3 0 7 600 19 2 0 283 „ 12 4 ... ... ... 30 6 1 14 564 10 0 21 598 16 2 7 286 „ 19 8 ... ... ... 31 5 3 14 596 8 1 14 635 14 1 0 302 „ 26 4 15 ... ... 17 9 0 0 346 8 1 7 368 12 1 7 176 April 2 9 12 2 ... 32 4 1 21 701 11 0 21 743 8 0 14 342 „ 9 5 ... ... ... 31 9 2 21 603 14 3 7 640 4 2 0 304 „ 16 5 10 ... ... 30 14 1 21 551 13 0 14 587 17 2 7 283 „ 23 6 15 ... ... 29 14 2 21 559 16 2 14 596 6 1 7 284 „ 30 5 ... ... ... 32 1 1 7 585 18 1 7 622 19 2 14 301 May 7 5 10 ... ... 31 11 1 21 582 10 2 0 619 11 3 21 291 „ 14 5 ... ... ... 24 6 1 0 474 18 3 7 504 5 0 7 255 „ 21 2 10 ... ... 28 16 2 0 559 19 3 14 591 6 1 14 315 „ 28 5 15 ... ... 26 14 2 14 470 5 3 7 502 15 1 21 386 June 4 1 ... ... ... 28 12 0 7 474 2 1 7 503 14 1 14 300 „ 11 ... ... ... 25 5 3 21 412 4 3 7 437 10 3 0 278 „ 18 1 5 ... ... 25 14 1 14 396 4 2 7 423 3 3 21 273 „ 25 15 ... ... 25 18 3 14 426 6 1 14 453 0 1 0 280 July 2 ... ... ... 22 8 1 0 393 10 1 0 415 18 2 0 276 „ 9 ... ... ... 19 17 2 21 360 17 1 14 380 15 0 7 249 Total of Refuse Destroyed for the Year ended December 31st, 1913—contd. Week ended Trade Refuse Shop Refuse House Refuse Total Refuse Total Loads 1913 Tons Cwts Qrs Lbs. Tons Cwts. Qrs Lbs. Tons Cwts. Qrs. Lbs. Tons CWt S. Qrs. Lbs. July 16 ... ... ... ... 25 13 2 21 485 19 3 14 511 13 2 7 303 23 1 10 ... ... 24 19 3 7 423 10 3 0 450 0 2 7 267 „ 30 ... ... ... ... 24 7 1 14 .394 6 3 7 418 14 0 21 267 August 6 ... ... ... ... 17 16 3 21 332 0 1 21 349 17 1 14 247 „ 13 ... ... ... ... 18 16 1 7 369 12 1 7 388 8 2 14 276 ,, 20 2 8 2 ... 22 16 3 21 352 3 1 21 377 8 3 14 262 „ 27 ... ... ... ... 21 11 0 7 340 10 0 14 362 1 0 21 260 September 3 1 3 2 ... 23 18 3 7 364 6 2 21 389 9 0 0 261 „ 10 ... ... ... ... 25 0 1 0 372 1 1 0 397 1 2 0 253 „ 17 ... ... ... ... 24 9 1 0 399 17 2 21 424 6 3 21 281 „ 24 ... ... ... ... 24 7 0 7 384 1 2 7 408 8 2 14 264 October 1 2 ... ... ... 24 6 3 21 380 18 1 21 407 5 1 14 272 „ 8 1 ... ... ... 24 5 1 0 389 17 3 21 415 3 0 21 271 „ 15 ... ... ... ... 25 14 2 7 426 2 2 21 451 17 1 0 266 ,, 22 ... ... ... ... 26 8 1 21 440 0 1 0 466 8 2 21 273 „ 29 ... ... ... 28 8 0 14 461 11 2 0 489 19 2 14 269 November 5 ... ... ... ... 27 17 1 21 460 8 3 0 488 6 0 21 276 „ 12 ... ... ... ... 27 17 1 0 464 13 2 14 492 10 3 14 275 „ 19 ... ... ... ... 26 9 2 14 483 17 3 14 510 7 2 0 271 ,, 26 ... ... ... ... 29 12 0 14 478 17 1 14 508 9 2 0 278 December 3 ... ... ... ... 29 11 2 14 463 17 0 21 493 8 3 7 274 „ 10 ... ... ... ... 28 1 3 7 467 0 1 21 495 2 1 0 .276 „ 17 ... ... ... ... 26 9 2 7 479 18 2 0 506 8 0 7 279 „ 24 ... ... ... ... 28 9 1 0 487 10 0 21 515 19 1 21 294 „31 ... ... ... ... 17 4 0 0 338 8 2 14 355 12 2 14 193 Total ... 120 19 2 ... 1,414 10 1 14 25,140 8 3 14 26,675 18 3 14 14,579 TOTTENHAM URBAN DISTRICT. COUNTY OF MIDDLESEX—SANITARY WORK, 1913. Inspections Notices Dwelling Houses and Action under H., T.P. &c., Act, 1909 Houses let in separate Dwellings or Lodgings Common Lodging Houses Movable Dwellings, Caravans, Tents, etc. Bakehouses Slaughter houses Number of Premises Inspected on Complaint Number of Premises Inspected in connection with Infectious Diseases Number of Premises under periodical Inspection Houses Inspected from House-to-House Total Number of Inspections and Re-inspections Cautionary Notices Given Statutory Orders Issued Summonses Served Convictions Obtained Number of Houses dealt with under Sect. 15 Number of Houses found to be in a state Dangerous or Injurious to Health (Sect. 17) Number of Representations made by M.O.H. (Sect. 17) Number of Honses made Habitable without Closing Orders Number of Closing Orders made by L.A. (Sec. 17) Number of Houses closed Voluntarily Number of Closing Orders determined after Repairs (Sect. 17) Number of Houses Demolished— (a) by order of L.A. (Sect. 17), (A) Voluntarily Illegal Underground Rooms Vacated Number Registered under Bye-Laws Number of Contraventions Number Registered under Bye-Laws Number of Inspections made Number Observed during the Year Number of Nuisances therefrom abated Number Removed from District Number in District Contraventions of Factory Acts Number 011 Register Number of Inspections Contraventions of Bye-Laws 734 1424 692 1146 17971 1884 766 8 4 ... 