Tottemham Urban District Council. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, FOR THE YEAR DAVID C. KIRKHOPE. M.D. Ch.M., D.P.H., Barrister-at-Law, ToT3 Tottenham Urban District Council. REPORT ON THE HEALTH OF TOTTENHAM for the Year 1923. HARRINGAY: GREENWAY & Co., T U. Printers, 435. Green Lanes. 2 SUMMARY OF STATISTICS FOR 1923. Population 154,300 Births 3,093 Birth-rate 20 0 per 1,000 of population. Deaths 1,408 Death-rate 9.12 per 1,000 of population. Deaths under 1 year of age 180 Infant Death-rate 58.1 per 1,000 births. Phthisis Death-rate 0.73 per 1,000 of population. Rateable Value £632,647 Amount Produced by Id. Rate £2,440 3 Tottenham Urban District Council. Health Committee: Chairman : Mr. Councillor A. Reed. Members : (Ex-Officio) : Mr. Councillor R. W. Clark, J.P. (Chairman of the Council.) (Ex-Officio): Dr. A. G. Newell, D.P.H. (Vice-Chairman of the Council.) Mrs. Councillor.F. C. Brighten. Mr. Councillor G. Dudman. Mr. „ J. Bristow. „ „ T. Elderfield. Mrs. „ A. E. Cook. „ „ H. Farthing. Miss „ R. F. Cox. „ „ W. R. Jackson. Mr. „ E. F. Davall. Major P. B. Malone, J.P. Mr. Councillor C. Wise. Representatives on the Middlesex Districts Joint Small box Hospital Board: Mr. Councillor T. Inglis. Dr. A. G. Newell, D.P.H. Mr. Councillor M. J. Sims. Council's Representative on the Metropolitan Water Board under the Metropolis Water Act, 1902: Major P, B. Malone, J.P. 4 Heads of Departments: Clerk and Solicitor:—Reginald C. Graves, Esq., LL.B. Engineer and Surveyor :—Captain H. F. Wilkinson, R.E., A.M.Inst.C E Treasurer:—E. Young, Esq., A.S.A.A. Clerk, Education Committee :—W. Mallinson, Esq. Director of Education :—A. J. Linford, Esq., B.Sc. Superintendent, Fire Brigade :—S. M. Eddington, Esq. Librarian:—W. J. Bennett, Esq., F.L.A. Superintendent of Baths:—T. J. Lewis, Esq. Staff. I. Health Department. Medical Officer of Health— David C. Kirkhope, M.D., Ch.M., D.P.H., Barrister-at-Law. Male Sanitary Inspectors— *Redston, W. (Chief Inspector) Hacringay Ward. (117, Broadwater Road.) †Portman, W. C. High Cross Ward. (13, West Road.) †*West, W. P. West Green Ward. (33, Drayton Road.) ‡*Miller, H. W. Middle Ward. (119, Sperling Road.) †*Shillito, J. A. Lower Ward. (9, Cedar Road.) †*Smith, J. B. (Cert., S.I. Ex. Brd.) St. Ann's Ward. (86, Chester Road.) Female Sanitary Inspector— *Lamb, Miss M. *The Officials so marked hold the Certificate of the Royal Sanitary Institute. †The Officials so marked hold Meat Inspector's Certificate. ‡This Inspector holds the Diploma of the Incorporated Institute of Hygiene. 5 Inspector under the Shops Acts— Stacy, H. J. "Milne" Nurses— R. Bentley-Corner. S. Swaffield. R. Hyatt. M. Timlin. K. Sandle. B. Whitaker. 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. Collin „ Drain Testers, Etc. H. Bysouth. J. Wilson. F. Dowse. C. Vessey. 6 2. School Medical Department. School Medical Officer— David C. Kirkhope, M.D., Ch.M., D.P.H., of Gray's Inn, Barrister-at-Law. Senior Assistant Medical Officer— Alice Stalker, M.B., Ch.B., D.P.H. Assistant Medical Officers— 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. 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.) L. S. Pilbeam, L.D.S., R.C.S. (Bng.) 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 (Chief Clerk). E. Ing. T. E. Cohen. J. E. Miller. 1 Tottenham Maternity and Child Welfare Committee. 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. E. M. Dunn. M. F. Reynolds. Creche : Matron—F. E. Trewinnard. Nurses—K. T. Brown. J. Byatt. M. Howe. Clerical Staff: E. Horton. M. B. Coleman. E. E. Fisher. W. Coleman. 8 Addresses of other public officers, more or less connected with Publie 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. Wrajmpling, 689, High Road, and Mr. J. Sweet, Stonebridge Hall, Stonebridge Road. West Tottenham: Mr. J. Graville and Mr. A. J. Mister, 186, West Green Road. Public Vaccinators— Dr. T. McLaren, 38, Bruce Grove. Dr. A. C. Hill, 99, Philip Lane. Dr. F. Sharpe, 326, Philip Lane. Vaccination Officer— Mr. H. J. Roynon, 664, High Road. Coroner's Officer— Police-Sergt. V. Bonn, Police Station, High Road. 9 INTRODUCTION to the ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH Health Department, Town Hall, Tottenham. March, 1924. To the Chairman and other Members of the Tottenham Urban District Council. Ladies and Gentlemen, I have pleasure in presenting to you my Eleventh Annual Report, namely that for the year ended December, 1923. There have been no very conspicuous alterations in the administration of the Health Department during the year. It has been a year of consolidation and of preparation for modifications and amplifications that promise further advantages. So far as figures can prove anything there has been no falling back in any direction except in the number of births. 3,093 have been recorded this year as against 3,167 for the previous year. On the other hand there has been a reduction in the number of deaths by 295. The General Death Rate, 9.1 per 1,000 of the population, the Infant Death Rate, 58.1 per 1,000 births, the Zymotic Death Rate, 0.29 per 1,000 of the population and the Phthisis Death Rate, 0.73 per 1,000 of the population are all reductions on previous years. Notifications of Diphtheria amounted to rather less than half the number in 1922, viz :—194, against 400, and whereas in 1922 Scarlet! Fever notifications numbered 919, in 1923 the number was 385. The housing difficulty remains a formidable proposition. So long as there is not a surplus of houses for persons of the working classes, so long will the difficulty remain of bringing occupied houses up to a 16 satisfactory standard of repair. There are many houses occupied today that would be represented to your Council as in urgent need of extensive structural repair or that should otherwise be closed against occupation by human persons, but for the apparent impossibility of finding alternative accommodation for the dishoused. It is not for lack of inspection that these houses have not been condemned, but that their condemnation creates an impossible position. It is astonishing that the vital statistics continue so favourable under the existing housing conditions; and that some scepticism is created in the minds of those who used to regard a satisfactory environment as the essential factor in the production of a low death and sickness, especially zymotic sickness, rate is not surprising. It is satisfactory to record that the staff of the Health Department have fulfilled their various tasks in a most efficient manner. I, personally, have to thank them for their loyalty and enthusiasm. To the Council I have to extend my cordial thanks for a continuance of their confidence and for patient and sympathetic consideration of all matters that it has been my duty and privilege to place before them. I am, Ladies and Gentlemen, Your obedient Servant, David b Kir Rhone. POPULATION. The Registrar General estimates the population at the middle of the year 1923 to be 151,700. The Treasurer estimates the population at November, 1923, to be 154,300. The latter figure, as being probably the more accurate, is used as the basis of calculation of the vital statistics. 11 Return of Houses, Population, etc., at November, 1923, as supplied to us by the Treasurer's Department. Ward Acreage a Houses Total No. of a Houses b Other Buildings and Assessments Estimated population Rateable Value Inhabited Empty High Cross 463 5,001 15 5,016 233 26,390 £ 122,639 Middle, East 449 2,872 1 2,873 131 14,560 52,188 Middle, West 168 2,859 5 2,864 136 14,240 56,611 Lower 950 5,860 16 5,876 248 30,020 107,019 West Green 470 3,773 26 3,799 149 18,980 73,660 Harringay 263 4,260 24 4,284 259 22,270 98,422 St. Ann's 251 4,836 21 4,857 211 27,840 78,747 Throughout the Parish — — - — 12c - 43,361 Totals 3,014 29,461 108 29,569 1,379 154,300 £632,647 29,569 a Houses, Houses and Shops, and Tenements. b Lock-up Shops, Stables, Workshops, Garages, Schools, Factories, Glasshouses, Land, etc. c Railways, Tramways, Reservoirs, Gas, Water, and Electric Mains. 12 BIRTHS. Births Registered :—Males 1,609 Females 1,484 Total 3,093 Including Illegitimate Births :—Male 34 Female 45 Total 79 Births occurring in the district 2,641 Births of Tottenham residents occurring outside the district 452 Total 3,093 Birth Rate, 20.0 per 1,000. Births notified under the Notification of Births Acts:— In district by Doctors 655 „ „ Midwives 1,574 „ ,, Parents and other persons 328 Notified from outside Institutions 409 2,966 Advised by Registrar 70 Total 3,036 13 DEATHS. The total number of deaths registered in Tottenham was 1,021 Of these, the number of non-residents was 194 Deaths of residents registered in the district 827 Deaths of residents registered outside the district 581 1,408 Deaths of residents under 1 year occurring in district 127 Deaths of residents under 1 year occurring outside district 53 Total deaths of Tottenham infants 180 These deaths are distributed according to age and sex as follows :— Males. Females Deaths under 1 year 120 60 Deaths from 1 to 5 years 40 27 Deaths from 5 to 15 years 24 25 Deaths from 15 to 25 years 29 50 Deaths from 25 to 65 years 286 250 Deaths 65 and upwards 211 286 710 698 The excess of births over deaths is 1,685. The death rate equalled 9.12 per 1,000 of the population. 14 Table showing the Population, Birth and Death Rates, in Wards, during 1923. Ward No. of Births No. of Deaths Population General Birth-rate General Death-rate No. of Deaths Under 1 Year Infant Mortality per 1000 of Population Infant Mortality per 1000 Births Harringay 385 189 22,270 17.3 8.4 17 0.7 44.1 West Green 367 183 18,980 19.3 9.6 25 1.3 68.1 St. Ann's 628 240 27,840 22.5 8.6 44 1.5 70.0 High Cross 515 275 26,390 19.5 10.4 27 1.0 52.4 Middle 564 247 28,800 19.5 8.0 24 0.8 42.5 Lower 634 274 30,020 21.1 9.1 43 1.4 67.8 Total 3,093 1,408 154,300 20.0 9.1 180 1.1 58.1 15 Table showing Percentage of Removals of Cases of Scarlet Fever, Diphtheria, and Enteric Fever. Ward Cases Removals Percentage Harringay 45 20 44.4 West Green 58 22 40.0 St. Ann's 148 57 38.5 High Cross 74 26 35.1 Middle 151 34 22.5 Lower 105 46 43.8 INFECTIOUS DISEASES. Diseases. Cases notified. Deaths. Death Rate. Measles — 6 0.03 Diphtheria 194 8 0.05 Diarrhoea — 19 0.12 Scarlet Fever 385 3 0.019 Enteric Fever 2 — — Whooping Cough — 10 0.06 Tuberculosis (Lungs) 291 113 0.73 Puerperal Fever 3 4 0.025 Erysipelas 43 2 0.012 Ophthalmia Neonatorum 15 — — Malaria 2 — — Encephalitis Lethargica 4 2 0.012 Influenza — 17 0.11 16 SCARLET FEVER. The system of treatment of this disease as applied in Tottenham was very fully considered in last year's report. Your Council has not found it necessary to modify it in any detail. The number of cases notified during the year was 385. Of these, 36 were removed to hospital. The number of cases treated at home by the Council's "Milne" nurses was 347. There were 216 premises in which 1 case occurred =216 cases. 