AC439(3)TOTTEN HAA Chater Mam B Tottenham Urban district Council. ANNUAL REPORT MEDICAL OFFICER OF HEALTH 1 9 2 4. DAVID C. KIRKHOPE, M.D. Ch.M., D.P.H., Barrister-at-Law. TOT 4 Tottenham Urban District Council. Report ON THE HEALTH OF TOTTENHAM FOR THE YEAR 1924. Crush a & Soil, Ltd.., Tottenham, Enfield and Wood Green. 2 SUMMARY OF STATISTICS FOR 1924. Area 3,014 acres. Population 156,000 Births 2,853 Birth-rate 18.2 per 1,000 of population. Deaths 1,559 Death-rate 9.9 per 1,000 of population. Deaths under 1 year of age 176 Infant Death-rate 61.6 per 1,000 births. Phthisis Death-rate 0.79 per 1,000 of population. Rateable Value £641,743 Amount Produced by 1d. Rate £2,475 3 Tottenham Urban District Council. HEALTH COMMITTEE: Chairman: Me. Councillor T. Elderfield. Members: (Ex-Officio): Dr. A. G. Newell, D.P.H., J.P. (Chairman of the Council.) (Ex-Officio): Mr. Councillor T. Inglis. (Vice-Chairman of the Council.) Mrs. Councillor F. C. Brighten. Mr. ,, J. Bristow. ,, ,, O. F. Broadway. (Until September). Miss Councillor R. F. Cox. Mr. ,, F. Easton. ,, ,, H. Farthing. Mrs. ,, E. L. Finch. (From October). Mr. Councillor W. R. Jackson. Major P. B. Malone, M.P., J.P. Mr. Councillor W. E. Montague. ,, ,, A. Reed. ,, ,, C. Wise. Representatives on the Middlesex Districts Joint Smallpox Hospital Board: Mr. Councillor T. Elderfield. ,, „ T. Inglis. Major P. B. Malone, M.P., J.P. Council's Representative on the Metropolitan Water Board under the Metropolis Water Act, 1902: Major P. B. Malone, M.P., 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. 1. Health Department. Medical Officer of Health— David C. Kirkhope, M.D., Ch.M., D.P.H., of Gray's Inn and Middle Temple, Barrister-at-Law. Male Sanitary Inspectors— *Redston, W. (Chief Inspector) (117, Broadwater Road) †*Portman, W. C. (13, West Road.) †*WEST, W. P. (33, Drayton Road.) †*Miller, H. W. (119, Sperling Road.) †*Shillito, J. A. (9, Cedar Road.) †*Smith, J. B. (Cert., S.I. Ex. Brd.) .. (86, Chester Road.) Harringay Ward. High Cross Ward. West Green Ward . Middle Ward. Lower Ward. St. Ann's Ward. 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 and Middle Temple, 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. and S.I. Ophthalmic Surgeon— T. W. Letchworth, F.R.C.S. Aurist— A. R. Friel, M.A., M.D., F.R.C.S.I. Dental Surgeons— V. Sainty, L.D.S., R.C.S. (Eng.) L. S. Pilbeam, L.D.S., R.C.S. (Eng.) School Nurses— E. Johns. M. Pickburn. W. Barnes. C. Vine. L. Rogers. E. Lindsay. E. Barratt. H. McMath. Clerical Staff— V. Goddard (Chief Clerk). E. Ing. T. E. Cohen. J. E. Miller. 7 Tottenham Maternity and Child Welfare Committee. Medical Officer— David C. Kirkhope, M.D., Ch.M., D.P.H., of Gray's Inn and Middle Temple, Barrister-at-Law. 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. Colman. 8 Addresses of other Public Officers, more or less connected with Public Health Work. Registrars of Births and Deaths— East Tottenham: Mr. H. J. Roynon, 664, High Road. West Tottenham: Mr. E. S. Chapman, 239, West Green Road. Relieving Officers— East Tottenham: Mr. A. J. Wrampling, 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. April, 1925. To the Chairman and other Members of the Tottenham Urban District Council. Ladies and Gentlemen, The Report upon the Health and Sanitary Conditions of Tottenham for the year 1924 does not differ materially from that for the previous year. Every fifth year, the Ministry of Health will require a lengthy and detailed account of the district and of the conditions prevailing therein, insofar as they relate to the health of the people. The 1924 Report is one of the "leaner" kind. It consists, for the most part, of statistical tables which, although they do not provide interesting reading, supply the material out of which may be gauged the improvement, or otherwise, in health and environment of the community as a whole. The one great outstanding environmental defect in the district is the lack of housing accommodation for the population of Tottenham. Quite a number of houses are ripe for demolition, but a certain amount of restraint has to be exercised in the matter of condemnation, lest the already badly overcrowded condition of much of the poorer quality of property is made worse. The unsatisfactory housing of Tottenham people has not been improved by the building of houses and tenements by the London County Council in the Lordship Lane and White Hart Lane district. These houses and tenements have been let to families displaced from Hoxton, Shoreditch and other areas where demolition schemes are in operation in London. How far the adverse housing conditions are responsible for the increase in the Death Rate of 1924 over that of 1923 it would be hazardous to say. But that there may have been a very close relation would not be a very far-fetched theory. Apart from the increase by 53 of that nondescript group called "Other Defined Diseases," the main incidence 10 of the increase belongs to Chest and Heart Diseases. Vitiated atmosphere would naturally be expected to exert its influence on the breathing apparatus, and impeded respiration throws a strain upon the heart that, in the presence of organic lesions, it may not be able to withstand. In the late Autumn the incidence of Diphtheria increased, but hospital accommodation proved adequate to the needs of the outbreak. The immunisation of susceptible persons against infectious diseases seems the most probable method by which they—the infectious diseases— may be controlled or eradicated. The Council has not yet expressed its desire that the Schick method of immunising persons susceptible to Diphtheria should be employed in this area. It is gratifying to note that no death took place during the year from Scarlet Fever. The last year in which so satisfactory a record occurred was 1917. There has been a declension in the number of births by 240, as compared with last year, and a slight increase in the infant mortality rate. The increased incidence of Encephalitis Lethargica is noteworthy. In 1923, 4 cases were notified; in 1924, 31 cases (7 deaths). Unfortunately, too little is known about its cause to suggest measures for its suppression. There is a suspicion that Encephalitis Lethargica and Influenza have some relation the one to the other. The pollution of the tributaries of the Lee has received your special consideration. The condition of the river is not yet satisfactory. It is hoped that the offending parties will be obliged to amend their ways, and that the river may yet come to be regarded as a place of beauty and a source of pleasure. The Health Department acknowledge with gratitude the consideration they have at all times received from the Council. I am, Ladies and Gentlemen, Your obedient Servant, David B. Kirkhone. POPULATION. The Registrar-General estimates the population at the middle of the year 1924 to be 153,100. The Treasurer estimates the population at November, 1924, to be 156,000. 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, 1924, as supplied to us by the Treasurer's Department. Ward. Acreage. Houses. Total Number of Houses. Other Buildings and † Assessments. Total Number of Assessments. Estimated Population. Rateable Value. Inhabited. Empty. £ High Cross 463 4,996 26 5,022 234 5,256 26,600 123,353 Middle East 449 2,909 11 2,920 132 3,052 14,850 53,663 Middle West 168 2,848 22 2,870 138 3,008 14,250 56,673 Lower 950 5,912 27 5,939 264 6,203 30,450 107,580 West Green 470 3,868 17 3,885 146 4,031 19,450 75,171 Harringay 263 4,272 10 4,282 265 4,547 22,550 98,757 St. Ann's 251 4,822 27 4,849 218 5,067 27,850 79,584 Throughout the Parish - — — - 12‡ 12‡ — 46,967 Totals 3,014 29,627 140 29,767 1,409 31,176 156,000 £641,748 * Houses, Houses and Shops, and Tenements. †Lock-up Shops, Stables, Workshops, Garages, Schools, Factories, Glasshouses, Land, etc. ‡Railways, Tramways, Reservoirs, Gas, Water, and Electric Mains. 12 BIRTHS. Births Registered:- Males 1,425 Females 1,428 Total 2,853 Including Illegitimate Births:- Male 37 Female 38 Total 75 Births occurring in the district 2,397 Births of Tottenham residents occurring outside the district 456 Total 2,853 Birth Rate, 18.2 per 1,000. Births notified under the Notification of Births Acts:— In district by Doctors 694 ,, ,, Midwives 1,415 ,, ,, Parents and other persons 303 Notified from outside Institutions 413 2,825 Advised by Registrar 71 Total 2,896 Less 70 Still Births 70 2,826 13 DEATHS. The total number of deaths registered in Tottenham was 1,183 Of these, the number of non-residents was 250 Deaths of residents registered in the district 933 Deaths of residents registered outside the district 626 1,559 Deaths of residents under 1 year occurring in district 128 Deaths of residents under 1 year occurring outside district 48 Total deaths of Tottenham infants 176 These deaths are distributed according to age and sex as follows:— Males. Females Deaths under 1 year 103 73 Deaths from 1 to 5 years 42 43 Deaths from 5 to 15 years 27 16 Deaths from 15 to 25 years 32 38 Deaths from 25 to 65 years 316 272 Deaths 65 and upwards 281 316 801 758 The excess of births over deaths is 1,294. The death rate equalled 9.9 per 1,000 of the population. 14 Table showing the Population, Birth and Death Rates, in Wards, during 1924. Ward. No. of Births. No. of Deaths. Population. General Birth.rate. General Death.rate. No. of Deaths Under 1 Year. Infant Mortality per 1,000 of Population. Infant Mortality per 1,000 Births. Harringay 399 217 22,550 17.6 9.6 15 0.6 37.6 West Green 326 184 19,450 16.7 9.4 25 1.2 76.6 St. Ann's 544 318 27,850 19.5 11.4 46 1.6 845 High Cross 463 270 26,600 17.4 10.1 27 1.0 58.3 Middle 569 287 29,100 17.4 9.8 25 0.8 49.2 Lower 612 283 30,450 20.1 9.2 38 1.2 62.0 Total 2,853 1,559 156,000 18.2 9.9 176 1.1 61.0 15 Table showing Percentage of Removals of Cases of Scarlet Fever. Diphtheria and Enteric Fever. Ward. Cases. Removals. Percentage. Harringay 47 10 34.0 West Green 01 11 18.0 St. Ann's 142 72 50.7 High Cross 110 01 55.4 Middle 137 03 45.9 Lower 105 57 54.2 INFECTIOUS DISEASES. Diseases. Cases notified. Deaths. Death Rate Measles — 22 0.14 Diphtheria 227 5 0.03 Diarrhoea — 13 0.08 Scarlet Fever 367 — — Enteric Fever 6 1 0.006 Whooping Cough — 8 0.05 Tuberculosis (Lungs) 231 124 0.79 Puerperal Fever 5 3 0.019 Erysipelas 22 1 0.006 Ophthalmia Neonatorum 12 — — Malaria — — — Encephalitis Lethargica 31 7 0. 