TOT046 Tottenham Urban District Council. REPORT ON THE HEALTH OF TOTTENHAM for the Year 1921. TOTTENHAM: CRUSHA & SON, Printers, 821-823, High Road. 3 Staff. 1. HEALTH DEPARTMENT. Medical Officer of Health— David C. Kirkhope.M.D. ,Ch.M., D.P.H., Barr.-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. West Green Ward. (33, Drayton Road.) ‡*Miller, H. W. Middle Ward. (119, Sperling Road.) †*Shillito, J. A. Lower Ward. (32, Willoughby Park Road.) †*Smith, J. B. (Cert., S.I. Ex. Brd.) St. Ann's Ward. (86, Chester Road.) Female Sanitary Inspectors— Parsons, Mrs. J. E. (Cert. San. Insp. Exam. Board) (Part Time.) *Lamb, Miss M. *The Officials so marked hold the Certificate of the Royal Sanitary Institute. Meat Inspector's Certificate. *This Inspector holds the Diploma of the Incorporated Institute of Hygiene. Inspector under the Shops Acts— Stacy, H. J. 4 Clerical Staff— Garvey, R., Chief Clerk (Cert., Roy. San. Inst.) Cozens, A. G., Clerk. Baker, S., Clerk. Bennett, P. W., Clerk. Potter, W., Junior Clerk. Mortuary Attendant— H. Corder, 24, Loobert Road, Clyde Circus. Disinfectors— A. Pitney (Houses). J. Mitchell (Clothing). J. Collins ,, Drain Testers, Etc. H. Bysouth. J. Wilson. F. Dowse. C. Vessey. 2. SCHOOL MEDICAL DEPARTMENT. SCHOOL MEDICAL OFFICER: DAVID C. KIRKHOPE, M.D., Ch.M., D P.H of Gray's Inn, Barrister at Law. ASSISTANT MEDICAL OFFICERS: ALICE STALKER, M.B., Ch.B., D.P.H. GRACE T. ANDERSON, M.B , Ch.B. R. HASTINGS SMYTHE, L.R.C P. S.I. Ophthalmic Surgeon : T. W. Letchworth, F.R.C.S. 5 X-Ray Clinician: C. R. Kempster, M.R.C.S., L.R.C.P. (Lond.) Dental Surgeons: V. Sainty, L.D.S., R.C.S. (Eng.) C. L. Taylor, L.D.S., R.C.S. (Eng.) School Nurses: E. Johns. M. Pickburn. W. Barnes. K. McNulty. C. Vine L. Rogers. E. Lindsay. E. Barratt. H. McMath. E. Preston. C. Wright. Clerical Staff: V. Goddard. E. Ing. T. E. Cohen. Laboratory Lad: J. E. Miller. 3. MATERNITY AND CHILD WELFARE DEPARTMENT. Medical Officer: DAVID C. KIRKHOPE, M.D., Ch.M., D.P.H. Part Time Medical Officer, Infant Welfare Clinics: CHARLOTTE ALICE KING, M.D., B.S., D.P.H. Part Time Medical Officer, Ante and Post Natal Clinics: DOROTHY C. LOGAN, M.D., B.S. Superintendent Health Visitor: Mrs. J. Kent-Parsons. Health Visitors: B. Wallace, M. Blanchard, G. Mason, N. Headley, M. L. Kilbey, F. Fletcher, G. M. Hockin, G. G. Pattle, M. M. Reynolds. 6 Cot Centre: Sister-in-Charge—S. E. M. Love. Nurses—N. V. Hobbs, I. Phillips. Creche: Matron—F. E. Trewinnard. Nurses—D. Saybourne, K. Allen. Clerical Staff: E. Horton, M. Coleman, E. Fisher, W. Colman. 7 INTRODUCTION to the ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. Town Hall, Tottenham. March, 1922. To the Members of the Tottenham Urban District Council, Tottenham Education Committee and Tottenham Maternity and Child Welfare Committee. Ladies and Gentlemen, The Ministry of Health have issued instructions that for the year 1921 Medical Officers' Annual Reports shall be mainly in statistical form, and that at five yearly periods only shall they be required to review in detail the sanitary conditions of the district. The School Medical Report and Maternity and Child Welfare Report, which are incorporated herewith, are, in conformity with the Health Report, for the most part in tabular form. The Medical Officer of Health expresses his thanks to the Health Committee, to the Canteen and General Cares Committee and the Maternity and Child Welfare Committee for their uniform courtesy and consideration. The staffs of the various Committees have fulfilled their duties during the year with unswerving loyalty. I am, Ladies and Gentlemen, Your obedient Servant, David Kirkhone. 8 GENERAL STATISTICS. Area 3,014 acres. Population 149,200 No. of inhabited houses and tenements 28,728 Rateable Value £605,019 Sum represented by a penny rate £2,360 BIRTHS. Males. Females. Total. Legitimate 1,724 1,558 3,282 Illegitimate 66 54 120 1,790 1,612 3,402 Birth Rate per 1,000 of the population 22.8 DEATHS. The total number of deaths registered in Tottenham was 1,274 Of these the number of non-residents was 258 Deaths of residents registered in the district 1,016 Deaths of residents registered outside the district 537 1,553 Deaths of residents under 1 year occurring in district 163 Deaths of residents under 1 year occurring outside district 68 Total deaths of Tottenham infants 231 General Death Rate per 1,000 of population 10.4 Infant Mortality per 1,000 births 67.9 Note.—The Registrar General's figures were received by us on the 28th March, when our manuscript was in the hands of the printers, too late to alter the tables concerned with deaths. 9 TABLE OF DEATHS during the year 1921 in the Tottenham Urban Sanitary District, classified according to Diseases, Ages, and Localities. Causes of Death Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District (a) 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 (b) 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 11 12 13 14 15 16 Enteric Fever 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 2 Scarlet Fever 6 .. 1 1 3 .. .. 1 .. .. .. .. .. 1 1 4 .. .. .. 23 Whooping Cough 15 8 4 3 .. .. .. .. .. .. .. .. .. .. 3 3 1 3 2 1 Diphtheria and Croup 49 1 4 16 24 3 .. .. .. 1 .. .. .. 10 3 9 10 9 8 141 Influenza .. .. .. .. .. 1 .. 1 1 3 1 1 .. 1 .. 3 .. .. 4 3 Erysipelas 4 1 .. .. .. .. .. 1 .. 1 1 .. .. 1 .. 2 .. 1 .. .. Phthisis (Pulmon. Tuberculosis) 119 .. .. 1 4 27 29 24 16 12 6 .. .. 17 14 23 15 24 26 5 Tuberculous Meningitis 14 3 2 2 2 3 .. 1 .. .. 1 .. .. 1 3 3 4 2 1 4 Other Tuberculous Diseases 23 6 .. 1 2 3 6 1 3 .. 1 .. .. 1 5 2 6 8 1 5 Cancer, malignant disease 162 .. .. 1 1 3 1 9 34 .. 48 19 .. 20 20 28 22 39 33 32 Rheumatic Fever 4 .. .. .. .. .. 1 .. .. .. 2 .. .. 1 .. .. 1 1 1 1 Meningitis 8 5 2 .. .. .. .. 1 .. .. .. .. .. 1 1 1 3 1 1 1 Organic Heart Disease 150 4 .. .. 5 6 8 7 22 24 35 33 6 17 18 33 31 29 22 12 Bronchitis 124 11 5 2 .. 1 1 4 11 21 32 29 7 16 13 30 20 30 15 10 Pneumonia (all forms) 102 22 14 5 9 5 4 6 8 16 10 3 .. 12 11 20 32 20 7 25 Other Diseases of Respiratory Organs 27 2 .. .. 2 2 .. 3 3 6 5 4 .. 14 2 3 3 3 2 2 Diarrhœa and Enteritis 59 51 7 1 .. .. .. .. .. .. .. .. .. 4 8 12 14 10 11 7 Appendicitis and Typhlitis 9 .. .. .. 5 .. 2 .. .. 2 .. .. .. 1 2 12 .. 1 4 5 Cirrhosis of Liver 7 .. .. .. .. .. .. .. 3 2 1 1 .. .. 2 2 1 1 1 .. Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Nephritis and Bright's Disease 39 .. .. .. .. 1 .. 6 9 12 5 6 .. 4 7 6 9 9 4 13 Puerperal Fever 3 .. .. .. .. .. 1 2 .. .. .. .. .. .. 2 .. .. 1 .. 2 Other Accidents and Diseases of Pregnancy and Parturition 7 .. .. .. .. l 3 3 .. .. .. .. .. 