16 16 ... 16 ... 16 ... ... ... ... 7 85 ... ... ... 71 2 11 68 98 SANITARY WORK, 1913—contd. Cowsheds Dairies and Milkshops Unsound Food Adulterated Food Water Supply and Water Service Water Closets Drainage and Sewerage Number on Register Number of Inspections Contraventions of Regulations Number on Register Number of Inspections Contraventions of Regulations Animals seized Articles or Parcels seized Articles or Parcels surrendered Samples taken Found Adulterated Percentage of Houses Supplied from Public Water Service Cisterns Draw Taps removed from Cisterns to Mains Percentage of Houses supplied on Constant System New, Constructed Repaired, supplied with Water, or otherwise Improved Percentage of Houses provided with Water Closets Drains New. Provided Cleansed, Repaired, Covered, etc. Overflow Pipes Disconnected from Drains Examined, Tested, Exposed, etc. Unstopped, Repaired, Trapped, etc. Waste Pipes, Rain Water Pipes Disconnected, Repaired, etc. Soil Pipes and Drains Ventilated Disconnecting Traps or Chambers In serted Reconstructed 11 78 ... 197 443 ... ... ... 15 ... ... 100 ... 208 ... ... 100 ... 621 100 1601 341 135 284 72 278 99 SANITARY WORK, 1913—contd. Drainage and Sewerage Disinfection Dust Sundry Nuisances Abated Percentage of Houses Draining into Sewers Rooms Disinfected— (a) Ordinary (b) Phthisis Rooms Stripped and Cleansed Articles Disinfected or Destroyed New Bins Provided or Repaired Periodical Frequency of Dust Removal Number of Complaints of Non-removal of Dust Overcrowding Smoke Observations Accumulations of Refuse Foul Ditches, Ponds, etc., and Stagnant Water Foul Pigs and other Animals Dampness Yards Re-paved or Repaired Other Nuisances 100 (а) 956 (b) 281 689 15,385 270 Weekly ... 48 54 93 6 7 95 346 243 100 The Housing of the Working Classes Act, 1890. The Housing, Town Planning, &c. Act, 1909. The Housing (Inspection of District) Regulations, 1910. There are very few houses in Tottenham that are in such a condition as to be unfit for human habitation, and most of these may, by the expenditure of a reasonable sum of money, be made fit for human habitation. Occasionally, however, it becomes necessary to resort to the extreme measure of issuing Closing Orders in respect of houses requiring extensive repairs ; but in no instances during the year have they led to the demolition of the houses. The houses in Tottenham are so fully occupied that when even a small scheme is considered, under which it is necessary to close certain houses for a time, adequate accommodation for the displaced tenants is difficult to find. There does not appear to be activity in the development of building land, commensurate with the increase in population. Were there such activity, the efforts of the Sanitary Authority to improve the conditions under which the poorer of the working classes live would be more fruitful. By concentration of energy upon the worst type of dwelling house, there would be exercised a gentle compulsion upon the inhabitants to shift into more desirable premises. It is hoped that in the near future a revival in the building trade will make it possible for such pressure to be employed. 101 LEGAL PROCEEDINGS. The results of the four cases in which it was considered necessary to institute legal proceedings will be found in the appended table. Date Result Remarks May Summons withdrawn on completion of work and payment of £1 Is. Od. costs. Non-compliance with sanitary notice. May Summonses withdrawn on completion of work and payment of £2 5s. 6d. costs. Non-compliance with sanitary notices. June Fined £5 and costs. Refusal to admit Inspector of Nuisances. Aug. Summons withdrawn on completion of work and payment of £1 Is. Od. costs. Non-compliance with sanitary notice. 