044 Influenza — 24 0.15 Poliomyelitis 1 — — Pneumonia 217 125 0.80 16 SCARLET FEVER. The number of cases notified during the year was 367. Of these, 67 were removed to hospital, the remainder being nursed at home. There were no fatal cases. Of the 67 cases removed to Hospital, 1 occurred within a Residential School outside the district and was accepted as being chargeable to Tottenham, 1 was a Wardmaid of the Fever Hospital whose usual place of residence was in the district, and 5 were wrongly diagnosed, 2 being cases of Measles, 2 of Erythema and 1 " not Scarlet Fever." The number of cases treated at home by the Council's Nurses was 295. the particulars being as follows:— 245 premises in which 1 case occurred = 245 cases. 16 premises in which 2 cases occurred = 32 cases. 2 premises in which 3 cases occurred = 6 cases. 3 premises in which 4 cases occurred = 12 cases. 266 premises. 295 cases. Multiple Home Cases, 1924:— No. occurring within 1 week after previous case 13* 2 weeks ,, ,, 6 „ „ 3 „ „ 7† „ „ 4 „ „ „ - „ „ 5 „ ,, ,, 2 „ „ 6 „ „ „ - „ „ 7 „ „ „ - „ „ 8 „ „ „ 1 29 *In 5 of these instances, dual notifications were received simultaneously, and in 1 instance triple notifications, †In one instance, dual notifications were received simultaneously. 17 Number of cases removed to hospital after treatment commenced 6 Number of notifications withdrawn — Number of cases wrongly diagnosed or indefinite 21 There were complications in 62 of the cases. The complications were as follows:— Rhinorrhoea 5 Otorrhoea 9 Glands *22 Albuminuria 13 Rheumatism 2 Albuminuria and Otorrhoea 1 Albuminuria and Glands 4 Albuminuria and Rheumatism 1 Chorea 1 Mastoid 2 Pyuria 1 Albuminuria, Glands, Rheumatism and Bronchitis 1 62 *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, 1925) they had cleared up. During the year under review the attention of Health Authorities has been directed to the possibility of immunization against Scarlet Fever. The results following inoculation with the toxin of Diphtheria have given satisfaction to the authorities who have made use of this procedure and hopes have been raised that a means will shortly be available substantially to reduce the incidence of Scarlet Fever. With that expectation, and by the courtesy of an American Scientist, I had an abundant supply of Anti-Scarlatinal Serum made available for experimental purposes. 18 Certain preliminary difficulties had to be overcome. For instance, no indication was given of the dosage of the serum necessary to produce passive immunity. The Health Department stocks Anti-Diphtheritic Serum in two strengths, 8,000 units for curative purposes and 500 units for prophylactic purposes, i.e., the latter is 1/16th of the former. My information was to the effect that for curative purposes 50 c.c's of the Anti-Scarlatinal Serum ought to be injected, and I assumed that for prophylactic purposes 3 c.c's or l/16th of thecurative dose might be taken as, approximately, the proper quantity to administer. As a fact, in order to be safe rather than sorry, I gave 2 c.c injections to 104 contacts. This quantity was quite insufficient and I have since learned that the prophylactic dose should be 10 c.c's, and increased the quantity to that amount. 73 of the cases had no re-action. I believe, however, that the serum used is the anti-toxin of the Scarlatinal poison, and that it is only a matter of a short time until Scarlet Fever can be brought under effective control. The serum is prepared according to Dochez's method, and is supplied to me in 10 c.c. hermetically sealed ampoules. There are two reasons for my belief that the anti-toxin is the appropriate antidote to the Scarlatinal toxin. First, the cases that developed shortly after inoculation were exceedingly mild and one or two appeared to abort. The following is a short resume of these abnormal cases:— Mild Cases:— K.B., 8 years, inoculated 6-9-24.— 7-9-24.—Sore throat. 8-9-24.—Tongue furred, raised papillae, rash on chest and back, morning temperature, 98.6 deg., evening, 101 deg. Evening—tongue clearing; rash extended, child not ill. 9-9-24.—Morning—tongue and throat almost normal. 9-9-24.—Evening—symptoms almost subsided, rash very faint. Child desquamated; temperature only once registered above normal. No complications. 16-10-24.—Satisfactory. J. D., 1 year, inoculated 20-10-24.— 18-10-24.—Very fretful and profuse nasal discharge. 20-10-24.—Rash, throat very red, tongue suspicious. 21-10-24.—Temp. 99 deg., and mother reported that child was "fretful" during night. 22-10-24.—Rash disappeared, throat normal, tongue peeled. 23-10-24.—Satisfactory. 4-11-24.—Powdery desquamation. 19 K. M., 3 years, inoculated 8-11-24.— 8-11-24.—Very poorly all night. 9-11-24.—Vomiting and throat very red. 10-11-24.—Notified as Scarlet Fever; rash all over body except for an area of 5 inches by 4 inches (at seat of inoculation) which was blanched. 13-11-24.—Throat and rash all cleared and child in satisfactory condition (desquamation very slight—on body only). 18-11-24.—Satisfactory. J. H., 9 years, inoculated 30-12-24.— 9-1-25.—Blotchy rash on trunk and limbs. 10-1-25.—Complains of headache and feeling sick. 11-1-25.—Rash gone. 12-1-25.—Slight sore throat; left cervical gland swollen; slight punctate rash, similar to Scarlatinal Rash (no blanching at seat of injection); treatment applied. 15-1-25.—Notified as Scarlet Fever. 21-1-25.—Desquamating. 11-3-25.—Satisfactory. Aborted Cases:— W. B., 10 years, inoculated 6-9-24.— 6-9-24.—Complained of sore throat; no rise of temperature; no rash. 9-9-24.—Returned to school quite fit. 16-10-24.—Satisfactory. W. M., 7 years, inoculated 23-9-24.— 22-9-24.—Reported to have had sore throat and vomiting. 23-9-24.—Throat red, no rash, no rise of temperature. 25-9-24.—Returned to school quite fit. 4-11-24.—Satisfactory. 10-1-25.—Satisfactory. E. H., 4 years, inoculated 8-10-24.— Notified 2 years previously as Scarlet Fever (not a definite case— no sore throat). 8-10-24.—Throat, tongue and palate suspicious. 9-10-24.—Slight blush on chest, throat red, but child not complaining. 10-10-24.—No further developments; throat still a little red; child looks pale and tired. 12-10-24.—Child "up"—quite fit. 11-11-24.—Satisfactory. 13-1-25.—Satisfactory. 20 J. T., 7 years, inoculated 25-10-24.— 5-11-24.—"Poorly." 6-11-24.—Slight rash, no sore throat, no temperature. 7-11-24.—Notified as Scarlet Fever as a precautionary measure. 16-11-24.—Satisfactory. 6-1-25.—Satisfactory. Inoculated Cases Removed to Hospital owing to Home Conditions:— H. C., 4 years, inoculated 26-11-24.— E. C., 4 years, inoculated 26-11-24.— 30-11-24.—Both patients ill; notified as Scarlet Fever. Both children had vomiting, no sore throat, rash all over body except for blanching on left side with inoculation spot in centre. 1-12-24.—Both removed to hospital owing to verminous and overcrowded condition of house. (Proved very mild cases and were allowed up on 11th day, whereas a previous case in family, who refused inoculation, was still in bed at 6th week.) R. G., 6 years, inoculated 28-11-24.— 2-12-24.—Sore throat, vomiting and rash, with large blanched place on left hip (seat of inoculation), notified as Scarlet Fever and removed to hospital owing to verminous and overcrowded condition of house. B. G., 8 years, inoculated 28-11-24.— 4-12-24.—Sore throat, vomiting and rash, with large blanched place on left hip (seat of inoculation); notified as Scarlet Fever and removed to hospital owing to verminous and overcrowded condition of house. The other reason for my belief that the serum is a true scarlatinal anti-toxin is that in five instances the rash of the fever did not affect the site into which the anti-toxin had been injected. Quite a large area of skin retained its normal colour, in marked contrast to the rest of the rash-covered skin. Inoculations were given to contacts only at the request of parents or guardians. Apart from serum rashes and malaise about a week or so after injection, nothing untoward occurred. The largest amount given was 10 c .c's, and the disturbance with the larger doses was no greater than with the smaller. The severest re-action occurred in a schoolgirl, after 2 c.c. inoculation. She, however, had had Diphtheria some years previously and anti-diphtheritic serum was then administered. It was 21 surmised that something of the nature of an anaphylactic re-action had occurred, causing some considerable prostration with albuminuria for three days. Ten c.c's constitute a very considerable injection in the matter of bulk, and it is hoped that means may be found for concentrating the antitoxic serum. The serum is injected into the vastus externus, and no difficulty has been experienced in giving 10 c.c's to a child of sixteen months. It is claimed that concentrated serum is now in use in America, but I am not yet fully satisfied that the means of standardisation ars sufficiently precise. Two means are employed of determining the unit of toxin. One is the amount of Toxin Skin Test Dose that will definitely produce the Schulz-Charlton re-action in a susceptible subject and will give a negative result in an insusceptible person. I apprehend that that amount of toxin will vary within wide limits. The second is a measured quantity of a 1 in 1,000 dilution of a 5 days' broth culture of the streptococcus haemoliticus scarlatinae. It is exceedingly problematical whether the organisms have not very varying toxin producing qualities. The matter is one that ought to be thoroughly investigated by hospital authorities in collaboration with serological establishments. It is worthy of note that the urine from a scarlatinal patient within the first week of illness will produce the Schultz-Charlton re-action, in all respects similar to the toxin produced by culture. The probability is, therefore, especially as organisms are not found in the blood of uncomplicated cases of Scarlet Fever, that kidney lesions are caused by the scarlatinal toxin. The administration of anti-scarlatinal serum may, therefore, be expected to rob the ailment of one of its worst complications. Supplies are available at the Town Hall for medical practitioners who desire to use it, either for treatment or prophylaxis. Passive immunity is supposed to last for about a fortnight only. Active immunity is stated to be acquired by the injection of 250 skin test doses on two consecutive weeks, and on the third, of 500 skin doses. The resultant immunity which is sufficient to cause a negative SchultzCharlton re-action in about four weeks is protective over a period of years, probably for life. In Tottenham, where only a small proportion of Scarlet Fever patients are removed to hospital, it is possible that contacts passively immunised against the disease may in some instances 22 simultaneously be developing an active immunity. The whole system of immunisation against the commonly prevalent infectious diseases is on its trial, and is well worthy of the most painstaking efforts of health authorities. DIPHTHERIA. The number of notified cases of Diphtheria was 227, as contrasted with 194 for last year. 211 were removed to Hospital and 5 died. Of the cases removed, 32 were reported from the hospitals as wrongly diagnosed, 22 being Tonsillitis, 2 Vincents Angina, 2 Erythema, 2 Whooping Cough, and 4 "Not Diphtheria." CEREBROSPINAL MENINGITIS. There were neither notifications of nor deaths from Cerebro-Spinal Meningitis during the year. MEASLES. Deaths from Measles numbered 22. From the same cause only 6 died in the previous year. 15 cases were removed to hospital suffering from the following complications: Measles and Pneumonia, 9; Measles and Mastoid, 2; Measles, Laryngitis and V.D.H., 1; Measles and Hernia, 1; Measles and Bronchitis, 1; Measles (after operation), 1. OPHTHALMIA NEONATORUM. There were 12 cases notified, 7 of them being treated in hospital and 5 at home. Complete recovery resulted in 9 cases; in 1 the vision was slightly impaired; 1 case is still under treatment, and 1 has removed from the district. 