2 1 2 1 1 .. 1 Congenital Debility and Malformation, inc. Prem. Birth 99 99 .. .. .. .. .. .. .. .. .. .. .. 12 9 25 15 14 24 12 Violent Deaths, excldg. Suicide 39 1 .. .. 7 4 3 4 5 6 8 1 .. 4 2 10 6 9 8 19 Suicide 12 .. .. .. .. .. .. 2 6 .. 4 .. .. 3 1 6 .. 2 .. 1 Encephalitis Lethargica 2 .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. 1 1 .. Other Defined Diseases 460 16 3 6 14 25 27 40 38 65 85 107 34 57 68 70 83\ 98 85 86 Totals 1553 231 42 39 72 85 86 116 160 215 | 245 204 51 203 196 299 277 317 261 413 10 Table of cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1921, in the Tottenham Urban District, classified according to diseases, ages and localities. Notifiable Disease Number of Cases Notified. Total Cases Notified in Each Locality. Total Cases Removed to Hospital At all Ages At Ages—Years 1 2 3 4 5 6 Under 1 1 to 5 5 to 15 15to25 25to45 45to65 65 and up wards Harringay West Green ! St. Ann's High Cross Middle Lower Dysentery 1 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. Encephalitis Lethargica 6 .. .. 2 1 .. .. 3 1 .. 1 1 2 1 2 Diphtheria (including Membranous Croup) 561 8 102 372 45 30 4 .. 76 44 139 108 105 89 482 Erysipelas 65 2 1 7 5 15 28 7 11 10 21 4 11 8 1 Scarlet Fever 1062 14 161 758 91 35 3 .. 136 160 255 231 160 120 500 Measles 166 20 67 73 2 4 .. .. 16 10 82 31 17 10 2 Enteric Fever 4 .. .. 2 1 .. 1 .. .. .. .. .. 3 1 4 Malaria 5 .. .. .. 1 4 .. .. 1 1 .. .. .. 3 .. Pneumonia 180 17 37 34 24 31 27 10 31 20 79 19 19 12 .. Puerperal Fever 5 .. .. .. .. 6 .. .. .. 3 1 1 .. .. .. Cerebro-spinal Meningitis 1 .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. Poliomyelitis 2 .. 2 .. .. .. .. .. .. 1 .. .. .. 1 .. Ophthalmia Neonatorum 29 29 .. .. .. .. .. .. 3 2 13 1 4 6 .. Pulmonary Tuberculosis 258 1 1 21 76 126 30 3 31 34 58 55 47 33 .. Other forms of Tuberculosis 54 2 4 19 12 15 2 .. 8 11 17 5 9 4 .. Totals 2399 93 375 1289 258 266 95 23 314 296 667 457 377 288 991 11 OPHTHALMIA NEONATORUM. CASES. Vision unimpaired. Vision impaired. Total blindness. Deaths. Notified. Treated. At home. In hospital 29 10 19 24 2 - 3 TUBERCULOSIS. Total Cases notified Total Deaths. Pulmonary:— Males 141 66 Females 117 53 Total 258 119 Non-pulmonary Males 21 22 Females 33 15 Total 54 37 Fatal Cases of Tuberculosis:— Notified Cases 104 Non-notified 52 Total Deaths 156 From the above figures it will be seen that of the deaths occurring in the district, or in respect of patients belonging to the district but residing outside, exactly one-third had not been notified, at least to this authority. Notification, therefore, cannot be regarded as efficient. It is not surprising that this should be so, having regard to the fact that the Health Authority of the district is responsible only for receiving notifications, and administrative control in relation to the patients is entrusted to the County, who cannot possibly be in such close touch with individuals as the staff of the Local Authority. 12 SCARLET FEVER AND DIPHTHERIA. Scarlet Fever and Diphtheria were prevalent during the year, and hospital accommodation proved, as it usually does during epidemic prevalence, to be totally inadequate. The consequence was that many of the patients in a highly infectious condition were nursed at home and multiple cases occurred with unfortunate frequency. The Scarlet Fever was not of a severe type, but Diphtheria claimed 49 victims, indicating a case mortality of 8"7 per cent. NURSING ARRANGEMENTS. General Nursing.—The District Nursing Association undertake, so far as their staff allows, nursing of general cases in the homes of the poor of Tottenham. Infectious Diseases.—The Maternity and Child Welfare Committee have an arrangement with the District Nursing Association for the domiciliary treatment of cases of Measles, Whooping Cough, Ophthalmia Neonatorum, Epidemic Diarrhoea and Ante-natal cases. Midwives.—There are 15 Midwives practising in the district. 13 CLINICS AND TREATMENT CENTRES. Name and Situation Nature of Accommodation By whom Provided Infant Welfare Clinic, ' 'The Chestnuts," N.15 Consulting Room, Weighing Room, Waiting and Stock Room, Pram Room. Tottenham Maternity and Child Welfare Committee. Infant Welfare Clinic, Bruce Castle, N.17 Consulting Room, Weighing Room, Waiting and Stock Room, Pram Room. Do. Infant Welfare Centre, Town Hall, N.15. Weighing Room and Waiting Room. Do. Maternity Clinic, "The Chestnuts." Consulting Room, Dressing Room, Waiting Room, Dining Room. Do. Maternity Clinic, Bruce Castle. Consulting Room, Dressing Room, Waiting Room. Do. Minor Ailments Clinic, Town Hall. Consulting and Treatment Room and Waiting Room Tottenham Education Committee. Minor Ailments Clinic, Bruce Castle. Consulting Room, Treatment Room and Waiting Room. Do. Dental Clinic, Bruce Castle. Surgery, Recovery Room, and two Waiting Rooms. Do. Dental Clinic, "The Chestnuts.'' Surgery, Recovery Room, and Waiting Room. Do. Throat Clinic, Bruce Castle. Operating Room, Recovery Room and Waiting Room. Do. Eye Clinic, Bruce Castle. Dark Room, Treatment, Fitting and Waiting Rms. Do. X-Ray Clinic, Bruce Castle. X-Ray Room and Waiting Room. Do. Spray Bath Clinic, Town Hall. Bath Room and Waiting Room. Do. Tuberculosis Dispensary, Tvnemouth Rd., N.15.* Consulting Room, Dressing Room, Waiting Room, Laboratory, Office. MiddlesexCounty Council Venereal Diseases Clinic Prince of Wales's Hospital, N.15. Two Consulting Rooms, Two Treatment Rooms, Two Waiting Rooms, and Laboratory. Do. 14 HOSPITALS. Maternity.—The North Middlesex Hospital undertakes in respect of a subsidy from the Local Authority to provide maternity beds for patients recommended for institutional treatment by the Medical Officer of Health. Children.—The Invalid Children's Aid Association are subsidised by the Education Committee, and in a few isolated cases by the Maternity and Child Welfare Committee, in respect of children who are recommended for convalescent treatment by the Medical Officer of Health. Fever.—The Metropolitan Asylums Board have, by an agreement, entered into with the Council in 1894, accepted for institutional treatment such infectious diseases as they are accustomed to receive into their Hospitals. Small Pox.—Tottenham is one of the contributory authorities to the Middlesex Districts Joint Small Pox Hospital Board. Other.—Locally there are two considerable Institutions, the Prince of Wales's General Hospital, a voluntary Institution, and the Jewish Home and Hospital for Incurables. The former has 125 beds and cots and: the latter 93 beds. AMBULANCE FACILITIES. (a) The Metropolitan Asylums Board make the ambulance provision for the removal of infectious cases. (b) The Local Authority have provided 3 ambulances for noninfectious and accident cases. 