102 SWIMMING AND WARM BATHS. The First-Class Swimming Bath, with a water space of 100-ft. by 35-ft. is fitted with the most modern requirements, and is espec'ally adapted for Swimming and Water Polo Competitions, and Aquatic Entertainments. The charge for admission is 6d., which includes use of water chute, diving stages, spring board, shower baths, 2 towels, and bathing drawers. Children up to 14 years of age are admitted at half price The bath is open from April to September from 7 a.m. to 9.30 p.m., and on Sundays from 6 a.m. to 10 a.m. On Wednesdays during the Summer, the FirstClass Swimming Bath is reserved for the use of Ladies, and on Tuesdays, from 6 p.m. to 9.30 p.m. it is reserved for mixed bathing. The charge for admission to the Second-Class Bath is 2d., and it is open for men daily during the Summer months from 7 a.m. to 9.30 p.m., with the exception of Fridays, when it is reserved for the use of School Children between 12.30 p.m. and G.30 p.m. During the Winter months (October to the end of March) it is open for Men daily from 9 a.m. to 8.30 p.m. (Thursdays, First-Class day, 6d.) with the exception of Wednesdays, when it is reserved for Ladies. It is open on Sundays, for Gentlemen only, during the Summer months from 6 a.m. to 10 a.m. and during the Winter from 7.30 a.m. to 9 a.m. School children are admitted to the Second-Class Swimming Bath at a charge of Id. The First-Class Swimming Bath is reserved for Ladies on Saturday mornings from 9 to 10.45 at first-class price only. 103 PRIVATE (SLIPPER) BATHS. These Baths are open for Ladies and Gentlemen during the Summer months on week-days from 7 a.m. to 10 p.m., and during the Winter months from 9 a.m. to 9 p.m. ; Sundays (Summer) 6 a.m. to 10 a.m., (Winter) 7 30 a.m. to 9.30 a.m. The charge for admission is—First-Class, 6d. ; Second-Class, 2d. School children are admitted between 4.30 and 6 p.m. at a fee of 1d. (hot and cold water and soap provided). Books containing 12 First-Class Tickets are available for either Swimming or Slipper Baths at a cost of 5s. Tickets are issued and accepted up to within 30 minutes of the time of closing. ****** Season Tickets are issued for the Large Swimming Bath at a cost of 10/6, available from 7 a.m. to 9.30 p.m. on week-days and from 6 to 10 a.m. on Sundays. They are also issued at a cost of 7/6, available from 7 a.m. to 9 p.m. on week-days only. OPEN-AIR SWIMMING BATH. Tottenham Marshes (5 minutes from Park Station, Great Eastern Railway). This Bath—the largest in England—covering a water area of 180-ft. by 60-ft. is open from 1st May to 30th September (6 a.m. to 9 p.m., and on Sundays from 6 a.m. to 9 a.m.). The admission charge is Id., bathing drawers and towels, Id. Season Tickets are available for this Bath at a cost of 5s. 104 Number of Bathers that used the Baths from April 1st to September 30th, 1913. Indoor Baths :—- 1st Class Swim 10,090 Total 1st Class Swim 25,557 Club 6,825 Girls and Boys „ Swim 7,942 Books of 100 1st Class Tickets 700 2nd Class Swim 15,567 Girls and Boys ,, ,, 13,170 School Children, Boys ,, 15,118 Paid for by Education Committee. „ „ Girls „ 11,134 Total 2nd Class Swim 54,989 1st Class Slipper Bath 5,453 Total Gentlemen's Slipper Bath 24,789 2nd „ „ „ 18,844 Boys' 2nd Class Slipper Bath 492 Ladies' 1st Class Slipper Bath 456 „ 2nd „ „ „ 7,944 Girls' „ „ „ „ 804 Total Ladies' Slipper Bath 9,204 Total 114,539 Open-Air Bath :— Boys 3,516 Paid for by Education Committee. Men 3,181 School Children—Boys 16,165 Total persons using bath 22,862 *Included in this figure are 4,483 persons admitted by season tickets, and 692 children admitted by school passes. 105 GENERAL IMPROVEMENTS. The following Works have been carried out by the Engineer's staff:— Widening portion of Philip Lane and West Green Road. Widening Spur Road. Widening section of Church Lane. Main Roads and Highways.—Repairing footways spreading and steam-rolling 6,965 tons of granite; restoring gas and water trenches; constructing pitched crossings; repairing steam rollers, water posts, water troughs and drinking fountains; clearing and Hushing 3,940 gullies; repairing and painting sand bins; cleaning down and painting 615 public lamps. Parks and Open Spaces.—Painting fences and chairs (band stand); repairing gates, green-houses, mowing machines, rollers, drinking fountains, etc. Public Baths.