23 PULMONARY AND OTHER FORMS OF TUBERCULOSIS. The County Council undertakes the treatment of Tuberculosis. Notifications. Mortality. Males. Females. Males. Females Under 1 year - — 1 — From 1 to 5 years 1 8 2 3 From 5 to 15 years 10 18 5 3 From 15 to 25 years 41 32 13 12 From 25 to 45 years 69 50 41 27 From 45 upwards 27 16 30 15 151 124 92 60 Organs affected:— Lungs 226 Glands 10 Meninges 1 Skin 1 Spine 2 Knee 1 Hip 8 Peritoneum . . .. .. .. . • ■ ■ 2 Kidney .. .. . . . . ■ • 1 Abdomen . . . . . . . • • • 3 Bowel .. . . . . • • ■ • ■ • • 1 Other .. .. .. • • • • 11 Dual Organs:— Lungs and Larynx .. .. .. • ■ • • 6 Lungs and Spine .. • • ■ ■ 1 Lungs and Peritoneum . • ■ • • ■ 1 275 24 MALIGNANT GROWTHS. CANCER. Digestive System:— Males. Females. Stomach (including Pylorus) 16 12 Jaw 1 — Palate 1 1 Tongue 1 — Parotid Gland 1 — Pharynx 1 — Œsophagus 5 1 Bowel (small and large, excluding rectum) 11 14 Rectum 11 11 Pancreas 3 3 Liver 4 6 Peritoneum — 1 Genito-urinary:— Breast — 19 Uterus — 11 Ovaries — 2 Prostate 5 — Kidney 1 1 Bladder — 4 Various:— Nose 1 — Face and Head 1 — Larynx 4 — Lung 1 — Mediastinum 3 — Cervical Glands 1 — Thyroid — 1 Clavicle — 1 SARCOMATA. Thigh 1 — Retro-peritoneal 1 — Skull 1 — Brain — 1 Hypernephroma 1 1 76 90 166 25 VIOLENCE. There were 58 deaths from Violence in 1924, including 6 which were suicidal. In 1923 the number was 56. Males. Females. Drowning 4 — Falls 6 — Burns 1 2 Knocked down by Motor Lorry 2 — Knocked down by Motor-Car 3 — Knocked down by Bicycle 3 — Fall from Bicycle 1 — Fall from Train 1 — Run over by Bus 1 — Scalds 1 — Fall from Motor Van 1 — Fall from Balcony 1 — Poison, Self-administered 1 4 Coal Gas 2 — Hanging 1 — Cut Throat — 1 Accidental causes not specifically defined 9 5 Suffocated in Bed 1 — Gunshot 1 — Suicide 3 — Electric Shock 1 — Run over by Steam Wagon 1 — Knocked down by Fall of Timber — 1 45 13 26 M. of H. Table I. Table showing the Population, Birth Kate, and Death Rate from all causes, in Tottenham during the last six years. Year. Populations 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 1919 152,508 2,554 2,711 17.7 1,273 8.3 188 477 180 66.4 1 ,564 10.2 1920 156,020 3,854 4,064 26.04 1 ,302 8.3 275 438 248 61.0 1,465 9.3 1921 149,200 3,402 3,402 22.8 1,274 8.5 258 537 231 67.9 1,553 10.4 1922 152,000 2,777 3,167 20.8 1,496 3.8 352 559 203 64.0 1 ,703 11.2 1923 154,300 2,641 3,093 20.0 1,021 6.6 194 581 180 58.1 1 ,408 9.12 1924 156,000 2,397 2,853 18. 2 1,183 7.5 250 626 176 61.6 1,50 9 9.9 27 NOTES TO (M. of H.) TABLE I. The nett rate is the true one, as it represents the deaths of all Tottenham people, whether they took place within or without the Parish, and is the rate adopted by the Registrar-General, non-residents being always allocated to the district to which they belong. By the term "Non-Residents," is meant persons brought into the district on account of illness, and dying there; and by the term "Residents," 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. Queen's, Bethnal Green. University College. St. Thomas'. London Temperance. Children's, Great Ormond Street, W.C. City of London Lying-in. German. Charing Cross. Cheyne Hospital, Chelsea. 28 Hospitals—(continued). Cancer, Chelsea. National (for Heart), St. Marylebone. St. Mary's, Paddington. St. Columbus, Hampstead. Springfield Mental Hospital, Wandsworth. Royal Free, Gray's Inn Road. Royal, City Road. Mildmay Memorial, Stoke Newington. Central London, Throat and Ear. Metropolitan. Hampstead General. St. Anthony's, Cheam. Royal Northern, Holloway. Middlesex County Tuberculosis, Isleworth. Elizabeth Garrett Anderson Hospital, St. Paneras. Asylums:— Metropolitan, Caterham. Napsbury. St. Joseph's Home, Hackney. Woodside Home, Whetstone. 29 M. of H. Table II.—Table of caues of Infections Disease coming to the knowledge of the Medical Officer of Health during the year 1924 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 Harringay 2 West Green 3 St. Ann's 4 High Cross s Middle 6 Lower Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Encephalitis Lethargica 31 — 2 8 5 11 4 1 2 3 3 14 6 3 3 Diphtheria (including Membranous Croup) 227 3 71 127 16 9 1 — 12 6 45 60 52 52 211 Erysipelas 22 1 — 1 4 8 7 1 2 2 9 3 3 3 — Scarlet Fever 367 2 112 218 29 6 — — 35 51 97 50 81 52 67 Enteric Fever 6 — 1 3 2 — — — — 4 — — 1 1 2 Malaria — — — — — — — — — — — — — — — Pneumonia 217 15 75 24 27 23 36 15 42 20 88 20 23 24 11 Puerperal Fevor 5 — — — 3 2 — — — 1 1 2 — 1 1 Cerebro-spinal Meningitis — — — — — — — — — — — — — — — Poliomyelitis 1 — 1 — — — — — — — — — — 1 — Ophthalmia Neonatorum 12 12 — — — — — — 1 2 1 3 1 4 — Pulmonary Tuberculosis 231 — 1 12 65 110 38 5 15 35 53 41 50 37 — Other forma of Tuberculosis 44 — 11 17 7 9 — — 3 9 9 9 5 9 — Totals 1,163 36 274 410 158 180 86 22 112 133 306 202 225 187 295 30 M. of H. Table III. TABLE OF DEATHS during the Year 1924 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 "nonResidents" in Institutions in the District. (b) All Ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and under 85. 85 and upwards. Harringay. West Green. St. Ann's. High Cross. Middle. Lower. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Enteric Fever 1 — — — — 1 — — — — — — — 1 — — — — — — Smallpox — — — — — — — — — — — — — — — — — — — — Measles 22 1 9 8 1 — — 3 — — — — — 3 3 7 2 5 2 48 Scarlet Fever — — — — — — — — — — — — — — — — — — — 8 Whooping Cough 8 4 3 1 — — — — — — — — — 1 1 3 1 1 1 15 Diphtheria and Croup 5 — — 3 1 1 — — — — — — — — — 2 1 2 — 47 ] Influenza 24 — — — — — 1 1 5 2 9 6 — 7 2 2 2 4 7 — Erysipelas 1 — — — — — — — 1 — — — — — — 1 — — — — Phthisis (Pulmonary Tuberculosis) 124 1 — 1 — 21 34 31 16 16 3 1 — 14 17 26 18 23 26 5 Tuberculous Meningitis 10 — 1 2 4 2 1 — — — — — — — 3 3 1 3 — 3 Other Tuberculous Diseases 18 1 1 — 4 2 9 4 3 1 — — — 1 2 2 4 7 2 7 Cancer, malignant disease 166 — — — — — 7 11 31 48 44 23 2 26 24 30 23 39 24 38 Rheumatic Fever 1 — — — — — 1 — — — — — — — — — — 1 — — Meningitis 3 2 — — — 1 — — — — — — — — — 1 2 — — 3 Organic Heart Disease 218 4 — — 4 7 6 9 27 48 55 49 9 31 26 44 38 42 3/ 27 Bronchitis 147 16 5 — 2 1 2 4 15 22 37 34 9 16 18 26 28 26 33 5 Pneumonia (all forms) 125 27 19 11 6 3 4 4 15 13 12 9 2 8 12 34 28 20 23 18 Other diseases of Respiratory Organs 18 — — — 1 — 1 1 4 1 6 3 1 4 3 3 4 4 — — Diarrhoea and Enteritis 13 13 — — — — — — — — — — — — — 1 4 3 5 1 Appendicitis and Typhlitis 9 — — — 4 1 — — — 2 2 — — 3 2 2 — 1 — — Cirrhosis of Liver 7 — — — — — — — — 2 4 1 — 1 — 3 — — 1 — Alcoholism 1 — — — — — 1 — — — — — 1 — — — — — — Nephritis and Bright's Disease 30 1 1 — — — — 3 6 13 5 1 — 8 3 4 7 2 6 5 Puerperal Fever 3 — — — — 2 1 — — — — — — — 1 — 1 1 — — Other accidents and diseases of Pregnancy and Parturition 4 — — — — 2 2 — — — — — — 2 1 — — 1 — — Congenital Debility and Malformation, including Premature Birth 88 88 — — — — — — — — — — — 7 13 28 9 13 18 6 Violent Deaths, excluding Suicide 52 1 — 4 5 5 4 5 6 8 10 4 — 8 7 9 9 11 8 25 Suicide 6 — — — — — — — 1 4 1 — — 1 1 1 1 2 — — Other Defined Diseases 445 16 7 6 10 20 15 30 45 41 95 129 31 76 45 82 86 71 85 75 Encephalitis Lethargica 7 — — 2 1 1 — 1 1 1 — — — — — 2 2 2 1 11 Cerebro-Spinal Meningitis — — — — — — — — — — — — — — — — — — — — Diseases ill-defined or unknown 3 1 1 — — — — 1 — — — — — — 1 — — — 2 — Totals 1550 176 47 38 43 70 81 109 176 222 283 260 54 219 185 316 271 286 282 355 31 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 "Diarrhoea," are included deaths certified as from diarrhoea, alone or in combination with some other cause of ill-defined nature; and also deaths certified as from Epidemic Enteritis; Zymotic Enteritis; Epidemic Diarrhoea, Summer Diarrhoea; Dysentery and Dysenteric Diarrhoea; Gastro-Enteritis and Muco-Enteritis; Choleraic Diarrhoea, Cholera Nostras (in the absence of Asiatic Cholera). Deaths from diarrhoea 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. 32 M. of H. Table IV. Table of Infant Mortality during the year 1924. CAUSE OF DEATH. Under 1 week. 1–2 weeks. 2–3 weeks. 3–4 weeks. Total under 4 weeks. 1–3 months. 3–0 months. 0–9 months. 9–12 months. Total Deaths under 1 year Small-pox – – – – – – – – – – Chicken-pox – – – –– – – – – – – Measles – – – – – – – – 1 1 Scarlet Fever – – – – – – – – – – Whooping-cough – – – – – – – 1 3 4 Diphtheria and Croup – – – – – – – – – – Erysipelas – – – – – – – – – – Tuberculous Meningitis – – – – – – – – – – Abdominal Tuberculosis – – – – – – – – – – Other Tuberculous Diseases – – – – – 1 — 1 — 2 Meningitis (not Tuberculous) – – – – – – – 3 — 3 Convulsions 2 — — — 2 1 — 1 2 3 Laryngitis — — — — — — -— — — — Bronchitis — 1 1 3 5 5 2 2 2 16 Pneumonia (all forms) — 1 3 — 4 4 3 6 8 25 Diarrhoea — 1 — — 1 2 2 — 1 6 Enteritis – – – – – 2 – – – 2 Gastritis — 1 — — 1 3 — 1 — 5 Syphilis – – – – – 1 – – – 1 Rickets – – – – – – – – – – Suffocation, overlying 1 -— — — 1 — 1 — — – Injury at Birth – – – – – – – – – – Atelectasis – – – – – – – – – – Congenital Malformations 5 2 — 2 9 1 1 — — 11 Premature Birth, Atrophy, Debility and Marasmus 45 5 4 5 59 12 2 2 – 75 Other Causes 7 – 2 – 9 4 3 1 – 17 Totals 60 11 10 10 91 30 14 18 17 176 33 Mortuary Table for the Year 1924. Bodies Admitted. No. of Post-Mortems. No. of Inquests Deaths from Violence Deaths from Drowning Month Males Females Total Males Females Total January 8 9 17 4 6 10 12 4 – February 8 8 16 5 6 11 12 2 – March 6 5 11 5 4 9 9 4 1 April 12 2 14 10 — 10 12 0 1 May 10 7 17 3 3 6 12 7 1 June 9 6 15 5 3 8 9 4 — July 7 5 12 3 2 5 5 1 – August 8 5 13 8 2 8 8 3 1 September 7 3 10 2 3 5 5 — — October 4 5 9 4 2 6 6 1 — November 5 3 8 1 1 2 3 1 — December 7 6 13 4 3 7 9 4 — Total 91 64 155 52 35 87 102 37 4 No. of bodies admitted to await Burial 55. 