33 premises in which 2 cases occurred = 66 cases. 15 premises in which 3 cases occurred = 45 cases. 3 premises in which 4 cases occurred = 12 cases. 2 premises in which 5 cases occurred = 10 cases. 269 premises. *349 cases. *The actual number of cases dealt with up to 31st December was 347. It will be seen, however, that 349 are accounted for. From that number, however, has to be deducted 2, which occurred in 1924, but in the same premises as cases notified during 1923. These 2 cases have been included in order that a complete record may be given of the multiple cases. Multiple Cases, 1923 (including 2 treated in 1924) :— No. occurring within 1 week after previous case 42* „ „ 2 weeks „ „ 16† „ „ 3 „ „ „ 11 „ „ 4 „ „ „ 6 „ „ 5 „ „ „ - „ „ 6 „ „ „ - „ „ 7 „ „ „ 1 „ „ 8 „ „ „ - „ „ 9 „ „ „ 2 „ „ 13 „ „ „ 1 „ „ 21 „ „ „ 1 80‡ *In 11 of these instances, dual notifications were received simultaneously, in 5 instances triple notifications and in 1 instance quadruple notifications, †In one instance, dual notifications were received simultaneously. ‡This number includes certain cases wrongly diagnosed. 17 Number of cases removed to hospital after treatment commenced 7 Number of notifications withdrawn 3 Number of cases wrongly diagnosed or indefinite 27 There were complications in 55 of the cases. The complications were as follows :— Rhinorrhoea 8 Otorrhoea 7 Glands 21* Albuminuria 6 Rheumatism 3 Glands and Otorrhoea 1 Rhinorrhoea and Otorrhoea 2 Albuminuria and Otorrhoea 2 Albuminuria and Glands 1 Rheumatism and Glands 1 Rheumatism and Rhinorrhoea 1 Albuminuria and Rheumatism 1 Albuminuria, Otorrhoea, Glands, Diphtheria and Hip Joint 1 55 * None of these suppurated. Cases of Otorrhoea and Rhinorrhoea of long-standing before the onset of Scarlet Fever have been excluded, but all cases that have been definitely associated with Scarlet Fever have been included in this list. All cases of complications arising in the course of Scarlet Fever have been periodically visited, and at the date of writing the Report (April, 1924) they had cleared up, with the exception of the Hip Joint Disease. There were 3 deaths from Scarlet Fever, namely :— 1. C.M. (female), 6 years, notified P. of W. Hospital 28-2-23, removed M.A.B. 28-2-23, died in M.A.B. Hospital, 17-6-23. 2. R.K. (male), 3 years, notified 19-4-23. " Milne " treatment until 22-4-23. Removed to Hospital 22-4-23, died 8-5-23. 3. E.B. (female), 11 years, notified 1-11-23. "Milne" treatment declined. Died 4-11-23. l8 DIPHTHERIA. 194 cases of Diphtheria were notified to us. 163 were removed to hospital. Of these, 21 were reported from the hospital as being wrongly diagnosed, 18 teeing Tonsillitis, 1 Vincents Angina, 1 Peritonsillar Abscess, and 1 Measles. CEREBRO SPINAL MENINGITIS. 1 notification was received. The case was removed to hospital and proved fatal. 1 ; The death returns show that there were 5 deaths of Tottenham "residents" occurring in the year. This is explained as follows. In addition to the above-mentioned case, 3 deaths occurred outside the distnct of persons who properly belonged to Tottenham ; one case admitted to the Prince of Wales's Hospital as suffering from Pneumonia was registered as having died from Cerabro-Spinal Meningitis. MEASLES. During the latter part of the year there was a rather sharp outbreak of Measles, many of the cases being complicated. As accommodation was available in the hospitals, the most urgent cases were removed there, to the number of 7, for the following reasons- Complicated with Pneumonia or Broncho-Pneumonia, 4; Complicated with Mastoiditis, 1: Nurses on the staff of the Prince of Wales's Hospital, 2. 19 PULMONARY AND OTHER FORMS OF TUBERCULOSIS. The County Council undertakes the treatment of Tuberculosis. Notifications. Mortality. Males. Females. Males. Females. Under 1 year 1 1 5 — From 1 to 5 years 2 5 1 5 From 5 to 15 years 16 25 2 4 From 15 to 25 years 46 34 11 28 From 25 to 45 years 67 51 28 24 From 45 upwards 30 13 16 14 162 129 63 75 Organs affected:— Lungs 242 Joints 3 Glands 12 Meninges 3 Skin 1 Spine 6 Knee 3 Hip 5 Peritoneum 1 Kidney 2 Bladder 1 Testicle 1 Other 9 Dual Organs:— Lungs and Larynx 1 Lungs and Skin 1 291 20 CANCER. 169 deaths resulted from Malignant disease, classified according to the organs affected as follows:— Digestive System: Males. Females. Stomach (including pylorus) 17 27 Mouth 2 — Œsophagus 4 — Tongue 1 — Bowel (small and large, excluding rectum) 6 11 Rectum 12 6 Liver — 7 Pancreas 4 2 Genito-urinary: Uterus — 18 Bladder 3 1 Ovary — 3 Prostate 3 — Breast — 20 Various: Larynx 5 2 Cervical Glands 2 — Mediastinum 1 1 Lung 1 — Skin 1 1 Spine 1 — Undefined — 1 Sarcomata : Tonsil 1 — Lung 2 — Leg 1 — Femur — 1 Retroperitoneal — 1 67 102 21 VIOLENCE. There were 34 deaths from Violence in 1923, including 4 which were suicidal. In 1922 the number was 68. Males. Females. Drowning 1 — Falls — 3 Burns 1 1 Knocked down by Motor Lorry 1 — Knocked down by Motor Car 1 — Knocked down by Bicycle 1 — Fall from Train 1 — Run over by Bus 1 — Scalds 6 — Fall from Motor Oil Tank 1 — Fall from Window — 1 Poison self-administered — 1 Coal Gas 2 2 Hanging 1 - Cut throat 1 1 Accidental causes not specifically defined 5 2 23 11 22 M. of H. Table I. 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 Nett Births Number Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1918 152,304 2327 2432 15.96 1794 11.7 259 525 206 84.7 2060 13.5 1919 152,508 2554 2711 17.7 1273 8.3 188 477 180 66.4 1504 10.2 1920 156,020 3854 4064 26.04 1302 8.3 275 438 248 61.0 1465 9.3 1921 149,200 3402 3402 22.8 1274 8.5 258 537 231 67.9 1553 10.4 1922 152,000 2777 3167 20.8 1496 9.8 352 559 203 64.0 1703 11.2 1923 154,300 2641 3093 20.0 1021 6.6 194 581 180 58.1 1408 9.12 23 NOTES TO (M. of H.) TABLE I. The nett rate is tha 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 here; 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 Incurables, High Road. Nursing Home, Bruce Grove. 2.—Institutions outside the District receiving sick and infirm persons from the District :— South Mimms Sanatorium. North Middlesex Hospital. 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 :— Hospitals :— Guy's. Middlesex. St. Bartholomew's London. Queen's, Bethnal Green. University College. St. Thomas'. Charing Cross. Children's, Great Ormond Street, W.C. City of London Lying-inKing's College. Mount Vemon, Northwood. German. 24 Hospitals—continued:— St. Mary's, Paddington. St. Peter's, Westminster. St. Columbus, Hampstead. Enfield and Edmonton Joint Hospital. Hospital of St. John, Scorton, Richmond. Groveland Hospital, Southgate. Royal Hospital for Incurables, Wandsworth. Seaman's Hospital, Greenwich. Knight's Memorial Hospital, Blyth. Infants Hospital, Westminster. Chest Hospital, Bethnal Green. Springfield Mental Hospital, Wandsworth. Tooting Bee Mental Hospital, Wandsworth. Hanwell Mental Hospital, Norwood. Royal Sussex County Hospital, Brighton. St. Mary's Hospital, Plaistow. St. Mark's Hospital, City Road. Queen Charlotte's Hospital, Marylebone. Royal Free, Gray's Inn Road. Royal, City Road. Mi'.dmay Memorial, Stoke Newington. Central London, Throat and Ear. Metropolitan. Hampstead General. St. Anthony's, Cheam. Royal Northern, Holloway. Royal, Waterloo Road. Middlesex County Tuberculosis, Isleworth. Asylums:— Metropolitan, Caterham. Napsbury. Broadmoor Asylum, Crowthorne. Brentwood Mental Asylum, Sth. Weald. Grosvenor Sanatorium, Kennington, Kent. Enfield House, Chase Side. Peckham House, Camberwell. County Sanatorium, Harefield. Rochester Row Almshouses, Westminster. 25 M. of H. Table II. Table of cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1923, 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 15 to 25 25 to 45 45 to 65 65 and upwards Harrin- gay West Green St. Ann's High Cross Middle Lower Dysentery 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... Encephalitis Lethargica 4 ... ... 1 ... 2 1 ... 1 1 ... ... 1 1 ... Diphtheria (including Membranous Croup) 194 13 55 88 21 15 2 ... 24 24 52 18 30 46 168 Erysipelas 43 1 2 5 6 8 13 8 7 6 16 5 3 6 4 Scarlet Fever 385 6 86 233 39 20 1 ... 20 34 96 55 121 59 36 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 2 ... ... 1 1 ... ... ... 1 ... ... 1 ... ... 1 Malaria 2 ... ... ... ... 2 ... ... ... ... ... ... ... 2 ... Pneumonia 200 20 53 34 23 35 25 10 42 22 81 13 18 24 2 Puerperal Fever 3 ... ... ... ... 3 ... ... ... 1 ... ... 1 1 ... Cerebro-spinal Meningitis 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 Poliomyelitis 2 ... 1 1 ... ... ... ... ... ... ... 1 ... 1 ... Ophthalmia Neonatorum 15 15 ... ... ... ... ... ... 1 4 7 ... 2 1 ... Pulmonary Tuberculosis 242 ... 1 24 68 109 39 1 23 25 45 42 62 45 ... Other forms of Tuberculosis 49 2 2 15 16 10 4 ... 2 5 6 10 14 12 ... Totals 1,143 57 200 403 174 205 85 19 121 122 305 145 252 198 212 26 M. of H. Table III. TABLE OF DEATHS during the Year 1923 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 6 ... 2 4 ... ... ... ... ... ... ... ... ... ... ... 2 1 1 2 10 Scarlet Fever 3 ... ... 1 2 ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 20 Whooping Cough 10 8 2 ... ... ... ... ... ... ... ... ... ... 1 2 1 2 2 2 12 Diphtheria and Croup 8 ... ... 5 3 ... ... ... ... ... ... ... ... ... 1 3 ... 3 1 50 Influenza 17 ... ... ... ... ... 1 3 4 6 3 ... ... 4 1 1 2 7 2 ... Erysipelas 2 ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... Phthisis (Pulmonary Tuberculosis) 113 ... ... 1 3 38 21 24 15 7 4 ... ... 17 12 23 18 20 23 1 Tuberculous Meningitis 11 3 2 2 2 1 1 ... ... ... ... ... ... 2 ... 4 2 2 1 1 Other Tuberculous Diseases 14 1 1 2 ... 1 3 2 1 1 1 1 ... 1 2 4 3 2 2 2 Cancer, malignant disease 169 ... ... ... ... 1 2 18 34 46 48 18 2 27 22 18 36 26 40 27 Rheumatic Fever 5 ... ... ... 4 1 ... ... ... ... ... ... ... ... ... 2 ... ... 3 ... Meningitis 9 5 ... ... 3 1 ... ... ... ... ... ... ... ... 1 3 2 1 2 6 Organic Heart Disease 176 2 ... ... ... 9 8 16 20 33 53 31 4 30 34 24 37 26 25 18 Bronchitis 119 7 2 1 1 ... 1 4 7 18 29 33 7 17 16 10 24 24 19 7 Pneumonia (all forms) 118 12 12 8 3 3 11 14 13 18 12 9 3 9 12 26 22 23 26 22 Other diseases of respiratory organs 21 2 1 ... ... 1 1 2 4 3 3 4 ... 4 1 1 5 5 5 1 Diarrhœa and Enteritis 19 19 ... ... ... ... ... ... ... ... ... ... ... 2 4 3 3 3 4 3 Appendicitis and Typhlitis 7 ... ... ... 2 1 1 1 1 ... 1 ... ... ... 1 2 3 ... 1 5 Cirrhosis of Liver 3 ... ... ... ... ... ... ... ... 1 2 ... ... 1 ... 1 1 ... ... ... Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis and Bright's Disease 24 ... ... ... 3 ... 1 2 4 4 7 3 ... 1 3 2 6 5 7 1 Puerperal Fever 4 ... ... ... ... ... 3 1 ... ... ... ... ... ... 1 1 ... 