—Making and fixing 19 dressing boxes at Open Air Bath ; taking up and relaying floor over 1st class bath ; altering and re-arranging platforms. Public Health Department.—Generally repairing asphyxiators, disinfecting vans, steam disinfector, &c. 106 PARTICULARS OF SEWER WORK CARRIED OUT DURING THE YEAR 1913. Soil and Surface Water Servers Relaid. Length Size Remarks 200 feet 9 inches Stoneware 5,330 „ 6 „ „ 1,078 „ 4 „ „ New Sewers Constructed. Length Size Remarks 35 feet 4ft. 6ins. by 5ft. Bellmouth with protection walls 320 „ 12 inches Stoneware 60 „ 9 „ „ 568 „ 6 „ „ 1,139 „ 4 „ „ 21,410 feet of ditches have been cleared out. 10,900 ,, „ old sewers ,, ,, „ 2,500 „ ,, culverts ,, „ ,, 480 ,, „ new drain connections in private roads have been examined and passed. 600 ,, ,, new soil connections have been made in public roads. 640 ,, ,, new surface water connections have been made in public roads. 24 new saddles have been fixed. 15 defective mains have been repaired. 107 5 blind manholes have been built up. 55 new manholes have been constructed. 47 new manhole frames and covers have been put in. 291 stoppages have been cleared. * * * * The length of soil and surface water sewers to be kept •clean and in working order is 346 miles. These sewers are ventilated by 73 six inch by four inch ventilating shafts and 34 large columns. All manholes and syphons are periodically examined and cleaned. BUILDING OPERATIONS DURING 1913. The number of houses, and shops and houses, actually erected during the year was 154, as against 124 for the previous year. Buildings of other descriptions numbered 50, as compared with 61 in 1912. The number of additions and alterations made to existing buildings was 44, as contrasted with 46 in 1912. Plans were approved for 190 new buildings during the year, as compared with 173 during 1912. New streets and extensions of existing streets numbered 7 (as against 7 for 1912), and their total length was 3,029 feet, as contrasted with a total length of 3,035 feet for 1912. 1,025 feet of new 9 inch and 1,091 feet of new 12 inch Soil Sewers, and 1,850 feet of new 9 inch, 375 feet of new 12 inch and 225 feet of new 15 inch Surface Water Sewers were laid under the supervision of the Building Department. The figures for the previous year were 1,920 feet of new Soil Sewers, and 3,265 feet of new Surface Water Sewers. 108 LONDON COUNTY COUNCIL ESTATE. Certificates have been given for 38 houses completed during the year ; 6 others are in course of erection. PLANS PASSED FOR NEW BUILDINGS IN TOTTENHAM DURING THE PAST 10 YEARS. 1904 682 1905 1,413 1906 1,010 1907 770 1908 691 1909 524 1910 312 1911 397 1912 173 1913 190 PRIVATE STREET WORKS. During the year 1913, 9 private roads were made up under the Tottenham Local Board Act, 1890, at a cost of £2,749 11s. 1d., and 1 private road was made up by the owners : all of these roads were declared public highways. 6 private roads were made up under the Tottenham Local Board Act, 1890, at a cost of ,£2,971 6s. 11d. and 2 passages were made up under Section 60, Tottenham Local Board Act, 1890, at a cost of ,£66 14s. 9d. but these have not yet been declared public highways. 109 l private road is in course of construction but has not yet been completed. The total length of Highways is 72 miles, 5 furlongs, 71 yards. The following is the list of Private Roads made up under the Tottenham Local Board Act, and declared Public Highways during the year under review:— £ s. d. Bromley Road 287 18 4 Oakdale Road 261 13 6 Hampden Road (Rem.) 495 2 11 Keston Road (Sec. 2) 65 9 0 Keston Road (Rem) 254 19 0 South Grove (Rem.) 366 15 7 Road between Avenue Road and South Grove 234 3 4 Craven Park Road 376 13 7 Barry Avenue 406 15 10 £2,749 11 1 Private Road made up by Owners, and declared a Public Highway:— Risley Avenue (East side of Wateville Road to East side of Shobden Road). 