5,008 patients were dealt with during the year, and deaf and dumb children were conveyed to and from school on 134 occasions. LABORATORY. Swabs for diphtheria and sputum for consumption are examined in the Council's Laboratory. 2,989 swabs (373 positive) and 187 specimens of sputum (33 positive) were dealt with during the year. 15 Other bacteriological and serological examinations (except venereal disease work, which is undertaken by the Prince of Wales's Hospital) are made by arrangement with a London Institution. STATUTES, BYE-LAWS, ETC., ADMINISTERED BY HEALTH DEPARTMENT. The Health Department is mainly concerned with carrying out the provisions of the following Acts, Bye-laws, Orders and Regulations. From time to time the Ministry of Health issue circulars relating to matters of outstanding importance, e.g., Cholera, Small Pox, Cerebro-Spinal Meningitis, Diarrhœa, Anthrax, Rabies, etc. These circulars are not enumerated in the following list: — Public Health Act, 1875. Contagious Diseases (Animals) Acts, 1878 and 1886. Dairies, Cowsheds and Milkshops Order, 1885. Infectious Disease (Notification) Acts, 1889 and 1899. Infectious Disease (Prevention) Act, 1890. Public Health Acts Amendment Act, 1890. Housing of the Working Classes Acts, 1890, etc. Tottenham Local Board Act, 1890. Cleansing of Persons Act, 1897. Tottenham Urban District Council Act, 1900. Factory and Workshop Acts, 1901, etc. Notification of Births Act, 1907. Public Health Acts Amendment Act, 1907. Housing, Town Planning. &c. Act, 1909. Housing (Inspection of District) Regulations, 1910. Diphtheria Antitoxin (Outside London) Order, 1910. Public Health (Tuberculosis) Regulations, 1911 and 1912. Rag Flock Act, 1911. Public Health (Cerebro-Spinal Fever and Acute Poliomyelitis) Regulations, 1912. Public Health (Milk and Cream) Regulations, 1912. Shops Acts, 1912, etc. Fabrics (Misdescription) Act, 1913. Tuberculosis Order, 1913 (Diseases of Animals Act). Milk and Dairies Act, 1914. 16 Public Health (Ophthalmia Neonatorum) Regulations, 1914. Public Health (Shell-fish) Regulations, 1915. Milk and Dairies (Consolidation) Act, 1915. Maintenance of Live Stock Orders, 1915, etc. Increase of Rent and Mortgage Interest Restrictions Acts, 1915, etc. Public Health (Acute Encephalitis Lethargica and Acute Polio-Encephalitis) Regulations, 1918. Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1918. Housing, Town Planning, &c., Act, 1919. Measles and German Measles Regulations, 1920. Bye-laws with respect to New Streets and Buildings, Cleansing of Cisterns, Common Lodging-houses, Houses let in Lodgings, Nuisances, Slaughter-houses, Tents, etc., used for human habitation. LEGAL PROCEEDINGS. Date Name Nature of Case Result. June, 1921 Spencer, 501, Seven Sisters Road. Serving in Shop after closing hour. Dismissed on payment of costs. „ Hurditch, 660, Seven Sisters Road. Do. Fined 20s. and costs. „ Wood, 797, High Road. Do. Dismissed on payment of costs. „ Evans, 191, St. Ann's Rd. Do. Do. Nov., 1921 Baker, 78, West Green Rd. Do. Fined 20s. „ West, 51, West Green Rd. Do. Fined 20s. and fee for witness. „ Evans, 191, St. Ann's Rd. Do Fined 20s. and fee for witness. July, 1921 Lawrence & Clark, Chancery Lane. Execution of repairs at 92, Hermitage Road. Order made for payment of expenses of repairs, plus interest and special costs. 17 SLAUGHTER HOUSES. There are 14 private slaughter-houses in the district. Some of them are not in all respects ideal, but they are kept in such a reasonable condition of cleanliness that there has been no justification for action on our part. DAIRIES, COWSHEDS AND MILKSHOPS. 17 applications (10 from purveyors and 7 from dairymen) were received during the year for registration under the Dairies, Cowsheds and Milkshops Order, 1885. These were acceded to. There are at present upon the register 6 cowkeepers, 44 dairymen, and 109 purveyors of milk. UNSOUND FOOD. The Sanitary Inspectors have seized or had brought to them for condemnation the following articles:— Meat:— Fish.—Contd. Corned Beef, 55lb. 6 tins. Cod's Roe, 4 boxes. Pigs' Heads, 12. Filleted Cod, 15 boxes. Pigs' Plucks, 3. Haddocks, 4 boxes. Collar pieces, 5. ,, 3 trunks. Pork, 6½cwt. Herrings, 1,485 tins. Rabbits, 701b. ,, 8½ barrels. ,, 31 cases. ,, 4 cases. ,, 2 boxes. Kippers, 16 boxes. Fruit and Vegetables:— Mackerel, 1½ boxes. Apples, 8 barrels. Megrums, 1 box. Apricots, 7 tins. Mussels, 1 bag. Cherries, 1 basket. Plaice, 1 box. Grapes, 231b. ,, 1 trunk. ,. 2 boxes Roker Wings, 281b. Onions, ¾cwt. Salmon, 7 tins. Peaches, 3 tins. Sardines, 2 tins. Pears, 4 tins. Shrimps, 1 pad. Pineapple, 2 tins. Skate, 5 stone. Tangerines, 2 boxes. ,, 1 cwt. Tomatoes, 175 boxes. ,, 1 box. ,, 90 packages. ,, 1 trunk. ,, 29 tins. Whiting, 2 trunks. Chestnuts, 4 bags. Miscellaneous: — Fish:— Butter, 16Jlb. Chats, 1 trunk. Condensed Milk, 69 tins. Cod, 2 trunks. Fish Paste, 1 jar. 18 DISINFECTION AND DISINFESTATION. Infected rooms are sprayed with formalin when the infected patient is removed to hospital or has recovered from the disease. The clothing is at the same time disinfected in a Washington Lyons Disinfector. With regard to disinfestation, slipper baths are provided at the Disinfecting Station, and persons in a verminous condition are bathed there while their clothing and bedding are disinfected by steam. 2,599 rooms were disinfected. 18,271 articles were disinfected or destroyed. 80 persons were bathed. 19 GENERAL SANITARY WORK. The work of the male Sanitary Inspectors is epitomised and subjoined. Harringay Ward (Mr. Redston) West Green Ward (Mr. West) St. Ann's Ward (Mr. Smith) High Cross Ward (Mr. Portman) Middle Ward (Mr. Miller) Lower Ward (Mr. Shillito) House-to-house inspections 89 130 103 62 24 165 Re-inspections 1461 1789 1426 1440 1493 1472 Drains examined, tested, etc. 145 97 214 62 256 258 Drains unstopped 31 36 20 12 29 129 Drains reconstructed and repaired 27 27 58 10 42 61 Disconnecting traps inserted .. .. 2 .. .. 13 Soil pipes and drains ventilated .. 12 64 6 27 32 R.W. pipes, wastes, etc., disconctd. 4 9 40 5 41 44 Dustbins provided 69 79 66 25 68 81 Roofs repaired 141 59 96 21 41 116 Gutters repaired and renewed 152 39 86 7 16 96 Cisterns cleaned, repaired, etc. 25 11 22 5 9 35 W.C. new apparatus provided 33 .. 18 6 25 31 W.C. repaired, cleaned, etc. 42 19 52 4 20 23 W.C. water fittings repaired 59 37 30 15 21 45 Yards paved and drained 31 36 20 7 68 48 Premises cleaned, etc. 269 193 252 56 220 228 Ventilation below floor provided 17 .. 