34 The following List gives the Causes to which Deaths were attributed by the Coroner or Coroner's Juries. Aneurism 1 Bronchitis 2 Cancer 1 Convulsions 2 Cerebral Haemorrhage 8 Encephalitis Lethargica 1 Gastritis 1 Haemorrhage 3 Inanition 2 Inattention at Birth 1 Nephritis 1 Peritonitis 1 Pneumonia 7 Septicaemia 1 Still-Born 2 Status Lymphaticus 2 Valvular Heart Disease 1 Syncope 19 Tuberculosis 3 Ptomaine Poisoning 1 Suicides:— Poisoning 3 Gas Poisoning 3 Hanging 1 Cut Throat 1 Drowning 4 Accidents:— Gas Poisoning 1 Burns 3 Run over by Motor 10 Caught in Machinery 1 Fall from Cycle 4 Suffocation 2 Drowning 2 Knocked down by Cycle 1 Killed on Railway 3 NURSING ARRANGEMENTS. General Nursing.—Notwithstanding the effort made to have established in Tottenham a branch of the District Nursing Association, nothing has yet been done. It is lamentable that when so much care is exercised over mothers and children up to the school-leaving age, no agency is available for the nursing of the aged and infirm humble folk in their own homes. From the General Hospitals, this Department is constantly being asked to send a nurse to the assistance of an afflicted adult; and it is grievous constantly to have to admit that we are not in a position either to supply the need ourselves or to give directions whereby the need can be supplied. I respectfully suggest that the Council do not allow this matter to rest until Tottenham is adequately equipped with a Nursing Staff for the domiciliary treatment of those requiring expert nursing care of illnesses other than of an infectious character. 35 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. Eye Clinic, Bruce Castle. Dark Room, Treatment, Fitting and Waiting Rooms. Do. Ear Clinic, Bruce Castle. Treatment Room and Waiting Room. Do. Sprav Bath Clinic, Town Hall. Bath Room and Waiting Rm. Do. Tuberculosis Dispensary, 140, West Greon Road, N.15. Consulting Room, Dressing Room, Waiting Room, Laboratory, Office. Middlesex County Council. Venoreal Diseases Clinic, Prince of Wales's Hospital, N.15. Two Consulting Rooms, Two Treatment Rooms, Two Waiting Rooms and Laboratory. Do. 36 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 and the North Middlesex Hospital receive for treatment, from the Tottenham Education Committee, such cases as are specially referred to them, and in respect of whom there are complications which would render it undesirable that the patient should be treated in our own Clinics. The North Middlesex Hospital undertakes, on behalf of the Education Committee, the X-Ray treatment cf Ringworm. 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. Smallpox.—Tottenham is one of the contributory authorities to the Middlesex Districts' Joint Smallpox 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 198 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 4 ambulances for noninfectious and accident cases. The following table, in relation to the Ambulance Service, is self-explanatory. 37 MOTOR AMBULANCE SERVICE, 1924. No. of Cases. Mileage. Receipts from Paying Cases. Surgical. Defective Children. £ s. d. January 600 326 2,776 13 3 6 February 664 374 2,823 18 11 3 March 663 364 2,946 13 8 0 April 680 262 2,777 19 13 0 May 555 529 2,465 11 3 0 June 496 592 2,725 13 8 0 July 654 1,096 3,674 15 9 6 August 465 173 2 227 14 7 6 September 539 1,265 3,726 9 0 3 October 685 1,352 3,993 9 16 6 November 627 1,324 4,593 15 15 0 December 592 933 3,987 9 12 9 Year's Totals 7,220 8,590 38,712 £163 8 9 15,810 Treasurer's Dept. £123 10 0 Education Committee *£219 19 6 £506 18 3 Total Cases to Date: Total Mileage to Date: Total Receipts to Date : 49,559. 192,847. *£3,188 2 0. Subject to revision. On 8 occasions the Oxygen Apparatus has been used, and in 5 cases was successful in restoring life. LABORATORY. At the Laboratory, 1,771 swabs from the throats or noses of persons in contact with sufferers from Diphtheria, or themselves supposed to be suffering from Diphtheria, and 238 specimens of sputum from persons suspected to be suffering from Consumption, have been examined during the year. Of the swabs, 199 were positive, and of the sputum, 36 specimens. Other bacteriological and serological examinations are made by arrangement with the Prince of Wales's Hospital. 38 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, Smallpox, 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 Acts, 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. Public Health (Acute Encephalitis Lethargica and Acute PolioEncephalitis) Regulations, 1918. 39 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. Public Health (Meat) Regulations, 1924. 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. SHOPS ACTS, 1912 to 1921. Half Holidays. Harringay Area. * Butchers Monday, 1p.m. (or alternatively Saturday, 1 p.m.) Bakers Wednesday, 2 p.m. (or alternatively Saturday, 2 p.m.) Other Shops Wednesday, 1 p.m. (or alternatively Saturday, 1 p.m.) (non-exempted trades). Tottenham Remainder Area. Monday, 1 p.m. (or alternatively Saturday, 1 p.m.) Thursday, 2 p.m. (or alternatively Saturday, 2 p.m.) Thursday, 1 p.m. (or alternatively Saturday, 1 p.m. 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 10p.m. Sunday 8 p.m. Other Shops .. .. Monday, Tuesday, Wednesday, (non-exempted trades) Thursday and Friday 8 p.m. Saturday 9p.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.) 40 LEGAL PROCEEDINGS. Date. Name. Nature of Case. Result. October A. Sullivan, High Road Serving in Shop after closing hour Fined 5s. „ J. L. Horner, St. Ann's Road Do. Do. „ L. J. Day, Seven Sisters Road Do. Do. „ D. Spector, St. Ann's Road. Do. Do. „ W. H. Speller, Seven Sisters Road Do. Do. „ P. Lefkovitch, Seven Sisters Road Do. Do. SLAUGHTER HOUSES. There are 12 private slaughter-houses in use in the district. They are periodically visited, and no occasion has been found to take serious exception to their condition. DAIRIES, COWSHEDS AND MILKSHOPS. 15 applications from retail purveyors were received during the year for registration under the Dairies, Cowsheds and Milkshops Order, 1885, and Milk and Dairies (Amendment) Act, 1922. These were acceded to. There are at present upon the register, 179 retail purveyors of milk. 1 purveyor was licenced for the sale of "Grade A (Tuberculin Tested)" Milk, 1 for the sale of "Certified" Milk, 1 for the sale of "Pasteurised" Milk (supplementary licence), and 1 for the sale of "Certified" Milk (supplementary licence). 41 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:— 78 Rabbits. 721bs. Beef. 6 tins Corned Beef. 4 Ox Livers. 1 Ham. Fruit and Vegetables:— 90 boxes Oranges. 55 crates Greengages. 10 barrels Plums. 20 baskets Plums. 2 barrels Grapes. 2 barrels Apples. 1 case Bananas. Fish:— 23 stone Skate. 5 bushels Winkles. 16 boxes Kippers. 3 stone Herrings. 1 trunk Whiting. 1 box Plaice. 3| stone Plaice. 1 box Mackerel. 2 boxes Cod. 6 boxes Haddock 1 case Onions. 1 ,, 3 "bundles " Tomatoes. 4 boxes Tomatoes. 3 barrels Potatoes. 20 bags Potatoes. 17 bags Walnuts. Miscellaneous:— 2 jars Jam. 42 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:— Name of Article. Samples. Taken. Found dulterated. Milk 462 18 Milk, separated 2 — Milk, condensed 2 — Butter 7 2 Cream 10 6 Beer 3 — Borax 6 1 Coffee 6 — Cream of Tartar 5 — Fish Paste 4 — Flour, self-raising 3 — Honey 6 — Sausage 3 1 519 28 Number of Prosecutions 4 Number of Convictions 4 Fines and Costs imposed £8 The figures given for adulterated samples include some adulterated informal samples, in respect of which no proceedings could be taken. 43 DISINFECTION AND DISINFESTATION. Infected rooms are sprayed with Formalin when the infected patient is removed to hospital. The clothing is, at the same time, disinfected in a Washington Lyons Disinfector. With regard to disinfestation, slipper baths are provided at the Disinfecting Station, and persons in a verminous condition are bathed there, while their clothing and bedding are disinfected by steam. 1,571 rooms were disinfected. 10,343 articles were disinfected or destroyed. 253 library books were disinfected. 33 persons were bathed. 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. One exhumation took place at the Tottenham Cemetery, under the supervision of the Sanitary Inspector, in compliance with the Home Office requirements. 44 GENERAL SANITARY WORK. The work of the male Sanitary Inspectors is epitomised and subjoined. Harringay Ward (Mr. Redston). West Green Ward (Mr. West). St. Ann's Ward (Mr. Smith). High Cross Ward (Mr. Portman). Middle Ward (Mr. Miller). Lower Ward (Mr. Shillito). House-to-house inspections 275 223 135 71 108 183 Re-inspections 1355 1312 1178 962 1346 1598 Drains examined, tested, etc. 59 58 70 97 101 171 Drains unstopped 21 25 124 16 38 73 Drains reconstructed and repaired 16 23 24 19 52 49 Disconnecting traps inserted .. — — — 4 — 15 Soil pipes and drains ventilated 2 4 26 27 24 9 R.W. pipes, wastes, etc., disconnected 9 3 46 5 34 5 Dustbins provided 33 59 56 31 58 61 Roofs repaired 104 64 92 28 69 103 Gutters repaired and renewed 91 63 70 15 36 36 Cisterns cleaned, repaired, etc. 27 31 26 34 6 42 W.C. new apparatus provided 10 15 22 17 18 37 W.C. repaired, cleaned, etc. 27 41 78 33 19 12 W.C. Water Fittings repaired 33 19 106 29 31 39 Yards paved and drained - 27 37 50 38 59 26 Premises cleaned, etc. 195 196 218 238 191 215 Ventilation below floor provided 10 4 54 5 6 4 Defective window frames and sashes 23 37 132 16 4 68 Other defects 37 51 260 5 35 34 Smoke observations 28 29 41 44 10 11 Overcrowding 7 6 6 6 16 22 Accumulations of refuse 25 7 8 2 5 19 Visits in connection with cases of infectious disease (including Tuberculosis) 99 124 179 113 105 176 Rooms inspected after disinfection .. £9 34 128 98 116 80 Other inspections, etc. 62 119 323 72 136 — Factories—No. of inspections.. 