110 Private Roads made up but not yet declared Public Highways :— £ s. d. Holcombe Road (Sec. 2) 137 6 2 South Grove (Sec. 1) 319 1 1 2 Hale Road 479 17 2 Seymour Avenue (Sec. 2) 538 13 11 Wargrave Avenue (Sec. 2) 976 11 8 Rusper Road (Sec. 1) 519 6 10 £2,971 6 11 Passages made up under Section 60, T. L. B. Act, but not yet declared Public Highways:— Passage rear of Nos. 743 to £ s. d. 755 High Road 53 18 11 Passage Cape Road 12 15 10 £66 14 9 Private Road in course of construction but not yet completed :— Tariff Road. COLLECTION OF SLOP. 15,451 loads of slop were collected and removed during the year. PUBLIC LAMPS. The total number of public lamps amounts to 2,291, 2,151 of which are lighted by gas under the Rostin System, the remaining 140 being lighted by electricity. 111 ELECTRIC LIGHTING OF THE DISTRICT. Electric Light is now available in every main road, and arc lamps have been installed in the High Road, Green Lanes, Seven Sisters Road, Bruce Grove, Lordship Lane, and West Green Road. SEWERAGE OF THE DISTRICT. The district is drained on the dual system, there beingseparate sewers for soil and surface water. The surface water is discharged into the River Lee, and the soil sewage is pumped into the London County Council's main sewers. UNDERGROUND CONVENIENCES. Three Underground Conveniences exist in the district, one at Seven Sisters Corner, provided with 6 w.c.'s, 12 urinal stalls, and 3 washing basins for males, and 3 w.c.'s, and 4 washing basins for females; another at Green Lanes (corner of Alfoxton Avenue), possessing 4 w.c.'s, 9 urinal stalls, and 3 washing basins for males, and 3 w.c.'s and 3 washing basins for females; and another in Bruce Grove containing 4 w.c.'s, 12 urinal stalls, and 2 washing basins for males, and 2 w.c.'s, and 2 washing basins for females. These are all kept in a clean condition and prove effectual to supply a public need. I 12 PETROL, PETROLEUM, AND CARBIDE OF CALCIUM LICENCES GRANTED. Petrol. 42 Licences, sanctioning the keeping of 42,292 gallons. Petroleum. 10 Licences, sanctioning the keeping of 180 gallons. Carbide of Calcium. 7 Licences, sanctioning the keeping of 2 tons 14 cwt. SHOPS ACTS, 1912 and 1913. Orders fixing the weekly half-holiday were made by the Council, and became operative during 1913, for the " Harringay " and " Tottenham Remainder " areas. All shops to which the Orders apply must be closed for the weekly halt-holiday at 1 p.m. on Wednesday in the case of the "Harringay" area, and 1 p.m. on Thursday in the case of the "Tottenham Remainder" area, provided that any shopkeeper may substitute Saturday on affixing a notice to that effect in his shop. "Harringay area" as defined for the purpose of this Act, is that portion of Harringay Ward west of a line running from the southern boundary of Harringay Ward at Green Lanes along the east rear of Green Lanes to Harringay Park Station; thence along the railway to and along the east rear of Warwick Gardens to the south rear of St. Ann's Road; thence along the south rear of St. Ann's Road to a point opposite to the east rear of Black Boy Lane; thence along the east rear of Black Boy Lane to a point opposite to the north 113 rear of Cranleigh Road; thence along the north rear of Cranleigh Road to and along the east rear of Woodlands Park Road to a point opposite the north rear of Clarendon Road; thence along the north rear of Clarendon Road to and along the east rear of Glenwood Road to the south rear of Park Road; thence along the south rear of Park Road to and along the west rear of Harringay Road to the south rear of West Green Road; thence along the south rear of West Green Road to Green Lanes; thence directly to the junction of Willoughby Road and Turnpike Lane. Appended is an epitome of the work done by the Inspector under the Act. Total number of visits to shops 3,162 Warnings given for— Not displaying " exempted trade notices " 495 Not having ''closing notices" 468 Not having regulation notices re Assistants' holidays 374 Not having regular notices re " young persons" 251 Displaying irregular trade notices 188 Serving after closing time 78 Not allowing proper meal times 4 Employing "young persons" beyond legal number of hours 3 Not giving assistants holidays according to notice 1 Total warnings given 1,862 H4 FIRE STATIONS IN THE DISTRICT. 1. *Central Fire Station, The Green. 2. *Conway Road (Woodlands Park Road). 