1 1 ... Other accidents and diseases of Pregnancy and Parturition 3 ... ... ... ... ... 1 2 ... ... ... ... ... 1 1 ... 1 ... ... ... Congenital Debility and Malformation, including Premature Birth 101 101 ... ... ... ... ... ... ... ... ... ... ... 11 11 30 16 13 20 5 Violent Deaths, excluding Suicide 47 ... 4 7 5 5 3 5 6 4 3 4 1 5 6 11 13 8 4 27 Suicide 9 ... ... ... ... ... ... 2 3 2 2 ... ... 1 2 1 2 1 2 ... Other Defined Diseases 392 18 2 5 16 17 18 32 27 48 78 108 23 53 48 64 73 72 82 63 Encephalitis Lethargica 2 ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... 2 Cerebro-Spinal Meningitis 5 2 ... 2 1 ... ... ... ... ... ... ... ... 1 1 1 ... 2 ... 3 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1408 180 29 38 49 79 76 129 139 192 246 211 40 189 183 240 275 247 274 286 27 NOTES TO (M. of H.) TABLE III. (a). In this table 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 among the deaths in their respective "Localities" according to the previous addresses of the deceased as given by the Registrars. Deaths 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 "Non-Residents," are, in addition to being dealt with as in note (a), entered in the last column of this table. (c) Under the heading of "Diarrhœa," are included deaths certified as from diarrhœa, alone or in combination with some other cause of ill-defined nature; and also deaths certified as from Epidemic Enteritis: Zymotic Enteritis; Epidemic Diarrhcea, Summer Diarrhœa; Dysentery and Dysenteric Diarrhœa; Gastro-Enteritis and Muco-Enteritis; Choleraic Diarrhœa, Cholera Nostras (in the absence of Asiatic Cholera). Deaths from diarrhœa secondary to some other well-defined 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. 28 M. of H. Table IV. Table of Infant Mortality during the year 1923. CAUSE OF 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 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... 1 ... 1 1 1 2 3 8 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 2 ... 1 3 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous) ... ... 2 ... 2 ... 1 1 1 5 Convulsions 4 ... ... ... 4 1 1 1 ... 7 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 1 1 4 ... ... 2 7 Pneumonia (all forms) 1 2 ... ... 3 5 2 ... 3 13 Diarrhœa ... ... ... 2 2 5 3 2 1 13 Enteritis ... 1 ... ... 1 1 3 ... ... 5 Gastritis ... ... ... ... ... ... 1 ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... 2 ... ... 2 ... 1 ... ... 3 Atelectasis 2 1 ... ... 3 ... ... ... ... 3 Congenital Malformations 3 ... ... ... 3 1 ... ... ... 4 Premature birth 34 3 2 2 41 2 ... ... ... 43 Atrophy, Debility and Marasmus 9 3 6 2 20 13 4 2 1 40 Other Causes 6 1 ... 1 8 6 3 3 4 24 59 13 11 8 91 39 22 11 17 180 29 Mortuary Table for the Year 1923. Bodies Admitted. No. of Post Mortems Number of Inquests Deaths from Violence Deaths from Drowning Month Males Females Total Males Females Total January 8 7 15 5 7 12 12 1 2 February 12 7 19 9 5 14 15 2 1 March 11 3 14 8 2 10 11 ... ... April 6 4 10 1 1 2 6 5 ... May 7 9 16 6 2 8 13 6 2 June 6 7 13 3 3 6 7 1 1 July 11 9 20 6 5 11 12 5 ... August 10 9 19 4 2 6 9 2 ... September 10 11 21 3 7 10 17 7 ... October 6 3 9 5 0 5 7 2 ... November 4 5 9 2 3 5 6 3 ... December 7 9 16 5 5 10 14 8 1 Total 98 83 181 57 42 99 129 42 7 No. of bodies admitted to await Burial 51. 30 The following List gives the Causes to which Deaths were attributed by the Coroner or Coroner's Juries. Appendicitis 1 Status Lymphaticus 2 Bronchitis 7 Senile Decay 3 Carcinoma 1 Valvular Heart Disease 3 Cancer 1 Accidents: Convulsions 3 Poisoning 1 Congestion of Lungs 2 Gas Poisoning 1 Cerebral Tumor 1 Burns 3 Cerebral Hæmorrhage 3 Drowning 4 Encephalitis Lethargica 1 Knocked down by Bicycle 1 Gastritis 2 Scalds 7 Heat Stroke 1 Fracture of Spine 1 Inanition 4 Run over by Motor 7 Inattention at Birth 1 Strangulation 1 Meningitis 2 Fracture of Skull 4 Marasmus 2 Fracture of Pelvis 1 Nephritis 1 Suffocation 1 Peritonitis 2 Suicides: Pneumonia 11 Poisoning 1 Septicaemia 4 Gas Poisoning 5 Syncope 23 Cut Throat 3 Toxaemia 2 Hanging 1 Still Born 3 Drowning 2 NURSING ARRANGEMENTS. General Nursing,—The local medical practitioners petitioned the Council to use their best efforts to have re-established the District Nursing Association in Tottenham. The Ministry of Health and other agencies were approached with a view of ascertaining whether sufficient financial help would be forthcoming to warrant the reopening of the work of this Association, but after all prospective sources of revenue had been investigated, it did not appear that sufficient support was likely to be given and the matter is still in abeyance. Midwives.—There are 20 Midwives practising in the district, 31 CLINICS AND TREATMENT CENTRES. Name and Situation. Nature of Accommodation. By whom Provided. Infant Welfare Clinic, "The Chestnuts," St. Ann's Road, N. 15 Consulting Room, Weighing Room, Waiting and Stock Room, Pram Room. Tottenham Maternity and Child Welfare Committee. Infant Welfare Clinic, Bruce Castle, Lordship Lane, N.17 Consulting Room, Weighing Room, Waiting and Stock Room, Pram Room. Do. Infant Welfare Clinic, 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. Day Nursery, 240, St. Ann's Road. Receiving Room, Dining Room, and Nursery for Toddlers; 2 Nurseries for Infants; Isolation Room; Shelter in Garden. 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, 140, West Green Road, N. 15. Consulting Room, Dressing Room, Waiting Room, Laboratory, Office. Middlesex County Council Venereal Diseases Clinic, Prince of Wales's Hospital, N. 15. Two Consulting Rooms, Two Treatment Rooms, Two Waiting Rooms, and Laboratory. Do. 32 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. The London Heart Hospital undertakes, for the Tottenham Education Committee, the examination of cases of Heart Disease specially referred to it. The Central London Throat, Nose and Ear Hospital receives for treatment, from the Tottenham Education Committee, such cases as are specially referred to it and in respect of whom there are complications which would render it undesirable that the patient should be treated in our own clinics. 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 179 beds and cots and the latter 104 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 non-in fectious and accident cases. The following table in relation to the Ambulance Service, is self-explanatory. 33 MOTOR AMBULANCE SERVICE, 1923. Months No. of Cases Mileage. Receipts. Surgical Children No. 1 Ambulance No. 2 Ambulance No. 3 Ambulance £ s. d. January 572 293 1,045 622 915 15 18 0 February 445 355 1,098 661 717 11 3 0 March 442 359 1,245 206 951 11 7 0 April 432 255 1,033 415 843 13 11 6 May 544 307 1,145 728 787 17 16 0 June 541 421 1,079 771 703 9 7 0 July 545 339 1,332 784 649 14 10 0 August 349 64 1,032 532 450 17 9 6 September 587 352 1,230 859 497 12 7 9 October 630 392 1,205 916 784 20 16 6 November 650 427 1,141 829 685 10 6 6 December 545 246 950 727 642 14 0 6 Total 6,282 3,810 13,535 8,050 8,623 £168 14 0 10,092 30,208 Treasurer's Dept. £123 10 0 Education Committee £165 0 0 £457 4 0 Total Cases to Date: Total Mileage to Date: Total Receipts to Date: 33,749. 154,135. £2,681 3s. 9d. Resuscitating apparatus is now provided in the Ambulance Service for administering oxygen in cases of gas poisoning, drowning, etc. This has already been used with success. The Council have now sanctioned the purchase of a fourth Ambulance, tenders for which are at present under consideration. LABORATORY. At the Laboratory, 1,165 swabs from the throats or noses of persons in contact with sufferers from Diphtheria or themselves supposed to be suffering from Diphtheria, and 287 specimens of sputum from persons suspected to be suffering from Consumption have been examined during the year. Of the swabs, 120 were positive, and of the sputum, 39 specimens. Other bacteriological and serological examinations are made by arrangement with the Prince of Wales's Hospital. 34 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, Cerebrospinal Meningitis, Diarrhoea, 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) Act, 1889. (Adopted, 5-11 89) Infectious Disease (Notification) Extension Act, 1899. Infectious Disease (Prevention) Act, 1890. (Parts adopted, 16-12 90.). Public Health Acts Amendment Act, 1890. (Parts adopted, 20-1-91.). 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. (Adopted, 17-12-07.). Public Health Acts Amendment Act, 1907. (Parts adopted, 17-12-09.). 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. Public Health (Ophthalmia Neonatorum) Regulations, 1914. Public Health (Shell-fish) Regulations, 1915. Rent and Mortgage Interest Restrictions Acts, 1920 and 1923, 35 Public Health (Acute Encephalitis Lethargica and Acute PolioEncephalitis) Regulations, 1918. Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1918. Housing, Town Planning, &c. Act, 1919. Milk and Dairies (Amendment) Act, 1922. Milk (Special Designations) Order, 1923. Housing, &c. Act, 1923. 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 February West Bros., Broad Lane Servingin Shop after closing hour. Fined and 5s. witness's costs. „ A. E. Coates, West Green Road do. Do. „ H. Hopwood, Green Lanes do. Fined 10s. August F. West. West Green Road do. Fined £5 „ H Cook, Green Lanes do. Fined £1. „ K. E. Brooke, Green Lanes do. Do. „ B. Rustin, Green Lanes do. Do. „ T. Young & Sons, Barking Execution of repairs at 13, Whitehall St. Work carried out by owner —case dismissed 36 RIVER LEE. An exhaustive report was made upon the pollution of the River Lee, a matter which had been brought to the notice of the Council on various occasions. This pollution was traced to the Tottenham and District Light, Heat and Power Company's Works at the Edmonton Boundary. The County Council, within whose jurisdiction comes the matter of pollution of streams, instituted proceedings against this Company in respect of the Boundary Ditch, but on the understanding that a new filter was to be installed to obviate further pullution, the summons was adjourned. Unfortunately much more serious pollution has since been discovered and reported upon to the Council. This pollution affects the ditch which surrounds on three sides Asplins Farm and enters Pymmes Brook, a tributary of the Lee, by a culvert in the vicinity of the Emery Works. SHOPS ACTS, 1912 to 1921. The Shops were kept under observation by the Shops Acts Inspector, who is attached to the Health Department. A certain number of persons were represented to the Council as having contravened the terms of the Act, and in 81 instances the Council considered that a warning notice to the offender would be sufficient to meet the case. In 7 cases prosecution was resorted to. The particulars of these will be found under the heading "Legal Proceedings." The Council had under