62 5 2 4 Smoke observations 7 .. 11 13 4 6 Overcrowding 4 .. .. 2 .. 12 Accumulations of refuse 35 11 14 3 4 9 Visits in connection with cases of infectious disease (including Tuberculosis) 450 578 880 324 531 650 Rooms inspected after disinfection 227 165 325 436 265 209 Other inspections, etc. 89 211 256 94 120 132 Factories, No. of inspections 25 62 19 14 14 35 Workshops and workplaces „ 56 100 30 12 26 80 Laundries „ 12 23 10 .. 10 4 Dairies, etc. „ 123 74 41 9 34 33 Cowsheds „ .. .. .. 1 .. .. Bakehouses „ 32 32 23 15 55 34 P.H. urinals „ 147 73 69 67 82 74 Stables and mews ,, 126 93 58 3 64 24 Complaints investigated „ 145 85 415 316 133 208 Appointments 31 190 239 71 56 172 School inspections 10 36 7 3 6 10 Pawnbrokers 3 .. .. .. .. 8 Common lodging houses .. .. .. 10 .. 36 Slaughterhouses .. 146 34 45 .. 52 Knackers yards .. .. .. 14 .. .. Brooks and watercourses 3 .. 39 7 50 .. Butchers' shops 186 102 42 81 86 61 Fishmongers' shops 188 40 30 27 61 46 Fruiterers' shops 162 16 20 28 47 41 Ice cream premises 15 .. 13 2 .. 15 20 SANITARY WORK CARRIED OUT BY FEMALE SANITARY INSPECTORS. Miss Lamb:— Visits to Outworkers' Premises 870 ,, Workshops 146 „ Laundries 8 ,, Factories 7 Complaints investigated 29 Visits re Infectious Disease 32 Miscellaneous visits 19 Reinspections 406 Swabs taken 1,829 S. F. contacts examined 1,253 Mrs. Kent Parsons: — Sanitary Inspections 91 Visits re Infectious Disease 11 Complaints 8 Visits to Factories and Workshops 7 (Note.—For other visits re infectious disease see table of Home Visits paid by M. and C. W. Staff.) FACTORY AND WORKSHOP ACT, 1901. In compliance with section 132, I have to submit a resumé 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) 186 80 .. Workshops (including Workshop Laundries) 450 Workplaces (other than out-workers' premises included in Part 3 of this Report) Total 636 80 .. 21 2.—Defects Found. Particulars No. of Defects No. of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts* : Want of cleanliness 32 32 .. .. Want of ventilation 2 2 .. .. Overcrowding 4 4 .. .. Want of drainage of floors .. .. .. Other nuisances 11 11 .. Sanitary accommodation— Insufficient 7 7 .. .. Unsuitable or defective 14 14 .. .. Not separate for sexes I 1 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (S. 101) .. .. .. .. Breach of special sanitary requirements for bakehouses (S. 97 to 100) .. .. .. .. Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) .. .. .. .. Total 71 71 .. .. *Including those specified in Sections 2, 3, 7 and 8 of the Factory and Work shop Act as remediable under the Public Health Acts. 22 3.—Home Work. OUTWORKERS' LISTS, SECTION 107. Number of Insp?ctions of Outworkers' premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Nature of Work Lists received from Employers. Number of Addresses of Outworkers received from other Councils. Number of Addresses of Outworkers forwarded to other Councils. Prosecutions Failing to keep or permit inspection of Lists. Failing to send Lists. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 109). Prosecutions (Sees. 109. 110). Twice in the year. Once in the year. Lists. Outworkers. Lists. Outworkers. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Wearing Apparel 8 63 2 44 467 32 .. .. 680 .. .. .. .. .. .. Boots and Shoes 2 55 1 12 18 61 .. .. 24 .. .. .. .. .. .. Stationery 2 12 .. .. 2 5 .. .. 12 .. .. .. .. .. .. Cardboard, etc., Boxes 2 11 .. .. 4 .. .. .. 15 .. .. .. .. .. .. Brushes .. .. 1 4 17 3 .. .. 25 .. .. .. .. .. .. Oil and Rubber .. .. 1 2 .. .. .. .. 2 .. .. .. .. .. .. Small ware 2 20 .. .. .. 1 .. .. 24 .. .. .. .. .. .. Lace Paper .. .. .. 19 .. 3 .. .. 20 .. .. .. .. .. .. Lamp Shades .. .. 1 2 .. .. .. .. 3 .. .. .. .. .. .. Upholstery .. .. .. .. 2 .. .. .. 4 .. .. .. .. .. .. Furs .. .. .. .. 10 .. .. .. 20 .. .. .. .. .. .. Umbrellas .. .. .. .. 3 .. .. .. 4 .. .. .. .. .. .. Feathers .. .. .. .. 1 .. .. .. 2 .. .. .. .. .. .. Ornamental Confectionery .. .. .. .. 2 .. .. .. 2 .. .. .. .. .. .. Fancy Goods .. .. .. .. 5 .. .. .. 10 .. .. .. .. .. .. Artificial Flowers .. .. .. .. 9 .. .. .. 15 .. .. .. .. .. .. Xmas Crackers .. .. .. .. 4 .. .. .. 6 .. .. .. .. .. .. Sports Goods .. .. .. .. 2 .. .. .. 2 .. .. .. .. .. .. Totals 16 161 7 83 546 105 .. .. 870 .. .. .. .. .. .. 23 4.—Registered Workshops. Workshops on the Register (S. 131) at the end of the year Number Workshops 197 Laundries 46 Bakehouses 65 Total number of Workshops on Register 308 5.—Other Matters. Class Number Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 5 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5):— Notified by H.M. Inspector 29 Reports (of action taken) sent to H.M. Inspector 29 Underground Bakehouses (S. 101):— Certificates granted during the year .. In use at the end of the year 4 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 State (Home Office). 24 HOUSING. Number of New Houses erected during the year:— (a) By private enterprise 1 (b) As part of a municipal housing scheme 318 Total 319 Unfit Dwelling Houses. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2777 Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 573 Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation •• 2169 Remedy of Defects without service of formal notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 1655 Action under Statutory Powers. (a) Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling houses in respect of which notices were served requiring repairs 358 25 (2) Number of dwelling houses which were rendered fit— By owners 385 By Local Authority in default of owners 11 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 156 (2) Number of dwelling-houses in which defects were remedied— By owners 156 By Local Authority in default of owners — (c) Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders Nil (2) Number of dwelling houses in respect of which Closing Orders were made ,, (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit „ (4) Number of dwelling-houses in respect of which Demolition Orders were made „ (5) Number of dwelling-houses demolished in pursuance of Demolition Orders „ 26 SCHOOL MEDICAL SERVICE. Co-ordination of the work of the School Medical Service with that of other Health Services. (a) A complete system has not yet been set up. The Committee have under consideration a scheme for unification of the health services. Health Visitors and School Nurses co-operate in home visitation, so as to prevent duplication of work in