3. *Coombes Croft House, 712 High Road. 4. St. Ann's (Minster Road), Fire Escape Station only. 5 *Green L ines (Umfreville Road), Fire Escape Station only. *Ambulance are kept at each of those Stations, and cases containing surgical and medical appliances are carried on all horse and automobile machines. FIRE ALARM POINTS. At Junction of High Road and Snell's Park. ,. High Road and White Hart Lane. „ College Road and White Hart Lane. ,, Chalgrove Road and Manor Road. „ Trulock Road and Northumberland Park. „ Tebworth Road and Church Road. ,, Sutherland Road and Park Lane. „ Park Lane and Northumberland Park. Lansdowne Road, corner of High Road. Kemble Road, near corner. Poynton Road. Opposite G.E.R. Station, Bruce Grove. Sperling Road. Stoneley South (near Devon Road). Broad Lane, opposite Post Office. Colstervvorth Road. The Hale, opposite The Pound. At Junction of High Road and West Green Road. „ West Green Road and Avenue Road. Braemar Road (opposite Board School). Culvert Road, facing Braemar Road. At Junction of Nassau Road and St. Ann's Road. Vale Road. 115 At Junction of Vartry Road and Seven Sisters Road. Vartry Road, opposite Board School. St. John's Road. Corner of Holmdale Road. Hillside Road, corner of High Road. Lealand Road, corner of Fairvew Road. High Road, opposite South Tottenham Station. Opposite St. Ann's Railway Station. Moreton Road, corner of Tewkesbury Road. Green Lanes, facing Endymion Road. „ „ Mattison Road. ,, „ St. Ann's Road. „ corner of Fairfax Road. ,, facing " Wellington " P.H., corner of Turnpike Lane. West Green Road, opposite Willow Walk. Stanmore Road, corner of Carlingford Road. West Green Road, corner of Woodlands Park Road. „ corner of Black Boy Lane. Philip Lane, corner of Mount Pleasant Road. „ corner of Summerhill Road. Lawrence Road, opposite Mr. Duncan Tucker's Saw Mills. Lordship Lane, opposite Bruce Castle. „ „ L.C.C. Estate. Mount Pleasant Road, facing The Avenue. Napier Road. Westbury Avenue, Junction with Lordship Lane. „ in middle of. „ near Lakefield Road. Hermitage Road, corner of Finsbury Park Avenue. St. Ann's Road, opposite Warwick Gardens. Rosebery Gardens, Rutland Gardens, n6 FIRE BRIGADE AND APPLIANCES. There are 25 men all told, five being on duty day and night. The remaining 20 are in bell call, in the various stations, available for turning out at any time. All Fire Stations are in Telephonic Communication with the Chief Fire Station, Police Stations, and nearest Turncocks. The principal appliances consist of— 1 Horsed Steamer, capable of throwing 400 gals, per minute, 1 „ „ „ „ 360 „ „ 1 Combined Horsed Escape, Hose Tender, and Chemical Fire Engine. 1 Motor Oil Fuel Steamer, throwing 320 gals, per minute. 1 Petrol Pump and Chemical Engine, 100 h.p. 2 Combined Motor Chemical Fire Engines, Hose Tenders, and Fire Escapes. 1 6-in. Manual. 1 4-in. Hose and Ladder Truck. 5,000 ft. of 2f.in. canvas hose (part rubberlined). 1,400 ft. of 3f-in. ditto. 530 ft. hose for Chemical Fire Engines. 4 Hand Fire Escapes, always on duty, one being permanently stationed in rear of Hospital. (The Escapes at the principal Stations are Automobile.) 3 Horses. Each hand Escape carries hose, stand-pipe, and turncock's tools ; and jumping sheets, long lines, and life lines are carried with all appliances First aid appliances are carried on all horsed or automobile machines. In addition to the Fire Alarms there are nearly 40 Telephones connecting all points in the District, and the Brigade is connected with the General Post Office Exchange, No. 100, Tottenham, and No. 100, Hornsey. The latter number should be used by the subscribers who are connected with the Hornsey Exchange. 117 PARTICULARS REGARDING PARKS, OPEN SPACES, ETC. OPEN SPACES. AREA. DATE ACQUIRED. I. Bruce Castle Park, Lordship Lane,Tottenham 20 acres 25th June, 1892 2. "The Chestnuts," Recreation Ground, St. Ann's Road, South Tottenham (including Common Land) 13 „ 3rd May, 1898 3. Land in Marshes (Less ¼ acre sold to Messrs. Lebus in April, 1909 Less 11 a.2/5 p. sold to Messrs. Lebus, April, 1911) 122 „ Between 1898 and July, 1905 4. " The Down Field " Recreation Ground (near Tottenham Hale) about (i.e.. Freehold Land 2 acres, late Lammas Land 17½ acres). 