consideration an application from the Confectioners to be allowed to remain open on Sunday evenings after 8 o'clock. Having regard to the case London County Council versus Gainsborough, the Council, after having given careful and sympathetic consideration to the application, communicated with the Home Secretary, and a letter in the following terms was received by the Council:— "An Order made under the Act of 1912 for the evening closing of confectioners' shops on Sundays for any later hour than that fixed by the General Early Closing Order under the Act of 1920 (viz:-—8 p.m.) would be inoperative . . . He would not, therefore, be prepared to confirm an Order to provide for the closing of confectioners' shops on Sundays at an hour later than 8 p.m." The closing hours in force in Tottenham are as follows:—- 37 HALF HOLIDAYS. Harringaxy Area. Tottenham Remainder Area. *Butchers Monday, 1 p.m Monday, 1 p.m. (or alternatively Saturday, 1 p.m.) (or alternatively Saturday, 1 p.m.) Quakers Wednesday, 2 p.m Thursday, 2 p.m. (or alternatively Saturday, 2 p.m.) (or alternatively Saturday, 2 p.m.) † Other Shops Wednesday, 1 p.m Thursday, 1 p.m. (or alternatively Saturday, 1 p.m.) (or alternatively Saturday, 1 p.m.) (non-exempted trades) EVENING CLOSING HOURS. *Butchers Monday 1 p.m. Tuesday, Wednesday and Thursday 7 p.m. Friday and Saturday 8 p.m. Confectioners Monday, Tuesday, Wednesday, Thursday and Friday 9.30 p.m. Saturday 10 p.m. Sunday 8 p.m. †Other Shops Monday, Tuesday, Wednesday, (non-exempted trades) Thursday and Friday 8 p.m. Saturday 9 p.m. Sunday 8 p.m. (subject to weekly half-holiday Order). Refreshments Special Licences 10 p.m. and 11 p.m. (consumed on premises) Exempted trades No closing hour. (newly cooked provisions, etc.) SLAUGHTER HOUSES. There are 14 private slaughter-houses in the district. They are periodically visited, and no occasion has been found to take serious exception to their condition. 38 DAIRIES, COWSHEDS AND MILKSHOPS. 70 applications from retail purveyors were received during the year for registration under the Dairies, Cowsheds and Milkshops Order, 1885, and Miik and Dairies (Amendment) Act, 1922. These were acceded to. There are at present upon the register, 175 retail purveyors of milk. The Milk and Dairies (Amendment) Act, 1922, gave additional powers to the Council enabling them to refuse to register purveyors of milk where satisfactory arrangements have not been made in relation to the quality, storage and distribution of milk. Advantage was taken of the section to have various improvements effected in the premises of certain vendors of milk in the area. Registration was with-held in respect of certain individuals until our requirements had bean complied with, and in one instance the purveyor was struck off the Register altogether. 1 purveyor was licenced for the sale of "Grade A. (Tuberculin Tested) "Milk, 1 for the sale of "Certified" Milk and 1 for the sale of "Pasteurised" Milk (supplementary licence). Periodical inspection is made of the premises where the Graded Milk is bottled, and samples are taken in accordance with the Ministry of Health's scheme. UNSOUND FOOD. The Sanitary Inspectors have seized or had brought to them for condemnation the following articles:— Meat:— Fruit and Vegetables:— Sheep, 4. Tomatoes, 114 boxes. Beef, 130 lbs. Cabbages, 4 sacks. Rabbits, 3 hampers. Peas, 6 cwt. Rabbits, 36. Oranges, 10 cases. Oranges, 107. Fish:— Apples, 2 bushels. Kippers, 13 boxes. Apples, 1 box. Skate, 13 stone. Pears, 40 boxes. Skate, 1 box. Plaice, 5 boxes. Haddocks (" fresh '), 3 boxes. Miscellaneous:— Rock Eel, 1 box. Condensed Milk, 102 tins. Cod Fillets, 4 stone. Dabs, 22 lbs. Prawns, 4 tins. 39 FOOD AND DRUGS. I am obliged to the County Council (who are the authority for administering the provisions of the Sale of Food and Drugs Act, 1875), for the following information:— Samples Name of Article. Taken. Found Adulterated. Milk 373 18 Milk, separated 11 — Milk, condensed 3 — Butter 7 — Cream 6 4 Black Pudding 1 — Coffee 3 — Olive Oil 1 — Prescription 7 2 Rice 1 — Salicylate of Soda 1 — Sponge Cake 2 — Sugar 1 — Sugar of Lead 1 — Syrup of Iodide of Iron 1 419 24 Number of Prosecutions 9 Number of Convictions 7 Fines and Costs imposed £12 6s. 6d. The figures given for adulterated samples include some adulterated informal samples, in respect of which no proceedings could be taken. 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. 40 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. 1,797 rooms were disinfected. 7,222 articles were disinfected or destroyed. 281 library books were disinfected. 171 persons were bathed. During the period that the Prince of Wales's Hospital has been in the hands of the builders the disinfector has been used for their purposes, and I am gratified to state that in this particular the Council have been of very great assistance to the hospital authorities. COMMON LODGING HOUSES. There are 5 Common Lodging Houses in the district. All have been kept under observation and have been found to be satisfactory at each of the visits. EXHUMATIONS. Two exhumations took place at the Tottenham Cemetery under the supervision of the Sanitary Inspector, in compliance with the Home Office requirements. 41 GENERAL SANITARY WORK. The work of the male Sanitary Inspectors is epitomised and subjoined. Harringay Ward (Mr. Redston) West Green Ward (Mr. West) St. Ana's Ward (Mr. Smith) High Cross Ward (Mr.Portman) Middle Ward (Mr. Miller) Lower Ward (Mr. Shillito) House to house inspections 86 189 106 188 89 166 Re-inspections 1251 1144 939 898 1208 1120 Drains examined, tested, etc. 74 59 153 156 111 124 Drains unstopped 27 29 29 30 20 209 Drains re-constructed & repaired 33 16 16 25 45 29 Disconnecting traps inserted 2 ... ... 1 5 9 Soil pipes and drains ventilated 4 2 35 5 19 32 R.W. pipes, wastes, etc., disconctd. 5 3 65 5 23 63 Dust bins provided 27 29 53 21 27 41 Roofs repaired 55 56 120 22 50 58 Gutters repaired and renewed 62 26 66 20 21 38 Cisterns cieaned, repaired, etc. 17 10 35 7 10 53 W.C. new apparatus provided 15 8 21 4 19 115 W.C. repaired, cleaned, etc. 15 26 73 5 14 19 W.C. Water Fittings repaired 31 29 31 17 11 37 Yards paved and drained 24 31 76 15 30 34 Premises cleaned, etc. 71 179 205 59 146 370 Ventilation below floor provided 6 8 86 2 2 6 Defective window frames and sashes 29 34 92 5 24 73 Other defects 42 65 81 15 60 ... Smoke observations 10 9 23 48 19 8 Overcrowding 4 ... 2 ... ... 8 Accumulations of refuse 29 3 8 7 8 8 Visits in connection with cases of infectious disease (including Tuberculosis) 149 139 153 101 192 196 Rooms inspected after disinfection 22 52 84 71 70 63 Other inspections, etc. 98 39 361 22 128 104 Factories, No. of inspections 35 48 13 11 20 36 Workshops & workplaces „ 49 81 99 6 23 70 Laundries „ 14 7 4 ... 4 ... Dairies, etc. „ 98 39 18 40 54 40 Cowsheds „ ... ... ... 2 10 4 Bakehouses ,, 25 23 22 15 52 39 P.H. urinals „ 150 25 34 84 83 12 Stables and Mews „ 155 60 36 3 82 40 Complaints investigated 131 109 323 247 89 170 Appointments 71 161 85 10 60 203 School inspections 6 ... 2 4 5 ... Pawnbrokers 3 ... ... ... ... 4 Common Lodging Houses ... ... ... 15 ... 26 Slaughterhouses ... 86 18 30 ... 52 Knackers Yards ... ... ... 25 ... ... Brooks and Watercourses 6 ... ... 5 10 6 Butchers' shops 127 42 27 139 77 49 Fishmongers' shops 121 21 17 64 72 50 Fruiterers' shops 98 13 9 18 53 47 Ice Cream premises 4 5 7 1 3 16 42 SANITARY WORK CARRIED OUT BY FEMALE SANITARY INSPECTOR. Visits to Outworkers Premises 809 „ Workshops 126 „ Laundries 2 „ Factories 8 Complaints investigated 114 Visits re Infectious Diseases 6 Miscellaneous visits 19 Reinspections 567 Swabs taken 554 S. F. contacts examined 307 FACTORY AND WORKSHOP ACT, 1901. In compliance with section 132, I have 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. Inspections made by Sanitary Inspectors. Premises Number of Inspections Written Notices Prosecutions Factories (including Factory Laundries) 161 61 ... Workshops (including Workshop Laundries) 401 Workplaces (other than outworkers' premises included in Fart 3 of this Report). Total 562 61 43 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 48 48 ... ... Want of ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 9 7 2 ... Sanitary accommodation insufficient 4 4 ... ... unsuitable or defective 4 5 ... ... not separate for sexes 2 4 ... ... 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) 4 4 ... ... Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) ... ... ... ... Total 71 72 2 ... *Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 44 3.—Home Work. OUTWORKERS' LISTS, SECTION 107 Number of Inspections 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 Twice in the year Once in the year Failing to keep or permit inspection of Lists Failing to send Lists Instances Notices served Prosecutions Instances Orders made(Sec.109) Prosecutions (Secs. 109, 110) Total Lists Outworkers Total Lists Outworkers 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Wearing Apparel 16 154 8 27 525 80 ... ... 626 ... ... ... ... ... Boots and Shoes 6 80 ... ... 19 79 ... ... 20 ... ... ... ... ... ... Stationery ... ... 2 8 ... 2 ... ... 6 ... ... ... ... ... ... Cardboard, etc., Boxes 2 24 ... ... 6 7 ... ... 23 ... ... ... ... ... ... Brushes 2 4 ... ... 13 4 ... ... 13 ... ... ... ... ... ... Smallware 2 30 ... ... ... 28 ... ... 2 ... ... ... ... ... ... Upholstery ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... Furs ... ... ... ... 15 ... ... ... 15 ... ... ... ... ... ... Umbrellas ... ... ... ... 6 ... ... ... 6 ... ... ... ... ... ... Ornamental Confectionery ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... Fancy Goods ... ... 1 ... 25 1 ... ... 26 ... ... ... ... ... ... Artificial Flowers ... ... ... ... 11 1 ... ... 10 ... ... ... ... ... ... Xmas Crackers 2 64 ... ... 2 15 ... ... 51 ... ... ... ... ... ... Sports Goods ... ... ... ... 3 ... ... ... 3 ... ... ... ... ... ... Leather Goods ... ... ... ... 6 ... ... ... 6 ... ... ... ... ... ... Totals 30 356 11 37 633 217 ... ... 809 ... ... ... ... ... ... 45 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year Number Workshops 133 Laundries 28 Bakehouses 63 Total number of Workshops on Register 224 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) 3 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 21 Reports (of action taken) sent to H.M. Inspector 21 Other ... 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). 46 HOUSING. New Houses erected during the Year. By private builders (no State assistance) 60 By the London County Council (State assistance) 120 180 Unfit Dwelling Houses. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2645 Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 824 Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 18 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 1322 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 1041 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 ... 220 (2) Number of dwelling - houses which were rendered fit— By owners 213 By Local Authority in default of owners 2 47 (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 74 (2) Number of dwelling-houses in which defects were remedied— By owners 72 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 18 (2) Number of dwelling-houses in respect of which Closing Orders were made 2 (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 4 (5) Number of dwelling-houses demolished in suance of Demolition Orders 2 Tottenham Maternity and Gbild Welfare 6on)nriftee. ANNUAL REPORT for the year 1923. LIST OF MEMBERS OF COMMITTEE. Mr. W. W. LEWIN, J.P. (Chairman). Mr. H. FARTHING (Vice-Chairman). Mrs. F. C. BRIGHTEN. Mr. J. BRISTOW. Mr. O. F. BROADWAY. Mrs. A. E. COOK. Miss R. F. COX. Mr. T. ELDERFIELD. Rev. T. W. OSWALD-HICKS, B.A. Mr. M. E. JAMES, Major P. B. MALONE, M.P., J.P. Mr. W. E. MONTAGUE. Mr. E. J. MORLEY. Dr. A. G. NEWELL, D.P.H. Mr. A. REED. Mr. C. WISE. CO-OPTED MEMBERS:— Mrs. H. BYERS. Mrs. F. M. HOPPER. Mrs. E. S. SCHIEFER. Mr. F. E. SHARLAND. Mr. S, TIMMS. Miss E. M. VERNON. 3 Infant Welfare and Maternity Centres. BRUCE CASTLE, BRUCE CASTLE PARK. INFANT WELFARE CLINICS. Monday Afternoon 2 to 5 o'clock Tuesday Afternoon 2 to 5 „ Wednesday Afternoon 2 to 5 „ Thursday Morning 9.30 to 12 „ A MATERNITY CLINIC FOR EXPECTANT MOTHERS is held on :— Tuesday Morning 9.30 to 12 o'clock THE CHESTNUTS, CHESTNUTS PARK. INFANT WELFARE CLINICS. Tuesday Afternoon 2 to 5 o'clock Wednesday Morning 9.30 to 12 „ Wednesday Afternoon 2 to 5 „ Thursday Afternoon 2 to 5 „ Friday Afternoon 2 to 5 „ MATERNITY CLINICS FOR EXPECTANT MOTHERS are held on :— Tuesday Afternoon 2 to 5 o'clock Friday Morning 9.30 to 12 „ TOWN HALL CENTRE. INFANT WELFARE. Wednesday Afternoon ... ... 2 to 5 „ DAY NURSERY, 240 St. Ann's Road. Open Daily from Monday to Friday inclusive, from 8 a.m. to 6 p.m. In addition to the ahove Clinics, a Sswing Class for Mothers who attend the Centres, is held on Wednesday afternoons at The 4 INTRODUCTION. Medical Officer's Department, Town Hall, Tottenham, N. 15. April, 1924. To the Chairman and other Members of The Maternity and Child Welfare Committee. Ladies and Gentlemen, It is gratifying to report that the Infant Mortality during 1923 was the lowest yet recorded, namely 58'1 per 1,000 births. Of the 180 deaths 91 occurred within the first month and may be considered as due to prenatal conditions operating after birth. Puerperal fever and other accidents of pregnancy accounted for 7 deaths of mothers. The means available for avoiding these neo-natal and maternal deaths, namely the ante-natal clinic and the District Maternity Home are not taken advantage of to the extent that they ought. It appears to me that it will be from the fuller use of these provisions that improvement in the infant and maternity mortality rate may be anticipated. My conviction is that every primiparous woman, at least, ought to seek the advantages that a maternal hospital confers. Too often the health of the woman is prejudiced by hasty delivery resulting from the clamour of the patient or her relatives. Natural processes are not permitted to operate and the mother suffers from the effects of precipitancy for the rest of her days. The remedy is institutional treatment, where everything necessary is available and surgical cleanliness is observed ; the patient is away from her domestic anxieties and there is no sympathetic interference with the practitioner's judgment. It will be noted that 80°/o of the infants under the supervision of the health visitors were Breast fed for six months or over. This is a 5 gratifying record. It is one of the most important functions of the visitors to ensure that mothers breast feed their infants. There is a tendency for mothers to resort too readily to artificial feeding, assuming that they are not going to be able to suckle their children, without making any serious attempt to do so. It is no easy matter to overcome this tendency, and that so much has been accomplished is satisfactory. The Centres continue to fulfil their useful functions, the attendances being 1,500 more than last year, notwithstanding a declension in the number of births. I have to express my thanks, for their generous support, to all who have been associated with me in the work coming within the purview of your Committee. Yours faithfully, Medical Officer of Health. 6 BIRTHS, 1923. LIVE BIRTHS. Registrar General's Figures—M 1,617 F 1,476 3,093 Local Information:- Live Births notified 2,975 Still Births 61 *3,036 Births outside the District included in above:- Council Cases in District Maternity Home 58 Other cases notified from District Maternity Home 221 Notified from other outside Institutions 130 409 The Registrar s and the local figures do not agree because they relate to different periods. The local notifications are those of children born within the year. The Registrar's figures are those of children registered within the year—i.e.—within 42 days of birth. BREAST FEEDING. As the result of the Health Visitors' enquiries, it was ascertained that the infants have been fed as follows:- Breast-fed for 6 months, or over 2,374 Part breast-fed—plus milk, dried milk, or condensed 193 Bottle-feeding—cows' milk 129 Dried milk 112 Other artificial food's 98 2,906 The difference between the notified live births, 2,975, and the total feedings, 2,906, is due to information being unavailable, owing to deaths Under 1 year of age or removals from the District. 7 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 under 1 year Children over 1 year  1st Visits Re-visits 1st Visits Re visits Notification of Births 3,335 8,517 346 18,327 30,525 Still-births 57 17 - - 74 Deaths 26 25 4 5 60 Ophthalmia Neonatorum 15 43 - - 58 †Other Infectious Diseases 38 86 78 153 355 Total 3,471 8,688 428 18,485 31,072 Maternity Visits;— 1st Visits Re-visits Ante-Natal 367 332 - - 699 Post-Natal 388 759 - - 1,147 Puerperal Fever 3 4 - - 7 Other Visits 1st Visit Re-Visits *326 202 - - 528 Total Visits - - - - 33,453 †Other Infectious Diseases include measles and German measles. *Other visits and revisits include visits to hospital with swabs in connection with suspected contagious disease; massage cases, complaints of neglect and inspection of premises as to their suitability for nursing of children after operation and visits for assisted milk supply. 8 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 Morning Aft'noon St. Ann's 15,159 900 50 206 39.62 63.97 1,745 Bruce Castle 11,898 836 52 146 47.86 64.44 1,560 Town Hall 1,906 131 - 48 - 39.7 269 Total 28,963 1.867 102 400 - - 3,574 Medical Inspections Total Number New Cases Number of Sessions Average No. of Inspections per Sessions St. Ann's 4,031 827 152 26.52 (The Chestnuts) Bruce Castle 2,512 643 100 25.12 Town Hall - - - - Town Hall 6,543 1,470 252 - Infant Mortality of Infants Attending the Infant Welfare Centre during 1923 No. on Register Deaths of Infants Centie Under 1 Yi\ of age Under 1 Yr. of Age Infantile Death-rate St. Ann's 1,020 .17 16.6 Bruce Castle 456 6 13.15 Town Hall 183 - - All Centres:— 1,659 23 13'86 Average Death-rate per 1,000 *Includes babies referred for Medical Examination from the Town Hall Clinic. 9 ANTE AND POST NATAL CLINICS. Medical Examinations Ante Natal Post Natal Total Number of Sessions Average Attendance per Session St. Ann's 956 384 1,340 100 13.4 Bruce Castle 519 187 706 49 14.4 Total 1,475 571 2,046 149 — New Cases St. Ann's 249 131 380 - - Bruce Castle 114 51 165 — — 363 182 545 — — 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 ;— In respect of — Contributions towards cost To Expeetant and Nursing Mothers To Toddlers Total 2,586 1,528 4,114 61 mothers 33 toddlers 12s. 7d. MATERNITY HOMES AND HOSPITALS. The arrangements 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 this institution subsidised by your Committee, and the details relating to them :— Admitted to the District Matemty Home, Edmonton Confinements— Total Delivered by Total Live Births Still Births Midwives Doctors 57 *55 3 58 54 3 57 *The difference between the 57 confinements and the 58 births is accounted for by the birth of twins. to No. of cases in Puerperaf Maternity which temper- Ophthalnfia Inflammation Not Entirely Sepsis Deaths ature ros«ab„ve oftheeyes breast.fed Nil Nil Nil Nil Nil Nil Causes of still births.—1, Prolapse of cord ; 2 and 3, Foetus macerated. Cost of patients admitted to Maternity Home £276 12 0 Contributions by patients towards maintenance £223 14 0 Net cost to Council £52 18 0 Average duration of stay, 16'19 days. CRECHE ATTENDANCES, The attendances from January 1st to December 31st, 1923, were as follows :—- Number of days on which the Creche was opened, 229. Quarter Attendances under 3 years of age Attendances over 3 years of Age Total January 1st to March 31st 1,390 666 2,056 April 1st to June 30th 1,222 587 1,809 July 1st to September 30th 1,346 598 1,944 October 1st to December 31st 1,327 768 2,095 5,285 2,619 7,904 Average daily attendance, 34.51 11 Applications for assistance have been dealt with as follows:- Assistance Granted Number of Cases Cost £ s. d. Convalescent Home Treatment 3 7 14 9 Invalid Children's Aid Association 32 97 17 11 Midwives' Fees 7 8 12 6 Home Helps 6 5 1 0 * Assistant Milk Supply:- Fresh Milk — 1,704 10 4 Dried Milk — 123 10 7 *The cost of this item is calculated for the financial year ending 31st March, 1924. VOLUNTARY SERVICES. The Mothers' Welfare Club continues at The Chestnuts and Bruce Castle. In May a Ladies' Visiting sub-committee, consisting of all the ladies of the Committee was appointed. This sub-committee has reported from time to time on the following matters, namely :— (a) Renewal of garments and utensils at the creche. (b) Disposal of voluntary contributions. (c) Management of voluntary activities. Baby Competitions were held in the month of September at all the centres. Towards the prizes, your Committee contributed £25. Other donations were received amounting to £5. 5s. Mrs. Pickford has rendered valuable services at The Chestnuts sewing class, as in previous years. Miss Cremolina has kindly assisted with sewing at the creche, and Miss M. Camm in the afternoons with the children in the shelter. 12 The mothers attending the centres have benefited by the following gifts .— From the Harringay Brotherhood £3. 