51 63 28 19 15 41 Workshops & workplaces ,, 59 102 28 17 28 80 Laundries ,, 19 12 3 — 12 D airies, etc. ,, 68 59 23 14 41 37 Cowsheds ,, — — — 4 6 6 Bakehouses ,, 42 35 33 25 46 37 P.H. urinals ,, 119 63 55 119 78 29 Stables and Mews ,, 84 103 54 4 57 6 Complaints investigated 95 177 362 168 90 182 Appointments 46 155 85 6 80 151 School inspections 2 — 4 7 10 — Pawnbrokers 3 — — — — 4 Common Lodging Houses — — —- 11 — 38 Slaughterhouses — 103 14 58 — 50 Knackers Yards — — — 53 — — Brooks and Watercourses 9 — 6 — 30 2 Butchers' shops 99 72 29 96 69 69 Fishmongers' shops 114 30 29 39 51 84 Fruiterers' shops 89 21 18 31 45 Ice Cream premises 8 14 6 — 6 21 45 SANITARY WORK CARRIED OUT BY FEMALE SANITARY INSPECTOR. Visits to Outworkers Premises 724 Workshops 101 ,, Laundries 6 ,, Factories 2 Complaints Investigated 162 Visits re Infectious Diseases 2 Miscellaneous Visits 15 Re-inspections 636 Swabs Taken 759 S. F. Contacts Examined 287 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) 225 56 — Workshops (including Workshop Laundries) 418 Workplaces (other than outworkers' premises included in Part 3 of this Report) J Total 643 56 — 46 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Roferred to H.M. Inspector. Nuisances under the Public Health Acts*— Want of Cleanliness 37 37 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 13 13 — — Sanitary accommodation insufficient — — — — unsuitable or defective 7 7 — — not separate for sexes — — — — Offences under the Factory & Workshop Act Illegal occupation of underground bakehouses (s. 101) — — — — Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) 1 1 Total 58 58 — — * Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 47 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. J Instances Notices served. Prosecutions. Instances. Orders made (Sec. 109). Prosecutions (Sees. 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 12 99 11 87 539 78 — — 564 — — — — — — Boots and Shoes 6 81 — — 27 75 — — 27 — — — — — — Stationery — — 1 1 2 — — — 3 — — — — — — Cardboard, etc., Boxes 4 36 — — 8 9 — — 17 — — — — — — Brushes — — 1 4 14 4 — — 14 — — — — — — Smallware — — 1 7 7 7 — — — — — — — — — Upholstery — — — — 2 — — — 4 — — — — — — Furs — — — — 13 — — — 26 — — — — — — Umbrellas — — — — — — — — — — — — — — — Fancy Goods — — — — — — — — — — — — — — — Artificial Flowers — — — — 12 — — — 18 — — —— — — — Christmas Crackers 2 39 — — 9 24 — — 9 — — — — — — Leather Goods — — — — 7 — — — 10 — — — — — — Feathers — — — — 3 — — — 6 — — — — — — Totals 24 255 14 99 651 197 — — 724 — — — — — — 48 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the Year. Number. Workshops 208 Laundries 28 Bakehouses 63 Total Number of Workshops on Register 299 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) — 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 15 Reports (of action taken) sent to H.M. Inspector 15 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). 49 HOUSING. New Houses erected during the Year. (State assistance, 13), Houses110 By private builders (no State assistance), Tenements 2 By the London County Council, Tenements 72 184 Unfit Dwelling Houses. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,781 Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 995 Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 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 1,655 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 1,295 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 253 (2) Number of dwelling-houses which were rendered fit— By owners 223 By Local Authority in default of Owners 4 50 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — (6) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 95 (2) Number of dwelling-houses in which defects were remedied— By owners 92 By Looal 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 1 (2) Number of dwelling-houses in respect of which Closing Orders were made 16 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit — (4) Number of dwelling-houses in respect of which Demolition Orders were made — (5) Number of dwelling-houses demolished in suance of Demolition Orders 2 Tottenham Maternity and Child Welfare Committee ANNUAL REPORT FOR THE YEAR 1924. 2 LIST OF MEMBERS OF COMMITTEE Mr. H. FARTHING (Chairman). Miss R. F. COX (Vice-Chairman). Mrs. F. C. BRIGHTEN. Mr. J. BRISTOW. Mr. 0. F. BROADWAY (Retired 6/9/24). Mr E. S. BROWN. Mr. F. W. COX. Mr. T. ELDERFIELD. Mrs. E L. FINCH (Appointed 18/30/24). Rev. T. W. OSWALD-HICKS, B.A. Mr. C. HARRIS (Appointed 18/10/24). Mr. W. W. LEWIN, J.P. Mr. W. D. McGUCKIN. Major P. B. MALONE. Mr. P. F. MASTERS (Retired 25/9/24). Mr. W. E. MONTAGUE. Mr. E. J. MORLEY. Mr. A. REED. CO-OPTED MEMBERS Mrs. H. BYERS. Mrs. A. M. ELLIS. Mrs. E. A. MALONE. Mrs. N. PICKFORD Mrs. E. S. SCHIEFER Mr. S TIMMS 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 „ Maternity Clinics for Expectant Mothers are held on :— Tuesday Morning 9.30 to 12 o'clock Thursday Afternoon 2 to 5 „ 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 Thursday Morning 9.30 to 12 „ TOWN HALL CENTRE. Infant Welfare. Wednesday Afternoon 2 to 5 o'clock. 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 above Clinics, a Sewing Class for Mothers who attend the Centres, is held on Wednesday afternoons, at The Chestnuts, and at Bruce Castle. MOTHERS' WELFARE CLUB.—A Social is held at each Centre once a month The Chestnuts Centre—Third Wednesday of each month. Bruce Castle Centre.—Last Wednesday of each month. 4 INTRODUCTION. Medical Officer's Department, Town Hall, Tottenham, N.15. April, 1925. To the Chairman and other Members of The Maternity and Child Welfare Committee. Ladies and Gentlemen, Your Committee is entrusted with the care of mothers, and of children until they reach the age of five years. The Maternity and Child Welfare Act was placed on the Statute Book in 1918, and the establishment of a system whereby every opportunity may be given to every child born within the area of your administration to develop normally has been thoughtfully considered along lines that have proved by their results to have been wise and effectual. What remains to be done is to make popular the means at their disposal for mothers to ascertain the proper methods of preserving their own health and that of their offspring, and to fill in the gaps, where they are discovered, that permit of wastage of health or life. At the moment, the clinic that requires fostering is the Ante-Natal Clinic. To that clinic should be assigned the function of ascertaining the causes of ante-natal death, and of preventing them. This becomes the more urgent, as the birth-rate shows indication of serious reduction. Another direction in which the serious consideration of your Committee is invoked is the preservation of very young infants. There does not appear to be a greater prospect of success in the reduction of mortality and morbidity than is likely to attend well-devised, organised and administered clinics for the care of the pregnant and parturient woman and for the neo-natal child. The lamentable maternal mortality may be reduced, and still-births, in large numbers of instances, may be obviated. Many infants die unnecessarily within the first four weeks of their lives. These problems require to be tackled vigorously. Your Committee have supplied the wherewithal for arresting the wastage of 5 maternal life and health, and they have in contemplation means for coping with still-births and early infant deaths. During the year the open-air shelter, provided by the Carnegie Trust, was officially opened at the creche by the late Viscountess Helmsley, and has met a much-felt need. Because of the continued unemployment of many breadwinners, the supply of milk to pregnant women and nursing women and children of pre-school age has been much appreciated. The Mothers' Social Club gives to the mothers a very live interest in the work of the centres. With a little outside aid, they purchased pianos for Bruce Grove and St. Ann's Centres, where they enjoy their own entertainments. That the mothers themselves have asked for vocal training with a view to glee-party singing, suggests a line of education worthy of encouragement. Your Committee have several projects before them for the consolidation and expansion of their work. The enthusiasm and encouragement with which your Committee inspire their officers and staff is a true reflex of the value they put upon the task they have undertaken; and the success attending the efforts of all is the measure of the response to that stimulus. I am, Ladies and Gentlemen, Yours faithfully, Medical Officer of Health. 6 BIRTHS, 1924. LIVE BIRTHS. Registrar General's Figures—M 1,425 F 1,428 *2,853 Local Information:— Total Births notified 2,897 ,, Still Births 69 Total Live Births 2,826 *Births outside the District included in above:— Council Cases in District Maternity Home 54 Other cases notified from District Maternity Home 221 Notified from other outside Institutions 138 413 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 2,178 Part breast-fed—plus milk, dried milk, or condensed 200 Bottle feeding—Cows' milk 132 Dried milk 127 Other artificial foods 80 2,717 The difference between the notified live births, 2,826, and the total feedings, 2,717, is due to information being unavailable, owing to deaths under one 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. Total. 1st Visits. Re-visits. 1st Visits. Re-visits. Notification of Births 3,096 8,875 242 18,594 30,807 Still-births 58 22 — — 80 Deaths 36 20 5 1 62 Ophthalmia Neonatorum 11 43 — — 54 †Other Infectious Diseases 105 234 290 542 1,171 Total 3,306 9,194 537 19,137 32,174 Maternity Visits. 1st Visits. Re-visits. Ante-Natal 396 594 990 Post-Natal 434 1,109 — — 1,543 Puerperal Fever 4 8 — — 12 Other Visits. Mothers. Children. *281 136 — — 417 Total Visits — — — — 35,136 †Other Infectious Diseases include Measles and German Measles, Bronchial Pneumonia, Tuberculosis. *Other visits and re-visits 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 14,044 773 52 200 38.115 60.31 1,730 Bruce Castle 11,363 693 51 151 47.647 59.158 1,484 Town Hall 1,874 125 — 50 — 37.48 272 Total 27,281 1,591 103 401 — — 3,486 Medical Inspections. Total Number. New Cases. Number of Sessions. Average No. of Inspections per Session. St. Ann's (The Chestnuts) 3,824 742 150 25,493 Bruce Castle 2,794 637 101 27,663 Town Hall — — — — Total 6,618 1,379 251 — Infant Mortality of Infants Attending the Infant welfare Centres during 1924. Centre. 