19½ „ Sept. and Xmas, 1900 5. Downhills Park (including 4 acres purchased from G.E.R. Company, March, 1905) 30¼ „ Aug. 11th, 1902 6. Land East side of River Lee, conveyed by Metropolitan Water Board under East London Water Works Company's Act, 1897 25 „ March, 1905 Total 229¾ „ COMMONS. ACRES. RDS. PLS. YDS. 1. Tottenham Green (East), High Road 2 31 24 2. Tottenham Green (West), High Road 1 2 6 4 3. Page Green, between High Rd. and Earlsmead Council School 1 2 8 26 4. Page Green Terrace, High Rd., South Tottenham 2 35 13 5. West Green, at the Junction of Philip Lane and West Green Road 1 O 0 0 6. West Green, near Green Lanes 2 1 8 27 7. Duckett's Green, Green Lanes 6 1 0 0 8. Common, High Road, between West Green Road and Seven Sisters Road 27 0 9. Common, opposite The Grove, High Road South Tottenham 3 32 0 10. High Cross Common, High Road 31 7 15 3 21 10 118 TRAM CARS. In view of the increased attention that is being given to Tuberculosis in all its forms, the bye-laws relating to spitting in or upon tram cars might with profit be more rigorously enforced. AMBULANCES. The Council possesses two Ambulances, one suitable for the removal of ordinary infectious cases, and the other especially built for the removal of Small Pox patients ; the former is occasionally used for the removal of "outside" cases of infectious disease to their own homes ; in the ordinary way, however, our infectious cases are removed to Hospital in the Metropolitan Asylums Board's Ambulances. METEOROLOGICAL STATION. The local Meteorological Station is recognised as belonging to the second order (normal Climatological Station) by the Meteorological Office; weekly and monthly reports are furnished to the Head Office, an analysis of which appears in the returns of the Registrar General, and the meteorological tables placed outside the Municipal Buildings should prove of considerable value to those interested in weather study, and in the influence exerted by weather upon special diseases.  BAROMETER THERMOMETERS hygrometer RAINFALL SUNSHINE Mean Highest Reading Lowest Reading Maximum Minimum Earth Grass Sun Dry Bulb Mean Wet Bulb Mean Vapour Pressure Mean Humidity Mean Inches Number of Days Estimated Hours Amount of Heaviest Fall Day on which Heaviest Fall occurred Hours of Bright Sunshine Number of Sunless Days Mean Highest Mean Lowest Mean Mean Mean January 29.745 30.339 29120 43.4 52.2 36.6 27.0 45.8 32.2 53.0 39.5 35.5 .257 90 2.92 17 72.0 0.70 11th 20.1 22 February 30.190 30.711 29.519 47.2 54.5 36.6 26.0 44.2 30.5 61.5 40.6 38.4 .219 85 0.68 11 29.0 0.21 1st 46.5 13 March 29.884 30.545 28.899 44.7 57.5 40.3 30.3 44.5 34.3 75.3 45.1 42.5 .261 82 21.8 22 66.0 0.36 16th 86.1 7 April 29.861 30.185 29.438 53.8 66.0 37.8 29.8 46.3 36.8 87.7 47.4 44.4 .258 75 2.59 21 66.5 0.47 11th 117.0 3 May 29.916 30.291 29.348 64.1 80.0. 47.3 38.3 51.1 44.2 106.1 55.6 51.2 .333 74 1.49 11 32.5 0.45 29th 196.8 2 June 30.095 30.390 29.778 68.7 83.0 51.6 44.0 57.3 49.1 111.2 59.9 54.8 .366 71 0.45 7 16.0 0.16 10th 208.1 0 july 30.028 30.379 29.690 64.3 75.0 52.9 49.7 59.9 51.0 100.3 58.8 55.6 .402 81 1.94 14 51.5 0.60 10th 100.6 4 August 30.051 30.366 29.722 70.2 81.0 53.9 47.0 61.1 47.1 110.1 61.1 57.4 .421 78 1.76 13 46.0 0.60 31st 148.2 3 September 29.953 30.329 29.363 66.8 76.0 52.1 43.0 60.5 47.6 96.7 57.9 55.9 .422 88 1.34 10 54.5 0.32 16th 130.5 4 October 29.883 30.484 29.285 63.8 69.0 50.1 35.0 57.9 43.2 79.4 52.5 51.0 ..353 90 3.39 16 60.5 0.79 20th 77.3 5 November 29.916 30.415 29.352 53.5 59.0 44.2 29.5 53.1 38.2 67.6 47.9 44.7 .301 90 2.63 15 73.5 0.72 21st 62.4 9 December 30.114 30.674 29.353 46.3 57.0 38.8 29.0 49.8 26.0 53.5 42.7 40.2 .236 86 0.74 9 21.0 0.22 23rd 36.9 18 Highest recorded reading 30.711 on February 12th. Lowest recorded reading 28899" on March 19th. Maximum temperature registered 83 0° on June 17th. Lowest temperature registered 26.0° February 23rd. Total Rainfall 22.11 inches. Heaviest Fall occurred on October 20th, 0.79 inch. Total hours of bright sunshine, 1,230 5 120 DISINFECTION OF LIBRARY BOOKS. When a case of infectious disease