17s. 4d., together with 6 parcels of clothing. From a parent in the Lower Ward, 10s., which was added to the mothers' social fund at Bruce Castle. From Crowland Road Girls School and Tottenham High School, gifts of clothing. FOR THE CRECHE:- The children have benefited from gifts from Mrs. Schiefer and Councillor E. J. Morley, and from the nursing staff and the staff at the creche. A Xmas party was also arranged and given to the children by the matron. Tottenham Education Committe. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR 1 923. MEMBERS OF THE COMMITTEE. Mr. T. ELDERFIELD (Chairman). Mr. T. INGLIS (Vice-Chairman). Mr. I. AKKER. Mr. O. F. BROADWAY. Mr. C. E. BROWN. Mrs. A. E. COOK. Miss R. F. COX. Mr. G. DUDMAN. Mr. H. FARTHING. Mr. E. FROST. Mr. A. E. HARVEY. Mr. W. R. JACKSON. Mr. W. W. LEWIN, J.P. Maior P. B. MALONE, M.P., J.P. Dr. A. G. NEWELL, D.P.H. Mr. A. REED. Mr. T. VICKERY. Mr. C. WISE. Miss E. GOWAN, B.A. Mr. F. E. SHARLAND. 2 INTRODUCTION. School Medical Department, Town Hall, Tottenham. March, 1924. To the Chairman and other Members of the Tottenham Education Committee. Ladies and Gentlemen, The Annual Report for 1923 is not expected by the Board of Education to be of a discursive nature. In concise form, chiefly tabular, the nature and amount of the work will be indicated. Although there has been no extension of the School Medical Services during 1923, plans have been laid and preliminary measures taken to consolidate all the Health Services of the district coming within the purview of the Council. When these measures have been brought to their full activity, they will result in considerable economy and an enhanced degree of efficiency. It is within the knowledge of your Committee that there are a considerable number of small private schools in the district. These cater for young children mostly, and the living rooms of private dwellings are made to serve the purpose of school rooms. As, of course, the main object of these establishments is to earn money, and, as statute does not definitely prescribe the air space to be provided in respect of each school child, there is the inducement to pack these rooms with scholars of tender years. In addition, these houses are without lavatory and W.C. accommodation for school purposes, and I recommend the Committee to urge in the proper direction, that these schools be brought oompulsorily under the supervision of the Local Elementary Education Authority, whose powers should extend to licensing or disapproving for school purposes premises other than school buildings. • The health of the school children is well maintained and the vigilance of your medical staff is such that there appears to be no reason why every child suffering from any defect should not receive the treatment necessary for its malady. The clinics provided by your Committee and 3 the arrangements made with other Authorities appear practically to cover every phase of medicine and surgery such as is necessary for the treatment of the diseases of childhood. The staff have worked during the year with their accustomed harmony. The active interest that the members of your Committee take in the work of the department is greatly appreciated. I am, Ladies, and Gentlemen, Yours faithfully. SCHOOL MEDICAL SERVICE. Co-ordination of the work of the School Miedical Services with that of other Health Services. The Council, the Education Committee, and the Maternity and Child Welfare Committee have had before them exhaustive reports upon the Co-ordination of Health Services, and have given their formal approval thereto. SCHOOL HYGIENE. The following report of the Surveyor indicates the improvements effected to school premises. SURVEYOR'S REPORT OF IMPROVEMENTS CARRIED OUT FROM 31st MARCH, 1923, TO 31st MARCH, 1924. All Hallows. Redecorated internally. Head Teacher's Room.—Compo floor laid. Gas for lighting and heating laid on. Desks and cupboards supplied. 4 Bruce Grove. Infants' Playground almost wholly reconstructed and lowered to remove a dangerous hump. Bruce Castle Clinic. Alterations to rooms to form suitable accommodation for Eye Specialist. Coleraine Park. Redecorated internally and externally. Boys' and Infants' Departments.—Windows in classrooms lowered. Hall.—Ventilation improved. Boys' Playground.—Brick wall removed to enlarge the playground. Girls' Department.—Galleries in all classrooms removed1, and lobby provided to give separate access to Room 8. Crowland Road. Redecorated externally and internally. Downhills. Central Department.—Classrooms altered to form Chemical, Physics and Demonstration Room. Junior Girls' Department.—Teachers' lavatory accommodation provided. Infants' Department.—Heating arrangements in the Babies' room and two other classrooms improved. Junior Boys' Department.—Boys' lavatory accommodation renewed and improved. Education Offices. Gas lighting removed and electric lighting installed. Holy Trinity. Redecorated internally. 5 Lancasterian. Redecorated internally and externally. Boys Department.—Lighting to classroom improved. Page Green. Junior Mixed Department.—New playsheds erected. Parkhurst Road. Concrete galleries removed, and floors levelled in two classrooms. Risley Avenue. New heating boiler installed. Central Department.—Provision of an iron roof glazed with wired glass, between Manual Room and Chemical Laboratory, to form cycle shed. St. Francis de Sales. Redecorated internally. St. Ignatius. Redecorated internally. St. Paul's. Girls' and Infants' Department.—Redecorated internally. Infants' Department.—Galleries removed and floor made level. Seven Sisters. Girls' Department.—Cloakroom converted into a Teachers' Room. New heating boiler installed. Stamford Hill. Fire emergency lobby provided in the Hall. Boys' Department.—One large classroom converted into two rooms; old floor in front of gallery removed and relaid with jointless Compo flooring. 6 Playgrounds. The playgrounds at the following schools have been given attention : St. Ann's Infants', Belmont Road Boys', Culvert Road Boys', Girls' and Infants', Downhills Boys', Lancasterian Boys', Risley Avenue Boys', Girls' and1 Infants', Woodlands Pk. Boys'. School Furnishing. Furniture has been supplied as follows:- (a) Belmont Road. Three adjustable tables. (b) Downhills Central. Two benches for Physics Room. Two do. for Chemical Lab. Six tables for Needlework Room. In addition to the above, Cupboards, Screens, Remedial Forms and Blackboards, have been made and supplied. MEDICAL INSPECTION. The details of medical inspections and the subsequent following-up and treatment of children found to be defective are set out in tabular form at the end of this report. 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 233 Diphtheria 156 Enteric Fever 1 Erysipelas 5 Voluntary Notifications.—The following cases were voluntarily notified by teachers and attendance officers during the year:- 7 Measles 319 Rash 13 German Measles 18 Sore Throat 39 Mumps 400 Tuberculosis 8 Whooping Cough 268 Influenza 68 Chicken Pox 398 Eye Diseases 16 Scarlet Fever 88 Ringworm of Head 74 Diphtheria 47 Ringworm of Body 12 Diphtheria and Scarlet Sores and Eczema 85 Fever 1 Impetigo 44 Scabies 19 Other Diseases 312 Skin Diseases 5 Children excluded owing Verminous 19 to infectious disease Tonsilitis 21 in house 231 Chorea 7 Debility 21 Pneumonia 12 Otorrhea 3 These cases were followed up by the School Nurses and were not readmitted 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. 638 such examinations were made, 32 were found to be positive, 546 negative, and 60 contained bacteria morphologically similar to Kleb's Loeffler bacilli. Microscopical Examinations.—Hairs were taken from children who were suspected to be suffering from ringworm' in 115 instances and submitted to microscopical examination. 75 were positive. FOLLOWING-UP. The system of following-up school children who have been found to be defective is the same as in the previous year. UNCLEANLINESS AND VERMINOUS CONDITIONS. The arrangements for cleansing of children is the same as in the year 1921. There are two slipper baths for the bathing of the children, and the clothing is simultaneously disinfected at the Council's Disinfecting Station adjoining. During the year 161 children were cleansed ; 26 in respect of 8 verminous conditions and 135 owing to the children being in a dirty state, generally. With regard to nits and vermin in the hair the procedure varies according to the frequency with which the same child is brought under scrutiny. Repeated offences lead to the exclusion of the child from school until the Medical Officer is satisfied that a remedy has been effectually applied. Alternatively, a Statutory Notice is served upon the parent, under the Children Act, and the nits are cut away from the hair. Children brought under notice for the first or second time with nits or vermin in the hair are advised how to have the hair cleansed or are assisted in the actual cleansing. Prosecutions under the School Attendance Bye-laws were undertaken in connection with verminous conditions in 18 cases. Fines were inflicted in respect of 14 of these cases, and 4 Attendance Orders were made. 99 Notices were served under Section 122 of the Children Act, 1908, in respect of verminous conditions. MEDICAL TREATMENT. The system of administering medical treatment in respect of defects found amongst school children has not been modified during the year in any particular. Some modifications are in contemplation, but will not be brought into effect until next year. They relate to the Institutional treatment of certain diseases m respect of which some measure of risk attaches to the treatment ; for instance, the operative treatment of tonsils and adenoids, and the X-Ray treatment of ringworm. In respect of otorrhoea your Committee has given its formal sanction, and the Board of Education has given its consent, to the treatment by ionic medication, at our centre, of this complaint which has proved one of the most difficult problems with which the department] has been confronted. The centre is being equipped and the treatment will be brought into operation at an early date. The Board of Education has at length given its permission for the opening of two classes for physically defective children in Tottenham. It is expected that by this means some 40 or 50 children, who are at present either receiving no education, or are receiving education at an elementary school at some measure of risk to themselves, will be instructed under more advantageous conditions. It is anticipated that these classes will 'be available for suitable scholars after next Easter recess. 9 OPEN-AIR EDUCATION. Tthe following Report, with respect to Open-Air Education, has been received from the "Director of Education :— 1. SCHOOL JOURNEYS AND HOLIDAY CAMPS. The Scheme for 1923, approved by the Board of Education, sanctioned five School Journeys and provided for financial assistance from the Education Committee not exceeding £187 10s. in all. The sum actually paid was £185. (In 1922 an expenditure of £187 10s. was approved and £138 17s. was spent. In 1921 £250 was approved and £209 10s. spent. In 1920 the amounts were £300 approved and £221 spent). The following are brief particulars of the Journeys carried out. Thai proposed 'by All Hallows Boys' School had to be abandoned. 