1924 Births. Infantile Death-rate No. on Register. Deaths of Infants. St. Ann's 545 *6 11 Bruce Castle 427 5 11.709 Town Hall 80 — Total 1,052 * Includes babies referred for Medical Examination from the Town Hall Clinic. 9 ANTE AND POST-NATAL CLINICS. Medical Examinations. Ante Natal. PostNatal. Total. Number of Sessions. Average Attendance per Session. St. Ann's 880 365 1,245 102 12.2 Bruce Castle 475 236 711 50 14.22 Total 1,355 601 1,956 152 — New Cases— St. Ann's 194 92 286 — — Bruce Castle 113 50 163 — — Total 307 142 449 — — 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— To Expectant and Nursing Mothers. To Toddlers. Total. 1,541 1,128 2,669 31 mothers 19 toddlers 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 Maternity Home, Edmonton. Discharged Before Confinement. Confinements. Total. Delivered by Total. Live Births. StillBirths. Midwives. Doctors. 56 2 54 — 54 5 49 54 10 Notified as Puerperal Sepsis. Maternity Deaths. No. of cases in which temperature rose above 100.4. Notified as Ophthalmia Neonatorum. Inflammation of the eyes. Not Entirely breast-fed. — — 8 — 1 3 £ s. d. Cost of patients admitted to Maternity Home 260 2 0 Contributions by patients towards maintenance 232 8 0 Net cost to Council £27 14 0 Average duration of stay, 16.037 days. CRECHE ATTENDANCES. The attendances from 1st January to 31st December, 1924, were as follows:— Number of days on which the Creche was opened, 235. Quarter. Attendances under 3 years of Age. Attendances over 3 years of Age. Total. 1st January to 31st March 1,178 782 1,960 1st April to 30th June 1,139 770 1,909 1st July to 30th September 789 505 1,294 1st October to 31st December 1,177 793 1,970 4,283 2,850 7,133 Number of children on the register:— Under three years 52 Over three years 27 Total 79 Average daily attendance, 30,353. 11 Applications for assistance have been dealt with as follows :— Fresh and dried milk, authorised free or at less than cost price, has been distributed during the year as follows:— 85,547 Quarts— £ s. d. Fresh Milk, at a cost of 1,511 11 7 Dried Milk, at a cost of 92 15 0 Total £1,604 6 7 Assistance has been given towards the payment of Midwives' Fees on two oocasions and in the provision of Home Helps in two instances. CONVALESCENT HOME TREATMENT. The arrangement with the Invalid Children's Aid Association for the maintenance of children at Convalescent Homes has been continued during 1924, as follows :— 30 children were sent away for varying periods, namely:— Number of Weeks 1 2 3 4 5 6 7 8 9 10 11 12 Number of Children 2 1 1 4 4 2 2 3 — 2 3 2 Number of Weeks 13 14 15 16 17 18 19 20 21 22 23 24 Number of Children 1 1 1 – – – – – – – – 1 In 4 of these cases the treatment has been continued in 1925. Convalescent Home Treatment has also been provided for 3 nursing mothers and their infants. VOLUNTARY SERVICES. The Mothers' Welfare Club continues at The Chestnuts and Bruce Castle. The Ladies' Visiting Sub-Committee, consisting of the ladies of the Maternity and Child Welfare Committee, have visited the various centres in rotation and reported periodically on the work. 12 The Sewing Class at The Chestnuts is under the supervision of Mrs. N. Pickford, one of the ladies of the Committee, and at Bruce Castle under one of the Health Visitors. The sewing necessary in connection with the Day Nursery is assisted in by Miss Cremolina, as in former years. Baby Competitions were held in the month of October at all the centres. Towards the expenses, your Committee contributed £27 12s. 7d. The mothers attending the centres have benefited by the following gifts:— From the Harringay Brotherhood—per Mr. J. J. Inward—the sum of £1 1s., which was used for purchasing vests, and a parcel of clothing. From Mr. Willand, £2 2s., used on behalf of the mothers. From the Dorcas Society of the High School for Girls—per Miss Felvus—garments. From Mrs. Buce, 178, Westbury Avenue, a large pram, which has since been given to one of the mothers. From Mrs. Uttley, 26, Queen Elizabeth's Walk, a high chair in use at the Sewing Class. The Mothers' Club presented a piano to the Committee for use at the Chestnuts Welfare Centre, and Mrs. Pickford gave a whist drive on behalf of the Mothers' Club, towards the piano fund. FOR THE CRECHE The children have benefited by gifts, toys and clothing from the following:—Viscountess Erleigh, Miss Boar, Mrs. Stanley Brown, Miss Cr. R. F. Cox, Miss Cremolini, Mrs. Lewin, Cr. E. J. Morley, Cr. W. E. Montague, Mrs. N. Pickford, Rev. F. Rice, M.A., Dr. A. Stalker, Mrs. E. S. Schiefer, and from the staff at the creche. A Christmas party was also arranged, and given to the children by the Matron. Tottenham Education Committee 4 ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER for 1924. MEMBERS OF THE COMMITTEE. Mr. T. ELDERFIELD (Chairman). Mr. T. INGLIS (Vice-Chairman). Mrs. F. C. BRIGHTEN. Mr. 0. F. BROADWAY. Mr. C. E. BROWN. Mr. R. W. CLARK. Miss R. F. COX. Mr. H. FARTHING. Mr. E. FROST. Mr. A. E. HARVEY. Rev. T. W. OSWALD-HICKS, B.A. Mr. W. R. JACKSON. Mr. W. W. LEWIN, J.P. Major P. B. MALONE, MP., J.P. Mr. P. F. MASTERS. Mr. J. W. PARDOE, A.K.C. Mr. A. REED. Mr. C. WISE. Miss E. GO WAN, B.A. Mr. F. E. SHARLAND. 2 INTRODUCTION. School Medical Department, Town Hall, Tottenham. March, 1925. To the Chairman and other Members of the Tottenham Education Committee. Ladies and Gentlemen, The Report for 1924 is similar in detail to that of the previous year. It is not required by the Board of Education that the Report shall be of the same exhaustive nature as will be called for in 1925. Alterations in the arrangements relating to the administration of the School Medical Services are referred to in their appropriate paragraphs in the body of the Report. The year's activities are, as far as possible, set out in tabular form. The thanks of the staff are accorded to the Committee for continued support and encouragement. I am, Ladies and Gentlemen, Yours faithfully, 3 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, 1924 TO 31st MARCH, 1925. Bruce Grove. Decorations internally and externally. Complete overhaul and partial reconstruction of the heating system. Down Lane. Decorations internally and externally. Improvement to the electric lighting in the Boys' Department. Downhills. Decorations internally and externally. The stone staircases leading to the Boys' Department re-treaded. Fire emergency exit and escape staircase provided. Lavatory accommodation provided for Head Master. Babies' Room.—Gallery removed and floor made level. Improvements in the natural lighting by the addition of a new skylight. Central.—Decorations internally and externally. Alterations to classroom to form Domestic Subjects Centre. Furnishing the Domestic Subjects Centre with laundry and cookery tables, and all other necessary appliances. Art Room.'—Gallery removed, floor made level, and room furnished with 24 art tables and the necessary cupboards and fittings. Alterations to electric lighting of Art Room. 4 Earlsmead. The stone staircase leading to the Boys' Department re-treaded. The classroom floors and galleries to Boys' Department re-laid. Page Green. Manual Room.—Alterations to classroom and a cloakroom adjoining to form a Manual Room. Installing wood-work and metal-work benches. Improvements in natural lighting to Manual Room by building in a large skylight. Alterations to gas lighting. Formation of a Domestic Subjects Centre by making alterations to a large classroom. Installation of laundry and cookery tables, washing-stools, gas-ranges and ironing-stove. Alterations to gas lighting. Parkhurst. Alterations to boiler-house and formation of a new watertight pit. Seven Sisters. Infants.—Removal of the galleries of two classrooms, and levelling and re-laying the floors with jointless flooring. Stamford Hill. Girls.—A large classroom divided by a half-glass partition. St. Ann's. Girls and Infants.—Decorations internally and externally. West Green. Boys.—Galleries in two classrooms removed, floors made level and re-laid with jointless flooring. 5 Woodlands Park. Decorations internally and externally. Deaf and Vale Road. All the new furniture required at these schools has been made and supplied by the Works Department. Playgrounds. The playgrounds at the following schools have been given attention: Earlsmead, Bruce Grove, and Culvert Road. School Furnishing. Furniture has been supplied as follows:— Parkhurst Road. Forty Pedestal Box Desks. Down Lane. Forty Locker Desks. School Library. One Filing Cabinet. Generally. In addition to the above, Cupboards, Screens, Remedial Form and Ladders, Blackboards and Needlework-boxes 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:— 6 Scarlet Fever 218 Diphtheria 127 Enteric Fever 3 Erysipelas 1 Pneumonia 24 Encephalitis Lethargica 8 Voluntary Notifications.—The following cases were voluntarily notified by teachers and attendance officers during the year:— Measles 771 German Measles 30 Mumps 263 Whooping Cough 192 Chicken Pox 461 Scarlet Fever 105 Diphtheria 59 Diphtheria and Scarlet Fever 1 Scabies 21 Skin Diseases 9 Verminous 9 Tonsilitis 19 Chorea 4 Pneumonia 1 Rash 15 Sore Throat 44 Tuberculosis 8 Influenza 108 Eye Diseases 12 Ringworm of Head 47 Ringworm of Body 18 Sores and Eczema 86 Impetigo 13 Other Diseases 244 Children excluded owing to infectious disease in house 396 Debility 17 Otorrhoea 4 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. 1,053 such examinations were made, 85 were found to be positive', 900 negative, and 68 contained bacteria morphologically similar to Klebs Lœffler bacilli. Microscopical Examinations.—Hairs were taken from children who were suspected to be suffering from ringworm in 107 instances and submitted to microscopical examination. 85 were positive. 7 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, 30 children were cleansed and their clothes disinfected. 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 14 cases. Fines were inflicted in respect of 10 of these cases, and 4 Attendance Orders were made. 33 Notices were served under Section 122 of the Children Act, 1908, in respect of verminous conditions. MEDICAL TREATMENT. An agreement has been entered into with the North Middlesex Hospital Authorities, whereby they undertake the X-Ray treatment of ringworm and the operative treatment of otorrhoea. In consequence, the X-Ray clinic at Bruce Castle has been discontinued, and the accommodation set free is utilised for the treatment, by ionic medication, of otorrhoea cases. 