the homes. The School Dentist and Assistant School Medical Officers are occasionally called upon for treatment of teeth, and tonsils and adenoids respecting children under school age. (b) Nursery Schools have not yet been established. (c) The care of debilitated children under school age comes within the purview of the Maternity and Child Welfare Committee. School Hygiene. The schools are in practically the same condition as in 1920. The following improvements have been carried out during 1921:— SURVEYOR'S REPORT OF IMPROVEMENTS EFFECTED TO SCHOOL PREMISES DURING THE YEAR 1921. School. Description. Belmont Road. New heating apparatus and improvement to the general circuit. Brucb Grove. Lavatory accommodation for teachers in Boys' cloakroom. Girls' playground re-tar-paved. Coleraine Park. Open-air class shed made and erected. Boys', Girls' and Infants' playgrounds re-tar-paved. Crowland Road. Boys', Girls' and Infants' playgrounds re-tar-paved. Down Lane. Improved ventilation to classrooms— Boys' Dept. New heating apparatus installed. Boys', Girls' and Infants' playgrounds re-tar-paved. Downhills do. do. do. Earlsmead. do. do. do. Redecorated throughout externally and internally. 27 Page Green. Open-air class shed made and erected. Indoor lavatory accommodation provided for teachers in Junior Mixed Dept. Parkhurst. Redecorated throughout internally and externally. Boys', Girls' and Infants' playgrounds re-tar-paved. Risley Avenue. Additional radiators installed in classrooms, first floor, facing north. Redecorated throughout externally and internally. Seven Sisters. Girls' and Boys' playgrounds re-tar-paved. Stamford Hill. Redecorated throughout externally and internally. Glass roof to Hall reglazed with wire woven glass. Teachers' room provided in Boys' Department. Floor of Hall levelled and planed. Boys', Girls' and Infants' playgrounds re-tar-paved. West Green. Redecorated throughout externally and internally. Ventilation to Hall improved. Teachers' Room (Boys' Dept.) altered and improved and further lavatory accommodation provided. Two new window openings formed in each of the Infants' Classrooms, and sashes and frames fixed with the consequent improvement in the lighting and ventilation. Entirely new heating apparatus (two boilers) installed. Boys', Girls' and Infants' playgrounds re-tar-paved. Green, Middle Class, Redecorated internally. St. Katharine's. Orchard House. Open-air class shed made and erected ; also cloakroom and lavatory accommodation. St. Paul's. Artificial lighting improved. SCHOOL FURNISHING. 40 New Locker dual desks made and supplied to Down Lane. 40 do. do. do. Downhills Senr. 40 do. do. do. Risley Avenue. 6 New folding art tables made and supplied to Down Lane. 1 New Lavatory demonstration bench supplied to Down Lane. 12 New Kindergarten tables supplied to St. Paul's. 12 New Woodwork benches supplied to Belmont (Manual). 28 In addition to the above, cupboards, screens and forms (for remedial exercises) have been made and supplied. The old quadruple desks have been renovated and converted into dual desks at the following schools :— West Green.— Boys', Girls' and Infants' Departments. Stamford Hill.— Boys' and Girls' Departments. Seven Sisters.— Boys' Department. Medical Inspection. The procedure is as detailed in my report for 1919, and there has been no disturbance of school arrangements. Findings of Medical Inspection. These are contained in the tables at the end of report. Additional details in connection with uncleanliness are as follows :— The average number of visits per annum made by the School Nurses to each school 24.6 The total number of examination of children made by the School Nurses in the year in the Schools 131,253 The number of individual children unclean (verminous condition) 5,297 Home visits 5,932 There are two slipper baths at the Disinfecting Station. Nurses attend there with children found to be in a verminous condition, and, while the children are bathed, the clothes are disinfected. When it has been ascertained that the bedding of the children is verminous, this is also simultaneously disinfected. During the year baths were given in respect of 65 children. Prosecutions under the School Attendance Byelaws were undertaken, in connection with verminous conditions, in 23 cases. Fines were inflicted in respect of 18 of these cases, and 5 Attendance Orders were made. 29 Infectious Disease. Notifications under the Infectious Disease Notification Acts, 18891899, were received in respect of the following diseases occurring amongst children of school age, with the noted frequency :— Scarlet Fever 758 Diphtheria 372 Enteric Fever 2 Measles 73 Cerebro Spinal Fever 1 Erysipelas 7 Voluntary Notifications.— The following cases were voluntarily notified by teachers and attendance officers during the year:— Measles 94 Rash 17 Mumps 554 Sore Throat 143 Whooping Cough 480 Tuberculosis 12 Chicken Pox 454 Influenza 76 Scarlet Fever 572 Eye Diseases 22 Diphtheria 249 Ringworm of Head 78 Scabies 123 Ringworm of Body 21 Skin Diseases 39 Sores and Eczema 243 Verminous 25 Impetigo 12 Tonsillitis 44 Other Diseases 409 Chorea 24 Children excluded owing to disease in house 848 Pneumonia 4 These cases were followed up by the School Nurses and were not re-admitted to school until they were free from infection and the possibility of communicating the disease to others. Bacteriological Examinations.— Swabs have been taken from children discharged from Isolation Hospital after diphtheria, and from children who have been in contact with cases of diphtheria, and examined bacteriologically. 2,014 such examinations were made, 133 were found to be positive, 1,881 negative, and 132 contained bacteria morphologically similar to Klebs Lœffler bacilli. Microscopical Examinations.— Hairs were taken from children who were suspected to be suffering from ringworm in 181 instances and submitted to microscopical examination. 105 were positive. 30 Following Up. The arrangements for the following up of children suffering from physical defects are as detailed in my report for 1919. Medical Treatment. The same methods are employed and are available for the treatment of defects as reported in 1920. Open -Air Education. Playground Classes.— Playground classes have been held during the Summer wherever conditions permitted. Holiday Camps and School Journeys.— These were conducted on the same lines as in 1920. The places visited being as follows :— Down Lane Central School.— Midhurst and Bangor. Risley Avenue Central School.— Jevington, Sussex. St. Katharine's Girls' School.