1. Down Lane Central Sichool. 96 First Year girls, in three parties, spent a week in April and May at Dunford House, Midhurst, Sussex, the holiday home of the London School of Economics. Excursions were made to Heyshott for the South Downs, Midhurst, Chichester, Arundel and Bognor. I visited Dunford House during the stay of one of the parties and accompanied the girls to Chichester and Arundel. The house was most suitable for the accommodation of a school party and the neighbourhood was full of beauty and interest. Excellent arrangements had been made for the comfort and convenience of the party. In July 60 Third Year girls spent a fortnight at Bangor, N.Wales, where they were accommodated at Bron Castell, one of the hostels of the University College. The Authorities of the University and those in charge of the hostel attended admirably to the needs of the girls, who lived the life of University students during their visit. Mr. Johns, H.M.I., visited the party at the request of the Board of Education and gave them valuable advice and assistance. The girls 10 were entertained by Lady Verney at her Welsh home. The Dean of Bangor, who had observed the party at the Cathedral services, visited them at the hostel. Excursions were made to Aber, Bethesda, Bettws-y-Coed, Anglesey, Beddgelert and the Aberglaslyn Pass. The total cost of the Journeys of this school amount to £501, of which £135 was contributed by the Committee. The balance was raised by the parents of the scholars, teachers, and by the organisation of Concerts, Sales of Work, &c. The task of raising £365 is a heavy one but the Head Mistress and Staff are strongly of opinion that the benefits derived from the journeys make the effort worth while. 2. Sit. Paul's Girls' School. A party of 20 girls spent a fortnight at Folkestone, where the history and geography of the district were studied. Visits were paid to Dover, St. Margaret s Bay, Sandgate, and Hythe, Boulogne, Canterbury, Dymchurch, &c. The total cost of the journey was £77 15s., of which £25 was contributed by the Committee. 3. Risley Avenue Central School. A party of boys from this school spent a week at Swanage for the study of the geography and geology of the Isle of Purbeck and neighbourhood. Visits were paid to Lulworth Cove, Corfe Castle, Studland Bay, &c. Maps, models and guide books prepared for this journey were selected by the Board of Education Inspectors for display at the Educational Exhibition organised by the Board last year. The exhibit received high praise in the educational papers. The cost of the journey was £52 13s., of which £25 was contributed by the Committee. All these journeys were admirably organised by the school staffs. From personal interviews with parents and from the reading of communications from many of them I am satisfied that they much appreciate the difficult work undertaken by the teachers for the educational and social benefit of their children. 11 2. OPEN-AIR SCHOOLS AND CLASSES. The Open-Air Class which has been conducted during several summers in the Bandstand at Downhills Park was again in operation from May to October, 1923. About 30 scholars, selected by the Medical Officer's staff, were in attendance. The educational and1 physical results of the class were very satisfactory. An undevteloped school site at Orchard House, Park Lane, was again used for the purpose of Open-Air work in connection with Coombes Croft Temporary Boys' School. All the classes of the school shared these facilities. The opportunities offered afforded a welcome relief from the occupation of unsuitable and depressing premises, the use of which is to terminate on 31st March, 1924. 3. PLAYGROUND CLASSES. Playground classes were held, when the weather was suitable, at Page Green Junior Mixed School and Coleraine Park Girls School, where suitable shelters have been erected. 4. PHYSICAL EXERCISES. Full attention continues to be given to Physical Training in all the schools. Many departments are organised so as to permit of the instruction in several classes being given by teachers who have special qualifications and aptitude for the work. In the three Central Schools, each of which has a specially trained Instructor, gymnastic apparatus has been provided and a carefully devised scheme of instruction is in operation. A public display of Physical Exercises and Country Dancing, given at the Annual Schools' Sports in September, was very successful in calling attention to the excellent work done in the schools. PROVISION OF MEALS. The same arrangements apply this year as last year. SCHOOL BATHS The public baths are made available for school children on special days at special rates. 12 CO-OPERATION OF PARENTS. There is nothing to add to my statement of previous years under this heading. CO-OPERATION OF TEACHERS. The teachers in general are well-disposed towards the School Medical Services. The amount of clerical work entai'ed, however, has proved at times irksome to certain of them and a conference was arranged between the department and their representatives in order that the difficulties might be mitigated. CO-OPERATION OF SCHOOL ATTENDANCE OFFICERS The school attendance officers give their whole-hearted support to the medical department and the superintendent, Mr. Lewis, by his courtesy and enthusiasm has proved a valuable ally to this department. CO-OPERATION OF VOLUNTARY BODIES, The Invalid Children's Aid Association has provided for the maintenance of children at Convalescent Homes and the supply of surgical instruments, as follows:- Convalescent Home Treatment.—During the year, 260 children were sent away for varying periods, namely:- No. of weeks 1 2 3 4 5 6 7 8 9 10 11 12 No. of Children 1 9 16 53 23 44 16 37 6 17 7 6 No. of weeks 13 14 15 16 17 18 19 21 23 - - - No. of Children 8 5 1 2 2 1 1 4 1 - - - In 17 of these cases the treatment has been continued in 1924. The following table gives the affections on account of which children received convalescent treatment :- 13 Debility 37 Chorea 17 Pre-tubercular Debility 25 Enlargement of Glands 16 Debility aft. Infectious Disease 16 Rheumatism 7 Post-operative Debility 15 Accidents 4 Post-Pneumonic Debility 6 Tonsilitis 1 Anaemia and Debility 19 Amputation of Leg 1 Heart Affections and Anaemia 14Dyspepsia 2 Bronchitis and Bronchi. Catarrh 43 Paralysis 4 Broncho pneumonia 3 Henoch's Purpura 1 Bronchiectasis 1 Nephritis 1 Pleurisy 2 Haemophilia 1 Asthma 3 Fainting Attacks 1 Other Non-tubercular Lung Dis 3 Severe Headaches 1 Tuberculosis:- Marasmus 4 Glands 2 Spinal Curvature 1 Peritoneum 1 Appendicitis 3 Hip 3 Provision of Surgical Instruments.—Surgical appliances were supplied, and repairs and replacements carried1 out in respect of the following defects:- Infantile and other forms of Pes Cavus 11 Paralysis :-82 Other forms of Deformed Tuberculosis:- Feet 8 Hip 5 Amputation stump 3 Knee 6 Rickety Deformities 12 Ankle 1 Hammer-toes 6 Spine 1 Weak Ankles 11 Flat-foot 11 Other cases 17 Club-feet 7 Blind, Deaf, Defective and Epileptic Children.—The same conditions prevail in relation to these cases as hitherto. There are 48 children from this district being maintained in Special Residential Schools. Ten of these are crippled and physically defective children, 17 blind, 14 mentally defective, 4 epileptic, and 3 deaf and dumb. One blind, and one n:entally defective child attend Special Day Schools in an adjoining district. 14 SECONDARY SCHOOLS. Table I, page 15, sets out the number of children, under their separate ages, examined in the secondary schools during the year. Tables 2—6, pages 16—19, show in detail the defects discovered during the inspections, and the number of defective children who were subsequently found to have received treatment. REMEDIAL EXERCISES. 922 children suffering from the undermentioned defects have been treated; 124 were cured, and the remainder were very much benefited by the treatment given. Curvature of Spine (threatened and established) 137 Round Shoulders 116 Other cases of deformity (flat foot,, torticollis, disparity of shoulders, defective development of chest, infantile paralysis, etc.) 669 FOOD ACCESSORIES AND DRUGS. During the year, Cod Liver Oil, Malt and Oil, Parrish's Food, Syrupus Ferri Iodidi, and Syrupus Calcii Lactophosphatis have been supplied at the Treatment Centres to necessitous cases recommended by the Medical Officers. The following quantities have been dispensed at cost price, at less than cost price, or gratuitously, according to circumstances:— Cod Liver Oil and Malt 2,737 lbs. Parrish's Food 1,473 lbs. Cod Liver Oil 2,194 ozs. Syrupus Ferri Iodidi 615 ozs. Syrupus Calcii Lactophosphatis 313 ozs. EXAMINATIONS BY THE MEDICAL OFFICERS. 17 teachers, 1 attendance officer, and 1 assistant caretaker have been examined by the Medical Officers. 7 children have been medically examined and licensed to take part in entertainments. 40 boys, between the ages of 15 and 16 years, have been examined and licenses granted under the Bye-Laws relating to Street Trading. 15 SECONDARY SCHOOLS. Table I.— Number of Pupils inspected 1st January, 1923, to 31st December, 1923. Ages Routine Inspections Specials Total 10 11 12 13 14 15 16 17 18 19 Boys 16 29 54 5 15 155 20 3 - - 3 300 Girls ... 1 12 18 41 162 39 — — - 273 Totals 16 30 66 23 56 317 59 3 — — 3 573 16 Table II.—Return of Defects found in the course of Medical Inspection in 1923. Defect or Disease Routine Inspections Number referred for Treatment Number requiring to be kept under Observation, but not referred for Treatment. (1) (2) (3) Malnutrition 1 - Uncleanliness:— Head 5 — Body — — Skin. Ringworm— Head — — Body — — Scabies — — Impetigo — — Other Diseases (Non-Tubercular) 7 — Eye. Blepharitis 1 — Conjunctivitis 1 — Keratitis — — Corneal Ulcer — — Corneal Opacities — — Defective Vision 44 3 Squint 3 — Other Conditions — — Ear. Defective Hearing 2 — Otitis Media 2 — Other Ear Diseases 1 — Nose and Throat. Enlarged Tonsils 11 2 Adenoids 1 — Enlarged Tonsils and Adenoids 6 — Other Conditions 8 2 Enl. Cervical Glands (Non-Tubercular) 3 — Defective Speech — — Heart and Circulate Heart Disease— Organic 1 — Functional — 9 Anœmia 10 — Lungs. Bronchitis and Bronchial Catarrh — 2 Other Non-Tubercular Diseases — — Tuberculosis. Pulmonary— Definite — — Suspected 2 — Non-Pulmonary Glands — — Spine — — Hip — — Other Bones and Joints — — Skin — — Other Forms — — Nervous System. Epilepsy — — Chorea — — Other Conditions 1 — Deformities. Rickets — — Spinal Curvature 3 — Other Forms 16 — Other Defects and Diseases 17 4 Number if Individual pupils having defects which required treatment or to be kept under observation 277 17 Table IV.