8 32 cases of ringworm of the scalp were treated to a completion at Bruce Castle prior to the discontinuance of the clinic there, and thereafter 24 at the North Middlesex Hospital. 137 cases of otorrhoea have been treated by ionic medication, and, in 82 of these, the discharge from the ears has ceased. It will be noted that cure of those 82 is not claimed. Those cases will be observed over a long period to ascertain that the cessation of discharge is permanent. Arrangements have also been made with the North Middlesex Hospital for the operative treatment of children suffering from enlarged tonsils and adenoids, and provision is made for retention of cases in hospital when necessary. Operations for enlarged tonsils and adenoids were performed in respect of 187 cases at Bruce Castle, and 201 at the North Middlesex Hospital. OPEN-AIR EDUCATION. The following Report, with respect to Open-Air Education, has been received from the Director of Education:— 1. HOLIDAY CAMPS AND SCHOOL JOURNEYS. For the year 1924, the Board of Education sanctioned the expenditure of a sum not exceeding £210 in aiding School Journeys. The whole of this amount waas spent. The following table shows the expenditure on School Journeys since the Committee decided to aid them:— Amount Sanctioned. Amount Spent. £ s. d. £ s. d. 1920 300 0 0 221 0 0 1921 250 0 0 209 10 0 1922 187 10 0 138 17 0 1923 187 10 0 185 0 0 1924 210 0 0 210 0 0 9 The following are brief particulars of the Journeys carried out:— Down Lane Central School. 88 First Year girls, in two parties, spent a week at Tankerton, near Whitstable, Kent, where they were lodged in the Alexandra and Marine Hotels. The latter was the more suitable for a school party. Visits were paid to Canterbury, Sandwich, Deal and Dover. Good weather made it possible for the entire programme to be carried out. The educational, social and physical results of the journey were excellent. 60 Fourth Year girls visited Bangor, N. Wales, where they stayed for a fortnight in the Hostel of the University College. Visits were paid to Llyns Ogwen and Idwal, the Swallow and Aber Falls, the Aberglaslyn and Nant Ffrancon Passes, Anglesey, Beaumaris and Carnarvon Castles, Penrhyn Quarries. The ascent of Snowdon was also made. Although the weather was wet, the journey was very successful. It is to be regretted that the crowded state of the school, and the difficulties of organisation, prevent the staff from undertaking the heavy work of a similar journey for 1925. The total cost of the journeys was £482 12s. 7d., towards which the Committee contributed £150. The raising of the balance by parents' contributions, concerts, sales of work, etc., was a heavy task. Risley Avenue Central School. A party of 21 spent a week at Swanage, the main object of the journey being the study of the geography and geology of the Isle of Purbeck. The party stayed at the Rockland Boarding House. Visits were paid to Corfe Castle, Worbarrow, Lulworth Cove, Beaulieu and the New Forest, etc. The journey was very successful in every respect. The total cost was £57 17s. 9d., of which £25 was contributed by the Committee. 10 St. Paul's Girls' School. A party of about 30 girls visited Swanage. One of the scholars, unfortunately, contracted chicken pox soon after her arrival. Consultation between Dr. Kirkhope and the local Medical Officer of Health resulted in the decision to send home some of the girls who had been in contact with the patient. Subsequent events showed the wisdom of the decision. The remainder of the party carried out a programme very similar to that of the Risley Avenue party. This school has organised a series of very successful school journeys, and it was regrettable that misfortune should have marred this visit. The Committee contributed £35 toward the cost of the journey. 2. OPEN-AIR SCHOOLS. The Open-Air Class was again held in the bandstand in Downhills Park. It was attended by about 30 girls from West Green School, who were selected by the Medical Officers as needing Open-Air treatment. The inclement weather caused the duration of the Class to be somewhat shortened, but the Medical Officers report that the girls who had attended gained considerable physical benefit. The Local Authority are considering an extension of Open-Air Classes during 1925. 3. PLAYGROUND CLASSES. Classes were held in playground shelters in Page Green (Girls' and Infants'), Stamford Hill (Infants') and other schools throughout the Summer and Autumn. 4. PHYSICAL EXERCISES. Physical Exercises have continued to be a prominent feature of the work of Tottenham Schools. 11 In the three Central Schools, the work is in charge of teachers who have had a year's special course in Physical Training in addition to the usual training of a Certificated Teacher. The value of the work is shown by the satisfactory development of the pupils. In many school departments there are specialist teachers who have taken courses in Physical Training. At the Annual School Sports, massed displays of Physical Exercises and Country Dancing were given by squads of pupils from nearly all the schools in the district. The Education Committee have continued to encourage Organised Games, and they have had valuable co-operation from the Tottenham Schools' Sports' Association. The records of the year's work show the extent of the undertaking. The following are brief particulars :— (a) General Athletic Sports. 23 School Departments had their own Sports Meetings on private grounds or in the Public Parks. Nearly all the schools sent competitors to the combined Annual Sports Meeting, held in September. A noteworthy feature of this Meeting is the fact that no prizes are offered for individual competitors. All entrants represent their schools. Championship trophies are presented to the schools scoring most points. (b) Football. Junior and Senior Leagues' Competitions were held in the season 1923-24. 32 teams entered, and over 500 matches (mostly on Saturday mornings) were played. There were, in addition, many matches with representative teams from other districts. (c) Cricket. 20 school teams took part in the Senior and Junior Leagues' Championship Competitions. 12 (d) Netball. This game is now very popular in Tottenham Schools. It is played in 21 departments by many hundreds of children. 14 teams took part in a League Competition, while "friendly" games were very numerous. (e) Swimming. Scholars from all senior schools attend regularly at the Baths for Swimming Instruction. The following table shows the number of Certificates gained during the season 1924:— Boys. 25 yards 365 100 „ 205 Quarter-Mile 124 Total 694 Girls . 15 yards 319 50 ,, 201 220 ,, 142 Quarter-Mile 87 Life-Saving 70 Total 819 15 departments held their own Swimming Gala, and nearly all departments participated in a most successful combined Gala. The Education Committee much appreciate the immense amount of voluntary work performed by their teaching staff in encouraging Organised Games. CO-OPERATION OF PARENTS. Objections to medical inspection on the part of parents are few. For the most part, parents are anxious to have their children medically inspected periodically. 13 CO-OPERATION OF TEACHERS. The school teachers, generally, are desirous of co-operating with the department, and, as far as is possible, the convenience of the teachers is considered in arranging for the medical inspections. CO-OPERATION OF ATTENDANCE OFFICERS. The School Medical Department is assisted very materially by the Attendance Officers, who bring to light cases requiring treatment that, otherwise, might escape attention, and also persuade parents to have the necessary treatment applied. CO-OPERATION OF VOLUNTARY BODIES. The Invalid Children's Aid Association has provided for the maintenance of children at Convalescent Homes and the supjily of surgical instruments, as follows:— Convalescent Home Treatment.—During the year, 276 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 2 11 4 58 33 39 16 49 13 17 5 12 No. of Weeks.. 13 14 15 16 18 19 21 23 29 31 52 — No. of Children 5 2 1 2 1 1 1 1 1 1 1 — In 27 of these cases, the treatment has been continued in 1925. The following table gives the affections on account of which children received convalescent treatment:— 14 Nervous Debility 6 Pre-tubercular Debility 41 Debility aft. Infectious Disease 7 Post-operative Debility 10 Post-Pneumonic Debility 4 Anaemia and Debility 42 Heart ASections and Anaemia 29 Bronchitis and Bronchi. Catarrh 37 Asthma 2 Other Non-tubercular Lung Dis. 10 Eczema 1 Gastric Catarrh 1 Gastric Influenza 1 Tuberculosis:— Knee 2 Peritoneum 1 Hip 3 Chorea 26 Enlargement of Glands 14 Rheumatism 6 Lachrymal Sac Infection 1 Tonsilitis 1 Boils 1 Dyspepsia 1 Paralysis 2 Rheumatism 2 Rheumatic Fever 6 Nephritis 3 Hernia. 1 Corneal Ulcer 1 Cellulitis of Finger 1 Marasmus 7 Spinal Curvature 4 Appendicitis 1 Torticollis 1 Provision of Surgical Instruments.—Surgical appliances were supplied, and repairs and replacements carried out in respect of the following defects:— Infantile and other forms of Pes Cavus 4 Paralysis 121 Other forms of Deformed Tuberculosis:— Feet 17 Hip 7 Amputation stump 6 Knee 9 Rickety Deformities 23 Ankle 3 Hammer-toes 8 Spine 4 Weak Ankles 9 Flat-foot 9 Other cases 12 Club-feet 5 Blind, Deaf, Defective and Epileptic Children.—There are 37 children from this district being maintained in Special Residential Schools. 4 of these are crippled and physically defective children, 13 blind, 13 mentally defective, 5 epileptic and 2 deaf and dumb. The Committee sends 23 mentally feeble children daily by ambulance to the Special School belonging to the Finchley Corporation. Children suffering from defective vision (myopia, etc.) to the number of 10 are in daily attendance at the Wood Green Special School for children with defective vision. 