— Dorking. St. Paul's Girls' School.— Aberystwyth. West Green Boys' School.— Deal. Open-Air Classes.— Those reported in 1920 are still in existence. Added to these the Coombes Croft Boys' School has now an open-air class. The one for Lancasterian School, in Bruce Castle Park, has not materialised. Physical Exercises. An addition specialist teacher for physical training of children has been appointed for Downhills Central School. There are now, therefore, two special teachers for physical exercises, the other teacher having charge of Risley Avenue Central School. Provision of Meals. The same arrangement obtains as in previous years, except that there has been a hut erected at Lancasterian School for the more commodious accommodation of sohool-fed children. 31 School Baths. School children attend the public Baths for swimming. A spray bath is provided at the Minor Ailments Clinic for the treatment of skin affections. Hot baths are provided at the Disinfecting Station for cleansing and disinfestation of childien. Co-operation of Parents. The same arrangements apply as were stated in 1919 report. Co-operation of Teachers. The teachers generally are sympathetic towards the School Medical Service and co-operate with the medical staff in facilitating inspection and treatment. Co-operation of School Attendance Officers. The Attendance Officers are under the supervision of Mr. Lewis, the Superintendent Attendance Officer. They are assisted by, and assist the School Medical Staff in ascertaining the causes of absence from school and a means of speedy remedy of defects and early return to school. ) Co-operation of Voluntary Bodies. Co-operation with the Invalid Children's Aid Association is as stated in the report for 1920. whereby provision is made for convalescent-home treatment and the supply of surgical instruments. Convalescent-Home Treatment.— During the year 282 children were sent away for varying periods, namely:— No. of weeks 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 No. of children 6 6 9 54 19 58 23 32 19 12 7 10 2 4 2 No of weeks 16 17 18 19 20 21 22 24 26 33 36 43 51 52 — No. of children 4 1 2 1 1 2 1 1 1 1 1 1 1 1 — In 26 of these cases the treatment has been continued in 1922. 32 The following table gives particulars of the affections on account of which children received convalescent treatment:— Debility 56 Nerve Tremors 1 Heart Affections and Anaemia 38 Post Diphtheritic and Scarlatinal Debility 6 Bronchitis and Bronchial Catarrh 47 Bright's Disease 1 Malnutrition & Marasmus 5 Other non-tubercular diseases of lung 7 Accidents 1 Post Pneumonic Debility 10 Pre-tubercular Debility 29 Eczema 1 Tuberculosis— Keratitis 1 Glands 3 Spinal Curvature 1 Bones and Joints 6 Rickets 1 Eye 1 Muscular Dystrophy 1 Peritonitis 5 Enlarged Glands 15 Appendicitis 6 Osteomyelitis 1 Other diseases of digestive system 4 Measles 1 Hernia 1 Rheumatism 1 Tonsillitis 4 Rheumatic Fever 2 Epileptic Fits 1 Adenitis 2 Myocarditis 1 Arthritis 3 Paralysis 1 Chorea 17 Mastoid Disease 1 Provision of Surgical Instruments.— Surgical appliances were supplied as follows: — Cases. Cases. Infantile and other forms Pes cavus 1 of paralysis 15 Rickets 5 Tuberculosis of hip joint 3 Weak ankles 5 Tuberculous knee 3 Poliomyelitis 4 Septic knee 1 Deformed feet 4 Flat foot 4 Other deformities 4 Spinal curvature 2 Repairs and replacements have been carried out in 91 instances. Blind, Deaf and Epileptic Children. Ascertainment of defective children is made at school inspections by the medical officers, and by school teachers, attendance officers, school nurses and health visitors. Occasionally information is received from parents and from other districts from which the children have been transferred. 33 All defective children requiring special school training are referred to the Education Committee, who authorise their admission to special schools. Tottenham has a special school for deaf children and children hard of hearing. Since 1913 my annual reports have given some details of the work done in this school, and the inadequacy of the buildings for the purpose. There is no material change for the better in the circumstances to-day. There are 33 children from this district being maintained in Special Residential Schools. Five of these are crippled children, 11 blind, 11 mentally defective, 3 epileptic and 3 suffering from heart disease. Secondary Schools. By arrangement with the County Council, school children are inspected according to the Board's requirements. No treatment is undertaken. Continuation Schools. These have not yet been provided. Remedial Exercises. During the year the Committee lost the advantages of Miss Walmsley's services and remedial exercises fell, in a large measure, into abeyance. 451 children suffering from the undermentioned defects have been treated, 121 were cured, and the remainder were much improved by the treatment given. Curvature of Spine (threatened and Fiat-Foot 23 established) 69 Infantile Paralysis 8 Lordosis 26 Torticollis 7 Round Shoulders 156 Other Forms 162 An Instructor of Remedial Exercises, under Dr. Anderson, is about to be appointed. 34 Food Accessories and Drugs. During the year Cod Liver Oil, Malt and Oil, Parrish's Food and Syrupus Ferri Iodide have been supplied at the Treatment Centres to necessitous cases recommended by the medical officers to receive them. The following quantities have been dispensed at cost price, at less than cost price, or gratuitously, according to circumstances:— Cod Liver Oil and Malt 2,892 lbs. Parrish's Food 1,411 lbs. Cod Liver Oil 1,382 ozs. Syrupus Ferri Iodide 690 ozs. Examinations by the Medical Officers. Twenty-two teachers have been examined by the medical officers. 35 Table I.— Number of Children Inspected 1st January, 1921. to 31st December, 1921. A.— Routine Medical Inspection. Age. Entrants. 4. 5. 6. Other Ages. Total. Boys 26 1,395 574 174 2,169 Girls 13 1,289 609 193 2,104 Totals 39 2,684 1,183 367 4,273 Ages Intermediate Group. Leavers. Other Ages. Total. Grand Total. 8. 9. 10. 11. 12. 13. 14. Boys 1,083 250 9 23 784 351 47 10 2,557 4,726 Girls 712 527 10 23 679 476 36 10 2,473 4,577 Totals 1,795 777 19 46 1,463 827 83 20 5,030 9,303 B.— Special Inspections. Special Cases. Re-Examinations. Boys 6,078 26,442 Girls Totals 6,078 26,442 C.— Total Number of Individual Children inspected by the Medical Officers, whether as Routine or Special cases (no child being counted more than once in one year). No. of Individual Children Inspected. 15,098 36 T^ble II.