—Treatment of Defects of Pupils during 1923. A.—Treatment of Minor Ailments. Disease or Defect. Number of Pupils. Referred for Treatment. Treated Under Local Education Authority's Scheme. Otherwise. Total Skin— Ringworm—Head - - - - Ringworm—Body — — — — Scabies - — — — Impetigo — — — . — Minor Injuries — — — — Other Skin Diseases 7 — 6 6 Ear Disease 3 — 3 3 Eye Disease— External and other 2 — 2 2 Miscellaneous — — — — Total 12 - 11 11 B.—Treatment of Visual Defect. Number of Pupils. Referred for Refraction. 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 For whom no Treatment was considered necessary Under Local Education Authority's Scheme Clinic or Hos. By Private Practitioner or Hosp. Otherwise Total 46 — 35 — 35 32 32 — — 3 18 C.—Treatment of Defects of Nose and Throat. (Enlarged Tonsils and Adenoids) Referred for Treatment Number of Pupils. Received Operative Treatment. Received other Forms of Treatment Under Local Education Authority's Scheme—Clinic or Hospital By Private Practitioner or Hospital Total 26 — 3 3 11 Table V.—Summary of Treatment of Defects as shown in Table IV. (A, B and C). Disease or Defect Number of Pupils Referred for Treatment Treated Under Local Education Authority's Scheme Otherwise Total Minor Ailments 11 10 10 Visual Defects 46 — 33 33 Defects of Nose & Throat 26 — 14 14 Dental Defects 164 — 75 75 Miscellaneous Defects 54 - 46 46 Total 301 — 178 178 19 Table VI.—Summary relating to Pupils medically inspected at the Routine Inspections during the Year 1923. (1) The total number of pupils medically inspected at the routine inspections 529 (2) The number of pupils in (1) suffering from— Malnutrition 2 Skin Disease 7 Defective Vision (including Squint) 84 Eye Disease 2 Defective Hearing 3 Ear Disease 1 Nose and Throat Disease 61 Enlarged Cervical Glands (non-tubercular) 6 Defective Speech 4 Dental Disease (2 or more decayed teeth) 168 Heart Disease— Organic 2 Functional 13 Anaemia 9 Lung Disease (non-tubercular) 5 Tuberculosis—Pulmonary definite — suspected 2 Non-pulmonary - Disease of the Nervous System 2 Deformities 39 Other Defects and Diseases 22 (3) The number of pupils 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) 20 (4) The number of pupils in (1) who were referred for treatment (excluding uncleanliness, defective clothing and decayed teeth) 260 (5) The number of pupils in (4) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 163 20 ELEMENTARY SCHOOLS. Table I.—Number of Children Inspected 1st January, 1923,to 31st December, 1923. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 4,029 Intermediates 2,401 Leavers 2,409 Total 8,839 Number of other Routine Inspections - B.—Other Inspections. Number of Special Inspections 8,029 Number of Re-Inspections 27,879 Total 35,908 21 Table II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1923. Defect or Disease. Routine Inspections Special Inspections No. of Defects No. of Defects Requiring Treatment Requiring to be kept under observation, but not requiring Treatment Requiring Treatment Requiring to be kept under observation, but not requiring Treatment (1) (2) (3) (4) (5) Malnutrition 51 9 56 1 Uncleanliness:— (See Table IV., Group V.) — — — — Skin Ringworm:— Scalp 5 — 124 — Body 6 — 66 2 Scabies 2 — 91 - Impetigo 30 — 726 - Other Diseases (Non-Tuberculous) 38 — 407 8 Eye Blepharitis 42 — 121 - Conjunctivitis 14 — 135 — Keratitis — — 7 - Corneal Opacities — — 11 — Defective Vision (excluding Squint) 463 19 385 — Squint 36 2 162 — Other Conditions 10 — 142 — Ear Defective Hearing 33 2 34 3 Otitis Media 36 — 267 1 Other Ear Diseases 42 — 81 2 Nose and Throat Enlarged Tonsils only 229 107 43 5 Adenoids only 35 20 36 8 Enlarged Tonsils and Adenoids 364 61 112 41 Other Conditions 13 5 148 4 Enlarged Cervical Glands (Non-Tuberculous) 19 32 124 9 Defective Speech 16 3 4 6 Teeth—Dental Diseases (See Table IV., Group IV.) — — — — Heart & Circulation Heart Disease:— Organic 10 34 30 18 Functional 18 83 24 10 Anaemia 73 46 293 Lungs Bronchitis 165 154 523 7 Other Non-Tuberculous Diseases... 2 1 21 7 Tuberculosis Pulmonary:— Definite 1 — 36 9 Suspected 16 5 34 28 Non-Pulmonary:— Glands 8 10 19 6 Spine 1 — 5 2 Hip 2 — 10 3 Other Bones and Joints — — 8 4 Skin 1 — 3 — Other Forms 2 1 18 8 Nervous System Epilepsy 1 2 19 15 Chorea 3 1 85 1 Other Conditions 14 7 17 7 Deformities Rickets 5 2 10 5 Spinal Curvature 19 3 148 — Other Forms 52 11 876 2 Other defects and diseases 106 51 1202 182 22 Table II.—continued. B. Number of individual children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Group (1) Number of Children Percentage of Children found to require Treatment (4) Inspected (2) Found to require Treatment (3) Code Groups:— ß x35 fs ß Entrants 4,029 828 20.5 Intermediates 2,401 516 ex??? 21.5 Leavers 2.409 481 19.9 Total (Code Groups) 8,839 1,825 20.6 Other Routine Inspections — — — 23 Table III- Return of all Exceptional Children in the Area. — — — Boys Girls Total Blind (including partially blind) (i.) Suitable for training in a School or Class for the totally blind Attending Certified Schools or Classes for the Blind 8 9 17 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution 1 1 2 (ii.) Suitable for training in a School or Class for the partially blind Attending Certified Schools or Classes for the Blind 1 - 1 Attending Public Elementary Schools 6 1 7 At other Institutions — — — At no School or Institution — - - Deaf (including deaf and dumb and partially deaf) (i) Suitable for training in a School or Class for the totally deaf or deaf and dumb Attending Certified Schools or Classes for the Deaf 15 13 28 Attending Public Elementary Schools - — — At other Institutions — — — At no School or Institution 1 — 1 (ii) Suitable for training in a School or Class for the partially deaf Attending Certified Schools or Classes for the Deaf 1 7 8 Attending Public Elementary Schools 5 14 19 At other Institutions — — — At no School or Institution - - - Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority) Attending Certified Schools for Mentally Defective Children 7 7 14 Attending Public Elementary Schools 101 65 66 At other Institutions 2 1 6 At no School or Institution 5 8 13 Notified to the Local Authority during the year Feebleminded 3 2 5 Imbeciles 3 — 3 Idiots 1 — 1 Epileptics Suffering from severe epilepsy Attending Certified Special Schools for Epileptics - 4 4 In Institutions other than Certified Special Schools 4 1 5 Attending Public Elementary Schools - - - At no School or Institution 4 8 12 Suffering from epilepsy which is not severe Attending Public Elementary Schools 9 18 27 At no School or Institution - — — 24 TABLE III.—continued. — — — Boys Girls Total Infections pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 3 4 At other Institutions — — — At no School or Institution 3 — 3 Non-infectious but active pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 3 12 15 At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools — — — At Public Elementary Schools 1 1 2 At other Institutions — 1 1 At no School or Institution - 4 4 Physically Defective Delicate children (e.g., pre—or latent tuberculosis, malnutrition,debility, anaemia, etc.) At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools — — — At Public Elementary Schools 119 218 337 At other Institutions 2 — 2 At no School or Institution 4 14 18 Active Non-pulmonary tuberculosis At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 5 6 11 At Public Elementary Schools — 1 1 At other Institutions 2 — 2 At no School or Institution - - - Crippled Children (other than those with active tuberculous disease), e.g.. children suffering from paralysis, etc.,and including those with severe heart disease At Certified Hospital Schools - - - At Certified Residential Cripple Schools 6 4 10 At Certified Day Cripple Schools — — — At Public Elementary Schools 17 28 45 At other Institutions 6 5 11 At no School or Institution 10 7 17 25 Table IV.—Return of Defects Treated during the Year ended 31st December, 1923. TREATMENT TABLE. Group I- Minor Ailments (excluding Uncleanliness, for which see Group V). Disease or Defect Number of Defects treated, or under treatment during the year. Under the Authority's Scheme Otherwise Total (1) (2) (3) (4) Skin— Ringworm-Scalp 116 9 125 Ringworm-Body 66 — 66 Scabies 91 — 91 Impetigo 723 10 733 Other skin disease 384 41 425 Minor Eye Defects (External and other, but excluding cases falling in Group II). 197 25 222 Minor Ear Defects 364 39 403 Miscellaneous (e.g. minor injuries, bruises, sores, chilblains, etc.) 205 18 228 Total 2,146 142 2,288 26 TABLE IV.—continued. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease (1) No. of Defects dealt with Under the Authority's Scheme (2) Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme (3) Otherwise (4) Total (5) Errors of Refraction (including Squint) 1,051 16 4 1,071 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 169 2 — 171 Total 1,220 18 4 1,242 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 741 (b) Otherwise 20 Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 739 (b) Otherwise 20 Group III.—Treatment of Defects of Nose and Throat. Number of Defects Received Operative Treatment Received other forms of Treatment (4) Total Number treated (5) Under the Authority's Scheme, in Clinic or Hospital (1) By Private Practitoner or Hospital, apart from the Authority's Scheme (2) Total (3) 381 105 486 148 634 27 TABLE IV.—continued. Group IV.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist: Aged: Routine Age Groups 5 1,947 16,796 6 2,542 7 2,648 8 2,776 9 2,657 10 2.076 Total 11 2,034 12 57 13 36 14 23 Specials 1,828 Grand Total 18,624 (b) Found to require treatment 12,143 (c) Actually treated 5,338 (d) Re-treated during the year as the result of periodical examination 1,804 (2) Half-days devoted to: Inspection 69 Total 808 Treatment 739 (3) Attendances made by children for treatment 7,812 (4) Fillings: Permanent Teeth 1,477 Total 2,278 Temporary Teeth 801 (5) Extractions: Permanent Teeth 1,415 Total 11,860 Temporary Teeth 10,445 (6) Administrations of general anaesthetics for extractions 1,170 (7) Other operations Permanent Teeth 390 Total 409 Temporary Teeth 19 (8) Regulation cases: 35 Group V-Uncleanliness and. verminous conditions. (i.) Average number of visits per school made during the year by the School Nurses 22.5 (ii.) Total number of examinations of children in the Schools by School Nurses 165,536 (iii.) Number of individual children found unclean 3,166 (iv.) Number of children cleansed under arrangements made by the Local Education Authority 293 (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws 18