15 A new school has been opened on the site of the old one for children dull of hearing, and it is hoped that a class will be established there for the cure of stammering. Provision has been made, in a small way, for educating physically defective children. Two classrooms have been set apart at Parkhurst Road Infants' School as a Special School for Physically Defective Children, together with the necessary cloakroom and lavatory accommodation. Approximately, 50 children are in attendance, and the nature of the defects from which they are suffering is as follows:— Infantile Paralysis 27 Infantile Paralysis and Rhematoid Arthritis 1 Congenital Deformities 3 Cerebral Diplegia 1 Fragilitas Oseum 1 Heart Disease (acquired) 2 Heart Disease (congenital) 4 Tuberculosis:— Spine 6 Knee 2 Hip 2 SECONDARY SCHOOLS. Table I, page 16, sets out the number of children, under their separate ages, examined in the secondary schools during the year. Tables II—IV, pages 17—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. 429 children suffering from the undermentioned defects have been treated; the number last year was 922. Cures were claimed in respect of 92 children, and the remainder are reported to have benefitted by the treatment given:— Curvature of Spine (threatened and established) 198 Round Shoulders 116 Other cases of deformity (flat foot, torticollis, disparity of shoulders, defective development of chest, infantile paralysis, etc.) 115 16 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 iess than cost price, or gratuitously, according to circumstances:— Cod Liver Oil and Malt 2,072 lbs. Parrish's Food 1,460 lbs. Cod Liver Oil 1,673 ozs. Syrupus Ferri Iodidi 1,624 ozs. Syrupus Calcii Lactophosphatis 1,115 ozs. EXAMINATIONS BY THE MEDICAL OFFICERS. 20 teachers, and 1 junior clerk have been examined by the Medical Officers. 4 children have been medically examined and licensed to take part in entertainments. 12 boys, between the ages of 15 and 16 years, have been examined and licenses granted under the Bye-Laws relating to Street Trading. SECONDARY SCHOOLS. Table I.—Number of Pupils inspected 1st January, 1924, to 31st December, 1924. Ages. Routine Inspections. Total. 10 11 12 13 14 15 16 17 18 Boys 2 46 51 82 107 85 2 10 2 387 Girls — 13 31 60 94 105 35 1 — 345 Totals 2 59 82 148 201 190 37 11 2 732 17 Table II.—Return of Defects found in the Course or Medical Inspection in 1924. 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 — - Body — - Skin 1 Ringworm - Head — - Body — - Scabies — - Impetigo — - Other Diseases (Non-Tubercular) 8 - Eye 'Blepharitis .. 1 - Conjunctivitis 2 - Keratitis — - Corneal Opacities — - Defective Vision 59 1 Squint — - Other Conditions 2 - Ear- Defective Hearing 2 - Otitis Media 2 - Other Ear Diseases 4 - Nose and Throat Enlarged Tonsils 12 1 Adenoids 5 - Enlarged Tonsils and Adenoids 11 1 Other Conditions 3 - Enl. Cervica Glands (Non-Tubercular) 2 1 Defective Speech — - Heart and Circulation Heart Disease:— - Organic 3 1 Functional 2 9 .Anaemia 4 — Lungs Bronchitis and Bronchial Catarrh 1 3 Other Non-Tubercular Diseases .. 'Pulmonary:— - — Tuberculosis Definite — Suspected 1 — Non-Pulmonary:— Glands — Spine — — Hip — — Other Bones and Joints — — Skin — .Other Forms — — Epilepsy — — Nervous System Chorea — — Other Conditions 2 1 Deformities Rickets — — Spinal Curvature 7 Other Forms 18 2 Other Defects and Diseases 15 1 18 Table IV.—Treatment of Defects of Pupils during 1924. Group I.—Treatment of Minor Ailments. Disease or Defect. No. of Defects Treated, or under Treatment During the Year. Under Local Education Authority's Scheme. Otherwise. Total. Skin:— Ringworm—Head — — — Ringworm—Body — — — Scabies — — — Impetigo — — — Minor Injuries — — — Other Skin Diseases — 8 8 Ear Disease — 5 5 Eye Disease:— External and other — 5 5 Miscellaneous — — — Total — 18 18 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise . Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) 47 47 Other Defect or Disease of the Eye3 (excluding those recorded in Group I.) - — — — Total — 47 — 47 Total number of Pupils for whom spectacles were prescribed:— (a) Under the Authority's Scheme Nil (b) Otherwise 14 Total number of Pupils who obtained or received spectacles:— (а) Under the Authority's Scheme Nil (б) Otherwise 41 19 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received Total Under the Authority's Scheme, in Clinic or Hospital. (1) By Private Practitioner or Hospital apart from the Authority's Scheme. (2) Total (3) other forms of Treatment. (4) Number treated. (5) — 3 3 8 11 Group IV.—Dental Defects. Number of Pupils who were:— Found to require treatment 118 Actually treated 67 ELEMENTARY SCHOOLS. Table I.—Number of Children Inspected 1st January, 1924, to 31st December, 1924. A.—Routine Medical Inspections. Number of Code Group Inspections Entrants 2,-828 Intermediates 2.4S7 Leavers 2,462 Total Number of other Routine Inspections B.—Other Inspections. Number of Special Inspections 6,213 Number of Re-Inspections 23,272 Total 29,485 20 Table II. A.—Return op Defects found by Medical Inspection in the Year ended 31st December, 1924. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observa. tion ,but not requiring Treatment. Requiring Treatment. Requiring to be kept under observa tion ,but not requir ing Treatment. (1) (2) (3) (4) (5) Malnutrition 27 11 74 1 Uncleanliness:—(See Table IV., Group V.) — — — — Skin Ringworm:— Scalp 4 — 99 — Body 1 — 56 1 Scabies 12 74 — Impetigo 5 531 — Other Diseases (Non-Tuberculous) 32 — 393 3 Eye Blepharitis 28 — 85 — Conjunctivitis 8 — 126 — Keratitis — — 30 — Corneal Opacities 3 — 4 — Defective Vision (excluding Squint) 389 24 545 — Squint 25 3 158 — Other Conditions Defective Hearing 9 1 196 — liar 6 3 15 — Otitis Media 25 3 201 2 Other Ear Diseases 62- — 114 2 Nose and Throat Enlarged Tonsils only .. 213 97 54 — Adenoids only 40 20 17 — Enlarged Tonsils and Adenoids.. 319 38 98 — Other Conditions 19 7 217 3 Enlarged Cervical Glands (Non-Tuberculous) 10 17 83 1 Defective Speech 5 4 1 2 Teeth—Dental Diseases — — — (See Table IV., Group IV.) Heart and Circulation ' Heart Disease:— Organic 3 38 26 9 Functional 8 98 18 8 Anaemia 93 46 342 3 - Lungs Bronchitis 119 107 399 2 Other Non-Tuberculous Diseases 4 2 60 2 Pulmonary:— 13 Tuberculosis Definite 2 1 — Suspected 4 12 20 5 Non-Pulmonary:— 15 Glands 4 4 — Spine — — 1 — Hip — — 10 — Other Bones and Joints 2 — 14 — Skin 1 - — 3 — . Other Forms 3 1 3 1 Nervous System Epilepsy 3 2 5 3 Chorea 10 1 99 3 Other Conditions 18 6 34 2 Deformities f Rickets 1 1 5 — Spinal Curvature 16 2 207 1 Other Forms 73 3 244 1 Other defects and diseases 109 54 1,126 67 21 Table II.—Continued. B. Number of individual children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Group. Number of Children. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. (1) (2) (3) (4) Code Groups:— Entrants 2,825 700 24"7 Intermediates 2,487 457 18'3 Leavers 2,462 484 196 Total (Code Groups) 7,774 1,641 211 Other Routine Inspections — — — 22 Table III. — Return of all Exceptional Children in the Area. — — - Boys Gir[s 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 2 o 4 Attending Public Elementary Schools At other Institutions — — — At no School or Institution — — — (n) Suitable for training in a School or Class for the partially blind Attending Certified Schools or Classes for the Blind .. 10 8 18 Attending Public Elementary Schools 2 6 8 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 8 11 19 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 8 9 Attending Public Elementary Schools 3 4 7 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 Chn. 23 13 36 Attending Public Elementary Schools 101 61 162 At other Institutions — 1 i At no School or Institution 7 9 16 Notified to the Local Authority during the year Feebleminded 2 3 5 Imbeciles — 4 4 Idiots 1 1 2 Epileptics Suffering from severe epilepsy Attending Certified Special Schools for Epileptics 2 3 5 In Institutions other than Certified Special Schools . . Attending Public Elementarv Schools At no School or Institution 3 6 9 Suffering from epilepsy which is not severe Attending Public Elementary Schools 11 7 18 At no School or Institution 23 Table III.—Continued. — — Boys Girls Total Infectious pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 3 2 5 At other Institutions 1 5 (i At no School or Institution 2 9 11 Non-infectious but active pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 3 9 12 At Certified Residential Open Air Schools At Certified Day Open Air Schools - - - At Public Elementary Schls. 5 12 17 At other Institutions 1 — 1 At no School or Institution — — — 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 Schls. 205 266 471 At other Institutions — 1 1 At no School or Institution 6 11 17 Active Non-pulmonary tuberculosis At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 12 6 18 At Public Elementary Schls. 3 5 8 At other Institutions 1 1 2 At no School or Institution 5 2 7 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 Schls. 4 4 At Certified Residential Cripple Schools 3 1 4 At Certified Day Cripple Scs. 21 23 44 At Public Elementary Schls. 12 21 33 At other Institutions 1 1 At no School or Institution 3 6 9 24 Table IV.—Return of Defects Treated during the Year ended 31si December, 1924. TREATMENT TABLE. Group 1.—Minor Ailments (excluding Uncleanliness, for whic 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 84 16 100 Ringworm—Body 56 1 57 Soabies 74 — 74 Impetigo 530 1 531 Other skin disease 387 20 407 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 424 14 438 Minor Ear Defects 299 37 336 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, ete.) 284 6 290 Total 2,138 95 2,233 25 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) 1,028 15 15 1,058 Other Defect or Disease of the Eyes (excluding those recorded in Group I,) 14 2 — 16 Total 1,042 17 15 1,074 Total number of children for whom spectacles were prescribed:— (a) Under the Authority's Scheme 799 (b) Otherwise 27 Total number of children who obtained or received spectac.es:— (а) Under the Authority's Scheme 796 (б) Otherwise 27 Group III.— Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Under the Authority's Scheme,in Clinic or Hospital. (1) By Private Practitioner or Hospital, apart from the Auth ority's Scheme. (2) Total (3) Received other forms of Treatment. (4) Total Number treated. (5) 388 153 541 231 772 26 Table IV.—Continued. Group IV.—Dental Defect*. (1) Number of Children who were:— (a) Inspected by the Dentist— Aged: Routine Age Groups 5 1,3801 Tota 1 15,850 6 1,481 7 1,823 8 2,510 9 2,627 10 2,744 11 2,192 12 757 13 258 14 78/ Specials 1,842 Grand Total 17,692 (6) Found to require treatment 12,596 (c) Actually treated 5,092 (d) Re-treated during the year as the result of periodical examination 2,201