— Return of Depects found in the course of Medical Inspection in 1921. Defect or Disease. Routine Inspections. Specials. Number referred for Treatment. Number requiring to be kept under Observation, but not referred for Treatment. Number referred for Treatment. Number requiring to1 be kept under Observation, but not referred for Treatment. (1) (2) (3) (4) (5) Malnutrition 44 8 22 5 Uncleanliness Head 1026 — 683 — Body— Verminous 6 — 45 — Dirty 19 - — — Flea bitten 179 - — — Skin. Ringworm Head 1 - 159 7 Body 2 - 61 — Scabies 4 — 313 1 Impetigo 11 — 980 — Other Diseases (Non-Tubercular) 14 — 558 — Blepharitis 64 — 134 — Conjunctivitis 26 — 106 — Keratitis 1 — 5 — Corneal Ulcer 3 — 15 — Eye, Corneal Opacities 3 1 3 2 Defective Vision 944 — 247 — Squint 52 — 59 — Other Conditions 13 — 92 1 Ear. Defective Hearing 66 — 34 — Otitis Media 56 — 310 1 Other Ear Diseases 47 — 141 — Nose and Throat. Enlarged Tonsils 311 32 112 2 Adenoids 122 8 82 6 Enlarged Tonsils and Adenoids 345 13 289 9 Other Conditions 8 10 197 7 Enl. Cervical Glands(Non-Tubercular) 27 23 141 7 Defective Speech 1 4 7 1 Heart and Circulation . Heart Disease— Organic 5 48 44 14 Functional 8 79 21 7 Antenna 63 18 269 3 Lungs. Bronchitis and Bronchial Catarrh 87 91 305 6 Other Non-Tubercular Diseases Pulmonary— — — 8 2 Tuberculosis. Definite 3 — 22 5 Suspected 16 6 8 5 Non-Pulmonary— Glands 7 2 13 - Spine — — 1 — Hip — 1 4 — Other Bones and Joints 1 1 9 — Skin 3 — 12 — Other Forms 7 — 19 2 Nervous System. Epilepsy 5 2 19 1 Chorea 11 3 64 2 Other Conditions 5 1 34 — Deformities. Rickets 10 — 7 — Spinal Curvature 17 — 31 — Round Shoulders 17 — 32 — Other Forms 22 6 40 — Other Defects and Diseases 108 53 925 90 Number of Individual Children having Detects which required Treatment or to be kept 8 421 under Observation (excluding Uncleanliness discovered at Routine Inspections). 37 Table III,— Numerical Return of All Exceptional Children in the Area in 1921. Boys Girls Total Blind (including partially blind) within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools 8 10 18 Attending Certified Schools for the Blind 6 6 12 Not at School 1 3 4 Deaf and Dumb (including partially deaf) within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools 22 16 38 Attending Certified Schools for the Deaf 19 20 39 Not at School 1 1 Mentally Deficient Feeble Minded. Attending Public Elementary Schools 43 50 93 Attending Certified Schools for Mentally Defective Children 5 6 11 Notified to the Local (Control) Authority by Local Education Authority during the Year . . 5 - 5 Not at School 16 6 22 Imbeciles. At School 1 2 3 Not at School 5 6 10 Idiots. — — — Epileptics. Attending Public Elementary Schools 8 13 21 Attending Certified Schools for Epileptics 1 2 3 In Institutions other than Certified Schools 1 - 1 Not at School 7 6 13 38 Table III.— Numerical Return of All Exceptional Children in the Area in 1921.— Continued. Boy's Girls Total Physically Defective Pulmonary Tuberculosis. Attending Public Elementary Schools 34 36 70 Attending Certified chools for Physically DefectiveChildren - - - In Institutions other than Certified Schools - - - Not at School 9 7 16 Crippling due to Tuberculosis. Attending Public Elementary Schools 9 11 20 Attending Certified Schools for Physically Defective Children - - - In Institutions other than Certified Schools - - - Not at School 2 4 6 Crippling due to causes other than Tuberculosis. i e., Paralysis, Rickets, Traumatism Attending Public Elementary Schools 46 20 66 Attending Certified Schools for Physically DefectiveChildren 8 8 In Institutionsotherthan Certified Schools 2 2 4 Not at School 10 5 15 Other physical defectives, e.g., delicate and other children suitable for admission to OpenAir Schools children suffering from severe heart disease. Attending Public Elementary Schools 14 154 268 Attending Open-Air Schools .. — 30 30 Attending Certified Schools for Physically Defective Children other than Open-Air Schools 1 2 3 Not at School 8 10 18 Dull or Backward. (Judged according to age and standard). Retarded 2 years 423 387 810 Retarded 3 years 148 121 269 39 Table IV.— Treatment of Defects of Children during 1921 A.— Treatment of Minor Ailments. Disease or Defect. Number of Children. Referred for Treatment Treated. Under Local Education Authority's Scheme. Otherwise. Total. Skin— Ringworm— Head 158 156 2 158 Ringworm— Body 60 59 1 60 Scabies 313 306 7 313 Impetigo 987 967 20 987 Minor Injuries — — - — Other Skin Diseases 565 514 51 565 Ear Disease 486 431 55 486 Eye Disease (External and other) 403 351 50 401 Total 2,972 2,784 186 2,970 A. 1.— Miscellaneous Defects. Disease or Defect. Number of Children. Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. Total. Enlarged Cervical Glands Non-Pulmonary 176 119 53 172 Circulatory Diseases 390 288 100 388 Lung Affections 367 271 89 360 Tuberculosis Pulmonary 65 15 50 65 Non-Pulmonary 77 32 44 76 Nervous System 138 44 93 137 Deformities 490 451 38 489 Other Defects and Diseases 1,283 811 371 1,182 Total 2,986 2,031 838 2,869 1,269 of the cases referred for treatment in A and A 1. were brought forward from 1920 and 1291 of the cases receiving treatment have been carried forward to 1922. 40 B.— Treatment of Visual Defect. Number of Children. Referred for tion. Submitted to Refraction. For whom Glasses were Prescribed For whom Glasses were Provided. Recommended for Treatment other than by Glasses. Received other Forms of Treatment. F or whom no Treatment was considered necessary. Under Local Education Authority's Scheme Clinic or Hospital By Private Practitioner or Hospital Otherwise. Total. 1,186 1,015 23 2 1,040 723 723 18 13 299 12 of the cases "referred for refraction" were brought forward from 1920 and 159 cases have been carried forward to 1922. C.— Treatment of Defects of Nose and Throat. (Enlarged Tonsils and Adenoids). Referred for Treatment. Number of Children. Received Operative Treatment. Received other Forms of Treatment. Under Local Education Authority's Scheme— Clinic or Hospital. By Private Practitioner or Hospital. Total. 1,881 635 57 592 — 674 of the cases "referred for treatment" were brought forward from 1920, and 1,289 cases have been carried forward to 1922. 41 D.— Treatment of Dental Defects. 1.— Number of Children dealt with. Age Groups. "Specials" Total. 5 6 7 8 9 10 11 12 13 14 (a) Inspected by Dentist 630 1063 1320 975 1011 652 29 19 28 21 2,247 8,004 (b) Referred for Treatment 4,425 2,212 6,637 (c) Actually Treated 1,506 2,076 3,582 (d) Re-treated * (result of periodical examination) 199 74 273 *It is understood that cases under this head are also included under (o) above. 