occurs in any house containing books borrowed from the Library, and which have been handled by the patient, such books are either disinfected, or, if their condition renders it necessary, destroyed altogether. PUBLIC INSTITUTIONS. The North-Eastern Fever Hospital at the close of the year contained 592 patients (77 Tottenham residents) and 362 officials, the Prince of Wales's General Hospital 110 patients (54 Tottenham residents) and 66 officials, the Jewish Home for Incurables 83 patients (no Tottenham residents) and 27 officials, and the Edmonton Workhouse 328 Tottenham inmates. The number of Tottenham persons receiving out-door relief at the end of the year was 798. MEDICAL EXAMINATIONS. The Medical Officer of Health has made a careful medical examination of all newly appointed school teachers and members of the Fire Brigade during the year. INHABITED HOUSE DUTY. A large number of inspections have been made under the Customs and Inland Revenue Act, 1890, on the application from owners for certificates exempting them from Inhabited House Duty. The applications have only been acceded to in those instances where suitable separate sanitary accommodation had been provided for the several families or persons inhabiting the different tenements. INDEX. A PAGE Ambulances 118 Area 17 B Babies and their Feeding 31 Bacteriological and Chemical Laboratory 89 Bakehouses 85 Baths 102 Births and Birth Rates 18 etc. Boundaries 10 Building Operations 107 Butchers' Shops 88 C Cancer 66 Common Lodging Houses 89 Comparative Health of Different Wards 76 Complaints 97 etc. Cowsheds 87 D Dairies, Cowsheds, and Milkshops 87 Deaths 23 Deaths in Public Institutions 72 Defective Drains 98 Diarrhœa 57 Diphtheria 44 Disinfections 99 Disinfector 99 Domestic Workshops 85 Drain Testing 98 Drainage 111. E PAGE Electric Lighting 111 Empty Houses 17 Enteric Fever 50 Erysipelas 59 Estate Development 107 Estimated Population 17 F Factories and Workshops 82 Female Staff 31 Fire Brigade 114 Fish Shops 88 Food, Animal and Vegetable 86 Food and Drugs Act 87 Food Inspections 86 G General District Statistics 15 Geographical Position 10 Geology of the District 10 Gipsies 88 Growth of the District 16 H Highway Refuse 94 Home Industries of District 85 Hospitals 120 Houses erected 107 House Refuse, Collection of 94 Housing of the Working Classes Act, etc. 100 I Ice Cream 88 Illegitimate Births 18 Improvements 105 Infant Death Rate 29 Infant Mortality 29 Infectious Diseases 36 Inhabited Houses 17 Inhabited House Duty 120 Inquests and Post Mortems 75 Introduction 8 L PAGE Lady Sanitary Inspectors 94 etc. Laundries 85 Legal Proceedings 101 Library Books, Disinfection of 120 Lighting of District 111 Local Government Board Tables 68 Local Industries 85 London County Council Estate 108 M Measles 54 Medical Examinations 120 Membranous Croup 44 Meteorological Station 118 Mortuary Table 75 N Notices Served 97 Notification of Infectious Diseases 52 Nuisances Detected 97 O Occupied Houses 17 Outworkers 85 P Parks and Open Spaces 117 Patients Removed to Hospital 51 Pawnshops 88 Petroleum and Petrol Licenses 112 Phthisis 60 Plans Passed 108 Poliomyelitis 59 Population 17 Precautions in Scarlet Fever, etc. 42 Private Street Works 108 Public Houses and Off Licenses 88 Public Institutions 120 Public Lamps 110 Puerperal Fever 59 R Rates and Rateable Value 17 Refuse Destructor 94 Respiratory System, Diseases of 65 s Page Sale of Food and Drugs Act. 87 Sanatoria 62 Scarlet Fever 37 Schools and School Hygiene 79 Scholars, Disease of 80. Sewerage of the District 111 Shops Act 112 Slaughter Houses 87 Slop, Collection of 110 Small Pox 36 Smoke Nuisance 89 Staff of Public Health Department 5 Street Improvements 108 Suicides 67 Swimming Baths 102 T Tram Cars 118 Tuberculous Diseases other than Phthisis 65 Tuberculosis 60 Typhoid Fever 50. U Underground Conveniences 111 Unsound Food 86. V Violent Deaths 67 Vital Statistics 68 Vital Statistics, Summary of 14 W Ward Statistics, Comparative 17 etc. Water Supply 89 Whooping Cough 55 Work of the Public Health Department 91 etc. Workshops and Workplaces 85 Z Zymotic Death Rate 14 etc.