810 children inspected during 1920 are not included in (a) and (b), but the cases treated in connection with these inspections are included in (c) and (d). 2. Particulars of Time given and of Operations undertaken. No. of Half Days devoted to Inspection No. of Half Days devoted to Treatment. Total No. of Attendances made by the Children at the Clinic. No. of Permanent Teeth. No. of Temporary Teeth. Total No. of Fillings. No. of Administrations of General Antrathetics included in (4) and (6). No. of other Operations. Herniation Cases Extracted Filled. Extracted Filled. Perma nent Teeth. Temporary Teeth. No, of Cases. No. of Attendances. Cases Finished. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) 28 378 5,110 1,642 463 8,862 474 937 1,175 385 105 14 *65 4 * This Figure is included in column 3. 42 Table V.— Summary of Treatment of Defects as shown in Table IV. (A, B, C, D and F, but excluding E). Disease or Defect. Number of Children. Referred for Treatment. Treated. Under Local Educate on Authority's Scheme. Otherwise. Total. Minor Ailments* 2,972 2,784 186 2,970 Visual Defects * 1,186 711 25 736 Defects of Nose & Throat * 1,881 535 57 592 Dental Defects* 6,637 3,582 — 3,582 Miscellaneous Defects* 2,986 2,031 838 2,869 Total 15,662 9,643 1,106 10,749 *See Notes to Tables. 43 Table VI.— Summary relating to Children medically inspected at the Routine Inpections during the Year 1921. (1) The total number of children medically inspected at the routine inspections. 9,303 (2) The number of children in (1) suffering from— Malnutrition 106 Skin Disease 32 Defective Vision (including Squint) 996 Eye Disease 111 Defective Hearing 99 Ear Disease 101 Nose and Throat Disease 1,239 Enlarged Cervical Glands (non-tubercular) 219 Defective Speech 51 Dental D cease (2 or more decayed teeth) 3,126 Heart Disease— Organic 53 Functional 108 Anaemia 94 Lung Disease (non-tubercular) 212 Tuberculosis— Pulmonary definite 3 suspected 22 Non-pulmonary 22 Disease of the Nervous System 27 Deformities 104 Other Defects and Diseases 203 (3) The number of children in (1) suffering from defects (other than uncleanliness or defective clothing or footgear) who require to be kept under observation (but not referred for treatment) 395 (4) The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing and decayed teeth) 2,249 (5) The number of children in (4) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 1,373 44 MATERNITY AND CHILD WELFARE The work of the MATERNITY AND CHILD WELFARE STAFF is set out in tabular form hereunder:— HOME VISITS MADE UNDER THE NOTIFICATION OF BIRTHS ACTS AND MATERNITY AND CHILD WELFARE ACT. Children 1st visits under 1 year Re-visits Children 1st visits over 1 year Re-visits Total Notification of Births 3,452 7,407 377 13,443 24,679 Still-births 77 32 — — 109 Deaths 34 20 10 3 67 Ophthalmia Neonatorum 29 83 — — 112 Other Infectious Diseases 92 156 104 239 591 Total 3,684 7,698 491 13,685 25,558 Maternity 1st visits Visits— Re-visits Ante-Natal 361 287 — — 648 Post-Natal 226 232 — — 458 Puerperal Fever 5 4 — — 9 Other 1st Visit Visits. Re-visits. 343 332 — — 675 Total Visits — — — — 27,348 45 INFANT WELFARE CLINICS. Total Attendances New Cases No. of Sessions Average Attendance per Session No. of Children on the Register 1—5 yrs. Morning Aft'noon Horning Aft 'noon St. Ann's 14,924 1,046 32 203 36 67 1,592 Bruce Castle 12,697 893 35 149 33 85 1,439 Town Hall 2,764 223 — 52 — 53 346 Total 30,385 2,162 67 404 — - 3,377 Medical Inspections Total Number New Cases Number of Sessions Average Attendance per Session St. Ann's 3,486 1,030 136 25 (The Chestnuts) Bruce Castle 2,190 747 79 27 Town Hall — — — — Total 5,676 1,777 215 — Infant Mortality of Infants Attending the Infant Welfare Centres during 1921. Centre No. on Register Under 1 Yr. of Age Deaths of Infants Under 1 Yr. of Age Infantile Death-rate Bruce Castle 519 10 19.2 Town Hall 143 1 6.99 St. Ann's 1,174 *19 16.18 Total 1,836 30 All Centres:— 14.12 Average Death-rate per 1,000 *Includes babies referred for Medical Examination from the Town Hall Clinic. 46 ANTE AND POST NATAL CLINICS. Medical Examinations Ante Natal Post Natal Total Number of Sessions Average Attendance per Session St. Ann'9 745 296 1041 82 12 Bruce Castle 695 150 845 47 18 Total 1440 446 1886 129 — New Cases St. Ann's 247 140 387 - - Bruce Castle 196 74 270 — — 443 214 657 — — DINNERS TO EXPECTANT AND NURSING MOTHERS. Dinners to expectant and nursing mothers, and to children under 5 years of age, in necessitous cases have been given as follows:— Number of Dinners Served Total. In respect of— Contributions towards cost. To Expectant and Nursing Mothers. To Toddlers. 3451 1906 5357 81 mothers 38 toddlers 45s. 6d. MATERNITY HOMES AND HOSPITALS. The arrangement with the Guardians, whereby Tottenham patients are admitted to the Maternity Home is still active and satisfactory. The following table sets out the number of cases treated in institutions subsidised by your Committee, and the details relating to them:— Mothers admitted to the District Maternity Home, Edmonton. Discharged before Confinement. Confinements:— Total Births. Mothers Delivered by:— Total. Live Births. Still Births. Midwives. Doctors. 70 2 65 3 68 57 11 68 47 Notified as Puerperal Sepsis. Maternity Deaths. No. of cases in which temperature rose above 1004. Notified as Ophthalmia Neonatorum. Inflammation of the eyes. Not Entirely breast-fed. Nil. Nil. Nil Nil Nil Nil Causes of still births.— Atelectasis, 1; still birth, 1; premature, 1. Cost of patients admitted to Maternity Homes £418 4 0 Contributions by patients towards maintenance 151 7 0 Net cost to Council £266 17 0 Average duration of stay, 20 days. CRECHE ATTENDANCES. The attendances from January 1st to December 31st, 1921, were as follows:— Number of days on which the Creche was opened, 236. Quarter Attendances under 3 years, of age Attendances over 3 years of age Total January 1st to March 31st 1,868 673 2,541 April 1st to June 30th 2,154 706 2,860 July 1st to September 30th 1,665 436 2,101 October 1st to December 31st 1,823 616 2,439 7,510 2,431 9,941 Average daily attendance, 42. 48 MID WIVES' FEES. Applications for payment of midwives' fees were received in respect of twelve cases. The payments amounted to £12 5s. 6d., and for assistance towards home helps, £17 10s. 0d. HOME VISITATION BY TOTTENHAM DISTRICT NURSING ASSOCIATION. No. of Cases No. of visits Cost visited 3 48 £3 4s. 0d. ASSISTED MILK SUPPLY. The total cost of the assistance given in the supply of milk for the year ended March 31st, amounted to:— Fresh Milk £1787 7 4 Dried Milk 156 15 3 Total £1944 2 7